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.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011

Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus:A community-based randomized controlled trial in China

BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.

Association of Serum Folate and Vitamin B_(12) Concentrations with Obesity in Chinese Children and Adolescents

Objective This study aimed to evaluate the associations of serum folate and/or vitamin B12 concentrations with obesity among Chinese children and adolescents.Methods A cross-sectional study was conducted including 3,079 Chinese children and adolescents,aged 6 to 17 years,from Jiangsu,China.Anthropometric indices,such as,children's body mass index(BMI),BMI z-scores,waist circumference,and waist-to-height ratio were utilized.Multivariable linear regression and generalized additive models were used to investigate the associations of serum folate and vitamin B12 levels with anthropometric indices and odds of obesity.Results We observed that serum vitamin B12 concentrations were inversely associated with all anthropometric indices and the odds of general obesity[odds ratio(OR)=0.68;95%confidence interval(CI)=0.59,0.78]and abdominal obesity(OR=0.68;95%CI=0.60,0.77).When compared to participants with both serum vitamin levels in the two middle quartiles,those with both serum folate and vitamin B12 levels in the highest quartile were less prone to general(OR=0.31,95%CI=0.19,0.50)or abdominal obesity(OR=0.46,95%CI=0.31,0.67).Conversely,participants with vitamin B12 levels in the lowest quartile alongside folate levels in the highest quartile had higher odds of abdominal obesity(OR=2.06,95%CI=1.09,3.91).Conclusion Higher serum vitamin B12 concentrations,but not serum folate concentrations,were associated with lower odds of childhood obesity.Children and adolescents with high levels of vitamin B12 and folate were less likely to be obese.

Causal relationship between circulating vitamin C and 25-hydroxyvitamin D concentrations and common mental disorders-a Mendelian randomization study

Mental disorders seriously affect people’s health and social stability.This Mendelian randomization(MR)study was designed to investigate the causal relationship between circulating vitamin C(VC)or 25-hydroxyvitamin D(25(OH)D)levels and mental disorders.The data used for the MR analysis were derived from the summary genome-wide association studies(GWAS)database for VC and 25(OH)D and from the Finn Gen consortium for fourteen mental disorders.Based on the inverse variance weighted(IVW)method,we found a potential causal association between circulating VC and anxiety disorders(IVW:OR=1.139,95%CI:1.023-1.269,P=0.018).However,no causal association was found between VC or 25(OH)D and other mental disorders(P>0.05).In the reverse MR analysis,individuals with Alzheimer’s disease was causally associated with higher concentrations of circulating VC(P=0.012),while individuals with anxiety disorders had a negative association between the concentrations of 25(OH)D(P=0.012).However,the current evidence does not support a causal relationship between VC or 25(OH)D and other mental disorders.In addition,there was no causal association between circulating VC and 25(OH)D(P>0.05).Future studies are needed to confirm these findings and to elucidate the mechanisms of potential causality.

Establishing and Validating Refractive Error Reference Values for Myopia Prediction Among Children Aged 6–12 Years-Jiangsu Province,China,2018-2023

Summary What is already known about this topic?Previously,it has been proved that a simplified model that uses refraction error value provides a robust and efficient means of predicting myopia for non-myopic students.Intervention targeting non-myopic children with alert refraction errors(or insufficient hyperopia reserve)holds significant importance in reducing the incidence rate of myopia.What is added by this report?This study,comprising two phases(surveillance and cohort studies),was aiming to pinpoint the precise refractive error value for the onset of myopia prediction among non-myopic children in Jiangsu Province.What are the implications for public health practice?First,when conducting myopia screenings using pupil dilation for non-myopic populations:the cycloplegic 50th percentile refractive error emerges as a more precise predictive indicator.Second,when conducting myopia screenings without pupil dilation:this study advocates for the incorporation of axial length(AL)and corneal curvature(CC)values as supplementary indicators in screenings.

Impact of COVID-19 Interventions on Respiratory and Intestinal Infectious Disease Notifications-Jiangsu Province,China,2020–2023

Introduction:Many measures implemented to control the coronavirus disease 2019(COVID-19)pandemic have reshaped the epidemic patterns of other infectious diseases.This study estimated the impact of the COVID-19 pandemic on respiratory and intestinal infectious diseases and potential changes following reopening.Methods:The optimal intervention and counterfactual models were selected from the seasonal autoregressive integrated moving average(SARIMA),neural network autoregression(NNAR),and hybrid models based on the minimum mean absolute percentage error(MAPE)in the test set.The relative change rate between the actual notification rate and that predicted by the optimal model was calculated for the entire COVID-19 epidemic prevention period and the“reopening”period.Results:Compared with the predicted notification rate based on the counterfactual model,the total relative change rates for the 9 infectious diseases were−44.24%,respiratory infections(−55.41%),and intestinal infections(−26.59%)during 2020–2022.Compared with the predicted notification rate based on the intervention model,the total relative change rates were+247.98%,respiratory infections(+389.59%),and intestinal infections(+50.46%)in 2023.Among them,the relative increases in influenza(+499.98%)and hand-foot-mouth disease(HFMD)(+70.97%)were significant.Conclusions:Measures taken in Jiangsu Province in response to COVID-19 effectively constrained the spread of respiratory and intestinal infectious diseases.Influenza and HFMD rebounded significantly after the lifting of COVID-19 intervention restrictions.

Association of smoking, alcohol drinking and dietary factors with esophageal cancer in high- and low-risk areas of Jiangsu Province, China

AIM： To study the main environmental and lifestyle factors that account for the regional differences in esophageal cancer （EC） risk in low- and high-risk areas of Jiangsu Province, China. METHODS： Since 2003, a population-based casecontrol study has been conducted simultaneously in lowrisk （Ganyu County） and high-risk （Dafeng County） areas of Jiangsu Province, China. Using identical protocols and pre-tested standardized questionnaire, following written informed consent, eligible subjects were inquired about their detail information on potential determinants of EC, including demographic information, socio-economic status, living conditions, disease history, family cancer history, smoking, alcohol drinking, dietary habits, frequency, amount of food intake, etc. Conditional logistic regression with maximum likelihood estimation was used to obtain Odds ratio （OR） and 95 % confidence interval （95% CI）, after adjustment for potential confounders. RESULTS： In the preliminary analysis of the ongoing study, we recruited 291 pairs of cases and controls in Dafeng and 240 pairs of cases and controls in Ganyu, respectively. In both low-risk and high-risk areas, EC was inversely associated with socio-economic status, such as level of education, past economic status and body mass index. However, this disease was more frequent among those who had a family history of cancer or encountered misfortune in the past 10 years. EC was also more frequent among smokers, alcohol drinkers and fast eaters. Furthermore, there was a geographic variation of the associations between smoking, alcohol drinking and EC risk despite the similar prevalence of these risk factors in both low-risk and high-risk areas. The dose-response relationship of smoking and smoking related variables, such as age of the first smoking, duration and amount were apparent only in high-risk areas. On the contrary, a dose-response relationship on the effect of alcohol drinking on EC was observed only in low-risk areas. CONCLUSION： The environmental risk factors, together with genetic factors and gene-environmental interactions might be the main reason for this high-risk gradient in .liangsu Province, China.

Incidence,mortality and survival of female breast cancer during 2003-2011 in Jiangsu province,China

Objective： To assess the incidence, mortality and survival status of female breast cancer in Jiangsu province of China. Methods： Population-based cancer registry data in Jiangsu province were collected during 2003-2011. Crude rates, age-specific rates, age-standardized rates and annual percent changes of incidence and mortality were calculated to describe the epidemiologic characteristics and time trends. Patients diagnosed from 2003 to 2005 were chosen for analyzing the survival status of breast cancer. Results： From 2003 to 2011, 17,605 females were diagnosed with breast cancer and 4,883 died in selected registry areas in Jiangsu province. The crude incidence rate was 25.18/100,000, and the age-standardized rates by Chinese population （ASRC） and by world population （ASRW） were 19.03/100,000 and 17.92/100,000, respectively. During the same period, the crude mortality rate was 6.98/100,000 and the ASRC and ASRW were 4.93/100,000 and 4.80/100,000, respectively. From 2003 to 2011, the incidence and mortality increased with annual percent change of 11.37% and 5.78%, respectively. For survival analysis, 1,392 patients in 7 areas were identified in 2003-2005 and finished 5 years of follow-up. Survival rates were found to decrease with survival years, the 5-year observed survival rate was 45.9% and the relative survival rate was 52.0%. We also found that the survival rate varied across the province, which was lower in the north and higher in the south of Jiangsu province. Conclusions： Breast cancer has become a significant public health problem in Jiangsu province and China. More resources should be invested in primary prevention, earlier diagnosis and better health services in order to increase survival rates among Chinese females.

Development and Validation of a Model for Predicting Diabetic Nephropathy in Chinese People

Objective To develop a risk model for predicting later development of diabetic nephropathy （DN） in Chinese people with type 2 diabetes mellitus （T2DM） and evaluate its performance with independent validation. Methods We used data collected from the project ＇Comprehensive Research on the Prevention and Control of Diabetes＇, which was a community-based study conducted by the Jiangsu Center for Disease Control and Prevention in 2013. A total of 11,771 eligible participants were included in our study. The endpoint was a clear diagnosis of DN. Data was divided into two components： a training set for model development and a test set for validation. The Cox proportional hazard regression was used for survival analysis in men and women. The model＇s performance was evaluated by discrimination and calibration. Results The incidence （cases per 10,000 person-years） of DN was 9.95 （95% CI; 8.66-11.43） in women and 11.28 （95% CI; 9.77-13.03） in men. Factors including diagnosis age, location, body mass index, high-density-lipoprotein cholesterol, creatinine, hypertension, dyslipidemia, retinopathy, diet control, and physical activity were significant in the final model. The model showed high discrimination and good calibration. Conclusion The risk model for predicting DN in people with T2DM can be used in clinical practice for improving the quality of risk management and intervention.

Association between Plasma Metal Levels and Diabetes Risk： a Case-control Study in China

Objective Many metals, some of which have been classified as environmental endocrine disruptors, are used extensively in everyday consumer products and are ubiquitous in our living environment. In the present study, we aimed to explore the associations between the prevalence risk of type 2 diabetes and plasma levels of 20 trace elements as well as those of heavy metals in a Han Chinese population. Methods We conducted a case-control study to investigate the associations between plasma concentrations of 20 metals and diabetes in Jiangsu province. A total of 122 newly diagnosed cases of type 2 diabetes and 429 matched controls were recruited from community physical examinations in Suzhou City of Jiangsu Province. Plasma metal levels were measured by inductively-coupled plasma mass spectrometry. Results After adjusting for confounders, plasma vanadium, chromium, manganese, copper, zinc, arsenic, selenium, strontium, palladium, cadmium, cesium, and barium were associated with diabetes risk （P 〈 0.05）. The adjusted OR increased with increasing concentration of vanadium, manganese, copper, zinc, and cesium. Conclusion Many metals, including manganese, copper, zinc, arsenic, selenium, and cadmium in plasma, are associated with the morbidity of diabetes. Monitoring of environmental metal levels and further studies are urgently needed.

Medical expenditure for esophageal cancer in China:a 10-year multicenter retrospective survey(2002-2011)

Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P < 0.05).Drugs contributed to 45.02% of the overall expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

Estimation of the actual disease burden of human H7N9 infection in Jiangsu of eastern China from March 2013 to September 2017

The actual incidence of human H7N9 infection is supposed to be much higher than the documented laboratoryconfirmed cases.In this study,we estimated the number of the actual H7N9 cases in Jiangsu,China using a probabilistic multiplier model.Then,disability adjusted life years(DALYs),direct and indirect economic loss caused by this disease were calculated and analyzed.Till September 2017,the estimated total number of H7N9 cases was 2952[median,90%probability range(PR):1487-22094],which was 11.8 times(5.9-88.4)as large as the reported number.The median morbidity was estimated to be 4(90%PR:2-29)per 100000 population.The total DALYs loss was 16548 years,and the total economic loss(direct and indirect)was estimated to be RMB 1044618758(US$16.7 M).The average economic loss for per case and for per year was RMB 353868(US$56440)and RMB 232137502(US$37.0 M),respectively.The actual burden of human H7N9 infections was much heavier than what was documented.Our study provided an approach to estimate actual burden of infectious diseases using laboratory-confirmation.

Genome-wide association study reveals novel loci for adult type 1 diabetes in a 5-year nested case-control study

BACKGROUND Type 1 diabetes(T1D)is a severe and prevalent metabolic disease.Due to its high heredity,an increasing number of genome-wide association studies have been performed,most of which were from hospital-based case-control studies with a relatively small sample size.The association of single nucleotide polymorphisms(SNPs)and T1D has been less studied and is less understood in natural cohorts.AIM To investigate the significant variants of T1D,which could be potential biomarkers for T1D prediction or even therapy.METHODS A genome-wide association study(GWAS)of adult T1D was performed in a nested case-control study(785 cases vs 804 controls)from a larger 5-year cohort study in Suzhou,China.Potential harmful or protective SNPs were evaluated for T1D.Subsequent expression and splicing quantitative trait loci(eQTL and sQTL)analyses were carried out to identify target genes modulated by these SNPs.RESULTS A harmful SNP for T1D,rs3117017[odds ratio(OR)=3.202,95%confidence interval(CI):2.296-4.466,P=9.33×10-4]and three protective SNPs rs55846421(0.113,0.081-0.156,1.76×10-9),rs75836320(0.283,0.205-0.392,1.07×10-4),rs362071(0.568,0.495-0.651,1.66×10-4)were identified.Twenty-two genes were further identified as potential candidates for T1D onset.CONCLUSION We identified a potential genetic basis of T1D,both protective and harmful,using a GWAS in a larger nested case-control study of a Chinese population.

Ambient formaldehyde concentrations in summer in 30 Chinese cities and impacts on air cleaning of built environment

Formaldehyde is an important carcinogen commonly found indoors.Its indoor sources have been intensively in-vestigated.But study on outdoor formaldehyde concentration,which is potentially an important source to indoors,remains scarce.This study attempts to characterize temporal and spatial distribution of the atmospheric formalde-hyde concentration in Chinese cities.Diurnal variation of ambient formaldehyde was examined in 6 cities and peak hours were identified between 12:00 pm and 3:00 pm.Consequently,outdoor formaldehyde concentrations were measured in the peak hours in 30 cities during the summer months of Jul.-Aug.,2022.The formaldehyde concentrations in the peak hours fell into a range of 0.005-0.087 mg/m^(3)(median value is 0.027 mg/m^(3)),87.7%of which have exceeded the chronic reference exposure criteria of 0.009 mg/m^(3) set by Office of Environmental Health Hazard Assessment.Health risk analysis suggests that exposure to ambient formaldehyde could cause a median carcinogenic risk of 1.9×10^(−5)(3.17×10^(−6)-6.13×10^(−5)),higher than threshold limit of 10−6.Pearson correlation analysis of the 30 cities shows that ambient summertime atmospheric formaldehyde concentrations of the city are positively correlated with its Gross Domestic Product(r=0.48).We also found that the outdoor formaldehyde concentrations in urban areas(median:0.017 mg/m^(3))is slightly higher than those in suburban areas(median:0.013 mg/m^(3)).Results here prove that outdoor formaldehyde is ubiquitous in Chinese cities and reduces effectiveness of ventilation in dilution indoor concentrations.Neglecting it would underestimate air cleaner capacity needed by a factor of about two.It should be accounted for in health analysis and air quality engineering control design of built environment in the future.

Exploration for the Priority of HIV Intervention:Modelling Health Impact and Cost-Effectiveness—Six Cities,Eastern China,2019-2028

Introduction:In order to enhance the effectiveness of resource allocation,regions must tailor their responses to their specific epidemiological and economic situations.Methods:Utilizing Spectrum software,we projected the cost-effectiveness of 10 chosen HIV interventions in six cities in eastern China from 2019 to 2028.We assessed three scenarios—Base,Achievable,and Idealized—for each city.The analysis included the projected number of HIV infections and deaths averted,as well as the incremental costeffectiveness ratios for each intervention in the six cities.Results:In Shijiazhuang,Wuxi,Yantai,and Zhenjiang,cities with initially low antiretroviral therapy(ART)coverage,ART showed significant effectiveness,especially for males.Conversely,in Foshan and Ningbo,where ART coverage was notably high,oral pre-exposure prophylaxis(PrEP)for men who have sex with men(MSM)proved effective in the Idealized scenario.MSM outreach,ART for males,and ART for females demonstrated cost-effectiveness across all six cities in both Achievable and Idealized scenarios at the predefined thresholds for each city.Discussion:Maintaining an appropriate coverage rate for outreach to MSM can lead to costeffectiveness.In cities with low ART coverage,scaling up ART remains a crucial intervention.In regions with high ART coverage,consideration may be given to the utilization of oral PrEP for MSM individuals,requiring budget allocation.

Evolutionary Diversity of Coxsackievirus A6 Causing Severe Hand,Foot,and Mouth Disease—China,2012-2023

Introduction:Coxsackievirus A6(CVA6)has emerged as a significant pathogen responsible for severe cases of hand,foot,and mouth disease(HFMD).This study aims to delineate the demographic characteristics and analyze the viral evolution of severe HFMD associated with CVA6,thereby assisting in its surveillance and management.Methods:In this investigation,74 strains of CVA6 were isolated from samples collected from severe HFMD cases between 2012 and 2023.The VP1 gene sequences of CVA6 were amplified and analyzed to assess population historical dynamics and evolutionary characteristics using BEAST,DnaSP6,and PopART.Results:A significant portion(94.4%)of severe CVA6-associated HFMD cases(51 out of 54,with 20 lacking age information)were children under 5 years old.Among the 74 CVA6 strains analyzed,72 belonged to the D3a sub-genotype,while only two strains were D2 sub-genotype.The average genetic distance between VP1 sequences prior to 2015 was 0.027,which increased to 0.051 when compared to sequences post-2015.Historical population dynamics analysis indicated three significant population expansions of severe CVA6-associated HFMD during 2012-2013,2013-2014,and 2019-2020,resulting in the formation of 65 distinct haplotypes.Consistent with the MCC tree findings,transitioning between regional haplotypes required multiple base substitutions,showcasing an increase in population diversity during the evolutionary process(from 14 haplotypes in 2013 to 55 haplotypes over the subsequent decade).Conclusions:CVA6,associated with severe HFMD,is evolving and presents a risk of outbreak occurrence.Thus,enhanced surveillance of severe HFMD is imperative.

A Multi-Center Cross-Sectional Study on Visual Impairment and Depression Among Students—Jiangsu Province,China,2017–2022

What is already known about this topic?China exhibits a significantly high prevalence ofmyopia compared to other countries globally. Childrenwith vision impairment have been found to engage lessin physical activities, achieve lower academicperformance, and have increased vulnerability todepression.What is added by this report?During a six-year observational study, a populationlevelcorrelation was identified between varying degreesof visual impairment and the presence of depressivesymptoms among students. Specifically, individualswith a visual acuity below 4.0 had a significantly higherodds ratio of 1.90 (95% confidence interval:1.53–2.37) compared to individuals with normal vision(visual acuity ≥5.0).What are the implications for public healthpractice?This study highlights the importance of holistic healthinterventions that address both visual and psychologicalaspects. Understanding common mechanisms andinfluential factors can guide the development of moreimpactful public health strategies.

Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model

BACKGROUND:Gastric lavage(GL)is one of the most critical early therapies for acute paraquat(PQ)poisoning;however,details of the treatment protocol remain to be established.METHODS:A rapid quantitative method involving sodium dithionite testing was developed.It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL,or without.The vital signs,laboratory testing,and PQ plasma concentrations were collected for therapeutic effect evaluation.RESULTS:The reaction conditions of the test were optimized for two types of samples.Early GL at one hour(H1)could improve the signs and symptoms after acute PQ poisoning at 24 hours(H24).In contrast,GL at 6 hours(H6)could only partially relieve the vital signs.The H1 GL group effectively reduced the peak of the plasma PQ concentration.In addition,the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24.Moreover,there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups.However,the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate.CONCLUSION:GL only at early stage may it benefit PQ poisoning in an animal model.The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate.The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

Risk assessment on the epidemics of human infection with a novel avian influenza A (H7N9) virus in Jiangsu Province, China

A novel avian influenza A （H7N9） virus was discovered in February 2013 in China and has resulted in more than 100 comfirmed human infections including 26 fatal cases as of May 2, 2013. The situation raises many ur- gent questions and global public health concerns. In this study, epidemiologic characteristics of infected human cases in Jiangsu province were analyzed and risk assessment was undertaken based on the information available. Briefly, it is highly unlikely that a pandemic of human infection with avian influenza A （HTN9） virus will happen in Jiangsu Province in the near future. Iia the end, some measures are recommended to prevent the situation from becoming worse.