Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

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.

Experience and practice of the Emergency Operations Centerz Chinese Center for Disease Control and Prevention:a case study of response to the H7N9 outbreak

Background:Emergency Operations Center(EOC)is a place to provide response to public health emergencies.Chinese Center for Disease Control and Prevention(China CDC)'s EOC was officially established in 2016,which has been the core department for the public health emergencies and risk response.In recent years,we have been continuously improving the function of EOC through many incidents.In the study,we hope to share the construction status,operation management experience of China CDC's EOC and the response process in the human avian influenza A(H7N9)outbreak.Main text:The China CDC's EOC mainly focus on building the five core elements including sites/places and facilities,information and data,plans and procedures,training and exercises,and logistics.Based on summarizing previous emergency respons巳the China CDC's EOC established its own incident management and the standardized response procedures.The event-specific data,context-specific data and event management data could be obtained through various source.The logistics department of the EOC also provides comprehensive support.The well-trained staff is another necessary conditions for its operation.Through sharing the response process of H7N9 outbreak,it further explains the EOC's functions in the five phases of outbreak response,such as the formulation of the incident response framework,monitoring,personnel dispatch and resource mobilization.Conclusions:The EOC con tributes to faster and more efficient responses during emergencies which en able a greater reduction in morbidity and mortality.Compared with the traditional incident response process,under the command and coordination of China CDC's EOC,each group involved in the response has a clearer goal,responsibilities and tasks at each stage.Meanwhile,each group also gave full play to its own expertise and advantages.As a whole,incident response tended to be more specialized and precise,which generally improves the efficiency of incident response.However,different countries and regions have different response processes to the events.We still suggested that appropriate emerge ncy operati on plan should be made according to the complexity of in cident response in the region when constructing response mechanism,through our experience.And the China CDC's EOC is still at growing and groping phase.

Seventy years’ achievements of international cooperation by the National Institute of Parasitic Diseases at the Chinese Center for Disease Control and Prevention

Background: With the promotion of national control programs on parasitic and tropical diseases in China,the National Institute of Parasitic Diseases(NIPD),Chinese Center for Disease Control and Prevention has gained significant experience in the global health arena through international cooperation over the last seven decades allowing a multilateral impact in the elimination of major endemic diseases.Methods:: The achievements of NIPD since 1950 has been analyzed with emphasis on the various stages that started with research and control of the endemic parasitic and other tropical diseases at the national level and progressed via international cooperation into a global presence.Results: The major achievements contributed by NIPD consist of(i)improving technical capability;(ii)promoting control and elimination of parasitic and tropical diseases;(iii)participating in global health governance and cooperation;and(iv)developing a cooperation model for technical assistance and global public health development.It is expected that NIPD’s experience of international cooperation will be essential for the dissemination of China's successful experience in global health governance,emergency response and development,with focus on malaria and neglected tropical diseases such as schistosomiasis,soil-borne and food-borne helminthiases and echinococcosis.Conclusions: NIPD’s new tasks will not only continue to promote national control of endemic parasitic infections and disease elimination programs in China,but also play a leading role in global health and disease elimination programs in the future.

A case-control study of risk factors for severe hand-foot-mouth disease in Yuxi, China, 2010–2012

Dear Editor,Here,we report the risk factors for severe hand-foot-mouth disease(HFMD)determined by our case-controlstudy.Our findings could help disease prevention and in-tervention initiatives.Patients with severe HFMD displayfatal clinical manifestations with sequelae,requiring≥7days of hospitalization.A tota1 of 249 severe cases treat-ed at Yuxi Children’s Hospital were included in the

Development of a High-throughput Sequencing Platform for Detection of Viral Encephalitis Pathogens Based on Amplicon Sequencing

Objective Viral encephalitis is an infectious disease severely affecting human health.It is caused by a wide variety of viral pathogens,including herpes viruses,flaviviruses,enteroviruses,and other viruses.The laboratory diagnosis of viral encephalitis is a worldwide challenge.Recently,high-throughput sequencing technology has provided new tools for diagnosing central nervous system infections.Thus,In this study,we established a multipathogen detection platform for viral encephalitis based on amplicon sequencing.Methods We designed nine pairs of specific polymerase chain reaction(PCR)primers for the 12 viruses by reviewing the relevant literature.The detection ability of the primers was verified by software simulation and the detection of known positive samples.Amplicon sequencing was used to validate the samples,and consistency was compared with Sanger sequencing.Results The results showed that the target sequences of various pathogens were obtained at a coverage depth level greater than 20×,and the sequence lengths were consistent with the sizes of the predicted amplicons.The sequences were verified using the National Center for Biotechnology Information BLAST,and all results were consistent with the results of Sanger sequencing.Conclusion Amplicon-based high-throughput sequencing technology is feasible as a supplementary method for the pathogenic detection of viral encephalitis.It is also a useful tool for the high-volume screening of clinical samples.

Seizing Opportunities for Further Advancements——Address at the 35th Anniversary Symposium of BES

The year 2023 marks the 35^(th) anniversary of the establishment of Biomedical and Environmental Sciences(BES) by the Chinese Center for Disease Control and Prevention (China CDC).This milestone provides an opportunity to review past achievements and envisage future advancements.Thirty-Five-Year Progress and Achievements In 1988,Professor Chunming Chen,the founding Director General of the Chinese Academy of Preventive Medicine (CAPM,renamed the China CDC in 2002),established the international journal BES to publish research results from Chinese scientists in English.Initially,Professor Chen,along with the renowned toxicologist Professor Frederick Coulston of Albany Medical College in the United States,jointly served as the editors-in-chief,propelling the growth and development of this pioneering journal,while the editorial team is composed exclusively of professionals from the China CDC,and the editorial office was located at the China CDC.

Low Selenium and Low Protein Exacerbate Myocardial Damage in Keshan Disease by Affecting the PINK1/Parkin-mediated Mitochondrial Autophagy Pathway

Objective Keshan disease(KD)is a myocardial mitochondrial disease closely related to insufficient selenium(Se)and protein intake.PTEN induced putative kinase 1(PINK1)/Parkin mediated mitochondrial autophagy regulates various physiological and pathological processes in the body.This study aimed to elucidate the relationship between PINK1/Parkin-regulated mitochondrial autophagy and KD-related myocardial injury.Methods A low Se and low protein animal model was established.One hundred Wistar rats were randomly divided into 5 groups(control group,low Se group,low protein group,low Se+low protein group,and corn from KD area group).The JC-1 method was used to detect the mitochondrial membrane potential(MMP).ELISA was used to detect serum creatine kinase MB(CK-MB),cardiac troponin I(cTnI),and mitochondrial-glutamicoxalacetic transaminase(M-GOT)levels.RT-PCR and Western blot analysis were used to detect the expression of PINK1,Parkin,sequestome 1(P62),and microtubule-associated proteins1A/1B light chain 3B(MAP1LC3B).Results The MMP was significantly decreased and the activity of CK-MB,cTnI,and M-GOT significantly increased in each experimental group(low Se group,low protein group,low Se+low protein group and corn from KD area group)compared with the control group(P<0.05 for all).The mRNA and protein expression levels of PINK1,Parkin and MAP1LC3B were profoundly increased,and those of P62 markedly decreased in the experimental groups compared with the control group(P<0.05 for all).Conclusion Low Se and low protein levels exacerbate myocardial damage in KD by affecting the PINK1/Parkin-mediated mitochondrial autophagy pathway.

Effects of forsythin extract in Forsythia leaves on intestinal microbiota and short-chain fatty acids in rats fed a high-fat diet

Forsythia suspensa,belonging to the deciduous shrubs of the Luteaceae family,a traditional Chinese medicine,has effects of alleviating swelling,clearing heat,detoxification and promoting blood circulation.The leaves of F.suspensa contain multiple chemical components and have a long history of use in folk medicines and health foods.The purpose of this study was to explore the effects of forsythin extract from F.suspensa leaves on intestinal microbiota and short-chain fatty acid(SCFA)content in rats with obesity induced by a high-fat diet.Forsythin extract in F.suspensa leaves increased the abundance of the intestinal microbiota,ameliorated intestinal microbiota disorders and inhibited the increase in total SCFA content in the intestinal tract in rats with obesity induced by a high-fat diet.These results suggested that forsythin extract in F.suspensa leaves may slow the development of obesity induced by a high-fat diet;thus,its active components and efficacy are worthy of further study.

Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

Farewell to the God of Plague: China for the world disease control program

Schistosomiasis was one of the most prevalent severe infectious diseases in China.Most ot the control plans implemented were based on local settings;thus,the national schistosomiasis control program involved different control phases.These included a working mechanism based on multisectoral cooperation which involved government at all levels,communities,and professionals.It also involved updating the technical strategies and interventions through intensive research,to provide adequate support for programs at different stageswith changing natural and social features.To commemorate the 61st anniversary of publishing Chairman Mao Zedong's two poems titled Farewell to the God of Plague,we have distilled lessons leamt from national schistosomiasis control programs,which could be transferred to other endemic countries.Based on this work,we published a series of articles to demonstrate the successive programs in different areas or levels in China,and also discussed how best to apply those successive experiences into African countries where schistosomiasis is still a public health problem.There are three major lessons learnt from the Chinese national schistosomiasis control program over the last six decades:(1) sustained commitment by the Chinese governments,from central to local levels;(2) continuous update of control strategies and interventions applied at the village level,based on local settings;and (3) maintaining surveillance-response systems implementation in programs at all levels.With sustained efforts,only 37,000 patients including 2.9% advanced patient cases were found in the country,with six provinces out of the 12 endemic provinces yet to achieve transmission interruption,based on the epidemiological report in 2017.Therefore,Chinese experiences in disease control program are sufficient to promote disease control programs in other developing countries,which would also improve the visibility of Chinese contribution to the world disease control programs.Pursuit of this global engagement will also provide the impetus to maintain our surveillance-response capacity in the post-elimination stage.

Characterization of microRNAs in serum： a novel class of biomarkers for diagnosis of cancer and other diseases

在各种各样的纸巾的 microRNAs (miRNAs ) 的 Dysregulated 表示与许多疾病被联系了，包括癌症。这里，我们证明 miRNAs 在象老鼠，老鼠，牛的胎儿，小牛，和马那样的人和另外的动物的浆液和血浆是在场的。在浆液的 miRNAs 的层次在一样的种类的个人之中稳定、可再现、一致。采用 Solexa，我们定序健康中国题目的所有浆液 miRNAs 并且分别地在男、女的题目发现超过 100 和 91 浆液 miRNAs。我们也为肺癌症， colorectal 癌症，和糖尿病识别了浆液 miRNAs 的特定的表示模式，提供证据那浆液 miRNAs 为各种各样的疾病包含指纹。癌症特定的浆液 miRNAs 由 Solexa 获得了的二个非小的房间肺进一步在 75 个健康施主和 152 个癌症病人的独立审判被验证，用量的反向的抄写聚合酶链反应试金。通过这些分析，我们断定浆液 miRNAs 能为各种各样的癌症和另外的疾病的察觉用作潜在的 biomarkers。

Multicenter Evaluation of the Molecular Line Probe Assay for Multidrug Resistant Mycobacterium Tuberculosis Detection in China

In order to evaluate the performance of a molecular Hain line probe assay(Hain LPA)for rapid detection of rifampicin and isoniazid resistance of Mycobacterium tuberculosis in China。

A Study of the Technique of Western Blot for Diagnosis of Lyme Disease caused by Borrelia afzelii in China

Objective To study the technique of Western blot for the diagnosis of Lyme disease caused by Borrelia afzelii in China and to establish the standard criteria by operational procedure. Methods FP1, which is the representative strain of B. afzelii in China, was analyzed by SDS‐PAGE, electro transfer and immunoblotting assays. The molecular weights of the protein bands of FP1 were analyzed by Gel‐Pro analysis software. In a study using 451 serum samples (159 patients with Lyme disease and 292 controls), all observed bands were recorded. The accuracy of the WB as a diagnostic test was established by using the ROC curve and Youden index. Results Criteria for a positive diagnosis of Lyme disease were established as at least one band of P83/100, P58, P39, OspB, OspA, P30, P28, OspC, P17, and P14 in the IgG test and at least one band of P83/100, P58, P39, OspA, P30, P28, OspC, P17, and P41 in the IgM test. For IgG criteria, the sensitivity, specificity and Youden index were 69.8%, 98.3%, and 0.681, respectively; for IgM criteria, the sensitivity, specificity and Youden index were 47%, 94.2%, and 0.412, respectively. Conclusion Establishment of WB criteria for B. afzelii is important in validating the diagnostic assays for Lyme disease in China.

Weighted Markov chains for forecasting and analysis in Incidence of infectious diseases in jiangsu Province,China

This paper first applies the sequential cluster method to set up the classification standard of infectious disease incidence state based on the fact that there are many uncertainty characteristics in the incidence course.Then the paper presents a weighted Markov chain,a method which is used to predict the future incidence state.This method assumes the standardized self-coefficients as weights based on the special characteristics of infectious disease incidence being a dependent stochastic variable.It also analyzes the characteristics of infectious diseases incidence via the Markov chain Monte Carlo method to make the long-term benefit of decision optimal.Our method is successfully validated using existing incidents data of infectious diseases in Jiangsu Province.In summation,this paper proposes ways to improve the accuracy of the weighted Markov chain,specifically in the field of infection epidemiology.

Seroepidemiological Investigation of Lyme Disease and Human Granulocytic Anaplasmosis among People Living in Forest Areas of Eight Provinces in China

Objective Lyme disease and Human granulocytic anaplasmosis are tick‐borne diseases caused by Borrelia burgdorferi and Anaplasma phagocytophilum respectively. We have investigated infection and co-infection of the two diseases in the population of forest areas of eight provinces in China by measuring seroprevalence of antibodies against B. burgdorferi and A. phagocytophilum. Methods Forest areas in 8 provinces were chosen for investigation using whole sampling and questionnaire survey methods. 3 669 serum samples from people in the forest areas were tested for the presence of antibodies by indirect immunofluorescent assay (IFA). Results Seroprevalence against B. burgdorferi was 3% to 15% and against A. phagocytophilum was 2% to 18% in the study sites in the 8 provinces in China. We also found co-infection of B. burgdorferi and A. phagocytophilum in 7 of the 8 provinces (the exception being the Miyun area in Beijing). The seroprevalence for both B. burgdorferi and A. phagocytophilum was significantly higher among people exposed to ticks than among people who were not exposed to ticks. Conclusion We conclude that both pathogens are endemic in the forest areas in the eight provinces, but the prevalence of B. burgdorferi and A. phagocytophilum differs between the provinces.

Effect of Na Fe EDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective To assess the effect of sodium iron ethylenediaminetetraacetate(Na Fe EDTA)-fortified soy sauce on anemia prevalence in the Chinese population. Methods A systematic review was performed to identify potential studies by searching the electronic databases of Pub Med, Cochrane Library, WHO Library, High Wire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of Na Fe EDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of Na Fe EDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. Results After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25(95% CI 0.19-0.35). For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L(95% CI 5.96-11.67). Conclusion Na Fe EDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Disease in Women in China: Surveillance Efforts

在这研究，我们试图与风险介绍的心血管的疾病(CVD ) 和 CVD 估计社会经济的地位和文化移入的关系并且检验与 CVD 联系的 CVD 风险因素。我们从 2010 中国长期的疾病和风险因素监视调查使用了数据，它由女人的一件全国地代表性的样品组成了。下列流行被发现：心肌的梗塞(MI ) ：0.4% ；击：0.5% ；反常 cholesterolemia：44.9% ；过重或肥胖：32.2% ；高血压：31.7% ；糖尿病：9.0% ；并且吸烟：2.5% 。总共， 30.9% 中国女人没有风险因素，但是 13.3% 有的 &ge;3 联系了风险因素。在调整 multivariate 的模型，高血压，糖尿病，超重或肥胖，并且吸烟都直接与 MI 被联系；为中风，协会与高血压，反常 cholesterolemia，糖尿病，和过重或肥胖是积极的。因此， CVD 风险因素在 &ge;18 年的中国女人之中是普通的，这能被结束。

Mobile device-based Reporting System for Sichuan Earthquake-affected Areas Infectious Disease Reporting in China

Objective To describe the experience of the China CDC in rebuilding reporting capacity and response to the Sichuan earthquake through use of mobile phones. Methods Software engineering and business modeling are used to design and develop a cell phone-based reporting system. The PDA-based system used by the Field Adapted Survey Toolkit (FAST) was deployed Results Approximately one week after deployment of the mobile phone-based reporting system, the cumulative reporting rate reached the same level (81%) as the same period in 2007. In the Sichuan provincial pilot investigation for infectious disease, 1339 records were collected using PDAs developed and deployed by FAST. Conclusion The mobile-based system is recognized as a quick and effective response solution to this public health challenge. Our experience suggests that mobile-based data collection tools provide faster, cleaner, standardized, and shareable data for critical decision making. This system could be adapted as complementary to national infectious disease reporting systems after natural disaster occurrences.

The Main Biological Hazards in Animal Biosafety Level 2 Facilities and Strategies for Control

Concern about the biological hazards involved in microbiological research,especially research involving laboratory animals,has increased in recent years.Working in an animal biosafety level 2facility(ABSL-2),commonly used for research on infectious diseases,poses various biological hazards.Here,the regulations and standards related

Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China:a hospital.based,multicenter,cross-sectional survey

Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.