Developing a development index system of Shanghai district-level disease prevention and control institutions using the Delphi method / 上海预防医学

ObjectiveTo construct an evaluation index system for the development of district-level disease prevention and control centers according to the requirements of the modernization of Shanghai’s disease control system and public health work practices， and to comprehensively assess the construction and development of district-level disease prevention and control institutions. MethodsAccording to the national and municipal requirements for the development of disease prevention and control institutions， an index framework was proposed through literature search and expert interviews. 39 representative experts in the field of public health at the national， provincial， and municipal （district） levels were selected to participate in the consultation and construction of the index system. The authority coefficient， the coefficient of variation， etc. were used to carry out quality control and determination of each index on the Delphi method. ResultsThe questionnaire response rate was 100%， the expert authority coefficient was 0.86，the degree of familiarity was 0.79， and the judgment basis was 0.92. The coefficients of variation of the necessary indicators in the index system were all <0.25 in the dimension of importance， and there were statistical differences in the statistical test of Kendall’s W coordination coefficients at all levels and dimensions （all P<0.001）. After multiple rounds of consultation， experts reached a consensus， forming a development evaluation index system of district-level CDCs with 6 first-level indicators， 24 second-level indicators， and 105 third-level indicators （including 63 necessary indicators and 42 recommended indicators）. ConclusionThe evaluation index system of Shanghai district-level CDCs based on the Delphi method has good authority， reliability， sensitivity and operability. This indicator system can effectively support the development of Shanghai district-level CDCs， and can be used for evaluation at multiple levels and in an all-round way in the future. The evaluation results can provide an evidence-based basis for the modernization of the disease prevention and control system and the continuous and dynamic updating of the development goals in the future.

Construction and strategies of disease prevention and control system in the new era in Shanghai / 上海预防医学

After the epidemic of novel Coronavirus Disease 2019(COVID-19), construction of disease prevention and control has become a top priority. As a pioneer in the recovery of global economy and society, Shanghai should play a fundamental role in building a comprehensive system of public health and advanced disease prevention and control in the new era. In this article, we systematically categorize the requirements for the construction of disease prevention and control system in the new era, identify the weakness and challenges during and after the epidemic, and then make suggestions. It is proposed that we should utilize the important window period of the"14th Five-Year Plan", with the"Healthy China"strategy and municipal"20 Tasks for Public Health Construction"as the starting point, to make substantial contribution to the functional orientation, investment of resources, capacity building, operational mechanism and team building, which may provide scientific evidence for the reform and development of disease prevention and control system.

Study on the construction of general index system of talent construction project in Shanghai Health System / 中华医学科研管理杂志

Objective To formulate the evaluation criteria for micro-appraisal of comprehensive talents and macro-evaluation of projects.Methods A total of 425 articles were included in the meta-analysis of literature review;Delphi's panel that involved 20 experts,2 rounds of questionnaire surveys were conducted to construct indicators for comprehensive evaluation of talent construction projects;AHP was used to calculate the index weight coefficients for each category of indicators.Results The talent construction project evaluation system includes two sub-systems:micro-evaluation of talents and macro-evaluation of projects.Among them,the talent micro-evaluation system,which includes 12 evaluation indicators,carries out assessments in terms of basic qualities,academic accomplishments,and research achievements.the macro-evaluation system of the project,include a total of 15 evaluation indicators,is mainly assessed from the macro level of project operations-project structure,project process,project results.Conclusions From the perspective of the combination of micro (human resources) and macro (projects),to build a universal index for comprehensive evaluation of talent construction projects,both for the evaluation of the project,but also to conduct a comprehensive evaluation of the training object.

Effect of Serum Free Light Chain on Renal Function and Prognosis in Patients with Newly Diagnosed Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To analyze the effect of serum free light chain (sFLC) on renal function and prognosis in patients with newly diagnosed multiple myeloma (MM).@*METHODS@#The clinical data of 70 newly diagnosed MM patients who received sFLC examination in Fujian Medical University Union Hospital were retrospectively analyzed from April 2012 to November 2016. Univariate analysis was used to analyze the risk factors that associated with renal impairment (RI) and prognosis. Logistic regression and Kaplan-Meier analyze were used to analyze the roles of sFLC in RI and the prognosis.@*RESULTS@#Out of the 70 patients, 20 patients had RI at the initial diagnosis. Compared to normal renal function group, RI group had lower level of hemoglobin, elevated levels of serum uric acid, corrected calcium, serum creatinine, serum β2 microglobulin, and involved sFLC, higher proportion of patients with ISS stage III, involved sFLC≥500 mg/L, hemodialysis (all P＜0.05). Multivariate logistic regression analysis showed that serum uric acid≥430 μmol/L, ISS stage III and a involved sFLC≥500 mg/L were all the independent risk factors for RI in patients with newly diagnosed MM patients (all P＜0.05). Receiver operating characteristic (ROC) curves analysis showed that the involved sFLC was 705.0 mg/L, which was a best cut-off value area under curve (AUC) for prediting RI in patients with MM was 0.727 (P=0.003), sensitivity was 65.0% and specificity was 82.0%). After a median follow-up period of 31 (1-84) months, the median overall survival (OS) of patients with involved sFLC≥500mg/L and involved sFLC＜500 mg/L were 52.0 and 27.0 months, respectively, there was no statistically significant difference (P=0.137). There was also no statistically significant difference in median OS between the high sFLC ratio group (κ/λ＞32 or ＜0.03) and the low sFLC ratio group (0.03≤κ/λ≤32) (27 months vs 40 months, P=0.436).@*CONCLUSION@#The involved sFLC in the RI group is significantly higher than that in the normal renal function group in newly diagnosed MM patients. Serum uric acid≥430 μmol/L, ISS stage III and involved sFLC≥500 mg/L are the independent risk factors for RI. Monitoring sFLC in newly diagnosed MM patients is helpful to the prediction of RI, and the involved sFLC level or sFLC ratio may not affect the prognosis of newly diagnosed MM patients.

Correlation of resistance to peer pressure and risky decision-making with adolescent health risk behaviors / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore possible interrelationships among resistance to peer pressure, risky decision-making and health risk behaviors among young adolescents.</p><p><b>METHODS</b>Based on the cluster sampling method, the participants who were recruited from 5 junior middle schools in Guangzhou and 3 junior middle schools in Shenyang city on October, 2010, were administered to complete the questionnaire concerned with their experiences with drinking and smoking during the past 30 days preceding the survey, and the hours using computer daily both in weekdays and in weekend. The level of resistance to peer influence and risky decision-making were assessed by Resistance to peer influence scale (RPIS) and Youth decision-making questionnaire (YDMQ). Logistic regression was used to explore possible interrelationships among resistance to peer influence, risky decision-making and health risk behaviors among young adolescents.</p><p><b>RESULTS</b>A total of 1985 questionnaires were valid, including 1001(50.4%) boys and 984 (49.6%) girls. About 27.1% (537/1985) junior middle school students reported having health risk behaviors, boys' (30.7%, 307/1001) was higher than girls' (23.4%, 230/984) with significant gender difference (P < 0.05). The prevalence of smoking, drinking during the past 30 days before the survey and using computer over 3 hours daily in weekdays and in weekend were 5.1% (102/1985), 14.3% (284/1985), 3.5% (70/1985) and 13.7% (272/1985), respectively. The rate of drinking, using computer over 3 hours daily in weekdays and in weekend were higher in males (16.4% (164/1001), 4.5% (45/1001), 16.2% (162/1001)) than those in females (12.2% (120/984), 2.5% (25/984), 11.2% (110/984)) (P < 0.05). The scores of RPIS and YDMQ of the two cities adolescents were 2.82 ± 0.39 and 1.68 ± 0.62. The students reported smoking, drinking during the past 30 days before the survey and using computer over 3 hours daily in weekend gained lower RPIS scores (2.43 ± 0.40, 2.61 ± 0.41, 2.77 ± 0.40) than their counterparts who didn't report these kind of health risk behaviors (2.84 ± 0.38, 2.85 ± 0.38, 2.82 ± 0.39)(P < 0.05). And those reported smoking, drinking during the past 30 days before the survey and using computer over 3 hours daily in weekdays and in weekend gained higher YDMQ scores (2.38 ± 0.66, 2.06 ± 0.66, 1.97 ± 0.72, 1.84 ± 0.64, respectively) than their counterparts who didn't report these kind of health risk behaviors (1.64 ± 0.38, 1.61 ± 0.58, 1.67 ± 0.61, 1.65 ± 0.61, respectively) (P < 0.05). After adjusting gender, area, parental education degree, self-reported family economic condition, multi-variant logistic regression analysis indicated that the low and middle level of resistance to peer influence (low and middle level vs high level, had odds ratios of 2.97 (1.96 - 4.50) and 1.51 (1.05 - 2.16)), and also the middle and high level of risky decision-making (middle and high level vs low level, had odds ratios of 1.62 (1.19 - 2.22) and 3.43 (2.39 - 4.90)) were all the risk factors of adolescent health risk behaviors.</p><p><b>CONCLUSION</b>Adolescents with poor ability of resistance to peer pressure and high risky decision-making were both the risk factors of adolescent health risk behaviors.</p>

Psychopathological sub-healthy status as predictor on self-or unintentional injuries among Chinese adolescents: a school-based follow-up study / 中华流行病学杂志

Objective To investigate the association between psychological sub-healthy status and risks on injuries and related predictors among adolescents in China,in order to develop reasonable intervention programs.Methods Adolescents were selected from middle schools and colleges in eight cities.Baseline status on sub-healthy that related to psycho-pathology was measured using the Multidimensional Sub-health Questionnaire of Adolescents (MSQA).Data on Self- or unintentional injuries were collected using a standardized injury surveillance questionnaire every 3 months,for three times (T0,T1,T2 and T3).Results A total of 12 113 students completed the study.Prevalence rates related to self-injury among boys and girls were 19.4％ and 19.9％,respectively.The rates of having more than 4 types of self-injuries in boys and girls were 4.7％ and 4.2％,respectively.Boys had a significantly higher unintentional injury rate than that of girls (62.2％ vs.57.3％ ).The differences in the rates of having more than 4 types of unintentional injury between boys (3.8％) and girls (3.4％) were also statistically significant.Rates on self- and unintentional-injuries increased in T1,T2 and T3 when the psychological symptoms had an increase.Data from Multiple regression analysis demonstrated that the baseline psychological sub-healthy status was a predictive factor for higher risk of self- and unintentional- injuries at each of the follow-up waves.Conclusion Sub-healthy status of psycho-pathology was associated with an increased risk on self-and unintentional injuries among adolescents.Integrative psycho-pathological and behavioralintervention programs might help in reducing the risk of injuries among the Chinese adolescents.

Association between body mass index and physical fitness index among children and adolescents / 中华流行病学杂志

Objective To explore the relationship between body mass index (BMI) and physical fitness index (PFI) among children and adolescents.Methods The study sample included 8941 students aged 7 to 18 years in Anhui who attended the Physical Fitness and Health Surveillance program of Chinese School Students,in 2010.Within each sex- and age-specific group,students were classified into five BMI categories which were:very low,BMI ＜5th percentile; low,BMI ≥5th but ＜15th percentiles; normal,BMI ≥15th but ＜85th percentiles; high,BMI ≥85th but ＜95th percentiles; and very high,BMI ≥95th percentiles.Z-scores based on urban-rural,sex- and age-specific means and standard deviations were calculated,and the sum of Z-scores for the fitness tests was used as a PFI.Differences in PFI between BMI categories were compared with ANOVA.Sex- and grade-specific regressions of PFI on BMI were done by using a linear model.Results For 8941 students,the PFIs on very low,low,normal,high and very high group were-1.77,-0.91,0.32,-0.17 and -0.54,respectively,and showed an inverted U shape.The normal BMI group students presented the highest PFI.Data from Linear regression analysis revealed that PFI was significantly positively correlated with BMI,while negatively associated with BMI square,which indicated that PFI was the quadratic function of BMI.When BMI was increasing,PFI showed a parabolic curvilinear.Conclusion Relationships between BMI and PFI were parabolic curvilinear among the children and adolescents aged 7 to 18 in Anhui province.

Association between self-assessed somatotypes and symptom depression among children and adolescents / 中华流行病学杂志

Objective To examine the association between self-assessed somatotypes and depression related symptoms.Methods The study sample included 5555 students aged 9 to 18 years who had attended the Physical Fitness and Health Surveillance of Chinese School Students(2010)in Chizhou city,Anhui province.Association between self-assessed somatotypes,body mass index(BMI)and depression symptom were examined.Results There was a slight consistency between self-assessed somatotypes and BMI in both boys and girls(Kappa=0.217,P=0.000; Kappa=0.203,P=0.000).Significant difference in the prevalence of depression was found among weight misperception groups in both genders(x2=145.223,P=0.000).The prevalence of umderestimation of somatotypes was significantly higher in boys than in girls,while the result was reversive on the prevalence of overestimation.Additionally,the prevalence of depression was higher in girls than in boys(x2=5.199,P=0.023).Through logistic regression,data showed that self-assessed somatotypes and miscalculated groups were significantly associated with depressive symptoms.Compared to the group that self-assessment as being normal,those students when self-assessed as being slim,overweight or obesity were more likely to be depressive,with odds ratio(ORs)as 1.255(95％CI:1.066-1.478),1.538(95％CI:1.275-1.856)and 1.713(95％ CI:1.035-2.834),respectively.Overestimated and underestimated somatotypes appeared to be risk factors causing symptoms of depression(OR=1.705,95％CI:1.382-2.105; OR=1.241,95％CI:1.059-1.454).Conclusion Slight consistency was found between self-assessed somatotypes and BMI,while the misjudged somatotypes were the risk factor related to depressive symptoms.It was suggested that life skills education should be carried out as preventive intervention approach,to improve the physical and mental health well-being of children and adolescents.

Comparison of Cellular Immunity Raised by a Novel Adjuvant DC-Chol with Different HBsAg Preparations / 中国生物工程杂志

Objective: To screen candidate antigen for therapeutic HBV vaccine with a novel adjuvant DC-Chol. Methods: BALB/c mice were injected with DC-Chol liposome and HBsAg prepared from CHO and Yeast respectively. One week later, IL-4, IL-2, IFN-?were measured by ELISA or ELISPOT. Results: The levels of IL-2, IFN-?of HBsAg from Yeast with DC-Chol liposome were 20 and 119 times higher respectively than those of HBsAg from CHO with DC-Chol liposome. ELISPOT assay showed that the counts of spot-forming cells of IL-4 and IFN-?of HBsAg from Yeast with DC-Chol liposome were 2.8 and 46.3 times higher respectively than those of HBsAg from Yeast with Al(OH)3. Conclusion: HBsAg prepared from Yeast together with DC-Chol liposome may be an appropriate candidate for therapeutic HBV vaccine .

Relationships between thiopurine methyltransferase gene polymorphisms and its enzymatic activity / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the relationship between the thiopurine methytransferase (TPMT) gene polymorphisms and its enzymatic activity, and to clarify the significance of TPMT activity and gene polymorphisms on individualized therapy with thiopurines.</p><p><b>METHODS</b>The TPMT activity and gene polymorphisms were determined in an unrelated population of 250 Chinese healthy blood donors, 100 cords blood and 280 patients with acute leukemia. The TPMT genotyping assay was based on polymerase chain reaction (PCR), restriction digestion of PCR products, denaturing high-performance liquid chromatography (DHPLC) and SNaPshot sequencing and direct DNA sequencing in the TPMT exon 5 (G238C), TPMT exon7 (G460A) and TPMTexon10 (A719G). Erythrocyte TPMT activity was measured by high-performance liquid chromatography (HPLC).</p><p><b>RESULTS</b>The frequency of TPMT polymorphism in 250 Chinese healthy blood donors, 100 cords blood and 280 patients with acute leukemia was low (3.5%), and all the varied alleles were TPMT* 3C (exon 10A719G). All of them were TPMT* 1/TPMT* 3C heterozygote. The TPMT activity was between 6 and 12 U. The activity in 95.1% was more than 12 U (13 - 32 U), while the activity in others (4.9%) was 6 - 12 U. TPMT activity and genotype were concordant. Of 630 subjects evaluated, TPMT activity of heterozygous individuals in Chinese healthy blood donors, cords blood and acute leukemia patients were 9.1 U, 9.3 U and 9.07 U, respectively, significantly lower than that in general population (17.6 U, 17.67 U and 18.6 U, respectively). In the samples analyzed, ten subjects with heterozygous phenotypes (6/15 acute leukemia children and 4/16 healthy blood donors and cords blood) did not have TPMT* 2, TPMT* 3A or TPMT* 3C. Therefore, other factors may affect on TPMT activity.</p><p><b>CONCLUSION</b>TPMT gene polymorphisms and its activity were concordant. The heterozygotes had low TPMT activity. Therefore, detection of TPMT genotype and its activity is useful. These findings hold a promise of improving the safety and efficacy of thiopurines therapy.</p>

Exploration of methodology for assay of single nucleotide polymorphism in thiopurine methyltransferase gene / 中国实验血液学杂志

The aim of the present study was to gain an insight into the thiopurine methytransferase (TPMT) genotyping assay, which was based on polymerase chain reaction (PCR), allele-specific PCR, restriction digestion of PCR products, denaturing high-performance liquid chromatography (DHPLC) and SNaPshot sequencing and in combination with direct DNA sequencing. Among the f our methods to test TPMT genetic SNPs based on PCR, allele specific PCR was not able to differentiate wild type from varied type. BsiYI, MwoI and AccI to digest PCR products were used so that SNP in TPMT exon 5, 7 and 10 tested. It showed that there were no differences between the results of digestion of PCR products and those of DNA sequence analysis. Therefore, this method was reliable. But some other methods were still needed to look for a compensation, because no restriction map changing resulted from the 2 SNPs in TPMT promotor was found. As to the results of DHPLC, those for the screening of TPMT exon-5 and -10 for SNPs were the same as restriction analysis of PCR products and direct DNA sequencing. But the variation of the heterozygotes in exon-7 was high, which was different from the results of direct DNA sequencing. After changing the Tm of DNA step by step, It was found that all the samples showed single peak when the temperature was 54 degrees C. But this result was unbelievable because a heterozygote in exon 7 as positive control could not be found. Therefore, it was necessary to test the sensitivity and accuracy of DHPLC, though DHPLC could be used as an effective method of SNPs screening. The results of the SNaPshot sequencing were also same as those of restriction analysis of PCR products and direct DNA sequencing. And the results showed that the bases of TPMT promoter -91 and -168 were G, instead of A and T. The results of the four methods to detect TPMT genetic SNPs based on PCR showed that SNPs analysis technique should be a combination of the techniques above-mentioned. One technique alone could not satisfy the need in clinics and research. The compensation of each other was very important.

Modulatory function of high-dose hepatitis B surface antigen vaccine to cellular immune responses in mice / 中国病理生理杂志

AIM: To observe the effects of high-dose hepatitis B surface antigen (HBsAg) vaccine on cellular immune response in BALB/C mice. METHODS: The mice were immunilized separately with low-dose and high-dose HBsAg vaccine by intramuscular injection two times. The specific proliferative activities of T lymphocytes were measured by [ 3H]-TdR incorporation assay. IL-2 as well as IFN-? levels in the culture supernatant of T cells and anti-HBs IgG2a lever in sera were detected by enzyme-linked immunoabsorbent assay. RESULTS: After first vaccination with high-dose HBsAg, the proliferative activities of T cells in the experimental group were significantly stronger, both levels of IL-2 and IFN-? were markedly higher than that in the control group and the percentage of mice to produce serum anti-HBs IgG2a was significantly higher compared to that of mice immunilized by low-dose HBsAg. All data in experimental groups were further increased after second dose of vaccine. CONCLUSION: Vaccination of mice with high-dose HBsAg can induce cellular immune responses tended to Th1(T helper 1 subset) response.