Human papillomavirus(HPV)vaccination administered before viral exposure(i.e.,prior to sexual debut)effectively prevents infection with vaccine-type HPV strains and associated diseases,including cervical cancer.To adva...Human papillomavirus(HPV)vaccination administered before viral exposure(i.e.,prior to sexual debut)effectively prevents infection with vaccine-type HPV strains and associated diseases,including cervical cancer.To advance HPV vaccination efforts and cervical cancer prevention,China has incorporated the bivalent HPV vaccine(types 16/18)into its National Immunization Program(NIP)as a program vaccine.This Policy Note presents comprehensive technical and implementation guidelines for HPV vaccine deployment,encompassing guidance development methodology,target population definition,routine vaccination schedules,catch-up vaccination protocols,implementation strategies,vaccine coverage and adverse event monitoring plans,and anticipated implementation challenges with proposed mitigation measures.The Vaccine Technical Working Groups of the China CDC developed relevant technical recommendations and guidelines,which were officially issued in November 2025.展开更多
Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vacc...Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.展开更多
Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of socie...Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of society.In western China,C4D activities have previously been conducted as part of province-level immunization programs.In this study,we evaluated the association of C4D with changes in parental knowledge of immunization services,measles disease,and measles vaccine,and changes in their children’s measles vaccine coverage.Methods:From April 2013 to April 2014,C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia,Guangxi,Chongqing,Guizhou,Tibet,Shaanxi,Gansu,Ningxia,and Qinghai provinces.We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage.Results:We surveyed 2107 households at baseline and 2070 households after 1 year of C4D activities.Following C4D,95%of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school;80%of caregivers were aware that migrant children were eligible for free vaccination;more than 70%of caregivers knew that measles is a respiratory infectious disease;and 90%of caregivers knew the symptoms of measles.Caregivers’willingness to take their children to the clinic for vaccination increased from 51.3%at baseline to 67.4%in the post-C4D survey.Coverage of one-dose measles-containing vaccine(MCV)increased from 83.8%at baseline to 90.1%after C4D.One-dose MCV coverage was greater than 95%in the Guangxi,Shaanxi,and Gansu provinces.Two-dose MCV coverage increased from 68.5 to 77.6%.House-to-house communication was the most popular C4D activity among caregivers(91.6%favoring),followed by posters and educational talks(64.8 and 49.9%favoring).Conclusions:C4D is associated with increased caregiver knowledge about measles,increased willingness to seek immunization services for their children,and increased measles vaccination coverage.Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas.C4D should be considered for larger scale implementation in China.展开更多
Hepatitis A is an infectious liver disease caused by hepatitis A virus(HAV)that results in mild to severe illness.HAV is spread to immunologically naïve persons who ingest food or water contaminated with feces fr...Hepatitis A is an infectious liver disease caused by hepatitis A virus(HAV)that results in mild to severe illness.HAV is spread to immunologically naïve persons who ingest food or water contaminated with feces from HAV-infected individuals(1).Hepatitis A is often seen in sporadic cases,but is also seen in large outbreaks,such as the 1988 outbreak in Shanghai that caused over 300,000 cases and huge economic losses(2).展开更多
To evaluate the achievements of China’s immunization program between 1950 and 2018,we chose 11 vaccine-preventable diseases(VPDs)as representative notifiable diseases and used annual surveillance data obtained betwee...To evaluate the achievements of China’s immunization program between 1950 and 2018,we chose 11 vaccine-preventable diseases(VPDs)as representative notifiable diseases and used annual surveillance data obtained between 1950 and 2018 to derive disease incidence and mortality trends.Quasi-Poisson and polynomial regression models were used to estimate the impacts of specific vaccine programs,and life-table methods were used to calculate the loss of life expectancy,years of life lost,and loss of working years.The total notification number for the 11 VPDs was 211,866,000 from 1950 to 2018.The greatest number occurred in 1959,with a total incidence of 1,723 per million persons.From 1978 to 2018,a substantial decline was observed in the incidence of major infectious diseases.The incidence of pertussis fell 98%from 126.35 to 1.58 per million,and the incidences of measles,meningococcal meningitis,and Japanese encephalitis fell 99%,99%,and 98%,respectively.The regression models showed that most of the 11 diseases exhibited dramatic declines in morbidity after their integration into the Expanded Program on Immunization(EPI),while varicella and paratyphoid fever,which were not integrated into the EPI,showed increased morbidity.From 1978 to 2018,the total life expectancy for the 11 VPDs increased by 0.79 years,and similar results were obtained for different age groups.China has had great success in controlling VPDs in recent decades,and improving vaccination coverage is a key aspect of controlling VPDs in China.展开更多
China CDC’s National Immunization Program’s Senior Research Scholars Program(NIP-SRSP)is a program created to foster the professional development of early-to-mid-career immunization experts,strengthen knowledge exch...China CDC’s National Immunization Program’s Senior Research Scholars Program(NIP-SRSP)is a program created to foster the professional development of early-to-mid-career immunization experts,strengthen knowledge exchange and cooperation between national and provincial/prefectural-level CDCs,and deepen scientific and programmatic capacity of the National Immunization Program and provincial/prefectural immunization programs.Initiated in September 2019.展开更多
Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system ...Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.展开更多
Objective To determine the hepatitis B immunoprophylactic failure rate in infants born to hepatitis B virus （HBV） infected mothers and to characterize HBV genes. Methods HBV-serological testing was conducted for pre...Objective To determine the hepatitis B immunoprophylactic failure rate in infants born to hepatitis B virus （HBV） infected mothers and to characterize HBV genes. Methods HBV-serological testing was conducted for pregnant women and infants. The complete genomes of 30 HBV isolates were sequenced, and genetic characteristics were analyzed using MEGA 5 software. Results The immunoprophylactic failure rate for infants who had completed the scheduled hepatitis B vaccination program was 5.76% （32/556）. High sequence homology （99.8%-100%） was observed in 8 of the 10 mother-infant pairs. We identified 19 subgenotype C2 strains, 9 subgenotype B2 strains, and 2 subgenotype Cl strains. Three serotypes were detected： adr （19/30）, adw （9/30）, and ayw （2/30）. The frequency of amino acid mutation of the ＇a＇ determinant region was 16.67% （5/30）, including that of Q129H, F134Y,S136Y, and G145E. We detected 67 amino acid mutations in the basal core promoter, precore, and core regions of the genome. Conclusion The immunoprophylactic failure rate in infants born to HBV-infected mothers is low in the regions of China examined during this study. Moreover, HBV mutation in the ＇a＇ determinant region could not account for immunoprophylactic failure for all infants.展开更多
Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been repo...Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been reported in southwest provinces,which include Yunnan.In this study,we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017,covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization(EPI)in 2007.Methods:We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in Yunnan.Cases were reported from hospital and county-level Centers for Disease Control in line with the National JE Surveillance Guideline.Epidemiological data were extracted,analysed and presented in appropriate ways.Immunization coverage was estimated from actual JE doses administered and new births for each year.Results:A total 4780 JE cases(3077 laboratory-confirmed,1266 clinical and 437 suspected)were reported in the study period.Incidence of JE(per 100000 population)increased from 0.95 in 2005 to 1.69 in 2007.With increase in vaccination coverage,incidence rates decreased steadily from 1.16 in 2009 to 0.17 in 2017.However,seasonality remained similar across the years,peaking in June-September.Banna(bordering Myanmar and Laos),Dehong(bordering Myanmar),and Zhaotong(an inland prefecture)had the highest incidence rates of 2.3,1.9,and 1.6,respectively.97%of all cases were among local residents.As vaccination coverage increased(and incidence decreased),proportion of JE cases among children<10 years old decreased from 70%in 2005 to 32%in 2017,while that among adults>20 years old increased from 12 to 48%.There were a large number of JE cases with unknown treatment outcomes,especially in the earlier years of the surveillance system.Conclusions:The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to adults.Improving vaccination coverage,including access to adults at risk,and strengthening the JE surveillance system is needed to further control or eliminate JE in the province.展开更多
Japanese encephalitis(JE)was first discovered in Japan in 1871;in 1924,a major outbreak occurred,with 6,000 JE cases reported and a mortality rate of approximately 60%[1,2].Later studies showed that JE is caused by th...Japanese encephalitis(JE)was first discovered in Japan in 1871;in 1924,a major outbreak occurred,with 6,000 JE cases reported and a mortality rate of approximately 60%[1,2].Later studies showed that JE is caused by the Japanese encephalitis virus(JEV),which is spread by mosquitoes.展开更多
Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization(EPI)in Guizhou Province of China(hereafter referred as Guizhou)in the 1980s.This vaccine ra...Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization(EPI)in Guizhou Province of China(hereafter referred as Guizhou)in the 1980s.This vaccine rapidly decreased incidence rates of pertussis in the province,however,despite the wide high coverage of the diphtheria,tetanus and acellular pertussis(DTaP)combined vaccine,there has been a resurgence of pertussis since 2014.Even with this recent increase in disease transmission,risk factors for pertussis infection have not been evaluated in Guizhou.We aimed to provide information on pertussis risk factors and insight on designing targeted pertussis control policies and measures through this study.Methods:A 1:2 matched retrospective case-control study was conducted between 2016 and 2017,involving infants and children younger than 6 years old and parents of the participants.The enrolled cases included clinical and laboratory confirmed pertussis cases according to the WHO-recommended pertussis definition.Controls were selected from children in the same neighborhood who were not diagnosed with pertussis prior to our investigation and did not exhibit any clinical manifestations of pertussis.Results:The household size[Matched odds ratio(OR_(m)=1.4,95%confidence interval(Cl):1.1-1.7]and household members with antecedent cough(OR_(m)=3.6,95%CI:1.8-7.2)were significantly associated with their child’s pertussis onset.The parents’occupations were significantly associated with their child’s pertussis onset(ORm=9.4,95%CI:1.6-54.8,for mother side;ORm=4.5,95%CI:1.2-16.5,for father side),when they worked in the business and/or service industry.Having family members with a history of cough was an independent risk factor for pertussis[Adjusted odds ratio(AOR)=43.6,95%CI:2.7-694.0].Besides,the parents’demographic characteristics and DTaP doses were not found to be independent factors.Conclusion:Household exposure is an important risk factor for pertussis infection in infants and young children and should therefore be considered as a major factor during formulation of pertussis control policies and measures.展开更多
Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a...Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a vesicular rash limited to one side of the body in the distribution of a nerve[2].The most common complication of HZ postherpetic neuralgia(PHN).展开更多
The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achiev...The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achieve these targets and milestones,the strategy set three pillars and 10 indicators,one of which is systematic screening of contacts and high-risk groups[1].展开更多
BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate...BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate the clinical and pathological characteristics of inferior mesenteric artery(IMA)root lymph node metastases in patients with rectal cancer.The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.METHODS Our study searched PubMed,Google Scholar,and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31,2023.After data extraction,the Newcastle-Ottawa scale was used to evaluate the quality of the included literature,and RevMan5.3 software was used for meta-analysis and heterogeneity testing.The fixed effect modules without heterogeneity were selected to combine the effect size,and the random effect modules with heterogeneity were selected to combine the effect size.The cause of heterogeneity was found through sensitivity analysis,and the data of various risk factors were combined to obtain the final effect size,odds ratio(OR)value,and 95%confidence interval(CI).Publication bias was tested by drawing funnel plots.RESULTS A total of seven literature were included in this study.By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors,we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows:Preoperative carcinoembryonic antigen(CEA)>5 ng/mL(OR=0.32,95%CI:0.18-0.55,P<0.05),tumor located above peritoneal reflexive(OR=3.10,95%CI:1.78-5.42,P<0.05),tumor size≥5 cm(OR=0.36,95%CI:0.22-0.57,P<0.05),pathological type(mucinous adenocarcinoma/sig-ring cell carcinoma)(OR=0.23,95%CI:0.13-0.41,P<0.05),degree of tumor differentiation(low differentiation)(OR=0.17,95%CI:0.10-0.31,P<0.05),tumor stage(T3-4 stage)(OR=0.11,95%CI:0.04-0.26,P<0.05),gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer(P>0.05).CONCLUSION Preoperative CEA level,tumor location,tumor size,tumor pathologic type,tumor differentiation,and T stage were correlated with IMA root lymph node metastasis.展开更多
Context: An unexplained increase in the risk of Guil- lain- Barré syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976- 1977. Guillain- Barré syndrome remains the most frequent neu...Context: An unexplained increase in the risk of Guil- lain- Barré syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976- 1977. Guillain- Barré syndrome remains the most frequent neurological condition reported after influenza vaccination to the Vaccine Adverse Events Reporting System (VAERS) since its inception in 1990. Objective: To evaluate trends of reports to VAERS of GBS following influenza vaccination in adults. Design, Setting, and Participants: VAERS is the US national spontaneous reporting system for adverse events following vaccination. Reports of GBS in persons 18 years or older following influenza vaccination were evaluated for each influenza season from July 1, 1990, through June 30, 2003. The number of people vaccinated was estimated from the National Health Interview Survey and US census data. Beginning in 1994, active follow- up was conducted to verify GBS diagnosis and obtain other clinical details. Main Outcome Measure: Reporting rates of GBS following influenza vaccination over time. Results: From July 1990 through June 2003, VAERS received 501 reports of GBS following influenza vaccination in adults. The median onset interval (13 days) was longer than that of non- GBS reports of adverse events after influenza vaccine (1 day) (P<.001). The annual reporting rate decreased 4- fold from a high of 0.17 per 100 000 vaccinees in 1993- 1994 to 0.04 in 2002- 2003 (P < .001). A GBS diagnosis was confirmed in 82% of reports. Preceding illness within 4 weeks of vaccination was identified in 24% of reported cases. Conclusions: From 1990 to 2003, VAERS reporting rates of GBS after influenza vaccination decreased. The long onset interval and low prevalence of other preexisting illnesses are consistent with a possible causal association between GBS and influenza vaccine. These findings require additional research, which can lead to a fuller understanding of the causes of GBS and its possible relationship with influenza vaccine.展开更多
This study aimed to evaluate emerging trends of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) among 290 former blood donor HIV-1 inf...This study aimed to evaluate emerging trends of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) among 290 former blood donor HIV-1 infected patients in Hubei, China, from 2004 to 2006, all of whom had received anti-HIV-1 therapy. The presence of NRTI- and NNRTI-associated mutations were established by sequencing; genotypic and predicted phenotypic drug resistance were evaluated using HIVdb Program version 5.0.1 (http://hivdb.stanford.edu/ pages/algs/HIVdb.html). Genotypic drug resistance analysis showed significant increases in percentages of patients carrying HIV-1 strains with M41L, T215Y/F, D67N, K103N, G190A/S, Y181C/F or L210W mutations. Of the variants' predicted phenotypic drug resistance, highly significant increases were detected in percentages of patients carrying HIV-1 with high resistance to zidovudine (AZT) or stavudine (D4T) in NRTIs, and to delavirdine (DLV), efavirenz (EFV) or nevirapine (NVP) in NNRTIs; intermediate resistance to abacavir (ABC), AZT, D4T, didanosine (DDI) or tenofovir disoproxil fumarate (TDF) in NRTIs, and to etravirine (ETR) in NNRTIs; and low and potential low resistance to lamivudine (3TC), ABC, emtricitabine (FTC) or TDF in NRTIs, and to ETR in NNRTIs.展开更多
BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking ...BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.展开更多
Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;...Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .展开更多
Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted....Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. Methods We undertook case finding in the two cities with Morocco’ s main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. Findings We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1- 12.7 cases per 100 000 livebirths. Interpretation We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.展开更多
Context.Each year 2.1 million children 19 to 35 months of age are undervaccinated.Among these are children who have received no vaccinations.Unvaccinated children are at increased risk of acquiring and transmitting va...Context.Each year 2.1 million children 19 to 35 months of age are undervaccinated.Among these are children who have received no vaccinations.Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases.Objectives.To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, tomonitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children.Design.A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001.Vaccination histories were ascertained from children’s medical providers.Undervaccinated children had received ≥1 dose of diphtheriatetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine butwere not fully vaccinated.Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations.Participants.A total of 151 720 children sampled between 1995 and 2001, 795 of whom were unvaccinated.Results.Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city.Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding ＄75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children.Unvaccinated children were more likely to be male than female.Annually, ～17 000 children were unvaccinated.The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan.States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.Conclusions.Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children.Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.展开更多
文摘Human papillomavirus(HPV)vaccination administered before viral exposure(i.e.,prior to sexual debut)effectively prevents infection with vaccine-type HPV strains and associated diseases,including cervical cancer.To advance HPV vaccination efforts and cervical cancer prevention,China has incorporated the bivalent HPV vaccine(types 16/18)into its National Immunization Program(NIP)as a program vaccine.This Policy Note presents comprehensive technical and implementation guidelines for HPV vaccine deployment,encompassing guidance development methodology,target population definition,routine vaccination schedules,catch-up vaccination protocols,implementation strategies,vaccine coverage and adverse event monitoring plans,and anticipated implementation challenges with proposed mitigation measures.The Vaccine Technical Working Groups of the China CDC developed relevant technical recommendations and guidelines,which were officially issued in November 2025.
文摘Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.
基金The UNICEF China Office and the Fourth Round of Three-Year Public Health Action Plan of Shanghai,China(15GWZK0101)supported the C4D intervention activities,the baseline investigation,and the evaluation investigation。
文摘Background:Communication for Development(C4D)is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual,family,community,social,and policy levels of society.In western China,C4D activities have previously been conducted as part of province-level immunization programs.In this study,we evaluated the association of C4D with changes in parental knowledge of immunization services,measles disease,and measles vaccine,and changes in their children’s measles vaccine coverage.Methods:From April 2013 to April 2014,C4D activities were implemented as part of provincial immunization programs in the Inner Mongolia,Guangxi,Chongqing,Guizhou,Tibet,Shaanxi,Gansu,Ningxia,and Qinghai provinces.We used a before-and-after study design and employed face-to-face interviews to assess changes in parental knowledge and vaccination coverage.Results:We surveyed 2107 households at baseline and 2070 households after 1 year of C4D activities.Following C4D,95%of caregivers were aware of the vaccination record check requirement for entry into kindergarten and primary school;80%of caregivers were aware that migrant children were eligible for free vaccination;more than 70%of caregivers knew that measles is a respiratory infectious disease;and 90%of caregivers knew the symptoms of measles.Caregivers’willingness to take their children to the clinic for vaccination increased from 51.3%at baseline to 67.4%in the post-C4D survey.Coverage of one-dose measles-containing vaccine(MCV)increased from 83.8%at baseline to 90.1%after C4D.One-dose MCV coverage was greater than 95%in the Guangxi,Shaanxi,and Gansu provinces.Two-dose MCV coverage increased from 68.5 to 77.6%.House-to-house communication was the most popular C4D activity among caregivers(91.6%favoring),followed by posters and educational talks(64.8 and 49.9%favoring).Conclusions:C4D is associated with increased caregiver knowledge about measles,increased willingness to seek immunization services for their children,and increased measles vaccination coverage.Tailored communication strategies based on insights gained from these analyses may be able to increase vaccination coverage in hard-to-reach areas.C4D should be considered for larger scale implementation in China.
基金funded by the Project of Strengthening National Laboratories,Surveillance&Program Monitoring Systems,and Service Delivery Models for Viral Hepatitis in China.
文摘Hepatitis A is an infectious liver disease caused by hepatitis A virus(HAV)that results in mild to severe illness.HAV is spread to immunologically naïve persons who ingest food or water contaminated with feces from HAV-infected individuals(1).Hepatitis A is often seen in sporadic cases,but is also seen in large outbreaks,such as the 1988 outbreak in Shanghai that caused over 300,000 cases and huge economic losses(2).
文摘To evaluate the achievements of China’s immunization program between 1950 and 2018,we chose 11 vaccine-preventable diseases(VPDs)as representative notifiable diseases and used annual surveillance data obtained between 1950 and 2018 to derive disease incidence and mortality trends.Quasi-Poisson and polynomial regression models were used to estimate the impacts of specific vaccine programs,and life-table methods were used to calculate the loss of life expectancy,years of life lost,and loss of working years.The total notification number for the 11 VPDs was 211,866,000 from 1950 to 2018.The greatest number occurred in 1959,with a total incidence of 1,723 per million persons.From 1978 to 2018,a substantial decline was observed in the incidence of major infectious diseases.The incidence of pertussis fell 98%from 126.35 to 1.58 per million,and the incidences of measles,meningococcal meningitis,and Japanese encephalitis fell 99%,99%,and 98%,respectively.The regression models showed that most of the 11 diseases exhibited dramatic declines in morbidity after their integration into the Expanded Program on Immunization(EPI),while varicella and paratyphoid fever,which were not integrated into the EPI,showed increased morbidity.From 1978 to 2018,the total life expectancy for the 11 VPDs increased by 0.79 years,and similar results were obtained for different age groups.China has had great success in controlling VPDs in recent decades,and improving vaccination coverage is a key aspect of controlling VPDs in China.
文摘China CDC’s National Immunization Program’s Senior Research Scholars Program(NIP-SRSP)is a program created to foster the professional development of early-to-mid-career immunization experts,strengthen knowledge exchange and cooperation between national and provincial/prefectural-level CDCs,and deepen scientific and programmatic capacity of the National Immunization Program and provincial/prefectural immunization programs.Initiated in September 2019.
基金funded by China CDC’s Public Health and Emergency Response Mechanism Programme[131031001000150001]。
文摘Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.
基金supported by the Chinese Twelfth Five-Year Plan,a major science and technology program for hepatitis(Grant Number:2012ZX10002001)
文摘Objective To determine the hepatitis B immunoprophylactic failure rate in infants born to hepatitis B virus （HBV） infected mothers and to characterize HBV genes. Methods HBV-serological testing was conducted for pregnant women and infants. The complete genomes of 30 HBV isolates were sequenced, and genetic characteristics were analyzed using MEGA 5 software. Results The immunoprophylactic failure rate for infants who had completed the scheduled hepatitis B vaccination program was 5.76% （32/556）. High sequence homology （99.8%-100%） was observed in 8 of the 10 mother-infant pairs. We identified 19 subgenotype C2 strains, 9 subgenotype B2 strains, and 2 subgenotype Cl strains. Three serotypes were detected： adr （19/30）, adw （9/30）, and ayw （2/30）. The frequency of amino acid mutation of the ＇a＇ determinant region was 16.67% （5/30）, including that of Q129H, F134Y,S136Y, and G145E. We detected 67 amino acid mutations in the basal core promoter, precore, and core regions of the genome. Conclusion The immunoprophylactic failure rate in infants born to HBV-infected mothers is low in the regions of China examined during this study. Moreover, HBV mutation in the ＇a＇ determinant region could not account for immunoprophylactic failure for all infants.
基金This study was conducted as part of the routine duties of the principal author at the Yunnan Provincial Centre for Disease Control and Prevention and required no additional funding resourcesFunding for the costs of publication in an open-access,peer-reviewed journal was supported by Yunnan Provincial Centre for Disease Control and Prevention.
文摘Background:Japanese encephalitis(JE)is a leading cause of childhood viral encephalitis both at global level and in China.Vaccination is recommended as a key strategy to control JE.In China most JE cases have been reported in southwest provinces,which include Yunnan.In this study,we quantify the epidemiological shift of JE in Yunnan Province from 2005 to 2017,covering before and after the introduction of JE vaccination into routine Expanded Program on Immunization(EPI)in 2007.Methods:We used routinely collected data in the case-based JE surveillance system from 2005 through 2017 in Yunnan.Cases were reported from hospital and county-level Centers for Disease Control in line with the National JE Surveillance Guideline.Epidemiological data were extracted,analysed and presented in appropriate ways.Immunization coverage was estimated from actual JE doses administered and new births for each year.Results:A total 4780 JE cases(3077 laboratory-confirmed,1266 clinical and 437 suspected)were reported in the study period.Incidence of JE(per 100000 population)increased from 0.95 in 2005 to 1.69 in 2007.With increase in vaccination coverage,incidence rates decreased steadily from 1.16 in 2009 to 0.17 in 2017.However,seasonality remained similar across the years,peaking in June-September.Banna(bordering Myanmar and Laos),Dehong(bordering Myanmar),and Zhaotong(an inland prefecture)had the highest incidence rates of 2.3,1.9,and 1.6,respectively.97%of all cases were among local residents.As vaccination coverage increased(and incidence decreased),proportion of JE cases among children<10 years old decreased from 70%in 2005 to 32%in 2017,while that among adults>20 years old increased from 12 to 48%.There were a large number of JE cases with unknown treatment outcomes,especially in the earlier years of the surveillance system.Conclusions:The 13-year JE surveillance data in Yunnan Province showed dramatic decrease of total incidence and a shift from children to adults.Improving vaccination coverage,including access to adults at risk,and strengthening the JE surveillance system is needed to further control or eliminate JE in the province.
基金supported by grants from the National Key Research and Development Program[2016YFD0500401](WH)the Development Grant of State Key Laboratory of Infectious Disease Prevention and Control[2014SKLID103](LG)and[2015SKLID505](WH)。
文摘Japanese encephalitis(JE)was first discovered in Japan in 1871;in 1924,a major outbreak occurred,with 6,000 JE cases reported and a mortality rate of approximately 60%[1,2].Later studies showed that JE is caused by the Japanese encephalitis virus(JEV),which is spread by mosquitoes.
基金supported by grants from the Science and Technology Foundation of Guizhou Province of China(Grant No.[2019]1185).
文摘Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization(EPI)in Guizhou Province of China(hereafter referred as Guizhou)in the 1980s.This vaccine rapidly decreased incidence rates of pertussis in the province,however,despite the wide high coverage of the diphtheria,tetanus and acellular pertussis(DTaP)combined vaccine,there has been a resurgence of pertussis since 2014.Even with this recent increase in disease transmission,risk factors for pertussis infection have not been evaluated in Guizhou.We aimed to provide information on pertussis risk factors and insight on designing targeted pertussis control policies and measures through this study.Methods:A 1:2 matched retrospective case-control study was conducted between 2016 and 2017,involving infants and children younger than 6 years old and parents of the participants.The enrolled cases included clinical and laboratory confirmed pertussis cases according to the WHO-recommended pertussis definition.Controls were selected from children in the same neighborhood who were not diagnosed with pertussis prior to our investigation and did not exhibit any clinical manifestations of pertussis.Results:The household size[Matched odds ratio(OR_(m)=1.4,95%confidence interval(Cl):1.1-1.7]and household members with antecedent cough(OR_(m)=3.6,95%CI:1.8-7.2)were significantly associated with their child’s pertussis onset.The parents’occupations were significantly associated with their child’s pertussis onset(ORm=9.4,95%CI:1.6-54.8,for mother side;ORm=4.5,95%CI:1.2-16.5,for father side),when they worked in the business and/or service industry.Having family members with a history of cough was an independent risk factor for pertussis[Adjusted odds ratio(AOR)=43.6,95%CI:2.7-694.0].Besides,the parents’demographic characteristics and DTaP doses were not found to be independent factors.Conclusion:Household exposure is an important risk factor for pertussis infection in infants and young children and should therefore be considered as a major factor during formulation of pertussis control policies and measures.
基金supported by the Operation of Public Health Emergency Response Mechanism of the Chinese Center for Disease Control and Prevention(10239322002001,0000017)Research on Vaccine Evaluation Strategy and capacity Building Project(09207).
文摘Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a vesicular rash limited to one side of the body in the distribution of a nerve[2].The most common complication of HZ postherpetic neuralgia(PHN).
基金sponsored by Beijing Natural Science Foundation[7174323]the Young Scholar Scientific Research Foundation of China CDC[2018A104]。
文摘The World Health Organization(WHO)launched the‘End TB Strategy’,which aims to reduce the mortality and incidence rate of tuberculosis(TB)by 95% and 90% by 2035,respectively,compared with the levels in 2015.To achieve these targets and milestones,the strategy set three pillars and 10 indicators,one of which is systematic screening of contacts and high-risk groups[1].
文摘BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate the clinical and pathological characteristics of inferior mesenteric artery(IMA)root lymph node metastases in patients with rectal cancer.The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.METHODS Our study searched PubMed,Google Scholar,and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31,2023.After data extraction,the Newcastle-Ottawa scale was used to evaluate the quality of the included literature,and RevMan5.3 software was used for meta-analysis and heterogeneity testing.The fixed effect modules without heterogeneity were selected to combine the effect size,and the random effect modules with heterogeneity were selected to combine the effect size.The cause of heterogeneity was found through sensitivity analysis,and the data of various risk factors were combined to obtain the final effect size,odds ratio(OR)value,and 95%confidence interval(CI).Publication bias was tested by drawing funnel plots.RESULTS A total of seven literature were included in this study.By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors,we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows:Preoperative carcinoembryonic antigen(CEA)>5 ng/mL(OR=0.32,95%CI:0.18-0.55,P<0.05),tumor located above peritoneal reflexive(OR=3.10,95%CI:1.78-5.42,P<0.05),tumor size≥5 cm(OR=0.36,95%CI:0.22-0.57,P<0.05),pathological type(mucinous adenocarcinoma/sig-ring cell carcinoma)(OR=0.23,95%CI:0.13-0.41,P<0.05),degree of tumor differentiation(low differentiation)(OR=0.17,95%CI:0.10-0.31,P<0.05),tumor stage(T3-4 stage)(OR=0.11,95%CI:0.04-0.26,P<0.05),gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer(P>0.05).CONCLUSION Preoperative CEA level,tumor location,tumor size,tumor pathologic type,tumor differentiation,and T stage were correlated with IMA root lymph node metastasis.
文摘Context: An unexplained increase in the risk of Guil- lain- Barré syndrome (GBS) occurred among recipients of the swine influenza vaccine in 1976- 1977. Guillain- Barré syndrome remains the most frequent neurological condition reported after influenza vaccination to the Vaccine Adverse Events Reporting System (VAERS) since its inception in 1990. Objective: To evaluate trends of reports to VAERS of GBS following influenza vaccination in adults. Design, Setting, and Participants: VAERS is the US national spontaneous reporting system for adverse events following vaccination. Reports of GBS in persons 18 years or older following influenza vaccination were evaluated for each influenza season from July 1, 1990, through June 30, 2003. The number of people vaccinated was estimated from the National Health Interview Survey and US census data. Beginning in 1994, active follow- up was conducted to verify GBS diagnosis and obtain other clinical details. Main Outcome Measure: Reporting rates of GBS following influenza vaccination over time. Results: From July 1990 through June 2003, VAERS received 501 reports of GBS following influenza vaccination in adults. The median onset interval (13 days) was longer than that of non- GBS reports of adverse events after influenza vaccine (1 day) (P<.001). The annual reporting rate decreased 4- fold from a high of 0.17 per 100 000 vaccinees in 1993- 1994 to 0.04 in 2002- 2003 (P < .001). A GBS diagnosis was confirmed in 82% of reports. Preceding illness within 4 weeks of vaccination was identified in 24% of reported cases. Conclusions: From 1990 to 2003, VAERS reporting rates of GBS after influenza vaccination decreased. The long onset interval and low prevalence of other preexisting illnesses are consistent with a possible causal association between GBS and influenza vaccine. These findings require additional research, which can lead to a fuller understanding of the causes of GBS and its possible relationship with influenza vaccine.
基金The Key Projects in the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period of China (2008ZX10001-002)the Major Science and Technology Innovation Cross Project of the Chinese Academy of Sciences (KSCX1-YW-10)
文摘This study aimed to evaluate emerging trends of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) among 290 former blood donor HIV-1 infected patients in Hubei, China, from 2004 to 2006, all of whom had received anti-HIV-1 therapy. The presence of NRTI- and NNRTI-associated mutations were established by sequencing; genotypic and predicted phenotypic drug resistance were evaluated using HIVdb Program version 5.0.1 (http://hivdb.stanford.edu/ pages/algs/HIVdb.html). Genotypic drug resistance analysis showed significant increases in percentages of patients carrying HIV-1 strains with M41L, T215Y/F, D67N, K103N, G190A/S, Y181C/F or L210W mutations. Of the variants' predicted phenotypic drug resistance, highly significant increases were detected in percentages of patients carrying HIV-1 with high resistance to zidovudine (AZT) or stavudine (D4T) in NRTIs, and to delavirdine (DLV), efavirenz (EFV) or nevirapine (NVP) in NNRTIs; intermediate resistance to abacavir (ABC), AZT, D4T, didanosine (DDI) or tenofovir disoproxil fumarate (TDF) in NRTIs, and to etravirine (ETR) in NNRTIs; and low and potential low resistance to lamivudine (3TC), ABC, emtricitabine (FTC) or TDF in NRTIs, and to ETR in NNRTIs.
基金Supported by the Academic Leaders Training Program of Pudong Health Bureau of Shanghai,No.PWRd2023-03Clinical Research Fund of Shanghai Municipal Commission of Health,No.202040136+1 种基金National Natural Science Foundation of China,No.82070842Jiangxi Health Commission Science and Technology Plan Project,No.202212838 and No.202212852.
文摘BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.
文摘Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .
文摘Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. Methods We undertook case finding in the two cities with Morocco’ s main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. Findings We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1- 12.7 cases per 100 000 livebirths. Interpretation We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.
文摘Context.Each year 2.1 million children 19 to 35 months of age are undervaccinated.Among these are children who have received no vaccinations.Unvaccinated children are at increased risk of acquiring and transmitting vaccine-preventable diseases.Objectives.To assess whether the characteristics of children with no vaccinations differ from those of undervaccinated children, tomonitor trends in the numbers of unvaccinated children, and to identify states with high rates and counties with large numbers of unvaccinated children.Design.A nationally representative probability sample of children 19 to 35 months of age was collected annually between 1995 and 2001.Vaccination histories were ascertained from children’s medical providers.Undervaccinated children had received ≥1 dose of diphtheriatetanus-pertussis, polio, measles, Haemophilus influenzae type b, hepatitis B, or varicella vaccine butwere not fully vaccinated.Unvaccinated children were children who were reported as having no medical providers and having received no vaccinations or children whose medical providers reported administering no vaccinations.Participants.A total of 151 720 children sampled between 1995 and 2001, 795 of whom were unvaccinated.Results.Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city.Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding ＄75 000, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children.Unvaccinated children were more likely to be male than female.Annually, ～17 000 children were unvaccinated.The largest numbers of unvaccinated children lived in counties in California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan.States that allowed philosophical exemptions to laws mandating vaccinations for children as they entered school had significantly higher estimated rates of unvaccinated children.Conclusions.Unvaccinated children have characteristics that are distinctly different from those of undervaccinated children.Unvaccinated children are clustered geographically, increasing the risk of transmitting vaccine-preventable diseases to both unvaccinated and undervaccinated children.
