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2022 Vol. 38, No. 2

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Criterion, Guideline, Consensus
Physical Activity Guidelines for Chinese (2021)
Composing and Editorial Board of Physical Activity Guidelines for Chinese
2022, 38(2): 129-130. doi: 10.11847/zgggws1137503
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The Physical Activity Guidelines for Chinese (2021) is composed of seven parts, including the general guidelines, children aged 2 years and below, children aged 3 – 5 years, children and adolescents aged 6 – 17 years, adults aged 18 – 64 years, the elderly aged 65 years and above, and patients with chronic diseases. The guidelines was compiled by the Composing and Editorial Board organized by Chinese Center for Disease Control and Prevention and China Institute of Sport Science. The compilation of the guidelines was directed by the Bureau for Diseases Prevention and Control of the National Health Commission of the People′s Republic of China.
Special Report – Studies on Health System Resilience
Conceptual connotation of health system resilience in the context of catastrophic medical surge
NING Ning, GUO Yang, QIAN Yu,
2022, 38(2): 131-133. doi: 10.11847/zgggws1135905
Abstract(306) HTML (132) PDF 505KB(31)
  Objective  To clarity conceptual connotation of health system resilience (HSR) in the context of catastrophic surge in medical demand and to provide references for improving disaster risk management in China.   Methods  Through searching PubMed, China National Knowledge Infrastructure (CNKI) and other databases, totally 33 Chinese and English literatures published from January 2014 through January 2021 were retrieved using the key words including “health system resilience, “health system”, and “resilience”. An Delphi consultation was then conducted among 31 domestic experts and scholars engaged in health emergency management and disaster medicine using a self-designed questionnaire based on analyses on subject words relevant to conceptual connotation of HSR.   Results  The coefficients were 81.6%, 0.84, and 0.383 for the consultation′s positivity, authority, and coordination. Towards to the connotation of resilience of a complex system, the experts′ grading scores were 4.84 ± 0.37 for the recognition on the resilience as a capability trait, 4.39 ± 0.76 for as a tacit capability trait, and 4.71 ± 0.46 for as a capability of interference absorption, adaptation, and transformation. The experts′ grading score was 4.77 ± 0.50 for the recognition on a health system as a dynamically changing complex system; towards to the connotation of a health system′s resilience, the experts′ grading scores were 4.29 ± 0.69, 4.39 ± 0.80, and 3.97 ± 0.95 for the recognition on the resilience as a capability of interference absorption, adaptation, and transformation, respectively.   Conclusion  The health system resilience in the context of a catastrophic surge in medical demand could be defined as a health system′s capability of interference absorption, adaptation, and transformation against internal and external adverse impact considering the system′s dissipative structure with its main subjects such as medical and health institutions in dynamic changes.
Establishment of an evaluation index system for health system resilience in the context of catastrophic medical surge
ZHOU Wen-jing, WANG Lu, GUO Yang, NING Ning,
2022, 38(2): 134-138. doi: 10.11847/zgggws1135894
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  Objective  To construct an index system for the evaluation on health system resilience in the context of catastrophic medical surge and to provide references for improving medical institutions′ disaster risk management capability in China.   Methods  An entropy theory-based framework of the index system was primarily constructed through literature studies; then an online Delphi consultation was conducted among 31 domestic experts with at least ten years′ experiences in health emergency management/disaster medicine-related research/teaching/administration during September – November, 2020. Saaty′s weight method was adopted to calculate weight coefficients of the indexes in the evaluation system.   Results  The positive coefficient was 81.6% for the expert consultation; for the first-, second-, and third-level indicators included in the evaluation system, the authoritative coefficients were 0.89, 0.76, and 0.85 and the coordination coefficients were 0.352, 0.301, and 0.260, respectively (all P < 0.05). The finally established evaluation index system included 2 first-, 9 second-, and 35 third-level indicators. The first-level indicator with the highest weight coefficient (0.7500) was for the balance between a health system′s supply capacity and the demand of a catastrophic medical surge; the second-level indicator with the highest weight coefficient (0.4476) was for emergency medical services; and the third-level indicator with the highest weight coefficient (0.0799) was for the professional resources of intensive care unit against the demand of a catastrophic medical surge.   Conclusion  The established index system for the evaluation on health system resilience in the context of catastrophic medical surge is valid and reliable and could be preliminarily used in promoting public health risk management capability in China.
Evaluation framework of medical institutions′ medical surge capacity and capability under the context of mass casualty incidents
QIAO Jin, NING Ning, ZHAO Zi-hua,
2022, 38(2): 139-141. doi: 10.11847/zgggws1135896
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The research on medical surge capacity and capability of medical institutions is a supplement to the research on the planning, mitigation, and response of the medical system in response to mass casualty incidents and of far - reaching policy significance. Based on the concept and key elements of medical institutions′ medical surge capacity and capability, this study divides the surge in demand for injuries caused by mass casualty incidents into two categories, the surge demand for intra - regional injuries and the surge demand for cross - regional injuries. The key issues and countermeasures that should be considered in the evaluation framework for different types of medical surge capacity and capability are pointed out to provide a theoretical basis for further construction of relevant index system.
Concept of hospital resilience governance in the context of major public health emergencies: a semantic network analysis
ZHOU Yi-dan, NING Ning, ZHAO Zi-hua,
2022, 38(2): 142-144. doi: 10.11847/zgggws1135893
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  Objective  To explore relevant concepts of hospital resilience governance (HRG) in the context of major public health emergencies and to provide theoretical support for improving hospitals’ ability to respond to major public health emergencies.   Methods  Via searching China National Knowledge Infrastructure, we retrieved 136 HRG-related literatures published from August 10, 2014 to April 25, 2021 and sorted out HRG-related semantics based on 1 662 paragraphs extracted from the literatures. ROST CM 6.0 software was used to perform semantic network analysis on the high-frequency keywords relevant to HRG.   Results  Through semantic network analysis on 35 key elements of HRG abstracted from high-frequency key words in the 1 662 paragraphs, the concept of HRG in the context of major public health emergencies is defined as a management process to enhance a hospital′s overall resilience against the disturbance and impact caused by major public health emergencies through multi-departmental comprehensive management and multi-subjects cooperation; the implementation of the management process could support a hospital to maintain the stability of main functions due to promoted resistance, absorption, recovery, adaptation and learning when coping with a major public health emergency.   Conclusion  The successful HRG in the context of major public health emergencies could be manifested directly by hospitals′ safe and orderly operation in high risk circumstances during whole process of major emergencies through continuous participation and cooperation of multiple subjects and departments.
Establishment of a logical model of community resilience system in response to public health emergencies
SU Ying-xue, PANG Zhi-yang, SUN Hong,
2022, 38(2): 145-148. doi: 10.11847/zgggws1135898
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It is urgent to improve communities′ response and resilience against various disasters frequently posing serious threats to the safety of people′s lives and property. With literature researches and based on complex system analysis, the study summarizes constituent elements of a community resilience system for coping with public health emergencies; the study also analyzes general characteristics and main loop logic of the resilience system′s four subsystems: social capital, community′s basic characteristics, disaster management, and community′s development capability. Then, a logical model of community resilience system for public health emergencies was constructed to provide a policy simulation tool for the development of community resilience. Among a community resilience system′ four subsystems, the social capital subsystem involves residents′ participation, community norms, relationship networks, and trust; the community basic characteristics includes a community′s physical environment, economic and demographic characteristics; the disaster management covers emergency organization management, disaster prevention and mitigation activities, disaster risk assessment, and residents′ awareness and skills for disaster reduction; the community development capability involves community innovation potential, information communication and public services. The constructed logical model for community resilience system to cope with public health emergencies could provide a certain reference for theoretical research and practical cultivation of community resilience.
Evaluation on key node issues in constructing community resilience to cope with public health emergencies in China
ZHANG Xin, ZHOU Wen-jing, ZHANG Jiu-rui,
2022, 38(2): 149-152. doi: 10.11847/zgggws1135902
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  Objective  To evaluate key node issues in the process of community resilience construction to deal with public health emergencies in China and to provide a reference for the construction and improvement of community resilience.   Methods  A list of problems in the construction of community resilience in response to public health emergencies was determined after literature studies and professional group discussions. The severity and the urgency of intervention for each of the problems were assessed through a consultation among 40 senior professionals engaged in emergency response or community management. Technique for order performance by similarity to ideal solution (TOPSIS) method was adopted to rank the importance of the problems.   Results  For the expert consultation, the positive coefficient was 95.0% and the authority coefficient was 0.774; and the coordination coefficients were 0.387 and 0.428 for the experts’ scores of evaluation on the severity and intervention urgency of the 16 items in the problem list of community resilience construction, indicating significant coordination of the experts′ evaluation (both P < 0.05). The results of the TOPSIS analysis revealed that the five key node issues in the construction of community resilience include: the absence of the multi-agent community resilience system, the lack of communication and coordination mechanism among participants of the resilience construction, the prevalence of traditional top-down management model for local governments and other stakeholders due to the lack of community-based disaster management concepts among administrative staff, poor engagement of community residents in public health emergency management with predominate role of governments and health institutions, and insufficient emergency response resources supported by local governments to communities and health institutions, with the weight indexes of 0.514, 0.487, 0.467, 0.454, and 0.437, respectively.   Conclusion  Efficient coordination mechanism among community participants, appropriate community management model, the participation of community residents, and relevant resources support are among the key node issues needing to be concerned in the construction of community resilience system to cope with public health emergency in China.
Epidemiological Research
Status and impact factors of social support for people with rare diseases in China
GAO Jia-min, MA Zheng
2022, 38(2): 153-156. doi: 10.11847/zgggws1126356
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  Objective  To analyze the status and correlated factors of social support for people with rare diseases in China.  Methods  We conducted an internet- or telephone-based survey among 1 771 self-reported rare disease patients recruited with snow balling sampling during February 2016 in China. The Medical Outcomes Study Social Support Survey – Chinese Version (MOS-SSS) was applied to measure the social support for the patients. Descriptive statistics and linear regression were employed in data analysis.  Results  The total score of social support for the patients was 60.37 ± 18.23 and domain scores were 13.40 ± 4.12 for tangible support, 22.99 ± 7.89 for emotional/informational support, 8.42 ± 3.11 for positive social interaction, 8.87 ± 3.21 for affectionate support, and 6.69 ± 1.92 for additional items, respectively. The results of multivariate stepwise linear regression analysis demonstrated that the rare disease patients being married, retired, and being a student were more likely to have a strong social support; while, those at elder age, with the education of primary school and below, unemployed, living in rural regions, and with disease complication were more likely to have a weak social support.  Conclusion  In China, the social support for rare disease patients is at a low level and associated with the patients′ age, education, marital status, occupation, residence, and whether having complicated disease.
Development of an Occupational Strain Scale for Chinese workers
PAN Shu-ya, ZHOU Bo, YANG Cheng-hui,
2022, 38(2): 157-160. doi: 10.11847/zgggws1125878
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  Objective  To develop an Occupational Strain Scale for Chinese employees and to evaluate its reliability and validity.  Methods  An initial scale was developed based on literature reviews, semi-structured interviews, Delphi expert consultation and a pilot survey. Then the complied scale was self-administered online among 2 432 in-service employees sampled at 10 domestic enterprises and institutions in 5 cities of Sichuan province during March 2019. Valid information were collected from 2 191 responders; of them, 1 096 were assessed for exploratory factor analysis and other process for item screening and 1 095 were assessed for the scale's reliability and validity analysis. Confirmatory factor analysis was adopted in validity test and Cronbach'α and split-half reliability were used in reliability evaluation.  Results  The established scale included 15 items for cognitive behavioral, psychological and physical strain, which could explain 68.796% of total variance of the scale. The results of confirmatory factors analysis demonstrated that the three-domain model fitted well (χ2/df = 3.894, normed fit index = 0.969, comparative fit index = 0.977, incremental fit index = 0.977, Tucker-Lewis index = 0.971, root mean square error of approximation = 0.051). The Cronbach α coefficient was 0.935 for the general scale and ranged 0.789 – 0.923 for the 3 subscales. The split-half reliability coefficient was 0.863 for the general scale, and ranged 0.766 – 0.898 for the 3 subscales.  Conclusion  The developed Occupational Strain Scale is of good reliability and validity and could be applied for measurement of occupational strain in Chinese working populations.
Association of maternal MTR gene polymorphism with offspring congenital heart disease: a case-control study
LI Yi-huan, HUANG Peng, WANG Ting-ting,
2022, 38(2): 161-166. doi: 10.11847/zgggws1134330
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  Objective  To explore the association between maternal methionine synthase (MTR) gene polymorphism and the risk of congenital heart disease (CHD) in offsprings.   Methods  A case-control study was conducted among 464 biological mothers of CHD children and 504 biological mothers of healthy children in the Department of Cardiothoracic Surgery, Hunan Children's Hospital from November 2017 to December 2019. Single nucleotide polymorphisms (SNPs) of MTR gene was detected with MassArray time-of-flight mass spectrometry. The association between MTR SNPs and offspring CHD was analyzed with SPSS 24.0 software, and Haploview software was used in haplotype analysis.   Results  The results of multivariate logistic regression analysis demonstrated that the SNPs of following MTR gene loci were significantly associated with increased risk of CHD incidence: rs1266164 (TT vs. CC: adjusted odds ratio [aOR] = 3.39, 95% confidence interval [95% CI]: 1.48 – 7.76; recessive model: aOR = 3.27, 95% CI: 1.44 – 7.45) and rs6668344 (dominant model: aOR = 1.55, 95% CI: 1.12 – 2.16); the results also revealed that SNPs of three MTR gene loci correlated with decreased risk of offspring CHD incidence included rs3768139 (CC vs. GG: aOR = 0.26, 95% CI: 0.11 – 0.58; dominant model: aOR = 0.29, 95% CI: 0.13 – 0.65; recessive model: aOR = 0.62, 95% CI: 0.45 – 0.85), rs1050993 (recessive model: aOR = 0.59, 95% CI: 0.42 – 0.82), and rs3820571 (GG vs. CC: aOR = 0.28, 95% CI: 0.12 – 0.64; recessive model: aOR = 0.56, 95% CI: 0.40 – 0.79). The haplotype TT and CT of rs6668344-rs3754255, AGTA of rs1805087-rs2275565-rs1266164- rs4659743, as well as AT and GT of rs1050993-rs6676866 were associated with the incidence risk of offspring CHD.   Conclusion  Both the polymorphism and haplotype of maternal MTR gene might be associated with the incidence risk of offspring CHD.
Status and influencing factors of mental health among veterans in China
MING Zhi-jun, CHEN Zhi-yan, LIU Ya-nan,
2022, 38(2): 167-171. doi: 10.11847/zgggws1130193
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  Objective  To investigate the status and influencing factors of depression, anxiety and post-traumatic stress disorder (PTSD) among veterans in China and to provide references for promoting mental health of the population.  Methods  We conducted a questionnaire survey among 1 100 veterans under 80 years recruited from 30 provincial-level regions across China with cluster sampling during May – July 2019. Mental health status of the participants was assessed using the short version of the Center for Epidemiologic Studies Depression Scale (CESD-9) Chinese version, the Generalized Anxiety Disorder Scale (GAD-2), and PTSD risk scale.  Results  For all the valid respondents (1 045, 95.00% of the veterans recruited), the mean depression score was 9.73 ± 6.86 and the score differed significantly by education, military rank and income (all P < 0.001); the mean anxiety score was 2.09 ± 1.91 and the score differed significantly by age, education, military rank, and economic income (all P < 0.01). The proportion of the participants assessed as at high risk of PTSD was 42.58% and the proportion was significantly associated with education, military rank, economic income, and major military action experience (all P < 0.01). The results of linear regression analysis indicated that significant influencing factors for depression score included income (β = – 0.13, P < 0.001), alcohol consumption (β = 0.12, P < 0.001), and sleep quality (β = – 0.59, P < 0.001) and significant impact factors for anxiety score included income (β = – 0.11, P < 0.01), alcohol consumption (β = 0.08, P < 0.01) and sleep quality (β = – 0.64, P < 0.001). The results of logistic regression analysis revealed that age (odds ratio [OR] = 1.04, 95% confidence interval [95% CI]: 1.02 – 1.06), with major military action experience (OR = 1.60, 95% CI: 1.11 – 2.30), alcohol consumption (OR = 1.18, 95% CI: 1.05 – 1.32) were significant risk factors for PTSD; while, sleep quality (OR = 0.74, 95% CI: 0.68 – 0.80) was a protective factors against PTSD significantly.  Conclusion  Among Chinese veterans, the mental health was at a low level; alcohol consumption is a risk factor but income and sleep quality are protective factors against depression and anxiety; at older age, with major military action experience, and alcohol consumption are risk factors for PTSD risk, while, sleep quality is a protective factor against PTSD risk.
Associations of family hypertension history and clustered behavioral risk factors with hypertension among community adult residents in Nantong city
DUAN Xiao-yang, LI Min, QI Zhi-gang,
2022, 38(2): 172-176. doi: 10.11847/zgggws1135107
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  Objective  To explore associations of family hypertension history and behavioral risk factor aggregation with hypertension incidence among adult residents for providing evidences to the development of effective strategies on prevention and treatment of hypertension.  Methods  Using stratified random cluster sampling and the uniform questionnaire for national program on chronic disease prevention and control, we conducted face-to-face interviews and physical examinations among 12 092 permanent residents aged 18 years and above in an urban district of Nantong city, Jiangsu province during October – November 2018. Multivariate logistic regression model was adopted in analysis on the effect of family hypertension history and clustered behavioral risk factors on hypertension incidence.  Results  Among the 12 064 residents with complete information, totally 4 042 hypertensives were identified, with the crude and standardized prevalence rate of 33.5% and 27.0%, respectively. After adjusting for confounding factors such as gender, age, education, marital status, occupation and body mass index, multivariate logistic regression analyses showed that the residents exposed to following factors had an increased risk of hypertension: family history of hypertension (odds ratio [OR] = 2.05, 95% confidence interval [95% CI]: 1.77 – 2.38), alcohol-drinking (OR = 2.04, 95% CI: 1.32 – 3.17), and consuming high salt diet (OR = 1.92, 95% CI: 1.19 – 3.07) compared to those without the exposures; the analyses also revealed that the residents with family history of hypertension and one or more behavioral risk factors were at a much higher risk of hypertension, with the ORs of 3.38 (95% CI: 2.35 – 4.85) for those with family hypertension history and consuming high salt diet, 5.42 (95% CI: 2.73 – 10.74) for those with the history and smoking plus consuming high salt diet, and 5.84 (95% CI: 2.74 – 12.43) for those with the history and smoking plus alcohol drinking and consuming high salt diet, respectively.  Conclusion  Family history of hypertension and aggregation of behavioral risk factors can increase the risk of hypertension among adult community residents.
Immunogenicity and safety of DTaP/Hib combined vaccination at different inoculation sites among infants
LIU Zhen-jiang, WU Chun-min, HUANG Jia-mei,
2022, 38(2): 177-180. doi: 10.11847/zgggws1131745
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  Objective   To evaluate the immunogenicity and safety of a diphtheria-tetanus-acellular pertussis and Haemophilus influenzae type b (DTaP/Hib) combined vaccination at different inoculation sites.   Methods   From September 2015 to March 2016 in Nanping city of Fujian province, China, a total of 164 infants aged 3 months were enrolled and assigned into three groups randomly for inoculations with 3 doses of the DTaP/Hib combined vaccine at 3-, 4-, and 5-month of age at three injection sites including deltoid muscle of upper arm, anterolateral thigh muscle and gluteal muscle. Follow-up observations on adverse effects after each dose of the vaccinations were conducted among all the infants and blood samples were collected before the first dose and 28 days after basic immunization for the detection on immunogenicity.   Results  The incidence of adverse reactions was low after inoculations of DTaP/Hib combined vaccine at the three different injection sites, and there was no significant difference in the incidence among the infants of the three groups; there were also no significant disparities in positive rate, seroconversion rate, geometric mean concentration and geometric mean increase (GMI) for antibodies among the three groups, except for an observed higher GMI of diphtheria antibody in the infants with the injections into anterolateral thigh muscle than that in the infants with the injections into gluteal muscle.   Conclusion   Deltoid muscle of upper arm, anterolateral thigh muscle and gluteal muscle all could be used as injection sites for the inoculation of DTaP/Hib combined vaccine and the injection sites do not affect the immunogenicity and safety of the vaccine.
Experimental Study
Antioxidant effect of cannabidiol in mice with liver fibrosis
MA Run, SHU Yuan-hui, XIE Na,
2022, 38(2): 181-185. doi: 10.11847/zgggws1135692
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  Objective  To explore antioxidant effect of cannabidiol (CBD) in mice with carbon tetrachloride (CCl4)-induced liver fibrosis.  Methods  Forty male C57BL/6J mice were divided into five groups: a control and a model group, two CBD groups (4 mg/kg and 8 mg/kg) and a colchicine (0.2 mg/kg) group. Intraperitoneal administration of carbon tetrachloride (CCl4) at the dosage of 5 mL/kg body weight was performed for all the mice twice a week for consecutive ten weeks except for those of the control group with intraperitoneal injection of peanut oil; meanwhile, the mice of CBD and colchicine groups were intraperitoneally injected with corresponding dose of medication each time and the control mice with saline. Serum alanine aminotransferase (ALT) was measured with an automatic biochemical analytic instrument; collagen deposition of liver tissue was examined with sirius red staining; superoxide dismutase (SOD), reduced glutathione (GSH) and malondialdehyde (MDA) were measured using commercial kits; gp91/Nrf2 in liver specimens was assessed with Western blot.   Results  In the mice of treated with low/high CBD and colchicine, significantly lower liver index (4.71 ± 0.34%/4.68 ± 0.20% and 4.24 ± 0.40%), serum ALT (79.38 ± 14.79/87.13 ± 9.40 and 77.88 ± 3.76 U/L), MDA in liver tissues (2.48 ± 0.43/2.74 ± 0.88 and 2.84 ± 0.87 nmol/mgprot) and significantly increased SOD (259.90 ± 36.05/223.13 ± 37.49 and 246.39 ± 53.49 U/mgprot) and GSH (63.07 ± 16.71/100.38 ± 22.44 and 96.39 ± 19.40 nmol/mgprot) in liver tissues were detected compared with those in the model rats (P < 0.05 for all); obviously ameliorated collagen deposition, down-regulated protein expression of gp91 but up-regulated and protein expression of nuclear factor-erythroid 2-related factor-2 (Ntf2) were also observed in liver tissues of the low/high CBD and colchicine groups (all P < 0.05).   Conclusion  The results suggeste that CBD has protective effect on CCl4-induced liver fibrosis in mice, probably via adjusting protein expression of gp91 and Nrf2, clearing free radicals and inhibiting the occurrence of lipid peroxidation.
Survey and Report
Knowledge about donation of hematopoietic stem cells among registered volunteers of Shanghai Marrow Donor Program
LIU Bao-song, ZHANG Gang, LÜ Jun,
2022, 38(2): 186-189. doi: 10.11847/zgggws1132693
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  Objective  To investigate the awareness on the knowledge about hematopoietic stem cell donation among the registered volunteers for improving volunteer recruitment and promoting donation willingness in the volunteers.  Methods  Using cluster sampling, we conducted a self-administered survey among 2 361 volunteers with oral swab-based registration in Shanghai Marrow Donor Program during 2017. A self-designed questionnaire was used to collect participants′ information on the situation and acquisition of knowledge about hematopoietic stem cell donation and related factors.  Results  For the 2 240 participants with valid responses, the mean score for knowledge about hematopoietic stem cell donation was 3.94 ± 1.951 to a maximum score of 7, indicating a relatively low level. The results of multivariate linear regression analysis demonstrated that significant influencing factors for the knowledge status included academic background, blood donation experience, voluntary service experience, with relatives or friends ever registered in donation programs, ever having discussion on organ transplantation with family members, value judgment on donation behavior, and the pattern of registration in the donor program (P < 0.05 for all). The participant-reported main ways of acquiring knowledge on hematopoietic stem cell donation were internet media, television program, and on-site publicity campaign.  Conclusion  The level of knowledge about hematopoietic stem cell donation is relatively low among registered donation volunteers, indicating that comprehensive and continuous supporting measures are needed to effective operation of the marrow donation program.
Impact of risk information characteristics on risk perception of COVID-19 among the Chinese public
MENG Xiang-wei, WU Qun-hong, HAO Yan-hua,
2022, 38(2): 190-193. doi: 10.11847/zgggws1131466
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  Objective   To examine the impact of risk information characteristics on the Chinese public's risk perception of coronavirus disease 2019 (COVID-19) and to put forward targeted suggestions for improving infectious disease epidemic information release.   Methods  Using a self-designed questionnaire, we conducted an online anonymous survey among 1 446 Chinese internet users recruited with snowball sampling in five provincial-level regions of China from June 15 to 18, 2020.   Results   Valid information were collected from 1 292 participants (43.0% males and 56.0% females) averagely aged 30.4 ± 9.3 years. Evaluated by a scale with the highest score of 5 for the greatest impact, the scores for the impact of characteristics of COVID-19 related information on participants' the epidemic risk perception were 3.37 ± 0.98 for personal experience associated with infectious disease, 3.81 ± 1.21/3.61 ± 0.79/3.48 ± 1.13/3.52 ± 0.90/2.92 ± 0.95 for obtaining information disseminated by government departments/experts or scholars/traditional media/internet or social media/neighbors or friends, 4.36 ± 0.59 for inconsistent or contradictory information, 4.35 ± 0.61 for different or controversial information from experts or scholars, 3.74 ± 0.87 for hearing about discussions or disputes among opinion leaders such as very important Microblog users or stars, 3.99 ± 0.94 for exposed to a great amount of information about COVID-19 during the epidemic, 3.75 ± 1.00 for rarely accessing to information other than COVID-19 epidemic, 3.53 ± 1.05 for obtaining information about previous infectious disease epidemic such as severe acute respiratory syndrome and influenza, 3.57 ± 0.94 for accessing information about outbreaks of other infectious diseases in foreign countries, 2.50 ± 1.08 for obtaining information on phenomenon or problems induced by the epidemic, 3.36 ± 0.98 for accessing text descriptions/photographs/videos on severe harms caused by the epidemic, and 3.48 ± 1.13 for accessing the information on panic or sadness induced by the epidemic among the public. The 5 common factors identified through factor analysis were source, dispute, quantity, association, and sentiment tendency of information accessed, with the corresponding variance contribution rate of 17.334%, 13.638%, 13.221%, 13.111%, and 10.593%, respectively, and a cumulative variance contribution rate of 67.897% for the 5 common factors.   Conclusion  The source, dispute, quantity, association, and sentiment tendency are main characteristics of COVID-19-related information affecting the public′s disease risk perception and information source is a primary factor among the five information characteristics.
Health condition and its influencing factors among residents in mountainous regions of Ningxia Hui Autonomous Region
LI Xiang-rong, DANG Yuan-yuan, TANG Rong
2022, 38(2): 194-197. doi: 10.11847/zgggws1126760
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  Objective  To examine the status and influencing factors of health among adult residents in mountainous regions of Ningxia Hui Autonomous Region (Ningxia) for developing strategies on health promotion in the population.  Methods  The participants of the survey were 1 500 residents of 18 years old and above randomly recruited with stratified sampling in 6 urban communities/rural villages in mountainous regions of Ningxia. Face-to-face interviews were conducted among the participants using a self-designed questionnaire during February 2016.  Results  Of the 1 298 participants with complete information, 287 (22.11%) reported having an illness during past two weeks (two-week prevalence) and 267 (20.57%) reported suffering from chronic diseases. Unconditional multivariate logistic regression analysis results revealed that for the participants, aged ≥ 40 years was a risk factor but with the education of senior high school/secondary school was a protective factor of two-week prevalence; whereas, aged ≥ 30 years was a risk factor but being married was a protective factor for suffering from chronic diseases.  Conclusion  In mountainous regions of Ningxia, the health status of urban and rural adult residents is mainly influenced by age, education and marital status and health promotion needs to be improved in the population.
Health inequality among rural elder residents in Shaanxi province
LI Dan, ZHOU Zhong-liang, ZHAO Dan-tong
2022, 38(2): 198-202. doi: 10.11847/zgggws1119709
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  Objective  To explore the status and contributing factors of health inequality among rural elder residents in Shaanxi province.  Methods  The data on 6 857 rural elderly aged 65 years and over were extracted from the dataset of Fifth National Health Services Survey held in 32 counties of Shaanxi province during 2013. Concentration index was employed to evaluate the health inequality. Decomposition of concentration index was used to quantify the contribution of every determinant to total inequality.   Results  The two-week prevalence and the prevalence rate of chronic diseases among the elderly were 37.15% and 47.15% in 2013. The concentration indexes were 0.0896 (95% confidence interval [95% CI]: 0.0716, 0.1075) and 0.0565 (95% CI: 0.0420, 0.0710) for the probability of two-week disease prevalence and the prevalence rate of chronic diseases. The main influencing factors of inequality in two-week prevalence and chronic disease prevalence were economic condition (with the contribution rates of 98.40% and 63.93%) and physical exercise (5.47% and 4.30%); economic status accounted for most of the existing inequality.   Conclusion  There was a relatively small pro-rich health inequality among rural elderly in Shaanxi province; the health inequality could be improved by further improving health system and rural social endowment insurance system, and promotion of health attitude and behaviors among the elderly population.
Impact of temperature on hand, foot and mouth disease and its attributable risk in Guangdong province
GAO Qi, LIU Zhi-dong, WANG Shu-zi,
2022, 38(2): 203-208. doi: 10.11847/zgggws1132059
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  Objective  To study the impact of ambient temperature on hand, foot and mouth disease (HFMD) and to explore the source of heterogeneity in the impact and the HFMD burden attributable to ambient temperature in Guangdong province.   Methods  The data on daily reported HFMD cases and meteorological condition from 2009 through 2016 in Guangdong province were collected. The distributed lag nonlinear model (DLNM) was adopted to assess the effect of average daily ambient temperature on HFMD incidence at city level with the pooled effect estimates from multivariate meta-regression model analysis. Fraction and number of HFMD incidents attributable to variation in ambient temperature were estimated according to the results of DLNM analysis.   Results   Totally 2 279 647 HFMD cases were reported during the period. The risk of HFMD incidence increased with the increment of average daily ambient temperature. The cumulative relative risk (RR) of HFMD incidence reached the highest for the average daily ambient temperature of 30.5 ℃ versus that of 24 ℃ (RR = 1.24, 95% confidence interval [95% CI]: 1.12 – 1.37). The most obvious effect of low average daily ambient temperature on HFMD incidence was on the lag day 8 but that of high temperature was on the lag day zero. The disparity in the effect of average daily ambient temperature on HFMD incidence among various cities was derived from population density, growth rate of gross domestic production, location longitude, and average annual temperature/humidity/hours of sunshine. The estimated total number of HFMD incidents attributed to the exposure to high average daily temperature was 241 918, accounting for 10.61% (95% CI: 9.67% – 11.53%) of all the cases during the period. When exposed to high average daily ambient temperature, the elderly and the children less than 5 years old were at a higher risk of HFMD incidence than other populations.   Conclusion  High average daily ambient temperature could increase the risk of HFMD incidence and the impact of the high temperature may appear immediately or at lag days. The results suggest that specific measures should be taken in vulnerable populations during seasons with high temperature for the prevention of HFMD incidents.
Recommendation practice on childhood vaccine and its determinants among pediatricians in China
ZANG Shu-jie, HU Si-meng, WANG Qian,
2022, 38(2): 209-212. doi: 10.11847/zgggws1135411
Abstract(242) HTML (94) PDF 502KB(23)
  Objective   To examine the behavior of recommendation on childhood vaccines and its influencing factors among pediatricians.   Methods   Using convenient sampling, we conducted a web-based voluntary anonymous questionnaire survey among 289 pediatricians at seven professional training sites in Beijing-Tianjin-Hebei Region and six municipalities in central, southern and northern China during November – December 2020. Multivariate ordinal logistic regression analysis was adopted to explore factors associated with the recommendation behavior.   Results  Of all the respondents, 25.3% (73/289), 50.2% (145/289), and 24.5% (71/289) reported often, sometimes, and occasionally recommending childhood vaccines to the parents of child clinic attendees, respectively. The main reason reported by 89.7% of the pediatricians not recommending childhood vaccines was there being no requirements and responsibilities on the vaccination recommendation. Among all the respondents, only 30.1% (87/289) considered being with adequate knowledge about childhood vaccines to answer relevant questions from child clinic attendees′ parents, although 84.8% (245/289) reported having been consulted by the parents on the issues during past one year. The results of multivariate logistic regression analysis revealed that the respondents with following characteristics were more likely to conduct the vaccination recommendation: with senior professional titles (odds ratio [OR] = 2.124, 95% confidence interval [95% CI]: 1.169 – 3.858), having received influenza vaccination (OR = 2.237, 95% CI: 1.296 – 3.861), ever receiving vaccine-related training (OR = 1.830, 95% CI: 1.112 – 3.012), having been consulted by child clinic attendees′ parents frequently (OR = 6.604, 95% CI: 3.042 – 14.338), with adequate knowledge about childhood vaccines (OR = 1.984, 95% CI: 1.152 – 3.418), and having perceived professional responsibilities for the vaccination recommendation (OR = 5.6, 95% CI: 3.083 – 10.172).   Conclusion   Recommendation on childhood vaccines is not often conducted by pediatricians and the situation needs to be improved in China.
Health literacy and its influencing factors among outpatients in China: a cross-sectional survey
DONG Jian, CHEN Ying, TIAN Xiang-yang
2022, 38(2): 213-217. doi: 10.11847/zgggws1136822
Abstract(371) HTML (88) PDF 489KB(28)
  Objective  To explore current situation and influencing factors of health literacy of outpatients in China for providing evidences to improve health literacy in the population.   Methods  With random cluster sampling, totally 2 808 outpatient clinic attendees aged 15 years and above were recruited at 14 secondary and tertiary hospitals in 8 provinces across China and a network-based onsite survey was conducted among the outpatients during January – May 2021 using a modified Chinese Patient Health Literacy Scale developed by domestic researchers previously.   Results  Valid information were collected from all the participants. The average total score of the participants was 43.38 ± 6.25 for the health literacy scale scoring from 0 to 60 and the participants′ average dimension scores were 10.24 ± 3.17 for the concept of medical science, 9.20 ± 2.12 for disease self-management skills, 7.55 ± 1.54 for self-efficacy, 9.03 ± 2.10 for general medical knowledge, and 7.36 ± 2.21 for cognition in medical information, respectively. Of all the participants, 68.38% (1 920) were assessed as with health literacy based on their total score of 41 and above. Multivariate binary logistic regression analysis showed that the participants with following characteristics were more likely to have a higher health literacy: aged ≥ 35 years, with the education of senior/vocational high school or technical secondary school and above, having a mean household monthly income of ≥ 8 000 RMB yuan, averagely spending one hour and more per day on surfing the internet, acquiring medical information generally from medical staff, and with a good or very good self-perceived doctor-patient communication; while, the participants engaging in professional techniques and other works were more likely to have a lower health literacy.   Conclusion  In Chinese outpatients, the health literacy is at relatively higher level and the literacy is influenced mainly by age, education, occupation, average monthly household income, mean daily time of internet use, doctor-patient communication, and the route of acquiring general medical information.
Four time series prediction models for incidence prediction of hand, foot and mouth disease: a comparative study
LIU Chao, MENG Yuan-yuan, ZHANG Qing-wen
2022, 38(2): 218-223. doi: 10.11847/zgggws1133517
Abstract(391) HTML (118) PDF 725KB(44)
  Objective  To compare the performance of seasonal autoregressive integrated moving average (SARIMA) model, Winter linear and seasonal exponential smoothing model, Census X12 seasonal decomposition model, and linear combination prediction model in incidence prediction of hand, foot and mouth disease (HFMD) for facilitating incidence prediction of the disease.   Methods  Data on reported monthly HFMD incidence from January 2008 through December 2019 were collected from the dataset published by China Center for Disease Control and Prevention and those on annual population during the same period were collected from China Statistical Yearbook 2020 for calculating the monthly incidence of HFMD in China in the period; then monthly incidence of HFMD in China from January 2008 to December 2018 was used as sample modeling data to construct SARIMA model, Winter linear and seasonal exponential smoothing model, Census X12 seasonal decomposition model and linear combination prediction model; finally the monthly incidence of HFMD in China from January through December 2019 was used as the out-of-sample evaluation prediction data to evaluate prediction efficacy of the four models.   Results  The mean absolute deviation (MAD), mean square error (MSE), mean absolute percentage error (MAPE) were 10.311, 30.757, 1.725% for SARIMA model, 14.433, 112.847, 2.415% for Winter linear and seasonal exponential smoothing model, 8.424, 12.007, 1.409% for Census X12 seasonal decomposition model, and 9.334, 18.847, 1.562% for linear combination prediction model, respectively. The optimum model established was Census X12 seasonal decomposition model, followed by linear combination prediction model, SARIMA model, and Winter linear and seasonal exponential smoothing model.   Conclusion  The established Census X12 seasonal decomposition model could well predict the incidence of HFMD in China and the utilization of the model could facilitate developing strategies on HFMD prevention and control.
Fertility intention and influencing factors under “two-child policy” among urban residents in Liaoning province, 2013 – 2017: a CGSS – data analysis
MAN Xiao-ou, LI He-yun, YANG Yang
2022, 38(2): 224-227. doi: 10.11847/zgggws1134299
Abstract(478) HTML (87) PDF 538KB(54)
  Objective  To examine fertility intention and its associates under the “two-child policy” and to explore possible causes of ultra-low fertility rate among urban residents in Liaoning province to provide references for developing relevant policies on fertility encouragement.   Methods   The data on 618 Liaoning province urban residents aged 18 – 49 years were extracted from three waves of Chinese General Social Survey (CGSS) conducted in 2013, 2015, and 2017. Stata14.0 software was used in general demographic descriptive statistical analysis and Poisson regression analysis on fertility intention and its influencing factors before and after the implementation of “two-child policy” in 2017.   Results   For all the residents surveyed, the reported ideal number of children was 1.71 and that of gender preference was 0.84 for boy and 0.89 for girl. Of the residents, 57.0% considered two children being the ideal number for their families. The higher ideal numbers of children reported by subgroup residents were 1.79 for 26 – 33 years old residents, 1.81 for the residents with the education of college and above, and 1.80 for the residents with personal annual income of 40 000 RMB yuan and more, respectively. The significant influencing factors for fertility intention included age, gender, education, marriage status, endowment insurance, occupation, pension concept, and attitude towards child bearing (P < 0.05 for all). Time effect analysis showed that the fertility intention of the residents was significantly higher (EXP[β] = 1.067) in 2017compared with that in 2013.   Conclusion   The two-child policy, especially the comprehensive two-child policy, has promoted the fertility intention of 18 – 49 years old urban residents in Liaoning province to a certain extent, but the fertility intention is affected by multiple individual and social factors. The results suggest that targeted strategies need to be developed to encourage fertility intention of the residents.
Antimicrobial resistance containment-related policies in China: a policy tool-based text quantitative analysis
MENG Xin-yu, MIAO Ya-nan, LIU Xin-yu,
2022, 38(2): 228-234. doi: 10.11847/zgggws1132882
Abstract(245) HTML (75) PDF 610KB(14)
  Objective  To study the structure and characteristics of national policies on the containment of antimicrobial resistance (AMR) in China for providing a reference to the improvement of relevant policy - making.  Methods  By searching websites of governmental agencies and China National Knowledge Infrastructure, we retrieved all AMR containment-related documents issued from January 2004 through July 2020. Using the content analysis method, we conducted textual quantitative analysis on 75 policy documents issued by government agencies with Nvivo 12 software.  Results  Of the 75 policy documents, 22, 51, and 2 were about AMR containment in health, agriculture, and environment sectors. From the text of the 75 documents, totally 316 policy tool - related item elements were coded. Of the 316 item elements, 175, 130, and 11 corresponded to policy items involving health, agriculture, and environment sectors; in terms of policy tool category, 155 item elements belong to the compulsory category and 86, 17, 49, and 9 belong to categories of capability construction, value judgment, incentive, and innovation promotion, respectively.  Conclusion  In China, the national AMR containment - related policies are under the government administration; the policies act mainly on health and agriculture sectors and on aspects of mandatory management and capability construction. More policy tools need to be developed for environment - related AMR containment and in the categories of value judgment and innovation promotion.
Prevalence and influencing factors of osteoporosis in Yugur adult women in Gansu province: a cross-sectional survey
REN Xiao-lan, LI Ming-yang, HU JI-hong,
2022, 38(2): 235-240. doi: 10.11847/zgggws1132721
Abstract(430) HTML (244) PDF 559KB(28)
  Objective  To explore the prevalence and influencing factors of osteoporosis and to analyze the relationship between biochemical indicators and bone mineral density among Yugur menopausal women and adult women (aged 20 – 80 years) in Gansu province.  Methods  Using stratified cluster sampling, we recruited 960 Yugur female residents aged 20 – 80 years in Su′nan Yugu Autonomous County, Gansu province and conducted a questionnaire survey, laboratory test and physical examination including calcaneal bone mineral density detection in the women during July – August 2016. Multivariate logistic regression was used to analyze associates of osteoporosis prevalence and multivariate linear regression was adopted to assess the relationship between biochemical indicators and bone density.  Results  For the 929 participants with complete information, the crude and standardized prevalence rate of osteoporosis was 27.64% and 23.53% and those were 13.99% and 12.78% for the menopausal participants, respectively. The prevalence rate of osteoporosis increased significantly with age among all the participants (χ2 = 114.576) and the menopausal participants (χ2 = 31.664) (both P < 0.05). The results of logistic regression analysis revealed that for menopausal women, the influencing factors of osteoporosis prevalence included marital status, menopause duration, and grip strength; while for adult women, the influencing factors included age, education, fracture history, and grip strength. Alkaline phosphatase was reversely correlated with bone mineral density significantly in menopausal women (β = – 0.003) and in the women aged 20 – 80 years (β = – 0.004) (both P < 0.05).  Conclusion  Among Yugur menopausal women and 20 – 80 years old women in Gansu province, the prevalence rate of osteoporosis is relatively low and increases with age; the main risk factors of osteoporosis prevalence include age, duration of menopause and fracture history; alkaline phosphatase is a predictor for bone density reduction in the women.
Framework completeness of maternal health care system in Beijing and Shanghai: a comparison analysis
TIAN Zhuang, MA Dong-ping, YIN Wen-qiang,
2022, 38(2): 241-245. doi: 10.11847/zgggws1122393
Abstract(423) HTML (175) PDF 642KB(61)
  Objective  To compare the disparity in framework completeness of maternal health care (MHC) system between Beijing and Shanghai and to explore the feasibility of quantitative evaluation on the degree of framework completeness of MHC system.  Methods  We systematically and extensively collected documents on MHC issued by administrative agencies of Beijing and Shanghai municipality and relevant literatures published during 2000 – 2017. Then we extracted information on the MHC system′s department, institution and organizational structure from 649 retrieved documents and literatures (232 relevant to Beijing and 417 to Shanghai) and analyzed the information quantitatively to assess framework completeness of MHC system in the two municipalities. Spearman correlation and linear regression analysis were used to analyze the relationship between framework completeness of MHC system and maternal mortality rate (MMR).  Results  The relevant information-derived index for framework completeness of MHC system increased from 52.9% in 2000 to 78.0% in 2017 in Beijing municipality; while, the index increased from 68.5% to 85.8% in Shanghai, with a gradually increasing trend. There was an inverse correlation between the index for framework completeness of MHC system and MMR in the two municipalities.  Conclusion  The framework completeness of maternal health care system was improved and the improvement facilitated maternal health care practice in Beijing and Shanghai gradually during 2000 – 2017; but some supportive departments were not embedded into the MHC system′s framework and the completeness of subsystem need to be improved. The study verified the feasibility of quantitative assessment on framework completeness of maternal health care system.
Influence of new media use on patients′ healthcare-seeking behavior
2022, 38(2): 246-249. doi: 10.11847/zgggws1124662
Abstract(251) HTML (90) PDF 693KB(24)
  Objective  To examine the status of new media dependence and healthcare-seeking behavior among patients and to explore the influence and mechanism of new media use on the patients′ healthcare-seeking behavior.   Methods   Totally 526 patients were randomly recruited at 22 medical institutions of various levels in urban Shanghai during January 11 – 24, 2018 for an online survey. A self-designed questionnaire was used to collect information on demographics, social support, self-efficacy, new media use, and healthcare-seeking attitude/behavior. A media dependency theory- and the theory of planned behavior-based structural equation model was adopted in analysis on the relationship between new media use and healthcare-seeking behavior.   Results  For the 526 respondents with complete information, the patients′ dependence on new media was at an average level but the patients′ healthcare-seeking behavior was good. Based on the established structural equation model with good fitting indicators, new media dependence is positively correlated with personal healthcare-seeking attitude (β = 0.50, P < 0.01); healthcare-seeking attitude positively affects healthcare-seeking intention (β = 0.78, P < 0.01) and indirectly affects healthcare-seeking behavior (β = 0.50, P < 0.01); however, new media dependence is not related to self-efficacy (β = – 0.19, P = 0.07) and social support (β = 0.15, P = 0.26); in addition, self-efficacy positively affects (β = 0.14, P = 0.03) healthcare-seeking intention and directly and indirectly affects healthcare-seeking behavior.   Conclusion  As a tool and channel of health communication, new media is of significant potential and practicability in the intervention on healthcare-seeking behavior among urban hospital attendees.
Advances in researches on mobile health technology-based disease management: a rewiew
TIAN Meng-ge, YIN Xiao-xu, LU Zu-xun,
2022, 38(2): 250-252. doi: 10.11847/zgggws1127198
Abstract(345) HTML (71) PDF 448KB(37)
With the popularization of internet technology, mobile health has been developed vigorously, which makes it possible to overcome the limitations of time, space and manpower and to realize the remote management of diseases aftercare. First, this study analyzes the application of mobile health from three aspects including technology sort, management mode and the direction of disease research; then the study introduces the effect of disease management and cost-benefit analysis based on literature evidences and considerations of patients' demand or feedback. With analyses mentioned above, the study put forward some suggestions for improving disease management system in China.
Public Health Forum
Preventive medicine physician system in the United States and its implications for China
LI Gang, FENG Da, TANG Shang-feng,
2022, 38(2): 253-256. doi: 10.11847/zgggws1129364
Abstract(2653) HTML (2212) PDF 516KB(212)
Medical education system and licensed physician management system in the United States are two relatively mature institutions with successful operation. This study systematically reviewed the policy content of the preventive medicine physician system in the United States by establishing a theoretical analysis framework covering the education, employment admittance, deployment, professional title, and incentive pay system. This study discussed the identity crisis of public health physicians in China and considered that Chinese public health physicians are not preventive medicine physicians. The study suggested that for improving public health physician system in China, the connotation of public health physicians should be rectified; the criterion for admittance of public health physicians should be upgraded; and approaches for the transition between clinicians and public health physicians should be diversified.