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2021 Vol. 37, No. 12

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Special Column – Promoting People′s Health: Efforts of Communist Party of China in the Century
China′s health supervision – development process under the leadership of the Communist Party of China
LU Wen-yuan, LU Jie, HAN Xiao-yue,
2021, 37(12): 1721-1725. doi: 10.11847/zgggws1137023
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Since its founding in 1921, the Communist Party of China has been committed to ensuring people′s life and health and developing healthcare undertaking. As a part of the party′s effort, a comprehensive supervision system for the medical and health industry with clear roles and responsibilities, division of labor, coordination, and rational and effective mechanism has basically been established and continuously improved after the 18th National Congress of the Communist Party of China. In the study, the development of China′s health supervision system over the century under the leadership of the Communist Party of China was reviewed and relevant experience was summarized for promoting reform and improvement of health supervision in the new era.
Special Report–HPV Vaccination Willingness
Knowledge on and willingness to receive human papillomavirus vaccination among child-bearing women in mainland China, 2009 – 2016: a pooled analysis
ZHANG Xi, SU Zheng, XU Hui-fang,
2021, 37(12): 1726-1730. doi: 10.11847/zgggws1135890
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  Objective   To examine situations and influencing factors of the knowledge about and the intention to receive prophylactic human papillomavirus (HPV) vaccine among child-bearing women in mainland China.  Methods  The information on 13 914 women aged ≤ 45 years were extracted from five population-based surveys in women on HPV vaccination intention conducted across mainland China between 2009 and 2016. Pooled analysis was performed on the data collected.  Results   Of all the participants, only 3 353 (24.12%) had heard of HPV vaccine and 10 592 (76.12%) reported the willingness to receive HPV vaccine. Main reasons for the participants not having the vaccination intention included without perceived-risk of developing HPV-related diseases (reported by 52.73% of the participants), the vaccine being not yet widely vaccinated (34.98%), and wearing about the vaccine′s effectiveness (31.72%) and safety (30.30%). Among the participants with valid responses, only 3 094 (24.14%) and 1 628 (12.72%) were willing to pay ≥ 1 000 RMB yuan/three doses for imported and domestic HPV vaccines; but 2 254 (17.59%) and 3 528 (27.56%) were willing to pay < 100 RMB yuan/three doses for imported and domestic HPV vaccine, respectively.  Conclusion  For the period of 2009 – 2016, the knowledge about HPV vaccine was at a low level but the willingness to receive the vaccine was high among child-bearing women in mainland China. The results suggest that increasing HPV vaccine related health education in the public and reducing the price of HPV vaccines are necessary for the promotion and popularization of HPV vaccination in China.
Knowledge and attitude toward HPV vaccination promotion after COVID-19 epidemic in various populations in China
YAN Hui-jiao, SU Zheng, LIU Shu-jun,
2021, 37(12): 1731-1736. doi: 10.11847/zgggws1136540
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  Objective  To investigate the acceptability and willingness to recommend human papillomavirus (HPV) vaccine in Chinese women, cervical cancer patients, health workers and governmental officers after coronavirus disease 2019 (COVID-19) epidemic.   Methods  With stratified cluster random sampling, a face-to-face questionnaire survey was conducted from December 2020 to April 2021 among 3 791 persons with different identities in seven geographical regions of China.   Results   Among the 3 599 respondents with complete information, the proportion (number) of persons having heard about HPV vaccine was 80.4% (1 387) in general women, 80.0% (296) in cervical cancer patients, 92.8% (989) in health workers, and 95.7% (419) in government officers, respectively, and the proportion was relatively higher in women and the respondents with higher education. In the female respondents with daughters, 341 (82.0%) general women and 176 (67.2%) cervical cancer patients reported the willingness to have their daughters being vaccinated. Of the health workers, 79.3% (784) expressed the willingness to recommend HPV vaccine to attendees in their routine work. Among government officers, 428 (97.7%) demonstrated a positive attitude toward HPV vaccination promotion, of which, 93.2% (399) considered that the women of right ages should be encouraged to receive HPV vaccine voluntarily and 318 (74.3%) thought that HPV vaccine should be included in national vaccination program for large-scale promotion of HPV vaccination.   Conclusion  After the incidence of COVID-19 epidemic, the willingness of having HPV vaccination increased among Chinese women but parental willingness to have their daughters being vaccinated was low. Despite high willingness of HPV vaccination promotion among governmental officers, the intention of recommending HPV vaccine to attendees in their routine work is not strong among health workers. The results suggest that specific health education on HPV vaccine is important for promoting HPV vaccination willingness in the public.
HPV vaccine-related recommendation and vaccination behavior among medical staff and attendees of immunization clinics in Beijing city
LI Juan, LI Xiao-mei, ZHANG Zhu-jia-zi,
2021, 37(12): 1737-1741. doi: 10.11847/zgggws1134078
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  Objective   To examine the status and influencing factors of human papilloma virus (HPV)-related recommendation behavior in medical staff engaged in immunization service and vaccination behavior in women in Beijing city.   Methods   An on-line and on-site survey was conducted at 75 vaccination clinics in 8 districts of Beijing from January to February 2020. A self-designed questionnaire was completed by 900 immunization service personnel, 1 200 women vaccinated with HPV vaccine, and 1 110 unvaccinated women recruited using stratified multistage cluster sampling.   Results  Of the immunization service personnel, 64.6% reported ever recommending HPV vaccination to potential vaccine recipients or common people and 57.6% expressed the willingness to do the recommendation actively in future. Based on the reporting of the personnel, the three major workloads increased due to HPV vaccination were answering telephone consultation calls, performing appointment notice and dealing with relevant complaints; of which, dealing with relevant complaints was a main factor affecting the willingness to do HPV vaccination recommendation in the future. The top three hindering factors for HPV vaccination reported by the immunization service personnel included staff shortage, increased workload and insufficient vaccine supply. Among the participants at the right age for HPV vaccination, 69.2% and 83.9% reported ever receiving recommendation on HPV vaccination from medical staff and their relatives and friends. Reported by the unvaccinated women, the main reasons for not having HPV vaccination were no time to get the vaccination, considering higher price of the vaccine, and worrying about the safety and effectiveness of the vaccine.  Conclusion  The recommendation for HPV vaccination from immunization service personnel was at a moderate level in Beijing, suggesting that the service mechanism of vaccination not covered by planned immunization program needs to be improved to promote recommendation and vaccination behavior relevant to HPV vaccination.
Application of transmission dynamics model in economic evaluation on HPV vaccine vaccination: a brief introduction
MA Yue, KE Xia-tong, LIANG Xu-yuan,
2021, 37(12): 1742-1745. doi: 10.11847/zgggws1128234
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To provide a reference for economic evaluation on human papillomavirus (HPV) vaccine vaccination, we briefly introduced the application of transmission dynamics model in HPV vaccine vaccination economic evaluation and related calculation methods. In the transmission dynamics model-based evaluation on vaccination of bivalent HPV vaccine, the population is divided into various age groups and individual activity levels; an ordinary differential equation set is established to simulate the transmission of HPV16/18 virus infection in the population and the occurrence of related diseases; and the health output of disease prevention is calculated in combination with the protection efficiency of the vaccine. The transmission dynamics model is a dynamic progress model, which is more realistic than the simulation results of static progress models such as Markov. However, due to the lack of some key parameters and large-scale population survey data in China, the quality of the economic evaluation on HPV vaccine vaccination is affected to some extent. Considering on the absence of some parameters for the evaluation nowadays, some data from other countries could be utilized in transmission dynamics model-based economic evaluation on HPV vaccine vaccination to obtain more accurate analysis results.
Vaccination prevalence and influencing factors of HPV vaccine among women in Tengzhou city, 2018 – 2020: a paired case-control study
YUAN Ke-bing, ZHANG Pei-ying, YANG Meng,
2021, 37(12): 1746-1750. doi: 10.11847/zgggws1134989
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  Objective  To examine current situation and influencing factors of human papillomavirus (HPV) vaccine vaccination among women in Tengzhou city, Shandong province and to provide references for developing strategies on promotion of HPV vaccine vaccination.   Methods  The study included an analysis on registry data of HPV vaccination among residents in Tengzhou city during 2018 – 2020 and a case-control survey. The cases were 268 women HPV-vaccinated in the three-year period and selected with cluster random sampling in the city; the controls were 1 : 1 gender-, age (± three years)-, and living residence (village/community)-matched un-vaccinated women without contraindications for HPV vaccination. Face-to-face household interviews were carried out among the participants using a self-desinged questionnaire. Conditional logistic regression model was adopted to explore influencing factors of HPV vaccination.   Results  The average annual coverage rate of HPV vaccination among the women of the city was 0.28% during the period, with a significant higher vaccination rate (0.67%) among the women in urban regions than that (0.13%) among those in rural areas (χ2 = 3261.74, P < 0.01) and a significant higher rate (0.54%) among the women aged 30 – 34 years than that (0.1%) among those aged 9 – 14 years (χ2 = 1703.87, P < 0.01). Multivariate logistic regression analysis revealed six significant promoting factors for HPV vaccination as following: married, with the education of collage and above, with an annual personal income of 40 000 yuan RMB and more, having family history of tumor, having knowledge about HPV infection, and believing in the effect of HPV vaccine (P < 0.05 for all).   Conclusion  The HPV vaccination rate among appropriate age women in Tengzhou city was lower than that among those surveyed in other regions in China and the study results suggest that associated factors should be concerned for promoting HPV vaccination among the women.
Willingness to have HPV vaccination and its determinants among women in Guangzhou city: an online survey
RAN Rui, ZHANG Chun-huan, HUANG Yong,
2021, 37(12): 1751-1755. doi: 10.11847/zgggws1135359
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  Objective  To examine human papillomavirus (HPV) vaccine-related awareness, vaccination willingness and its impact factors among women in Guangzhou city, Guangdong province.   Methods  With convenient sampling, we conducted a voluntarily self-administrated anonymous survey among 4 360 women in Guangzhou city during 5 – 13 March, 2021. The information on participants′ health literacy, HPV vaccine-related awareness and vaccination willingness were collected using an online questionnaire.   Results  Among the 3 933 participants with valid responses, 49.0% were assessed with qualified health literacy; 78.8% and 76.5% reported the awareness of HPV and HPV vaccine; 76.3% reported the willingness to have HPV vaccine vaccination. Of the 606 participants being unwilling to have HPV vaccine, 22.9% reported the consideration on high price of HPV vaccine; 21.1% reported the difficulty in booking an vaccination appointment; and 20.5% reported the concern about safety of HPV vaccine. The results of multivariate logistic regression analysis showed that the respondents with following characteristics were more likely to have HPV vaccination willingness: with sexual experience (odds ratio [OR] = 1.578, 95 confidence interval [95% CI]: 1.293 – 1.926), having heard about HPV (OR = 1.376, 95% CI: 1.088 – 1.742), having heard about HPV vaccine (OR = 1.682, 95% CI: 1.335 – 2.118), and with a qualified health literacy (OR = 3.422, 95% CI: 2.754 – 4.254).   Conclusion  Among the women in Guangzhou city, the willingness to have HPV vaccination is at a relatively high level and the willingness is mainly associated with previous sexual experience, awareness of HPV and HPV vaccine, and health literacy; the results suggest that promoting health education on HPV vaccination and formulating a mechanism for reasonable sharing of HPV vaccine cost may increase the coverage of HPV vaccination in the women.
Epidemiological Research
Influencing factors of COVID-19 infection among close contacts of confirmed COVID-19 cases in Fujian province, China: a case-control study
CHEN Guang-min, LAN Mei-fang, CHEN Xiao-hong,
2021, 37(12): 1756-1761. doi: 10.11847/zgggws1135552
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  Objective   To explore influencing factors of coronavirus disease 2019 (COVID-19) infection among close contacts of COVID-19 cases in Fujian province for providing evidences to the development of effective control measures and intervention strategies.   Methods  We recruited 103 locally laboratory-confirmed COVID-19 cases reported from January through March, 2020 in Fujian province; the age (± 5 years)- and region (in the same county/district)-matched controls were 430 persons randomly selected from close contacts completing medical observation in designated quarantine sites and with negative results of throat swab coronavirus nucleic acid detection at 1-, 7-, 14-day of isolation period. The participants′ information was collected online with a self-designed questionnaire. Logistic regression was conducted to analyze influencing factors of COVID-19 infection.   Results  There were no significant differences in gender, age, and body mass index between cases and controls (all P > 0.05). Compared to those of the controls, the proportions of the cases reporting following conditions/behaviors were significantly higher: with chronic disease (37.86% vs. 24.65%), co-habitation with confirmed COVID-19 patient (35.92% vs. 15.35%), having daily conversation with confirmed COVID-19 patient (40.78% vs. 23.72%), contacting with symptomatic COVID-19 patient (71.84% vs. 50.93%), contacting with fever COVID-19 patient (48.54% vs. 25.81%), contacting one-time with COVID-19 patient at a distance of one meter or less in close indoor environment for one hour and more (59.22% vs. 30.47%), contacting with COVID-19 patient several times at a distance of one meter or less in close indoor environment cumulatively for 5 hours and more (40.78% vs. 14.65%), contacting with COVID-19 patient several times at a distance of 2 meters or less in close indoor environment cumulatively for 10 hours and more (12.62% vs. 6.74%), contacting with COVID-19 patient at a distance of one meter or less in outdoor environment for 2 hours and more only one time (5.83% vs. 0.47%), and contacting with COVID-19 patient several times at a distance of one meter or less in outdoor environment cumulatively for 10 hours and more (3.88% vs. 0.47%) (all P < 0.05); but there were significantly lower proportions of the cases reporting current smoking (8.74% vs. 26.74%), washing hands frequently (59.22% vs. 74.65%), using soap or liquid soap almost every time when washing hands (32.04% vs. 56.51%), wearing a mask every time when going out (38.83% vs. 70.00%), checking the quality of a mask to be used (13.59% vs. 29.77%), using a new mask all the time when needing mask-wearing (26.21% vs. 36.98%), without direct contact with COVID-19 patient when coexisting in the same close indoor environment with the patient (10.68% vs. 28.14%), taking protective measures when contacting with COVID-19 patient (39.81 vs. 55.81%), conducting hand-washing and other disinfection procedures after contacting with suspected COVID-19 patient (6.80% vs. 28.14%), and ever going to farmers' market two weeks before the disease incidence (67.96% vs. 81.40%) (P < 0.05 for all). Unconditional multivariate logistic regression analysis revealed that ever contacting with symptomatic COVID-19 patient and contacting one-time with COVID-19 patient at a distance of one meter or less in close indoor environment for one hour and more were significant risk factors of COVID-19 infection; the analysis also indicated that wearing a mask every time when going out, checking the quality of a mask to be used, and conducting hand-washing and other disinfection procedures after contacting with suspected COVID-19 patient were significant protective factors against COVID-19 infection.   Conclusion  Mask-wearing when going out, checking the quality of a mask to be used, contacting with symptomatic COVID-19 patient, conducting hand-washing and other disinfection procedures after contacting with suspected COVID-19 patient, and contacting one-time with COVID-19 patient at a distance of one meter or less in close indoor environment for one hour and more are significant influencing factors of COVID-19 infection among close contacts of confirmed COVID-19 cases in Fujian province.
Prevalence and influencing factors of chronic obstructive pulmonary disease among middle-aged and elderly residents in Sichuan province, 2015
DONG Ting, XU Xin-yin, DENG Ying,
2021, 37(12): 1762-1765. doi: 10.11847/zgggws1130083
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  Objective  To explore the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among permanent residents aged 40 years and over in Sichuan province and to provide evidences for COPD prevention and control.  Methods  Using stratified multistage cluster sampling, we recruited 3 601 permanent residents aged ≥ 40 years in urban communities or rural villages in two districts and 4 counties covered by a national disease surveillance program in Sichuan province. Household questionnaire interview, physical examination and lung function test were carried out among the participants from December 2014 to December 2015.  Results  Among 3 391 participants with complete information, 813 were diagnosed as COPD and the COPD prevalence was 24.0%. The results of multi-level variance component model analysis revealed that being male, aged ≥ 50 years, living in rural region, being an ex-smoker, occasionally smoking, daily smoking, and underweight were risk factors of COPD; while, with the education of senior high school and above and exposed to second-hand smoke were protective factors against COPD.  Conclusion  The prevalence of COPD was high and mainly influenced by gender, age, education level, residence, smoking status, second-hand smoke exposure and body weight among middle aged and elderly permanent residents in Sichuan province.
Prevalence and influencing factors of comorbidity of chronic diseases among community residents in Jiading district of Shanghai city
LI An-le, ZHAO Gen-ming, JIANG Feng,
2021, 37(12): 1766-1769. doi: 10.11847/zgggws1131982
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  Objective  To examine the comorbidity of chronic diseases and its associates among community residents of Jiading district of Shanghai city and to provide evidences for comprehensive prevention of common chronic diseases in community populations.   Methods   Using multistage stratified cluster random sampling, we recruited 10 053 permanent residents aged 20 – 75 years in 12 neihborhood committees/villages in Jiading district of Shanghai municipality and conducted face-to-face questionnaire survey and physical examination among the residents during July – September 2019.  Results  Among the participants, 4 920 (48.94%) were identified suffering from at least two chronic diseases; of all the sufferers of chronic disease comorbities, 1 988 (40.41%), 1 314 (26.71%), and 1 618 (32.89%) had two, three, and four or more chronic diseases. The results of unconditional multivariate logistic regression analysis demonstrated that male gender, aged ≥ 30 years, lack of physical exercise and with poor sleep quality were risk factors for chronic disease comorbidities; whereas, not smoking, having good sleep quality and without sweet food preference were protective factors against chronic disease comorbidities for the participants.  Conclusion  Among community residents of Jiading district of Shanghai municipality, the prevalence of chronic disease comorbidities is relatively high and mainly influenced by gender, age, smoking, physical exercise, sleep quality and sweet food preference.
Acquirement of health education on public health emergency and its associates among college students in Shandong province
WANG Na, ZHANG Wen, CAO Xiao-hua,
2021, 37(12): 1770-1773. doi: 10.11847/zgggws1131623
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  Objective   To examine the situation and influencing factors of acquirements of health education on public health emergency among college students in Shandong province and to provide references for developing education programs relevant to public health emergency among the students.   Methods  Using stratified random sampling, we recruited 8 000 students in 6 universities in Shandong province and conducted an online anonymous questionnaire survey during April – May 2020.   Results  Among the 7 719 students with valid responses, 4378 (56.7%) reported that there were on-campus education programs on infectious disease prevention and control; 4219 (54.7%) and 3238 (41.9%) reported that there were on-campus education programs on sports safety and on prevention/first aid of accidental injury. In terms of college courses on health education, 3 090 (40.0%) and 3 889 (50.4%) of the students considered that the number of enrolment registration and class hour were not large enough; inflexible teaching, informal examination, and lectures′ professional deficit were reported by 3 543 (45.9%), 2 264 (29.3%), and 2345 (30.4%) of the students, respectively. Of the students, 4 602 (59.7%) and 4 995 (64.7%) reported being aware of and having received health education on public health emergency. The results of unconditional multivariate logistic regression analysis indicated that the girl students and the students entering colleges from regions other than in Shandong province were less likely to receive the education on public health emergency; while, the students with following characteristics were more likely to receive the education: being a sophomore, with a rural registered permanent residence, with health education courses in college, considering lectures with adequate professional quality for health education, being aware of public health emergency events, and being aware of college authorities′ general or great concerns on health education.  Conclusion  Among college students in Shandong province, the acquirement of health education on public health emergency is at a relatively low level and mainly influenced by students′ gender, schooling grade, type of household registration, living region before college entrance, awareness on public health emergency events, and consideration on professional quality of health education lectures and colleges′ health education courses and concerns on health education.
Associations of waist circumference, waist-hip ratio, waist-height ratio, and body mass index with hypertension incidence among 35 – 74 years old residents in Jiangsu province: a prospective cohort study
CHEN Feng-mei, GUO Zhi-rong, HAI Bo,
2021, 37(12): 1774-1777. doi: 10.11847/zgggws1128795
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  Objective  To explore effects of body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHtR) on hypertension incidence among adult community population.  Methods  During April 1999 in Jiangsu province, a baseline survey was conducted among 8 865 residents aged 35 – 74 years in three urban communities and nine natural villages and then two follow-up studies were carried out among 4 582 and 3 847 residents 2 and 5 years after the baseline survey. Finally, physical examination and questionnaire interview were performed among 2 531 residents being followed-up 2 or 5 years later and without hypertension, diabetes, cardiovascular diseases and high fasting blood glucose (≥ 5.6 mmol/L) at the baseline survey. Multivariate Cox proportional hazard regression analysis was adopted to analyze the effects of WC, BMI, WHR and WHtR on hypertension incidence.  Results  Among the 2 531 participants with a median follow-up interval of 3.8 years, 469 new hypertension were diagnosed by the end of follow-up and the hypertension incidence rate was 18.53%. After adjusting for gender, age, education, occupation, family annual income per capita, smoking and alcohol drinking, significantly higher hypertension risks were estimated for the participants with the third and the highest quartile value of BMI (hazard risk [HR] = 1.46 and 2.42), WC (HR = 1.63 and 2.51), WHR (HR = 1.70 and 2.62), and WHtR (HR = 1.63 and 2.62) compared to the participants with the lowest quartile value of the four indicators, respectively; furthermore, the hypertension risk was significantly higher for the participants with the highest tertile value of BMI and the second or the highest tertile values of WC (HR = 1.86 and 2.55) in comparison with the participants with the lowest tertile value of BMI and WC.  Conclusion  High somatotype indexes including WC, BMI, WHR and WHtR are associated with increased risk of hypertension incidence among adult community residents.
Effect of different dietary carbohydrate/fat ratios on aging biomarkers under the same energy and protein intake in healthy people: a metabonomics study
ZHANG Dan-dan, ZHU Qiu-shuang, LIU Jin-xiao,
2021, 37(12): 1778-1782. doi: 10.11847/zgggws1131740
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  Objective   To explore the relationship between different carbohydrate/fat intake ratio and aging biomarkers under normal energy and protein intake in healthy people.   Methods  Form 4 973 adult residents participating in Harbin Cohort Study on Diet, Nutrition and Non-Communicable Chronic Diseases conducted in 2015, we selected 90 healthy people reporting normal dietary protein and energy intake but without personal and family history of chronic disease and divided them into three groups (30 in each group): normal control (N), high fat (HF) and high carbonhydrate (HC) group. Ultrahigh performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-Tof-MS) was used to detect metabolic fingerprints of plasma samples of the participants. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were employed to analyze differences in metabolites among the participants of different age group. Aging biomarkers were screened out according to the values of variable importance in the projection (VIP) and variation ratio obtained by PLS-DA model, and changes in the aging biomarkers in different dietary groups were analyzed.  Results  The results of UPLC-Q-Tof-MS showed that all the study groups could be distinguished accurately under PLS-DA mode and there were significant differences in plasma metabolic mode. Five aging biomarkers were identified; among which, 12 (s)-hpete, aminoadipic acid and 3-hydroxynonylcarnitine increased with age, while L-leucine and dehydroe-piandrosterone sulfate decreased with age. In comparison with those of the N group, the concentrations of L-leucine and dehydroepiandrosterone sulfate of the HF and the HC group decreased, but the concentrations of 12 (s)-hpete, aminoadipic acid and 3-hydroxynonylcarnitine of the two groups increased. Compared with the HF group, the HC group had decreased L-leucine and dehydroepiandrosterone sulfate but increased 12 (s)-hpete, aminoadipic acid and 3-hydroxynonanoylcarnitine. The results suggested that both high-fat and high carbohydrate could promote aging to some extent, and the effect of high carbohydrate on aging is more obvious.  Conclusion  Under the same energy and protein intake, high-fat and high carbohydrate intake are not conducive to healthy life span; compared with high-fat intake, high carbohydrate intake is easier to promote aging process and shorten life expectancy.
Public trust in medical staff during COVID-19 epidemic in China: a cross-sectional survey
CHI Shang-xin, CHEN Jun-hang, LÜ Shi-jia,
2021, 37(12): 1783-1787. doi: 10.11847/zgggws1133392
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  Objective  To explore public trust in medical staff and its change during coronavirus disease 2019 (COVID-19) epidemic and to provide evidences for improving doctor-patient trust in China.  Methods  Using a self-designed questionnaire and snowball sampling, we conducted a three-day online anonymous survey during COVID-19 epidemic (February 24 – 26, 2020) among 2 100 internet users in 31 provincial-level regions across China.   Results  A high level of trust in medical staff was reported by 2 065 participants with valid responses, with dimensional scores (maximum score of 5 for all dimensions) of 4.33 ± 0.72 for overall trust in doctors, 4.25 ± 0.72 for trust in medical skills, 3.27 ± 0.70 for trust in medical ethics of the staff, 4.15 ± 0.69 for overall trust in nurses, 3.98 ± 0.69 for trust in nurses′ competence, and 3.88 ± 0.75 for trust in nurses′ attitude, respectively. The majority of the participants expressed positive attitude towards improving the welfare of frontline medical staff. The participant′s trust scores of different dimensions differed significantly by their gender, age, educational background and occupation (P < 0.05 for all). Under the context of COVID-19 epidemic, an increased trust in medical staff was reported by 56.17% of the participants and the participants of female gender, at middle and older age, and with lower educational background were more likely to report the increased trust (all P < 0.05); hard working in frontline services was a main factor for the increased trust attributed by the participants.   Conclusion   The level of public trust in medical staff improved under the context of COVID-19 epidemic but realizing mutual trust between doctors and patients is still a core issue in the reformation of health care system in China.
Correlation between arsenic methylation metabolism and skin and liver damage in patients with coal-burning arsenism
LIU Shu-hong, SUN Bao-fei, WANG Qing-ling,
2021, 37(12): 1788-1792. doi: 10.11847/zgggws1133524
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  Objective  To analyze the level of urinary arsenic methylation metabolism and its correlation with skin and liver damage among coal-burning arsenism patients.  Methods  Based on the “Diagnostic Criteria of Endemic Arsenism” (WS/T 211 — 2015) issued by Health and Family Planning Commission of the People′s Republic of China, we recruited 202 arsenism patients in an endemic area with arsenic pollution caused by coal-burning in southwestern region of Guizhou province and subdivided the patients into a mild (n = 48), moderate (n = 70) and severe group (n = 84) according to the severity of skin damage of the patients. The controls of the study were 56 healthy residents recruited in a region 12 kilometers away from the endemic arsenism area and the controls had everyday life similar to that of patients and no history of exposure to burning high arsenic coal. Serum albumin (ALB) and albumin/globulin (A/G) ratio were used to assess liver damage of the participants. High performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS) was adopted to detect trivalent arsenic (As3+), pentavalent arsenic (As5+), monomethyl arsenic (MMA) and dimethyl arsenic (DMA) in the urine samples of the participants and the detection results were used to calculate total arsenic (tAS), proportions of As3+, As5+, MMA and DMA (As3+%, As5+%, MMA% and DMA%), primary methylation index (PMI), and the secondary methylation index (SMI).  Results  Compared to the controls, the arsenism patients had significantly increased urinary As3+, MMA, As3+% and MMA% (P < 0.05 for all) but decreased DMA%, PMI and SMI (all P < 0.05). The patients′ urinary As3+% and MMA% increased and SMI decreased significantly with the severity of skin damage (P < 0.05 for all). In the arsenism patients, the serum ALB and A/G decreased significantly in comparison with those in the controls (both P < 0.05); the serum ALB declined with the increase of urinary As3+% and MMA% and the decrease of urinary DMA%, PMI and SMI (all P < 0.05), while with the increase of urinary As3+% the serum A/G declined significantly (P < 0.05). When used as two indicators for the assessment of arsenism, the urinary As3+% and MMA% presented the area under the receiver operating characteristic curve (AUC) of 0.84 and 0.63 and the optimal cutoff point of 14.37% and 12.10%; the specificity of the two cutoff points were 83.93% and 73.21% and the sensitivity of the two cutoff points were 73.27% and 50.99%. When combining As3+% and MMA% as an integrated indicator, the indicator′s AUC was 0.82, with a specificity of 89.29% and a sensitivity of 66.83%, respectively.  Conclusion  Attenuated arsenic methylation metabolism is a risk factor for skin and liver damage among coal-burning arsenism patients. Urinary As3+% and MMA% could be used as potential indicators for the assessment of coal-burning arsenism and the assessment specificity increases when the two indicators being combined.
Experimental Study
Effect of dietary restriction on manganese-induced neurotoxicity in mice
LANG Jing, GAO Liang, WANG Wen-bo,
2021, 37(12): 1793-1796. doi: 10.11847/zgggws1133241
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Abstract:
  Objective  To explore the effect and mechanism of dietary restriction (DR) on manganese (Mn)-induced neurotoxicity.  Methods  Forty adult Kunming mice (male : female = 1 : 1) were randomly divided into four groups (10 in each group): control group (25.0 g feed/day and intraperitoneal injection of saline), DR control group (12.5 g feed/day and intraperitoneal injection of saline), Mn exposure group (25.0 g feed/day and intraperitoneal injection of Mn at dose of 200 μmol/kg) and DR intervention group (12.5 g feed/day and intraperitoneal injection of Mn at dose of 200 μmol/kg). The treatments were conducted once a day continuously for 6 weeks. The mice′s weight and blood glucose were measured and their behavioral changes were observed every week. By the end of the treatments, the brain specimens were collected for determinations of brain coefficient, cumulated Mn content, levels of inflammatory factors, and expressions of related proteins.  Results  In the Mn exposed mice, abnormal behavioral changes were observed; decreased brain coefficient and interleukin 4 (IL-4) but increased tumor necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS), protein expression of nuclear factor kappa B (NF-κB), and caspase-8 were detected compared to those in the control mice (all P < 0.05). Decreased brain coefficient, TNF-α, iNOS, NF-κB, and caspase-8 were detected in the Mn exposed mice with DR in comparison with those in the Mn exposed mice with normal feeding (P < 0.05 for all).  Conclusion  Dietary restriction could play a protective role in Mn-induced neurotoxicity and the effect may be related to inflammation suppression, apoptosis reduction, and autophagy enhancement in mice.
Survey and Report
Involvement in integrated basic medical care and basic public health services among medical personnel in Guangzhou city: a cross-sectional survey
WANG Chang, LIU Hui, SUN Min-ying,
2021, 37(12): 1797-1799. doi: 10.11847/zgggws1134578
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Abstract:
  Objective  To examine the involvement in integrated basic medical care and basic public health services among medical staff in Guangzhou city, Guangdong province and to provide evidences for promoting the integration of medical care and public health in the city.  Methods  Using convenience sampling and a self-designed questionnaire, we conducted an online anonymous survey among 7 416 grassroots medical staff in community/town health care institutions and village clinics covered by National Basic Public Health Service Project in 11 districts of Guangzhou city from December 2019 to January 2020.  Results  Among the 7 305 participants with valid responses, 1 148 (15.72%) and 2 713 (37.14%) reported being engaged only in basic medical care and only in basic public health service; while, 3 444 (47.15%) reported being engaged in both basic medical care and basic public health service, of which, 541 (15.71%), 1 164 (33.80%), 1 012 (29.38%), and 727 (21.11%) were involved in one, 2 – 4, 5 – 7, and 8 or more integrated items of basic medical care and public health service, respectively. Reported by the participants, the top three integrated service items covered by National Basic Public Health Service Project were health education (reported by 2 522 [73.23%] of the participants), residents′ health record management (2 428 [70.50%]), and hypertensives′ management (2 201 [63.91%)]. The reported proportion of being engaged in the integrated service items differed significantly by living residence, gender, occupation, category of medical institution, and whether being general practitioners (all P < 0.001); the participants not living in central urban regions, being male, being clinicians, working in village clinics, and being general practitioners reported a higher proportion compared to those reported by the participants living in central urban regions, being female, being public health doctors, working in community health care centers, and being medical personnel other than general practitioners.  Conclusion  In Guangzhou city, the majority of grassroots medical staff were involved in integrated service items of health education, resident health records management, and hypertension patients management covered by National Basic Public Health Service Project. The participation of integrated medical care and public health services should be promoted among grassroots medical staff working in central urban regions, being female, being public health doctors, working in community health care centers, and being medical personnel other than general practitioners.
Prevalence characteristics of cerebral infarction among residents in Hebei province, 2015 – 2018: a time series analysis
SHI Wei-wei, XUN Lu-ning, CAO Ya-jing,
2021, 37(12): 1800-1804. doi: 10.11847/zgggws1131022
Abstract(307) HTML (135) PDF 694KB(32)
Abstract:
  Objective   To examine prevalence characteristics of cerebral infarction (CI) among residents in Hebei province from 2015 to 2018, and to explore the application of time series model in the prediction of CI incidence for the prevention and control of the disease.   Methods   From National Chronic Non-Communicable Disease Surveillance System, we collected the data on registered cerebral infarction incidents in 18 surveillance points in Hebei province from January 1, 2015 through December 31, 2018. The prevalence characteristics of CI and its changing trend were analyzed and a time series model was established to predict annual and monthly incidence rate of CI in 2019.  Results  During the 4-year period in the province, the average annual CI incidence rate were 311.73/100 000, with the yearly incidence rate of 283.22, 296.36, 322.93, and 342.55 per 100 000 for the year from 2015 to 2018 and a significantly increasing trend (χ2 = 624.353, P < 0.001). The CI incidence rate in the male residents were significantly higher than that in the female residents (348.81/100 000 vs. 273.60/100 000, χ2 = 1 680.960; P < 0.05). The age-specific CI incidence rate was significantly different among various age groups, with the rate of 2.58, 48.96, 263.21, 650.61, 1 641.77, 2 083.59, and 3 000.88 per 100 000 for the residents aged < 35, 35 – 44, 45 – 54, 55 – 64, 65 – 74, 75 – 84, and ≥ 85 years, respectively (χ2 = 381 051.465, P < 0.001). The established best fitted model was ARIMA (autoregressive integrated moving average) (0, 1, 1)(2, 1, 0)12; the model's residual sequence was white noise sequence (P > 0.05); and the parameters for the established model were as following: Akaike information criterion (AIC) = 214.480, Bayesian information criterion (BIC) = 220.698, root mean square error (RMSE) = 2.97, mean absolute error (MAE) =1.62, and mean absolute percentage error (MAPE) = 7.55%. Based on the model, the predicted yearly CI incidence rate was 362.46/100 000 for the residents in 2019, which was higher than that in previous years; the predicted monthly CI incidence rates ranged between 23.62/100 000 and 33.33/100 000 and the variation of the rates for the year of 2019 was similar to that in previous years.   Conclusion   The incidence rate of cerebral infarction was at a high level and increased yearly during 2015 – 2018 among residents in Hebei province; the incidence rate was relatively higher in the male and the elderly residents. Time series model can be used to predicate the incidence rate for the prevention and control of cerebral infarction.
Depressive symptoms, perceived social support and their correlation among adolescent lesbians
GUO Meng-lan, WANG Li-yin, DUAN Zhi-zhou,
2021, 37(12): 1805-1808. doi: 10.11847/zgggws1132758
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Abstract:
  Objective  To examine the prevalence of depression symptoms and its association with perceived social support among adolescent lesbians for providing references to depression prevention in the population.  Methods  Totally 160 lesbians aged 15 – 25 years were recruited with the help of Beijing Lespark (a lesbian organization) for an online anonymous survey conducted during July – December 2018. The Centre for Epidemiologic Studies Depression Scale (CESD-10), Perceived Social Support Scale (PSSS) and a self-designed questionnaire were completed by the participants via Sojump platform.  Results  More a than half (56.9%) of the participants reported depressive symptoms. The participants′ mean score for overall social support was 58.25 ± 13.39 and the mean score for family, friend, and other people support were 17.96 ± 5.64, 20.64 ± 4.86, and 19.65 ± 5.28, respectively; 45.6% of the participants reported a high level of perceived social support. Logistic regression analysis revealed that the perceived overall social support was significantly related to a decreased risk of depressive symptoms (odds ratio = 0.930, 95% confidence interval: 0.898 – 0.964).  Conclusion  Depressive symptoms are common and the prevalence of depressive symptoms is associated with perceived social support among adolescent lesbians.
Clarity of responsibilities for all parties in public health emergency response in Liaoning and Jilin province: a literature analysis
GONG Jian-hua, LI Cheng-yue, XU Ling-zhong,
2021, 37(12): 1809-1812. doi: 10.11847/zgggws1124622
Abstract(2020) HTML (1179) PDF 782KB(28)
Abstract:
  Objective  To analyze the clarity of responsibilities for all parties in public health emergency (PHE) response and the relationship between the clarity and the response efficacy in Liaoning and Jilin province for providing references for the improvement in public health organization system construction.  Methods  We searched literatures and documents referring to responsibility assignment for all parties in PHE response published by government agencies and professional institutions in the two provinces from 2000 through 2017 via public websites, China National Knowledge Infrastructure (CNKI), Wanfang Data and Web of Science. Cluster analysis and qualitative and quantitative methods were used to evaluate the clarity of the responsibility assignment for all parties of the two provinces. Spearman correlation and linear regression were used to analyze the relationship between the clarity and response efficacy.  Results  For the administration in Liaoning and Jilin province, the index for the clarity of the responsibilities assignment increased gradually from zero in 2000 to 20.60% and 21.95% in 2017; the index for response efficacy also gradually increased from 40.00% and zero to 53.33% and 60.00%, respectively. Significantly positive correlation between the clarity and the response efficacy was observed in Liaoning and Jilin province, with the correlation coefficients of 0.496 and 0.605, respectively (both P < 0.05).  Conclusion  The clarity of responsibilities for all parties in public health emergency response and the response efficacy have been improved in Liaoning and Jilin province since 2000, indicating an improvement in the construction of public health organization system of the two regions.
Association of specific keywords index in Baidu website with influenza monitoring data during 2012 – 2020 and potential use of the index for influenza epidemic prediction
LI Le, ZHOU Zi-hao, WU Qun-hong,
2021, 37(12): 1813-1818. doi: 10.11847/zgggws1132684
Abstract(231) HTML (102) PDF 715KB(35)
Abstract:
  Objective  The analyze change trend in the correlation between specific keywords index in Baidu website (keyword Baidu index) and influenza monitoring data in China and to construct a Baidu index-based prediction model for influenza epidemics.   Methods   The data on weekly number of influenza virus-positive cases in China from the first week of 2012 through the 12th week of 2020 were collected from the Global Influenza Surveillance and Response Network (GISRS). Using influenza-related keywords of four domains (disease name, prevention, treatment, and symptom) screened out with literature studies, the daily Baidu indexes of those keywords during the same period were extracted from the Baidu index database (http://index.Baidu.com/). Using SPSS 22.0 software, the coefficients for the correlation between the keyword Baidu index and the number of influenza virus-positive cases were calculated for the two periods separated by a time node of 2017, when the scale of influenza epidemics in China changed significantly, and multivariate linear regression models for the correlation between the two variables were also constructed with Eviews 8 software.   Results   Totally 70 keywords were screened out. Before 2017, there were 18 keywords with the coefficients of greater than 0.5 for the correlation between keyword Baidu index and the weekly number of virus-positive influenza cases; while there were 30 such keywords after 2017, among which, 28 keywords were with the coefficients of much greater than 0.5. The top four keywords with the greatest coefficients were swine flu, influenza, influenza A, and fever before 2017; but after 2017, the top four keywords were swine flu symptom, influenza symptom, medicine for the treatment of influenza, and Tylenol (product name for paracetamol). The constructed regression model with the independent variables including a non-specific keyword of ‘high fever’ was of a better prediction outcome, and the prediction deviation of the model was reduced when the specific keyword was replaced.   Conclusion   In China, the scope of influenza-related keywords has been extending in network media based on big data monitoring and the correlation between the keywords with influenza epidemic has also been increased. The public tend to acquire more information on symptoms and treatment of influenza than on general knowledge about the infectious disease. The results suggest that the selected keywords should be updated timely and more specific keywords should be adopted in influenza epidemic surveillance with big data from network media.
Prevalence and influencing factors of cyberbullying among high school students in Liaoning province
CUI Shi-min, TIAN Dan, SUN Yan-bo,
2021, 37(12): 1819-1822. doi: 10.11847/zgggws1135702
Abstract(102) HTML (26) PDF 503KB(14)
Abstract:
  Objective  To explore the prevalence and influencing factors of cyberbullying among high school students.   Methods  An onsite and online survey was conducted among 970 high school students selected with probability proportionate to size sampling (PPS) in Dandong and Chaoyang municipality, Liaoning province in September, 2020. The Questionnaire on Health Behavior of Chinese Adolescent developed by University of Chinese Academy of Social Sciences was used in the study.   Results  Valid responses were collected from all the participants and the reported prevalence rate of cyberbullying victimization and perpetration were 6.3% and 5.6%, respectively. The results of logistic regression analysis showed that for cyberbullying perpetration, male gender was a risk factor (odds ratio [OR] = 2.199, 95% confidence interval [95% CI]: 1.212 – 3.992) but self-perceived good parent-child relationship was a protective factor (OR = 0.660, 95% CI: 0.484 – 0.898); while, self-perceived close parent-child relationship (OR = 0.640, 95% CI: 0.477 – 0.857) and self-perceived good maternal understanding of him/her self (OR = 0.906, 95% CI: 0.829 – 0.991) were significant protective factor for cyberbullying victimization.   Conclusion  Good parent-child relationship may be a protective factor against cyberbullying among high school students.
Influencing factors of HIV testing behaviors among college students in Jiangxi province
CHENG Hui, FU Jun, YANG Qing,
2021, 37(12): 1823-1826. doi: 10.11847/zgggws1135137
Abstract(133) HTML (21) PDF 476KB(10)
Abstract:
  Objective  To examine current situation and influencing factors of human immunodeficiency virus (HIV) infection testing behavior among college students for developing strategies and measures on the prevention and control of HIV infection in the students.   Methods  An online survey was conducted among 319 college students recruited with convenient sampling in two universities in Jiangxi province during September – November, 2020. A self-designed structural questionnaire was used to collect relevant information and multivariate logistic regression analysis was adopted in statistical analysis.   Results  Of all the students, 87.15% (278) had never been tested for HIV infection and only (12.85%) had HIV infection test. The results of logistic regression analysis showed that the students with self-perceived risk of HIV infection and ever having high-risk sex were more likely to have HIV test, with the odds ratio of 2.51 and 2.33, respectively.   Conclusion  Among college students in Jiangxi province, the rate of having HIV infection test is relatively low and the rate is influenced by the students' perceived HIV infection risk and the risk-related behaviors.
Overview
Progress in researches on logistic capacity allocation of immunization units under mass vaccination
GEMG Shu-fan, YU Wen-zhou
2021, 37(12): 1827-1830. doi: 10.11847/zgggws1136245
Abstract(115) HTML (35) PDF 539KB(17)
Abstract:
During the mass vaccination, the involved immunization units should undertake some extra vaccination services besides routine vaccination and the immunization units may need to expand their logistic capacity. Published studies showed that the volume of refrigerators, the number of vaccination-related staff and the area of clinics are the key aspects of immunization logistic capacity. Focusing on the three aspects mentioned, we reviewed published researches on configuration standards and the demand measurement methods of immunization logistic capacity. Problems in logistic capacity allocation of the involved immunization units, potential impacts of these problems on mass vaccination, and countermeasures to deal with the problems were also discussed.
Progress in researches on vitamin D in prevention and treatment of coronavirus disease
ZHU Qian-rang, ZHANG Jing-xian, XIE Wei,
2021, 37(12): 1831-1834. doi: 10.11847/zgggws1133951
Abstract(85) HTML (45) PDF 454KB(19)
Abstract:
The coronavirus disease 2019 (COVID - 19) pandemic has imposed an enormous burden on health and economy around the world. All public health measures that can reduce the risk of infection and death are of great practical importance. Vitamin D is a fat - soluble vitamin, which plays a certain role in preventing respiratory tract infection, enhancing immune system and maintaining cardiopulmonary function, and it's deficiency may be related to infection rate, case fatality rate and clinical symptoms of COVID - 19. In view of this, the study starts with the potential mechanism of vitamin D in the prevention and treatment of COVID - 19, combined with current epidemiological research results and relevant clinical evidences on the relationship between vitamin D and COVID - 19, and synthesizes current progress in researches on the relationship between vitamin D and COVID - 19, to provide new thought for the prevention and treatment of COVID - 19.
Progress in researches on physical exercise for dementia prevention
WANG Hong-li, LI Yong, HAN Yan-bai,
2021, 37(12): 1835-1839. doi: 10.11847/zgggws1134857
Abstract(122) HTML (35) PDF 550KB(24)
Abstract:
Cognitive function of old people gradually declines with aging and may further progress to mild cognitive impairment (MCI) or even dementia. There is no effective drug treatment currently available to cure dementia and controlling risk factors of cognitive decline is one of key measures to prevent dementia. Physical exercise can reduce the risk of cognitive decline and the occurrence of dementia. In this study, we reviewed the relationship between physical exercise and cognitive function and the mechanism of prevention dementia with exercise to provide a basis for further studies on exercise for the prevention of dementia.
Progress in researches on plasma homocysteine level and stroke: a review
ZHANG Ou, LIU Yang, MENG Hang-juan, CONG Shu-yan
2021, 37(12): 1840-1844. doi: 10.11847/zgggws1127767
Abstract(360) HTML (197) PDF 568KB(43)
Abstract:
Homocysteine, as an independent risk factor for stroke, is closely related to the incidence, recurrence rate and prognosis of stroke. Homocysteine level varies in different stroke subtypes, and the pathogenesis mainly involves vascular endothelial injury, hyperplasia of smooth muscle cells, coagulopathy, and abnormal fat metabolism. Homocysteine level is affected by genotype, metabolism, age, gender, drugs and other factors. Supplementation with B vitamins and folic acid can significantly reduce homocysteine level, which is important for secondary prevention of cerebrovascular disease. In this study, the correlation between homocysteine level and stroke, subtype and severity, and the role of homocysteine in the pathogenesis of stroke, and the treatment status were reviewed to provide references for clinical prevention and treatment.
Public Health Forum
Identity crisis of public health physicians and its countermove in China: a brief discussion
LI Gang, FENG Zhan-chun
2021, 37(12): 1845-1848. doi: 10.11847/zgggws1136210
Abstract(161) HTML (40) PDF 520KB(33)
Abstract:
“Healthy China Initiative” is an important part of national governance modernization and its realization relies on a sound public health system, which needs to be supported by a great number of qualified public health physicians. However, public health physicians were not generally acknowledged by the public and there was a serious identity crisis among the public health physicians in China. The absence of physicians′ role and the lack of well-defined professional function for public health physicians are two main manifestations of the identity crisis. To deal with public health physicians′ identify crisis, following countermeasures were suggested: clarifying whether public health physicians being exactly preventive medicine physicians in China, reconfirming professional role of public health physician, specifying bachelor degree in preventive medicine being a basic requirement for the appointment of a public health physician, appropriately broadening the way for clinical medicine students being recruited as public health physicians, and reforming education and training system for preventive medicine and public health.
Enlightenment of Singapore′s public health system construction experience on Hainan Free Trade Port construction
WANG Shan-shan, SHAO Hai-ya
2021, 37(12): 1849-1852. doi: 10.11847/zgggws1134630
Abstract(174) HTML (41) PDF 603KB(14)
Abstract:
Singapore is a mature free trade port recognized by the international community. In the process of port construction, the improvement of public health system has been attached to a great importance and many indicators of sustainable development of public health were ranked at the forefront of the world. Especially during the coronavirus disease 2019 epidemic, the effectiveness of Singapore′s epidemic prevention and control has been widely recognized by countries, and the implemented emergency measures are also known as “epidemic prevention samples” for the international community. In the study, we summarize Singapore′s advanced practices in the process of public health system construction and discuss the practices′ enlightenment on Hainan Free Trade Port′s public health system construction for promoting the development of public health system in Hainan province.
“The Apollo Program for Biodefense” of the United States: a brief introduction
JIN Mei-ling, MA Qin-yi, GUO Jin-peng,
2021, 37(12): 1853-1856. doi: 10.11847/zgggws1137096
Abstract(211) HTML (68) PDF 626KB(42)
Abstract:
The Bipartisan Commission on Biodefense of United States issued and planned to implement the Apollo Program for Biodefense. Fifteen core priority technologies/capabilities were proposed in the program document, demonstrating a strong determination for devoting much attention to national bio-security and for establishing an effective bio-defense system. For improving biological defense capability and preventing catastrophic biological risks in China, an overall plan for national biological safety is also should be worked out and relevant guarantee system and technology support need to be established.