Effectiveness of 13-valent pneumococcal conjugate vaccine against vaccine-serotype community acquired pneumococcal diseases among children in China: A test-negative case-control study.

BACKGROUND: In 2016, China licensed 13-valent pneumococcal conjugate vaccine (PCV13) based on a study that demonstrated its immunogenicity is non-inferior to PCV7. However, the real-world effectiveness of PCV13 against vaccine-serotype pneumococcal diseases in China has limited evidence. METHODS: A test-negative case-control study was conducted among children under 5 years old admitted to the Children's Hospital of Soochow University (SCH) with respiratory tract infections from January 2018 to December 2020. Cases were defined as children from whom the isolates were tested positive for Streptococcus pneumoniae (S. pneumoniae) with serotypes included in PCV13. Two control groups were included, one represented children with isolates positive for S. pneumoniae of non-PCV13 serotypes and the other comprised children who tested negative for S. pneumoniae. The S. pneumoniae-negative controls were selected by matching them to the cases based on gender, age and admission date in a 1:1 ratio. Vaccine effectiveness (VE) was calculated using a logistic regression model as (1- adjusted odds ratio) * 100 %. RESULTS: A total of 2371 pneumococcal isolates were included in the analysis, of which 75.0 % (1779/2371) were covered by PCV13 serotypes. Consequently, these 1779 children were classified as cases, and 592 children were designated as non-PCV13 serotype controls. Another 1779 children were correspondingly recruited as S. pneumoniae-negative controls. Overall, 40 cases (2.3 %) and 148 controls (6.2 %) had received vaccination. The overall VE in the PCV13/non-PCV13 serotypes case-control study was 50.0 % (95 % CI: 15.0, 70.7), which was lower than the VE of 74.4 % (95 % CI: 60.7, 83.3) in the matched PCV13/S. pneumoniae-negative case-control study. VE was higher for ≥ 2 or ≥ 3 doses of vaccination compared to ≥ 1 dose. VE against specific PCV13 serotypes (6B, 6A and 19F) was higher than for other serotypes. CONCLUSIONS: PCV13 vaccination demonstrates effectiveness against vaccine-serotype pneumococcal diseases in children, particularly for serotypes 6B, 6A and 19F.

Correlation between urinary protein levels and the incidence of chronic obstructive pulmonary disease in middle-aged and elderly population / 公共卫生与预防医学

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ2=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

Efficacy of different questionnaires in screening COPD in the communities of Songjiang District， Shanghai / 上海预防医学

ObjectiveTo evaluate the efficacy of three screening questionnaires for COPD in the community residents of Songjiang District， Shanghai， and to provide a basis for selecting COPD screening questionnaire and process that are more suitable. MethodsCommunity residents aged 40 years or over were randomly selected from the Shanghai Suburban Adult Cohort and Biobank for the study with screening questionnaires and spirometry. Questionnaires included the COPD screening questionnaire （COPD-SQ）， the COPD population screener （COPD-PS） and the revised COPD diagnostic questionnaire （revised-CDQ）. Evaluation of the efficacy of these questionnaires was based on the area under the receiver operating characteristic curve （AUC） of the subjects. DeLong test was used to compare the accuracy of different questionnaires； Z test was used to compare the accuracy of different cut-off values for the same questionnaire. ResultsAmong 3 184 community residents， a total of 259 （8.1%） COPD patients were screened by spirometry. AUC values of these 3 screening questionnaires were >0.7 indicating that they were reliable COPD screening tools. The sensitivity and specificity of the questionnaires at the recommended cut-off values were COPD-SQ （63.7% and 72.2%）， COPD-PS （12.0% and 96.1%）， and revised CDQ （78.8% and 52.7%）， with the COPD-SQ having the highest screening accuracy （AUC=0.754）. The optimal and recommended cut-off values for the three questionnaires differed in this population， but the difference in accuracy was statistically significant only for COPD-PS. The optimal cut-off values for the three questionnaires differed between male and female， and the sensitivity and accuracy of COPD-SQ and COPD-PS improved when lower cut-off values were used for women. The AUC was greater when two questionnaires were utilized simultaneously for screening， but the differences were not statistically significant. ConclusionThe COPD-SQ is recommended for primary COPD screening； a lower cut-off value for women should be considered. The COPD screening questionnaire needs to be further improved for the early diagnosis and treatment of COPD patients.

Non-alcoholic fatty liver disease related health outcomes and influencing factors among community inhabitants / 上海预防医学

ObjectiveTo describe different non-alcoholic fatty liver disease （NAFLD） outcomes among community inhabitants， and further to explore the correlation between bio-indicator level variance and the outcomes. MethodsPhysical indicators （height， weight， waist circumstances， hip circumstances， blood pressure， etc）， biochemical indicators ［fasting plasma glucose， HbA1c， serum triglycerides（TG）， serum total cholesterol（TC）， low-density lipoprotein cholesterol（LDL-C）， high-density lipoprotein cholesterol（HDL-C）， liver related transaminase， etc］ and clinical imaging （B-scan ultrasonography） were collected during the follow-up from the Songjiang Natural Population Sub-cohort. The identification of NAFLD was supported by the definition criteria from Guidelines for the diagnosis and treatment of non⁃alcoholic fatty liver disease. Paired t-test and multifactorial logistic regression model were used to compare the difference between the indicator level of the subjects from different outcome subgroups and to further analyze the correlation between these indicator variance and different NAFLD outcomes. ResultsDuring a median follow-up time of 2.94 years， 12 076 subjects were involved. The cumulative NAFLD incidence and remission rate were 21.57% and 31.15%， respectively. The proportion of subjects who still had NAFLD was 27.96%. Among subjects with newly-developed NAFLD， indicators including blood pressure， BMI， fasting plasma glucose， and plasma lipid level increased， while in the remission subgroup， blood pressure， BMI（WHR）， waist-hip ratio（WHR）， and TG level were significantly decreased. Increased level of systolic pressure， WHR， BMI， HbA1c， and LDL-C might be the risk factors to the occurrence of NAFLD. While decreased level of WHR， BMI， TC and LDL-C level and elevated HDL-C level were likely to be the influencing factors of NAFLD remission process. ConclusionThe NAFLD morbidity in the community inhabitants is relatively high. BMI， WHR， fasting plasma sugar and plama lipid level variance may act as the influencing factors towards different NAFLD outcomes.

New progress in research and prevention of respiratory syncytial virus infection in children / 上海预防医学

Respiratory syncytial virus （RSV） is the most important viral pathogen causing acute lower respiratory tract infections in children under 5 years of age and poses a serious threat to infant health. After more than 60 years， the development of RSV vaccines and monoclonal antibodies has been moving forward amid bumps. Recently， several RSV vaccines and monoclonal antibodies have entered phase Ш clinical trials， which brings light to the prevention of RSV. We reviewed the new progress in research and prevention of RSV， so as to provide help for the prevention and control of RSV.

Prevalence and influencing factors of diabetes mellitus among a community population aged from 20 to 74 in Songjiang District， Shanghai / 上海预防医学

ObjectiveTo investigate the prevalence and influencing factors of diabetes mellitus among community population in Songjiang District of Shanghai， and to provide scientific basis for prevention and treatment of diabetes mellitus. MethodsBased on the baseline data of the Shanghai Suburban Adult Cohort （2016‒2017） and local medication database， the prevalence of diabetes in the cohort was described， and the influencing factors for the prevalence of diabetes in different genders were analyzed. ResultsAmong 35 928 participants， males accounted for 40.57%， and the median age was 58 years old. There were 5 342 diabetic patients with a crude prevalence rate of 14.87% and the standardized prevalence rate of diabetes mellitus was 7.57%. The prevalence rate of diabetes in males （15.81%） was significantly higher than that in females （14.23%， P<0.001）. Multivariate logistic regression analysis showed that the following factors were associated with high risk of diabetes mellitus in males： 40‒59 age group （OR=7.111，95%CI：4.900‒10.320）， 60‒74 age group （OR=8.994，95%CI：6.154‒13.144）， family history of diabetes （OR=3.369，95%CI：2.963‒3.83）， overweight （OR=1.272，95%CI：1.123‒1.439）， obesity （OR=1.912，95%CI：1.623‒2.252）， hypertension （OR=1.685，95%CI：1.512‒1.877）， and dyslipidemia （OR=1.396，95%CI：1.263‒1.542）. In females， the high risk of diabetes was associated with： 40‒59 age group （OR=2.718，95%CI：1.838‒4.02）， 60‒74 age group （OR=3.517，95%CI：2.34‒5.286）， family history of diabetes （OR=3.071，95%CI：2.761‒3.416）， overweight （OR=1.254，95%CI：1.125‒1.398）， obesity （OR=2.018，95%CI：1.764‒2.308）， central obesity （OR=1.515，95%CI：1.357‒1.692）， hypertension （OR=2.128，95%CI：1.929‒2.347）， dyslipidemia （OR=1.506，95%CI：1.379‒1.644）， exercise （OR=1.241，95%CI：1.137‒1.355）， and menopause （OR=1.967，95%CI：1.693‒2.286）. ConclusionThe prevalence rate of diabetes is high in Shanghai， and the related factors are different in different gender groups.

Epidemiological characteristics and risk factors of hypertension in residents in Songjiang District， Shanghai： a cohort based cross-sectional study / 上海预防医学

ObjectiveTo determine the epidemiological characteristics and risk factors of hypertension in residents in Songjiang District of Shanghai， and provide evidence for prevention and control of hypertension. MethodsLocal residents aged between 20 and 74 years were recruited from four towns in Songjiang District from 2016 to 2017 by using a multistage sampling strategy. Questionnaire surveys were conducted， and then physical examination， blood pressure measurement， glucose test and lipid test were performed. The data was analyzed by SPSS 16.0 software. Chi-square test was used to compare the differences in the prevalence of hypertension in residents， stratified by demographics and health conditions. Risk factors were determined by multivariate logistic regression. ResultsAmong 35 759 residents with a median age of 58 years and the proportion of male being 40.67%， crude prevalence of hypertension was 54.24% （19 395/35 759） and standardized prevalence was 31.69%. In the hypertensive patients， proportion of hypertension awareness was 61.09%， with 63.67% in male and 59.10% in female. Proportion of receiving treatment was 49.00%， with 50.91% in male and 47.51% in female. Furthermore， in the hypertensive patients with treatment， proportion of effectively controlling hypertension was 40.50%， with 44.46% in male and 37.21% in female. Multivariate logistic regression showed that male （OR=1.272）， senior age （40‒59 years old： OR=4.353， 60‒74 years old： OR=9.802）， overweight （OR=1.823）， obesity （OR=3.070）， central obesity （OR=1.380）， diabetes （OR=1.923）， dyslipidemia （OR=1.452）， and drinking （OR=1.338） were risk factors associated with hypertension. ConclusionPrevalence of hypertension is high， while the proportions of receiving treatment and effective control remain low in residents in Songjiang District. It warrants strengthening prevention and control of hypertension in targeted and young residents.

The prevalence of gout and related factors in community population / 中华内分泌代谢杂志

Objective:To explore the prevalence of gout and related factors in community population, thereby provide evidence for comprehensive prevention and control of gout in community.Methods:A stratified multi-stage cluster sampling was used to survey the permanent residents of 20 to 75 years old in the 3 selected streets (towns), univariate analysis was performed using logistic regression by SPSS statistical software.Results:The prevalences of hyperuricemia and gout were 9.82% and 5.75% respectively(male 18.88% and 7.94%, female 3.79% and 4.29%)in Jiading Shanghai. The positive rate of family history was 17.13%, and the relationship between family history and gout was significant( OR=3.140, 95% CI 2.365-4.169, P<0.01). Age( OR=1.034, 95% CI 1.021-1.047), body mass index ( OR=1.102, 95% CI 1.074-1.131), waist-hip ratio ( OR=4.876, 95% CI 1.153-20.622), sleep quality ( OR=1.310, 95% CI 1.159-1.480), other animal meat ( OR=1.117, 95% CI 1.007-1.240), fresh water fish ( OR=1.138, 95% CI 1.005-1.288), and processed meat ( OR=1.145, 95% CI 1.033-1.270) were closely related to gout ( P<0.05 or P<0.01). Sex, alcohol drinking, marine fish, and soybean milk/soymilk were related to gout ( P<0.05 or P<0.01), but showed a protective effect ( OR<1.000). Conclusion:Reducing uric acid production through less consumption of purine-rich food such as animal meat as well as processed meat and weight control would be helpful in preventing gout.

Epidemiological characteristics and antibiotics susceptibility of Streptococcus pneumoniae isolated from children in Suzhou area during 2010 to 2017 / 中华传染病杂志

Objective:To explore the epidemiological characteristics and the antibiotic resistance of Streptococcus pneumoniae isolates, and to provide the evidence for the rational use of antimicrobial agents to treat Streptococcus pneumoniae infection. Methods:The positive microbiological laboratory identification and antimicrobial susceptibility testing of Streptococcus pneumoniae from sputum of children with respiratory infections during January 2010 to December 2017 in Children′s Hospital of Soochow University were retrospectively analyzed. The positive rates of Streptococcus pneumoniae of different genders, ages, years and seasons were compared. The annual detection rates and trends of drug resistance of Streptococcus pneumoniae to penicillin, amoxicillin and cefotaxime were analyzed by Mann-Kendall trend test. The seasonal decomposition of time series was conducted to assess the association between Streptococcus pneumoniae detection rate and season. Enumeration data was compared using χ2 test. Results:Of the 88 480 sputum specimens, the total positive rate of Streptococcus pneumoniae was 10.3%(9 081/88 480). The detection rates of Streptococcus pneumoniae in children aged 0 to <0.5 years old, 0.5 to <2 years old, 2 to <3 years old, 3 to <5 years old, and 5 to <15 years old were 4.2%(1 407/33 224), 13.1%(3 191/24 390), 14.9%(2 417/16 252), 17.9%(1 474/8 246) and 9.3%(592/6 368), respectively. The difference was statistically significant ( χ2=2 421.6, P<0.01). The detection rates were 8.1%(1 321/16 306) from January to March, 10.9%(2 194/20 207) from April to June, 8.5%(2 141/25 058) from July to September, and 12.7%(3 425/26 909) from October to December. The discrepancy of positive rates in different seasons showed statistical significance ( χ2=311.5, P<0.01). During 2010 to 2017, significant decreases in antibiotic resistant rates of Streptococcus pneumoniae to penicillin, amoxicillin and cefotaxime were detected (tau=-0.93, -0.93 and -0.71, respectively, all P<0.05). Conclusions:The detection rate of Streptococcus pneumoniae in sputum of children with respiratory infections may present seasonal pattern and vary between different ages of children. The resistance to β-lactam antibiotics has declined.

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017 / 中华流行病学杂志

Objective To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou,China,2011-2017.Methods From March 2011 to February 2017,we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital.Through standard questionnaires and follow-up survey via telephone,we collected information regarding the demographic characteristics,medical history,clinical symptoms and both direct and indirect costs associated with influenza,of the patients.We then compared clinical characteristics and economic burden of influenza A/H1N1,A/H3N2,and B infections among children with ILI.Results We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs.791 (12.9％) of the swabs showed positive for influenza virus,including 88 (11.1％) subtype influenza A/H1N1,288 (36.4％) subtype influenza A/H3N2,and 415 (52.5％) type influenza B.The proportions of cough,rhinorrhea,wheezing,vomiting and convulsion in influenza-positive children were higher than those influenza-negative children.Except for the prevalence rates of cough (x2=9.227,P=0.010),wheezing (x2=7.273,P=0.026) and vomiting (x2=8.163,P=0.017),other clinical symptoms appeared similar between the three viral subtypes.Among all the ILI children,the average total cost per episode of influenza was 688.4 Yuan (95％ CI:630.1-746.7) for influenza-negative children;768.0 Yuan (95％CI:686.8-849.3) for influenza-positive children and 738.3 Yuan (95％CI:655.5-821.1) for influenza B.Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (x2=7.237,P=0.028).Conclusion Children infected influenza showed higher prevalence rates of cough,rhinorrhea,wheezing,vomiting and convulsion than those without influenza.Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

Epidemiological features of adult chronic kidney diseases in a community-based population in Songjiang district, Shanghai / 中华流行病学杂志

Objective To investigate the prevalence and associated factors of chronic kidney diseases (CKD) in adult residents living in a community of Songjiang district,Shanghai.Methods A total of 9 257 residents aged 20-75 years old in Xinqiao township of Songjiang district were selected by random cluster sampling.All the participants were interviewed to complete a set of personal questionnaire and undergo physical examinations.Urine and blood tests including markers of kidney damage and related associated factors with CKD,were carried out.Results Eligible data from 8 207 subjects were enrolled in the study.After adjustment for age and gender,the prevalence of CKD was 8.4％ (95％CI:7.8％-9.0％),with majority of the patients (76.5％) appeared in the early stage (Ⅰ and Ⅱ) of the disease.The prevalence of CKD increased with age and higher prevalence was seen in females than in males (P＜0.001).Results from logistic regression analysis showed that factors as:being elderly or female,having hypertension,hyperuricemia,and hyperlipidemia were all independently associated with CKD.Conclusions The prevalence of CKD appeared relatively high in adult residents of Xinqiao township,Songjiang district where CKD had become a public health problem.Factors as:being female or elderly,hypertension,hyperuricemia,and hyperlipidemia were found to be associated with CKD.Our findings suggested that early prevention and control on CKD to reduce the incidence of end-stage renal diseases and related complications had called for more urgent attention.

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017 / 中华流行病学杂志

Objective: To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017. Methods: From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI. Results: We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 (12.9%) of the swabs showed positive for influenza virus, including 88 (11.1%) subtype influenza A/H1N1, 288 (36.4%) subtype influenza A/H3N2, and 415(52.5%) type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough (χ(2)=9.227, P=0.010), wheezing (χ(2)=7.273, P=0.026) and vomiting (χ(2)=8.163, P=0.017), other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan (95%CI: 630.1-746.7) for influenza-negative children; 768.0 Yuan (95%CI: 686.8-849.3) for influenza-positive children and 738.3 Yuan (95%CI: 655.5-821.1) for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (χ(2)=7.237, P=0.028). Conclusion: Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

Epidemiological features of adult chronic kidney diseases in a community-based population in Songjiang district, Shanghai / 中华流行病学杂志

Objective: To investigate the prevalence and associated factors of chronic kidney diseases (CKD) in adult residents living in a community of Songjiang district, Shanghai. Methods: A total of 9 257 residents aged 20-75 years old in Xinqiao township of Songjiang district were selected by random cluster sampling. All the participants were interviewed to complete a set of personal questionnaire and undergo physical examinations. Urine and blood tests including markers of kidney damage and related associated factors with CKD, were carried out. Results: Eligible data from 8 207 subjects were enrolled in the study. After adjustment for age and gender, the prevalence of CKD was 8.4% (95%CI: 7.8%-9.0%), with majority of the patients (76.5%) appeared in the early stage (Ⅰ and Ⅱ) of the disease. The prevalence of CKD increased with age and higher prevalence was seen in females than in males (P<0.001). Results from logistic regression analysis showed that factors as: being elderly or female, having hypertension, hyperuricemia, and hyperlipidemia were all independently associated with CKD. Conclusions: The prevalence of CKD appeared relatively high in adult residents of Xinqiao township, Songjiang district where CKD had become a public health problem. Factors as: being female or elderly, hypertension, hyperuricemia, and hyperlipidemia were found to be associated with CKD. Our findings suggested that early prevention and control on CKD to reduce the incidence of end-stage renal diseases and related complications had called for more urgent attention.

A 22-year-follow-up cohort study on primary liver cancer in Haimen city of Jiangsu province / 中华流行病学杂志

Objective A prospective cohort study was carried out to assess the mortality and potential risk factors for primary liver cancer (PLC) in Haimen city of Jiangsu province.Methods The cohort involved 89 789 adult residents aged 25-69 years.Upon the entry of this project,each subject was asked to complete a questionnaire and to provide a blood sample of 10 ml.Surface antigen of hepatitis B virus (HBsAg) was tested by radioimmunoassay.All the subjects were followed-up every year for vital statistics and death certificate information until 2014.Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95％ confidence interval (95％ CI) for PLC mortality associated with HBsAg status and other risk factors.Results During the 1 299 611 person-years of follow-up,a total of 2 583 PLC cases were identified,including 2 149 men and 434 women.Mortality of the PLC for men and women were 247.80/100 000 person-years and 100.38/100000 person-years,respectively.Among those who died of PLC,73.87％ had been tested HBsAg positive.HBV infection seemed the predominant risk factor for PLC and the HRs were 15.97 for men (95％CI:14.29-17.85) and 21.63 for women (95％CI:16.16-28.96) respectively.Ageing,cigarette smoking,previous history of hepatitis,and family history of HCC were factors associated with the increased risk for PLC.Conclusion People living in Haimen city had a high risk on PLC.HBV infection appeared the most important risk factor for HCC mortality in this area.

Cost-effectiveness of multiple screening modalities on breast cancer in Chinese women from Shanghai / 中华流行病学杂志

Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.

A 22-year-follow-up cohort study on primary liver cancer in Haimen city of Jiangsu province / 中华流行病学杂志

Objective A prospective cohort study was carried out to assess the mortality and potential risk factors for primary liver cancer (PLC) in Haimen city of Jiangsu province.Methods The cohort involved 89 789 adult residents aged 25-69 years.Upon the entry of this project,each subject was asked to complete a questionnaire and to provide a blood sample of 10 ml.Surface antigen of hepatitis B virus (HBsAg) was tested by radioimmunoassay.All the subjects were followed-up every year for vital statistics and death certificate information until 2014.Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95％ confidence interval (95％ CI) for PLC mortality associated with HBsAg status and other risk factors.Results During the 1 299 611 person-years of follow-up,a total of 2 583 PLC cases were identified,including 2 149 men and 434 women.Mortality of the PLC for men and women were 247.80/100 000 person-years and 100.38/100000 person-years,respectively.Among those who died of PLC,73.87％ had been tested HBsAg positive.HBV infection seemed the predominant risk factor for PLC and the HRs were 15.97 for men (95％CI:14.29-17.85) and 21.63 for women (95％CI:16.16-28.96) respectively.Ageing,cigarette smoking,previous history of hepatitis,and family history of HCC were factors associated with the increased risk for PLC.Conclusion People living in Haimen city had a high risk on PLC.HBV infection appeared the most important risk factor for HCC mortality in this area.

Cost-effectiveness of multiple screening modalities on breast cancer in Chinese women from Shanghai / 中华流行病学杂志

Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.

Applications of the performance evaluation index system for rural public health service system in China's rural health reform / 中国卫生政策研究

Objective: To evaluate the project performance of public health service system in rural areas during the implementation of China Rural Health Project ( hereinafter referred to asHealth XI Project) . Methods: In this paper, all 40 counties covered by the Health XI Project are selected as case study. This paper uses the performance evaluation index system for rural public health system developed for the project and continuously collect input and out-put indexes between 2008 and 2013 in order to conduct a comprehensive analysis and evaluation. Results: During the implementation of the Health XI Project, the inputs and outputs of the rural public health service system had gradual-ly increased in all the countries covered by the project. The score for inputs and outputs increased from 22. 73 and 39. 05 in 2008 to 32. 62 and 57. 60 in 2013, with a growth rate of 43. 15% and 47. 50%, respectively. The input scores significantly grew faster than output scores in some provinces. The input-output ratio increased from 1. 72 to 1. 77, with slight fluctuations between different years. Conclusion: The application of the performance evaluation index system for public health service system in monitoring project implementation process can help to timely discover the weak links associated with the implementation of rural public health service system, and thus take effective measures to promote the improvement of the system. . When increasing investment in public health, how to efficiently use re-sources and improve the service effectiveness is still an urgent problem.

Management and control of hypertension and diabetes in rural areas of China: Based on the practice of China Rural Health Project / 中国卫生政策研究

With the support of World Bank ( WB ) and UK Department for International Development ( DFID) , China Rural Health Project ( hereinafter referred asHealth XI Project) has successfully covered 40 coun-ties in 8 provinces. With the establishment of community diagnosis and health records as the entry point, hyperten-sion, diabetes and other major chronic diseases as the starting point, and focus on the needs of healthy people, high-risk groups and patients, the project mainly adopts health education and promotion, health management, disease management and other measures to explore the establishment of a new model of rural chronic disease management. By analyzing the monitoring data of chronic diseases in the project zones, this study found that the number of registered and managed patients with hypertension and diabetes increased significantly, from 397,113 and 136,326 in 2009 to 1,500,252 and 388,846 in 2013, respectively. The management rate also increased from 60. 8% and 32. 2% in 2009 to 92. 2% and 88. 8% in 2013, respectively. The results of the 5th National Health Service Survey show that, the control rates for self-reported hypertension and diabetes ((53. 8% and 50. 2%, respectively) in the project zones were significantly higher than the national average in rural areas ( 54 . 9% and 38 . 3%, respectively ) . This paper suggests that, with focus on training, health education, health promotion, health management and disease manage-ment as the core mainline, the chronic disease management model has effectively improved the chronic disease service capabilities in rural areas,. The comprehensive and integrated chronic disease interventions implemented by the pro-ject in the rural areas is practical, and it has value of popularization and application.

Distribution of univalvia molluscs in area with natural decline of Oncomela-nia hupensis snails in Eastern Dongting Lake area / 中国血吸虫病防治杂志

Objective To understand the distribution of univalvia molluscs in Eastern Dongting lake area where the Oncome-lania hupensis is extinct,so as to explore the causes of extinction and to provide the evidence for formulating schistosomiasis con-trol strategy. Methods The univalvia molluscs of the Qianliang Lake district,Jianxin District and Junshan Park were investigat-ed in August of 2013. All the collected snails were classified and identified. The data were analyzed by using the method of Shapiro-Wilk normality test and non-parametric test. The ecological biodiversity differences from each district were compared by the biodi-versity indexes. Results The univalvia molluscs collected were from 6 species in 3 families in Gastropoda class,namely Oncome-lania hupensis Gredler in Pomatiopsidae family,Parafossarulus striatulus,Alocinma longicornis,Parafossarulus sinensis,Bithynia fuchsisana in Bithyniidae family,and one genus provisionally named Radix in Lymaneidae family. In Junshan Park ,a total of 4 553 snails were collected,among which 1 264 were Oncomelania snails. In Jianxin District,336 univalvia molluscs were collect-ed,and no Oncomelania snails were found. In Qianliang Lake district,there were only 7 Alocinma longicornis snails,2 Parafossa-rulus sinensis snails and 1 Parafossarulus striatulus snail collected. There were significant differences among the distributions of the samples from the three districts(χ2=166.225,P<0.01).The Simpson’s diversity indexes in Qianliang Lake area,Jianxin Dis- trict and Junshan Park were 0.402 8,0.718 6 and 0.678 8,respectively,and the Shannon-Wiener indexes of the 3 areas were 0.721 5,1.431 3 and 1.199 9,respectively. Conclusions With the extinction of Oncomelania snails,the species and quanti-ties of other snails become rare in Qianliang Lake area. Whether their causes are relevant is worth further studying.