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Objective: To quantitatively estimate the incidence of COVID-19 in different backgrounds, including vaccination coverage, non-pharmacological interventions (NPIs) measures, home quarantine willingness and international arrivals, and the demands of healthcare resource in Shanghai in the context of optimized epidemic prevention and control strategies. Methods: Based on the natural history of 2019-nCoV, local vaccination coverage and NPI performance, an age-structured Susceptible-Exposed-Infections-Removed (SEIR) epidemic dynamic model was established for the estimation of the incidence of COVID-19 and demand of hospital beds in Shanghai by using the data on December 1, 2022 as the basis. Results: Based on current vaccination coverage, it is estimated that 180 184 COVID-19 cases would need treatment in hospitals in Shanghai within 100 days. When the booster vaccination coverage reaches an ideal level, the number of the cases needing hospitalization would decrease by 73.20%. School closure or school closure plus workplace closure could reduce the peak demand of regular beds by 24.04% or 37.73%, respectively, compared with the situation without NPI. Increased willingness of home quarantine could reduce the number of daily new cases and delay incidence peak of COVID-19. The number of international arrivals has little impact on the development of the epidemic. Conclusions: According to the epidemiological characteristics of COVID-19 and the actual situation of vaccination in Shanghai, the incidence of COVID-19 and health resource demand might be reduced by increasing vaccination coverage and early implementation of NPI.
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Humans , COVID-19/prevention & control , Incidence , China/epidemiology , Epidemics/prevention & control , SARS-CoV-2ABSTRACT
The rapid development of sequencing technology brings the explosive growth of pathogen genetic data. The combination of genomic data and phylogenetic method is being used to elaborate the origin and evolution of pathogens, the time and space distribution and parameter changes in the prevalence process, and how phenotypes like antigen, virulence, and resistance change over time. This method is also being used to predict pathogen transmission trends. In this study, we described the aim of phylogeny and the process of the phylogenetic construction method. We elaborated the advantages and disadvantages and scope of application of tree-building methods including distance-based, maximum parsimony, maximum likelihood and bayesian methods. We have reviewed the application and the estimation methods of major epidemiological parameters of phylodynamics and phylogeography in domestic and foreign studies. We concluded that the time- and location-scaled phylogenetic trees are increasingly used for outbreak investigation and routine surveillance of infectious diseases.
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Humans , Bayes Theorem , Communicable Diseases/genetics , Epidemiologic Studies , Genomics , PhylogenyABSTRACT
Objective:To develop an early warning index system to identify the outbreak of respiratory infectious diseases and to assess the epidemic risk of these diseases in Shanghai. Methods:A two-round Delphi survey with a panel of 31 experts was used to select the modifying indicators. All indicators were evaluated for necessity，feasibility，stability， and sensitivity through online questionnaires. Results:The consultation recovery rates of both rounds were 100%. The authority coefficient was 0.88， and the Kendall's W of the second-round consultation was 0.138 （P<0.001）， suggesting a good coordination among experts’ opinion. Our early warning index system was developed after the two-round Delphi survey and included two sets of indicators， one for rapid risk assessment and another for monitoring and tracing risk. Both sets of the indicators involved three aspects： transmissibility， clinical severity and potential influence of emerging diseases. The rapid risk assessment system part covered 10 indicators while the risk monitor system part covered 23 indicators. In the rapid risk assessment system part， the weight value of the top three indicators were greater than 0.10， with the highest weight value of 0.171 for titled visiting rate of influenza-like illness patients in the Emergency Department or other outpatient visits. In the risk monitor system part， the weight value of the top eight indicators were greater than 0.05， and the greatest was 0.087 for R0 （basic reproductive number）. Conclusion:The developed scientific and reliable evaluation indicator system can be used to forecast the outbreak and epidemic risk of respiratory infectious diseases. However， sensitivity and stability of the indicators need further validation and evaluation.
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The earthquake occurred in Japan on March 11， 2011 was accompanied by a tsunami， which also led to a leakage accident at the Fukushima Daiichi nuclear power plant. The disaster caused large-scale casualties and property damage. Soma City in Fukushima Prefecture established a disaster response headquarter and held its first meeting 9 minutes after the earthquake. Disaster response can be divided into three stages. In the first phase， life protection is the primary task. In the second phase， the primary tasks are health protection and basic life support. And in the third phase， life quality improvement is the primary task. This article reviewed the public health emergency response of local governments in Japan after the disaster in order to improve the response to public health emergencies in China.
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Objective To analyze the effects and influencing factors of community-based detailed management program for hypertension on the blood pressure control for hypertensive patients in communities so as to provide bases for improving the community-based detailed management mode for hypertension.Methods In accordance with relevant selection criteria, 400 hypertensive patients living in the Fenglin Community of Shanghai who were diagnosed with idiopathic hypertension at the year in question were randomly selected, and were separated into an intervention group and a control group, with 200 patients belonging to each group.Community health education was combined with individual guidance in managing the intervention group while the control group was managed via conventional hypertension grouping.The blood pressure control of these two groups before(Jan., 2007) and after(Jan., 2015) the intervention were compared.Results After the intervention, the average systolic blood pressure(SBP) and the average diastolic blood pressure(DBP) of the intervention group were below those of control group by 8.03 mmHg and 6.55 mmHg, respectively, which showed statistic significance(P<0.01).The intervention group was better than the control group in terms of rate of reaching target blood pressure, risk stratification and medication compliance (P<0.05);the main factors influencing the effect of blood pressure control were sex, body mass index, high salt diet and smoking.Conclusion The community-based detailed management program for hypertension in Shanghai has achieved remarkable effects in controlling the blood pressure of hypertensive patients, and is an efficient approach to help stabilize the blood pressure thereof.
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Objective To investigate the contribution of recent transmission in the epidemic of drug-resistant Mycobacterium tuberculosis (M. TB) and related factors from biomedical and social-demographic perspectives in the Eastern rural areas of China. Methods Identified by proportio5n method of drug susceptibility test, 223 drug resistant M. TB isolates and their hosts were included in the present study. These drug resistant tuberculosis isolates were first genotyped by Mycobacterial Interspersed Repetitive Units(MIRU),and those isolates with identical MIRU defined as two patients' M. TB isolates harboring the identical MIRU genotype and IS6110-based RFLP pattern simultaneously. Unique strains denoted those with the unparalleled MIRU genotype in the study collection. Socio-demographic and biomedical characteristics of host patients were compared between the clusters and unique groups through univariate and multivariate logistic regression analysis. Results Based on the MIRU-IS6110 pattern, there were 52 isolates belonged to the "cluster" group and 171 as the "unique" group. Drug resistant M. TB strain isolated from patients at the age of 30-60 year had a higher probability of being clustered, comparing to those from patients below 30 years of age (30.9% vs. 11.9%;OR=3.297; 95%CI: 1.169-9.297). Such finding were also seen in the isolates from patients with previous treatment history compared to newly diagnosed patients (32.9% vs. 18.4%; OR=2.163, 95% CI: 1.144-4.090). The multi-drug resistant M. TB strain was found to have been more frequently clustered when comparing to the mono-drug resistant M. TB (47.2% vs. 15.5%; OR=4.773; 95%CI: 2.316-9.837). The transmission pattern of drug resistant tuberculosis was presented mainly by the sporadic distribution in small group within rural villages. Conclusion Transmission of drug-resistant tuberculosis was seen in the population living in the Eastern rural areas of China, and causal contact within villages was considered as the main route of recent transmission. Patients at middle age and having previous tuberculosis treatment history might have increased the risk of transmission by patients with drug resistant tuberculosis.
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Objective To describe the drug resistance-related molecular characterization and clustering feature of rifampicin-resistant (RIFr) M.tuberculosis (M.tb) in rural area of eastern China. Methods All patients diagnosed as RIFr M.tb in Deqing and Guanyun county during one year period from 2004 to 2005 were included in the study. By proportion method of drug susceptibility test, 65 isolates were identified resistant to rifampicin and regarded as the studied strains. Hotspots of rpoB gene and katG gene were detected by direct DNA sequencing. Beijing genotype M.tb strains were identified by spoligotyping. IS6110-RFLP (IS6110 restriction fragment length polymorphism) and clustering analysis were performed on all RIFr M.tb isolates available. Results The mutations in 81 bp rifampicin-resistance determination region (RRDR) of the rpoB gene were observed among 60 (92%) RIFr M.tb isolates, with mutation in locus 531 observed in the majority of RIFr isolates (37/65). 49(82%) of the 60 isolates were multidrug resistant TB (MDR-TB), which were referred to as resistant to both RIF and isoniazid (INH). Through spoligotyping, 54(83%) isolates were identified as Beijing genotype strains. In clustering analysis of IS6110-RFLP, 24 isolates were grouped into 11 clusters, suggesting that the recent transmission of M.tb did exist among patients. Regarding the drug resistance profile in clusters, all the isolates in clusters were also MDR-TB. 7 clusters contained isolates carrying different mutations were related to RIF-resistance. Multivariate analysis showed the proportion of new cases in clustered patients is higher than that in the un-clustered patients (new/previously treated: OR=3.342; 95% CI: 1.081-10.32). Conclusion The acquisition of rifampicin resistance in M.tb was more likely to be resulted from the selective growth of RIFr M.tb in the specific drug resistant M.tb such as isoniazid-reisistant M.tb. Previous elongated irregular treatment might favor the epidemic of RIFr M.tb.
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Objective To investigate the therapeutic efficacy of short course chemotherapy (SCC)on drug resistant tuberculosis (DR-TB) cases and related influencing socioeconomic factors. TB patients registered in local county TB dispensaries of two rural counties were followed up in Deqing and Guanyun of Eastern China, during 2004/2005. Methods Culture-positive patients (Deqing: 182, Guanyun: 217)were selected as subjects of this study. A cohort of TB patients was established at the beginning of their treatment and each patient was followed-up three times by questionnaires. Proportional method of drug susceptibility test was used to define the resistance to the 1st-line anti-TB drugs.χ2 test Kaplan-Meier method and Cox analysis were applied in multivariate analysis to investigate the negative conversion of smear positive sputum, treatment result of SCC and its socioeconomic influencing factors. Results The cure rates of multi-drug resistant TB (MDR-TB),other drug resistant TB (ODR-TB) and pan-drug susceptible TB,were 58.3%, 91.0%, 98.7% and 51.3%, 89.5%, 93.5% respectively in Deqing and Guanyun. The liver dysfunction (RR = 0.18, 95% CI:0. 04-0. 69 ) and previous treatment history (RR = 0.26,95% CI:0.07-0.93) were associated with treatment result among MDR-TB. Result on treatment in ODR-TB was influenced by previous treatment history (RR = 0.66, 95% CI:0. 44-0. 98 ) and Patient delay (＞2 weeks)(RR = 0.67, 95% CI: 0.46-0.97). Conclusion The priority in treating MDR-TB would include:managing side effect, developing the fast sensitive drug susceptibility test and modifying the treatment regimen corresponding to drug resistance.
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<p><b>OBJECTIVE</b>Using 'diabetes treatment satisfaction questionnaire status version (DTSQs)' to evaluate the reliability, validity and responsiveness, among Chinese type 2 diabetes mellitus (T2DM) outpatients.</p><p><b>METHODS</b>A cross-sectional study was carried out in 749 T2DM outpatients from seven hospitals in Guangzhou and Shanghai, China. The DTSQs was self-administered by patients, under the help from interviewers for those having difficulties in reading. Split-half reliability correlation coefficient, Cronbach alpha and Spearman' were used to test the reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed separately to examine the construct validity of the scale. The responsiveness of the scale was appraised by the multiple analysis of covariance (MANCOVA).</p><p><b>RESULTS</b>The split-half correlation coefficient was 0.807 and the Cronbach alpha was 0.717 of the six items on satisfaction of treatment. The three factors extracted by EFA explained 67.656% of the overall variance. The relative chi2 was 4.95 and DK was 0.18 in the goodness of test by CFA. The vector of treatment satisfaction, perceived hyperglycemia and hypoglycemia were different in males versus females and in poor versus good blood glucose controlled groups. The DTSQs showed good reliability and validity among T2DM outpatients.</p><p><b>CONCLUSION</b>DTSQs was applicable to Chinese T2DM patients.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Epidemiology , Therapeutics , Patient Satisfaction , Surveys and QuestionnairesABSTRACT
Objective To explore the impact of chronic complications of type 2 diabetic mellitus (T2DM)on quality of life(QOL)among T2DM outpatients in urban China.Methods A cross.Sectional study was carried Out in 1524 T2DM outpatients recruited from 15 hospitals in 4 major cities of China.Questionnaire interviews were used to collect data on general characters and complications of T2DM.SF-36 questionnaire(version 1)was used and self-completed by patients under the help from interviewers for those having difficulties in reading.T test,one-way ANOVA and generalized linear model were used to explore the association between complications of T2DM and quality of life.Results Complication Was a significant predictor leading to poorer SF-36 subscale scores(decreased by 4.68-16.06 scores)and two summary scores (PCS,MCS).The scores of role-physical subscale(decreased by 22.45％)and role-emotionsl subscale(decreased by 16.28％)decreased much more than the other subscales in patients with complication.Overall,QOI Was reduced by 11.02％in patients with complication.The QoL had a gradual decrease with the increasing number of complications.The average scores descended from 2.82 to 10.33 in the eight subscales with the increase of one complication.Conclusion Having complication or multiple complications seemed to be predietors of poor QOL among T2DM outpatients.
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<p><b>OBJECTIVE</b>To improve the respiratory isolation policy for patients with suspected pulmonary tuberculosis (TB).</p><p><b>METHODS</b>All consecutive patients with suspicion of having pulmonary TB when seeking health care at the County TB dispensary of the Center of Disease Control and Prevention received face to face interview.</p><p><b>RESULTS</b>A Classification model was constructed with a sensitivity of 90.9% and specificity of 90.2%, while predictive factors of culture-proven pulmonary TB among smear negativecases were soakage in Chest X-ray exam (77.0% vs. 4.4%; P<0.0001), bilateral lung's abnormal (1.6% vs. 19.4%; P<0.0001) and reaction of tuberculin skin testing (0.0% vs. 2.6%; P=0.014).</p><p><b>CONCLUSION</b>Soakage, bilateral lung's abnormal and positive reaction of tuberculin skin testing were important predictors to prognosticate culture positive diagnosis. The model had been proved to have promising sensitivity and specificity in the rural population covered by NTP-DOTs.</p>
Subject(s)
Humans , Models, Theoretical , Patient Isolation , Predictive Value of Tests , Sensitivity and Specificity , Tuberculin Test , Tuberculosis, Pulmonary , Classification , Diagnosis , EpidemiologyABSTRACT
<p><b>OBJECTIVE</b>To study the feasibility and cost-effectiveness of a case-finding program on tuberculosis (TB) in richer rural areas.</p><p><b>METHODS</b>Screening was implemented every three months for a total period of 9 months, in rural areas with high case notification rates. Three villages, each with ten thousand population, were selected to carry out a household screening program. A suspect was defined as who coughed for more than 3 weeks. The suspect was then referred to further diagnosis in county TB dispensary to undergo chest X-ray and sputum test.</p><p><b>RESULTS</b>Of the 86,168 community population screened, 26 TB patients were identified with 7 of them were smear positive. The ratio of effectiveness vs. cost decreased on the second but slightly increased on the third screening program. The direct costs for the 3 screening programs were 6,312,397 and 1637 RMB respectively. Of total direct cost, 5.9% was paid by TB patients, whereas 35.9% was through financing of the county itself.</p><p><b>CONCLUSION</b>The community household screening program could achieve higher case detection rate than passive case-finding approach which could be used in richer areas with low case detection rate in China.</p>