综合心理干预对社区慢性病患者的效果评价:一项源于社区的整群、随机、对照试验（英文）

背景:抑郁与焦虑经常出现在慢性躯体疾病患者中,通常这会加深这些躯体疾病所造成的损失,但是在中低等收入国家中这一问题却很少受到关注。目标:评估非专业临床人员和志愿者进行以社区为基础的心理干预对缓解慢性躯体疾病患者抑郁和焦虑症状的疗效。方法:将共计10,164名接受糖尿病或高血压治疗的上海社区居民任意分配到常规治疗组(n=2042)或干预组(n=8122),对干预组的干预包括社区范围的心理健康教育、同伴支持小组和个人咨询。采用自评患者健康问卷(Patient Health Questionnaire,PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder scale,GAD-7)和12项健康状况调查问卷(12-item Short-Form Health Survey,SF-12)来评定基线和干预6个月后的抑郁症状、焦虑症状和生活质量。结果:8813人完成了基线评估,其中16%的人有轻度或较严重的抑郁或焦虑症状(PHQ-9或GAD-7>5),并有4%的人伴有中度或重度抑郁或焦虑症状(PHQ-9或GAD-7>10)。本研究有效实施了干预内容中的健康教育部分,但是在符合条件成为同伴支持小组的成员中仅31%的对象接受了干预措施,接受个人咨询的仅9%。本研究脱落率较高(51%),并且在完成和没有完成随访评估的人群之间存在显著差异。经过这些混杂因素的调整后,在完成两项评估的对象中,结果表明抑郁症状(F=9.98,p<0.001)、焦虑症状(F=12.85,p<0.001)以及SF-12中的心理部分总分(F=16.13,p<0.001)均得到显著改善。然而,自我报告未受控制的糖尿病或高血压的率没有显著变化。结论:这些结果支持了以社区为基础的干预措施的可行性,以降低在精神科人力资源有限的中低等收入国家中慢性疾病患者抑郁和焦虑症状的严重程度。然而,在确认该措施广泛大规模实施前还有大量方法学上的挑战需在未来研究中解决。

Knowledge Level about HIV/AIDS among Reproductive Men in Five Counties in China

To understand the HIV/IDS knowledge level and its influential factors among reproductive men in China so as to provide scientific evidence for preventive measures. Methods Cross-sectional survey, system random sample and constructed questionnaire were used in this study. There were 1 285 male subjects who had filled in anon）,mous questionnaires. Results There were significant differences on the HIV/IDS knowledge level in different counties and different demographic characteristic people. Major inJluential factors inchtded area, urban/rural, marriage, educational level, age, consultation about HIV/AIDS. Conclusion It is necessary to strengthen the training of HIV/AIDS knowledge among reproductive men.

Three Gorges Dam:the changing trend of snail density in the Yangtze River basin between 1990 and 2019

Background The area of Oncomelania hupensis snail remains around 3.6 billion m^(2),with newly emerging and reemergent habitats continuing to appear in recent years.This study aimed to explore the long-term dynamics of snail density before and after the operation of Three Gorges Dam(TGD).Methods Data of snail survey between 1990 and 2019 were collected from electronic databases and national schistosomiasis surveillance.Meta-analysis was conducted to estimate the snail density.Joinpoint model was used to identify the changing trend and inflection point.Inverse distance weighted interpolation(IDW)was used to determine the spatial distribution of recent snail density.Results A total of 3777 snail survey sites with a precise location of village or beach were identified.For the downstream area,snail density peaked in 1998(1.635/0.11 m^(2),95%CI:1.220,2.189)and fluctuated at a relatively high level before 2003,then declined steadily from 2003 to 2012.Snail density maintained lower than 0.150/0.11 m^(2) between 2012 and 2019.Joinpoint model identified the inflection of 2003,and a significant decreasing trend from 2003 to 2012 with an annual percentage change(APC)being−20.56%(95%CI:−24.15,−16.80).For the upstream area,snail density peaked in 2005(0.760/0.11 m^(2),95%CI:0.479,1.207)and was generally greater than 0.300/0.11 m2 before 2005.Snail density was generally lower than 0.150/0.11 m^(2) after 2011.Snail density showed a significant decreasing trend from 1990 to 2019 with an APC being−6.05%(95%CI:−7.97,−7.09),and no inflection was identified.IDW showed the areas with a high snail density existed in Poyang Lake,Dongting Lake,Jianghan Plain,and the Anhui branch of the Yangtze River between 2015 and 2019.Conclusions Snail density exhibited a fluctuating downward trend in the Yangtze River basin.In the downstream area,the operation of TGD accelerated the decline of snail density during the first decade period,then snail density fluctuated at a relatively low level.There still exists local areas with a high snail density.Long-term control and monitoring of snails need to be insisted on and strengthened.

Cryptosporidiosis threat under climate change in China:prediction and validation of habitat suitability and outbreak risk for human-derived Cryptosporidium based on ecological niche models

Background Cryptosporidiosis is a zoonotic intestinal infectious disease caused by Cryptosporidium spp.,and its transmission is highly influenced by climate factors.In the present study,the potential spatial distribution of Cryptosporidium in China was predicted based on ecological niche models for cryptosporidiosis epidemic risk warning and prevention and control.Methods The applicability of existing Cryptosporidium presence points in ENM analysis was investigated based on data from monitoring sites in 2011–2019.Cryptosporidium occurrence data for China and neighboring countries were extracted and used to construct the ENMs,namely Maxent,Bioclim,Domain,and Garp.Models were evaluated based on Receiver Operating Characteristic curve,Kappa,and True Skill Statistic coefficients.The best model was constructed using Cryptosporidium data and climate variables during 1986‒2010,and used to analyze the effects of climate factors on Cryptosporidium distribution.The climate variables for the period 2011‒2100 were projected to the simulation results to predict the ecological adaptability and potential distribution of Cryptosporidium in future in China.Results The Maxent model(AUC=0.95,maximum Kappa=0.91,maximum TSS=1.00)fit better than the other three models and was thus considered the best ENM for predicting Cryptosporidium habitat suitability.The major suitable habitats for human-derived Cryptosporidium in China were located in some high-population density areas,especially in the middle and lower reaches of the Yangtze River,the lower reaches of the Yellow River,and the Huai and the Pearl River Basins(cloglog value of habitat suitability>0.9).Under future climate change,non-suitable habitats for Cryptosporidium will shrink,while highly suitable habitats will expand significantly(χ^(2)=76.641,P<0.01;χ^(2)=86.836,P<0.01),and the main changes will likely be concentrated in the northeastern,southwestern,and northwestern regions.Conclusions The Maxent model is applicable in prediction of Cryptosporidium habitat suitability and can achieve excellent simulation results.These results suggest a current high risk of transmission and significant pressure for cryptosporidiosis prevention and control in China.Against a future climate change background,Cryptosporidium may gain more suitable habitats within China.Constructing a national surveillance network could facilitate further elucidation of the epidemiological trends and transmission patterns of cryptosporidiosis,and mitigate the associated epidemic and outbreak risks.

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China.We investigated whether the implementation of a citywide Acute Stroke Care Map(ASCaM)is associated with an improvement of acute stroke care quality in a Chinese urban area.Methods The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals.We identified 7827 patients with ischaemic stroke admitted from April to October 2017,and 506 patients underwent thrombolysis were finally included for analysis.Results Compared with‘pre-ASCaM period’,we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours(65.4% vs 54.5%;adjusted OR,1.724;95% CI 1.21 to 2.45;p=0.003)during‘ASCaM period’.In multivariate analysis models,‘ASCaM period’was associated with a significant reduction in onset-to door time(114.1±55.7 vs 135.7±58.4 min,p=0.0002)and onset-to needle time(ONT)(169.2±58.1 vs 195.6±59.3 min,p<0.0001).Yet no change was found in door-to needle time.Clinical outcomes such as symptomatic intracranial haemorrhage,favourable functional outcome(modified Rankin Scale≤2)and in-hospital mortality remained unchanged.Conclusion The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT.The ASCaM may,in proof-of principle,serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.

The precision of epidemiological investigation of COVID-19 transmission in Shanghai, China

Background:Shanghai had a local outbreak of COVID-19 from January 21 to 24.Timely and precise strategies were taken to prevent further spread of the disease.We discussed and shared the experience of COVID-19 containment in Shanghai.Process:The first two patients worked at two hospitals but no staff from the two hospitals were infected.