Strengthening the primary health care for non-communicable disease prevention and control in the post-pandemic period:a perspective from China

Non-communicable diseases(NCDs)have become the leading cause of deaths in China and many other countries worldwide.To call for actions in strengthening primary health care(PHC)and accelerate NCD prevention and control in the post-pandemic era in China,the 2023 Duke Kunshan Health Forum focused on innovative approaches and lessons learned during the pandemic that can be applied in addressing NCD challenges.In this article we summarize key points discussed by the participants in three areas:PHC as the foundation and ultimate solution for NCD prevention and control,post-pandemic opportunities to accelerate the NCD program with innovative approaches,and an action framework proposed by the Forum collaborators to address remaining challenges and achieve NCD control objectives in China.The core of the suggested action framework is to offer people-centered,lifetime,comprehensive,continued,and quality NCD prevention and control services,which rely on an integrated healthcare system connecting the primary,secondary,and tertiary levels of care.To achive this objective,six interconnected actions are recommended in the framework:prioritizing and integrating NCD in PHC and Universal Health Coverage(UHC)framework,engaging multiple stakeholders,directing resources to PHC for quality NCD services,leveraging advantages of new technology,encouraging the use of PHC and improving services,and strengthening best practice sharing.

Correction:Strengthening the primary health care for non-communicable disease prevention and control in the post-pandemic period:a perspective from China

Following publication of the original article[1],it was reported that the institution numbers of Jing Wu and Yunguo Liu were incorrectly labelled.The institution number for Jing Wu should be 2 instead of 1 and the institution number for Yunguo Liu should be 1 instead of 2.

Prospects and Problems for Identification of Poisonous Plants in China using DNA Barcodes

Objective Poisonous plants are a deadly threat to public health in China. The traditional clinical diagnosis of the toxic plants is inefficient, fallible, and dependent upon experts. In this study, we tested the performance of DNA barcodes for identification of the most threatening poisonous plants in China. Methods Seventy-four accessions of 27 toxic plant species in 22 genera and 17 families were sampled and three DNA barcodes （motK, rbcL, and ITS） were amplified, sequenced and tested. Three methods, Blast, pairwise global alignment （PWG） distance, and Tree-Building were tested for discrimination power. Results The primer universality of all the three markers was high. Except in the case of ITS for Hemerocollis minor, the three barcodes were successfully generated from all the selected species. Among the three methods applied, Blast showed the lowest discrimination rate, whereas PWG Distance and Tree-Building methods were equally effective. The ITS barcode showed highest discrimination rates using the PWG Distance and Tree-Building methods. When the barcodes were combined, discrimination rates were increased for the Blast method.

Onset of Coronary Heart Disease is Associated with HCMV Infection and Increased CD14^+CD16^+Monocytes in a Population of Weifang,China

Objective To investigate the relationship between human cytomegalovirus(HCMV)infection and peripheral blood CD14+CD16+monocytes in the pathogenesis of coronary heart disease(CHD),and to elucidate the mechanism of pathogenesis in CHD by analyzing the correlation between infection,inflammation,and CHD,to provide a basis for the prevention,evaluation,and treatment of the disease.Methods In total,192 patients with CHD were divided into three groups:latent CHD,angina pectoris,and myocardial infarction.HCMV-IgM and-IgG antibodies were assessed using ELISA;CD14+CD16+monocytes were counted using a five-type automated hematology analyzer;mononuclear cells were assessed using fluorescence-activated cell sorting;and an automatic biochemical analyzer was used to measure the levels of triglyceride,cholesterol,high-and low-density lipoprotein cholesterols,lipoprotein,hs-CRp and Hcy.Results The positive rates of HCMV-IgM and-IgG were significantly higher in the CHD groups than in the control group.HCMV infection affects lipid metabolism to promote immune and inflammatory responses.Conclusion HCMV infection has a specific correlation with the occurrence and development of CHD.The expression of CD14+CD16+mononuclear cells in the CHD group was increased accordingly and correlated with acute HCMV infection.Thus,HCMV antibody as well as peripheral blood CD14+CD16+mononuclear cells can be used to monitor the occurrence and development of CHD.

Now-and Fore-casting the Secular Epidemiological Trends and Seasonality of the Comeback of Scarlet Fever in China:A 16-year Time Series Analysis

Scarlet fever(SF)is a common communicable disease that results from group A Streptococcus(GAS)infections[1].SF accounted for the global loss of life among children 5–15 years of age in the 18th and 19th centuries[2].A rapid reduction in SF morbidity and mortality occurred due to the scale-up of effective antibiotics and improvements in sanitation and nutrition[3].The unexpected increase in the incidence of SF has attracted a renewed interest in infectious diseases[3].Because the triggers that cause SF outbreaks are not fully understood and there is a scarcity of available vaccines protecting susceptible populations from GAS infections,effective prevention and control plans are required to stop the continued spread of SF.

Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics

Mother-to-child transmission(MTCT)of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries.In 2007,World Health Orgernization launched the global elimination of MTCT(EMTCT)of syphilis.Given the high burden of congenital syphilis,China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis.The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019.However,due to the global pandemic of COVID-19,the current measures for eliminating MTCT of syphilis are greatly challenged.In this article,we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years,the remarkable achievements by the policy support under the leadership of the government.In the context of COVID-19 pandemics,strengthening emergency response to the regional outbreaks of COVID-19,adopting safe,rapid,early and high-quality clinical care for 100%of pregnant women to receive prenatal syphilis testing services,ensuring the availability of Benzathine penicillin for the treatment,and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis.Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.

Awareness of Tobacco-Related Health Hazards among Adults in China

Objective To determine the level of awareness of the hazards of tobacco smoking and secondhand smoke inhalation among adults in China. Methods Household surveys were conducted with a total of 13 354 respondents aged 15 years or over from 100 counties of 28 Chinese provinces using a stratified multi-stage geographically clustered sample design. Results The findings revealed that 81.8% of the population was aware that smoking causes serious diseases, and 27.2% and 38.7% were aware that smoking causes stroke and heart attack, respectively. Only 64.3% of respondents were aware that secondhand smoke can cause serious diseases, and 27.5%, 51.0%, and 52.6% were aware that secondhand smoke causes heart disease in adults, lung disease in children and lung cancer in adults, respectively. Awareness regarding smoking-related hazards across all participants was significantly associated with several factors, including gender, smoking status, urban/rural residency, education level and exposure to tobacco control publicity in the last 30 days. Awareness regarding tobacco-related hazards in smokers was significantly associated with urban/rural residency, education level, exposure to tobacco control publicity in the last 30 days, and physician＇s advice. Awareness relating to the hazards of inhaling secondhand smoke was associated with smoking status, urban/rural residency, age, education level, and exposure to tobacco control publicity in the last 30 days. Medical professionals were found to know more about the health hazards of tobacco compared with people in other types of employment. Conclusions Overall awareness of the health hazards of tobacco has improved in the last 15 years in China, but is still relatively poor. Improved means of communicating information and more effective warning labels on cigarette packaging are necessary for increasing public awareness of tobacco hazards, particularly among rural residents and people with less education.

An Investigation of the First Case of Human Rabies Caused by a Fox in China in May 2016

This study assesses the causes and prevention measures of rabies through epidemiological investigation and analysis. A field epidemiological survey was conducted to investigate a case of rabies by fox bite. The onset of symptoms began 50 days after the bite. The patient did not receive standard treatment, rabies vaccination, or rabies immunoglobulin injection. The fox was killed on the spot. Saliva and pre-death blood samples were collected at different periods, and only blood RT-PCR tests yielded positive results. Wild fox bite is a major risk factor of rabies infection in Xinjiang Province, China.

Antiretroviral regimen change among people infected with HIV:evidence from a crosssectional study in China

Background:The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy(HAART).However,the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern.The aim of this study was to determine factors in uencing antiretroviral regimen changes among people living with HIV/AIDS in China.Methods:This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART,and gathered relevant information from infectious disease hospitals.The following information were collected:social-demographic characteristics,antiretroviral therapies,CD4 cell counts,virus loads,reasons for changing medication and other related data.Mean and percentages were used to describe the frequency of regimen change among patients,and binary logistic regression was employed to test the factors in uencing regimen change.Results:1,123 people who had experienced regimen change were included in the analysis.On average,patients remained on HAART for 10.2 months before changing regimen,and the average CD4 cell count and viral load(VL)were 383.1 cells/ l and 28,132.4 copies/mL respectively when changing regimen.The reasons for modi cation were determined as treatment failure(52.5%),adverse reactions(32.3%),and other reasons including pregnancy(15.2%).There are significant differences in regimen change among people with different genders(P<0.001),modes of transmission(P<0.001),duration of HAART(P<0.001)and initial CD4 cell counts(P=0.0024).Males,drug users,people taking long-term medication,and those with lower initial CD4 counts when starting HAART tend to change regimen.Conclusion:Treatment failure was the main reason for the change of HAART regimen.Males,drug users,people on longterm medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

Drug-resistant tuberculosis control in China: progress and challenges

Background:China has the second highest caseload of multidrug-resistant tuberculosis(MDR-TB)in the world.In 2009,the Chinese government agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year.Discussion:China is facing high prevalence rates of drug-resistant TB and MDR-TB.MDR-TB disproportionally affects the poor rural population and the highest rates are in less developed regions largely due to interrupted and/or inappropriate TB treatment.Most households with an affected member suffer a heavy financial burden because of a combination of treatment and other related costs.The influential Global Fund programme for MDR-TB control in China provides technical and financial support for MDR-TB diagnosis and treatment.However,this programme has a fixed timeline and cannot provide a long term solution.In 2009,the Bill and Melinda Gates Foundation,in cooperation with the National Health and Family Planning Commission of China,started to develop innovative approaches to TB/MDR-TB management and case-based payment mechanisms for treatment,alongside increased health insurance benefits for patients,in order to contain medical costs and reduce financial barriers to treatment.Although these efforts appear to be in the right direction,they may not be sufficient unless(a)domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control and(b)appropriate incentives are given to both health facilities and their care providers.Summary:Along with the on-going Chinese health system reform,sustained government financing and social health protection schemes will be critical to ensure universal access to appropriate TB treatment in order to reduce risk of developing MDR-TB and systematic MDR-TB treatment and management.

Heterosexual transmission of HIV and related risk factors among serodiscordant couples in Henan province, China

Background HIV transmission between discordant couples has become an important source of new infections in China.To describe the seroconversion rate among serodiscordant couples and to identify salient behavioral and clinical risk factors including ART that affect heterosexual HIV transmission risk among couples in rural China.Methods Longitudinal follow-up of an open cohort of HIV serodiscordant couples took place between 2007 and 2011 in Zhumadian,a city in southern Henan province in China,where blood plasma selling in 1990s led to a regional HIV epidemic.Annual follow-up included separate face-to-face interviews of husbands and wives,and HIV antibody testing for non-index partners.Cox proportional-hazard modeling was used to assess the relationship between HIV seroconversion and covariates of interest.Results By the end of 2011,4499 HIV serodiscordant couples had been enrolled in at least two follow-up interviews; 100 non-index partners seroconverted during the entire observation period for an incidence rate of 0.82 per 100 person-years （95% CI：0.66-0.99）.The incidence rates by the end of 2008,2009,and 2010 were 2.14,1.51,and 0.90 per 100 personyears respectively.Always using condoms in the past year of sex,gender of the index partner,frequency of sex,and ART exposure were all significant predictors of HIV seroconversion in the negative spouse.ART was highly protective against seroconversion whether the index partner was actively receiving treatment at the last follow-up （RR=0.05,95% CI,0.01-0.16） or if the index partner had ever received ART （RR=0.01,95% CI,0.00,0.12）.The risk of seroconversion in the nonindex spouse also decreased the longer the duration of the index partner＇s exposure to ART.Conclusions ART exposure and always using condom were highly protective against HIV semconversion in the negative spouse.HIV incidence in serodiscordant couples has been decreasing over time,associated with ART treatment time within 7 years in the index partner.Gender of the index spouse and frequency of sex were also important predictors.Treatment as part of a combination prevention package may be a feasible method of HIV control in this population.

Impact of Temperature on Mortality in Three Major Chinese Cities

Objective To study the relation between temperature and mortality by estimating the temperature-related mortality in Beijing, Shanghai, and Guangzhou. Methods Data of daily mortality, weather and air pollution in the three cities were collected. A distributed lag nonlinear model was established and used in analyzing the effects of temperature on mortality. Current and future net temperature-related mortality was estimated. Results The association between temperature and mortality was J-shaped, with an increased death risk of both hot and cold temperature in these cities. The effects of cold temperature on health lasted longer than those of hot temperature. The projected temperature-related mortality increased with the decreased cold-related mortality. The mortality was higher in Guangzhou than in Beijing and Shanghai. Conclusion The impact of temperature on health varies in the 3 cities of China, which may have implications for climate policy making in China.

Trends in Mortality and Prevalence of Reported HIV/AIDS Cases——China,2002-2021

Summary What is already known about this topic?Annually,only the incidence and mortality for Acquired Immune Deficiency Syndrome(AIDS)patients are officially disclosed.What is added by this report?For the first time,information detailing the reported rate,mortality rate,and prevalence rate trends of HIV,AIDS,and HIV/AIDS in China’s entire population over the past two decades has been provided.What are the implications for public health practice?Our research overcomes the longstanding limitation of HIV/AIDS analysis as the sole denominator.Rather,it incorporates a comprehensive examination of the overall population,utilizing indicators and analytic methods from chronic disease analyses.

Multichannel Financing Reduces Economic Burden and Improves the Medical Security Level for Tuberculosis Patients

Tuberculosis(TB)is one of the main infectious diseases to simultaneously cause poverty and be caused by poverty.Reducing the economic burden of TB patients in China is essential to improving patient compliance and reducing the impact of the TB epidemic.In accordance with the national reform of the medical and health system and the current status of the country’s TB prevention and treatment service system,representatives of the government proposed the concept of a multichannel financing mechanism.

Differential mRNA Expressions in HCMV infected HUVECs

Objective The aim was to identify the gene expressions of human cytomegalovirus(HCMV)-infected human umbilical vein endothelial cells(HUVECs)and to study its possible pathogenic mechanism on atherosclerosis using microarray technology.Methods The gene expression differences in HCMV AD169 strain-infected HUVECs were studied by the microarray technology to explore the potential molecular mechanism of HCMV infection.The qPCRs were performed to verify the transcriptome results.Results A total of 2,583 differentially expressed genes,including 407 down-regulated genes and 2,176 up-regulated genes,were detected by the systematic bioinformatics analysis.The Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses showed that the significantly differentially expressed genes were mainly involved in regulating protein kinase activity,inflammatory response,ubiquitination,protein phosphorylation,cell metabolism,and exosomes,among which 12 genes had significant changes and were screened by protein-protein interaction(PPI)analysis and verified by qPCR.The experimental qPCR results were consistent with the microarray results.Conclusion The GO and KEGG analyses revealed that the regulation of protein kinase activity,inflammatory response,ubiquitination,protein phosphorylation,and cell metabolism played important roles in the process of endothelial cell infection.Furthermore,12 genes were involved in the process of HCMV infection of endothelial cells and contributed to the current understanding of the infection and pathogenic mechanisms of atherosclerosis.

Energy and Macronutrient Intake Among Children Aged 6−11 Years Old—China,2016−2017

Summary What is already known on this topic?Low level energy and macronutrient intakes and dietary imbalances are still important issues and should be prioritized in children aged 6-11 years old in China.What is added by this report?Among children aged 6-11 years in China in 2016-2017,the average protein intake was 55.2 g/d in urban areas and was higher than the estimated 45.4 g/d in rural areas.

Fiber Optic SPR POCT: A Novel Nucleic Acid Detection Biosensor for Environmental Viruses

In the post-COVID-19 pandemic era, the long-term surveillance of pathogens is still important. The rapid detection of pathogens facilitates the accurate and convenient real-time monitoring of microbial contamination and improves the management of diseases. Here, a novel surface plasmon resonance (SPR)-based point of care testing (POCT) approach of microorganism nucleic acids with the guidance of CRISPR enzyme is described, including the application of optical fiber-based detection of trace SARS-CoV2 virus in sewage water on SPR and validation of the plasmonic biosensor for the detection of single-nucleotide mutations in natural water samples.

Dynamic mathematical models of HIV/AIDS transmission in China

Social, cultural, and political aspects of the disease may alter the dynamics of infection.In the early 1980s, China＇s first outbreak of HIV was found in intravenous drug users （IDUs） and in the mid-1990s,there was a concentrated outbreak in individuals who were donors and recipients of illegal blood donations.

Field Simulation of Aerosol Transmission of SARS-CoV-2 in a Special Building Layout—Guangdong Province,China,2021

What is already known on this topic?Aerosol transmission was one route for the spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and usually occurred in confined spaces.What is added by this report?Aerosol transmission was found to exist between handshake buildings,i.e.,buildings with extremely close proximity that formed relatively enclosed spaces.Transmission was mainly affected by the airflow layout caused by switching air conditioners on and off as well as opening and closing doors and windows.What are the implications for public health practice?Centralized isolation and home isolation in handshake buildings creates a risk of SARS-CoV-2 aerosol transmission under certain conditions.Attention should be paid to the influence of air distribution layout on aerosol diffusion in isolation wards,and disinfection of isolation venues should be strengthened.

The Role of the Kurtosis Metric in Evaluating the Risk of Occupational Hearing Loss Associated with Complex Noise—Zhejiang Province,China,2010−2019

Summary What is already known about this topic?Occupational noise-induced hearing loss(NIHL)has been the second most common occupational disease in China.Noise energy is the main risk factor for occupational NIHL.Evidence shows the temporal structure of noise(as indicated by kurtosis metric)contribute to the development of NIHL.However,the role of the kurtosis metric in evaluating the risk of occupational NIHL associated with complex noise has been rarely reported.