Improvement of China's legal system for public health emergency management from the perspective of lifecycle management / 中华流行病学杂志

A crucial lesson gained through the pandemic preparedness and response to COVID-19 is that all measures for epidemic control must be law-based. The legal system is related not only to public health emergency management per se but also to all aspects of the institutional supporting system throughout the lifecycle. Based on the lifecycle emergency management model, this article analyses the problems of the current legal system and the potential solutions. It is suggested that the lifecycle emergency management model shall be followed to establish a more comprehensive public health legal system and to gather the intelligence and consensus of experts with different expertise, including epidemiologists, sociologists, economists, jurist and others, which will collaboratively promote the science-based legislation in the field of epidemic preparedness and response for the establishment of a comprehensive legal system for public health emergency management and with Chinese characteristics.

Possible association of ACE gene I/D polymorphism with blood pressure--lowering response to hydrochlorothiazide / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To explore the association between polymorphism in the ACE I/D gene and blood pressure-lowering response to hydrochlorothiazide (HCTZ) in 829 patients.</p><p><b>METHODS</b>HCTZ 12.5 mg was taken once a day for six weeks. The blood pressure reduction and ratio reaching target blood pressure were compared in different ACE genotype groups.</p><p><b>RESULTS</b>The reduction in SBP of patients carrying DD was greater than that in other groups carrying II or ID (12.2 mmHg versus 5.4 mmHg, 12.2 mmHg versus 4.4 mmHg, respectively, P<0.05). The reduction in MAP of patients carrying DD was also greater than that in other groups carrying II or ID (6.9 mmHg versus 3.9 mmHg, 6.9 mmHg versus 3.6 mmHg, respectively, P<0.05). The ratio reaching target blood pressure in DD groups was significantly higher than that in II or ID groups (P<0.05). The pre-treatment SBP, DD genotype, aldosterone levels entered the multi-linear regression model significantly and might affect the reduction of SBP. The pre-treatment DBP, aldosterone levels, DD genotype entered the multi-linear regression model significantly and might affect the reduction of DBP. The pre-treatment MAP, DD genotype, aldosterone levels entered the multi-linear regression model significantly and might affect the reduction of MAP.</p><p><b>CONCLUSION</b>ACE genotyping is associated with blood pressure-lowering response to HCTZ. Specific genotypes might be associated with the response to specific antihypertensive treatment.</p>

Related factors on quality of life in 291 outpatient adults with epilepsy / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess and explore the quality of life and related factors among 291 outpatient adults with epilepsy.</p><p><b>METHODS</b>From July, 2005 to July, 2006, eligible outpatient epilepsy in a hospital was evaluated by the scale on quality of life in epilepsy-31 (Chinese version).</p><p><b>RESULTS</b>The total scores of quality of life was low (56.46 +/- 16.58). The scores of quality of life in each item were as follows: seizure worry (45.01 +/- 25.25); overall quality of life (56. 12 +/- 16.37); emotional well-being (59.35 +/- 19.56); cognitive function (58.58 +/- 22.41); energy/fatigue (59.12 +/- 18.98); medication effects (40.45 +/- 24.44) and social function (53.00 +/- 26.36). The quality of life of patients with different education background, drug intake and side effects was different significantly (P < 0.05). Data on Multi-linear regression showed that education background, side effects would affect the quality of life.</p><p><b>CONCLUSION</b>The quality of life of outpatient adults with epilepsy was low with education background, while side effects and drugs intake might serve as important factors affecting the quality of life with epilepsy.</p>

Risk factors for SARS-related deaths in 2003, Beijing / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the potential risk factors for severe acute respiratory syndromes (SARS)-related deaths in Beijing.</p><p><b>METHODS</b>Epidemiological data were collected among the confirmed SARS patients officially reported by Beijing Centers for Disease Control and Prevention (BCDC), and information was also supplemented by a follow-up case survey. Chi-square test and multivariate stepwise logistic regression analysis were performed.</p><p><b>RESULTS</b>Old age (over 60 years) was found to be significantly associated with SARS-related deaths in the univariate analysis. Also, history of contacting SARS patients within 2 weeks prior to the onset of illness, health occupation, and inferior hospital ranking as well as longer interval of clinic consulting (longer than 1 day) were the risk factors for SARS-related deaths. Multivariate stepwise logistic regression analysis found four risk factors for SARS-related deaths.</p><p><b>CONCLUSION</b>Old age (over 60 years) is the major risk factor for SARS-related deaths. Moreover, hospital health workers, the designated hospitals for SARS clinical services and the interval of consulting doctors (less than 1 day) are protective factors for surviving from SARS.</p>

Severe acute respiratory syndrome--retrospect and lessons of 2004 outbreak in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To summarize lessons learned from an outbreak of severe acute respiratory syndrome (SARS) in China during the spring of 2004.</p><p><b>METHODS</b>Data of SARS cases were officially reported by Beijing Municipal Center for Disease Control and Prevention (BCDC) and Anhui Provincial Center for Disease Control and Prevention (APCDC) and results of epidemiological investigations were collected and analyzed.</p><p><b>RESULTS</b>Three generations of 11 cases of SARS were identified during the outbreak. Initial two cases were most likely to be infected in Diarrhea Virus Laboratory of National Institute of Virology, China Centers for Disease Control and Prevention and main mode of transmission was direct contact with SARS patients. Delay in detecting initial case resulted in spread of the illness at hospitals and communities with two generations of secondary cases.</p><p><b>CONCLUSIONS</b>SARS outbreak in 2004 has yielded following lessons for public health globally. (1) Lab bio-safety programs should be made and should be strictly abided by. Studies in highly pathogenic viruses such as SARS coronavirus should be utmost cautious. (2) Management systems of occupational exposure to virus and disease surveillance need to be strengthened to take all risk factors into account so as to detect potential patients with infectious disease as early as possible.</p>

Altered systemic iron metabolism in welders exposed to manganese / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the systemic changes of iron metabolism following manganese exposure.</p><p><b>METHODS</b>Ninety-seven welders and 91 workers with no history of exposure to manganese were recruited from the same factory in Beijing serving as the exposure group and the control group respectively. The welding rods used were type J422. The concentration of the manganese in the air of the work place was determined respectively with the national standard method. The serum iron and manganese, ferritin, transferrin and transferrin receptors were measured with the graphite furnace atomic absorption spectrophotometry and ELISA in both groups.</p><p><b>RESULTS</b>The permissible concentration-STEL of ambient Mn in welders' breathing zone ranged from 0.53 mg/m(3) to 2.19 mg/m(3), while the permissible concentration-TWA of ambient Mn was between 0.29 mg/m(3) and 0.92 mg/m(3) in the breathing zone of the workplace. Serum Mn and Fe concentrations in welders were about 1.40 times (P < 0.0l) and 1.2 times (P < 0.01), respectively, higher than those of control subjects. At the same time, the transferrin concentrations in serum were significantly higher (about 1.2 times, P < 0.05) in welders than in controls. In contrast, transferrin receptors were significantly lower (about 1.2 times) in exposed subjects than controls (P = 0.001). There was no difference in serum ferritin between the two groups (P = 0.112). Although there was no significant trend, the serum ferritin level was increased by 18% in comparison with that of the control. The abnormal percentage of serum Fe and Serum Mn in welders were 55.67% and 67.01% respectively, higher than those of control subjects. In addition, the correlations between all indicators and the duration of employment were not observed.</p><p><b>CONCLUSION</b>The long term exposure to the manganese can induce the disorder of the iron metabolism, which is found in the expression of increase of the serum iron and transferrin as well as the decrease of transferrin receptors.</p>

Case fatality rate of severe acute respiratory syndromes in Beijing / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To describe the case fatality rate of SARS in Beijing.</p><p><b>METHODS</b>Data of SARS cases notified from Beijing Center for Disease Control and Prevention (BCDC) and supplemented by other channels were collected. The data were analyzed by rate calculation.</p><p><b>RESULTS</b>The case fatality rate of SARS in Beijing was 7.66%, and had an ascending trend while the age of cases was getting older, and a descending trend while the epidemic development. The case fatality rate in Beijing was lower than that in other main epidemic countries or regions.</p><p><b>CONCLUSIONS</b>The risk of death increases with the increment of age of SARS patients. Beijing is successful in controlling and treating SARS.</p>

Epidemiological features of severe acute respiratory syndrome in Beijing urban and suburb areas in 2003 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To describe the epidemiologic features of an outbreak of severe acute respiratory syndrome (SARS) in urban and suburb areas in Beijing and to explore their differences between these two areas.</p><p><b>METHODS</b>Data of SARS cases were collected from daily notification of China Ministry of Health and a database of infectious diseases was established by the Beijing Municipal Center for Disease Prevention and Control (BCDC). All the data were put into dataset files by Microsoft Excel-2000 and analyzed with SPSS version 10.0 software.</p><p><b>RESULTS</b>The respective urban incidence and mortality rate were 29.06 and 2.21 per 100,000, while the case fatality rate was 7.62%. In contrast, the respective suburb incidence and mortality rate were 10.61 and 0.78 per 100,000, and the case fatality rate was 7.32%. No significant differences were found in demographic characteristics between the urban and suburb areas.</p><p><b>CONCLUSION</b>Beijing urban area suffered a more serious SARS epidemic than the suburb area in 2003.</p>

Specific features of the contact history of probable cases of severe acute respiratory syndrome / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To describe the specific features of the contact history of probable cases of severe acute respiratory syndrome (SARS) in Beijing.</p><p><b>METHODS</b>Data of SARS cases notified from the Beijing Municipal Center for Disease Control and Prevention (BCDC) and supplemented by other channels were collected. All the data were analyzed by descriptive epidemiology.</p><p><b>RESULTS</b>(1) The number of probable cases with contact history was significantly higher than the excluded cases. (2) The proportion of probable cases with contact history descended with epidemic development, but this situation did not occur in health care workers (HCWs). (3) The fatality rate of probable cases with contact history was significantly higher than the cases without contact history (OR = 1.489). (4) The proportion of probable cases with contact history was 85.86% among health care workers, which was significantly higher than that of non-health care workers (85.86% v.s. 56.44%, OR=4.69).</p><p><b>CONCLUSIONS</b>(1) The susceptible persons with contact history may not get infected, and the contact history is just a sufficient condition of infecting SARS; (2) There are 3 conceivable reasons for the descending trend of the proportion in probable cases with contact history; (3) The contact history is one of the risk factors of the death of SARS cases; (4) The risk of contacting with SARS among health care workers is approximately 5 times higher than that of non-HCWs.</p>

Assessment of impacts of public health interventions on the SARS epidemic in Beijing in terms of the intervals between its symptom onset, hospital admission, and notification / 生物医学与环境科学（英文）

<p><b>OBJECTIVES</b>To assess the impacts of public health interventions on the outbreak of SARS in Beijing by analyzing the intervals between symptom onset, hospital admission and notification of its cases.</p><p><b>METHODS</b>Data of SARS cases reported from the Beijing Municipal Centers for Disease Prevention and Control (BCDC) were collected and analyzed by descriptive epidemiology.</p><p><b>RESULTS</b>In the early epidemic period, the intervals between the disease onset and the hospital admission seemed irregular, so was the intervals between the hospital admission and the notification. After the middle ten days of April, the intervals turned out to be more regular, and the disordered situation in terms of the hospital admission and the case notification was gradually brought under control.</p><p><b>CONCLUSIONS</b>Public health interventions against SARS has revealed positive impacts on SARS control program in Beijing. The timing and sensitivity of epidemic information reporting systems has been greatly improved in Beijing as a result of successful fight against this disease.</p>

Analysis on 2071 cases excluded from severe acute respiratory syndrome in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the characteristics of cases excluded from severe acute respiratory syndrome (SARS) and the reasons for exclusion.</p><p><b>METHODS</b>2071 probable or suspected cases excluded from SARS between March and June, 2003 were analyzed.</p><p><b>RESULTS</b>Two-thirds of the excluded cases were males. Construction workers, students and retired people ranked top three in all the occupation categories. Three peaks appeared in the dates of exclusion, and the most obvious one was from June 7 to June 13. There were two peaks in the distribution of time period from onset to exclusion, one was six to ten days and the other was forty-eight to fifty-two days after onset. Patients with history of close contact were more likely to be excluded within fifty days after onset than those without close history of contact. Pneumonia, common cold and lung infection were the leading causes for correction in the 1211 excluded cases.</p><p><b>CONCLUSION</b>Study on the diagnosis and differential diagnosis should be emphasized.</p>

Epidemiological features of severe acute respiratory syndrome in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the epidemiologic features of severe acute respiratory syndrome (SARS) in Beijing.</p><p><b>METHOD</b>Database of the 2 521 probable cases of SARS in Beijing Center for Disease Prevention and Control was used.</p><p><b>RESULTS</b>The course of SARS epidemic in Beijing could be divided into five phases: import and spreading-from 1 to 31 in March, rising-from April 1 to April 15, peak-from April 16 to May 4, declining-from 5 to 18 in May, terminating-from 19 to 28 in May. The proportions of portable cases of SARS in each phase were 2.7%, 13.6%, 71.0%, 11.6% and 1.1%, respectively. Totally, 2 521 portable cases were diagnosed and verified according to the diagnostic criteria of SARS issued by the Ministry of Health. Among them, 192 died from SARS. The incidence and mortality rates of SARS were 18.57 per 100,000 and 1.41 per 100,000 with the fatality of 7.6%. The ratio of male to female with SARS was 1:0.97. The highest incidence rate of SARS was in the group of 20 - 29 years (30.85 per 100,000), and the lowest was in the group of 0 - 14 years (2.54 per 100,000). People aged 20 - 49 accounted for 72.3% of all SARS cases. The incidence rates in urban, suburb and far-suburb were 32.25/100,000, 20.57/100,000 and 8.90/100,000, respectively, decreasing according to the population density. Health care providers (17.3%), staff (12.9%), retirees (11.4%), workers (9.7%) and house-hold unemployees (8.8%) appeared to be at the five top risk populations being infected. The fatality increased significantly with age.</p><p><b>CONCLUSION</b>Beijing was the most severe epidemic region of SARS in the world, but the fatality was the lowest.</p>

Epidemiological characteristics of an outbreak of severe acute respiratory syndrome in Dongcheng District of Beijing from March to May 2003 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To describe epidemiologic features of an outbreak of severe acute respiratory syndrome (SARS) in Dongcheng District, Beijing occurred in a period between March and May 2003.</p><p><b>METHODS</b>Data of SARS cases notified from Dongcheng District Center for Disease Control and Prevention(CDC)and supplemented by other channels were collected. Clinicians and officials of local hospitals were interviewed in groups and medical records of fatal cases of SARS were reviewed to verify the diagnosis. Stored serum specimens of the patients were detected for IgG antibody against SARS Co-V by enzyme-linked immunosorbent assay (ELISA). All the data were input into dataset files by Microsoft Excel-2000 software and analyzed with SPSS version 10.0 software.</p><p><b>RESULTS</b>Outbreak of SARS in Dongcheng District started on March 14, 2003 with a peak in mid- and late April, and dropped in early May. A total of 572 reported cases were collected during this period in Dongcheng District, Beijing, and 99 of them were excluded from SARS, because of diagnosis of common cold, regular pneumonia, measles and rubella, etc. Actually, 473 SARS cases, which included 390 (82.5%) probable cases and 83 (17.5%) suspect cases, were analyzed. About 90% of the probable cases were positive for IgG antibody. Attack rate of SARS in permanent residents of Dongcheng District was 28.3 per 100 000. Forty-one of them died, with a case-fatality rate of 8.7%. Persons were all susceptible to infection of SARS Co-V, with the highest proportion at ages of 20-50 years, which accounted for 68.7% of the total cases. Average age of the patients at their onset was 40.7 years. No gender difference in SARS cases was found. Number of SARS cases in health-care workers (HCWs) accounted for 18.0% and that in retired workers accounted for 15.4% of the total cases. Cases occurred in all 10 sub-districts of Dongcheng, with the highest in Beixinqiao and Andingmen Sub-districts. Totally, 230 of the 572 notified cases (40.2%) were hospitalized at local hospitals under the jurisdiction of Dongcheng District. Eighteen of 85 cases of SARS occurred in HCWs of local hospitals, accounting for 4.5% of the total number of HCWs working at wards caring for SARS patients or fever clinics. There were 34.7% of SARS cases without any histories of contact before the onset of the disease. Familial aggregation phenomena were observed in 41.8% of the cases and 18.1% of households. And 7.4% (attack rate) of those exposed to SARS cases suffered from the illness during the periods of quarantine.</p><p><b>CONCLUSIONS</b>SARS appeared to be infectious in origin and caused outbreak in Dongcheng District, Beijing introduced by an imported case traveling from Hong Kong in a period between March and May 2003. People are all susceptible to infection of SARS Co-V, which mainly threatens the young adults and the middle-aged, as well as HCWs and the retired workers. The main mode of transmission is direct exposure to SARS patients in a near distance at hospitals or families via droplets spread. Prevention and control of SARS should be focused on early isolation of patients and quarantine for close contacts. Current available measures to prevent and control SARS are proved to be effective.</p>

Studies on direct and indirect economic burden of disease and related factor in countryside of Qingdao city in 2001 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the condition of economic burden of disease in the countryside and to explore the related factors.</p><p><b>METHODS</b>Human capital method and two-step method were used in the calculation of economic burden of disease.</p><p><b>RESULTS</b>The total economic burden of disease among 3359 persons was 3072 225 Yuan. Noncommunicable conditions were accounted for 62.95%, while communicable disease, maternal and perinatal conditions accounted for 24.25%, and injury accounted for 9.83% respectively. The direct economic burden of disease was 1,559,619 Yuan and the indirect economic burden of disease was 1,472,606 Yuan. The economic burden of disease for each person was 914 Yuan. The equal burden of disease among patients with disability and without disability were 3070 Yuan and 680 Yuan respectively (P < 0.001). There was significant difference among different age groups. The influencing factors were found to include having noncommunicable disease, age, disability and the condition of marriage.</p><p><b>CONCLUSION</b>Corresponding policy to cope with conditions of different age groups needs to be developed to reduce the economic burden of disease in the countryside.</p>