Objective To develop the Chinese Version People's Voice Survey(PVS-CN)that incorporates both international comparability and local characteristics and test its reliability and validity.Methods On the basis of collaborative development of the global version of the evaluation tool,the PVS-CN was formed through localization revisions,translation-back translation,cross-cultural adaptation,and adjustments,with the scale items being tested.In October 2023,a mobile phone survey was conducted across China's mainland(excluding Hong Kong,Macao,and Taiwan),where mobile phone numbers were randomly selected.A total of 534 valid questionnaires were collected,with 42 participants undergoing retesting after a two-week interval.The reliability and validity of the scale were assessed by item analysis,exploratory factor analysis,confirmatory factor analysis,and other methods of reliability and validity testing.Results The PVS-CN scale consists of 27 items,covering five dimensions:self-assessed health status,recent healthcare experience,evaluation of the public healthcare system,overall evaluation of the health system,and expectations for the quality of the health system,explaining 67.663%of the total variance.The scale presents the item-level content validity index(I-CVI)ranging from 0.71 to 1.00,the scale-level content validity index/universal agreement(S-CVI/UA)of 0.85,and the average scale-level content validity index(S-CVI/Ave)of 0.98,demonstrating strong content validity.Confirmatory factor analysis shows that the structural validity of the scale is good,with χ2/df=2.131,normed fit index(NFI)=0.934,comparative fit index(CFI)=0.964,goodness-of-fit index(GFI)=0.910,Tucker-Lewis index(TLI)=0.960,incremental fit index(IFI)=0.964,and root mean square error of approximation(RMSEA)=0.046.The reliability test results show that the overall scale has the Cronbach's α coefficient of 0.942,the split-half reliability of 0.849,and the test-retest reliability of 0.874,indicating good internal consistency and stability of the scale.Conclusion The PVS-CN developed in this study demonstrates good reliability and validity,serving as an effective tool for assessing China's healthcare system from the public perspective,with potential for further application.

[Background]The occurrences of occupational stress and sleep disorders are closely related.As a high-risk group of occupational stress,the sleep quality of locomotive engineers is of great sig-nificance for road traffic safety. [Objective]To explore the direction and degree of occupational stress affecting the sleep quality among locomotive engineers,and to analyze potential mediating and moderating roles of response strategy and overcommitment in the relationship. [Methods]From July 1st to July 31st,2022,a total of 6219 locomotive engineers from three lo-comotive depots of China Railway Lanzhou Group Corporation were selected.We conducted an online survey on occupational stress,overcommitment,response strategy and sleep quality using the Effort-Reward Imbalance,Personal Resources Questionnaire,and Pittsburgh Sleep Quality Index.Single factor analysis and correlation analysis were conducted using SPSS 25.0 software,mediation and moderation models were constructed using the Process V3.3 macro program plugin,and Harman's single factor test was used for common method bias testing. [Results]A total of 6219 questionnaires were distributed,and 5738 valid questionnaires were collected,with an effective response rate of 92.27%.The average locomotive engineers'occupational stress score(1.22±0.29),overcommitment score(16.38±3.55),response strategy score(50.00±10.00),and sleep quality score(11.51±3.95)were calculated.The Pearson correlation analysis results showed that occupational stress was positively correlated with overcommitment and sleep quality(r=0.435,0.321,P<0.01),and negatively correlated with response strategy(r=-0.286,P<0.01);overcommitment was positively correlated with sleep quality(r=0.367,P<0.01),and negatively correlated with response strategy(r=-0.210,P<0.01);there was a negative correlation between response strategy and sleep quality(r=-0.244,P<0.01).Occupational stress positively associated with sleep quality in locomotive engineers(b=3.658,t=21.177,P<0.001);re-sponse strategy exhibited a partial mediating role between occupational stress and sleep quality,with an effect size of 0.581,accounting for 15.88%of the total effect;overcommitment presented a significant moderating effect in the first half of the mediating process of"oc-cupational stress-response strategy-sleep quality"(P<0.001). [Conclusion]Occupational stress has an impact on the sleep quality of locomotive engineers through the mediating effect of response strategy,and the first half of this mediating pathway is moderated by overcommitment.

OBJECTIVES:Patient and public versions of guidelines (PVGs) have gradually gained wide recognition and attention from the public and the society due to their scientific, professional, and authoritative characteristics. This study aims to survey the awareness and knowledge of PVGs among stakeholders in China. STUDY DESIGN AND SETTING:This was a cross-sectional survey among stakeholders (guideline developers, clinicians, journal editors, patients, and the public) in China. We self-designed the questionnaire and distributed it through the Questionnaire Star platform. The primary outcomes were awareness of PVGs and opinions about the development methodology, writing, dissemination, and implementation of PVGs. The Kruskal-Wallis H test and post hoc multiple comparison tests were used to compare the levels of awareness of PVGs between different subgroups of respondents. RESULTS:A total of 1319 valid questionnaires were collected: 722 from guideline developers, 136 from clinicians, 83 from journal editors, 284 from patients, and 94 from members of the public. Of all respondents, 253 (19.2%) had not heard of PVGs, 349 (26.5%) had heard of PVGs but had no further knowledge, 475 (36.0%) had some knowledge of PVGs, and 242 (18.3%) were familiar with or had participated in the development of PVGs. Guideline developers, clinicians, and journal editors had higher awareness than patients and the public. Higher education and older age also correlated with higher awareness of PVGs. More than half (52.9%) of guideline developers considered that both rewriting of the source guidelines and direct development as independent documents were appropriate methods for developing PVGs. The survey respondents agreed that clinicians (97.3%), guideline methodologists (76.6%), representatives of patients and the public (74.5%), and medical editors or writers (63.4%) should participate in the development of PVGs. More than 80% of the respondents agreed that the quality of evidence and strength of recommendations should be presented; however, there was no consensus in the form of presentation. CONCLUSIONS:The level of awareness of PVGs among stakeholders in China is relatively low and differs between different stakeholder groups, but the majority of key stakeholders have a positive attitude toward PVGs. The collection of the perspectives and opinions on the development methods, writing, dissemination, and implementation provides a key reference and basis for the future optimization and improvement of PVGs development.

Background. Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students. Methods. The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed. Results. Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = −0.29; 95% CI: −0.49 to −0.09), depression (SMD = −0.32; 95% CI: −0.62 to −0.02), and perceived stress (SMD = −0.41; 95% CI: −0.60 to −0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = −0.59; 95% CI: −1.14 to −0.04). No significant differences were observed in sleep quality (SMD = −0.20; 95% CI: −0.06 to 0.20), social function (SMD = −0.71; 95% CI: −2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: −0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low. Conclusions. MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students’ clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

Background and Aims Physicians' knowledge and practices regarding the diagnosis, treatment, and follow-up of Helicobacter pylori (H. pylori) infection can impact the effectiveness of eradication therapy. This study aimed to investigate the current state of knowledge and practices concerning H. pylori infection management among physicians in Gansu Province, northwest China. Materials and Methods From October to November 2023, 557 physicians from 14 cities and prefectures in Gansu Province participated in this multicenter cross-sectional study and completed a survey questionnaire. Results A total of 519 valid questionnaires were collected. 43.2% of the physicians supported H. pylori screening for high-risk populations or individuals with H. pylori-related diseases. The awareness of target screening populations varied among these physicians, ranging from 69.6% to 98.2%. Most physicians preferred the urea breath test (UBT) as the method for diagnosing H. pylori infection (98.3%) and for follow-up after eradication therapy (98.5%). 89.6% of the physicians preferred bismuth-containing quadruple therapy for initial eradication, with amoxicillin and clarithromycin being the most commonly used antibiotic combination (56.3%). In addition, 84.6% of the physicians indicated that they would inquire about the antibiotic usage history for most patients before treatment, 93.8% would ask patients about their previous eradication history, and 94.2% would inform patients about treatment-related considerations. However, only 43.5%, 27.7%, and 29.7% of the physicians were aware of the high resistance rates of H. pylori to clarithromycin, levofloxacin, and metronidazole, respectively, in Gansu Province. Subgroup analysis revealed that the performance of gastroenterologists, nongastroenterologists, and physicians from different levels of hospitals differed in the diagnosis, treatment, and follow-up of H. pylori infection. Conclusions Knowledge and practices regarding H. pylori infection management among physicians in Gansu Province, China, need further improvement. Strengthening targeted continuing education to increase the overall management level of H. pylori infection is recommended.

Stroke is the second leading cause of death and the third-leading cause of disability in the world. The skeletal muscles play a key role in disability following stroke. Although many studies have reported the prevalence and risk factors of sarcopenia in patients with stroke, the results have not been synthesized. This systematic review was conducted to explore the prevalence and risk factors of sarcopenia in patients with stroke. PubMed, Embase, The Cochrane Library, Web of Science, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Weipu Database (VIP), Wanfang Database were comprehensively searched for studies exploring the prevalence and risk factors of sarcopenia in patients with stroke from inception to October 5th, 2022. This review included 19 studies involving 4148 subjects. The total prevalence of sarcopenia in patients with stroke is 46

BACKGROUND:The impact of COVID-19 on the epidemiology, clinical characteristics, and infection spectrum of viral and bacterial respiratory infections in Western China is unknown.METHODS:We conducted an interrupted time series analysis based on surveillance of acute respiratory infections (ARI) in Western China to supplement the available data.RESULTS:The positive rates of influenza virus, Streptococcus pneumoniae, and viral and bacterial coinfections decreased, but parainfluenza virus, respiratory syncytial virus, human adenovirus, human rhinovirus, human bocavirus, non-typeable Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydia pneumoniae infections increased after the onset of the COVID-19 epidemic. The positive rate for viral infection in outpatients and children aged <5 years increased, but the positive rates of bacterial infection and viral and bacterial coinfections decreased, and the proportion patients with clinical symptoms of ARI decreased after the onset of the COVID-19 epidemic. Non-pharmacological interventions reduced the positive rates of viral and bacterial infections in the short term but did not have a long-term limiting effect. Moreover, the proportion of ARI patients with severe clinical symptoms (dyspnea and pleural effusion) increased in the short term after COVID-19, but in the long-term, it decreased.CONCLUSIONS:The epidemiology, clinical characteristics, and infection spectrum of viral and bacterial infections in Western China have changed, and children will be a high-risk group for ARI after the COVID-19 epidemic. In addition, the reluctance of ARI patients with mild clinical symptoms to seek medical care after COVID-19 should be considered. In the post-COVID-19 era, we need to strengthen the surveillance of respiratory pathogens.

目的:了解铁路机车乘务员职业紧张现状及与付出—回报失衡之间的关系.方法:2022年7-8月,整群随机抽取中国铁路兰州局集团公司3个机务段5 738名机车乘务员为调查对象,利用付出—回报失衡问卷(ERI)和职业紧张量表(OSI-R)进行问卷星线上调查,采用多元线性回归法分析影响列车乘务员职业紧张的主要因素.结果:职业角色紧张方面,同一组别比较,B机务段、＜30岁、电力机车司机、值乘列车为货车、硕士及以上学历、丧偶、工龄6～10年、周工作时间＞50小时、临时合同制列车乘务员的职业紧张量表评分较高,近5年换过3个以上工作岗位的个体紧张反应分值较高,说明以上群体职业压力较大.个体应变能力方面,同一组别比较,A机务段、动车司机、值乘列车调车、近5年换过1个工作岗位、周工作时间40～50小时、技师的评分较高.付出、回报和内在投入与职业紧张各维度具有显著相关性.在控制人口学变量的影响后,付出和过度投入能够增加职业角色和个体紧张反应程度,使个体应变能力降低;回报能够降低职业角色和个体紧张反应程度,增加个体应变能力.结论:铁路机车乘务员职业紧张水平适度,但付出—回报失衡严重,建议相关部门改进工作流程,重视对乘务员工作的支持和认可,以降低其职业紧张程度.

Japanese encephalitis (JE), a mosquito-borne zoonotic disease, has emerged as a major public health concern around the world. Previous research has shown that JE has serious sequelae, and the recent shift in the population from children to adults presents a significant challenge for JE treatment and prevention. Therefore, we examined the differences in clinical manifestations (clinical symptoms, clinical signs, complications, and clinical typing) of JE between children and adults over the 15 years in Gansu Province to provide a theoretical basis for better response to JE treatment. Clinical typing was found to be statistically significant in the child versus adult groups and the groups with or without vaccination. Only the dysfunction of consciousness differed statistically between children with and without vaccination, whereas neurological symptoms such as vomiting (jet vomiting), irritability, drowsiness, convulsions, and hyperspasmia differed statistically between children and adults, and the rest of the symptoms did not differ statistically. Only pupil size changes were statistically different in clinical signs between the children with and without vaccination, while blood pressure changes, change in pupil size, positive meningeal stimulation signs, and positive pathological reflexes (increased muscle tone and Babinski's sign) were statistically different between adults and children. Bronchopneumonia was the most common complication, especially in adults. Therefore, the authors believe that children and adults differ in some clinical manifestations and propose that efforts should be directed toward developing individualized treatment plans for different age groups and employing more effective supportive treatment for various populations. In addition, we suggest expanding the coverage of the JE vaccine and increasing overall vaccination rates and adopting multiple measures in conjunction with JE prevention and control.

In 2008, Mainland China included the Japanese encephalitis (JE) vaccine in the Expanded Program on Immunization (EPI) to control the JE epidemic. However, Northwest China experienced the largest JE outbreak since 1994 in 2018, and the effects of the EPI in different regions are unclear. Therefore, we used an interrupted time series design to evaluate the effects of the EPI in different regions. In this study, β1 and β1+β3 represented the slope or trend of the JE incidence before and after the EPI, respectively; β2 was the level change of the JE incidence immediately after the EPI; β3 represented the slope change of the JE incidence before and after the EPI. We found that the JE incidence in all regions showed a decreasing trend before the EPI (β1<0.000, P<0.05). The JE incidence in Mainland China (β2=-7.669, P<0.05), East China (β2=-9.791, P<0.05), Central China (β2=-10.695, P<0.05), South China (β2=-6.551, P<0.05) and Southwest China (β2=-2.216, P<0.05) decreased by 7.669/100,000, 9.791/100,000, 10.695/100,000, 6.551/100,000 and 2.216/100,000 immediately after the EPI, and the EPI had short-term effects on the JE incidence in these regions. The slope of the JE incidence in Mainland China (β3=0.272, P<0.05), East China (β3=0.337, P<0.05), Central China (β3=0.381, P<0.05), South China (β3=0.254, P<0.05) and Southwest China (β3=0.081, P<0.05) increased by 0.272, 0.337, 0.381, 0.254 and 0.081 after the EPI, and the EPI had long-term effects on the JE incidence in these regions. The JE incidence in many regions (excluding North China) showed a decreasing trend after the EPI (β1+β3 <0.000). Northwest China (GDP from 2008 to 2020 ranked last in Mainland China) and Southwest China (GDP from 2008 to 2020 ranked fifth in Mainland China), with underdeveloped economy, used to be low-epidemic regions of JE, but they have become high-epidemic regions in recent years. Economic development may contribute to the geographic variations in the effects of the EPI. Therefore, it is significant for JE control in Mainland China to increase support for underdeveloped regions and adjust the vaccine strategy according to the new epidemic situation of JE.

Objective:To evaluate the impact of the Japanese encephalitis vaccine included in an expanded immunization program on the reported incidence rate of Japanese encephalitis in Gansu province.Methods:Information on the reported incidence rate of Japanese encephalitis in Gansu province from 1987 to 2019 was collected through the National Population Health Science Data Center and the China Disease Prevention and Control Information System. In addition, the trend of Japanese encephalitis reported incidence rate in Gansu province before and after the inclusion of the Japanese encephalitis vaccine in the expanded immunization program was analyzed using an interrupted time-series design.Results:The annual reported incidence rate of Japanese encephalitis in Gansu province from 1987 to 2019 was 0.448/per 100 000. However, after the inclusion of the Japanese encephalitis vaccine in the expanded immunization program in Gansu province in 2008, the amount of change in the level of Japanese encephalitis reported incidence rate was -2.223/per 100 000 ( t=-2.90, P=0.007), the amount of change in the slope of Japanese encephalitis reported incidence rate was 0.082 ( t=2.87, P=0.008) with the slope of Japanese encephalitis reported incidence rate as 0.071 ( β1+ β3=0.071). Conclusions:The Japanese encephalitis vaccine has achieved good prevention and control effects in Gansu province in the short term after its inclusion in the expanded immunization program, but outbreaks of Japanese encephalitis have still occurred. Therefore, in the future, Gansu province should promptly adjust the immunization strategy of the Japanese encephalitis vaccine, and strengthen the vaccination of the adult population, especially the rural adult population in the southeastern region of Gansu province, based on the continued focus on the works on Japanese encephalitis vaccination for children and adolescents.

BACKGROUNDHirschsprung-associated enterocolitis (HAEC) is a leading cause of serious morbidity and potential mortality in children with Hirschsprung's disease (HD). People with HAEC suffer from intestinal inflammation, and present with diarrhoea, explosive stools, and abdominal distension. Probiotics are live microorganisms with beneficial health effects, which can optimise gastrointestinal function and gut flora. However, the efficacy and safety of probiotic supplementation in the prevention of HAEC remains unclear.OBJECTIVESTo assess the effects of probiotic supplements used either alone or in combination with pharmacological interventions on the prevention of Hirschsprung-associated enterocolitis.SEARCH METHODSWe searched CENTRAL, PubMed, Embase, the China BioMedical Literature database (CBM), the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, the Chinese Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, and Clinical Trials Registry-India, from database inception to 27 February 2022. We also searched the reference lists of relevant articles and reviews for any additional trails.SELECTION CRITERIARandomised controlled trials (RCTs) comparing probiotics and placebo, or any other non-probiotic intervention, for the prevention of HAEC were eligible for inclusion.DATA COLLECTION AND ANALYSISTwo review authors independently extracted data and assessed the risk of bias of the included studies; disagreements were resolved by discussion with a third review author. We assessed the certainty of evidence using the GRADE approach. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes.MAIN RESULTSWe included two RCTs, with a total of 122 participants. We judged the overall risk of bias as high. We downgraded the evidence due to risk of bias (random sequence generation, allocation concealment, and blinding) and small sample size. The evidence is very uncertain about the effect of probiotics on the occurrence of HAEC (OR 0.58, 95% CI 0.10 to 3.43; I² = 74%; 2 studies, 120 participants; very low-certainty evidence). We found one included study that did not measure serious adverse events and one included study that reported no serious adverse events related to probiotics. Probiotics may result in little to no difference between probiotics and placebo in relation to the severity of children with HAEC at Grade I (OR 0.66, 95% CI 0.14 to 3.16; I² = 25%; 2 studies, 120 participants; low-certainty evidence). The effects of probiotics on the severity of HAEC at Grade II are very uncertain (OR 1.14, 95% CI 0.01 to 136.58; I² = 86%; 2 studies, 120 participants; very low-certainty evidence). Similarly, the evidence suggests that probiotics results in little to no difference in relation to the severity of HAEC at Grade III (OR 0.43, 95% CI 0.05 to 3.45; I² = 0%; 2 studies, 120 participants; low-certainty evidence). No overall mortality or withdrawals due to adverse events were reported. Probiotics may result in little to no difference in the recurrence of episodes of HAEC compared to placebo (OR 0.85, 95% CI 0.24 to 3.00; 1 study, 60 participants; low-certainty evidence).AUTHORS' CONCLUSIONSThere is currently not enough evidence to assess the efficacy or safety of probiotics for the prevention of Hirschsprung-associated enterocolitis when compared with placebo. The presence of low- to very-low certainty evidence suggests that further well-designed and sufficiently powered RCTs are needed to clarify the true efficacy of probiotics.

目的 分析影响基层社区卫生服务中心院前急救能力的主要因素,提出针对性的改进策略.方法 整群随机抽取庆阳市某主城区3个社区卫生服务中心的127名卫技人员进行现场问卷调查,了解卫技人员院前急救能力、培训学习情况等;召集社区卫生服务中心负责填写本单位的基本情况.采用有序多分类logistic回归模型分析院前急救能力的影响因素.结果 3家社区卫生服务中心的建设规模尚未完全达标.3家服务中心均未设急诊科,一些常规急救设备尚未充分配备.针对卫技人员的调查,收回有效问卷122份,有效回收率96.06％.122名卫技人员中以护理人员为主(占59.1％),学历构成以大专为主(占61.5％),初级职称人数最多(占63.1％).3家社区卫生服务中心卫技人员的学历、职称、年龄、工龄比较,差异均无统计学意义(P＞0.05).参加过急救专业知识培训的卫技人员占95.0％;所参与的各类培训中,含有急救知识的比率介于86.7％～96.6％.卫技人员对不同急救知识技能的掌握程度的自评结果不同(P＜0.05):对生命体征检测、心肺复苏技术和伤口处理表示"完全掌握"的人数占比相对较多,分别为57.4％、40.2％和34.4％;针对骨折固定技术、急性中毒处理、急救设备运用,表示"未掌握"的人数占比相对较多,分别为27.0％、20.5％和17.2％.对培训需求较高的3项知识技能为急救设备运用(占89.3％)、伤口处理技术(占88.5％)和急性中毒处理(占87.7％).logistic回归分析结果显示:认为社区有必要开展院前急救、参加过急救专题培训可能是"非常胜任院前急救工作"的促进因素(OR=7.576、25.179,P＜0.05).结论 基层社区卫生服务中心急救设施配备不足,卫技人员急救专业能力有待提高.政府需加强主导作用,加强各种形式的急救能力培训,科学规划全市急救医疗资源,稳定基层急救人才队伍.

Background: We aimed to quantify the impact of each vaccine strategy (including the P3-inactivated vaccine strategy [1968-1987], the SA 14-14-2 live-attenuated vaccine strategy [1988-2007], and the Expanded Program on Immunization [EPI, 2008-2020]) on the incidence of Japanese encephalitis (JE) in regions with different economic development levels. Methods: The JE incidence in mainland China from 1961 to 2020 was summarized by year, then modeled and analyzed using an interrupted time series analysis. Results: After the P3-inactivated vaccine was used, the JE incidence in Eastern China, Central China, Western China and Northeast China in 1968 decreased by 39.80 % (IRR = 0.602, P < 0.001), 7.80 % (IRR = 0.922, P < 0.001), 10.80 % (IRR = 0.892, P < 0.001) and 31.90 % (IRR = 0.681, P < 0.001); the slope/trend of the JE incidence from 1968 to 1987 decreased by 30.80 % (IRR = 0.692, P < 0.001), 29.30 % (IRR = 0.707, P < 0.001), 33.00 % (IRR = 0.670, P < 0.001) and 41.20 % (IRR = 0.588, P < 0.001). After the SA 14-14-2 live-attenuated vaccine was used, the JE incidence in Eastern China and Northeast China in 1988 decreased by 2.60 % (IRR = 0.974, P = 0.009) and 14.70 % (IRR = 0.853, P < 0.001); the slope/trend of the JE incidence in Eastern China and Central China from 1988 to 2007 decreased by 4.60 % (IRR = 0.954, P < 0.001) and 4.70 % (IRR = 0.953, P < 0.001). After the EPI was implemented, the JE incidence in Eastern China, Central China and Western China in 2008 decreased by 10.50 % (IRR = 0.895, P = 0.013), 18.00 % (IRR = 0.820, P < 0.001) and 24.20 % (IRR = 0.758, P < 0.001), the slope/ trend of the JE incidence in Eastern China from 2008 to 2020 decreased by 17.80 % (IRR = 0.822, P < 0.001). Conclusions: Each vaccine strategy has different effects on the JE incidence in regions with different economic development. Additionally, some economically underdeveloped regions have gradually become the main areas of the JE outbreak. Therefore, mainland China should provide economic assistance to areas with low economic development and improve JE vaccination plans in the future to control the epidemic of JE.

目的 通过对近年"一带一路"沿线国家出入我国国境的人员传染病监测结果的分析,探讨降低传染病跨国传播潜在风险的策略.方法 收集2012-2016年原国家质量监督检验检疫总局发布的传染病监测数据,从世界银行、世界卫生组织和中国"一带一路"官方网站检索各国的社会经济、人口及地理相关资料,进行流行病学描述与关联性分析.结果 2012-2016年,来自"一带一路"沿线国家出入我国国境人员传染病病例检出种类逐年增加,检出量占全部出入境检出传染病例数的比例由2012年的9.9％增加至2016年的33.6％.检出传染病病例数以流感为首位,多来自东亚和东南亚国家;检出的传染病以呼吸道传染病为主;传染病病例来源国地理特征与检出病种数分级的构成有统计学意义(P＜0.05);社会人口特征对检出病种数的分级的构成无统计学意义(P＞0.05).结论 随着"一带一路"倡议的深入推进,应进一步加强对出入境人员的传染病监测,对不同来源国家及不同地理带的出入境人员采取针对性的检疫策略.

Objective To evaluate the effect of early mobilization on mortality in intensive care unit (ICU) patients with mechanical ventilation after discharge by Meta-analysis. Methods Databases including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang data, PubMed, the Cochrane Library, Web of Science, and Embase were searched from inception to September 17th, 2020, to collect randomized controlled trials (RCT) about early mobilization on mortality of patients with mechanical ventilation in ICU after discharge, the references included in the literature were traced. The control group was given routine care, the experimental group was given early mobilization on the basis of the control group, including passive or active mobilization on the bed, sitting on the bed, standing by the bed, transferring to the bedside chair and assisting walking. The literature screening, data extracting, and the bias risk assessment of included studies were conducted independently by two reviewers. Stata 12.0 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias. Results A total of 10 RCT studies involving 1 323 patients were included, with 660 patients in the control group and 663 patients in the experimental group. The results of literature quality evaluation showed that 7 studies were grade A and 3 studies were grade B, indicating that the overall quality of included literatures was high. The Meta-analysis results showed that early mobilization did not increase the mortality of patients with mechanical ventilation in ICU after discharge [odds ratio (OR) = 0.92, 95% confidence interval (95%CI) was 0.75-1.13, P = 0.449]. Subgroup analysis results showed that early mobilization had a tendency to reduce the mortality of ICU patients with mechanical ventilation at 3, 6 and 12 months after discharge, but the difference was not statistically significant (3-month mortality: OR = 1.02, 95%CI was 0.74-1.40, P = 0.927; 6-month mortality: OR = 0.95, 95%CI was 0.70-1.27, P = 0.712; 12-month mortality: OR = 0.60, 95%CI was 0.33-1.10, P = 0.101). Funnel plot showed that the distribution of included literatures was not completely symmetrical, suggesting that publication bias might exist. Conclusions Early mobilization does not increase the mortality of ICU patients with mechanical ventilation after discharge. Although it tends to have a favorable outcome in reducing mortality, and has a trend to reduce the mortality. However, due to the small number of included literatures, small sample size and differences in the specific implementation of early mobilization among various studies, a large number of high-quality RCT studies are still needed for further verification.

BACKGROUND:Intensive-care-unit-acquired weakness (ICU-AW) not only leads to difficulty weaning off mechanical ventilation, prolonged hospital stay and increased medical costs, but also reduces the patient's quality of life after discharge and increases the 1-year mortality rate. Early identification and intervention can improve the prognosis of critically ill patients. However, much remains unknown about current clinical practice for ICU-AW assessment by ICU staff in China. OBJECTIVES:To investigate current practices and barriers to ICU-AW assessment among ICU staff, and provide insights to improve ICU-AW assessment in ICUs in China. METHODS:Qualitative interviews were used to construct a survey questionnaire (test-retest reliability 0.92, validity 0.96). This survey was subsequently completed by 3206 ICU staff from 31 provinces, municipalities and autonomous regions in China. RESULTS:In total, 3206 ICU staff responded to the survey (response rate 90%): 616 doctors (19%), 2371 nurses (74%), 129 respiratory therapists (4%), 51 physiotherapists (2%) and 39 dieticians (1%). Only 27% of the respondents had treated/cared for patients with ICU-AW. Reported methods for ICU-AW assessment were clinical experience (53%), ICU-AW assessment tools (12%), and physiotherapy consultation (35%). Forty-three percent of respondents felt that their ICU-AW-related knowledge did not meet clinical needs, only 10% had received ICU-AW-related training, and 19% proactively assessed whether their patients had ICU-AW. In terms of frequency of assessment, 42%, 16% and 11% of respondents considered that ICU-AW should be assessed daily, every 3 days, and on ICU admission and discharge, respectively. The Medical Research Council scale, electrophysiological assessment and the Manual Muscle Testing scale were considered to be optimal tools for ICU-AW diagnosis by 79%, 70%, and 73% of respondents, respectively. The main reported barriers to ICU-AW assessment were lack of knowledge, cognitive impairment among patients, and lack of ICU-AW assessment guidelines and procedures. CONCLUSION:Current practices for ICU-AW assessment are non-specific, and the main barriers include lack of skills and knowledge.

目的 探讨甘肃省2017-2018年流行性乙型脑炎(简称乙脑)的流行病学特征和疾病负担.方法 利用甘肃省2017年1月1日—2018年12月31日乙脑病例数据和随访数据,计算乙脑的发病率、死亡率、病死率以及潜在减寿年数,比较不同分组的乙脑病例病情转归情况,采用二项Logistic回归分析模型分析甘肃省乙脑患者病情转归的主要影响因素.结果 乙脑发病率、死亡率以及病死率随着年龄增长而增加.不同年龄(H=61.797,P＜0.001)、不同临床分型(H=53.953,P＜0.001)、有无意识障碍(H=64.367,P＜0.001)以及有无脑膜刺激征(H=5.251,P=0.022)的乙脑病例病情转归比较均有统计学差异.二项Logistic逐步回归分析模型结果显示,年龄(OR=3.217,P＜0.001)、临床分型(OR=1.621,P＜0.001)及有无意识障碍(OR=1.969,P=0.002)对甘肃省乙脑病例病情转归的影响均有统计学意义.甘肃省2017年和2018年乙脑病例的潜在寿命损失分别为945.84人年和1 056.92人年,0～＜15岁损失最小,女性损失高于男性.结论 成人乙脑发病率、死亡率及病死率均高于儿童,乙脑造成的潜在寿命损失也主要以成人为主,影响乙脑病例转归的主要因素为年龄、临床分型以及有无意识障碍.