Nanotube topography rejuvenates the senescence of mesenchymal stem cells by activating YAP signalling.

Improving the regenerative ability of senescent stem cells is a critical issue in combating aging. The destiny and function of senescent stem cells are controlled by the niche, including the physical architecture of the surface of the extracellular matrix (ECM). In this study, we explored the functions of TiO2 nanotube topography on mesenchymal stem cells (MSCs) under senescence, as well as its mechanical effects on senescence. First, we created different nanotube topographies on the titanium samples. Next, we cultured senescent mesenchymal stem cells (S-MSCs) on samples with various nanotube topographies to determine suitable parameters. We found nanotube with a diameter of 10 nm significantly alleviated the cellular senescence of S-MSCs and improved the osteogenic differentiation of S-MSCs in vitro. Using an ectopic periodontium regeneration model, we confirmed that specific nanotube topography could promote tissue regeneration of S-MSCs in vivo. Moreover, we demonstrated that nanotube topography activated YAP in S-MSCs and reformed nuclear-cytoskeletal morphology to inhibit senescence. Taken together, our study establishes a bridge linking between nano-topography, mechanics, and senescence, suggesting a potential strategy to improve tissue regeneration in aged individuals by providing optimized surface topography on biomaterials.

Clinical significance of small extracellular vesicles in cholangiocarcinoma.

Cholangiocarcinoma is an aggressive and heterogeneous malignancy originating from the bile duct epithelium. It is associated with poor prognosis and high mortality. The global incidence of cholangiocarcinoma is rising, and there is an urgent need for effective early diagnosis and treatment strategies to reduce the burden of this devastating tumor. Small extracellular vesicles, including exosomes and microparticles, are nanoscale vesicles formed by membranes that are released both normally and pathologically from cells, mediating the intercellular transfer of substances and information. Recent studies have demonstrated the involvement of small extracellular vesicles in numerous biological processes, as well as the proliferation, invasion, and metastasis of tumor cells. The present review summarizes the tumorigenic roles of small extracellular vesicles in the cholangiocarcinoma microenvironment. Owing to their unique composition, accessibility, and stability in biological fluids, small extracellular vesicles have emerged as ideal biomarkers for use in liquid biopsies for diagnosing and outcome prediction of cholangiocarcinoma. Specific tissue tropism, theoretical biocompatibility, low clearance, and strong biological barrier penetration of small extracellular vesicles make them suitable drug carriers for cancer therapy. Furthermore, the potential value of small extracellular vesicle-based therapies for cholangiocarcinoma is also reviewed.

Factors associated with recommendation behaviors of four non-National Immunization Program vaccines: a cross-sectional survey among public health workers in China.

BACKGROUND: Immunization is a crucial preventive measure to safeguard children under five years old against a range of diseases. In China, the coverage rate of non-National Immunization Program (non-NIP) vaccines can be improved by leveraging the recommendation from public health workers. Hence, understanding the influencing factors of recommendation behaviors assume paramount importance. This study aims to investigate influencing factors of public health workers' recommendation behaviors towards non-NIP vaccines, with a particular emphasis on financial incentives. METHODS: A cross-sectional survey was conducted using a multi-stage sampling method in 2019 from August to October. 627 public health workers were recruited from 148 community healthcare centers in ten provincial-level administrative divisions in China. An anonymous questionnaire was used to collect demographic information, attitudes towards vaccination, and recommendation behaviors towards non-NIP vaccines, including Haemophilus influenzae type b (Hib) vaccine, pneumococcal conjugate vaccine, varicella vaccine, and rotavirus vaccine. Descriptive analysis and multivariate logistic regression analysis were adopted in this study. RESULTS: Of the 610 public health workers with complete survey data, 53.8%, 57.4%, 84.1%, and 54.1% often recommended Hib vaccine, pneumococcal pneumonia vaccine (PCV), varicella vaccine, and rotavirus vaccine, respectively. Logistic regression revealed that gender (Hib vaccine: OR = 0.4, 95% CI: 0.2-0.8; PCV: OR = 0.4, 95% CI: 0.2-0.8; rotavirus vaccine: OR = 0.3, 95% CI: 0.2-0.6), financial incentives for non-NIP vaccination (Hib vaccine: OR = 1.9, 95% CI: 1.1-3.6; PCV: OR = 2.1, 95% CI: 1.1-3.9; rotavirus vaccine: OR = 2.0, 95% CI: 1.1-3.8) and perception of vaccine safety (Hib vaccine: OR = 2.7, 95% CI: 1.1-7.0; PCV: OR = 3.2, 95% CI: 1.2-8.0; rotavirus vaccine: OR = 3.0, 95% CI: 1.2-7.7) were associated with public health workers' recommendation towards Hib vaccine, PCV and rotavirus vaccine. CONCLUSIONS: The findings highlighted public health workers' recommendation behaviors of non-NIP vaccines in China and revealed strong association between vaccine recommendation and financial incentives. This highlights the importance of financial incentives in public health workers' recommendation toward non-NIP vaccines in China. Proper incentives are recommended for public health workers to encourage effective health promotion in immunization practices.

Lipidomic and comparative transcriptomic analysis of fatty acid synthesis pathway in Carya illinoinensis embryo.

Pecan (Carya illinoinensis (Wagenh.) K. Koch) is an important oilseed nut and is rich in fatty acids (FAs) and flavonols. Pecan FA has significantly edible, industrial and clinical value. To investigate the dynamic patterns and compositions of FA, and the molecular mechanism that controls FA accumulation in pecan, lipidomic and transcriptomic analyses were performed to determine lipid profiles and gene expression in pecan's FA biosynthesis pathway. In the present study, compared with cultivars 'Caddo' and 'Y-01', 'Mahan' formed larger and heavier embryos and accumulated higher oil content. Lipidomic analysis showed that FA and (O-acyl)-1-hydroxy FA contents were higher in 'Mahan' at the mature stage. Based on full-length and comparative RNA-Seq, differential expression gene enrichment analysis revealed that many functional genes participated in the pathways of 'fatty acid biosynthesis', 'fatty acid metabolism' and 'linoleic acid metabolism'. High FA accumulation model from 'Mahan' demonstrated that key enzyme-encoding genes played an important role in regulating FA biosynthesis. Co-expression module analysis indicated that several transcription factors (TFs; MYB, TCP, bHLH, Dof, ERF, NAC) were involved in FA accumulation by regulating the expression of functional genes, and real-time quantitative PCR verification proved that these TFs had a high correlation with the pecan FA accumulation pattern. These findings provided an insight into the molecular mechanism of FA accumulation in C. illinoinensis embryo, which contributes to pecan oil yielding and pecan molecular breeding.

Hertwig's epithelial root sheath cells show potential for periodontal complex regeneration.

BACKGROUND: Although researchers have been exploring therapeutic strategies of treating serious periodontal tissue loss, including the application of stem cells, tissue regeneration of the periodontal complex involving cementum, periodontium, and alveolar bone has hardly been achieved. Aiming at tackling the problem of severely damaged periodontal complex, it is worth trying to make advantages of Hertwig's epithelial root sheath (HERS) cells to tissue regeneration mimicking the physiological developmental process with their ability of cementum, bone, and periodontium formation. METHODS: HERS cells and dental follicle cells (DFCs) were acquired from Sprague Dawley rats' molar germs and identified by immunofluorescence. Alizarin red assay, ALP staining, AKP test, real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot were conducted to confirm the osteogenic potential, epithelial-mesenchymal transition (EMT) character of harvested HERS cells and epithelial-mesenchymal interaction (EMI) with DFCs. An animal model of periodontal defect was constructed to testify the tissue regeneration ability in vivo. Micro-CT and histological examinations were interpreted to unveil the tissue repair outcomes. RESULTS: HERS cells expressed strong epithelial cell markers CK14 and E-cadherin. The in vitro experiments overall showed the concretely enhanced osteogenic differentiation ability in either HERS group or HERS+DFC group. Meanwhile, the in vivo conduction of rat mandibular periodontal repair experiment showed regenerative effectiveness of periodontal complex structure in both HERS and HERS+DFC group in situ, testified by Micro-CT and histological analysis. CONCLUSIONS: HERS cells show potential for periodontal tissue regeneration which suggests the future possibilities of being considered as one of the cell choices for severely damaged periodontal tissue repair.

PPSV-23 recommendation and vaccination coverage in China: a cross-sectional survey among healthcare workers, older adults and chronic disease patients.

BACKGROUND: 23-valent pneumococcal polysaccharide vaccine (PPSV-23) is crucial to protecting high-risk groups. This study aimed to investigate the influencing factors of PPSV-23 recommendation among healthcare workers, and PPSV-23 coverage among Chinese older adults and chronic disease patients. RESEARCH DESIGN AND METHODS: In 2019, a cross-sectional questionnaire survey was conducted in ten provinces in China among older adults aged ≥65 years, chronic disease patients aged 18-64 years, and primary healthcare workers. Multiple logistic regression model was adopted to identify the influencing factors of PPSV-23 recommendation and vaccination uptake. RESULTS: Of the 1138 healthcare workers, 46.75% often recommended PPSV-23 to target groups, and public health workers were more likely to recommend than general practitioners. PPSV-23 vaccination rate was 3.29% among chronic disease patients aged <65 years, 6.69% among older adults without chronic disease(s), and 8.87% among chronic disease patients aged ≥65 years. Multiple logistic regression revealed that only general practitioners' recommendation was associated with increased PPSV-23 coverage (p < 0.05). CONCLUSIONS: The findings highlighted the suboptimal PPSV-23 coverage rate in China and the strong association between healthcare workers' recommendation and residents' vaccination uptake. Targeted and coherent PPSV-23-related training is suggested for general practitioners to encourage effective health promotion in clinical practices.

Precision Feeding in Ecological Pig-Raising Systems with Maize Silage.

Ecological pig-raising systems (EPRSs) differ from conventional breeding systems, focusing more on environmental consequences, human health, and food safety during production processes. Thus productions from EPRSs have undergone significant development in China. Thus far, adding plant fiber sources (e.g., sweet potato leaves, maize or wheat straw, potato, alfalfa, and vinasse) to feed has become a common practice to reduce the cost during the fattening period. Under such a context, it is necessary to choose the precision EPRS diet components and fattening period with low environmental consequences and high economic benefits. This study set up a database via pig growth models to predict environmental and economic performance based on two trials with 0%, 10%, 40%, 60%, and 80% maize silage (dry weight) added to the feed. A continuous curve about plant fiber concentration was built through the generated database. Our results showed that, with increased plant fiber concentration, the environmental performance of the EPRSs exhibited an "increase-decrease-increase" trend, and the economic performance firstly increased and then decreased. The best maize silage added percentages of emergy yield ratio (EYR), environmental loading ratio (ELR), unit emergy value (UEV), and emergy sustainability index (ESI), and the economic profits were 19.0%, 34.3%, 24.6%, 19.9%, and 18.0%, respectively. Besides, the 19.9% sun-dried maize silage added to the feed with a 360-day raising period had the best balance for environmental impact and economic performance. At the balance point, the performances of EYR, ELR, UEV, ESI, and the economic profit were only 0.04%, 3.0%, 0.8%, 0.0%, and 0.1%, respectively, lower than their maximum values. Therefore, we recommended the feed added 20% sun-dried maize silage is suitable for practical pig raising systems.

From COVID-19 Vaccination Intention to Actual Vaccine Uptake: A Longitudinal Study Among Chinese Adults After Six Months of a National Vaccination Campaign.

BACKGROUND: Mass COVID-19 vaccination campaigns have been launched globally, but the translation from vaccination intention to actual vaccine uptake by the public remains unknown, hindering the evaluation of present promotion strategies. METHODS: Six months after the national vaccination campaign in China, a longitudinal study was conducted among the Chinese adult population, whose vaccination intention has been previously surveyed, to examine the vaccine uptake, the relationship between intention and actual vaccination, and factors associated with actual vaccination behaviors with multiplelogistic models. RESULTS: Among the total 1047 participants, 81.8% (834/936) of those who had a prior COVID-19 vaccination intention before the campaign actually received the vaccine, while 61.3% (68/111) of those without a prior intention got vaccinated. Having a prior vaccination intention, believing in vaccine safety and receiving frequent recommendations from community sources were significant predictors of vaccine uptake, while the shortage of vaccine supply would reduce the likelihood of getting vaccinated. CONCLUSIONS: Promotion interventions for vaccination intentions need to be launched well before the availability of the vaccine. Sustaining vaccination attitudes and intentions, reducing barriers (e.g. vaccine safety concerns, accessibility, affordability) and shaping vaccination behavior would be effective in closing the intention-action gap and motivating vaccine uptake.

Schwann cell-derived EVs facilitate dental pulp regeneration through endogenous stem cell recruitment via SDF-1/CXCR4 axis.

The dental pulp is critical for physiological vitality of the tooth, and dental pulp regeneration has great potential for rebuilding live pulp tissue after pulp disease. Schwann cells (SCs) play a critical role in the support, maintenance, and regeneration of nerve fibers in dental pulp. Extracellular vesicles (EVs), which possess cell homing and tissue repair potential, derived from SCs (SC-EVs), can regulate dental mesenchymal stem cells (MSCs) proliferation, multipotency, and self-renewal. However, the role of SC-EVs in dental pulp tissue regeneration remains unclear. To address this question, we treated dental pulp stem cells (DPSCs) and bone marrow stem cells (BMSCs) with SC-EVs, and the results showed an obvious increase in the proliferation, migration, and osteogenic differentiation of both cell types. SC-EVs also promoted neurite outgrowth and neuron migration of rat dorsal root ganglia, as well as vessel formation in vitro. In an in vivo model of subcutaneous, SC-EVs enhanced the recruitment of endogenous vascular endothelioid-like cells and MSCs, and promoted the formation of a pulpo-dentinal complex-like structure. Finally, mass spectrometry analyses and western blot revealed that stromal cell-derived factor 1 (SDF-1, also known as CXCL12) plays a dominant role in SC-EVs. Together, these data suggest that SC-EVs successfully recruit endogenous stem cells to promote dental pulp regeneration. Our results provide a cell-free strategy for pulp regeneration that avoids the risks associated with stem cell transplantation. STATEMENT OF SIGNIFICANCE: Dental pulp is vulnerable to infections resulting from dental care, trauma, and multiple restorations, with such infections resulting in pulpitis and pulp necrosis. The current endodontic treatment of irreversible pulp disease cannot restore the function of dental pulp and tissue engineering strategies using cell-based approaches are limited by several disadvantages, including immune rejection and limited cell sources. In this study, we found that schwann cells-derived EVs facilitated dental pulp regeneration through endogenous stem cells recruitment via SDF-1/CXCR4 axis without exogenous cell transplantation. We believe that our study makes a significant contribution to describe a cell-free strategy to promote dental pulp regeneration.

[Cone beam CT imaging findings in patients with temporomandibular joint disorder syndrome and unilateral chewing].

PURPOSE: To analyze the cone beam CT (CBCT) features in patients with temporomandibular disorder syndrome (TMD) and unilateral chewing. METHODS: A total of 80 patients with temporomandibular disorder syndrome (TMD) and unilateral chewing were selected as the experimental group, and 40 healthy volunteers were selected as the control group. Both groups underwent bilateral CBCT scans to obtain three-dimensional images, and the temporomandibular joint(TMJ) parameters were measured and compared between the two groups. The data were analyzed performed using SPSS 22.0 software package. RESULTS: There was no significant difference in bilateral TMJ parameters in the control group(P＞0.05). The inner and outer diameter of the condyle on the unilateral chewing side of the experimental group was significantly lower than that on the non-unilateral chewing side, and the condyle horizontal angle and condyle height were significantly higher than those on the non-unilateral chewing side(P＜0.05). The anteroposterior diameter of the condyle, the inner and outer diameter of the condyle, the horizontal angle of the condyle, the vertical angle of the condyle, the intra-articular space and the post-articular space of the experimental group were significantly lower than those of the control group, while the pre-articular space was significantly higher than that of the control group(P＜0.05). The anteroposterior diameter and retro-articular space of the condyle on the non-unilateral chewing side were significantly lower than those in the control group, and the inner and outer diameters of the condyle were significantly higher than those on the unilateral chewing side, and the height of the condyle was significantly lower than that on the unilateral chewing side(P＜0.05). CONCLUSIONS: Patients with TMD syndrome and unilateral chewing have abnormal changes in bilateral TMJ structure, showing medial and posterior displacement of the condyle on the unilateral chewing side and a compensatory increase in the pre-articular space on the non-unilateral chewing side.

The Acceptance of COVID-19 Vaccination Under Different Methods of Investigation: Based on Online and On-Site Surveys in China.

As Coronavirus Disease-2019 (COVID-19) vaccines became available in December 2020, increasingly more surveys were organized to examine the acceptance of vaccination, while most of them were conducted online. This study aimed to explore the difference between online and traditional on-site surveys in terms of COVID-19 vaccine acceptance. From November to December 2020, an online survey (n = 2013) and an on-site survey (n = 4,316) were conducted simultaneously in China. Multivariate logistic regression was used to identify influencing factors of acceptance, and propensity score matching (PSM) was adopted to balance the outcomes. As a result, 90.0% of the online respondents accepted COVID-19 vaccination, while it was only 82.1% in the on-site survey. After applying PSM, the acceptance rate of the on-site survey was declined to 78.6%. The age structure, residence location, education, and health status were observed as important factors in addressing vaccination acceptance, which needed to be specifically considered when designing online surveys.

Public Perceptions and Acceptance of COVID-19 Booster Vaccination in China: A Cross-Sectional Study.

Coronavirus disease 2019 (COVID-19) booster vaccination has been proposed in response to the new challenges of highly contagious variants, yet few studies have examined public acceptance of boosters. This study examined public acceptance of COVID-19 booster vaccination and its influencing factors by using the data from a self-administered online cross-sectional survey conducted in June 2021 in China. Multiple logistic analysis was used to examine the influencing factors of booster acceptance based on the health belief model (HBM). Among 1145 respondents, 84.80% reported to accept COVID-19 booster vaccination. Having COVID-19 vaccination history, perceiving high benefits and low barriers to booster vaccination, being younger (18-30 vs. 41-50), having a lower education level, being employed, and belonging to priority groups for vaccination were associated with increased odds of booster acceptance. The primary reason for refusing booster vaccination was concern about vaccine safety. The vast majority (92.8%) of respondents reported an annual willingness to pay between 0 and 300 CNY (0-46.29 USD) if the booster was not free. Our findings suggest that the acceptance rate of booster vaccination is relatively high in China, and the HBM-based analysis reveals that more efforts are needed to increase perceived benefits and reduce perceived barriers of vaccination to design effective and proper vaccination extension strategies when boosters become widely recommended.

Willingness to accept COVID-19 vaccine among the elderly and the chronic disease population in China.

A cross-sectional field survey was conducted from November 2020 to January 2021 among 7259 participants to investigate the public perception, willingness, and information sources for COVID-19 vaccination, with the focus on the elderly and non-communicable chronic disease (NCD) population. Multiple logistic regressions were performed to identify associated factors of the vaccination willingness. The willingness rate of the elderly to accept the future COVID-19 vaccine (79.08%) was lower than that of the adults aged 18-59 (84.75%). The multiple analysis didn't identify significant relationship between NCD status and the vaccination intention. The main reasons for vaccine hesitancy by the public were: concern for vaccine safety, low infection risk, waiting and seeing others getting vaccinated, concern of vaccine effectiveness and price. Their relative importance differed between adults aged 18-59 and the elderly, and between adults aged 18-59 with or without NCD. Perception for vaccination importance, vaccine confidence, and trust in health workers were significant predictors of the vaccination intention in both age groups. The elderly who perceived high infection risk or had trust in governments were more likely to accept the vaccine. Compared with the adults aged 18-59, the elderly used fewer sources for COVID-19 vaccination information and more trusted in traditional media and family, relatives, and friends for getting vaccination recommendations. To promote vaccine uptake, the vaccination campaigns require comprehensive interventions to improve vaccination attitude, vaccine accessibility and affordability, and tailor strategies to address specific concerns among different population groups and conducted via their trusted sources, especially for the elderly.

Association Between Traditional Herbal Diet and Nasopharyngeal Carcinoma Risk: A Prospective Cohort Study in Southern China.

INTRODUCTION: Prospective evidence for herbal diet and nasopharyngeal carcinoma (NPC) development is absent. We therefore evaluated the associations of herbal soup and herbal tea with NPC in a prospective cohort study in southern China. METHODS: Based on an NPC screening cohort established in 2008-2015, information on herbal diet consumption, potential confounding factors, and Epstein-Barr virus (EBV) antibody levels were collected from 10,179 individuals aged 30-69 years in Sihui city, southern China. Cox regression models were performed to examine herbal diet with NPC risk, and logistic regression models were used to examine herbal diet with EBV reactivation. RESULTS: During a median of 7.54 years of follow-up, 69 participants developed NPC. Herbal soup consumption was associated with decreased NPC risk, with HRs of 0.31 (95% confidence interval (CI): 0.15-0.62) for the highest intake frequency and 0.29 (95% CI: 0.16-0.51) for a longer duration. However, herbal tea was not significantly associated. Moreover, we identified herbal soup was inversely associated with EBV seropositivity among all the participants at baseline, with the adjusted ORs being 0.78 (95% CI: 0.65-0.93) for immunoglobulin A antibodies against EBV capsid antigens (VCA-IgA) and 0.76 (95% CI: 0.64-0.91) for nuclear antigen 1 (EBNA1-IgA) in those with the highest frequency and 0.70 (95% CI: 0.59-0.84) for VCA-IgA and 0.64 (95% CI: 0.54-0.77) for EBNA1-IgA in those with the longer duration. Inverse associations were also observed in non-NPC individuals. CONCLUSIONS: With inhibition of EBV reactivation by plants, herbal soup could significantly decrease the risk of NPC in endemic areas.

Caregivers' intentions to COVID-19 vaccination for their children in China: a cross-sectional survey.

Chinese caregivers' intentions to allow their children to be vaccinated against coronavirus disease 2019 (COVID-19) is unknown. We explored the intention rate of Chinese caregivers to allow their children to be vaccinated and examined potential influencing factors and underlying reasons for their unwillingness or hesitation. From November 30, 2020, to January 31, 2021, we conducted a cross-sectional survey of 3703 caregivers in six representative provinces in China. We assessed intention rates and correlates of caregivers' intentions to vaccinate children against COVID-19, using descriptive analyses and a multiple logistic regression analysis, respectively. In the study sample, about 84.0% of caregivers intended to get their children vaccinated for COVID-19 if the vaccine was available. In particular, 92.2% of caregivers who were willing to be vaccinated themselves for COVID-19 intended to have their children vaccinated, yet among caregivers who were unwilling (or uncertain) whether to be vaccinated, only 41.1% intended to have their children vaccinated. Older age, lower education level, and perceived safety and effectiveness of the COVID-19 vaccine were associated with increased odds of caregivers intending to have their children vaccinated. Of the six provinces included in the study, residence in a province other than Hubei increased the likelihood that caregivers would choose not to have their children vaccinated. We found a relatively high vaccination rate (84.0%) among caregivers by using a cross-sectional sample in China. Concerted efforts are needed to address caregivers' concerns about vaccine safety, especially among caregivers who do not intend to be vaccinated themselves.

Plain Language Summary: Recently, COVID-19 infection in children has increased. Although most countries have not approved the COVID-19 vaccine for children, it is likely that they will do so. There is a clear need to explore caregivers' intentions and to understand potential hesitancy as means to inform vaccination policies. We found a relatively high caregivers' intention rate to have their children vaccinated against COVID-19, and caregivers' intentions to be vaccinated themselves was associated with their own decision to have their children vaccinated. In this study, older age, lower education level, belief that the COVID-19 vaccine was safe and effective, and residence in Hubei province were associated with increased odds of caregivers intending to have their children vaccinated. Policy makers should address caregivers' concerns about vaccine safety and encourage caregivers themselves to get vaccinated before they decide to have their children vaccinated.

The associations of geographic location and perceived risk of infection with the intentions to get vaccinated against COVID-19 in China.

BACKGROUND: Vaccines are a critical tool against coronavirus disease 2019 (COVID-19) pandemic, yet little is known regarding the associations of geographic location and perceived risk with the intentions to get vaccinated against COVID-19 in China. METHODS: An on-site survey of adults aged 18 or older (n = 7261) was conducted from November to December, 2020 in China, and this survey selected six provinces based on the geographic location. RESULTS: In the total sample, 82.5% reported that they would intend to get vaccinated against COVID-19. Compared with Hubei province, respondents' intentions to get vaccinated decreased by 70% in Zhejiang, 61% in Guangdong, 87% in Gansu, and 71% in Jilin, respectively. However, within Hubei province, compared with Wuhan city, respondents' intentions to get vaccinated in other cities were not significantly different. Respondents with higher perceived risk of infection were associated with increased odds of intentions to get vaccinated against COVID-19. CONCLUSION: Our study identified priority geographic regions that need to pay attention on the vaccination campaign and help design effective immunization strategies to increase the vaccine uptake against COVID-19. More attention should be paid to adults residing farther from the epicenter of the outbreak and having lower perceived risk of infection.

The Economic Burden of Influenza-Like Illness among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey.

Background: The disease burden of seasonal influenza is substantial in China, while there is still a lack of nationwide economic burden estimates. This study aims to examine influenza-like illness (ILI) prevalence, healthcare-seeking behaviors, economic impact of ILI, and its influencing factors among three priority groups during the 2018-19 influenza season. Methods: From August to October 2019, 6668 children's caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China to participate in an on-site survey. The economic burden of ILI consisted of direct (medical or non-medical) and indirect burdens, and a two-part model was adopted to predict the influencing factors of total economic burden. Results: There were 45.73% children, 16.77% chronic disease patients, and 12.70% elderly people reporting ILI, and most participants chose outpatient service or over-the-counter (OTC) medication after ILI. The average economic burden was CNY 1647 (USD 237.2) for children, CNY 951 (USD 136.9) for chronic disease patients, and CNY 1796 (USD 258.6) for the elderly. Two-part regression showed that age, gender, whether the only child in the family, region, and household income were important predictors of ILI economic burden among children, while age, region, place of residence, basic health insurance, and household income were significant predictors of ILI economic burden among chronic disease patients and the elderly. Conclusions: A large economic burden of ILI was highlighted, especially among the elderly with less income and larger medical burdens, as well as children, with higher prevalence and higher self-payment ratio. It is important to adopt targeted interventions for high-risk groups, and this study can help national-level decision-making on the introduction of influenza vaccination as a public health project.

The Changing Acceptance of COVID-19 Vaccination in Different Epidemic Phases in China: A Longitudinal Study.

COVID-19 vaccines have been conditionally used in a few countries, including China since December 2020. The present study aimed to examine whether the acceptance of COVID-19 vaccination changed in different COVID-19 epidemic phases in China. Two consecutive surveys were conducted among Chinese adults in March (n = 2058) (severe epidemic phase) and November-December (n = 2013) (well-contained phase, right before the COVID-19 vaccine was conditionally approved) 2020, and 791 respondents were longitudinally followed-up. The attitude, acceptance, and preferences for future COVID-19 vaccination were compared between two epidemic phases. Multivariate logistic regression was used to identify influencing factors of acceptance. Among the 791 respondents longitudinally followed, 91.9% in March and 88.6% of them in November-December 2020 would like to get COVID-19 vaccination in China. In March 58.3% wished to get vaccinated immediately, but the proportion declined to 23.0% in November-December 2020, because more respondents wanted to delay vaccination until the vaccine's safety was confirmed. Similar results were found by comparing all respondents from the two cross-sectional surveys in different epidemic phases. The risk perception, attitude for the importance of vaccination against COVID-19, vaccination history, valuing doctor's recommendations, vaccination convenience, or vaccine price in decision-making had impacts on respondents' intention for immediate vaccination. The public acceptance for COVID-19 vaccination in China sustained at a high level in different COVID-19 epidemic phases. However, the intention of immediate vaccination declined substantially due to concerns about the vaccine's safety. Information about vaccination safety from authoritative sources, doctor's recommendations, and vaccination convenience were important in addressing vaccine hesitancy and promoting successful herd immunity for the general population in China.

Willingness to pay and financing preferences for COVID-19 vaccination in China.

BACKGROUND: The COVID-19 pandemic has caused significant diseases and economic burdens in the world. Vaccines are often considered as a cost-effective way to prevent and control infectious diseases, and the research and development of COVID-19 vaccines have been progressing unprecedently. It is needed to understand individuals' willingness to pay (WTP) among general population, which provides information about social demand, access and financing for future COVID-19 vaccination. OBJECTIVE: To investigate individuals' WTP and financing mechanism preference for COVID-19 vaccination during the pandemic period in China. METHODS: During March 1-18, 2020, we conducted a network stratified random sampling survey with 2058 respondents in China. The survey questionnaires included out-of-pocket WTP, financing mechanism preference as well as basic characteristics of the respondents; risk perception and impact of the COVID-19 pandemic; attitude for future COVID-19 vaccination. Multivariable Tobit regression was used to determine impact factors for respondents' out-of-pocket WTP. RESULTS: The individuals' mean WTP for full COVID-19 vaccination was CNY 254 (USD 36.8) with median of CNY 100 (USD 14.5). Most respondents believed that governments (90.9%) and health insurance (78.0%) needed to pay for some or full portions of COVID-19 vaccination, although 84.3% stated that individuals needed to pay. Annual family income, employee size in the workplace, and whether considering the COVID-19 pandemic in China in a declining trend affected respondents' WTP significantly. CONCLUSION: The findings demonstrated the individuals' WTP for COVID-19 vaccination in China and their preferences for financing sources from individuals, governments and health insurance. And to suggest an effective and optimal financing strategy, the public health perspective with equal access to COVID-19 vaccination should be prioritized to ensure a high vaccination rate.

Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China.

BACKGROUND: Faced with the coronavirus disease 2019 (COVID-19) pandemic, the development of COVID-19 vaccines has been progressing at an unprecedented rate. This study aimed to evaluate the acceptance of COVID-19 vaccination in China and give suggestions for vaccination strategies and immunization programs accordingly. METHODS: In March 2020, an anonymous cross-sectional survey was conducted online among Chinese adults. The questionnaire collected socio-demographic characteristics, risk perception, the impact of COVID-19, attitudes, acceptance and attribute preferences of vaccines against COVID-19 during the pandemic. Multivariate logistic regression was performed to identify the influencing factors of vaccination acceptance. RESULTS: Of the 2058 participants surveyed, 1879 (91.3%) stated that they would accept COVID-19 vaccination after the vaccine becomes available, among whom 980 (52.2%) wanted to get vaccinated as soon as possible, while others (47.8%) would delay the vaccination until the vaccine's safety was confirmed. Participants preferred a routine immunization schedule (49.4%) to emergency vaccination (9.0%) or either of them (41.6%). Logistic regression showed that being male, being married, perceiving a high risk of infection, being vaccinated against influenza in the past season, believing in the efficacy of COVID-19 vaccination or valuing doctor's recommendations could increase the probability of accepting COVID-19 vaccination as soon as possible, while having confirmed or suspected cases in local areas, valuing vaccination convenience or vaccine price in decision-making could hinder participants from immediate vaccination. CONCLUSION: During the pandemic period, a strong demand for and high acceptance of COVID-19 vaccination has been shown among the Chinese population, while concerns about vaccine safety may hinder the promotion of vaccine uptake. To expand vaccination coverage, immunization programs should be designed to remove barriers in terms of vaccine price and vaccination convenience, and health education and communication from authoritative sources are important ways to alleviate public concerns about vaccine safety.