Epidemiology for public health practice:The application of spatial epidemiology

Spatial epidemiology is the description and analysis of geographic patterns and variations in disease risk factors,morbidity and mortality with respect to their distributions associated with demographic,socioeconomic,environmental,health behavior,and genetic risk factors,and time-varying changes.In the Letter to Editor,we had a brief description of the practice for the mortality and the spacetime patterns of John Snow's map of cholera epidemic in London,United Kingdom in 1854.This map is one of the earliest public heath practices of developing and applying spatial epidemiology.In the early history,spatial epidemiology was predominantly applied in infectious disease and risk factor studies.However,since the recent decades,noncommunicable diseases have become the leading cause of death in both developing and developed countries,spatial epidemiology has been used in the study of noncommunicable disease.In the Letter,we addressed two examples that applied spatial epidemiology to cluster and identify stroke belt and diabetes belt across the states and counties in the United States.Similar to any other epidemiological study design and analysis approaches,spatial epidemiology has its limitations.We should keep in mind when applying spatial epidemiology in research and in public health practice.

Role of traditional Chinese medicine in the initiative practice for health

To achieve awareness of the initiative practice for health concept in the Chinese population,traditional Chinese medicine(TCM)doctors should popularize TCM culture and knowledge among young people,people with a low level of education,in low-income populations,and in rural populations.

Awareness of initiative practice for health in the Chinese population:A questionnaire survey based on a network platform

BACKGROUND In 2016,the Chinese government issued the Healthy China 2030 plan,which also produced the initiative practice for health(IPFH)concept.However,people’s knowledge and awareness of the IPFH are unclear.AIM To investigate awareness of IPFH in the Chinese population and explore the relevant influential factors.METHODS An internet-based self-designed questionnaire survey was used to collect respondents’demographic characteristics and awareness of health and the IPFH from March 26 to April 18,2020.IPFH consciousness was assessed by the scores for different related questions.The Student’s t test,the Chi-square test,and multiple logistic regression analysis were performed to analyze the differences and influencing factors.RESULTS A total of 2678 valid questionnaires were collected.Of the respondents,973(36.3%)had heard of the IPFH concept.In addition,89.5% of participants agreed with the view that the IPFH is beneficial to improving quality of life,and over half thought that a regular schedule,a reasonable diet,tobacco and alcohol control,a cheerful mood,specific life goals and plans,taking the initiative to accept health-related education and implement health knowledge,good interpersonal relationships,and regular physical examinations were closely related to the IPFH.The majority of respondents paid attention to their health and usually obtained health-related knowledge via social media and were also willing to promote the IPFH.Most of the participants underestimated the role of hospitals,family doctors,and health managers in promoting the IPFH.Age,monthly income,and medical-related work experience were the influencing factors for IPFH awareness.CONCLUSION The Chinese population has limited knowledge of the IPFH.People with strong IPFH awareness are older,earn more,and have medical-related work experience.

Clinical and epidemiological features of patients with clonorchiasis

AIM:To study the clinical and epidemiological features of patients with clonorchiasis so as to provide scientific evidences for the diagnosis and prevention of clonorchiasis. METHODS:Stools from 282 subjects suspected of having clonorchiasis were examined for helminth eggs with modified Kato's thick smear and sedimentation methods,and their sera were tested for HAV-DNA,HBV-DNA,HCV-RNA,HDV- RNA and HEV-RNA with polymerase chain reaction (PCR). Clinical symptoms of patients with clonorchiasis only were analyzed,and their blood samples were tested for circulating antigen (CAg) with Dot-ELISA,esoinophilic granulocyte count, and alanine aminotransferase (ALT).Meanwhile,they were asked to provide data of occupation,eating habit,hygienic habit and knowledge of donorchiasis.In addition,the ecosystem of the environment in epidemic areas was surveyed. RESULTS:Among the 282 patients,61 (21.43%) were infected with clonorchis sinensis only,97 (34.64%) were co-infected with clonorchis sinensis and other pathogens, 92 (32.86%) were infected with hepatitis virus only and 31 (11.07%) neither with clonorchis sinensis nor hepatitis virus. Among the 61 patients with clonorchiasis only,there were 14 (22.95%) subjects with discomfort over hepatic region or epigasfrium,12 (19.67%) with general malaise or discomfort and inertia in total body,6 (9.84%) with anorexia,indigestion and nausea,4 (6.56%) with fever,dizziness and headache (6.56%),and 25 (40.98%) without any symptoms;sixty one (100%) with CAg (+),98.33% (59160) with eosinophilic granulocytes increased and 65.00% (39/60) with ALT increased.B-mode ultrasonography revealed 61 cases with dilated and thickened walls of intrahepatic bile duct,and blurred patchy echo acoustic image in liver.Twenty-six cases had stones in the bile duct,39 cases had slightly enlarged liver with diffuse coarse spots in liver parenchyma.Twenty cases had enlarged gallbladder with thickened coarse wall and image of floating plagues,9 cases had slightly enlarged spleen.By analysis of epidemiological data,we found that the ecologic environment was favorable for the epidemiology of clonorchiasis.Most patients with clonorchiasis were lack of knowledge about the disease.Their living environment, hygienic habits,eating habits and their occupations were the related factors that caused the prevalence of the disease. CONCLUSION:The clinical symptoms of clonorchiasis are non-specific,and the main evidences for diagnosis of clonorchiasis should be provided by etiologic examination, B-mode ultrasonography and clinical history.The infection of clonorchis sinensis is related to occupations,bad eating habits and lack of knowledge about prevention of the disease.

From talk to action:Developing a model to foster effective integration of traditional medicine into the Ghanaian healthcare system

This research assessed the experience of stakeholders and the efficacy of integrating traditional medicine into the Ghanaian health system using the Ashanti Region as the focal point.Elements of an integrative healthcare delivery model including philosophies/values,structure,process and outcome were used to conduct a quality assessment of the integrated health system in Ghana.Each element clearly showed that Ghana is currently not running a coordinated health practice model,thus making it a tolerant,rather than an inclusive,health system.Therefore,the primary purpose of this research is to discuss the development of a new and appropriately customised model that could enhance the practice of integrated healthcare in Ghana.The model we present has flexibility and far-reaching applicability in other African countries because such countries share similar socio-cultural and economic characteristics.As such,governments and health practitioners could adapt this model to improve the practice of integrated healthcare in their specific settings.Hospital administrators and health system researchers could also adapt the model to investigate or to monitor the progress and efficacy of integrated healthcare practices within their settings.This might help to understand the relationships between the integration of traditional medicine and health outcomes for a given population.

Delivery of acupuncture in clinical trials:Research acupuncturists’perspectives

Delivery of acupuncture in the setting of a clinical trial is a unique practice that diverges significantly from the delivery of acupuncture in a real-world clinical setting. Research acupuncturists, particularly those trained in traditional Chinese medicine(TCM), are often required to set aside valued precepts of traditional care, including diagnosing imbalances, individualizing treatment, and forging a therapeutic relationship with patients. TCM-trained acupuncturists express mixed feelings about participating in clinical trials. Many are eager to play a vital role in the advancement of acupuncture science and appreciate the need for strict protocol adherence to minimize bias. However, the acupuncturist(s) may also have concerns about clinical trial methodology, including but not limited to the delivery of a control condition, e.g., sham acupuncture. Investigators should anticipate certain questions and even a level of resistance to the requirements of research among acupuncturists and be prepared to address them. This manuscript presents a brief review of the subjective experience of the research acupuncturist within the available scientific literature as it pertains to the delivery of active and sham clinical research protocols. Our goals are to better understand the perspectives of acupuncturists who may participate in clinical research, so that their concerns may be addressed in study design and methodology. To that end, we suggest the creation of a novel training program specifically for clinical trial acupuncturists, intended for qualified TCM-and Western-trained practitioners, that would help to standardize the research acupuncturist’s role and help to strengthen the design and execution of acupuncture studies.

Gap between evidence and physicians＇ knowledge and practice regarding hypertension and its drug treatment： a survey in a Chinese city

Background Evidence-based medicine has come into its second decade. How prepared clinicians are in practicing it in particular in developing countries remains unclear. Thus we conducted this survey of physicians in urban hospitals in China to determine the size of the gap between research evidence and physicians＇ knowledge and practice regarding antihypertensive drugs for primary prevention of cardiovascular diseases in China.Methods A cross sectional survey by a face-to-face interview was conducted in 20 tertiary general hospitals in China in 2005. A total of 444 physicians （mostly cardiologists） in internal medicine who had treated at least one hypertensive patient in the past 12 months were invited for the interview on their perception of the cardiovascular risk of hypertension,the magnitude of the benefit of antihypertensive drugs, knowledge on the overall risk approach, first-line drugs used, the risk above which drug treatment is recommended, and knowledge on evidence-based medicine.Results A total of 444 of the 468 eligible physicians were successfully interviewed with a response rate of 94.9%. They estimated that a hypertensive man with an actual 5-year cardiovascular risk of 8.4% would have a 5-year cardiovascular risk of 40% （95% CI： 38% to 42%） if not treated, and have an absolute risk reduction and relative risk reduction from drug treatment by 20% （95% CI. 18% to 22%） and 39% （95% CI： 37% to 42%） respectively, as compared to 3.3% and 33%respectively shown in research evidence. On average, the physicians would recommend drug treatment at a number needed to treat （NNT） of 368 or smaller, as compared to the actual NNT of 50 for drug treatment in an average hypertensive Chinese. Fifty-five percent （95% CI： 50% to 59%） of them had never intently used the national hypertension guidelines. The majority still prescribed drugs primarily based on blood pressure alone by ignoring other risk factors or the overall risk and 78% （95 % C/. 76% to 83%） used new expensive drugs such as calcium channel blockers and angiotensin converting enzyme （ACE） inhibitors as first-line treatment. Only 13% （95% CI：9% to 18%） could correctly interpret the NNT. Forty-three percent （95% CI： 39% to 48%） did not know the randomized controlled trial was scientifically the most rigorous among other study designs for evaluating the effectiveness of anti-hypertensive drugs.Ninety-two percent （95% CI： 90% to 94%） did not know they could start by searching systematic reviews when looking for evidence on the effectiveness of anti-hypertensive drugs as opposed to trials. Ninety-six percent （95% CI： 94% to 98%）did not know the Cochrane Library was an important source of systematic reviews.Conclusions The surveyed physicians significantly over-estimated the cardiovascular risk of hypertension and the benefit of drug treatment, and had insufficient knowledge on the overall risk approach. They recommended drug treatment at a cardiovascular risk which was even much lower than the cutoff suggested for western populations, which would make many more people eligible for drug treatment. They also tended to prescribe new expensive drugs although the older cheaper ones may be more appropriate in many patients. They showed inappropriate knowledge on the basics of evidence-based medicine.

Patient Feedback for Acupuncture Practice Improvement:A Survey from Mayo Clinic

Objective： To understand patient satisfaction with acupuncture appointment duration for the first and subsequent appointments in the plan of care, time spent with the acupuncture provider, willingness to pay for longer duration appointments, and lack of insurance coverage. Methods： Patients who were referred for an acupuncture consult to the Center for Integrative Medicine at Mayo Clinic were asked to participate in the survey in August 2014. Patients were given paper survey at time of appointment check-in and entered into Research Electronic Data Capture Survey database tool to reveal patient-reported outcomes. Results： In total, 104 of 329 patients receiving acupuncture treatment responded to the survey with a 32% response rate. Insight and recommended changes to the duration of the initial and subsequent appointments were obtained. Most patients reported that time spent with the provider（76 cases, 74%） and appointment length（74 cases, 68%） were ＂just right＂. Seventy cases（70%） of respondents indicated that they wanted longer treatment. Patients reported return appointments with duration of 30 min was not enough. Fifty-three patients（62%） were willing to pay for additional costs not covered by insurance. Conclusions： We used patient feedback to assess the acupuncture practice in a complementary and integrative medicine program. Most patients referred for the acupuncture consult appeared to be satisfied with the current level of practice. These findings were used to establish a quality improvement plan that may be implemented to improve patient satisfaction with the acupuncture practice.

Reconsidering the Barefoot Doctor Programme

This paper examines the widely acclaimed Barefoot Doctor campaign in China. The Barefoot Doctor campaign has come to symbolise the success of Chinese health care to the extent that it has become a model for WHO public health strategy. Yet little has been done to understand how or whether it worked on the ground and what difficulties and contradictions emerged in its implementation. Using previously unexplored party archives as well as newly collected oral interviews, this paper moves away from a narrow focus on party politics and policy formulation by examining the reality of health care at the local level and the challenges faced by local authorities and individuals as the campaigns evolved.