The role of environmental efficiency and economic development in fertility: implications for public health and sustainability among OECD nations

Introduction

As global economies rapidly develop, the interplay between environmental efficiency, economic development, and public health outcomes has gained significant attention. Air pollution and resource-intensive economic activities threaten both environmental sustainability and human health, including reproductive health and overall well-being.

Methods

This study focuses on OECD member countries, using data from 1999 to 2021. An undesirable outputs-oriented DEA approach is employed to assess environmental efficiency across these countries. Baseline regression analysis is conducted to examine the relationship between environmental efficiency and fertility, while heterogeneity analysis explores the impact of industrial and energy consumption structures. Additionally, the moderating effect of economic development levels is investigated.

Results

The baseline regression results indicate an inverted U-shaped relationship between environmental efficiency and fertility, where fertility initially declines as environmental efficiency increases, then rises after reaching a certain threshold. Heterogeneity analysis reveals that industrial and energy consumption structures significantly influence this relationship across different regions. Furthermore, economic development is found to be a reverse moderator: in countries with higher economic development levels, the relationship between environmental efficiency and fertility follows a significant U-shaped curve.

Discussion

These findings highlight the necessity of integrating environmental policies with public health strategies. Improvements in environmental efficiency may reduce pollution-related health risks, indirectly supporting fertility recovery in advanced economies. By addressing the interaction between environmental efficiency, economic development, and fertility, this study provides evidence-based insights for designing policies that promote sustainable environmental health and equitable social outcomes.

T-Cell-Dependent Bispecific IgGs Protect Aged Mice From Lethal SARS-CoV-2 Infection

T-cell ageing may be a key factor in the disproportionate severity of coronavirus disease 2019 (COVID-19) in older populations. For hospitalized COVID-19 patients, treatment involving the use of monoclonal antibodies with the ability to neutralize SARS-CoV-2 usually involves the administration of high doses but has not been very effective at preventing complications or fatality, highlighting the need for additional research into anti-SARS-CoV-2 therapies, particularly for older populations. In this study, it is discovered that older persons with a severe SARS-CoV-2 infection has weaker T-cell responses. Therefore the development and characterization of spike-targeting T-cell-dependent bispecific (TDB) full-length human immunoglobulin Gs with enhanced efficacy in the treatment of COVID-19 is described. Using S-targeting TDBs, polyclonal T cells are guided to target and destroy S-expressing cells, preventing the cell-to-cell transmission of SARS-CoV-2 and thereby eliminating the need for SARS-CoV-2-specific immunity. Using animal models of COVID-19, it is shown that the selective activation of T cells improves the efficiency of treatment in preinfected mice by attenuating disease-induced weight loss and death. The significance of T-cell-based immunity during infection is highlighted by the findings. These results have implications for better clinical effectiveness of therapies for COVID-19 and the development of T-cell-dependent medicines for the elderly population.

Trends, Age-Period-Cohort Effects, and Projections in the Incidence and Mortality of Human Immunodeficiency Virus/AIDS Among the Elderly in China

BACKGROUND

Human immunodeficiency virus (HIV)/AIDS among elderly persons presents a new public health challenge in China. We aimed to explore historical trends (2004-2018) and project the future (2019-2030) burden of HIV/AIDS incidence and mortality among the elderly in China.

METHODS

We utilized data from the Data Center of China Public Health Science database on HIV/AIDS incidence and mortality, employing the Bayesian age-period-cohort model to reveal the age-period-cohort effect in the HIV/AIDS burden, and projecting the incidence and mortality rates up to 2030.

RESULTS

From 2004 to 2018, HIV/AIDS incidence rates increased from 0.56 to 20.78 per 100 000 for men and 0.28 to 7.84 per 100 000 for women. The mortality rates also increased in both sexes. We observed the highest age effect in incidence among men aged 70-74 years and women aged 55-59 years, with the effect estimates being 0.02 (95% confidence interval [CI], -.10 to .13) and 0.46 (95% CI, .35-.57), respectively. Similar sex disparities were observed for mortality, with the highest age effect observed in men aged 75-79 years and women aged 50-54 years. However, no significant disparities were found between men and women in the period and cohort effects. By 2030, the incidence rates were projected to be 96.25 per 100 000 in men and 44.90 per 100 000 in women, while the mortality rates were projected to be 48.27 and 13.67 per 100 000, respectively.

CONCLUSIONS

HIV/AIDS incidence and mortality rates rose notably among the elderly in China and are expected to keep increasing in the coming decades. Rates were consistently higher in men than in women. Tailored interventions for older men are crucial.

Community-Based Surveillance of Acute Flaccid Paralysis: A Review on Detection and Reporting Strategy

Polio is a highly contagious viral disease that primarily affects children under 15, often leading to permanent paralysis, known as acute flaccid paralysis (AFP). AFP surveillance is essential for the eradication of polio, with community-based surveillance (CBS) playing a pivotal role in detecting and reporting cases. CBS improves the timeliness and accuracy of AFP detection, but challenges such as underreporting, delays, and low community awareness persist. Strategies involving use of mobile applications, awareness campaigns, and improvements in healthcare infrastructure were implemented to improve CBS of AFP. While numerous case studies from various countries illustrate the implementation of CBS, a comprehensive synthesis of these studies across diverse contexts is limited. This paper examines state-of-the-art CBS approaches for AFP, analyzing progress, challenges, and potential solutions. A targeted literature review of English-language studies published between 2004 and 2024 was conducted, focusing on the roles of communities, technological integration, and practical recommendations, while excluding studies that lacked methodological rigor or direct relevance. The review revealed that CBS has significantly advanced the global fight against polio by increasing community awareness, enabling earlier detection, and improving the reporting of AFP cases. However, issues such as security concerns, delayed reporting, low levels of community awareness, and underutilization of technology persist. This review recommends strengthening organizational structures, improving healthcare access, raising community awareness, and using technology for more efficient AFP surveillance. The implication of this work is beyond polio as it offers a comprehensive framework for integrating disease surveillance, technology and community involvement to strengthen public health strategies and build robust health systems.

Care Tasks and Caregiver Burden Among Family Caregivers of Patients With Mental Disorders in China: Illness Perception as a Mediator and Social Support as a Moderator

INTRODUCTION

Caring for a family member with mental disorders is burdensome, which may not only damage the caregivers' well-being and health, but also hinder patients' recovery. It is critical to investigate the underlying mechanisms for caregiver burden.

AIM

To examine the mediating effect of illness perception and the moderating function of social support on the association between care tasks and caregiver burden.

METHOD

A total of 1169 family caregivers of patients with mental disorders were recruited via convenience sampling across China. Data were collected using acceptable reliability scales (Cronbach's α > 0.6). The relationships among care tasks, illness perception, social support and caregiver burden were examined in the SPSS PROCESS macro.

RESULTS

Illness perception partially mediates the relationship between care tasks and overall caregiver burden, personal strain and role strain, while social support only alleviates the impact of care tasks on personal strain but not on role strain.

DISCUSSION

Care tasks could positively predict caregiver burden. As a mediating moderating mechanism, illness perception and social support could further explain how care tasks affect caregiver burden.

IMPLICATIONS FOR PRACTICE

Psychiatric nurses should provide psychoeducation for family caregivers of patients with mental illness to improve their negative illness perception, as well as increase their social support.

A Social Network Theory-Based Investigation into the Characteristics of MSM in Virtual Communities

Social networks significantly influence MSM's HIV prevention behaviors, with virtual communities serving as key interaction platforms. Using a Python web crawler, we analyzed 960 user profiles from Baidu Tieba's "Gay Bar" forum. The social network within this community exhibits a core-periphery structure, where a densely connected core facilitates effective information dissemination, while the majority of users reside in peripheral positions with limited and isolated connections. Relationships within the network are primarily formed based on shared interests rather than geographical proximity, fostering homophilous interactions that enhance peer support and community cohesion. Despite the fragmented nature of peripheral connections, the tightly knit core enables the strategic targeting of key individuals to optimize the spread of health-related information and interventions. These findings highlight the importance of leveraging the network's core structure to implement efficient and inclusive public health strategies, ensuring that resources reach all members of the MSM community effectively. In addition, interest-based connections are essential in promoting a fair and supportive virtual environment, which is essential to address stigma and promote broad participation in HIV prevention.

A new wave of resurgence for GII.4 Sydney in Huzhou, particularly GII.4 Sydney[P16], between 2019 and 2023

BACKGROUND

Norovirus (NoV) infection is a major pathogen causing acute gastroenteritis (AGE) across all age groups worldwide. In the past few years, there were some situations where non-GII.4 genotypes of NoV became predominant in Huzhou region. To understand the latest prevalence of genotypes, we investigated the prevalence and genetic diversity of NoV in sporadic AGE cases from January 2019 to October 2023 in Huzhou City, Zhejiang, China.

METHODS

Between January 2019 and October 2023, a total of 2846 specimens collected from patients with AGE were tested for NoV in Huzhou. Partial sequences of the RNA-dependent RNA polymerase (RdRp) and capsid gene of the positive samples were amplified by RT-PCR and sequenced. Genotyping of NoV sequences was carried out by the RIVM online NoV Genotyping Tool. Phylogenetic analyses were conducted using MEGA.

RESULTS

In total, 460 (16.16%) specimens were identified as NoV-positive. GII genogroup accounted for most of the NoV-positive specimens (83.70%, 385/460), followed by the GI genogroup (13.26%, 61/460), and dual infection with both GI and GII genogroups (3.04%, 14/460). NoV infection was found in all age groups tested. During this period, at least 20 NoV genotypes were observed, with GII.4 Sydney being the most predominant. Phylogenetic analysis of selected strains revealed that all GII.4 Sydney[P16] strains clustered together and were closely related to strains from Beijing, Shanghai, Hangzhou, Nanjing and the United States, with nucleotide homologies ranging from 96.9 to 99.7%.

CONCLUSIONS

We report that during the period from January 2019 to October 2023, the GII.4 Sydney is undergoing a new wave of resurgence, and becoming the main epidemic strain again, particularly GII.4 Sydney[P16] with P16 polymerase.

Preparation of the Hypoallergenic Enzymatic Hydrolyzate of Cra a 4 with the Potential to Induce Immune Tolerance

Sarcoplasmic calcium-binding protein identified in Crassostrea angulata (Cra a 4), is a stable allergen; the methods to reduce its allergenicity are still limited. The present study aimed to develop the hypoallergenic enzymatic hydrolyzate of Cra a 4 (ECra a 4) by enzymolysis. After screening of proteases by bioinformatics and optimization of enzymolysis conditions, ECra a 4 was obtained by enzymolysis with Trypsin. Further, ECra a 4 was used to stimulate splenocytes from Cra a 4-sensitized mice, with findings that ECra a 4 could stimulate CD4+ T-cell proliferation, inhibit IL-4 secretion, and promote TGF-β secretion. Spectroscopy analysis revealed that enzymolysis destroyed the structure of Cra a 4, which affected its allergenicity. Peptidomic analysis revealed that enzymolysis destroyed the B-cell epitopes of Cra a 4 while retaining its T-cell epitopes. Overall, ECra a 4 with hypoallergenicity and T-cell stimulating ability can be used as an immune tolerance product for further study.

Current challenges and future perspectives of drug discovery in China

INTRODUCTION

China's pharmaceutical industry, which is historically centered around generic medicines, has largely transformed from imitation to innovation over the past three decades. Despite unprecedented progress, critical challenges remain such as insufficient indigenous research funding, underdeveloped academia-industry relationships, and significant barriers to market access.

AREAS COVERED

This perspective examines the evolving pharmaceutical landscape of China, focusing on its participation in global clinical trials and the resultant new drug approvals. Data for this analysis was sourced from several databases (e.g. PharmCube, NextPharma, and PharmaGO), academic reports, and published literature, covering data up to 2024 (unless otherwise specified). This perspective highlights ongoing regulatory challenges, such as inconsistencies in product standards, and the approval processes relative to the U.S.A. and the European Union. There is also an urgent demand for sustained international investment and recognition, partially due to the recent changes in the geopolitical environment. This perspective also discusses China's efforts to implement accelerated approval pathways and foster multilateral development collaborations.

EXPERT OPINION

China must align its regulatory policies more closely to the international norm to generate robust trial data that will be readily acceptable to the FDA and EMA. Continued investment in biologics as well as cell and gene therapy and artificial intelligence will drive innovation and enhance competitiveness. Additionally, strengthening the academia-industry collaboration is crucial to obtaining new leads through translational research. Ultimately, structural reforms are required to solidify the country's goal of becoming a major player in the global pharmaceutical market.

Modeling-based design of adaptive control strategy for the effective preparation of 'Disease X'

This study aims at exploring a general and adaptive control strategy to confront the rapid evolution of an emerging infectious disease ('Disease X'), drawing lessons from the management of COVID-19 in China. We employ a dynamic model incorporating age structures and vaccination statuses, which is calibrated using epidemic data. We therefore estimate the cumulative infection rate (CIR) during the first epidemic wave of Omicron variant after China relaxed its zero-COVID policy to be 82.9% (95% CI: 82.3%, 83.5%), with a case fatality rate (CFR) of 0.25% (95% CI: 0.248%, 0.253%). We further show that if the zero-COVID policy had been eased in January 2022, the CIR and CFR would have decreased to 81.64% and 0.205%, respectively, due to a higher level of immunity from vaccination. However, if we ease the zero-COVID policy during the circulation of Delta variant from June 2021, the CIR would decrease to 74.06% while the CFR would significantly increase to 1.065%. Therefore, in the face of a 'Disease X', the adaptive strategies should be guided by multiple factors, the 'zero-COVID-like' policy could be a feasible and effective way for the control of a variant with relative low transmissibility. However, we should ease the strategy as the virus matures into a new variant with much higher transmissibility, particularly when the population is at a high level of immunity.

A Study on Dining-Out Habits Among Beijing Residents: A Case of Fast Food

Background: With the continuous elevation of living standards, dining-out behavior has become increasingly prevalent among urban residents. The acceleration of lifestyle rhythms has prompted fast food to emerge as a frequently considered dietary option for urban residents when dining out. This study aims to investigate the current status and characteristics of dining-out habits for fast-food consumption among urban residents in Beijing. Methods: Urban residents in Beijing were selected using a stratified sampling method to survey restaurants. A database of fast-food items was created, and data were collected through a combination of field observations and qualitative interviews. Nutrient intake from fast food was systematically analyzed. Results: Residents consuming fast food while dining out exhibited high per-meal energy intake (737.5 kcal) and protein (44.8 g) consumption; however, the intakes of vitamin A (147.6 μg RAE), vitamin C (22 mg), vitamin E (3.2 mg), and calcium (89.5 mg) were inadequate. Western fast-food meals had higher protein (57.2 g) and sodium (251.5 mg) content compared to Chinese fast food. Conclusions: This study provides essential data to guide urban residents toward rational dining choices, offering key insights for the fast-food industry to develop balanced meal options.

Spatio-temporal analysis of human brucellosis distribution in Neyshabur, Iran from 2015 to 2022, a cross-sectional study

BACKGROUND

Human brucellosis is a global endemic disease and a significant public health concern. This cross-sectional study aims to explore the characteristics of human brucellosis, as well as its spatial and temporal clustering.

METHODS

This cross-sectional study analyzed the population infected with human brucellosis in Neyshabur, Iran from 2015 to 2022. Data were obtained from the Neyshabur health center. Spatial analysis was conducted using Anselin Local Moran's I and Global Moran's I with ArcGIS 10.8.2. Descriptive statistical analyses were performed using SPSS 26.

RESULTS

During the study period, a total of 4568 brucellosis patients were reported. The incidence of disease was higher in men with 55.37%. The majority of patients belonged to the 30 to 39-year-old age group. Temporal clustering analysis revealed a peak incidence between March and June. The highest incidence rates were observed in spring and summer, with 34.76% and 33.84% of cases, respectively. Spatial clustering analysis indicated a higher prevalence in the southern and southeast districts of Neyshabur. The results of Global Moran's I analysis indicated that the distribution of brucellosis was not clustered in Neyshabur (P-value > 0.05).

CONCLUSION

The findings of this study highlight the importance of educational programs for mothers and animal vaccination strategies, particularly in the months leading up to the peak brucellosis season in high-incidence areas. Further research is needed to assess the coverage of livestock vaccination and its impact on human brucellosis rates.

Chemical risk assessment in food animals via physiologically based pharmacokinetic modeling - Part I: Veterinary drugs on human food safety assessment

Veterinary drugs and environmental pollutants can enter food animals and remain as residues in food chains threatening human food safety and health. Performing health risk and food safety assessments to derive safety levels of these xenobiotics can protect human health. Physiologically based pharmacokinetic (PBPK) modeling is a mathematical tool to quantitatively describe chemical disposition in humans and animals informing human food safety and health risk assessments. However, few reviews focus on the application of PBPK models in food animals and discuss their relationship to human food safety and health risk assessments in the last five years (2020-2024). In this series of reviews, we introduce the methodology, recent progress and challenges of PBPK modeling in food animals. The present review is Part I of this series of reviews and it focuses on applications of PBPK models of veterinary drugs in food animals, whereas Part II is a companion review focusing on environmental chemicals. Advanced strategies of PBPK modeling in risk and food safety assessment, including population PBPK, interactive PBPK web dashboard, and generic PBPK are also summarized in Part I. Additionally, we share our perspective on the existing challenges and future direction for PBPK modeling of veterinary medicines in food animals.

Age-period-cohort study of active pulmonary tuberculosis in eastern China: analysis of 15-year surveillance data

BACKGROUND

Tuberculosis remains a major public health challenge worldwide. This study aimed to determine the long-term trends in the notification rate of tuberculosis in Zhejiang Province, and to assess the potential independent risks associated with age, time period, and birth cohort.

METHODS

Data on all pulmonary tuberculosis (PTB) cases in Zhejiang Province from 2008 to 2022 were collected from the Tuberculosis Information Management System. Long-term trends in the notification rate and independent risks associated with quantitatively decomposed variables were determined using joinpoint regression model and age-period-cohort model.

RESULTS

Between 2008 and 2022, a total of 323,745 PTB cases were notified in Zhejiang Province. Overall, the notification rate declined, with notable turning points in 2010 and 2019. Net drift analysis revealed an average annual decrease of 5.7% (95% CI: -6.8%, -4.6%; P < 0.01), with faster declines among males than females. Age effects showed peaks in notification rates among people aged 15-29 and 65-74. Period effects peaked during 2008-2012 (RR = 1.4; 95% CI: 1.3, 1.5; P < 0.01). Cohort effects indicated decreasing risks in later birth cohorts, with the highest risk observed in the 1928-1932 birth cohort (RR = 11.0, 95% CI: 7.2, 16.8; P < 0.01) and relative protective effects in cohorts born after 1978-1982.

CONCLUSIONS

Notification rates of PTB declined consistently across various age groups in Zhejiang Province. Young individuals aged 15-29 and older individuals aged 65-74 were identified as high-risk groups requiring active intervention. Additionally, pre-1978 birth cohorts had a relatively higher risk of PTB. These findings provided valuable insights into the age, period, and birth cohort characteristics of patients with PTB in Zhejiang Province, aiding relevant authorities in formulating appropriate policies and implementing targeted preventive control measures.

Temporal trends in the burden of vertebral fractures caused by falls in China and globally from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate temporal trends in the burden of vertebral fractures (VFs) caused by falls by gender and age in China and globally from 1990 to 2021.

METHODS

Data concerning the characteristics of VFs caused by falls in China and worldwide, with a focus on metrics in incidence, prevalence and years lived with disability (YLDs) and their age-standardised rates, were sourced from the Global Burden of Disease (GBD) Study 2021. Joinpoint regression analysis was used to identify periods with significant changes. The average annual percentage change (AAPC) was calculated to reflect the temporal trends from 1990 to 2021. We utilised the age-period-cohort (APC) model to assess the effects of age, period, and cohort on the burden of VFs in China.

RESULTS

From 1990 to 2021, the age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised YLD rate (ASYR) of VFs caused by falls exhibited an overall increase in China, whereas a general decline was observed globally. Furthermore, the ASIR, ASPR and ASYR were higher for males than females in China and worldwide. In 2021, across all age groups, the disease burden of VFs was primarily observed among the elderly population, particularly in the older female population, both in China and globally. The impact of age, period, and cohort on the incidence, prevalence, and YLDs exhibited variations in China.

CONCLUSION

The burden of VFs in China remains significant, particularly among older females. Given the considerable size of the elderly population and the ageing of the Chinese population, VFs remain critical public issues. Therefore, continued efforts must be made to address the health consequences of VFs caused by falls.

Wheat tends to accumulate higher levels of cadmium in the grains than rice under a wide range of soil pH and Cd concentrations: A field study on rice-wheat rotation farmland

Dietary intake is a predominant pathway of human exposure to environmental Cadmium (Cd), but wheat (Triticum aestivum L.) has not received enough concerns for its risk of Cd contamination. A field survey of Cd-contaminated rice-wheat rotation farmlands in China provided detailed comparison of Cd accumulation capacity by rice and wheat grains. The results indicated that Cd-BCF of wheat grains (median values 0.42) were obviously higher than those of rice grains (median values 0.12) under wide soil Cd levels and pH ranges. Soil Cd levels rather than pH played a vital role on Cd accumulation by wheat grains, and high wheat grain Cd concentrations (0.12-0.13 mg kg⁻1) were even observed in mildly alkaline soil that normally have low Cd mobility. Dietary Cd exposure risks were assessed by the crop Cd exposure models considering different soil Cd content, pH and dietary structures of residents. The results indicated that the intake of wheat grains contributed 56.1-86.5% of total crop Cd exposure, with an increase in its contribution with the increase of soil pH. Residents favoring wheat would have a significant Cd exposure risk if consuming crops from soils with Cd levels above 0.41 mg kg⁻1, which was considerably lower than the current soil Cd risk screening value for alkaline soils (0.6 mg kg-1). Our findings indicate a high Cd accumulation capacity of wheat grains and consequent risk of dietary Cd exposure, which deserves further exploration on the correlation among soil Cd screening value, grain Cd limit value and its dietary exposure risk.

Identification and characterization of Streptococcus suis strains isolated from eastern China Swine Farms, 2021-2023

The Streptococcus suis (S. suis) is an important zoonotic pathogen that causes streptococcal disease in pigs and poses a threat to humans. This study provides an understanding of the prevalence of  S.suis in eastern China and provides guidance for clinical prophylaxis. From 2021 to 2023, a total of 143 strains of S. suis were isolated from 1642 lung tissue and nasal swabs from healthy and suspected infected pigs in Shandong Province, China, using the Phenotypic tests and PCR technique. The isolates were then tested for serotype, virulence-related genes, and resistance genes. Among the 143 isolates, type 2 was the predominant serotype with 98 isolates (98/143, 68.5%), followed by type 5 with 22 isolates (22/143, 15.3%), type 4 with 6 isolates (6/143, 4.2%), type 19 with 4 isolates (4/143, 2.8%) and type 21 with 5 isolates (5/143, 3.5%), respectively. A minimum of 78.3% of the strains exhibited the presence of virulence-related genes including pgda, dlta, mann, fbps, orf2, and sspa, whereas the virulence-associated genes Sum, Sly, and Salkr are not widely prevalent. For the detection of resistance genes, it was found that the tetO gene had a high detection rate of 70.1% (101/143), whereas neither the pbp2b gene nor the cat1 and cat2 genes were detected. Antimicrobial susceptibility testing revealed that 96.5% (138/143) of the isolates exhibited multidrug resistance (MDR). And polypeptide B was found to be tolerated by 125 of the 143 strains (87.4%). Although we did not detect the β-lactam resistance gene in any of the 143 strains, an average of 39.2% of the strains were resistant to β-lactam antibiotics. The results of the current study is thought it may be help to understand the prevalence of S. suis and provide important insights into treatment and prevention.

Wastewater-based monitoring of antipyretics use during COVID-19 outbreak in China and its associated ecological risks

At the end of 2022, a sudden policy shift in China triggered an unprecedented COVID-19 outbreak that led to a dramatic increase in the consumption of antipyretics. In this study, the occurrence of the two most commonly used antipyretics (ibuprofen and paracetamol) and their metabolites were analyzed in the wastewater of nine major cities in China, covering the periods before, during, and after the policy change. The remarkable surge after the policy change for ibuprofen and paracetamol reached 67 times (in Nanning) and 311 times (in Lanzhou) compared to pre-pandemic levels, respectively. The variation of increases was mainly affected by the availability and the sampling period. During the outbreak period, direct discharge of high-drug-load wastewater could cause even higher risks; the RQ values were 0.43 for invertebrates in Lanzhou and 0.30 for fish in Nanning. Furthermore, during the post-pandemic period, wastewater discharge might pose high risks (RQ value was 2.58 in Xining to algae) associated with ibuprofen chronic toxicity. Fortunately, wastewater treatments would significantly reduce this risk to a low level (RQ < 0.1). In some less developed areas, the lack of a comprehensive wastewater treatment system may lead to the direct discharge of untreated wastewater due to exfiltration of sewers, overflow of combined sewers, or lack of centralized or decentralized treatment facilities. Establishing a comprehensive wastewater treatment system is of great importance, especially in remote and impoverished areas. These results indicated that the potential ecological risks associated with epidemic outbreaks should not be overlooked. These risks may be heightened due to acute toxicity during health incidents, such as the COVID-19 outbreak, providing valuable insights for ecological management in future public health crises.

Potential Biomarkers for Neurobrucellosis Diagnosis and Treatment Based on Cerebrospinal Fluid Metabolomics Analysis

BACKGROUND

Zhenzhu Tongluo pills (ZZTL) have been utilized for the treatment of neurobrucellosis (NB) in the Inner Mongolia region of China. However, the specific mechanism underlying the neuroprotective effects of ZZTL in NB remains insufficiently explored. Therefore, this study aimed to analyze the metabolite profiles across different groups to identify potential biomarkers for the diagnosis and treatment of NB.

METHODS

LC-MS analysis was used to screen differential metabolites in cerebrospinal fluid (CSF) samples from control subjects, NB patients, and NB patients undergoing ZZTL therapy.

RESULTS

We identified 225 common metabolites across two comparison groups (NB vs. control group and NB + ZZTL vs. NB group). Among these metabolites, 138 were downregulated, and 87 were upregulated in the NB group compared to the control group, while the levels of these metabolites were reversed by ZZTL therapy. Creatinine exhibited the highest VIP score in both comparison groups, with elevated levels observed in CSF samples from NB patients compared to controls; however, its levels were reduced following ZZTL therapy. Additionally, hypoxanthine and uric acids levels were also increased in CSF samples from NB patients, indicating dysregulation of purine metabolism in NB; however, these changes were reversed by ZZTL. Furthermore, pantothenic acid (vitamin B5) and niacinamide (vitamin B3) levels were decreased in CSF samples from NB patients, suggesting a potential link between NB and vitamin B3 and B5 deficiency; however, these changes were reversed by ZZTL.

CONCLUSION

Collectively, CSF metabolomics may effectively differentiate NB patients from control subjects, providing valuable insights for NB diagnosis and treatment.

Developing a progress assessment model for age friendly primary health care initiatives

BACKGROUND

In response to the significant increase in the global aging population, countries have increasingly prioritized Age-Friendly Primary Health Care (AFPHC) to address the unique needs of older adults. This study aims to develop a comprehensive model for assessing the progress of PHC systems in achieving the goals of an elderly-centered services.

METHOD

A qualitative study design was utilized to develop the progress assessment model for AFPHC initiatives. This process involved a literature review (academic databases and manual search), semi-structured interviews, an expert panel discussion, and the Delphi technique for achieving consensus on the final model. Participants in the semi-structured interviews were selected based on specific inclusion criteria, which required professionals and stakeholders to have a minimum of two years of experience in care for older adults and active involvement in PHC. Additionally, older adults with a university education who had accessed PHC services in Iran at least three times were included. The expert panel was composed of multidisciplinary professionals who met similar criteria, ensuring a diverse and informed perspective.

FINDINGS

According to literature review results, 16 main domains and 28 sub-domains were identified. In the next step, through interviews, 7 main domains and 71 indicators were extracted. After summarizing the results of literature reviews, and interviews, and analyzing the results of the Delphi technique, the initial model with 7 main domains, including policymaking and planning processes related to older adults, principles of respect and interaction with older adults, education for older adults, principles of care and provision of services to older adults, access to PHC facilities, physical environment, specialized facilities and equipment, and human resources, was finalized along with the 60 indicators.

CONCLUSION

The developed model for assessing progress of AFPHC Initiatives offers a comprehensive framework by focusing on key domains and indicators tailored to the needs of older adults. This model serves as a practical tool for assessing the progress of AFPHC, facilitating improvements in the quality and accessibility of PHC services for older adults.

Health effects associated with ozone in China: A systematic review

As the ozone (O3) pollution becomes severe in China, it poses a threat to human health. Currently, studies on the impacts of O3 on different regions and groups are limited. This review systematically summarizes the relationship between O3 pollution and mortality and morbidity across the nation, regions, and cities in China, with a focus on the regional and group-specific studies. Then, we clarify the overall limitations in the research data, methods, and subjects. In addition, we briefly discuss the mechanisms by which O3 exposure affects human health, analyzing the effects of O3 on human health under heatwaves (temperature) condition, multi-pollutant modeling, and future climate scenarios. Finally, we give some suggestions for future research directions. Studies found that increased risks of premature mortality and morbidity of respiratory and cardiovascular diseases are closely associated with high concentration O3 exposure. Besides, the old and children are sensitive groups, more studies are needed estimate the risk of their health associated with O3 pollution. Severe O3 pollution in Northern and Eastern China, has significantly increased premature mortality. O3 pollution has led to decreased lung function in the elderly in East China, and a higher asthma risk among young people in South China. Comparing with other regions, less research studied the relationship between O3 pollution and health of local people in Southwest, Central, Northeast, and Northwest Regions. Therefore, it is necessary to enhance research in these regions, with a particular emphasis on the distinctive health consequences of O3 pollution in these regions. Given the diversity of regions and research groups, comprehensive comparison is crucial for determining the impact of O3 pollution on human health in China.

Comparing nutritional status, quality of life and physical fitness: aging in place versus nursing home residents

BACKGROUND

Quality of life (QoL) is a key indicator of well-being in older adults (OAs) and several factors, including nutrition, physical fitness, and dwelling place, can influence QoL. OA residing in institutional settings, such as nursing homes (NH), often can exhibit different QoL outcomes, nutrition status and physical fitness compared to those living independently in age-in-place (AIP) environments. This study seeks to compare the QoL, and physical activity levels of OA residing in NH with those AIP and to evaluate their dietary quality.

METHODS

This cross-sectional study included a total of 400 voluntary OAs, residing either in Narlıdere Nursing Home and Aged Care Rehabilitation Centre (n = 200) or aging in place (n = 200) in İzmir, Turkey. Participants were recruited between May 2023 and December 2023. Data collection involved face-to-face interviews using a questionnaire that covered demographic and anthropometric measurements, Mini Nutritional Assessment (MNA), Older People's Quality of Life (OPQOL-brief), Physical Fitness and Exercise Activity Levels of Older Adults Scale (PFES), and a 24-hour dietary recall. Nutritional status was further assessed using the Healthy Eating Index for Older Adults (HEI-OA).

RESULTS

Mean age of OAs was 77.8 ± 6.5 years and BMI was 25.8 ± 3.9 kg/m². HEI scores were not differed between groups (NH: 42.8 ± 8.1, AIP: 42.2 ± 11.0, p < 0.542), but AIP residents had lower poor diet quality (NH: 40.4 ± 5.9, AIP: 37.5 ± 7.9, p < 0.001). NH residence had higher OPQOL scores (NH: 54.8 ± 7.8, AIP: 47.6 ± 10.4, p < 0.001), and higher MNA scores (NH: 25.6 ± 2.7, AIP: 22.4 ± 5.5, p < 0.001). NH group had lower PFES scores, indicating reduced physical fitness compared to AIP participants (NH: 67.3 ± 6.3, AIP: 74.7 ± 7.7, p < 0.001). Nutrient intake analysis revealed that NH residents consumed more daily water, protein, and micronutrients than AIP participants, with statistically significant differences in protein, MUFA, and SFA intake (p < 0.001). A significant relationship between MNA and QoL total score in NH (r = 0.157, p = 0.027) and AIP (r = 0.619, p < 0.001) was found.

CONCLUSION

The findings of this study revealed the potential influence of nutritional status on QoL, in enhancing QoL outcomes.

Comparative Analysis of Epidemiological and Clinical Characteristics Between Mpox Cases with and Without HIV - China, 2023

Objective

This study aimed to analyze the epidemiological characteristics and clinical symptoms of mpox cases with and without human immunodeficiency virus (HIV) reported in China in 2023, providing evidence for coordinated prevention and control strategies for both infections.

Method

All confirmed mpox cases reported in 2023 were extracted from China's Information System for Disease Control and Prevention. Data were collected from the surveillance system and epidemiological investigations. Statistical analyses were performed using SPSS 24.0, with group comparisons conducted using t-tests and chi-square tests.

Results

Among 1,712 confirmed mpox cases in China during 2023, 802 (46.8%) were people with human immunodeficiency virus (PWH). Of the 1,702 male cases, 97.3% of PWH and 91.1% of those without HIV self-identified as men who have sex with men (MSM). Age distribution showed 79.4% of PWH and 87.6% of those without HIV were under 40 years old, while 64.2% of PWH and 71.3% of those without HIV were reported from eastern regions. Cardinal symptoms at diagnosis occurred at similar rates between those with and without HIV, including rash (90.9% vs. 93.4%), fever (52.5% vs. 53.8%), and lymphadenopathy (23.8% vs. 25.4%). Among coinfected cases, individuals diagnosed with HIV after mpox or within one year before mpox demonstrated higher rates of immunodeficiency and lower rates of HIV viral suppression.

Conclusion

Male mpox cases with HIV was more likely to be MSM, older, and reported from central and western regions compared to those without HIV. No significant differences were observed in cardinal symptom occurrence between groups. These findings emphasize the importance of implementing integrated prevention strategies targeting both HIV and mpox, particularly among key populations.

Evaluation of the Factors Influencing the Survival Times of Chinese Patients with Probable Creutzfeldt-Jacob Disease - China, 2020-2022

What is already known about this topic?

The clinical durations of sporadic Creutzfeldt-Jacob disease (sCJD) patients typically do not exceed 2 years, though considerable variation exists. The factors influencing survival among Chinese sCJD patients remain incompletely characterized.

What is added by this report?

A comprehensive evaluation of 31 factors across 7 categories was conducted in a retrospective cohort of 300 probable Chinese sCJD patients. The analysis revealed that patients over 65 years of age at onset, those presenting with pyramidal or extrapyramidal dysfunction, those showing high signal intensity in caudate/putamen on magnetic resonance imaging, and those not receiving nasal feeding demonstrated significantly shorter survival times.

What are the implications for public health practice?

This study provides the first systematic documentation of potential risk factors affecting survival times in Chinese sCJD patients, establishing an evidence base for developing and implementing targeted intervention strategies.

Age-period-cohort analysis and prediction of tuberculosis trends in China-based on the Global Burden of Disease 2021 data

Background

This study explores the epidemic trend of tuberculosis (TB) in China from 1990 to 2021, analyzes its relationship with age-period-cohort factors from 1992 to 2021, and predicts the development trend of TB in China from 2022 to 2046.

Methods

Annual Percent Change (APC), Average Annual Percent Change (AAPC) and 95% confidence interval (CI) were calculated by Joinpoint regression model to describe the epidemic trend of TB in China. The Age-Period-Cohort (APC) model was used to explore the effects of age, period and cohort effects on the trend of TB incidence rate, mortality and DALYs rate. APC model and Bayesian Age-Period-Cohort (BAPC) model were used to predict the epidemic trend of TB in China from 2022 to 2046.

Results

In 2021, it is estimated that there are 617,700 incidence cases of TB, 37,300 deaths and 1,375,500 DALYs cases in China, and the corresponding number of male cases is higher than that of female cases. From 1990 to 2021, the number of TB incidence, deaths and DALYs, as well as ASIR, ASDR and ASR of DALYs in China decreased year by year. The AAPC of ASIR, ASDR and ASR of DALYs were -3.33, -7.28% and -6.77%, respectively, all p < 0.05, indicating that the overall trend showed a significant decrease. With the increase of age, the incidence rate of TB first decreased, then increased and then decreased, while the mortality and DALYs rate first decreased rapidly and then decreased slowly, and both reached the highest value in the <5 years age group. The period effect showed that the risk of the total population, male and female population decreased overall. The cohort effect showed that the risk of TB incidence rate, mortality and DALYs rate decreased significantly. The ASIR, ASDR and ASR of DALYs of TB in China are predicted to decrease year by year from 2022 to 2046. The BAPC model predicts that the number of incidence, deaths and DALYs will reach 177,100,077,000 and 181,700 in 2046, respectively.

Conclusion

The APC model shows that the earlier the contemporary people are born, the older the age, the higher the risk of disease. APC and BAPC models predict that the ASR of TB in China will decrease year by year, but men and the older adult are still at high risk of TB burden in China. It is recommended to strengthen the screening of TB patients in key populations, especially in the older adult.

Prevalence and associated factors with low birth weight among human immunodeficiency virus exposed infants between 2004 and 2021 in Hubei, China: a retrospective cohort study

BACKGROUND

Low birth weight (LBW, < 2500 g) is an essential indicator of neonatal death and poor infant development, but data on LBW among human immunodeficiency virus (HIV)-exposed infants in China is inadequate.

OBJECTIVE

This study aimed to explore the temporal trend and factors associated with the LBW among HIV-exposed infants in Hubei province, China.

METHODS

The pregnant women living with HIV in Hubei province, China between Jan 2004 and Dec 2021 were enrolled this study. Recruited HIV-positive women were provided with consultation about preventing mother-to-child transmission (PMTCT). The intervention measures for PMTCT were provided to pregnant women and HIV-exposed infants, and the LBW and HIV status of infants were followed. Collected data included women's demographic information, HIV status of sexual partner, route of HIV transmission, HBV infection, HCV infection, syphilis infection, intrapartum CD4 count, whether received antiretroviral therapy (ART), the time of ART initiation, and ART regimens during pregnancy. Multivariable logistic regression was used to analyze factors associated with the LBW.

RESULTS

In total, 531 mothers (581 pregnancy events) and 581 infants were enrolled. The mean birth weight and LBW rate were 3075 ± 470.2 g and 8.4%, respectively. From 2004 to 2021, a significantly increased LBW rate (4.7-14.0%, P = .004) was observed. The use of protease inhibitor (PI)-based regimen (P = .04) and the exposure to ART in the first trimester (P = .01) were positively correlated with the increase of LBW rate. Exposure to ART in the first trimester (adjusted odds ratio [aOR] 3.64, 95%CI 1.29-10.27) and the second trimester (aOR 4.53, 95%CI 1.52-13.48), premature delivery (aOR 48.44, 95%CI 16.98-138.18), and infant with HIV infection (aOR 5.91, 95%CI 1.55-22.58) were predictors for LBW.

CONCLUSIONS

The significantly increased LBW rate in our study indicated that specific attention should be paid to HIV-exposed infants in China. More importantly, our study identified significant factors that can predict the risk of LBW. Interventions targeting these risk factors may prevent LBW among pregnant women living with HIV in future research and prenatal care.

Qualitative assessment of the scale-up of COVID-19 testing network in Armenia: turning adversities into opportunities

BACKGROUND

The COVID-19 pandemic reaffirmed the importance of high-quality laboratory services in the face of elevated demand for timely COVID-19 laboratory diagnosis. We explored the scale-up experience of the laboratory system in Armenia as well as the successes and challenges it brought to the overall laboratory system with the aim to identify lessons that can serve as opportunities for improvement.

METHODS

We conducted a qualitative study to explore the experiences concerning the process of scale-up of the COVID-19 testing network through in-depth interviews with policymakers/experts (n = 6), heads (n = 6) and physicians (n = 3) of private and public laboratories conducting COVID-19 testing. Eight domains of the WHO Laboratory Assessment Tool System (S-LAT) questionnaire guided the study and directed the content analysis.

RESULTS

According to the findings, within the COVID-19 testing network, numerous advancements were documented across all essential elements of the S-LAT as a result of the COVID-19 response. The most vivid improvements were related to the newly established network of public and private laboratories for COVID-19 testing and related coordination mechanisms, new laboratory information management practices, improved compliance with biosafety measures, novel quality assurance mechanisms as well as improved technical and human resources. However, suboptimal coordination of the COVID-19 testing network and the whole laboratory system, the gap between existing and proper biosafety management and quality control practices, and insufficient training of laboratory professionals were mentioned as potential challenges for the laboratory system in the future.

CONCLUSION

The assessment revealed challenges and achievements of the laboratory system during the COVID-19 response. Enhancement of coordination and cooperation mechanisms within and beyond the COVID-19 testing network, continuous improvement of human resources as well as quality and biosafety control practices throughout the whole system are crucial for sustaining the achievements and for strengthening future preparedness of the laboratory system to infectious disease outbreaks.

Epidemiological Characteristics of Human Respiratory Syncytial Virus in Children with Acute Respiratory Infection - Shijiazhuang City, Hebei Province, China, 2021-2023

Introduction

Human respiratory syncytial virus (HRSV) is the predominant respiratory pathogen causing acute respiratory tract infection (ARTI). Globally, HRSV infection represents the leading cause of acute respiratory morbidity and hospitalization in children under 2 years of age. HRSV infection continues to pose a significant public health challenge worldwide. Through epidemiological surveillance of HRSV in children with ARTI, we can elucidate its incidence patterns and epidemic characteristics to inform evidence-based prevention and control strategies.

Methods

We collected upper and lower respiratory tract specimens and clinical data from children under 14 years of age with ARTI. HRSV was detected using Real-time Polymerase Chain Reaction to analyze its incidence and epidemic characteristics.

Results

Among 1,440 specimens, the overall HRSV detection rate was 7.8% (HRSVA and HRSVB detection rates were 4.0% and 3.8%, respectively). Detection rates peaked in spring (12.2%), followed by winter (10.3%), with the lowest rates in autumn (2.8%) (P<0.05). HRSVB was the dominant subtype throughout 2021, while HRSVA predominated during 2022 and the first half of 2023. Detection rates were significantly higher in children under 5 years compared to older children, with lower respiratory tract infections in the 0-2 years age group showing notably higher detection rates (18.1%) than upper respiratory tract infections (8.1%) (P<0.05).

Conclusions

HRSV exhibited consistent circulation among children with ARTI in the Shijiazhuang area from 2021 to 2023, characterized by winter and spring outbreaks and alternating predominance of subtypes A and B. Infections predominantly affected children under 5 years of age.

Synthesis, Antimicrobial Activities, and Model of Action of Indolyl Derivatives Containing Amino-Guanidinium Moieties

The objectives of the study were to design, synthesize, and evaluate the antibacterial activity of a series of novel aminoguanidine-indole derivatives. Thirty-seven new compounds were effectively synthesized through nucleophilic substitution reaction and guanidinylation reaction. Chemical structures of all the desired compounds were identified by NMR and HR-MS spectroscopy. Most of the synthesized compounds showed significant antibacterial activity against ESKAPE pathogens and clinical resistant Klebsiella pneumoniae (K. pneumoniae) isolates. K. pneumoniae is an important opportunistic pathogen that often threatens the health of immunocompromised people such as the elderly, children, and ICU patients. The most active compound 4P showed rapid bactericidal activity against resistant K. pneumoniae 2108 with MIC and MBC values that were 4 and 8 µg/mL, respectively. The hemolytic activity of 4P was low, with an HC50 value of 123.6 µg/mL. Compound 4P induced the depolarization of the bacterial membrane and disrupted bacterial membrane integrity and was not prone to antibiotic resistance. The dihydrofolate reductase (DHFR) activity was also notably inhibited by 4P in vitro. Molecular docking revealed that the aminoguanidine moiety and indole structure of 4P played an important role in binding to the target site of the K. pneumoniae dihydrofolate reductase (DHFR) receptor. In the mouse pneumonia model caused by K. pneumoniae, 4P improved the survival rate of mice, reduced bacterial loads, and alleviated tissues' pathological injuries at a dosage of 4 mg/kg. Therefore, compound 4P may be a promising lead compound or drug candidate for antibacterial purposes against K. pneumoniae.

Phylogenetic analyses of the spread of Clade I MPOX in African and non-African nations

Recently, mpox has spread in some parts of Africa, such as Congo (DRC), Burundi, Rwanda, Uganda, and Kenya, worsening the situation in DRC and Burundi compared to the other parts of Africa due to the spread of the Clade Ib, with several confirmed and lethal cases. The study aims to analyze the broader molecular phylogenetics using greater complete genome sequences and molecular phylogenetics of Clade I (Clade Ia and Clade Ib), nucleotide diversity of the genome of Clade I, NGA/TCN context of G- > A/C- > T mutations, and epidemiology of the recent spread of mpox in the African countries. Overall molecular phylogenetics of mpox inform the divergence was noted between 0.00220 and 0.00265 and found Clade IIb has further subdivided into 37 sublineages. From our phylogenetic analysis and the tracking of recent mpox variants, we report the spread of Clade I (Clade Ib) of mpox, a virulent mpox, in the African continent, Thailand, Sweden, and USA. Furthermore, two Clades, Clade Ia and Clade Ib, have originated from Clade I. Recently, Clade Ib has expanded its region within African continent. We reported the mutation pattern in the genome. Epidemiological analysis indicates the most affected country is the Democratic Republic of the Congo (DRC). This work shows that mpox is steadily adapting as geographic area increases and can help the health authorities develop policies such as vaccinations, and travel restrictions to contain the spread of mpox.

Evaluating the effectiveness of integrated traditional Chinese and Western treatment based on symptom grading: a study protocol for a multi-center, randomized controlled trial of patients with depressive disorder

Background

Approximately one-third of depressed individuals receive treatment globally. The application rate of traditional Chinese medicine (TCM) for treating depression globally remains relatively low. The proposed study presents a pilot trial to evaluate the effectiveness of interventions at different levels in improving depression status in community populations.

Methods

A randomized controlled trial will be conducted in two communities in Guangdong, China, with a follow-up period of 12 weeks. Participants will be randomly allocated to control or intervention groups. Participants in the control group will be assigned to routine care, while participants in the intervention group will receive TCM intervention measures. The participants in the intervention group will receive integrated traditional Chinese and Western treatment according to the symptom grading of depression severity. Primary outcome measurements include the Patient Health Questionnaire (PHQ-9), the Hamilton Depression Rating Scale (HAMD-17), and the Self-Rating Depression Scale (SDS). Secondary outcome measurements include the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), the Multiple Mental Health Literacy Scale (MMHL), the Short-Form 12 (SF-12), and the Treatment Emergent Symptom Scale (TESS). The data will be collected at baseline (T1), 2 weeks after intervention (T2), 4 weeks after intervention (T3), 8 weeks after intervention (T4), and 12 weeks after intervention (T5).

Discussion

This study will provide an experimental basis for the effectiveness of hierarchical integrated traditional Chinese and Western medicine (ITCWM) in improving the condition of patients with different degrees of depression. At the end of the study, it is expected for the experimental group to have an improvement in depressive symptoms and sleep quality and an enhancement in mental health awareness.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR2300075169.

Case report: Clinical characteristics of anthrax meningoencephalitis: two cases diagnosed using metagenomic next-generation sequencing and literature review

Purpose

To explore the clinical features, diagnosis, treatment, and prognosis of anthrax meningoencephalitis.

Methods

The clinical data of two cases of anthrax meningoencephalitis were summarized and the relevant literature was reviewed.

Results

Both patients, who were farmers, had cutaneous lesions prior to the onset of meningoencephalitis. The clinical manifestations included fever (2/2), headache (2/2), stupor (2/2), meningeal signs (2/2), and lymph node enlargement (2/2). The CSF analysis showed erythrocytes, increased neutrophils, low glucose levels and high protein levels. CSF cytology revealed rod-shaped bacilli. Metagenomic next-generation sequencing of the CSF from both patients detected Bacillus anthracis. Additionally, cultures confirmed the presence of endogenous spores of macrobacteria. Brain imaging revealed subarachnoid hemorrhages and minimal cerebral edema. Despite aggressive antibiotic treatment, both patients died. Fifty-seven articles of the past 70 years were reviewed. There were 59 patients of anthrax meningoencephalitis in total, including 46 patients died. Stupor (42/46, 91.3% vs. 3/13, 46.2%, p = 0.001), agitation (15/46, 32.6% vs. 0/13, 0.0%, p = 0.043) and intracranial hemorrhage (37/46, 80.4% vs. 4/13, 30.8%, p = 0.002) were more common in the deceased group. Two types of bactericidal drugs or intrathecal injection drugs presented more often in the surviving group (10/13, 76.9% vs. 13/46, 28.3%, p = 0.001), whereas penicillin monotherapy presented more often in the deceased group (23/46, 50.0% vs. 2/13, 15.4%, p = 0.026).

Conclusion

Anthrax meningoencephalitis typically presents as a rapidly progressive bacterial meningoencephalitis. The occurrence of stupor, agitation and intracranial hemorrhage is possibly correlated with poor outcome. Two types of bactericidal drugs or intrathecal injection drugs are associated with better prognosis. Metagenomic next-generation sequencing can quickly and accurately detect B. anthracis in CSF.

CoMIT: a bioinformatic pipeline for risk-based prediction of COVID-19 test inclusivity

BACKGROUND

The global Coronavirus Disease 2019 (COVID-19) pandemic highlighted the need to quickly diagnose infections to identify and prevent viral spread in the population. In response to the pandemic, BioFire Defense leveraged its PCR-based "lab-in-a-pouch" technology for expedited development of the BioFire® COVID-19 Test, a novel in vitro diagnostic detecting SARS-CoV-2 nucleic acid in human samples. Following clearance of an in vitro diagnostic device, regulatory bodies such as the U.S. Food and Drug Administration (FDA) require regular post market surveillance to monitor test performance against viral lineages circulating in the field, using predictive in silico inclusivity evaluations. Exponential increases in the number of sequences deposited in bioinformatic repositories such as GISAID, during the pandemic, impeded progress in meeting these post market requirements. In response, BioFire Defense developed a new bioinformatic tool to overcome scalability problems and the loss of accuracy encountered with the standard inclusivity method.

RESULTS

The Coronavirus Monitoring for Inclusivity Tool (CoMIT) uses the Variant Sorter Algorithm to sidestep multiple sequence alignments, a significant barrier inherent in the standard inclusivity method. The implementation of CoMIT and its Variant Sorter Algorithm are described. Automated summary tables and visualizations from a typical inclusivity evaluation are presented. We report our approach to filter and display relevant information in the pipeline outputs using risk factors tied to test performance.

CONCLUSIONS

BioFire Defense has developed CoMIT, an automated bioinformatic pipeline for efficient processing and reporting of variant inclusivity from the GISAID EpiCoV™ repository. This tool ensures continuous and comprehensive post market evaluations of BioFire COVID-19 Test performance even from datasets large enough to impede standard inclusivity analyses. CoMIT's low computational space complexity and modular code allow this tool to be generalized for inclusivity monitoring of multianalyte or single analyte tests with complex assay designs and/or highly variable targets. CoMIT's databasing capabilities and metadata handling hold the potential for new investigations to improve readiness for future outbreaks.

ITGA4 as a potential prognostic and immunotherapeutic biomarker in human cancer and its clinical significance in gastric cancer: an integrated analysis and validation

Background

Integrin Subunit Alpha 4 (ITGA4), a member of the integrin protein family, is involved in the progression of malignant tumors. However, its role across different cancer types is not well understood.

Methods

Utilizing multi-omics data, we comprehensively evaluated ITGA4's expression, clinical relevance, diagnostic and prognostic value, functions, mutations, and methylation status, along with its impact on immunity, mismatch repair (MMR), heterogeneity, stemness, immunotherapy responsiveness, and drug resistance in pan-cancer, with partial validation in gastric cancer (GC) using transcriptomic analysis, single-cell data, western blot (WB), wound-healing assay, flow cytometry and immunohistochemistry (IHC). We further investigated its correlation with clinicopathology and serological markers on tissues from 80 GC patients.

Results

ITGA4 expression was generally low in normal tissues but varied significantly across tumor types, with higher levels in advanced stages and grades. It demonstrated diagnostic value in 20 cancer types and effectively predicted 1-, 3-, and 5-year survival rates as part of a prognostic model. ITGA4 played roles in cell adhesion, migration, immune regulation, and pathways like PI3K-Akt and TSC-mTOR. It showed alterations in 22 cancer types, with methylation at 9 sites inhibiting its expression. ITGA4 positively correlated with immune cell infiltration, immune regulatory genes, chemokines, and might reduce microsatellite instability (MSI) and tumor mutation burden (TMB) by promoting MMR gene expression. It could also predict immunotherapy efficacy and chemotherapy sensitivity. In GC, high ITGA4 expression was related to poor prognosis, promoted tumor proliferation and migration, and enhanced immune cell infiltration. ITGA4 expression was higher in GC cells and tissues than normal ones. Its downregulation inhibited GC cell migration and promoted apoptosis. Moreover, ITGA4 was correlated with N stage, pathological stage, neural and vascular invasion, serum levels of Ki-67, immune cells, CRP and CA125.

Conclusion

ITGA4 is a potential biomarker and therapeutic target to enhance cancer treatment and improve patient outcomes.

Tracing the evolution: the rise of Salmonella Thompson co-resistant to clinically important antibiotics in China, 1997-2020

As clinical Salmonella enterica serovar Thompson (S. Thompson) emerged among the top ten prevalent serovars in China, understanding the distribution and origin of its multidrug-resistant (MDR) strains becomes imperative. This study employed antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatics analysis to investigate the prevalence and genomic profiles of clinically important S. Thompson ST26 across China from 1997 to 2020. Upon analyzing 141 isolates from various sources, we identified 29 isolates, derived from 25 diarrhea patients and four animal-derived foods, displayed co-resistance to ciprofloxacin, cefotaxime, and azithromycin (CIPRCTXRAZIR), all of which are considered the front-line and critically-important antimicrobial agents for treating Salmonella infections in humans. The IncC plasmid was the predominant mobile vector identified among the CIPRCTXRAZIR isolates, harboring four crucial resistance genes qnrS1, qepA4, blaCMY-2, and mph(A) that confer resistance to three critically important antimicrobials. However, the closely related and clustered IncC-harboring CIPRCTXRAZIR isolates (0-23 single nucleotide polymorphisms [SNPs]) indicated the clonal spreading of these clinically important isolates in different provinces of China. Notably, the CIPRCTXRAZIR isolates appeared in aquatic products of animal-derived food, highlighting the possibility of aquaculture practices in the emergence and transmission of important antimicrobial resistance. Our findings emphasize the critical public health implications of IncC-carrying clinically important S. Thompson ST26. The study calls for enhanced surveillance of the clinically important S. Thompson ST26 clone in clinical and aquaculture and implementation of targeted interventions to mitigate its spread, thereby protecting food safety and public health.IMPORTANCEWe highlighted the critical veterinary public health issue of clinically important Salmonella enterica serovar Thompson (S. Thompson) prevalence in animal-derived foods, particularly aquatic products, calling for urgent action. The ability of S. Thompson to resist critically important antimicrobials across diverse environments highlights the transmission and survival of resistant strains within the livestock and poultry industry, aquaculture, and food production chains. This study underscores the importance of continuous surveillance of clinically important S. Thompson, especially in aquaculture settings, and considers the global trade of aquatic products as a potential vector for international dissemination. Further investigation on the factors contributing to the clone spread of clinically important Salmonella strain and the development of intervention strategies to mitigate its public health impact.

The influence of menopause age on gynecologic cancer risk: a comprehensive analysis using NHANES data

Background

Menopause, a natural transition, affects women's health risks, including gynecologic cancers. Early menopause, linked to lower estrogen, may increase cancer susceptibility. This study analyzed NHANES data from 1999 to 2020 for 8,219 postmenopausal women to explore the relationship between menopausal age and gynecologic cancers. We used regression models and RCS models to assess the risk.

Methods

This study utilized data from the NHANES spanning 1999 to 2020, focusing on 8,219 postmenopausal women selected through stratified sampling. Variables including socioeconomic factors, health behaviors, nutritional status, and medical history were assessed in relation to participants' menopausal age and gynecologic cancer prevalence. We analyzed the relationship between menopausal age and gynecologic cancers (cervical, ovarian, and uterine) using multiple regression models. Additionally, we employed RCS models to evaluate nonlinear relationships between menopausal age and gynecologic cancer risk.

Results

Our findings indicate a significant inverse association between menopausal age and the risk of gynecologic cancers. After controlling for confounding factors such as age, race, BMI, and lifestyle variables, a later age at menopause was associated with a reduced risk of cervical, ovarian, and uterine cancers. The RCS model revealed a non-linear, low-L-shaped relationship, particularly highlighting increased cancer risks at younger menopausal ages. Subgroup analyses demonstrated consistent results across demographic and lifestyle factors, confirming the robustness of the observed associations.

Conclusion

This study reveals the link between menopausal age and gynecologic cancer prevalence. Early menopause is a significant risk factor for cervical, ovarian, and uterine cancers. Our findings support tailored cancer screening based on menopausal age, potentially improving preventive care for postmenopausal women.

Assessment of Knowledge Gaps in Cervical Cancer Screening and HPV Vaccination Among Chinese Women: A Comprehensive Population-Based Study

Background

While studies on cervical cancer screening (CCS) and human papillomavirus (HPV) vaccine uptake exist in China, few have examined both within populations participating in CCS programs.

Methods

This cross-sectional, population-based survey included 37,797 women aged 18-64 years attending gynecological outpatient clinics. Participants completed a questionnaire assessing CCS awareness and participation. Additionally, HPV vaccine knowledge was investigated in a sub-sample of 17,010 women aged <45 years.

Results

The mean age of participants was 45.06 years (SD: 8.52). The mean CCS knowledge score was 63.13%, with 52.53% reporting prior CCS uptake. Factors associated with lower CCS knowledge included low monthly household income, lack of rural cooperative medical insurance, low literacy, not having received CCS within the past 3 years, unmarried status, and childbirth history. A strong positive correlation was observed between CCS knowledge and adherence to CCS recommendations (Spearman correlation coefficient: 0.708, p < 0.01). Awareness of the HPV vaccine was reported by 48.33% of participants, with HPV vaccine knowledge positively correlated with CCS awareness (Spearman correlation coefficient: 0.629, p < 0.01). CCS knowledge partially mediated the relationship between HPV vaccine knowledge and willingness to vaccinate, with a mediating effect size of 21.16%.

Conclusion

Integrated health education efforts targeting CCS and HPV vaccine awareness are essential. Empowering women to understand the significance of HPV vaccination and regular CCS participation can enhance cervical cancer prevention strategies.

Changes in drinking levels and metabolic dysfunction-associated steatotic liver disease: a longitudinal study from the China multi-ethnic cohort study

BACKGROUND

Little is known about the associations of changes in drinking levels with the newly defined metabolic dysfunction-associated steatotic liver disease (MASLD). We therefore sought to estimate the associations between changes in drinking levels and MASLD in less developed regions of China.

METHODS

This longitudinal study included 8727 participants from the China Multi-Ethnic Cohort (CMEC) in less developed regions, all participating in baseline and a follow-up survey. MASLD was defined as hepatic steatosis, along with the presence of at least one of five cardiometabolic risks, in addition to limiting excessive alcohol consumption. We applied the parametric g-formula to evaluate the association between changes in drinking levels and MASLD. We further estimated the association between changes in drinking levels and fibrosis scores (AST-to-platelet ratio and fibrosis-4 index) in patients with MASLD.

RESULTS

Compared with sustained non-drinking, sustained modest drinking was associated with a higher risk of MASLD (Mean Ratio (MR): 1.127 [95% CI: 1.040-1.242]). Compared to sustained non-drinking, the MR for those transitioning from non-drinking to modest drinking was 1.065 [95% CI: 0.983-1.169], while the MR for those changing from modest drinking to non-drinking was 1.059 [95% CI: 0.965, 1.173]. Non-invasive fibrosis scores tended to increase with modest drinking compared to sustained non-drinking.

CONCLUSION

In the less developed regions of China, sustained moderate drinking was associated with the risk of MASLD compared with sustained non-drinking. Increased drinking showed a trend towards a higher risk of MASLD. This study can inform drinking policies related to MASLD and liver fibrosis in less developed regions.

Surveillance of SARS-CoV-2 variants in Henan, China from 2023 to 2024

Objective

In January 2023, China implemented the "Class B Management" policy, marking a new phase in COVID-19 control. As new SARS-CoV-2 variants continue to emerge, some have shown significant immune evasion, posing challenges to epidemic control efforts. To manage the pandemic effectively, Henan Province launched a surveillance program for SARS-CoV-2 variants, systematically analyzing their clinical characteristics and epidemiological patterns.

Methods

This study collected genomic sequence data from 5,965 COVID-19 cases between January 1, 2023, and March 17, 2024, using the Henan Province SARS-CoV-2 variant surveillance system. Genome sequence analysis was performed with CLC Genomics Workbench, and genotyping and sequence alignment were carried out using the Nextclade platform. The clinical severity of different variants was assessed in relation to patient sex, age, clinical classification, and vaccination status.

Results

Between Week 1 of 2023 and Week 11 of 2024, a total of 5,965 complete SARS-CoV-2 genome sequences were obtained, including 3,004 male (50.36%) and 2,961 female (49.64%) cases. The majority of cases were mild (5,451 cases, 91.38%), followed by moderate (311 cases, 5.21%) and severe or critical cases (203 cases, 3.4%). The predominant variants included BA.5.2, XBB, and BA.2.86. BA.5.2 was dominant until April 2023, after which it was gradually replaced by XBB. From December 2023, BA.2.86 began to increase and became the predominant variant by January 2024. The XBB variant exhibited a significantly lower rate of severe cases, with most infections being mild (P < 0.05). Male patients, the elderly, and certain variants (e.g., BA.5.2) were associated with more severe outcomes, while XBB and BA.2.86 showed lower pathogenicity, with a marked reduction in severe and fatal cases (P < 0.05).

Conclusion

As SARS-CoV-2 variants evolve, the incidence of severe cases has progressively decreased. Both XBB and BA.2.86 variants exhibit lower pathogenicity. This study provides vital scientific evidence on the epidemiological features, clinical manifestations, and control strategies of SARS-CoV-2 variants. It underscores the importance of continuous viral surveillance and genomic sequencing to guide public health decision-making.

Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with predictions to 2046

BACKGROUND

Metabolic risks are significant factors associated with colorectal cancer. This study aimed to assess global, regional and national burden for CRC attributable to metabolic risks from 1990 to 2021 and to predict mortality by 2046.

METHODS

Data from the Global Burden of Disease Study 2021 were used to quantify deaths, disability-adjusted life years (DALYs), and age-standardized rates of CRC due to metabolic risk factors, disaggregated by sex, age, region, country/territory, and sociodemographic index (SDI). The average annual percentage change (AAPC) was used to analyze temporal trends from 1990 to 2021. Metabolic risks include high fasting plasma glucose (FPG) and high body mass index (BMI). Future mortality trends up to 2046 were forecast using age-period-cohort models.

RESULTS

Globally, CRC deaths attributable to metabolic risks increased 2.47-fold, rising from 73,443 in 1990 to 181,689 in 2021. The global age-standardized mortality rates (ASMRs) and age-standardized rates of DALYs (ASDRs) of CRC attributable to high FPG and ASDRs attributable to high BMI increased from 1990 to 2021. The ASMRs and ASDRs of males was higher than that of females, with increasing trends. Central Europe had the highest ASMRs and ASDRs of CRC attributable to metabolic risks in 2021. Most regions and countries showed increasing trends in ASMR and ASDR for CRC due to metabolic risks, with Andean Latin America, Southeast Asia, and Cabo Verde increasing the most. High-SDI regions had the largest burden of CRC attributable to metabolic risks, while burden of other SDI regions have been significantly increased. A positive association was observed between SDI and age-standardized rates (ASMR: RFPG = 0.803, RBMI = 0.752; ASDR: RFPG = 0.812, RBMI = 0.756). By 2046, the ASMR of CRC attributable to high FPG was projected to remain stable and the ASMR due to high BMI was expected to see a slightly increase.

CONCLUSION

Colorectal cancer deaths and DALYs attributable to metabolic risk factors remain high, particularly in males and high-SDI regions. Further researches into the metabolic mechanisms of CRC and effective treatment strategies are needed.

Spatio-temporal distribution of COVID-19 cases and tuberculosis in four provinces of Sumatra Islands, Indonesia

BACKGROUND

The COVID-19 pandemic disrupted national tuberculosis programs in high-burden countries. We hypothesize that COVID-19 occurrence had a delayed effect on tuberculosis case reports from the Indonesia Ministry of Health, also known as the tuberculosis case notification. The objectives of this study are: (1) to describe the potential effect of the reported COVID-19 cases on the spatial distribution of tuberculosis in four provinces of Sumatra Islands (Aceh, North Sumatra, West Sumatra, and Riau Provinces), Indonesia; (2) to estimate the temporal lag effect of the occurrence of COVID-19 on tuberculosis case notifications.

METHODS

We retrieved data from the Indonesian Ministry of Health and the Indonesia COVID-19 Task Force. We also examined the monthly tuberculosis and COVID-19 case notifications. We identified time series clusters of tuberculosis case notifications and used lag non-linear model to assess the delayed effect of the occurrence of COVID-19 cases on tuberculosis case notifications.

RESULTS

The secondary data included 217,593 tuberculosis case notifications (January 2019 to December 2022) and 373,671 reported COVID-19 cases (January 2020 to December 2022). Time series cluster analysis revealed 5 clusters each for monthly tuberculosis case notifications and monthly reported COVID-19 cases. There was a negative association with a 0-month lag in more than 10,000 reported COVID-19 cases (RR = 0.95, 95%CI: 0.91-0.98).

CONCLUSIONS

The findings suggested that Indonesia's national tuberculosis program in four provinces of Sumatra Island was disrupted during the COVID-19 pandemic. Lag analysis showed that COVID-19 case occurrence had an immediate effect on tuberculosis case notifications.

CLINICAL TRIAL

Not applicable.

Adaptation and validation of a condom-related stigma scale for older adults in China

BACKGROUND

Condom use has long been recommended as an effective method for preventing HIV/AIDS. However, a large proportion of older adults in China reported not using condoms, leading to an alarming increase in HIV prevalence among this population. Negative attitudes, especially condom-related stigma, have been identified as the main barrier. However, no condom-related stigma scale has been developed or validated for older adults in the Chinese cultural context. This study aimed to adapt and validate a condom-related stigma scale for older adults (CRSS-OA) in China, based on a scale previously developed for men who have sex with men (CRSS).

METHODS

Based on qualitative interviews, we adapted and revised the CRSS to better address the ageism and unique stigma faced by older adults in the Chinese cultural context. The reliability and validity of the adapted CRSS-OA were examined using a random sample of 498 older adults in Hunan Province, south-central China. Reliability was assessed by calculating Cronbach's alpha. Construct validity was assessed through exploratory and confirmatory factor analyses. Concurrent validity was assessed by examining the correlation between each factor of the CRSS-OA and two criterion scales (the HIV/AIDS Stigma Scale and the Aging Sexual Attitudes Scale). Predictive validity was evaluated by analyzing the association between condom-related stigma and engagement in condomless sexual behavior.

RESULTS

The adapted scale included 16 items, loading on three factors, and collectively explaining 70.646% of the variance. These factors were named "labeling condom use," "shaming condom purchase," and "violating traditional sex beliefs," demonstrating strong internal consistency with Cronbach's alpha coefficients of 0.942, 0.850, and 0.852, respectively. Concurrent validity was established by evaluating the correlation between each factor of the CRSS-OA and two criterion scales, with Pearson correlation coefficients ranging from 0.227 to 0.508 (p < 0.05). Predictive validity was assessed by measuring the scale's ability to correctly predict condomless sexual behavior, with an average predictability of 0.77.

CONCLUSIONS

The adapted CRSS-OA has proven to be a valid and cultural-adaptive tool for assessing condom-related stigma among older adults in China. Further studies are needed to explore the external validity of this scale in the future.

Association between respiratory pathogens and severe clinical outcomes in people living with HIV-1 and pulmonary infections: A 180-day longitudinal cohort study

BACKGROUND

Many respiratory pathogens have been identified in people living with HIV-1 and pulmonary infection, but their impact on clinical outcomes remains largely unclear.

METHODS

Metagenomic sequencing and traditional laboratory diagnostics were applied to identify bacterial, viral, and fungal respiratory pathogens. Clinical outcomes were assessed by (i) mortality or ICU transfer during hospitalization, and (ii) 30-day re-hospitalization and 180-day mortality after hospital discharge.

RESULTS

Microbiological analyses of bacterial, viral and fungal pathogens in 237 in-patients with HIV-1 and pulmonary infections revealed Pneumocystis jirovecii (58 %) as the most prevalent respiratory pathogen, followed by Cytomegalovirus (39 %), Mycobacterium tuberculosis (22 %), Talaromyces marneffei (17 %), and Epstein-Barr virus (16 %). Fifty-six patients (24 %) were coinfected with bacterial, viral and fungal pathogens, referred to as bacterial+fungal+viral coinfections. Risk factors for bacterial+fungal+viral coinfections (RR=8.41, 95 %CI: 4.2-14.3), severe pneumonia (RR=13.6, 95 %CI: 8.14-19.3), and elevated C-reactive protein levels (RR=6.42, 95 %CI: 1.58-10.13) were significantly associated with mortality or ICU transfer during hospitalization. After hospital discharge, 38 patients (16 %) were rehospitalized within 30 days. Antiretroviral therapy reduced the risk of 30-day rehospitalization (HR=0.21, p = 0.01). During the 180-day follow-up, 13 patients (5.5 %) died. Survival analyses identified severe pneumonia and age ≥ 60 years as risk factors for 180-day mortality.

CONCLUSIONS

Multiple pulmonary coinfections are associated with severe outcomes in in-patients with HIV-1 infection. Effective management of both HIV-1 and pulmonary infections is crucial to reduce hospitalization rates and mortality risk.

Trends in the disease burden of cystic echinococcosis in China, 1990-2044 analysis and forecasting study

This study aims to analyze changes in the disease burden of cystic echinococcosis in China from 1990 to 2019 and to predict trends from 2020 to 2044. Using the Global Burden of Disease 2019 (GBD 2019) database, we analyzed the trends in annual percentage change (APC) and average annual percentage change (AAPC) for incidence, prevalence, death, and disability-adjusted life years (DALY) rates of cystic echinococcosis in China via the Joinpoint Regression Program 4.8.0.1 software. Additionally, we applied Nordpred modeling to predict future trends in disease burden over the next 25 years. From 1990 to 2019, the incidence and prevalence of cystic echinococcosis in the Chinese population showed an overall increasing trend, whereas the death and DALY rates exhibited an overall decreasing trend. The disease burden of cystic echinococcosis was greater in males than in females, with significant differences across age groups. The highest incidence and prevalence rates were observed in the 10-24 years age group, whereas the lowest occurred in the 0-9 years age group. Fatalities and DALY rates increased with age, particularly in the 70 and older age groups. According to the Nordpred modeling results, the incidence, prevalence, and DALY rates of cystic echinococcosis in China are expected to rise slightly over the next 25 years. The overall disease burden of cystic echinococcosis is projected to increase gradually between 2020 and 2044, with men exhibiting higher incidence, prevalence, and DALY rates than women.

Self-Reported Medical Errors and Primary Care Physicians' Performance and Confidence in Delivering Care: A Multilevel Empirical Study in China

Background/Objectives: Patient safety is fundamental to primary healthcare, and medical errors impose a considerable burden on patients globally. However, the impact of medical errors on primary healthcare physicians remains understudied, especially in developing countries. This study aimed to examine the associations between self-reported medical errors and physicians' performance and confidence in Chinese primary care practice. Methods: A cross-sectional survey was conducted from November 2021 to May 2022 with 224 primary care physicians from 38 community health centers (CHCs) across four large cities in China. The quality of clinical and preventative care, and confidence in managing commonly occurring diseases, multimorbidity, and common mental health disorders served as indicators of performance and confidence, respectively. Hierarchical linear regression and linear regression with cluster-robust standard errors were employed. Results: Clinical care quality (β = -0.159, SE = 0.075, p < 0.05), preventive care quality (β = -0.165, SE = 0.068, p < 0.05), confidence in managing multimorbidity (β = -0.175, SE = 0.074, p < 0.05), and confidence in managing common mental health disorders (β = -0.189, SE = 0.076, p < 0.05) were negatively associated with self-reported medical errors, with scores of 4.08 (SD 0.95), 3.59 (SD 0.87), 3.63 (SD 1.04), and 3.10 (SD 1.21) out of 5 (where 5 represents the best possible score), respectively. The association between self-reported medical errors and confidence in managing commonly occurring diseases (β = -0.063, SE = 0.075, p > 0.05) was not statistically significant, with a score of 3.81 (SD 1.00) out of 5 (where 5 represents the best possible score). Conclusions: This study offers new insight into the associations between self-reported medical errors and primary healthcare physicians' performance and confidence. It is crucial for CHCs to be aware of the impact of self-reported medical errors on physicians' performance in delivering clinic and preventative care, and confidence in managing multimorbidity and common mental health disorders. Strategies such as strengthening organizational support should be developed to maintain performance and rebuild confidence in delivering care for physicians who were involved in medical errors.

Incidence, severity, risk factors and outcomes of SARS-CoV-2 reinfections during the Omicron period: a systematic review and meta-analysis

Background

Our previous systematic review estimated the cumulative incidence of SARS-CoV-2 reinfections as 1.16% (95% CI = 1.01-1.33%) during the pre-Omicron period. The Omicron variant that emerged in November 2021 was significantly genetically distinct from the previous SARS-CoV-2 variants and thus, more transmissible and posed an increased risk of SARS-CoV-2 reinfections in the population. We, therefore, conducted a fresh systematic review and meta-analysis to estimate the SARS-CoV-2 reinfection burden during the Omicron period.

Methods

We searched CINAHL, Medline, Global Health, Embase, and WHO COVID-19 in October 2023 for studies reporting the SARS-CoV-2 reinfection incidence during the Omicron period. The quality of the included studies was assessed using the Joanna Briggs Institute checklists. Random effects meta-analyses were conducted to estimate the incidence, and requirement of hospitalisation of SARS-CoV-2 reinfections. Symptomatic severity of reinfections and case fatality rates were analysed narratively.

Results

Thirty-six studies were included. The reinfection cumulative incidence during the Omicron period was 3.35% (95% CI = 1.95-5.72%) based on data from 28 studies. The cumulative incidence was higher in 18-59-year-old adults (6.62% (95% CI = 3.22-13.12%)) compared to other age groups and in health care workers (9.88% (95% CI = 5.18-18.03%)) compared to the general population (2.48% (95% CI = 1.34-4.54%)). We estimated about 1.81% (95% CI = 0.18-15.87%) of the reinfected cases required hospitalisation based on limited and highly variable data.

Conclusions

There was an increased risk of reinfections during the Omicron period compared to the pre-Omicron period. The incidence was higher in 18-59-year-old adults and health care workers and generally less severe during the Omicron period. However, data were limited on disease severity and long-term outcomes.

Registration

PROSPERO: CRD42023482598.

Characteristics and risk factors associated with COVID-19 reinfection in Hong Kong: a retrospective cohort study

We aimed to identify risk factors related to COVID-19 reinfection in Hong Kong. We performed a population-based retrospective cohort study and reviewed case-based data on COVID-19 infections reported to the Centre for Health Protection from 8 January 2020 to 29 January 2023. We analyzed the epidemiology of COVID-19 infections and performed a Cox regression analysis. In this period, 3.32% (103,065/3,106,579) of COVID-19 infections recorded were classified as reinfection. Compared with primarily infected cases, a higher proportion of re-infected cases had chronic diseases (33.54% vs. 27.27%) and were residents of residential care homes (RCH) (10.99% vs. 1.41%). The time interval between the two episodes ranged from 31 to 1,050 days (median 282 days). Cox regression analysis of Omicron cases with the adjustment of covariates showed that being female (Hazard Ratio [HR] 1.12, 95% CI 1.11-1.13), chronic diseases (HR 1.18, 95% CI 1.16-1.20) and RCH residents (HR 6.78, 95% CI 6.61-6.95) were associated with reinfection, while additional vaccination after primary infection was protective (HR 0.80, 95% CI 0.79-0.81). Further analytical studies on the risk factors and protectors of COVID-19 reinfection are needed to guide targeted interventions.

Evaluation of dried blood spot sampling for real-time PCR malaria diagnostics in a rural setting in Angola

BACKGROUND

Malaria is the parasitic disease with the highest morbidity and mortality worldwide. Angola is one of the five sub-Saharan African countries with the highest malaria burden. Real-time PCR diagnosis in endemic areas has not been implemented due to its high cost and the need for adequate infrastructure. Dried blood spots (DBSs) are an alternative for collecting, preserving, and transporting blood samples to reference laboratories. The objective of the study was to assess the efficacy of DBS as a sampling method for malaria research studies employing real-time PCR.

METHODS

The study was divided into two phases: (i) prospective study at the Hospital Universitario Vall d'Hebron (HUVH) to compare real-time PCR from whole blood or DBS, including 12 venous blood samples from patients with positive real-time PCR for Plasmodium spp. and 10 quality control samples (nine infected samples and one negative control). Samples were collected as DBSs (10, 20, 50 µl/circle). Samples from both phases of the study were analyzed by generic real-time PCR (Plasmodium spp.) and the subsequent positive samples underwent species-specific real-time PCR (Plasmodium species) and (ii) cross-sectional study conducted at the Hospital Nossa Senhora da Paz, Cubal (Angola), including 200 participants with fever. For each patient, a fresh capillary blood specimen [for thin and thick blood films and rapid diagnostic test (RDT)] and venous blood, collected as DBSs (two 10-µl circles were combined for a total volume of 20 µl of DBS), were obtained. DBSs were sent to HUVH, Barcelona, Spain.

RESULTS

(i) Real-time PCR from whole blood collection was positive for 100% of the 21 Plasmodium spp.-infected samples, whereas real-time PCR from DBSs detected Plasmodium spp. infection at lower proportions: 76.19% (16/21) for 10 µl, 85.71% (18/21) for 20 µl, 88.24% (15/17) for 50 µl and 85.71% (18/21) for 100 µl DBSs. (ii) Field diagnosis (microscopy and/or RDT) showed a 51.5% (103/200) positivity rate, while 50% (100/200) of the DBS samples tested positive by real-time PCR. Using field diagnosis as the reference method, the sensitivity of real-time PCR in DBS samples was 77.67% with a specificity of 79.38%. Plasmodium species were identified in 86 samples by real-time PCR: 81.40% (16/86) were caused by Plasmodium falciparum, 11.63% (10/86) were coinfections of P. falciparum + P. malariae, 4.65% (4/86) were P. falciparum + P. ovale, and 2.33% (2/86) were triple coinfections.

CONCLUSIONS

The DBS volume used for DNA extraction is a determining factor in the performance of real-time PCR for Plasmodium DNA detection. A DBS volume of 50-100 µl appears to be optimal for malaria diagnosis and Plasmodium species determination by real-time PCR. DBS is a suitable method for sample collection in Cubal followed by real-time PCR analysis in a reference laboratory.

mapPat: tracking pathogens evolution in space and time

Motivation

The COVID-19 pandemic highlighted the importance of genomic surveillance for monitoring pathogens evolution, mitigating the spread of infectious disorders, and informing decision-making by public health authorities. Since the need for the summarization and interpretation of large bodies of data, computational methods are critical for the implementation of effective genomic surveillance strategies.

Results

Here, we introduce mapPat, an R Shiny application for the interactive visualization of pathogens genomic data in space and time. mapPat is designed as a user-friendly dashboard and allows the dynamic monitoring of the evolution of variants, lineages, and mutations in the genome of a pathogen at glance through informative geographic maps and elegant data visuals. mapPat provides a fine-grained map of pathogens evolution and circulation and represents a useful addition to the catalogue of bioinformatics methods for the genomic surveillance of pathogens.

Availability and implementation

mapPat is available at GitHub (https://github.com/F3rika/mapPat.git).

Physical Activity Patterns Across Life Domains in Chinese Older Adults Aged 60-79 Years - China, 2020

What is already known about this topic?

Physical inactivity among older adults is increasing globally. Analyzing the characteristics and influencing factors of physical activity patterns (PAPs) can inform the design of targeted physical activity (PA) promotion strategies for diverse subgroups.

What is added by this report?

Analysis of national data from 2020 revealed three distinct PAPs among Chinese older adults across life domains: low activity (LA) cluster (53.3%), active leisure (AL) cluster (31.4%), and active home (AH) cluster (15.3%). The AL cluster demonstrated superior psychological status, physical fitness, and built environment conditions compared to both AH and LA clusters. The AH cluster exhibited better physical fitness and built environment characteristics than the LA cluster.

What are the implications for public health practice?

The distinct characteristics among clusters suggest that targeted interventions and policies may be beneficial for each subgroup. These interventions should incorporate enhanced psychosocial support, built environment modifications, and evidence-based guidance for physical fitness improvement, specifically tailored to each cluster's unique characteristics and needs.