[Analysis of verification results of protective effects of hearing protectors in different industries].

Objective: To get insight into the current practice of noise reduction effect of workers as they wore hearing protectors in different domestic enterprises and the possible affected factors. Methods: From October 2020 to April 2021, using a random sampling method, 1197 workers exposed to noise in petrochemical factories, textile factories, and parts manufacturing factories were selected as the study subjects. The noise reduction effect of hearing protectors worn by workers in daily use was tested using a hearing protector suitability testing system. The personal sound attenuation level (PAR) was compared among workers in three enterprises, Targeted intervention and repetitive testing were conducted for workers who did not meet the noise reduction effect required by the enterprise, and the changes in PAR of workers before and after the intervention were compared. The comparison of baseline PARs between two or more groups was performed using the Mann Whitney test, the comparison of baseline PARs with post intervention PARs was performed using the Wilcoxon signed rank sum test, and the comparison of qualitative data between two or more groups was performed using the Chi square test. Results: The median baseline PAR for all workers was 15 dB. Men, age<30 years old, education level at or above college level, working experience of 5 to 15 years, and those who used hearing protectors for 5 to 15 years had higher PARs, with statistically significant differences (P<0.05). The median difference in baseline PAR among workers from three enterprises was statistically significant (H=175.06, P<0.01). The median PAR of subjects who did not pass the baseline increased from 3 dB to 21 dB after intervention (Z=-27.92, P<0.01) . Conclusion: Some workers wearing hearing protectors do not meet the required PAR, and low PARs may be related to incorrect wearing methods and incorrect selection of hearing protectors. As a tool for testing, training, and assisting in selection, the hearing protector suitability testing system is of great significance for worker hearing protection.

[JCOG lung cancer surgery trial series: review and interpretation].

Surgery is so far the most effective treatment for early-stage non-small cell lung cancer (NSCLC). Since the 1990s, the pathology spectrum of early-stage lung cancer has gradually changed because of the increased detection of ground-glass opacity (GGO). The findings from preoperative thin-section computed tomography are strong predictors for the invasiveness and lymph node involvement of GGO, and limited surgery is believed to be implemented safely for radiological less invasive lesions, which calls into question the dominance of lobectomy. After the JCOG0201 trial establishing the radiologic criteria of pathological noninvasiveness for lung adenocarcinoma, the Japan Clinical Oncology Group (JCOG) and the West Japan Oncology Group (WJOG) have successively carried out a series of prospective imaging-guided trials to investigate the optimal surgical procedure for early-stage lung cancer. JCOG0804, was a single-arm, non-randomized, confirmatory trial to evaluate the efficacy and safety of sublobar resection (wedge resection and segmentectomy) for GGO dominant peripheral lung cancer. The primary end point was 5-year relapse-free survival. JCOG0802/WJOG4607L, was a multicentre, open-label, phase 3, randomized, controlled, non-inferiority trial to investigate if segmentectomy was non-inferior to lobectomy in patients with small-sized peripheral NSCLC. The primary endpoint was 5-year overall survival. JCOG1211 was also a non-randomized confirmatory trial to confirm the efficacy of a segmentectomy for clinical T1N0 lung cancer with dominant GGO. The primary endpoint was 5-year relapse-free survival. The findings of JCOG0804 and JCOG0802, and the primary analysis results of JCOG1211 have been officially published. This article systematically reviewed and interpreted the results of the JCOG lung cancer surgery trial series.

[Risk assessment on noise-induced hearing loss of 488 workers in a petrochemical plant].

Objective: To assess the risk of noise-induced hearing loss in workers from a petrochemical plant. Methods: In October 2020, 488 male workers exposed to noise in a petrochemical plant in Guangdong Province were selected by cluster sampling. Acoustics-Estimation of Noise-Induced Hearing Loss (ISO 1999: 2013) was used to assess the risk of noise-induced hearing loss of workers, and individual fit testing was used to evaluate the sound attenuation obtained by the workers. The risk assessment results and fitness test results of workers with different hearing levels were compared. Results: The average noise exposure equivalent sound level of the workers in the petrochemical plant was 86.7 dB (A) . The median of PARs (personal attenuation ratings) was 16 (4, 23) dB. There were statistically significant differences in age and service years among workers with different hearing results (P<0.05) , but no statistically significant differences in noise intensity and PARs (P>0.05) . According to risk assessment results of ISO 1999: 2013, the current risk of high-frequency hearing loss in 488 workers were negligible risk and acceptable risk. The risk of noise-induced deafness weredivided into three levels: negligible risk in 452 workers (92.7%) , medium risk in 27 workers (5.5%) and high risk in 9 workers (1.8%) . The risk of high-frequency hearing loss in next 5 to 15 years for workers with noise exposure level of >94 to 97 dB and >97 dB or above would be medium risk or above. The risk of noise-induced deafness in next 5 to 15 years for workers exposed to noise withlevel of 91 to 94 dB would be medium risk or above. Conclusion: The risk of noise-induced hearing loss in workers from the petrochemical plant is high in next 5 to 15 years, and noise prevention and control measures need to be strengthened. ISO1999: 2013 assessment method may underestimate the risk of hearing loss among workers.

[Development of a deep learning based prototype artificial intelligence system for the detection of dental caries in children].

Objective: To develop a prototype artificial intelligence image recognition system for detecting dental caries, especially those without cavities, in children. Methods: Seven hundred and twelve intraoral photos, which were taken by dental professionals using a digital camera from October 2013 to June 2020 in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, were collected from the children who received dental treatment under general anesthesia. The well-documented post-treatment electronic dental record of each child was identified as label standard to determine whether the teeth were carious and the type of caries types such as caries that had become cavities (caries with cavities), pit and fissure caries that had not become cavities (pit and fissure caries) and proximal caries which the marginal ridge enamel had not been destroyed (proximal caries). The various teeth and caries types were labeled by pediatric dentists using VoTT software (Windows 2.1.0, Microsoft, U S A). There were five labeled groups: pit and fissure caries, approximal caries, non-carious approximal surfaces, caries with cavities and teeth without caries (including intact fillings). Each group was randomly divided into training dataset, validation dataset and test dataset at a ratio of 6.4∶1.6∶2.0 by using random number table. After using the labeled training dataset for deep learning training, a deep learning-based artificial intelligence (AI) image recognition system for detecting dental caries was established, with the caries probability greater than 50.0% as the criterion for determining caries. Sensitivity and accuracy were used as indicators of recognition specificity. Results: Seven hundred and twelve single-jaw intraoral photographs were segmented and annotated into 953 pit and fissure caries, 1 002 approximal caries, 3 008 caries with cavities, 3 189 teeth without caries and 862 non-carious approximal surfaces, totaly 9 014 labels. The sensitivities and specificities of the test set were 96.0% and 97.0% for caries with cavities, 95.8% and 99.0% for pit and fissure caries and 88.1% and 97.1% for approximal caries. Conclusions: The current AI system developed based on deep learning of the intra-oral photos in the present study showed the ability to detect dental caries. Furthermore, the AI system could accurately verify different types of dental caries such as caries with cavities, pit and fissure caries and proximal caries.

[Deep learning-based dental plaque detection on permanent teeth and the influenced factors].

Objective: To develop an artificial intelligence system for detecting dental plaque on permanent teeth and find the influenced factors. Methods: Photos of the labial or buccal surfaces of the permanent teeth were taken by using an intraoral camera (1 280×960 pixels; TPC Ligang, Shenzhen, China) before and after applying the plaque-disclosing agent (Cimedical, Japan) in 25 volunteers [12 males, 13 femals, aged (23±3) years] recruided in accordance with the inclusion criteria from the students of Peking University School of Stomatology from October 2018 to June 2019. A total of 549 groups of photos were captured and then divided into a training dataset containing 440 groups of photos and a test dataset including 109 groups of photos. The scopes of teeth and dental plaque on photos were labeled using LabelMe (Windows 3.2.1, MIT, U S A). A DeepLab based deep learning system was designed for the intelligent detection of dental plaque on permanent teeth. The mean intersection over union (MIoU) was employed to indicate the detection accuracy. Matlab (Windows R2017a, MathWorks, U S A) was used to extract the plaque edge line of 109 groups of photos and to calculate the number of pixels for the measurement of the complexity of the plaque edge line. The percentage of dental plaque area was calculated. Multivariate linear regression was used to explore whether tooth site, plaque percentage, number of plaque edge line pixels and lens light spot location would influence the detection accuracy, of which P<0.05 was considered statistically significant. Results: The MIoU of the permanent tooth model was 0.700±0.191 when 440 photos were used for training and 109 photos were used for testing. In the regression model of significance test (P<0.05), the percentage of plaque and the number of pixels on the edge of plaque had significant influence on the accuracy of dental plaque detection. The standardized coefficient of the number of pixels of the plaque edge line is -0.289, and the standardized coefficient of the percentage of plaque is -0.551. Conclusions: In the present study, an artificial intelligence system was built to detect dental plaque area on tooth photos collected by family intraoral camera. The system showed the ability to detect the dental plaque of permanent teeth. The more complex the marginal line of dental plaque and higher the percentage of dental plaque are, the lower the accuracy of plaque recognition is.

[Longitudinal surveillance of schistosomiasis in hilly regions of Sichuan Province from 2015 to 2019].

OBJECTIVE: To investigate the changes in the endemic situation of schistosomiasis in national surveillance sites of Sichuan Province, so as to provide the scientific evidence for formulating the schistosomiasis elimination strategy. METHODS: From 2015 to 2019, 63 national schistosomiasis surveillance sites were assigned in Sichuan Province, in which Schistosoma japonicum infections were monitored in humans, livestock, wild feces and snails. The monitoring data were descriptively analyzed. RESULTS: A total of 94 119 person-time local residents were serologically screened for S. japonicum infections in 63 national surveillance sites of Sichuan Province from 2015 to 2019, with sero-prevalence rates ranging from 1.28% to 3.11%, and the sero-positives were predominantly detected in local residents at ages of over 50 years and in farmers. A total of 94 119 person-time mobile populations were serologically screened for S. japonicum infections in the national surveillance sites during the 5-year period, with sero-prevalence of 1.10% to 1.59%. There were no egg-positives identified in either local residents or mobile populations. Among the 6 126 herd-time livestock detected, no egg-positives were identified, and no S. japonicum infection was detected in the 205 wild feces. Snail survey was performed covering an area of 8 484.08 hm2, and 724.80 hm2 snail habitats were identified, including 2.43 hm2 emerging snail habitats and 63.00 hm2 re-emerging snail habitats. The mean occurrence of frames with snails was 6.87% to 19.63%, and the mean density of living snails was 0.18 to 0.62 snails/0.1 m2 in the national surveillance sites of Sichuan Province from 2015 to 2019; however, no S. japonicum infection was detected in snails. CONCLUSIONS: The endemic situation of schistosomiasis has reduced to the lowest level in Sichuan Province; however, there is a rise in snail habitats, and there is still a risk of schistosomiasis resurgence. Further improvements of the surveillance system for schistosomiasis are required to achieve the goal of schistosomiasis elimination in Sichuan Province as soon as possible.

[Analysis of factors affecting health-related behaviors for schistosomiasis prevention and control among primary and secondary school students in Sichuan Province].

OBJECTIVE: To analyze the influencing factors of health-related behaviors for schistosomiasis prevention and control among primary and secondary school students in Sichuan Province using a multilevel and multivariate logistic model, so as to provide the theoretical evidence for developing the schistosomiasis prevention and control strategy among primary and secondary school students in Sichuan Province. METHODS: A multi-stage sampling was conducted among 63 schistosomiasis-endemic counties (districts) in Sichuan Province. Five endemic townships were sampled from each county (district), and 100 Grade 4 to 6 students in each primary school and 100 Grade 1 to 3 students in each secondary school were sampled from each township as the study subjects. The health-related behaviors for schistosomiasis prevention and control were investigated using a questionnaire survey, and factors affecting infested water contact behaviors were identified using univariate and multilevel logistic analyses. RESULTS: Among the 62 200 questionnaires distributed, there were 59 134 recovered, and 56 510 were qualified. The qualified 56 510 respondents included 22 955 secondary school students and 33 555 primary school students, and 28 297 male students and 28 213 females. A higher proportion of infested water contacts was seen in male students than in females (P < 0.001), and the students living in heavily endemic areas had a higher proportion of infested water contacts than those in mildly endemic areas (P < 0.001). In addition, there was no significant difference in the proportion of infested water contacts between primary and secondary school students (P >0.05). Multilevel and multivariate logistic analyses revealed a lower proportion of infested water contacts with the increase of knowledge, belief and self-efficacy levels (P < 0.001), and there was a cluster of infested water contacts among students at a county scale (P < 0.001). CONCLUSIONS: There is a cluster of infested-water contact behaviors among primary and secondary school students at a county scale in Sichuan Province. Individual and environmental factors should be considered during the formulation of health education strategy and interventions for schistosomiasis among primary and secondary school students.

[Analysis of caries experience and the dental treatments under general anesthesia in 103 cases of children with autism spectrum disorders].

Objective: To compare the caries experience and the kinds of dental treatment between children with autism spectrum disorders (ASD) and children without systemic disease who were all treated under general anesthesia. Methods: Totally 103 children with ASD who received dental treatments under general anesthesia in 13 professional dental hospitals around China from April to November 2016 were included in the present study. A group of 97 children without systemic disease, according to the age, gender and application propensity score matching method, were chosen as controls, who received dental treatments under general anesthesia between January 2015 to November 2018 in the same hospitals as the children with ASD. Decay missing filling tooth (DMFT/dmft, DMFT for permanent teeth and dmft for primary teeth) indices of two groups of children and the contents of the dental treatments under general anesthesia were analyzed. Results: No significant difference of DMFT/dmft index ï¼»M (Q 25, Q 75)ï¼½ was found between children with ASD group ï¼»0 (0, 3)/11(8, 14)ï¼½ and control group ï¼»0 (0, 3)/9(7, 13)ï¼½ (P>0.05). The average number of dental treatments under general anesthesia and the average number of endodontic treatment in children with ASD were 13 (11, 15) and 3 (2, 6) teeth respectively, while those in the control group were 12 (9, 14) and 2 (1, 4) teeth respectively, the differences were statistically significant (P<0.01, P<0.05). Conclusions: No significant difference was found between children with ASD and the normal controls who receive dental treatments under general anesthesia in DMFT/dmft index, but the treatment needs of children with ASD is relatively higher, and their tooth decay is relatively severer.

[Application of three semi-quantitative risk assessment methods in electroplating enterprises].

Objective: To apply the semi-quantitative risk assessment model in the Technical Guidelines for Occupational Health Risk Assessment of Chemical Hazardous Factors in the Workplace to assess the occupational health risk of electroplating enterprises and explore its applicable conditions and characteristics. Methods: Three electroplating enterprises were selected as the research objects. Occupational hygiene survey and hazard factor detection were conducted on the spot. Three semi-quantitative risk assessment methods were used to assess the risk, and the evaluation results were compared. Results: The consistency between the contact index method and the comprehensive index method was strong. The weighted Kappa value was 0.946 and the P value was less than 0.001, but the consistency between the contact ratio method, the contact index method and the comprehensive index method was poor. The weighted Kappa value was 0.345 and 0.391, and the P value was 0.009 and 0.004, respectively. When the contact concentration is less than 50% OELs, the evaluation results of the contact ratio method are lower than those of the exponential method and the comprehensive exponential method. The consistency of the three methods was the highest when the contact concentration (>50%) and (OELs, the results of the contact ratio method are higher than those of the index method and the comprehensive index method. Conclusion: Contact ratio method is suitable for occupational health risk assessment under the condition of incomplete occupational health information and for enterprise managers to identify key control points of health risk through self-assessment; Contact index method is suitable for hazard risk assessment of occupational hazards without sampling test conditions or OELs, and pre-assessment of occupational hazards of construction projects without access to analogical test data. The index method is suitable for occupational health risk assessment with available testing data and complete occupational health information.

[Relationship between occupational stress, psychological capital and depressive symptoms among female workers in five electronic manufacturing enterprises].

Objective: To explore the relationship between occupational stress, psychological capital and depressive symptoms among electronic manufacturing female workers in the Pearl River Delta region. Methods: Using cluster sampling method, 845 female workers from 5 electronic manufacturing enterprises in the Pearl River Delta region were selected as research subjects from June to August 2017. The Effort Reward Imbalance questionnaire (ERI) , Psychological Capital questionnaire-24 (PCQ-24) and Patient Health questionnaire-9 (PHQ-9) were applied to measure the level of occupational stress, psychological capital and depressive symptoms in female workers. Results: Effort (r=0.197, P<0.01) and over commitment (r=-0.260, P<0.01) were positively correlated with the score of depressive symptoms, and the rewards was negatively correlated with depressive symptoms (r=-0.211, P<0.01) . The reward and over-commitment for depressive symptoms were accounted for 8.2%. Psychological capital was negatively correlated with depressive symptoms, and plays a partly mediating role in the relationship between occupational stress and depressive symptoms of female workers. The psychological capital for depressive symptoms was accounted for 8.7%. Conclusion: Occupational stress can affects the depressive symptoms of electronic manufacturing female workers, or indirectly affect depressive symptoms through psychological capital, reduce occupational stress and improve psychological capital as a way to relieve the depressive symptoms of female workers.

[Association between dietary supplementation during pregnancy and low birth weight: a prospective study].

Objective: To explore the association between dietary supplementation during pregnancy and low birth weight. Methods: 11 311 pregnant women who had regularly visited outpatient gynecology clinic of Wuhan Women and Children Medical Center with intention to delivery in the hospital were recruited in the cohort between September 2012 and October 2014. Social-demographic characteristics of pregnant women and spouses, dietary supplementation during pregnancy, pre-pregnancy body mass index (BMI), exercise in the third trimester, work during pregnancy, pregnancy complications and related pregnancy information were collected through self-designed questionnaires, maternal health manuals and medical records. Birth weight of the newborns was measured. Non-conditional multivariate logistic regression analysis was used to determine the correlation between dietary supplementation and low birth weight. Results: 11 311 pregnant women were (28.21±3.70) years old, and they gave birth to 477 low birth weight newborns (4.2%). Iron supplementation during the whole period of pregnancy (OR (95%CI): 0.60 (0.43-0.63)) and folic acid supplementation during the early pregnancy (OR (95%CI): 0.74 (0.60-0.90)) were negatively associated with low birth weight. Conclusion: Supplementation of iron during the whole period of pregnancy and folic acid during the early pregnancy would reduce the risk of low birth weight.

[The Wuhan Twin Birth Cohort Study].

The prevalence of child and adolescent growth and mental-behavior related diseases are increasing, and the pathogenesis are complex. Twins are excellent natural resources for complex chronic diseases research as they share the maternal intrauterine environment, born at the same time and share the same family environment in early years, which could benefit the adjust ment of confounding factors, such as age, genetic factors and early family environmental factors. Birth cohort with twin families involved could be more effective in exploring the genetic and environmental factors for complex chronic diseases at the very beginning of life. This paper summarizes the objective, content, progress, strengths and potential problems of Wuhan Twin Birth Cohort, with emphasis on the overall design and progress of the study.

Identification and diversity of Y-chromosome haplotypes in Qinghai yak populations.

The aim of the present study was to perform a preliminary analysis of the characterization and diversity of Y-chromosome haplotypes/haplogroups in yak of Qinghai Province, China. A total of 322 male yaks from nine populations belonging to three officially recognized breeds (Gaoyuan, Huanhu and Datong) were sampled. Animals were genotyped using six previously reported Y-SNPs present in the SRY, USP9Y, UTY, AMELY and OFD1Y genes and four new Y-SNPs in the OFD1Y gene (g.569A>C, g.578A>C, g.608G>T and g.653G>C) identified in this study. Seven Y-chromosome haplotypes (H1-H7) were identified according to the combination of the 10 Y-SNPs. H1, H2 and H6 were the most common and shared haplotypes across all yak populations/breeds. Private haplotypes H3 and H7 were detected in the Datong breed; H4 in Guoleimude, Qumalai, Qilian, Tianjun and Ganglong populations; and H5 in Qumalai of Gaoyuan breed. Haplotype clustering and network analyses inferred two haplogroups, Y1 and Y2, indicating two divergent lineages of paternal origins of Qinghai yak. The analysis of molecular variance showed a significant difference among individuals (P < 0.0001) with more than 93% of the total genetic variation present within populations, suggesting a weak genetic structure among Qinghai yak populations. The overall Y-haplotype diversity was 0.538 ± 0.028, showing a relatively high diversity in Qinghai yak. The Gaoyuan and Datong breeds had similar haplotype diversities (0.547 ± 0.030 and 0.553 ± 0.083, respectively), which were higher than that of the Huanhu breed (0.441 ± 0.098). Our results support the conservation and sustainable use of unique yak genetic resources in Qinghai.

Investigation of serum miR-411 as a diagnosis and prognosis biomarker for non-small cell lung cancer.

OBJECTIVE: Biomarkers in blood have become increasingly appreciated in the diagnosis and prognosis of non-small cell lung cancer (NSCLC). The purpose of the current study was to explore potential diagnostic and prognostic value of serum miR-411 in NSCLC patients. PATIENTS AND METHODS: 153 patients with NSCLC and 75 healthy controls were enrolled in the study. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to determine the expression level of serum miR-411 in NSCLC patients and healthy controls. The association of miR-411 expression with clinicopathological factors or the prognosis of NSCLC patients was also analyzed. Patient survival was determined by telephone interview, and survival curves were plotted by using the Kaplan-Meier method and compared by the Log-rank test. Receiver operating characteristic curves was used to evaluate the sensitivity and specificity of serum miR-411. RESULTS: Our data showed that serum miR-411 levels were significantly greater in NSCLC patients than healthy controls (p < 0.001). High serum miR-411 expression was significantly associated with TNM stage (p = 0.018), lymph node status (p = 0.006) and differentiated degree (p < 0.015). Kaplan-Meier analysis showed that high serum miR-411 expression levels predicted poor survival (p = 0.0053). The area under the curve (AUC) of high expression of serum miR-411 to diagnose NSCLC was 0.835 (95% CI: 0.737-0.933, p < 0.001). Univariate and multivariate analyses suggested that high expression of miR-411 was an independent poor prognostic indicator for NSCLC patients. CONCLUSIONS: The present results suggested that detection of serum miR-411 levels may have clinical potentials as a non-invasive diagnostic/prognostic biomarker for NSCLC patients.

[Application of State Space model in the evaluation of the prevention and control for mumps].

Objective: To analyze the epidemiological characteristics of mumps in 2012 and 2014, and to explore the preventive effect of the second dose of mumps-containing vaccine (MuCV) in mumps in Shandong province. Methods: On the basis of certain model assumptions, a Space State model was formulated. Iterated Filter was applied to the epidemic model to estimate the parameters. Results: The basic reproduction number (R(0)) for children in schools was 4.49 (95%CI: 4.30-4.67) and 2.50 (95%CI: 2.38-2.61) respectively for the year of 2012 and 2014. Conclusions: Space State model seems suitable for mumps prevalence description. The policy of 2-dose MuCV can effectively reduce the number of total patients. Children in schools are the key to reduce the mumps.

[Spatial distribution of occupational disease prevalence in Guangzhou and Foshan city by geographic information system].

Objective: To explore the occupational disease spatial distribution characteristics in Guangzhou and Foshan city in 2006-2013 with Geographic Information System and to provide evidence for making control strategy. Methods: The data on occupational disease diagnosis in Guangzhou and Foshan city from 2006 through 2013 were collected and linked to the digital map at administrative county level with Arc GIS12.0 software for spatial analysis. Results: The maps of occupational disease and Moran's spatial autocor-relation analysis showed that the spatial aggregation existed in Shunde and Nanhai region with Moran's index 1.727, -0.003. Local Moran's I spatial autocorrelation analysis pointed out the "positive high incidence re-gion" and the "negative high incidence region" during 2006~2013. Trend analysis showed that the diagnosis case increased slightly then declined from west to east, increase obviously from north to south, declined from? southwest to northeast, high in the middle and low on both sides in northwest-southeast direction. Conclusions: The occupational disease is obviously geographical distribution in Guangzhou and Foshan city. The corresponding prevention measures should be made according to the geographical distribution.

Epidemiological Features and Effectiveness of Schistosomiasis Control Programme in Mountainous and Hilly Region of The People's Republic of China.

Schistosomiasis is a parasitic disease that affects over 200million people worldwide in at least 76 countries, ranking second only after malaria in terms of its socio-economic and public health importance in tropical and subtropical areas of the world. Chinese surveillance data since the mid-1950s have shown that endemic areas are divided into three types based on geographical, ecological and epidemiological factors, such as marshland and lake region, plain region with waterway networks and hilly and mountainous region. As confirmed by numerous epidemiological investigations, schistosomiasis endemic areas of the mountainous type are distributed in 178 counties in 11 provinces of The People's Republic of China. Over the past several decades great success in transmission control has been achieved by implementation of control strategies that were suitable for the mountainous and hilly endemic region.

Health Education as an Important Component in the National Schistosomiasis Control Programme in The People's Republic of China.

Schistosomiasis control programme in The People's Republic of China had promoted the mass mobilization of health education in various forms, such as films, drama, traditional opera, poems, slogans, posters, exhibits. This paper is trying to review the impacts of those forms on different endemic settings and targeted populations. In the future, health education and health promotion will still be the effective strategy and one of the interventions in the national control programme for schistosomiasis and other infectious diseases, even in the pre- or posttransmission stages. With the social and economic development and improvement of people's living standard, it is necessary to establish a sustainable mechanism, in combination of health education with health guarantee of improving the quality of life, improving the production and living conditions, changing the unhealthy production methods and lifestyle of the residents in the endemic areas, in order to reach the goal of schistosomiasis elimination in The People's Republic of China.

The affordability for patients of a new universal MDR-TB coverage model in China.

BACKGROUND: China has piloted a new model of universal coverage for multidrug-resistant tuberculosis (MDR-TB), designed to rationalize hospital use of drugs and tests and move away from fee-for-service payment towards a standard package with financial protection against catastrophic health costs. OBJECTIVE: To evaluate the affordability to patients of this new model. DESIGN: This was an observational study of 243 MDR-TB cases eligible for enrolment on treatment under the project. We assessed the affordability of the project from the perspective of households, with a focus on catastrophic costs. RESULTS: Of the 243 eligible cases, 172 (71%) were enrolled on treatment; of the 71 cases not enrolled, 26 (37%) cited economic reasons. The 73 surveyed cases paid an average of RMB 5977 (US$920) out-of-pocket in search costs incurred outside the pilot model. Within the pilot, they paid another RMB 2094 (US$322) in medical fees and RMB 5230 (US$805) in direct non-medical costs. Despite 90% reimbursement of medical fees, 78% of households experienced catastrophic costs, including indirect costs. CONCLUSION: The objectives of the pilot model are aligned with health reform in China and universal health coverage globally. Enrollment would almost certainly be higher with 100% reimbursement of medical fees, but patient enablers will be required to truly eliminate catastrophic costs.

Treatment interruption and directly observed treatment of multidrug-resistant tuberculosis patients in China.

BACKGROUND: China has nearly one fifth of global multidrug-resistant tuberculosis (MDR-TB) cases, and follows the 24-month World Health Organization (WHO) standardised regimens. OBJECTIVE: To assess treatment interruption among MDR-TB patients and its association with the provision of directly observed treatment (DOT). METHODS: We reviewed clinical charts and conducted a questionnaire survey among all confirmed MDR-TB patients who had been treated for at least 6 months from 1 January 2009 to 30 April 2012 in Shandong Province. Treatment interruption was defined as missing a dose for at least 1 day but for <8 consecutive weeks; the subset 'severe interruption' was defined as missing doses for 2-8 consecutive weeks. RESULTS: Of 110 patients, 75 (68%) interrupted treatment; 19 (17%) reported severe interruption, with a median duration of 30 days. Of the 110 patients, 26 (24%) received injections from family members and 55 (50%) received DOT, 7 (13%) from village doctors and 48 (87%) from family members. Patients who underwent DOT with a family member had less severe interruptions (OR 0.25, 95%CI 0.05-0.98) than those who were given DOT by a village doctor or who did not undergo DOT. CONCLUSIONS: Family members may act as treatment supporters for MDR-TB patients to reduce treatment interruptions, but require orientation on their role.