[Development of an index system for the comprehensive evaluation on public health emergency events surveillance system in China].

OBJECTIVE: To establish a comprehensive evaluation index system for the China Public Health Emergency Events Surveillance System (CPHEESS). METHODS: A draft index system was built through literature review and under the consideration of the characteristics on CPHEESS. Delphi method was adapted to determine the final index system. RESULTS: The index system was divided into primary, secondary and tertiary levels. There were 4 primary indicators: System structure, Network platform, Surveillance implementation reports with Data analysis and utilization. There were 16 secondary and 70 tertiary indicators being set, with System structure including 14 tertiary indicators (accounted for 20.00%), 21 Network platforms (accounted for 30.00%). Twenty-four Surveillance implementation reports (accounted for 34.29%), 11 Data analysis and utilization (accounted for 15.71%). The average score of importance of each indicators was 4.29 (3.77-4.94), with an average coefficient variation as 0.14 (0.12-0.16). The mean Chronbach's α index was 0.84 (0.81-0.89). The adaptability of each related facilities indicator was specified. CONCLUSION: The primary indicators were set in accordance with the characteristics and goals of the surveillance systems. Secondary indicators provided key elements in the management and control of the system while the tertiary indicators were available and operative. The agreement rate of experts was high with good validity and reliability. This index system could be used for CPHEESS in future.

[Information obtained through Internet-based media surveillance regarding domestic public health emergencies in 2013].

OBJECTIVE: To analyze the information obtained through Internet-based media surveillance in 2013 on domestic public health emergencies and to compare with the related data reported through Chinese Public Health Emergency Management Information System (PHEMIS), and to study the role of Internet-based Media Surveillance Program (IBMSP) in the detection of public health emergencies. METHODS: A descriptive analysis was conducted based on the database of the information on domestic public health emergencies. Information was obtained through the Internet-based media surveillance in 2013. RESULTS: A total of 752 pieces of information regarding domestic public health emergencies in 31 provinces were obtained, through the IBMSP, run by the China CDC in 2013. 53.46% of all the information were categorized as initial ones on public health emergency while another 22.07% were considered as updated ones. 41.62% of the information were related to infectious diseases with another 24.73% to food poisoning. 27.53% of the information were from official websites of governments and professional organizations, with the rest 72.47% were from media. As for corresponding public health emergencies, 41.79% were food poisoning and 18.66% were infectious diseases. 22.39% of them occurred in schools, 18.16% in other organizations and 16.92% in households. 28.86% were reported through Chinese PHEMIS. For the 116 public health emergencies that both related to information obtained through Internet-based media surveillance in 2013 and reported through PHEMIS, the median days of interval between illness onset of the first case as well as reported by media, interval between onset of the first case as well as reported through PHEMIS, were 2.5 days and 2.0 days respectively. 19.83% of the emergencies were first reported by media than through PHEMIS. CONCLUSION: Internet-based media surveillance programs had become an important way to detect public health emergencies and could serve as the supplement to the classic surveillance programs on public health emergencies.

Epidemiology of human infections with avian influenza A(H7N9) virus in China.

BACKGROUND: The first identified cases of avian influenza A(H7N9) virus infection in humans occurred in China during February and March 2013. We analyzed data obtained from field investigations to describe the epidemiologic characteristics of H7N9 cases in China identified as of December 1, 2013. METHODS: Field investigations were conducted for each confirmed case of H7N9 virus infection. A patient was considered to have a confirmed case if the presence of the H7N9 virus was verified by means of real-time reverse-transcriptase-polymerase-chain-reaction assay (RT-PCR), viral isolation, or serologic testing. Information on demographic characteristics, exposure history, and illness timelines was obtained from patients with confirmed cases. Close contacts were monitored for 7 days for symptoms of illness. Throat swabs were obtained from contacts in whom symptoms developed and were tested for the presence of the H7N9 virus by means of real-time RT-PCR. RESULTS: Among 139 persons with confirmed H7N9 virus infection, the median age was 61 years (range, 2 to 91), 71% were male, and 73% were urban residents. Confirmed cases occurred in 12 areas of China. Nine persons were poultry workers, and of 131 persons with available data, 82% had a history of exposure to live animals, including chickens (82%). A total of 137 persons (99%) were hospitalized, 125 (90%) had pneumonia or respiratory failure, and 65 of 103 with available data (63%) were admitted to an intensive care unit. A total of 47 persons (34%) died in the hospital after a median duration of illness of 21 days, 88 were discharged from the hospital, and 2 remain hospitalized in critical condition; 2 patients were not admitted to a hospital. In four family clusters, human-to-human transmission of H7N9 virus could not be ruled out. Excluding secondary cases in clusters, 2675 close contacts of case patients completed the monitoring period; respiratory symptoms developed in 28 of them (1%); all tested negative for H7N9 virus. CONCLUSIONS: Most persons with confirmed H7N9 virus infection had severe lower respiratory tract illness, were epidemiologically unrelated, and had a history of recent exposure to poultry. However, limited, nonsustained human-to-human H7N9 virus transmission could not be ruled out in four families.

[Epidemiological characteristics of human avian influenza A (H7N9) virus infection in China].

OBJECTIVE: To investigate the epidemiological characteristics of human infections with avian influenza A (H7N9) in China and to provide scientific evidence for the adjustment of preventive strategy and control measures. METHODS: Demographic and epidemiologic information on human cases were collected from both reported data of field epidemiological investigation and the reporting system for infectious diseases. RESULTS: A total of 433 cases including 163 deaths were reported in mainland China before June 4, 2014. Two obvious epidemic peaks were noticed, in March to April, 2013 and January to February, 2014. Confirmed cases emerged in 14 areas of China. Five provinces, including Zhejiang, Guangdong, Jiangsu, Shanghai, and Hunan, reported about 85% of the total cases. Median age of the confirmed cases was 58 years (range, 1-91), with 70% as males. Of the 418 cases with available data, 87% had ever exposed to live poultry or contaminated environments. 14 clusters were identified but human to human transmission could not be ruled out in 9 clusters. CONCLUSION: Human infections with avian influenza A (H7N9) virus showed the characteristics of obvious seasonal distribution, with certain regional clusters. The majority of confirmed cases were among the elderly, with more males seen than the females. Data showed that main source of infection was live poultry and the live poultry market had played a significant role in the transmission of the virus.

Use of national pneumonia surveillance to describe influenza A(H7N9) virus epidemiology, China, 2004-2013.

In mainland China, most avian influenza A(H7N9) cases in the spring of 2013 were reported through the pneumonia of unknown etiology (PUE) surveillance system. To understand the role of possible underreporting and surveillance bias in assessing the epidemiology of subtype H7N9 cases and the effect of live-poultry market closures, we examined all PUE cases reported from 2004 through May 3, 2013. Historically, the PUE system was underused, reporting was inconsistent, and PUE reporting was biased toward A(H7N9)-affected provinces, with sparse data from unaffected provinces; however, we found no evidence that the older ages of persons with A(H7N9) resulted from surveillance bias. The absolute number and the proportion of PUE cases confirmed to be A(H7N9) declined after live-poultry market closures (p<0.001), indicating that market closures might have positively affected outbreak control. In China, PUE surveillance needs to be improved.

[Application of statistics on chronic-diseases-relating observational research papers].

OBJECTIVE: To study the application of statistics on Chronic-diseases-relating observational research papers which were recently published in the Chinese Medical Association Magazines, with influential index above 0.5. METHODS: Using a self-developed criterion, two investigators individually participated in assessing the application of statistics on Chinese Medical Association Magazines, with influential index above 0.5. Different opinions reached an agreement through discussion. RESULTS: A total number of 352 papers from 6 magazines, including the Chinese Journal of Epidemiology, Chinese Journal of Oncology, Chinese Journal of Preventive Medicine, Chinese Journal of Cardiology, Chinese Journal of Internal Medicine and Chinese Journal of Endocrinology and Metabolism, were reviewed. The rate of clear statement on the following contents as: research objectives, t target audience, sample issues, objective inclusion criteria and variable definitions were 99.43%, 98.57%, 95.43%, 92.86% and 96.87%. The correct rates of description on quantitative and qualitative data were 90.94% and 91.46%, respectively. The rates on correctly expressing the results, on statistical inference methods related to quantitative, qualitative data and modeling were 100%, 95.32% and 87.19%, respectively. 89.49% of the conclusions could directly response to the research objectives. However, 69.60% of the papers did not mention the exact names of the study design, statistically, that the papers were using. 11.14% of the papers were in lack of further statement on the exclusion criteria. Percentage of the papers that could clearly explain the sample size estimation only taking up as 5.16%. Only 24.21% of the papers clearly described the variable value assignment. Regarding the introduction on statistical conduction and on database methods, the rate was only 24.15%. 18.75% of the papers did not express the statistical inference methods sufficiently. A quarter of the papers did not use 'standardization' appropriately. As for the aspect of statistical inference, the rate of description on statistical testing prerequisite was only 24.12% while 9.94% papers did not even employ the statistical inferential method that should be used. CONCLUSION: The main deficiencies on the application of Statistics used in papers related to Chronic-diseases-related observational research were as follows: lack of sample-size determination, variable value assignment description not sufficient, methods on statistics were not introduced clearly or properly, lack of consideration for pre-requisition regarding the use of statistical inferences.

The changes of nutrition labeling of packaged food in Hangzhou in China during 2008-2010.

OBJECTIVE: To understand the changes of the nutrition labeling of packaged food in China two years after the promulgation of the Regulation for Food Nutrition Labeling, which encourages food manufacturers to identify nutrition labeling. METHODS: Investigators copied out the nutrition information panel, nutrition claim and nutrient function claim of packaged food in a supermarket with prepared questionnaire and finished normative judgment in 2008 and 2010. RESULTS: 4693 and 5526 kinds of packaged food were investigated separately. Nutrition information panel, nutrition claim and nutrient function claim were found on the food label of 27.6%, 13.0% and 1.9% of packaged food respectively in 2008, while 35.1%, 7.7% and 2.3% in 2010. The nutrition information panel which labeled energy, protein, fat, carbohydrate and sodium was 597 (43.8%) and 1661 (85.9%) in 2008 and 2010, only 134 (9.8%) and 985 (51.0%) nutrition information panel were totally normalized. Nutrition claim and nutrient function claim focused on vitamin, mineral and dietary fiber. The total qualified proportions for nutrition claim were increased significantly for most of the nutrients, except for cholesterol. There were 6 (6.4%) and 5 (3.9%) nutrient function claims with hinting of therapeutic effects on diseases separately. CONCLUSION: Although the voluntary regulation remarkably improved the level of normalization for nutrition labeling, its role on the prevalence was minus. It's imperative to enforce nutrition labeling for not only China but also other countries, and furthermore, health education on nutrition labeling should be initiated to support the policy.

[Study on knowledge, attitudes and use of the pre-packaged food nutrition labeling in Hangzhou supermarket consumers in 2010].

OBJECTIVE: To study the prevalence rates of knowledge, attitudes and use of the nutrition labeling and related influential factors in Hangzhou supermarket consumers. METHODS: Using a self-developed survey questionnaire, randomly selected customers were conducted a face-to-face interview program in a large supermarket of Hangzhou city. RESULTS: 586 people were interviewed, including 202 males and 384 females, with the mean age as 41.6 ± 17.23 years. The accuracy rates of 6 questions related to the 'ability of choosing healthier food by using the Nutrition Facts Labels' were as follows: dietary fiber (71.84%), fat (70.99%), calcium (60.75%), salt (58.36%), energy (50.85%) and sugar (39.42%). The support rates of the three attitudes indicators were "support marking the Nutrition Facts Label" (90.44%), "support marking the nutrition claims" (87.03%) and "want to know more relative knowledge" (77.13%). There were 58.36% and 80.03% first-time buyers who would read the Nutrition Facts Food Labels and the Nutrition Claims. Through logistic model analysis, male, youth, low-educated people were found to be the risk factors related to the nutrition label reading behavior. CONCLUSION: The capacity of the reading, understanding and correct application of nutrition labeling among consumers was not satisfactory. Improvement on the readability and the authority of nutrition labeling and the development of the national nutrition knowledge and health education programs were in urgent needs.

Implementation of the WHO Framework Convention on Tobacco Control in mainland China.

As per China's ratification of the WHO Framework Convention on Tobacco Control (FCTC), it should have implemented effective packaging and labelling measures prior to 9 January 2009 and enacted a comprehensive ban on all tobacco advertising, promotion and sponsorship prior to 9 January 2011. In addition, universal protection against secondhand tobacco smoke should have been implemented before 9 January 2011 by ensuring that all indoor workplaces, all indoor public places, all public transportation and possibly other (outdoor or quasi-outdoor) public places are free of secondhand smoke. The authors conducted a review of various sources of information to determine the current status of FCTC implementation in mainland China. Even though China has made considerable efforts to implement the FCTC, there is still a significant gap between the current state of affairs in China and the requirements of the FCTC. The Chinese tobacco monopoly under which commercial and other vested interests of the tobacco industry are jeopardizing tobacco control efforts is thought to be the most crucial obstacle to the effective implementation of the FCTC across the country.

[Development and evaluation of complex intervention].

Experimental studies with only one intervention are not always sufficient for health care issues, while the method of complex intervention is more useful. But the complex intervention is more complicated and needs carefully design and evaluation. This article will introduce the framework for design and evaluation of complex intervention and the revised version made by Medical Research Council, with five examples showing its application.