Resilience is widely discussed and applied across multiple disciplines, with its concept having evolved in the field of hazards and disasters over recent decades. However, there remains a lack of a resilience concept specifically applicable to infectious disease outbreaks, which can lead to misidentification of key issues in outbreak prevention and control, hindering the effective application of this concept. This study aims to provide a clear definition of resilience against infectious disease outbreaks. Building on the fundamental meaning of resilience and its application to hazards and disasters, the research has identified and developed several essential elements for resilience against infectious disease outbreaks by comparing infectious diseases with other types of natural hazards. This study then proposes that resilience against infectious disease outbreaks is the capacity to effectively prevent, detect, respond to, and control outbreaks without seriously affecting essential functions of health and social systems, which could be measured by the intensity of infectious diseases that an area can effectively manage. The concept and scope of resilience proposed in this study provide a valuable framework for improving regional capacity to better prepare for potential epidemic and pandemic threats in the future.

目的 分析和比较全球卫生安全相关指标评价体系的实际应用结果,为完善和整合全球卫生安全相关指标体系提供参考.方法 采用文献研究法和定量研究法,查阅文献资料和有关报告,并开展定量数据资料研究;对全球卫生安全相关评价工具结果进行标准化,并利用Microsoft Excel 2021和SPSS 25.0软件进行数据整理和分析,采用方差分析探索区域间差异,Bonferroni检验进行组间比较,Pearson线性分析探索相关性.结果 欧洲区评估结果较高,其全球卫生安全指数(global health security index,GHSI)、全民健康覆盖指数(universal health coverage index,UHCI)、区域安全评估指数(regional safety assessment in-dex,RSAI)、全球治理指数(worldwide governance index,WGI)结果均为最高值;非洲区评估结果较差,其联合外部评估(joint external evaluation,JEE)、GHSI、UHCI、RSAI、WGI 结果均为最低值;JEE与GHSI、UHCI、WGI及RSAI之间存在相关性(0.3≤|r|≤0.8);各工具最高分和最低分国家,JEE为新加坡92.1分,中非27.2分;GHSI为美国75.9分,索马里16.0分;UHCI为加拿大89.0分,索马里27.0分;RSAI为瑞士 75.2分,马里、卢旺达、南苏丹30.0分;WGI为新西兰97.8分,叙利亚1.5分;政策遏制指数(policy containment and health index,PCI)为中国84.5分,塔吉克斯坦和坦桑尼亚14.9分;全球风险指数(global risk index,GRI)为斯洛伐克88.0分,塞尔维亚5.0分.结论 单一类型指标工具得出的评估结果可能无法完整反映和评价全球卫生安全状况,多种不同指标工具整合得出的综合结果更具预测性,未来有必要探索和比较不同指标工具的具体指标,以全面分析指标内容的应用价值.

Purpose This study compares doctor staffing level and the scale of medical education in China with those of other countries and proposes policy recommendations for future adjustments to the scale of China's medical education. Design/Approach/Methods This study employs a literature review and descriptive analysis. Findings China had 1.98 medical doctors per 1,000 people in 2018, ranking 85th out of the 193 member-states of the World Health Organization (WHO). In 2017, China had 1.99 practicing doctors per 1,000 people, only ranking above Turkey (1.88) in Organisation for Economic Co-operation and Development (OECD) countries. China had only 10.28 medical graduates per 100,000 people—placing in the bottom third of OECD countries. China's provision of 1.4 medical schools per 10 million people was also significantly lower than the global average (3.9). However, the average number of students enrolled in medical schools (509) in China was significantly higher than the global average (160). Originality/Value Although the scale of admission in undergraduate medical education must be expanded in China, this needs to be achieved while controlling the average number of medical students per school and reducing enrollment in low-quality medical schools. Furthermore, it is necessary to establish new medical schools while improving the operating level of existing ones.

全球卫生教育是一个以跨国因素引起的健康问题为重点的教育领域,其重要性和必要性随着全球化进程的加速和传染性疾病在全球的肆虐日益突出.开展全球卫生教育成为国际医学教育的重要发展趋势.我国发展全球卫生教育具有十分重要的意义,迫切需要加强高等院校全球卫生科研与教学机构建设,为医学生提供更多全球卫生教育机会,并重视高层次全球卫生专业人才培养.

我国临床医学教育培养了大量的临床医学人才,为服务公众医疗健康需求和健康中国建设提供了有力支撑.本文聚焦我国高等临床医学教育管理、人才培养体系、人才培养规模和结构、质量保证保障体系等,论述我国临床医学教育现状、存在的问题和进一步改革发展的建议.我国高等临床医学教育应该顺应新时代健康中国建设的新要求,基于我国国情,进一步加强医教协同,完善医学教育管理的体制机制和人才培养体系;面向卫生健康行业需求,优化我国临床医学人才培养的规模、结构和布局;遵循医学教育规律和临床医学教育标准,不断优化人才培养模式,提升医学生胜任力;坚持质量优先,建立健全质量保障体系,保障资源投入.

Objectives:To review and summarize the development of China's medical schools, existing issues and put forward policy suggestions based on the perspective of domestic and international comparison.Methods:Descriptive analysis and literature review were implemented.Results:After 150 years' development, the number of China's medical schools reached 192 in 2020. However, there is still a serious shortage of medical schools if taking into account of the large population in the country. The number of medical schools per 10 million persons in China was only about one third of the world average level. The teaching quality of some medical colleges is not satisfactory, and the quantity of highly qualified medical colleges is insufficient. Some other weakness also exist, including large scale of enrollment per school, mal-distribution of medical schools in different regions and lack of a professional administration entity at the national level.Conclusions:China should improve the top-level design and making a national development plan for construction and development of medical schools. Multiple approaches should be taken to steadily increase the number of medical schools. A national organization for professional administration should be established to improve the macro management of medical schools. Finally, Chinese government should play a crucial role in facilitating the construction of medical schools in developing areas.

课程体系设置的合理性是实现人才培养目标的前提条件,在很大程度上决定了教育产品的最终质量.对美国3所一流大学的医学博士(MD)课程体系研究后发现:美国MD课程体系可分为临床见习前、临床见习、临床见习后3个阶段,分别侧重于基础核心课程、专业课程和职业导向课程.基础核心课程是基于"器官-系统"的模块化整合课程;临床见习的前后衔接功能及纵向整合见习得到重视与发展;临床见习后课程侧重于临床能力和学术经验的进一步拓展.美国MD课程体系有弹性,为学生多样化、个性化的学习和发展提供了条件.我国的临床医学课程体系应借鉴国际先进经验,不断推进课程体系的改革和重塑.

On December 29, 2019, the health authorities in Hubei Province and Wuhan City received a report of a cluster of pneumonia cases of unknown etiology from a local hospital, and all four patients were employees of the Wuhan Huanan Seafood Wholesale Market (HN market for short) (1). By January 8, 2020, Chinese authorities had identified a new virus 2019 novel coronavirus (2019-nCoV) linked with the outbreak of disease, which has been named novel coronavirusinfected pneumonia (NCIP) (2). On 15 January, the National Health Commission (NHC) issued guidelines for the diagnosis, treatment, prevention, and control of NCIP. These guidelines directed case monitoring, reporting, diagnosis, treatment, management, close contact management, and laboratory testing. On January 20, the State Council agreed to include NCIP into the Management of the Infectious Diseases Law and the Health and Quarantine Law. On January 25, the Central Committee of the Communist Party of China set up a leading group to deal with this epidemic.

Objective:Analyzing the quantity and geographic distribution of colleges offering undergraduate clinical medicine program in China and so to provide research basis for the development of national strategy for specialty establishment.Methods:Using the data from the Ministry of Education in 2018, the distribution of colleges in regions were analyzed by descriptive statistics. Using the Theil index to explore the source of difference.Results:Up to 2018, there were 181 colleges offering undergraduate clinical medicine program in China, accounting for 14.54% of the total undergraduate colleges and 51.28% (20/39)of the 985 Project colleges offering undergraduate clinical medicine program, while in other undergraduate colleges the percentage is only 13.24(150/1133). On average, each province has 5.84 colleges offering undergraduate clinical medicine program. The number of colleges offering undergraduate clinical medicine program for every 10 million populations and every 100 thousand square kilometers is 1.30 and 1.88. The contribution rate of the Theil index in the interior region was 81.58%.Conclusions:The proportion of high-level colleges offering undergraduate clinical medicine program is much higher than other undergraduate colleges. The level and number of colleges offering undergraduate clinical medicine program vary greatly among regions. Setting the undergraduate clinical medicine program must to consider the factors such as the absolute number and relative number of colleges offering undergraduate clinical medicine program, the academic level of colleges and the strength of clinical medicine discipline.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解中国卫生行政部门卫生应急能力现状,发现卫生应急能力存在的不足,为合理配置卫生应急资源,明确卫生应急能力建设工作的重点提供科学依据。方法采用普查的方法,基于2014年国家卫生计生委回收的全国卫生应急能力评估数据,对中国31个省级、342个市级、2 995个县级卫生行政部门进行问卷调查;卫生应急能力评估指标体系包含8个一级指标（体系建设、应急队伍、装备储备、培训演练、宣教科研、监测预警、应急处置、善后评估）、24个二级指标和81个三级指标;据此设计调查问卷并制定赋分标准,应急能力评估满分为900分,将原始分转换成百分制进行描述比较;采用K-均值聚类分析法将得分划分为高、中、低3类。结果实际回收有效填报数据省级30个,市级307个,县级2 584个;全国省、市、县三级卫生行政部门的应急能力评估总分均值分别为82.7、77.9、75.8分;省级卫生行政部门东、中、西部得分分别为83.7、79.6、83.9分;市级卫生行政部门东、中、西部得分分别为83.3、76.7、74.8分;县级卫生行政部门东、中、西部得分分别为78.7、75.0、73.8分。结论全国卫生行政部门应急能力在区域和行政级别上存在差异,基层能力亟需加强;总体应急能力中的善后评估、培训演练、宣教科研能力有待提高。</span>

Objective:By analyzing the overall situation of enrolment scale and the differences among different types of HEIs and different regions of undergraduate medical education of Higher Education Institutions (HEIs) in China in 2018, to provide basis for the optimization of enrolment scale.Methods:Descriptive statistical analysis was applied to analyze the single HEI enrolment, the average enrolment, and enrolment of different provinces.Results:Totally 180 HEIs admitted 70 480 medical undergraduate students in 2018, 5.1 students per 100, 000 population, 392 students per school, the single enrolment size of 44 HEIs was more than 600 students. The average scale of ordinary HEIs is much higher than that of 985 and 211 Project HEIs. The overall size and relative size of enrolment vary greatly among different provinces.Conclusions:The enrolment scale of undergraduate medical education needs to be expanded, and there still exist problems to be solved, such as large single HEI enrolment scale in many HEIs, obvious differences in the enrolment scale of different types of HEI and uneven distribution among provinces.

目的 流行病学是公共卫生的主干学科,也是一门广泛应用于其他学科的应用科学.全科医学以人的健康为中心,在疾病预防与健康管理方面具有重要作用,是居民健康的“守门人”.分析流行病学思维方法在全科医生培养中的应用意义,为我国全科医学教育的进一步发展提供启示.方法 以“流行病学”“全科医学”“全科医生”“家庭医生”“全科团队”和“全科医学教育”为关键词,对中国知网、万方数据库、维普及Pubmed数据库中1990年以来近30年的文献进行分析,结合我国全科医学教育现状,总结和分析流行病学思维方法在全科医生培养中的主要结合点.结果 目前全科医生培养过程中融入流行病学思维方法的教学理念与方法不足,应将预防为主的大健康理念贯穿于全科医生教育和工作中,并增加突发公共卫生疫情防控协调处置技能训练,突出流行病学三级预防理念、流行病学调查在全科医生培养中的融合效果.结论 应将流行病学的思维方法融入到全科医学教育与实践全过程之中,培养具有大健康观念、能维护和促进居民健康的全科医生.

目的:描述2002—2018年我国临床医师人力资源配置和人才培养情况,比较供给侧和需求侧的规模匹配情况,分析我国与相关国家人均配置情况的差异,为我国临床医师人力资源发展和人才培养规划提供参考依据.方法:基于中国卫生健康统计年鉴数据和全国医学教育发展中心数据平台,采用描述性统计分析和比较分析方法.结果:2002—2018年我国临床医师人力资源和人才培养情况均经历了增量提质的发展过程,但人均数量和层次结构仍与一些中高收入国家有差距.2018年每千人口临床医师数量已达到2020年的规划目标.临床医学毕业生从医比例不断提高,本科毕业生从医比例高于专科毕业生.临床医学毕业生规模和初步估算的需求数量基本平衡.结论:2002—2018年我国临床医师人力资源和人才培养的规模不断扩大,层次结构得到显著优化,但规模和层次结构仍有提升空间.目前我国高等临床医学人才培养供需基本平衡.应进一步控制专科临床医学专业培养规模.

Objective To investigate the value of sodium hyaluronate in endoscopic dacryocystorhinostomy(En-DCR)in the treatment of chronic dacryocystitis. Methods A total of 58 patients with chronic dacryocystitis were treated with En-DCR in our hospital from January 2017 to July 2017.During the operation,1-2 ml sodium hyaluronate gel was injected into the lacrimal sac via upper puncta to brace the lacrimal sacs after full exposure in 33 cases(sodium hyaluronate group), while 25 cases were given traditional method of Bowman probe to support the lacrimal sac(Bowman probe group).The partial operation time(from the first exposure of lacrimal sacs to the ending of application of gelatin sponge), functional score, anatomical score and success rate after 2 months were compared. Results The partial operation time of sodium hyaluronate group were shorter than the Bowman probe group [(21.3 ±4.5)min vs.(26.8 ±5.1)min,t=-4.334,P=0.000],while the functional score,anatomical score and success rate after 2 months had no statistical differences(P>0.05)between the two groups. Conclusion The procedure of sodium hyaluronate gel injection into the lacrimal sac via upper puncta in the En-DCR in the treatment of chronic dacryocystitis can simplify the operation and shorten the operation time,while the long-term postoperative effect remains to be further researched.

Objective To describe current situation of the development of public health emergency response framework at provincial,municipal and county level in China and to provide evidences for promoting the development of the framework.Methods A questionnaire-based cross-sectional survey was conducted in 2013 to collect the information on the development of public health emergency response framework (policy,preparedness planning,legislation,organizational structure,mechanism and decision making system) in health related facilities at provincial,municipal,and county levels in China.Results The average scoring percentage in the evaluation on overall development of health emergency response framework was 83.1％,72.0 ％,and 65.8 ％ for health related facilities at provincial,municipal,and county level;the average scoring percentages for evaluating the overall development in eastern,central,and western region of China were as following:84.8 ％,84.8 ％,and 80.1％ for the health related facilities at provincial level;77.1％,73.0 ％,and 66.9 ％ for the facilities at municipal level;and 68.6 ％,65.4 ％,and 60.5 ％ for the facilities at county level.Conclusion The development of health emergency response framework at the provincial,municipal and county level in China has been improved in recent years but the development differs obviously by administration level and geographical region.Special concern should be paid to the development in grass roots health related facilities and the facilities in western China.

Background: Quantifying syphilis prevalence is important for planning interventions and advocating for resources on syphilis. However, data on large sample studies regarding the prevalence of syphilis among reproductive-age women in rural China were not available for analysis. The aim of the study was to determine the prevalence, epidemiological characteristics, and related factors of syphilis infection among reproductive-age women in rural China. Methods: Data were obtained from a nationwide, population-based, cross-sectional study under the National Free Preconception Health Examination Project which covered all the 31 provinces in Mainland China. Women intending to get pregnant within the next 6 months were enrolled between January 1, 2010, and December 31, 2012. Sociodemographic, gynecological and obstetric characteristics, and other relevant information were obtained through face-to-face interviews. Treponema pallidum particle agglutination assay test was used to detect positive samples of syphilis. Univariate and multivariate logistic regressions were performed to assess the associations between syphilis seropositivity and related factors. Results: The overall seroprevalence of syphilis (SPS) among the 2,044,126 women who received syphilis screening test during 2010–2012 was 0.37% (95% confidence interval [CI]: 0.36–0.37%). The SPS appeared 0.24% (95% CI: 0.23–0.26%) and 0.66% (95% CI: 0.59–0.72%) in women at 21–24 and 40–44 years of age, respectively, showing an increase of SPS, parallel with age, and the difference was significant. SPS was significantly higher in ethnic minorities than that in Han nationality (0.58% vs. 0.35%, respectively, odds ratio [OR] = 1.41, 95% CI: 1.30–1.53) and higher in workers than that in farmers (0.45% vs. 0.36%, respectively, OR = 1.27, 95% CI: 1.14–1.41). Women with primary school or below level had a higher SPS as compared to those with college or above educational level (0.61% vs. 0.32%, respectively, OR = 2.49, 95% CI: 2.14–2.89), and the increase reversely correlated with the levels of education. Women whose spouses were syphilis seropositive had significant greater risk (OR = 48.26, 95% CI: 44.38–52.48) as compared those whose spouses were seronegative. Women who reported having had a history of sexually transmitted infections were more likely to be tested positive for serological syphilis (OR = 27.17, 95% CI: 20.44–36.11) as compared to those without. Conclusions: High SPS is seen among reproductive-age women in rural China that calls for targeted interventions on syphilis prevention and control in this target population, with emphasis on those who are 35 years of age and above, less educated, being minor ethnicity, workers, and living in the western regions of China.

Global DNA hypomethylation is commonly observed in benzene‐exposed workers, but the underlying mechanisms remain unclear. We sought to discover the relationships among reduced white blood cell (WBC) counts, micronuclear (MN) frequency, and global DNA methylation to determine whether there were associations with mutations in DNMT3A/3B. Therefore, we recruited 410 shoe factory workers and 102 controls from Wenzhou in Zhenjiang Province. A Methylated DNA Quantification Kit was used to quantify global DNA methylation, and single nucleotide polymorphisms (SNPs) in DNMT3A (rs36012910, rs1550117, and R882) and DNMT3B (rs1569686, rs2424909, and rs2424913) were identified using the restriction fragment length polymorphism method. A multilinear regression analysis demonstrated that the benzene‐exposed workers experienced significant global DNA hypomethylation compared with the controls (β = −0.51, 95% CI: −0.69 to −0.32, P < 0.001). The DNMT3A R882 mutant allele (R882H and R882C) (β = −0.25, 95% CI: −0.54 to 0.04, P = 0.094) and the DNMT3B rs2424909 GG allele (β = −0.37, 95% CI: −0.70 to −0.03, P = 0.031) were significantly associated with global DNA hypomethylation compared with the wild‐type genotype after adjusting for confounding factors. Furthermore, the MN frequency in the R882 mutant allele (R882H and R882C) (FR = 1.18, 95% CI: 0.99 to 1.40, P = 0.054) was higher than that of the wild‐type. The results imply that hypomethylation occurs due to benzene exposure and that mutations in DNMTs are significantly associated with global DNA methylation, which might have influenced the induction of MN following exposure to benzene. Environ. Mol. Mutagen. 58:678–687, 2017. © 2017 Wiley Periodicals, Inc.

Global DNA hypomethylation is commonly observed in benzene-exposed workers, but the underlying mechanisms remain unclear. We sought to discover the relationships among reduced white blood cell (WBC) counts, micronuclear (MN) frequency, and global DNA methylation to determine whether there were associations with mutations in DNMT3A/3B. Therefore, we recruited 410 shoe factory workers and 102 controls from Wenzhou in Zhenjiang Province. A Methylated DNA Quantification Kit was used to quantify global DNA methylation, and single nucleotide polymorphisms (SNPs) in DNMT3A (rs36012910, rs1550117, and R882) and DNMT3B (rs1569686, rs2424909, and rs2424913) were identified using the restriction fragment length polymorphism method. A multilinear regression analysis demonstrated that the benzene-exposed workers experienced significant global DNA hypomethylation compared with the controls (β = −0.51, 95% CI: −0.69 to −0.32, P  < 0.001). The DNMT3A R882 mutant allele (R882H and R882C) (β = −0.25, 95% CI: −0.54 to 0.04, P  = 0.094) and the DNMT3B rs2424909 GG allele (β = −0.37, 95% CI: −0.70 to −0.03, P  = 0.031) were significantly associated with global DNA hypomethylation compared with the wild-type genotype after adjusting for confounding factors. Furthermore, the MN frequency in the R882 mutant allele (R882H and R882C) (FR = 1.18, 95% CI: 0.99 to 1.40, P  = 0.054) was higher than that of the wild-type. The results imply that hypomethylation occurs due to benzene exposure and that mutations in DNMTs are significantly associated with global DNA methylation, which might have influenced the induction of MN following exposure to benzene. Environ. Mol. Mutagen. 58:678–687, 2017. © 2017 Wiley Periodicals, Inc.

目的 通过对全国卫生系统省市县各级卫生应急能力现状进行调查分析,了解我国卫生应急能力建设现状,并为将来卫生应急能力建设的工作重点提出科学建议.方法 采用横断面调查的方法,利用自填问卷方式对省市县各级卫生行政机构、疾控机构、医疗机构、监督机构在8个方面能力进行问卷调查,并对调查结果进行分析.结果 全国省市县各级评估结果总分的平均分分别为823.1分,790.3分,760.9分.省市县各级在8个能力方面得分较高的为应急队伍、应急处置、监测预警,而得分比例相对较低的能力为宣教科研、培训演练、善后评估.结论 全国省市县各级卫生部门在应急队伍、应急处置、监测预警等方面具备了较好的能力,但市级和县级总体卫生应急能力水平仍有待提高,特别是在卫生应急专门部门的设置、卫生应急日常工作经费安排、卫生应急指挥决策系统建设、应急物资储备、风险评估、突发事件处置事后评估等方面,仍有较大提升的空间.