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ObjectiveTo analyze the clinical and epidemiological characteristics of confirmed cases of human monkeypox infection in Changning District， Shanghai， and to explore their clinical and epidemiological characteristics. MethodsClinical data from 10 reported cases of monkeypox in individuals residing in Changning District or identified by local medical institutions between July 20 and September 30， 2023， were collected. Epidemiological case investigations were conducted， and throat swabs， anal swabs， and rash swabs were collected by the treating medical institutions. Real-time fluorescence quantitative PCR was used for monkeypox virus nucleic acid testing， and descriptive epidemiological analysis was applied to analyze the epidemiological characteristics of the cases. ResultsAll 10 confirmed cases of human monkeypox infection were all young males with an average age of 35.4 years， all of whom belonged to the men who have sex with men （MSM） population， with no occupational clustering. The primary clinical symptoms included fever， rash， enlarged inguinal lymph nodes， and muscle soreness. Nine cases presented with a rash， and seven cases experienced fever symptoms. Among the 10 cases， one experienced fever， rash， enlarged lymph nodes， and muscle soreness； two had fever， rash， and enlarged lymph nodes； two had fever， rash， and systemic soreness； two had only a rash； one had fever or rash； and one was asymptomatic. Among the nine cases with a rash， the rash was mainly localized to the genital or anal area， with fewer cases presenting rashes on the limbs or trunk simultaneously. All cases reported a history of non-exclusive MSM behavior within 21 days before the onset of the disease. The interval between the last suspected high-risk exposure and the onset of symptoms was 4 to 10 days， with an average interval of 6.9 days. The time from the onset of fever to the appearance of a rash was 0 to 5 days， with an average of 1.87 days. ConclusionThe main clinical manifestations of human infection with monkeypox are fever， rash， and enlarged inguinal lymph nodes. The MSM population is a high-risk group for monkeypox infection， and its source of infection may be associated with MSM exposure. Early-stage symptoms are mild， leading to potential underdiagnosis. Additionally， patients may conceal information during the investigation process， which increases the difficulty of epidemic prevention and control.
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Objective: To analyze the secular trends of incidence and mortality of ovarian cancer in the Changning district of Shanghai, 1973-2013. Methods: Using the data from Shanghai Cancer Registry, the crude rates of incidence and mortality, and the age-standardized rates (ASRs) by Chinese standard population and Segi’s world standard population were calculated for ovarian cancer in the Changning district of Shanghai, 1973-2013. Joinpoint software was utilized to analyze the secular trends of incidence and mortality, as well as to calculate the annual percent changes (APCs) and average annual percent changes (AAPCs). Age-period-cohort model was performed to further investigate the contributions of age, period and cohort effects on the secular trends of incidence and mortality. Results: Total of 936 new incidence cases and 504 deaths in the Changning district of Shanghai were identified during 1973-2013. The crude incidence rate, age-standardized incidence rates by Chinese standard population and Segi’s world standard population were 8.72/105, 6.32/105 and 6.00/105, respectively. The crude mortality rate, age-standardized mortality rates by Chinese standard population and Segi’s world standard population were 4.70/105, 2.99/105 and 2.92/105, respectively. The crude incidence rate, age-standardized incidence rates by Chinese standard population and Segi’s world standard population of ovarian cancer showed steady rising trends during 1973-2013, by an average of 2.96%, 1.51% and 1.63% per year, respectively. The crude mortality rate increased by an average of 2.53% per year, but the secular trends of age-standardized mortality rates by Chinese standard population and Segi’s world standard population were not significant (both P > 0.05). Age-period-cohort analysis showed that both the incidence and mortality rates of ovarian cancer increased with age (both P 0.05). Conclusion: The crude incidence rate, age-standardized incidence rates by Chinese standard population and Segi’s world standard population, and crude mortality rate of ovarian cancer in the Changning district of Shanghai show steady rising trends during 1973-2013. The secular trends of age-standardized mortality rates by Chinese standard population and Segi’s world standard population are not significant. Both the incidence and mortality rates increased with age, suggesting the elderly women are key population for the prevention of ovarian cancer. ovarian cancer.
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Objective To evaluate the present family doctors staffing and service capacity building in Changning under the linkage reform of contracting service and health insurance payment . Methods The staffing data of family doctors were collected from the 2013-2015 annual reports ,while the data on their qualifications ,training ,job stress and competence were collected from two follow-up investigations. These data were analyzed with descriptive statistics .Results in 2016 ,the number of family doctors totaled 27000 ,up to 2.75 doctors per 10000 people.Over 97％ of the family doctors were qualification certificated.More than half of the family doctors participated in the standardized training .68.80％ (97/141)of the family doctors complained overwork.More than 80％ of the family doctors have encountered technical problems with medical services .Conclusions The number and quality of family doctors in Changning have been greatly improved to satisfy contracting services of the residents to a minimal extent. However ,more family doctors are needed ,as they still face much work stress. The family doctors call for standardized training ,better payroll and incentive mechanism ,better career development and coordinated support mechanism ,as well as better team building for greater performance .
ABSTRACT
Exploring the Chinese family doctor system is an important policy issue in the process of deepening the medical and health care system reform in China. Changning District is the first comprehensive reform pilot area of community health service in the country,and the first demonstration area to explore the family doctor system reform. Since 2008,Changning began to gradually explore the family doctor system, and it has accumulated a lot of experi-ences which can be copied and extended in signing services to improve the family doctor,the full establish a compre-hensive system of hierarchical diagnosis and treatment system,the formation of the reasonable medical order that first primary diagnosis,two-way referral,upper and lower linkage,acute and chronic treatment. The four articles of this topic are from a survey from 10th anniversary of the comprehensive reform of the family doctor system in Changning District,Respectively from the service model,government coordination,performance appraisal and continuing educa-tion,to demonstrate the effectiveness of the policy and practice of the comprehensive reform about family doctor sys-tem in Changning District. With the implementation of the family doctor service on-site promotion meeting, the Changning model of Chinese family doctor system will provide valuable experience to explore and deepen the reform of the family doctor system.
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Any reform needs to be converted into a series of institutional arrangements or micro behavior incen-tive mechanism,not only to ensure basic behavioral strategies of incentive compatibility between actors are motivated, but also to ensure that the behavior mode of grass-roots actors and policy direction are consistent. From the practice of community health reform of Changning District of Shanghai,it has generally gone through four stages:standardization construction and organization establishment,service model and mechanism reform, incentive mechanism design and connotation construction,platform build and performance improvement. Changning medical reform in the continuous deepening of policy trials and solve all kinds of new problems in the new medical reform policy implementation gener-ated by the process of policy and system innovation in the test(such as doctors weakened incentive problems after two lines of revenue and expenditure) and its compatibility with the environment problem. In order to realize the system of health care policy and provide stable behavioral expectations for the stakeholders to improve the welfare of stake-holders thereby continuously reducing the potential resistance to the implementation of the policy of grass-roots actors, and gradually guide the behavior of various actors to guide the direction consistent with the policy objectives