Investigation of Babesia spp. and Theileria spp. in ticks from Western China and identification of a novel genotype of Babesia caballi.

Babesia spp. and Theileria spp. are tick-borne protozoan parasites with veterinary importance. In China, epidemiological and genetic investigations on many Babesia and Theileria species were still absent in many areas and many tick species. From Aug 2021 to May 2023, 645 ticks were collected from the body surface of domestic animals (camels, goats, sheep, and cattle) using tweezers in seven counties in three provinces including Xinjiang (Qitai, Mulei, Hutubi, and Shihezi counties), Chongqing (Youyang and Yunyang counties), and Qinghai (Huangzhong county). Three tick species were morphologically and molecularly identified (334 Hyalomma asiaticum from Xinjiang, 245 Rhipicephalus microplus from Chongqing, and 66 Haemaphysalis qinghaiensis from Qinghai). A total of three Babesia species and two Theileria species were detected targeting the 18S gene. The COI and cytb sequences were also recovered from Babesia strains for further identification. In R. microplus from Chongqing, Babesia bigemina, the agent of bovine babesiosis, was detected. Notably, in H. asiaticum ticks from Xinjiang, a putative novel genotype of Babesia caballi was identified (0.90%, 3/334), whose COI and cytb genes have as low as 85.82% and 90.64-90.91% nucleotide identities to currently available sequences. It is noteworthy whether the sequence differences of its cytb contribute to the drug resistance of this variant due to the involvement of cytb in the drug resistance of Babesia. In addition, Theileria orientalis and Theileria annulata were detected in R. microplus from Chongqing (12.20%, 31/245) and H. asiaticum from Xinjiang (1.50%, 5/334), respectively. These results suggest that these protozoan parasites may be circulating in domestic animals in these areas. The pathogenicity of the novel genotype of B. caballi also warrants further investigation.

A novel nomogram to predict testicular torsion in children with acute scrotal pain: a single-center retrospective study in western China.

Background: Acute scrotal pain (ASP) is the most common urological emergency in pediatrics, and its causes include testicular torsion (TT), testicular appendage torsion, and epididymo-orchitis. Among them, TT requires prompt and accurate diagnosis and urgent surgical exploration to prevent testicular loss. Conservative anti-infective treatment is recommended for epididymo-orchitis, and surgery is considered only when scrotal abscess formation and sepsis occur. Improving the understanding of TT in primary care doctors, early diagnosis, and timely surgical exploration are essential to improve the survival rate of TT and avoid excessive treatment. This study aimed to explore the risk factors for TT in children with ASP and construct a predictive model. Methods: Clinical data of children who presented with ASP and underwent emergency scrotal exploration surgery were retrospectively analyzed, including general information, physical examination, laboratory tests, and color Doppler ultrasonography (CDU) findings. Based on surgical exploration, the outcomes were categorized as confirmed TT or not. Results: A total of 283 children were included in this study, among whom 134 had TT. The mean age of all patients was 105±47.9 months, with the majority being of Han ethnicity (87.6%) and residing in urban areas (83%). Most patients had normal C-reactive protein levels and negative results in urine routine white blood cell tests (63.3%). After conducting univariate and multivariate logistic regression analyses, we identified laterality, neutrophil count, mean erythrocyte sedimentation rate, epididymal blood flow signal, testicular parenchymal echogenicity, and testicular blood flow signal as independent risk factors influencing the occurrence of TT in ASP patients. Conclusions: This study is the report with the largest sample size on the construction of prediction models for ASP in children in southwestern China. The predictive model we developed demonstrated excellent performance and higher accuracy in predicting TT in children compared to the traditional Testicular Workup for Ischemia and Suspected Torsion (TWIST) score. It can assist pediatric surgeons in diagnosing and treating children with ASP.

[Relationship between serum 25-hydroxyvitamin D and handgrip strength in middle-aged and elderly people in five cities of Western China].

OBJECTIVE: To explore the association between serum 25-hydroxyvitamin D [25(OH)D] and handgrip strength in middle-aged and elderly people in 5 cities of Western China. METHODS: Based on the data of a cross-sectional survey conducted in the 5 cities of Western China from February to July 2023, the relevant demographic characteristics of people were collected by questionnaire, handgrip strength was collected by physical examination, and serum 25(OH)D was detected by HPLC-MS/MS. The association between the serum 25(OH)D and handgrip strength was analyzed using Logistic regression and Chi-square test for between-group comparisons models. RESULTS: The prevalence of 25(OH)D deficiency and insufficiency among the middle-aged and elderly people in the 5 cities of Western China was 52.9% and 34.5%, respectively. The people who were older, female, and sampled in winter had lower serum 25(OH)D levels (P < 0.05). The prevalence of loss of handgrip strength among the middle-aged and elderly people was 25.3%. The prevalence of handgrip strength loss was higher in the aged 65-80 participants with 25(OH)D deficiency (45. 0%) than in those with 25(OH)D insufficiency (32.6%) and 25(OH)D sufficiency (20.6%). The highest prevalence of loss of handgrip strength was found in the aged 75-80 participants with 25(OH)D deficiency (62. 1%), followed by the 25(OH)D insufficient group (11.1%, P < 0.05). The study found that middle-aged and elderly people with 25(OH)D deficiency had a 1.4-fold increased risk of handgrip strength loss compared with those with 25(OH)D sufficiency (OR=2.403, 95%CI: 1.202-4.804, P=0.013). No significant association was found between 25(OH)D insufficiency and handgrip strength status in the middle-aged and elderly people. For every 5 µg/L increase in total serum 25(OH)D, the risk of handgrip strength loss reduced by 13.1% (OR=0.869, 95%CI: 0.768-0.982, P=0.025). For every 5 µg/L increase in serum 25(OH)D2, the risk of handgrip strength loss reduced by 24.1% (OR=0.759, 95%CI: 0.582-0.990, P=0.042). No significant association was found between serum 25(OH)D3 levels and the risk of handgrip strength loss. The risk of handgrip strength loss in middle-aged and elderly people was reduced by 25.2% for each incremental increase in the total serum 25(OH)D levels (deficient, insufficient and sufficient) (OR=0.748, 95%CI: 0.598-0.936, P=0.011). The risk of handgrip loss was reduced by 40.0% for each incremental increase in serum 25(OH)D levels in the aged 65-80 and aged 65-69 participants, and by 80.0% for each incremental increase in 25(OH)D levels in the aged 75-80 parti-cipants. CONCLUSION: Serum total 25(OH)D and 25(OH)D2 levels are associated with handgrip strength status in middle-aged and elderly people in the 5 cities of Western China.

Effect of the combined intervention of low-FODMAPs diet and probiotics on IBS symptoms in Western China: A randomized controlled trial.

The effect of low-FODMAPs diet on irritable bowel syndrome (IBS) in Western China has not been reported. We aimed to investigate the effect of low-FODMAPs diet on IBS patients in the area and whether low-FODMAPs diet-induced alterations of microbiota could be improved through probiotics. IBS patients were randomized to the control group, low-FODMAPs diet group, probiotics group, or combined group. IBS Symptom Severity Score questionnaire (IBS-SSS) and IBS Quality of Life Score questionnaire (IBS-QOL) were completed at baseline, 2 and 4 weeks to evaluate the severity of symptoms. Fresh feces were collected for analyses of gut microbiota and short-chain fatty acids at baseline and 4 weeks after intervention. Seventy-three patients were included in the per protocol analysis. After intervention, there was significant improvement in IBS-SSS in the low-FODMAPs group (37.5%, 44.2%), probiotics group (51.4%, 62.0%), and combined group (34.1%, 40.4%) at both 2 weeks and 4 weeks, compared with the baseline (p < .05). In the low-FODMAPs group, the abundance of several microbiota (Lachnoclostridium, Enterococcus, etc.) was significantly decreased. Furthermore, after the supplementation of probiotics in the combined group, the abundance of Genus_Ruminococcus, Coprococcus, Acidaminococcus, Ruminiclostridium, Akkermansia, Eggerthella, and Oxalobacter was significantly increased, which was associated with the improvements of symptoms score in the Pearson correlation analysis. Our study confirmed the effectiveness and safety of short-term low-FODMAPs diet in IBS symptoms based on the Chinese diet in Western China. The combination of low-FODMAPs and probiotics plays a beneficial role in gut microbiota in IBS.

Knowledge, attitude, and practice of medication and its influencing factors among residents in western China: a large-scale cross-sectional study.

Background: This study aimed to understand the knowledge, attitude, and practice (KAP) of drug use among residents in western China and its influencing factors for accurately designing the knowledge, contents, and methods of popular science activities for safe drug use among residents to provide a reference for conducting rational drug use educational activities and improving residents' level of safe drug use. Methods: A cross-sectional questionnaire survey was conducted to investigate the KAP of medication among western China residents and its influencing factors from March to April 2023. Each question option was assigned a score according to logic, and the risk factors for resident medication safety KAP were explored through univariate and logistic regression analyses. Results: A total of 7,557 valid questionnaires were collected, with an effective recovery rate of 96.7%. The average scores of KAP were 72.77 ± 22.91, 32.89 ± 10.64, and 71.27 ± 19.09, respectively. In the evaluation criteria of the questionnaire, the score of medication knowledge reached "good," and the score of attitude and practice was "average." Multiple linear regression analysis indicated that male sex and low education level were significant factors affecting the lack of drug knowledge among residents. Old age and low education level were the factors of poor attitude toward medication. The low condition of medical security was a factor in residents' irregular drug use behavior. Conclusion: The overall level of rational drug use among residents in western China is good, but there are still some inconsistencies. Rational drug use education should be conducted according to the risk points of residents in drug safety KAP to further improve the level of rational drug use of residents.

Evaluation of the current situation and quality of neonatal hearing screening from hearing screening practitioners' perspective: a cross-sectional study.

BACKGROUND: In recent years, neonatal hearing screening (NHS) has gained rapid traction in both developed and developing nations. However, the efficacy of these efforts depends on comprehensive standardization across all screening facets. This study aimed to assess the status and quality of NHS by investigating the knowledge, attitudes, beliefs, and practices of hearing screening practitioners regarding NHS. METHODS: A cross-sectional survey was conducted, and an online questionnaire based on the knowledge-attitude/belief (A/B)-practice model was distributed to all NHS practitioners in Luzhou, western China. Valid questionnaires were examined and uniformly graded. RESULTS: A total of 63 valid questionnaires were collected. The practitioners were mainly female (96.83%), with nursing backgrounds (63.49%), and undergraduate degrees (66.67%). Most had ≤5 years of experience (74.60%) and had junior/intermediate titles (93.65%). The NHS within the Luzhou area started in 2006 with provincial institutions, expanding to 42 institutions by 2022. Statistically significant correlations were observed between the A/B score and the conducting years of each NHS institution (p < .05) as well as between the Knowledge (K) and Practice (P) scores (p < .01). No significant correlation was found between the K score, P score, A/B score, and working years of practitioners (p > .05), or in the total score of NHS institutions at different levels or in different counties by one-way ANOVA (p > .05). CONCLUSIONS: It has been 17 years since the first medical institution in Luzhou launched NHS, and the overall performance of practitioners from different institutions has been consistent in terms of their knowledge, attitudes, or level of practice. However, there is room for further improvement in both the professional development of individuals and aspects related to work, such as health education and long-term follow-up.

Three new species and two newly recorded species of Tachininae from Tibet, China (Arthropoda, Insecta, Diptera, Tachinidae).

During our studying of the fauna of Tibet, China, many specimens of the subfamily Tachininae (Diptera, Tachinidae) were collected and examined. Three species are described here as new to science, Leskialatisurstylasp. nov., Trichoformosomyiacuonaensissp. nov., and Tachinajilongensissp. nov., and two species, Nemoraeajavana (Brauer & Bergenstamm, 1894) and N.echinata Mesnil, 1953, are newly recorded from Tibet. In addition to their descriptions, illustrations, and diagnoses, three identification keys are provided. The specimens in this study are kept in the Insect Collection of Shenyang Normal University, China (SYNU).

Barriers and Implications of 5G Technology Adoption for Hospitals in Western China: Integrated Interpretive Structural Modeling and Decision-Making Trial and Evaluation Laboratory Analysis.

BACKGROUND: 5G technology is gaining traction in Chinese hospitals for its potential to enhance patient care and internal management. However, various barriers hinder its implementation in clinical settings, and studies on their relevance and importance are scarce. OBJECTIVE: This study aimed to identify critical barriers hampering the effective implementation of 5G in hospitals in Western China, to identify interaction relationships and priorities of the above-identified barriers, and to assess the intensity of the relationships and cause-and-effect relations between the adoption barriers. METHODS: This paper uses the Delphi expert consultation method to determine key barriers to 5G adoption in Western China hospitals, the interpretive structural modeling to uncover interaction relationships and priorities, and the decision-making trial and evaluation laboratory method to reveal cause-and-effect relationships and their intensity levels. RESULTS: In total, 14 barriers were determined by literature review and the Delphi method. Among these, "lack of policies on ethics, rights, and responsibilities in core health care scenarios" emerged as the fundamental influencing factor in the entire system, as it was the only factor at the bottom level of the interpretive structural model. Overall, 8 barriers were classified as the "cause group," and 6 as the "effect group" by the decision-making trial and evaluation laboratory method. "High expense" and "organizational barriers within hospitals" were determined as the most significant driving barrier (the highest R-C value of 1.361) and the most critical barrier (the highest R+C value of 4.317), respectively. CONCLUSIONS: Promoting the integration of 5G in hospitals in Western China faces multiple complex and interrelated barriers. The study provides valuable quantitative evidence and a comprehensive approach for regulatory authorities, hospitals, and telecom operators, helping them develop strategic pathways for promoting widespread 5G adoption in health care. It is suggested that the stakeholders cooperate to explore and solve the problems in the 5G medical care era, aiming to achieve the coverage of 5G medical care across the country. To our best knowledge, this study is the first academic exploration systematically analyzing factors resisting 5G integration in Chinese hospitals, and it may give subsequent researchers a solid foundation for further studying the application and development of 5G in health care.

Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study.

OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

Measuring the cross-border spillover effects and telecoupling processes of ecosystem services in Western China.

Ecosystem services provide the basic elements for global economic development. In the context of the deepening global integration process, countries and regions are increasingly connected, resulting in a series of cross-country, cross-regional, multi-scale socio-economic-environmental impacts, these new situations and changes require a multi-site, two-way, and cross-temporal and spatial scale comprehensive study of "the relationship between ecosystem services and humans". Based on this, we apply a telecoupling synthesis framework to explore the socio-economic and eco-environmental interactions of ecosystem service spillover effects. Results show that (1) the spillover effect of ecosystem services in western China is significant. More than 66% of ecosystem services spillover to eastern China provinces, and more than 40% of ecosystem services spillover to countries in Southeast Asia, South Asia, and Central Asia, resulting in a total of 679 million people benefiting from the spillover effect. (2) There are also multiple telecoupling processes between the ecosystem service spillovers in the ecologically fragile areas in western China and the rest of the world. In combination with the scenario simulation of the InVEST model, the services such as water supply, soil retention, flood mitigation, and food supply have significant impacts on sustainable development and human well-being in Asia and even the world. (3) The positive feedback effect of telecoupling is critical to the protection of the ecological environment as well as the improvement of people's livelihood and well-being in Western China's ecologically fragile areas. Therefore, we propose strengthening ecological compensation cooperation between local governments and implementing compensatory transfer payments between upstream and downstream. Simultaneously, international cooperation must be strengthened, and an ecological compensation transfer mechanism with beneficiary countries must be established, while the cross-regional flow of ecosystem services must be maintained. This study provides an example for the "ecosystem services and human relations" in multiple places, two directions and across time and space scales, and also practical reference significance for China implementation of projects such as the "the Belt and Road" initiative and transnational and cross regional resource allocation.

The Relationship between Principals' Instructional Leadership and Teacher Retention in the Undeveloped Regions of Central and Western China: The Chain-Mediating Role of Role Stress and Affective Commitment.

Enhancing teacher retention in underdeveloped regions of Central and Western China is an important issue for high-quality education development. By investigating 1558 teachers from nine provinces and municipalities in these regions, this study uses quantitative research methods to analyze the relationship between principals' instructional leadership and teacher retention and introduces a moderated chain-mediated model. The results show that principals' instructional leadership and teacher retention are at a relatively moderate to high level in these regions. Principals' instructional leadership not only has direct effect on teacher retention, but also has indirect effects by three paths: through the separate mediating role of role stress, the separate mediating role of affective commitment, and the chain-mediating role of role stress and affective commitment. Teacher gender negatively moderates the relationship between principal's instructional leadership and teacher role stress. The sample need to be extended to developed areas to form a comparison. Underdeveloped regions of Central and Western China also need to take more action.

Cut-off points of the Ishii test to diagnosing severe sarcopenia among multi-ethnic middle-aged to older adults: results from the West China Health and Aging Trend study.

Objective: This study was designed to establish the cut-off value and diagnostic utility of the Ishii test, which gauges the odds of severe sarcopenia based on the results of an equation based upon age, grip strength, and calf circumference among middle-aged and older adults in Western China. Methods: This study incorporated adults ≥ 50 years of age from the West China Health and Aging Trend (WCHAT) study. Severe sarcopenia was defined as per the Asian Working Group for Sarcopenia: 2019 Consensus (AWGS2019) recommendations, with the odds of severe sarcopenia being estimated with the Ishii test score chart. The diagnostic utility of the Ishii test in this patient cohort was assessed by analyzing its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve (AUC). Results: In total, 4,177 individuals ≥ 50 years of age were included in this study including 2668 females (63.9%) and 1,509 males (36.1%). These included 568 (13.6%) participants affected by severe sarcopenia, of whom 237 were male (15.7%) and 331 were female (12.4%). Optimal Ishii test cut-off values established based on Youden's index were ≥ 114 for males and ≥ 120 for females when using the AWGS2019 reference standard. The sensitivity/specificity/PPV/NPV of the Ishii test when screening for severe sarcopenia were 89.45%/77.15%/0.42/0.98 in males and 90.03%/77.05%/0.36/0.98 in females. The AUC values for the Ishii test in males and females were 0.899 (95% CI, 0.883-0.916) and 0.905 (95% CI, 0.892-0.917), respectively. Conclusion: These data indicate that the Ishii test offers value as a candidate diagnostic test that can be used to screen for severe sarcopenia, with recommended diagnostic cut-off values of ≥ 114 for males and ≥ 120 for females.

Geographical equations of Swertia mussotii bioactivities: evidence from the western Sichuan region of China.

Swertia mussotii is the most authentic raw material used in Tibetan medicine in China for its various bioactivities. This natural medicine resource is at risk of being exhausted due to the double interference of climate change and anthropogenic over-collection. Little is known about habitat characteristics and the crucial environmental factors that influence the levels of active ingredients. The goal of this study is to understand the variability in the bioactive compound content of a wide range of wild S. mussotii as it adapts to changing environmental conditions. The target compound content of the whole plant material was analyzed with the environmental explanatory variables of the field sample sites using a constrained ordination method for their correlation analysis. The results show that 16.3 percent of the sampled wild S. mussotii populations with the highest bioactive content can be grouped into the elite type. The most prominent environmental variables affecting the content of major bioactive products include altitude, aspect, soil TK content, Fe content, and C/N and N/P ratios. Altitude and aspect put indirect effects that are mediated by plant height and density, N/P ratio puts a direct effect, while soil TK content, Fe content and C/N ratio have both direct and indirect effects on the bioactivity of S. mussotii. In addition to the total negative effects of altitude and C/N ratio, the remaining factors play a driving role. These findings demonstrate variation by geographical conditions across S. mussotii accessions for physiologic responses and secondary compounds in wild populations. The knowledge gained from this study can be used for environmental and plant physiology research, efficient collection of naturally active compounds, and conservation strategies for rare natural plant resources.

Abundance, community and driving factor of nitrifiers in western China plateau.

Complete ammonia oxidation (comammox) is one of the most important biogeochemical processes, with recent studies showing that comammox process dominates nitrification in many ecosystems. However, the abundance, community and driving factor of comammox bacteria and other nitrifying microorganisms in plateau wetland is still unclear. Here, the abundances and community features of comammox bacteria, ammonia-oxidizing archaea (AOA) and ammonia-oxidizing bacteria (AOB) in the wetland sediments of western China plateaus were examined using qPCR and high-throughput sequencing. The results indicate that comammox bacteria were more abundant than AOA and AOB, and dominated the nitrification process. Compared with low-elevation samples (below 3000 m: samples 6-10, 12, 13, 15, 16), the abundance of comammox bacteria was much higher at high-elevation samples (above 3000 m: samples 1-5, 11, 14, 17, 18). The key species of AOA, AOB, and comammox bacteria were Nitrososphaera viennensis, Nitrosomonas europaea, and Nitrospira nitrificans, respectively. The key factor affecting comammox bacteria community was elevation. Elevation could increase the interaction links of key species Nitrospira nitrificans, resulting in high comammox bacterial abundance. The results of this study advance our knowledge of comammox bacteria in natural ecosystems.

The accuracy of body mass index and calf circumference values when assessing sarcopenia in a multi-ethnic cohort of middle-aged and older adults: West China health and aging trend study results.

Objective: This analysis was designed to explore the utility of body mass index (BMI) and calf circumference (CC) values in the diagnosis of sarcopenia. Methods: A cross-sectional analysis of community-dwelling adults ≥50 years old was conducted. An InBody 770 bioimpedance analysis (BIA) device was used for measuring muscle mass, a grip-strength dynamometer was used to assess muscle strength, and a 4 m gait speed (GS) analysis was used to gauge physical function. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used to define sarcopenia. The cut-off values for BMI and CC were based on the computed Younden's index values and AWGS 2019 criteria, respectively. The area under the ROC curves (AUC), specificity, sensitivity, and positive and negative predictive values (PPV and NPV) were calculated to establish the value of BMI and CC for the diagnosis of sarcopenia. Results: In total, the data of 4177 participants ≥50 years of age were analyzed. These included 2668 (63.9%) females and 1509 (36.1%) males. Of these participants, 946 (22.6%) met the criteria for sarcopenia, including 408 (27%) males and 538 (20.2%) females. The sensitivity, specificity, and NPVs obtained when using BMI and CC values to predict sarcopenia were as follows: 84.03%/65.51%/0.90 and 74.76%/83.51%/0.87, respectively, in males; 87.36%/64.12%/0.94 and 78.25%/82.09%/0.93, in females. The respective AUC values for BMI and CC in males were 0.83 (0.80-0.85) and 0.85 (0.83-0.88), while in females they were 0.85 (0.83-0.87) and 0.88 (0.87-0.90). Conclusions: These data suggest that BMI and CC can both serve as accurate predictors of sarcopenic incidence in a multi-ethnic population ≥50 years of age. The specificity values for BMI were relatively low in both males and females, however, underscoring the relative advantages of measuring CC when assessing individual sarcopenia risk.

Diffusion of a micronutrient home fortification program for infants and toddlers in a multi-ethnic population in rural western China.

BACKGROUND: The micronutrient home fortification programs contribute to the prevention of childhood anemia. WHO suggested applying culturally appropriate strategies to implement the micronutrient home fortification programs in various communities. However, there is little knowledge on evidence-based effective diffusion strategies of the micronutrient home fortification programs in multi-ethnic populations. This study aims to examine the diffusion of a micronutrient home fortification program with micronutrient powder (MNP) in a multi-ethnic population by investigating factors associated with being an 'early' or a 'later' adopter of MNP. METHODS: We conducted a cross-sectional study in rural western China. Multistage sampling was used to select children's caregivers in Han, Tibetan, and Yi ethnic communities (N = 570). The diffusion of innovations theory informed the data collection on caregivers' decision process and was applied to classify participants into the MNP adopter categories of 'leaders', 'followers', 'loungers', and 'laggards'. The ordered logistic regression model estimated the factors associated with the MNP adopter categories. RESULTS: Caregivers from the Yi ethnic subgroup were likely to adopt MNP relatively late (AOR = 1.67; 95%CI = 1.09, 2.54) compared with Han and Tibetan ethnic subgroups. Caregivers with more knowledge regarding the MNP feeding method (AOR = 0.71; 95%CI = 0.52, 0.97) and those with stronger self-efficacy in adopting MNP (AOR = 0.85; 95%CI = 0.76, 0.96) were more likely to adopt MNP earlier than others. The following messages and channels also tend to make caregivers adopt MNP earlier: hearing that 'MNP was free' from villagers (AOR = 0.45; 95%CI = 0.20, 0.98), and learning 'MNP feeding method' from township doctors (AOR = 0.16; 95%CI = 0.06, 0.48). CONCLUSIONS: Disparities in adopting MNP existing among different ethnic groups require more effective diffusion strategies in disadvantaged minority ethnic groups. Enhancing self-efficacy in adopting MNP and knowledge on feeding method of MNP have the potential to make caregivers adopt MNP earlier. Peer networks and township doctors can be effective agencies to facilitate the diffusion and adoption of MNP.

Adults in Northwest China experienced the largest outbreak of Japanese encephalitis in history 10 years after the Japanese encephalitis vaccine was included in the national immunization program: A retrospective epidemiological study.

Mainland China included Japanese encephalitis (JE) vaccine in the national immunization program in 2008 to control the JE epidemic. However, Gansu province in Western China experienced the largest JE outbreak since 1958 in 2018. We conducted a retrospective epidemiological study to explore the causes of this outbreak. We found that adults aged ≥20 years (especially those in rural areas) were the main JE cases in Gansu Province, with a significant increase in the JE incidence in older adults aged ≥60 years in 2017 and 2018. In addition, JE outbreaks in Gansu Province were mainly located in the southeastern region, while the temperature and precipitation in Gansu Province were gradually increasing in recent years, which made the JE epidemic areas in Gansu Province gradually spread to the western of Gansu Province. We also found that adults aged ≥20 years in Gansu Province had lower JE antibody positivity than children and infants, and the antibody positivity rate decreased with age. In the summer of 2017 and 2018, the density of mosquitoes (mainly the Culex tritaeniorhynchus) in Gansu Province was significantly higher than in other years, and the genotype of JEV was mainly Genotype-G1. Therefore, in the future JE control in Gansu Province, we need to strengthen JE vaccination for adults. Moreover, strengthening mosquito surveillance can provide early warning of JE outbreaks and the spread of epidemic areas in Gansu Province. At the same time, strengthening JE antibody surveillance is also necessary for JE control.

Limitations on knowledge of autoimmune encephalitis and barriers to its treatment among neurologists: a survey from western China.

BACKGROUND: Autoimmune encephalitis (AE) is a group of severe antibody-mediated brain diseases. The understanding of clinical management of AE has developed rapidly. However, the knowledge level of AE and barriers to effective treatment among neurologists remains unstudied. METHODS: We conducted a questionnaire survey among neurologist in western China on knowledge of AE, treatment practices, and perspectives on barriers to treatment. RESULTS: A total of 1113 neurologists were invited and 690 neurologists from 103 hospitals completed the questionnaire with a response rate of 61.9%. Respondents correctly answered 68.3% of medical questions about AE. Some respondents (12.4%) never assayed for diagnostic antibodies if patients had suspected AE. Half (52.3%) never prescribed immunosuppressants for AE patients, while another 7.6% did not know whether they should do so. Neurologists who never prescribed immunosuppressants were more likely to have less education, a less senior job title, and to practice in a smaller setting. Neurologists who did not know whether to prescribe immunosuppressants were associated with less AE knowledge. The most frequent barrier to treatment, according to respondents, was financial cost. Other barriers to treatment included patient refusal, insufficient AE knowledge, lack of access to AE guidelines, drugs or diagnostic test, etc. CONCLUSION: Neurologists in western China lack AE knowledge. Medical education around AE is urgent needed and should be more targeted to individuals with less educated level or working in non-academic hospitals. Policies should be developed to increase the availability of AE related antibody testing or drugs and reduce the economic burden of disease.

Reproducibility and Validity of a Semi-Quantitative Food Frequency Questionnaire for Children Aged 6-12 in Western China.

The Food Frequency Questionnaire (FFQ) is often used to assess dietary intake in large-scale epidemiological studies. This study aimed to evaluate the reproducibility and validity of the FFQ newly developed for children aged 6 to 12 in western China. A total of 133 children were included in the analysis, and all the children and their caregivers completed the FFQs twice with a three-month interval period, and three 24 h recalls were carried out one month after the first FFQ. We assessed the relative validity and reproducibility using various methods, such as the Spearman correlation coefficient, intra-class correlation coefficient, weighed Kappa, quartile agreement, and Bland-Altman analysis. The Spearman correlation coefficients for food ranged from 0.30 to 0.84, and for nutrients from 0.46 to 0.82 regarding reproducibility. The food intra-class correlation coefficients ranged from 0.20 to 0.85, while nutrients' ranged from 0.37 to 0.75. In terms of relative validity, the average Spearman correlation coefficients for food were 0.20, and 0.30 for energy and nutrients. The energy-adjusted and de-attenuation coefficients were calculated. Moreover, the average percentage of participants misclassified into the extreme quartile for food and nutrients was 8.0% and 7.0%, respectively. Weighted Kappa values indicated acceptable agreement between the FFQs and 24 h recalls. Furthermore, the percentage of results in the limits of agreement (LOA) were all above 93.0%. In conclusion, The FFQ showed good reproducibility and acceptable relative validity for assessing the dietary intake of children aged 6-12 in western China.

Virome diversity of ticks feeding on domestic mammals in China.

Ticks are considered the second most common pathogen vectors transmitting a broad range of vital human and veterinary viruses. From 2017 to 2018, 640 ticks were collected in eight different provinces in central and western China. Six species were detected, including H.longicornis, De.everestianus, Rh.microplus, Rh.turanicus, Rh.sanguineous, and Hy.asiaticum. Sixty-four viral metagenomic libraries were constructed on the MiSeq Illumina platform, resulting in 13.44 â€‹G (5.88 â€‹× â€‹107) of 250-bp-end reads, in which 2,437,941 are viral reads. We found 27 nearly complete genome sequences, including 16 genome sequences encoding entire protein-coding regions (lack of 3' or 5' end non-coding regions) and complete viral genomes, distributed in the arboviral family (Chuviridae, Rhabdoviridae, Nairoviridae, Phenuiviridae, Flaviviridae, Iflaviridae) as well as Parvoviridae and Polyomaviridae that cause disease in mammals and even humans. In addition, 13 virus sequences found in Chuviridae, Nairoviridae, Flaviviridae, Iflaviridae, Hepeviridae, Parvoviridae, and Polyomaviridae were identified as belonging to a new virus species in the identified viral genera. Besides, an epidemiological survey shows a high prevalence (9.38% and 15.63%) of two viruses (Ovine Copiparvovirus and Bovine parvovirus 2) in the tick cohort.