ABSTRACT
ObjectiveTo conduct on-site epidemiological investigation， emergency response， tracing of infection source and analysis of a confirmed COVID-19 case of a foreign airline cargo service staff member in Shanghai’s international airport， aiming to provide reference for prevention of imported COVID-19 cases under regular prevention and control of COVID-19. MethodsA retrospective field epidemiological investigation was conducted to collect information of basic characteristics， illness onset， diagnosis， treatment， clinical manifestations， exposure history and risk factors within 14 days before onset， close contacts， close contacts of close contacts， and key places related to activity trajectories. Respiratory tract specimens of cases and contacts were collected for detection of SARS-CoV-2 by real time RT-PCR （rRT-PCR）. Emergency response， including infection source analysis and contact management， was conducted. ResultsThe case developed pharyngeal itch on July 28， 2021， and fever on the 30th， and went to the hospital for treatment twice on the 31st. Because his specimen was positive for SARS-CoV-2 by rRT-PCR on August 1， he was isolated and treated on August 2 and diagnosed as a confirmed case of COVID-19. The case was a foreign airline cargo service member at an international airport. The two regular nucleic acid screenings of him as a high-risk occupation on July 21 and 28 were negative. He did not leave Shanghai within 14 days before the onset of illness. During July 22nd and 23rd， he was repeatedly exposed during work to the high-risk environment that may have been contaminated by SARS-CoV-2 and had contact with the crew of foreign airlines， and the personal protection was not standardized. None of the 67 close contacts and 567 close contacts of close contacts in Shanghai showed symptoms during the 14-day medical quarantine， and the specimens of them were all negative for SARS-CoV-2 by rRT-PCR. The results of genome sequencing analysis showed that the genomic homology between the virus of the case and the one of recent domestic local epidemic and the recent imported cases was low， and the homology with the overseas Delta mutant strain was higher than that of the domestic Delta mutant strain. ConclusionThe situation of prevention of COVID-19 import is still serious. It is necessary to conduct regular nucleic acid screening for high-risk occupational groups， strengthen the diagnosis and reporting awareness of medical institutions， effectively implement the prevention and control measures for people， objects， and environment at international airports， and further enhance the public's awareness of personal protection.
ABSTRACT
In order to meet the needs of prevention and control of intestinal infectious diseases， a comprehensive surveillance for diarrheal diseases has been innovated and explored in Shanghai since 2012. The surveillance has extensive distribution of sentinel hospitals， systematic sampling， multi-pathogen collection， and hospital information system （HIS） as the basis， which has achieved “One system for surveillance of multiple diseases and one sample for detection of multiple pathogens". Continual active surveillance for the whole population has been conducted， covering demography， clinical information， epidemiology， pathogen detection， and drug sensitivity test for diarrhea cases. The surveillance has obtained preliminary achievements as follows. First， diarrheal diseases and their periodic changes have been characterized， in which the most prevalent pathogen of diarrhea is determined to be norovirus in Shanghai. Second， some rare pathogens and serotypes have been identified that may provide clues to the sources of outbreaks. Third， it facilitates the information sharing between public health institutions and clinical institutions， and provides scientific evidence for clinical diagnosis and treatment. In the future， Shanghai diarrhea comprehensive surveillance will be improved for expanding range and depth of surveillance， artificial intelligence assisted diagnosis and treatment， early warning of outbreaks， prediction of epidemic trends， and application of new detection technologies.
ABSTRACT
Objective@#To understand the seasonality and etiological characteristics of infectious diarrhea in adults from Shanghai.@*Methods@#Adult patients with diarrhea who had visited the enteric disease clinics in 22 hospitals that carrying on the Diarrhea Comprehensive Surveillance sentinel programs in Shanghai during 2014-2017, were surveyed. Stool specimens were collected according to the different intervals of sampling and detected for 12 bacteria and 5 viruses. Concentration ratio and circular distribution method were used for data analysis.@*Results@#From 2014 to 2017, a total of 9 573 stool specimens were collected from the targeted diarrhea patients ≥18 years old (n=96 067), through the Shanghai Diarrhea Comprehensive Surveillance program. The positive rate of detection was 46.44%. Seasonal peaks of infectious diarrhea were both seen in summer (bacteria peak, diarrheagenic Escherichia coli and Vibrio parahaemolyticus, etc.) and in winter (virus peak, Norovirus, etc.). Both bacterial and viral infections presented seasonal concentration (Raleigh’s test P<0.001) but more obvious with bacterial infection. Viral infection accounted for 60.19% of the cause of infectious diarrhea. The top five predominant pathogens appeared as Norovirus, Rotavirus, diarrheagenic Escherichia coli, Vibrio parahaemolyticus, and Salmonella spp..@*Conclusions@#Among the adult outpatients with infectious diarrhea in Shanghai, obvious seasonality was seen, with peaks in both summer and winter. Viral infection with Norovirus in particular, appeared as the predominant source of infection. Active, continuous and comprehensive diarrhea-related surveillance programs would be able to monitor the changing dynamic of pathogen spectrum, and lead to the adoption of targeted preventive measures.
ABSTRACT
Objective@#To investigate the epidemiologic characteristics of Norovirus among adult patients suffering from infectious diarrhea in Shanghai, so as to provide evidence for developing related strategies on prevention and control of the disease.@*Methods@#Diarrheal outpatients were monitored at the 'Intestinal clinic’ from 22 hospitals involved in the sentinel surveillance program in Shanghai. Information on demographic and epidemiologic features of the patients was collected while data and clinical, fecal specimens were collected and sent to the district CDC for Norovirus detection. Positive rates of Norovirus were also compared in various populations and seasons during 2013-2018. Multivariate logistic regression model was adopted to fit into the comparisons between non-Norovirus and Norovirus groups.@*Results@#19.28% of the 12 083 diarrheal cases were found to have carried the Norovirus, with GⅡgroup the most commonly identified genotype. Rates of detection was seen higher in males (20.78%) than in females (17.73%). 30-44 year-old were found having the highest positive rate (21.51%). The positive rates were found the highest (23.60%) in the year of 2015. All the above shown differences were statistically significant (P<0.05). Diarrheal patients affected with Norovirus would present watery stool (75.94%) and vomiting (35.84%). Data from the multivariate logistic analysis showed that factors as: being males, 30-44 years old, officials/clerks, in winter season and with histories of travelling etc., were related to higher risks on Norovirus infection.@*Conclusions@#Infectious diarrhea caused by Norovirus occurred all year round, with seasonal peaks seen in winter and spring, in Shanghai. Specific prevention and control measures should be taken on Norovirus- caused infectious diarrhea, according to the difference on age, gender and season.
ABSTRACT
Objective@#To investigate the molecular characterization of adult diarrhea cases caused by enterotoxic Escherichia coli (ETEC) and explore the practical model of epidemiology for laboratory technique and data needs based on the surveillance network.@*Methods@#Epidemiological design and sampling targeted adult cases ETEC caused diarrhea in epidemic season. The enterotoxin type, serogroup, resistance, colonization factor and molecular type of ETEC were identified. Multiple dynamic phenotypic characteristics of ETEC were indicated by multidimensional and multivariable data.@*Results@#From 2016 to 2018, 84 eligible ETEC strains were detected. The dominant serums/toxins were O∶6 (STh), O∶25 (LT), O∶159 (STh), O∶153 (STh). O∶6 (STh+CS21), which replaced O∶25 and O∶159 as the popular clones in 2018. Six cases of O∶153 (STh+CFA/I+CS8+PT34) in outbreak in 2017 were imported ones. The resistance rates of ETEC strains detected in adults to sulfasoxazole, naproxinic acid, ampicillin and azithromycin were more than 30%, multidrug resistance (MDR) reached 58.3%. Serum/toxin types suggested that attenuated strains were more likely to become MDR. Molecular typing confirmed that the genetic similarity of the dominant clone of O∶6 serogroup (PT20-24) was higher than O∶25 and O∶159. There was a high correlation between the minimal inhibitory concentration (MIC) of azithromycin and the resistant gene mphA (87.5%, 28/32). O∶6 (STh+CS21+mphA) resistant clone was first detected in 2016.@*Conclusion@#A new epidemic clone in adult ETEC diarrhea cases in Shanghai was O∶6 (STh+CS21+mphA). For the first time the association between azithromycin resistance gene mphA and a serum group of ETEC was observed. Multidimensional and multivariate analysis techniques based on epidemiology can help reveal the potential transmission pattern of ETEC for the accurate surveillance and early warning of outbreaks.
ABSTRACT
Objective To introduce the establishment of Shanghai Diarrhea Comprehensive Surveillance System ,and to analyze the epidemiological and etiological characteristics of infectious diarrhea outpatients in Shanghai based on data of Shanghai Diarrhea Comprehensive Surveillance System .Methods Diarrhea patients were surveyed according to a unified designed questionnaire ,who visited one of 22 adult sentinel hospitals and 4 children sentinel hospitals of Shanghai Diarrhea Comprehensive Surveillance during September 2013 to August 2016 .Stool specimens were collected according to different sampling intervals and detected for 12 bacteria and 5 viruses .Characteristics of diarrhea patients were compared and analyzed .Chi-square test was used for statistical analysis .Results Of 4497 infectious diarrhea patients ,the detection rate of viral infection was 29 .77％ ,of which norovirus infection (16 .33％ ) , rotavirus infection (7 .90％ ) and sapovirus infection (1 .90％ ) were dominated . The detection rate of bacterial infection was 15 .38％ ,diarrheagenic E .coli (DEC) infection (5 .25％ ) ,V . parahaemolyticus infection (4 .27％ ) and Salmonella spp .infection (3 .13％ ) .Mixed infection accounted for 11 .07％ .The detection rate ,the infection types and the predominant pathogens in different age groups were statistically different (χ= 18 .11 ,61 .86 and 449 .52 ,respectively ,all P< 0 .01) .DEC ranked first in 3 - 14 years age group , and norovirus ranked first in all other age groups .The pathogen spectrum of infectious diarrhea patients≥ 15 years old showed obvious seasonal changes ,with mainly bacterial infection in summer (peaked in August ,accounting for 81 .56％ ) and mainly viral infection in winter (peaked in January ,accounting for 95 .27％ ) .Norovirus ranked first through the year ,except January ,June ,July and August .Among patients ≥ 15 years old , abdominal pain , fever and loose stools were main symptoms in bacterial infections .Vomiting and watery stool were main symptoms in viral infections . Loose stools appeared frequently in patients ≤ 14 years old .Conclusions Diarrhea Comprehensive Surveillance System based on scientific design and rational distribution is beneficial for understanding the epidemic trends and pathogen characteristics of diarrhea .Viral infections are predominant in infectious diarrhea patients in Shanghai . Norovirus and rotavirus are the most common diarrheal pathogens .The pathogen spectrum of infectious diarrhea patients shows obvious seasonal changes .DEC is common in diarrhea patients ≤ 14 years old . The clinical symptoms of infectious diarrhea caused by different pathogens are different . Targeted preventive measures should be taken for infectious diarrhea of different ages ,different pathogens ,and in different seasons .
ABSTRACT
Background:The evaluation system for predicting prognosis in patients with liver cirrhosis includes Child-Pugh,model for end-stage liver disease (MELD) and its derivative system,which provides important guiding value for evaluating the prognosis.However,its value still needs to be verified by further clinical studies.Aims:To investigate the predictive value of Child-Pugh,MELD,MELD-Na and iMELD score in assessing 3-month and 1-year survival rates in patients with hepatitis B cirrhosis.Methods:A total of 236 patients with hepatitis B cirrhosis from January 2012 to December 2016 at Fukang Hospital were enrolled.The 3-month and 1-year survival rates of patients with hepatitis B cirrhosis were determined,and Child-Pugh,MELD,MELD-Na and iMELD score were calculated.Area under ROC curve (AUC) was used to evaluate the accuracy of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 3-month and 1-year survival rates.Results:Of the 236 patients with hepatitis B cirrhosis,43 died within 3 months,and 71 died within 1 year.The causes of death were upper gastrointestinal bleeding,hepatic encephalopathy,hepatorenal syndrome,spontaneous peritonitis and infection.Child-Pugh,MELD,MELD-Na and iMELD score in 3-months and 1-year survival group were significantly decreased than those in death group (P ＜ 0.05 or 0.01).AUC of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 3-month survival were 0.791,0.818,0.853 and 0.897,respectively,and the difference among the four groups was significant (P ＜ 0.05).AUC of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 1-year survival were 0.772,0.832,0.861 and 0.906,respectively,and the difference among the four groups was significant (P ＜ 0.05).The accuracy of Child-Pugh,MELD,MELD-Na and iMELD score for predicting 3-month and 1-year survival were 70.1％,79.8％,86.2％ and 89.3％,respectively.Conclusions:The accuracy of Child-Pugh,MELD,MELD-Na and iMELD score for assessing 3-month and 1-year survival rates of patients with hepatitis B cirrhosis is high,and is worthy to be applied in clinical practice.
ABSTRACT
Objective@#To analyze the pathogen spectrum and epidemiological characters of infectious diarrhea cases in Shanghai from July 2013 to June 2015.@*Methods@#From July 2013 to June 2015, using multi-stage sampling to select 22 hospitals as adult diarrhea surveillance sentinels, and 3 district central hospitals together with Shanghai municipal children's hospital as children diarrhea surveillance sentinels. A total of 6 267 diarrhea cases were sampled. The demographic characters, main clinical manifestations and signs of cases were investigated, and stool specimens were collected to conduct the bacteria culture and virus nucleic acid detection. The difference of positive rate of bacteria and virus in different seasons, and age difference of relevant pathogens were compared.@*Results@#Among 6 267 cases, 3 262 (52.05%) were male, and most of them were in 50-69 years group (1 999 cases, 31.90%) and 30-49 years group (1 691 cases, 26.98%). Totally, 2 783 positive specimens were detected out of 6 267 specimens with the positive rate being 44.41%. A total of 7 kinds of bacteria and 5 kinds of viruses were detected. The positive rate for bacterium was 12.61%(790 cases), mainly being vibrio parahaemolyticus (256 cases), diarrheagenic E.coli (239 cases) and salmonella (209 cases). The positive rate for virus was 31.80% (1 993 cases), mainly being norovirus (1 172 cases) and rotavirus (546 cases). The positive rates of viruses in winter of 2013 and 2014 were 57.89%(429 cases) and 62.14%(522 cases) respectively, higher than those of bacterium in the same periods which were 2.43% (18 cases) and 2.86% (24 cases) respectively. The positive rates of bacterium in summer of 2013, 2014 and 2015 were 14.56% (97 cases), 25.29%(258 cases) and 21.21% (49 cases), also higher than those of viruses in the same periods which were 7.51% (50 cases), 8.43%(86 cases) and 11.69% (27 cases) respectively, all of the above differences were statistically significant (P<0.05). The cases of 50-69 years group had the highest positive rate of pathogen, which was 47.57% (951/1 999). Secondly was those of 30-49 years group with 47.13% (797/1 691). Positive rate of pathogen for cases of 0-2 years group was 35.74% (213/596).@*Conclusion@#The pathogen spectrumes of infectious diarrhea in Shanghai are mainly vibrio parahaemolyticus, diarrheagenic E.coli, salmonella, norovirus and rotavirus. The summer and winter season peak was obvious. Specific etiological surveillance and control strategies should be strengthened aiming at focus groups including children and the elderly in different seasons.
ABSTRACT
In recent years, there has been increasing recognition of the importance of psychosocial interventions' studies on quality of life in cancer survivors because of improving cancer survival rate. This paper was an integrative literatures review of various psychosocial interventions including cognitive behavioral therapy, group-based supportive therapy, counseling or psychotherapy, education or psychoeducation and music therapy et al, and analyzing the complexity of psychosocial interventions' RCTs in oncology and the current characteristic of these studies in China.
Subject(s)
Humans , China , Cognitive Behavioral Therapy , Counseling , Neoplasms , Psychotherapy , Quality of Life , SurvivorsABSTRACT
<p><b>OBJECTIVE</b>To investigate the associations between physical exercise and quality of life in breast cancer patients.</p><p><b>METHODS</b>A cross-sectional study was conducted among 3 344 community breast cancer patients between April and July 2013 in Shanghai, China. Data were collected using a questionnaire, including socio-demographic situation, cancer survival and health behaviors, and scores of EORTC QLQ-C30 Simplified Chinese version and FACT-G Simplified Chinese version.</p><p><b>RESULTS</b>Among a total of 3 344 breast cancer patients, the patients doing exercise reported significantly higher EORTC physical functioning scores, role functioning scores, emotional functioning scores, global health scores, and FACT-G physical well-being scores, social well-being scores, emotional well-being scores, functional well-being scores, and FACT-G total scores than the patients who didn't take exercise (P < 0.05, P(Adjusted)<0.05) . Breast cancer patients who did exercise more than or equal to 5 times/week reported significantly higher EORTC role functioning scores, cognitive functioning scores, emotional functioning scores, global health scores and FACT-G physical well-being scores, functional well-being scores, and FACT-G total scores than patients who did exercise less than 5 times/week (P < 0.05, P(Adjusted)<0.05 ).</p><p><b>CONCLUSIONS</b>There are active associations between physical exercise and quality of life in breast cancer patients. Engagement in physical exercise is beneficial to breast cancer patients with long-term survival.</p>
Subject(s)
Humans , Asian People , Breast Neoplasms , Epidemiology , China , Epidemiology , Cross-Sectional Studies , Exercise , Quality of Life , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To investigate the associations between vegetables and fruit intake and quality of life in breast cancer patients.</p><p><b>METHODS</b>A total of 3 344 community breast cancer patients were selected through cluster sampling method between April and July 2013, in Shanghai, China. Data were collected using a questionnaire, which included socio-demographic situation, cancer survival and health behaviors(i.e. vegetables or fruit intake, exercise), European Organization for Research and Treatment (EORTC) QLQ-C30 Simplified Chinese version(3rd edition) and Functional Assessment of Cancer Therapy scale (FACT-G) Simplified Chinese version(4th edition) were used to evaluate the quality of life. Crude quality of life scores were compared between groups. Multiple linear models were used to calculate and compare adjusted means of quality of life between groups, controlling relevant factors.</p><p><b>RESULTS</b>After adjusting relevant factors, breast cancer patients who ate more than 250 g vegetables reported higher EORTC physical functioning scores, cognitive functioning scores, emotional functioning scores, global health scores than patients who ate equal or less than 250 g vegetables(respectively (80.79 ± 0.85) vs (79.34 ± 0.82), (80.07 ± 1.03) vs (77.84 ± 0.99), (84.17 ± 0.95) vs (82.76 ± 0.92), (65.75 ± 1.50) vs (62.92 ± 1.45)), t values respectively were 2.76, 3.54, 2.40, 3.17, all P values were <0.05; and breast cancer patients who ate more than 250 g vegetables reported higher FACT-G social well-being scores, function well-being scores, FACT-G total scores than patients who ate equal or less than 250 g vegetables (respectively (17.92 ± 0.40) vs (17.31 ± 0.39), (14.86 ± 0.42) vs (14.34 ± 0.40), (74.78 ± 1.01) vs (73.05 ± 0.97)), t values respectively were 2.49, 2.05, 2.90, all P values were <0.05. After adjusting relevant factors, breast cancer patients who ate fruit everyday reported higher EORTC physical functioning scores, role functioning scores, cognitive functioning scores, emotional functioning scores, social functioning scores, global health scores than patients who didn't eat fruit everyday (respectively (80.40 ± 0.82) vs (79.22 ± 0.87), (89.81 ± 1.00) vs (88.06 ± 1.05), (79.78 ± 0.99) vs (77.11 ± 1.04), (84.43 ± 0.92) vs (81.56 ± 0.97), (77.95 ± 1.25) vs (75.56 ± 1.31), (65.48 ± 1.44) vs (61.74 ± 1.51)), t values respectively were 2.15, 2.64, 4.07, 4.71, 2.89, 4.02, all P values were <0.05; and breast cancer patients who ate fruit everyday reported higher FACT-G physical well-being scores, social well-being scores, emotional well-being scores, functional well-being scores, FACT-G total scores than patients who didn't eat fruit everyday(respectively (23.35 ± 0.26) vs (22.85 ± 0.28), (17.91 ± 0.39) vs (16.98 ± 0.41), (18.59 ± 0.22) vs (18.18 ± 0.23), (14.79 ± 0.40) vs (14.17 ± 0.42), (74.71 ± 0.97) vs (72.17 ± 1.02)), t values respectively were 2.92, 3.65, 2.91, 2.35, 4.05 , all P values were <0.05.</p><p><b>CONCLUSION</b>There are active associations between vegetables / fruit intake and quality of life in breast cancer patients. Proper diet may help improve quality of life in breast cancer patients.</p>