Spatial distribution, influencing factors and innovative development countermeasures of farmer cooperatives in Hunan Province, China

China's rural reform is reliant on farmers' cooperatives as a key organization vehicle. It plays an important role in promoting rural revitalization. Such as, realizing the organic connection between small farmers and agricultural modernization. This study used the nearest neighbor index and kernel density estimation to analyze the spatial distribution and structural characteristics of farmer cooperatives in Hunan Province. It revealed the spatial differentiation law of cooperatives. Also using geographical detectors to figure out the main factors that affect the spatial distribution. The results show that: ① Hunan Farmers Cooperatives show significant spatial agglomeration. The overall spatial distribution shows the spatial characteristics of "one core, one circle, and multiple points". And the spatial distribution pattern of "large agglomeration, finger-shaped radiation distribution". Among them, the distribution of provincial demonstration cooperatives is relatively balanced. ② Cooperatives in six types of industries, such as planting, forestry, and feeding, showed agglomeration distribution. Different industrial cooperatives spread out in different ways, such as in an anti-"L" shape, a dual-core shape, or a one-center area. ③ The 24 influence factors selected from the five dimensions of the natural environment, social economic basis, production basis, output capacity, and facility basis have high, general, and weak influence on cooperatives' spatial distribution. The development and distribution of cooperatives mainly depend on resource endowment, social and economic development level, and market dependence. The spatial distribution heterogeneity of different professional cooperatives is mainly affected by slope, per capita disposable income of rural residents, road density, and other factors. ④ The progression of farmer cooperatives in Hunan Province should prioritize high-quality development, emphasizing the need for innovative approaches and transformative strategies within rural industrial organizations. It is imperative to optimize the spatial distribution of cooperatives, strategically contributing to the establishment of a novel framework for modern agricultural development in Hunan Province. Additionally, there is a critical emphasis on spearheading collaborative initiatives among cooperatives of varied industrial types, aimed at fostering the integrated development of rural primary, secondary, and tertiary industries.

Seroprevalence and Risk Factors of Chlamydia Infection in Pigs in Hunan Province, Southern China, 2017-2018

Background: Chlamydia is a Gram-negative obligate intracellular bacterium that is pathogenic for humans and a large variety of veterinary animal species. However, there is no continuous monitoring of chlamydia infection data in pigs in Hunan province, southern China. Therefore, in order to evaluate the seroprevalence and identify risk factors associated with Chlamydia infection in pigs within this region, a comprehensive study was conducted. Methods: A total of 3848 serum samples were collected from pigs (from farmers and companies) between May 2017 and August 2018. The presence of specific antibodies against Chlamydia was determined through the employment of the indirect hemagglutination assay (IHA). Results: The overall seroprevalence of Chlamydia was determined to be 26.90% (1038/3848, 95% confidence interval: 25.60-28.40). By employing statistical analysis using SPSS software (p < 0.05), factors such as altitude, sampling regions, and rearing systems of pigs were identified as potential risk factors for Chlamydia infection. Conclusion: These findings elucidate a substantial prevalence of Chlamydia in pigs within the mountainous region of Hunan province, southern China, thereby highlighting a potential risk to human health. These results underscore the need for proactive measures and targeted interventions to mitigate the transmission of Chlamydia in porcine populations, safeguarding both animal welfare and public health.

Characterization of Extended-Spectrum β-Lactamase-Producing Escherichia coli in Animal Farms in Hunan Province, China

Multi-drug resistance of bacteria producing extended-spectrum β-lactamase (ESBL) is a public health challenge. Thus, this study aimed to investigate the antimicrobial susceptibility of ESBL-producing Escherichia coli (ESBL-EC) in Hunan Province, China. A total of 1366 fecal samples were collected from pig, chicken, and cattle farms over a six-year period, which were assessed using strain isolation, 16S rRNA identification, polymerase chain reaction, drug sensitivity testing, whole-genome sequencing, and bioinformatics analysis. The results showed an overall prevalence of 6.66% for ESBL-EC strains, with ESBL positivity extents for pigs, chickens, and cattle isolates at 6.77%, 6.54%, and 12.5%, respectively. Most ESBL-EC isolates were resistant to cefotaxime, tetracycline, and trimethoprim-sulfamethoxazole; however, all the isolates were susceptible to meropenem, with relatively low resistance to amikacin and tigecycline. Various multi-locus sequence types with different origins and similar affinities were identified, with ST155 (n = 16) being the most common subtype. Several types of resistance genes were identified among the 91 positive strains, with beta-lactamase blaCTX-M-55 being the most common ESBL genotype. IncFIB was the predominant plasmid type. Widespread use of antibiotics in animal farming may increase antibiotic resistance, posing a serious threat to the health of farmed animals and, thus, to human food security and health.

Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study

BACKGROUND

Drug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China.

METHODS

A case-control study was conducted in Hunan province. Cases were all DR-TB patients who were confirmed by culture and Drug susceptibility testing (DST) and enrolled at the DR-TB treatment center of Hunan Chest Hospital from 2013 to 2018. Controls were all Drug Susceptible TB (DS-TB) patients confirmed by DST and enrolled at the same hospital during the same period. A multivariable logistic regression model was fitted to identify factors significantly associated with DR-TB.

RESULTS

A total of 17,808 patients (15,534 DS-TB controls and 2274 DR-TB cases) were included in the study, with a mean age of 42.5 years (standard deviation (SD) ± 17.5 years) for cases and 46.1 years (SD ± 19.1 years) for controls. Age 15-64 years (Adjusted odds ratio (AOR = 1.5, 95% CI; 1.4, 1.8)), ethnic minorities (AOR = 1.5; 95% CI; 1.4, 1.8), and a history of previous TB treatment (AOR) = 1.84; 95% CI: 1.57, 2.15) was significantly associated with DR-TB. Being resident in a province outside Hunan was also a significant risk factor (AOR = 1.67; 1.27, 2.21) for DR-TB.

CONCLUSION AND RECOMMENDATIONS

To prevent the occurrence of DR-TB in Hunan Province, interventions should be targeted at high-risk demographic groups such as ethnic minorities, individuals of productive age, and residents living outside the province. Interventions must also be targeted to previously treated cases, suggesting the appropriateness of diagnosis, treatment, and follow-up. Understanding the risk factors at the province level helps design strategies for controlling DR-TB due to variations by socioeconomic differences, quality of health care, and healthcare access.

Risk factors for diagnosis and treatment delay among patients with multidrug-resistant tuberculosis in Hunan Province, China

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) is a global health threat associated with high morbidity and mortality rates. Diagnosis and treatment delays are associated with poor treatment outcomes in patients with MDR-TB. However, the risk factors associated with these delays are not robustly investigated, particularly in high TB burden countries such as China. Therefore, this study aimed to measure the length of diagnosis and treatment delays and identify their risk factors among patients with MDR-TB in Hunan province.

METHODS

A retrospective cohort study was conducted using MDR-TB data from Hunan province between 2013 and 2018. The main outcomes of the study were diagnosis and treatment delay, defined as more than 14 days from the date of symptom to diagnosis confirmation (i.e., diagnosis delay) and from diagnosis to treatment commencement (i.e., treatment delay). A multivariable logistic regression model was fitted, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify factors associated with diagnosis and treatment delay.

RESULTS

In total, 1,248 MDR-TB patients were included in this study. The median length of diagnosis delays was 27 days, and treatment delays were one day. The proportion of MDR-TB patients who experienced diagnosis and treatment delay was 62.82% (95% CI: 60.09-65.46) and 30.77% (95% CI: 28.27-33.39), respectively. The odds of experiencing MDR-TB diagnosis delay among patients coming through referral and tracing was reduced by 41% (AOR = 0.59, 95% CI: 0.45-0.76) relative to patients identified through consultations due to symptoms. The odds of experiencing diagnosis delay among ≥ 65 years were 65% (AOR = 0.35, 0.14-0.91) lower than under-15 children. The odds of developing treatment delay among foreign nationalities and people from other provinces were double (AOR = 2.00, 95% CI: 1.31-3.06) compared to the local populations. Similarly, the odds of experiencing treatment delay among severely ill patients were nearly 2.5 times higher (AOR = 2.49, 95% CI: 1.41-4.42) compared to patients who were not severely ill. On the other hand, previously treated TB cases had nearly 40% (AOR = 0.59, 95% CI: 0.42-0.85) lower odds of developing treatment delay compared with new MDR-TB cases. Similarly, other ethnic minority groups had nearly 40% (AOR = 0.57, 95% CI: 0.34-0.96) lower odds of experiencing treatment delay than the Han majority.

CONCLUSIONS

Many MDR-TB patients experience long diagnosis and treatment delays in Hunan province. Strengthening active case detection can significantly reduce diagnosis delays among MDR-TB patients. Moreover, giving attention to patients who are new to MDR-TB treatment, are severely ill, or are from areas outside Hunan province will potentially reduce the burden of treatment delay among MDR-TB patients.

Spatial distribution and migration of lead and zinc and the influence of parent materials in typical paddy soils of Hunan Province, China

This study aimed to investigate the distribution and migration characteristics of lead (Pb) and zinc (Zn) in paddy soils in Hunan Province, China. A total of 343 soil samples from 63 profiles were collected from typical regions. The concentration, spatial distribution, and migration behaviors of Pb and Zn in the paddy soils were examined. The results showed that (1) the concentration ranges of Pb and Zn in the surface layer were 17.62-114.07 mg/kg and 44.98-146.84 mg/kg, respectively. (2) The content was higher in the middle and lower reaches of the Xiangjiang River basin horizontally and exhibited shallow enrichment characteristics vertically. (3) Pb migration was weaker than Zn migration, and the parent material had the most significant influence on Pb and Zn content in the bottom soil layer. The research results will clarify the characteristics of Pb and Zn contents in paddy soils in Hunan Province, further understand the horizontal distribution and vertical migration and transformation characteristics of Pb and Zn contents in paddy soils, and provide basic data for scientific rice cultivation and safe food production.

Hunan Cardiovascular and Cerebrovascular Health and Disease Report Compilation Group. Report on cardiovascular and cerebrovascular health and diseases in Hunan Province, 2020

Being the leading cause of death among both urban and rural residents in Hunan Province, China, cardiovascular and cerebrovascular diseases hold a significant position in the region's public health landscape. Their prevalence and impact not only underscore the urgency of effective disease prevention and control but also provide crucial guidance for future initiatives. Consequently, the Hunan Province Cardiovascular and Cerebrovascular Health and Disease Report Summary (2020) hereinafter referred to as the "Annual Report", serves as an extensive and informative document. It meticulously examines the current status of these diseases, highlighting both the existing challenges and opportunities for prevention and control efforts in Hunan Province. The primary objective of this report is to furnish valuable insights and evidence that will empower and enrich future endeavors aimed at combatting cardiovascular and cerebrovascular diseases within the region. In 2017, the year of life expectancy lost due to cardiovascular and cerebrovascular diseases in Hunan Province remained higher than the national average. Additionally, the per capita life expectancy in 2019 (77.1 years) was slightly lower by 0.2 years compared with the national average (77.3 years). Alarmingly, the mortality rates associated with cardiovascular and cerebrovascular diseases were consistently ranking highest, indicating an upward trajectory. Moreover, the prevalence and mortality rates of conditions such as hypertension, coronary heart disease, and stroke, all encompassed within the domain of cardiovascular and cerebrovascular diseases, surpassed the national averages. Consequently, the economic burden attributable to cardiovascular and cerebrovascular diseases is on the rise. And under vertical comparison, in 2019, the life expectancy per capita in Hunan Province increased by 1.26 years compared with 2015. The incidence rate of cardiovascular and cerebrovascular events decreased by 8.34% compared with 2017. A new model of hypertension medical and preventive integration has been established with the efforts of many experts in Hunan Province, and full coverage of standardised outpatient clinics for hypertension at the grassroots level has been realised. The rate of standardised management of patients with hypertension under management in Changsha County, a demonstration area, rose to 65.27%, and the incidence rate of cardiovascular and cerebrovascular events, the incidence rate of stroke, and the mortality rate due to cardiovascular and cerebrovascular events were reduced by 28.08%, 28.62%, and 25.00%, respectively. Hunan Province has made significant strides in the prevention and control of cardiovascular and cerebrovascular diseases in recent years.

System dynamics modelling to simulate regional water-energy-food nexus combined with the society-economy-environment system in Hunan Province, China

Nexus approaches provide an efficient way to analyze the dynamic evolution of the water-energy-food nexus (WEFN), yet there is a need to close the science-policy divide by making simulation models more practically relevant. This study incorporates society, economy and environment systems (SEE) into the WEFN, simulating a broad environmental system. A system dynamics model is constructed to simulate and dynamically track the development of the WEF-SEE system in Hunan Province, China. The developed model is applied to assess WEF-SEE system trajectories from 2021 to 2035 against nine policy goals formulated by the Hunan Provincial Government. Baseline results suggest that Hunan Province will have a surplus of grain production and will be in a state of "self-sufficiency" in water resources. The energy security situation is not as optimistic, with imports being required to meet demand. The sustainable development of the WEF Nexus will be constrained by resource shortages. As the future development of Hunan Province outpaces environmental protection policies, water pollution and CO₂ emissions and are expected to increase. Intra-system trade-offs and synergies under the impacts of different policies indicate that the implementation of an indicative policy has the intended impact within its particular subsystem, but may lead to trade-offs in other subsystems. Due to system interconnectedness, the simultaneous implementation of multiple policies may increase or hinder progress towards certain goals. For example, expanding planting area increases food production, but increase agricultural water demand and water pollutant discharge, counter to water security goal and environmental protection goals. Cross-system impacts must be considered when choosing policies. This study advances environmental system analysis and evaluation, and contributes to practical policy recommendations, providing useful insights for Hunan Province, especially considering potential trade-offs and synergies. Such information could lead to more effective, holistic environmental policy formulation.

Spatiotemporal Dynamic Evolution and Its Driving Mechanism of Carbon Emissions in Hunan Province in the Last 20 Years

Global warming caused by carbon emissions is an environmental issue of great concern to all sectors. Dynamic monitoring of the spatiotemporal evolution of urban carbon emissions is an important link to achieve the regional "double carbon" goal. Using 14 cities (prefectures) in Hunan Province as an example, based on the data of carbon emissions generated by land use and human production and life, and on the basis of estimating the carbon emissions in Hunan Province from 2000 to 2020 using the carbon emission coefficient method, this paper uses the Exploratory Spatial-Temporal Data Analysis (ESTDA) framework to analyze the dynamic characteristics of the spatiotemporal pattern of carbon emissions in Hunan Province from 2000 to 2020 through the Local Indicators of Spatial Association (LISA) time path, spatiotemporal transition, and the standard deviation ellipse model. The driving mechanism and spatiotemporal heterogeneity of urban carbon emissions were studied by using the geographically and temporally weighted regression model (GTWR). The results showed that: (1) In the last 20 years, the urban carbon emissions of Hunan Province have had a significant positive spatial correlation, and the spatial convergence shows a trend of first increasing and then decreasing. Therefore, priority should be given to this relevance when formulating carbon emission reduction policies in the future. (2) The center of carbon emission has been distributed between 112°15'57″~112°25'43″ E and 27°43'13″~27°49'21″ N, and the center of gravity has shifted to the southwest. The spatial distribution has changed from the "northwest-southeast" pattern to the "north-south" pattern. Cities in western and southern Hunan are the key areas of carbon emission reduction in the future. (3) Based on LISA analysis results, urban carbon emissions of Hunan from 2000 to 2020 have a strong path dependence in spatial distribution, the local spatial structure has strong stability and integration, and the carbon emissions of each city are affected by the neighborhood space. It is necessary to give full play to the synergistic emission reduction effect among regions and avoid the closure of inter-city emission reduction policies. (4) Economic development level and ecological environment have negative impacts on carbon emissions, and the population, industrial structure, technological progress, per capita energy consumption, and land use have a positive impact on carbon emissions. The regression coefficients are heterogeneous in time and space. The actual situation of each region should be fully considered to formulate differentiated emission reduction policies. The research results can provide reference for the green and low-carbon sustainable development of Hunan Province and the formulation of differentiated emission reduction policies, and provide reference for other similar cities in central China.

Urbanization, ecosystem services, and their interactive coercive relationship in Hunan Province, China

Failing to balance developmental considerations of the urbanization level (UL) and ecosystem services (ESs) causes issues such as land degradation and social conflict, presenting significant challenges for regional sustainable development. Although numerous studies reported the relationship between UL and ESs, only a few have explored the coupling coordination relationship between urbanization subsystems and ESs from a multidimensional perspective. This study aimed to measure the spatiotemporal characteristics of UL and ESs in Hunan Province from 2000 to 2018 using statistical data and remote sensing monitoring data regarding land use. The multidimensional coupling coordination relationship between urbanization systems and ESs was analyzed using a coupling coordination degree (CCD) model. The results showed that the UL of Hunan Province increased from 2000 to 2018, was spatially high in the east and low in the west, and extended outward from city centers. The average ecosystem services value (ESV) in Hunan Province showed a decreasing trend with some fluctuation. The average ESV in mountainous areas and lake areas was higher than that in the areas surrounding major urban agglomerations. Although the overall CCD between UL and ESs in Hunan Province increased during the study period and entered the coordination stage, the degree of coupling coordination between urbanization subsystems and ESs varied greatly. Thus, the findings of the present study can support the formulation of policies for ecosystem protection and sustainable urbanization in Hunan Province.

Serological Investigation and Genetic Characteristics of Pseudorabies Virus in Hunan Province of China From 2016 to 2020

Pseudorabies (PR), caused by variant pseudorabies virus (PRV), is an economically important viral disease in China. Recently, PRV infection in humans has also received attention worldwide. To investigate the PRV infection in Hunan province, China, we collected a total of 18,138 serum specimens from 808 PRV-vaccinated pig farms cross this region during 2016–2020, and we detected the presence of PRV glycoprotein B (gB) and gE-specific antibodies. The enzyme-linked immunosorbent assay (ELISA) results revealed that 80.47% (14,596/18,138, 95 CI 79.9–81.0) and 23.55% (4,271/18,138, 95 CI 22.9–24.2) of serum samples were positive for PRV gB and gE-specific antibodies, respectively. Further analysis indicated that the seroprevalence of wild PRV infection was associated with the season and breeding scale (p < 0.01). In addition, five PRV strains were isolated from PRV-positive samples in Vero cells and the virus titers varied from 10^6.5 to 10^7.51 TCID₅₀/0.1 ml. The phylogenetic analysis revealed that one isolate was a classical strain of PRV genotype II, and four other isolates belonged to the variants of genotype II. Collectively, the data indicate that the prevalence of PRV remains high in pigs in Hunan province, and the variant PRV strains are the major genotypes affecting the development of the pig industry.

Molecular characterization of Blastocystis sp. in Chinese bamboo rats (Rhizomys sinensis)

Blastocystis sp., a parasitic eukaryote, widely colonizes the intestines of humans and a large number of animals, including rodents and lagomorphs. More than 30 million bamboo rats (Rhizomys sinensis) are farmed in China as a source of meat for human consumption. However, there have been no published articles on Blastocystis infection in Chinese bamboo rats prior to the present study. Herein, 480 fresh faecal samples were collected from R. sinensis on six farms located in four cities (Wugang, Chenzhou, Huaihua and Jishou) in Hunan Province, south-central China, and were examined for Blastocystis infection using polymerase chain reaction (PCR) targeting the small subunit ribosomal RNA (SSU rRNA) gene. The total prevalence of Blastocystis in R. sinensis was 4.58% (22/480), and significant differences in prevalence were detected among four age groups (<6 months, 6–12 months, 12–24 months and >24 months), with the highest prevalence (7.81%) in rats aged 6–12 months but with no positive samples in rats over 24 months. All farms, except for one in Jishou, were positive for Blastocystis infection, with the prevalence ranging from 1.80% to 7.27%. Sequence and phylogenetic analyses revealed two potentially zoonotic subtypes (namely ST4 and ST5) in these rodents, with ST4 predominant in all except one farm in Huaihua. Seven and five sequence types were identified within ST4 and ST5, respectively. This is the first report of Blastocystis infection in Chinese bamboo rats and the findings suggest the potential of R. sinensis to transmit Blastocystis to humans.

Spatial Differentiation and Influencing Factors of Poverty Alleviation Performance Under the Background of Sustainable Development: A Case Study of Contiguous Destitute Areas in Hunan Province, China

Poverty eradication is a realistic requirement for the addressing of the urban-rural development imbalance. It consolidates the achievements of the poverty alleviation, and accelerates the realization of the United Nations Sustainable Development Goals. In research that deals with poverty, qualitative analysis is often used to study the connection between a single influencing factor and poverty reduction, and to solve regional poverty through government measures. However, these studies usually ignore the multidimensional nature of poverty, and the fact that poverty alleviation also needs to be approached from multiple perspectives. By constructing a theoretical framework of poverty alleviation performance from the perspective of sustainable development, this study selects contiguous poverty-stricken areas in the Hunan Province, China as the empirical study area, constructs an evaluation index system from the three dimensions of economic development, infrastructure and people's livelihood security, and selects influencing factors from three aspects of 'population', 'land' and 'industry'. The spatial differentiation characteristics and influencing factors of poverty alleviation performance in poverty-stricken areas were studied by using the methods of entropy weight method and geodetector. The results show: firstly, in the concentrated and contiguous poverty-stricken areas of the Hunan Province, the performance of poverty alleviation in the economic development makes little difference, showing a 'high-medium-low' cross-distribution pattern. The poverty alleviation performance of the infrastructure presents a distribution pattern of 'low in the middle and high on both sides. The poverty alleviation performance of people's livelihood security has significant spatial differentiation characteristics, which all present a reunion distribution. The overall poverty alleviation performance varies greatly, showing a funnel-shaped distribution in space. Secondly, the spatial differentiation of poverty alleviation performance in the concentrated and contiguous poverty-stricken areas of the Hunan Province is the result of the combined effects of multiple factors. 'Population' is the dominant factor affecting the performance of poverty alleviation, 'land' is the basic factor that causes the spatial differentiation of poverty alleviation performance, and 'industry' is the key factor for the improvement of the poverty alleviation ability.

Foodborne Parasites Dominate Current Parasitic Infections in Hunan Province, China

Great progress has been made in the prevention and treatment of human parasitic diseases in China over the past six decades, but parasitic diseases are still one of the most serious public health problems in the world. The specific prevalence of parasitic diseases varies in different provinces due to their geographical environment and the dietary habits of people. In this study, a total of 4,428 patients suspected to have parasitic infection by clinicians or themselves from January 1, 2016, to December 31, 2020 were recommended to our laboratory for further testing. In total, 5,246 samples including fecal, blood, and other body fluids were detected by etiological and immunological methods. Approximately 15.20% (673/4,428) of all suspected patients were infected by at least one species of parasite, and the overall positive rate of suspected patients from Hunan Province was 15.10% (594/3,933). A total of 18 species of parasites, namely, nematodes (4 species), trematodes (5 species), cestodes (4 species), protozoa (2 species), and medical arthropods (3 species), and 3 of them were imported parasites outside of Hunan Province. There are 9 species of foodborne parasites, accounting for 89.92% (464/516) of patients infected by one species of parasite. Common parasites in Hunan Province include plerocercoid, Paragonimus westermani, Clonorchis sinensis, cysticercus, Toxoplasma gondii, and Schistosoma japonicum. In this study, we found that the incidence of soilborne nematode infections has decreased significantly. However, foodborne parasites gradually become the main parasitic infections as well as multiple infections are becoming more common. Therefore, we should not only continue the prevention and control of soil-derived nematodes but also focus on the prevention and control of foodborne parasites in the future.

[Genetic diversity of Sparganum isolates from snakes in Hunan Province based on mitochondrial nad4 and nad5 genes]

OBJECTIVE

To investigate the genetic diversity and phylogenetic relationship of Sparganum isolates from snakes in Hunan Province.

METHODS

The partial mitochondrial NADH dehydrogenase subunit 4 (pnad4) and NADH dehydrogenase subunit 5 (pnad5) genes were amplified using a PCR assay in 7 Sparganum isolates from snakes in Hunan Province and the amplification product was sequenced. The homology and genetic evolution were investigated using the software DNAMAN 7.0, MegAlign, DnaSP 5.0 and MEGA 5.0.

RESULTS

The pnad4 and pnad5 gene sequences were approximately 578 bp and 484 bp in length in the 7 Sparganum isolates from Hunan Province, and the percentages of genetic variations were 0 to 2.8% and 0 to 0.8%, respectively. There were 4 haplotypes detected in both the pnad4 and pnad5 genes, with global haplotype diversities of 0.810 ± 0.016 and 0.905 ± 0.011, nucleotide diversities of 0.006 ± 0.005 and 0.004 ± 0.003, and mean nucleotide variations of 3.960 and 1.905, respectively. Phylogenetic analysis showed that all 7 Sparganum isolates from snakes in Hunan Province were clustered into the same branch with Spirometra erinaceieuropaei isolates from different regions/hosts in the world, which belonged to S. erinaceieuropaei, which were close to Diphyllobothrium latum and far from other tapeworms.

CONCLUSIONS

There is a low genetic variation in snake-derived S. erinaceieuropaei isolates from Hunan Province, and both pnad4 and pnad5 genes may be potential molecular genetic markers for identification of S. erinaceieuropaei.

Current Status of Schistosomiasis Control and Prospects for Elimination in the Dongting Lake Region of the People's Republic of China

Schistosomiasis japonica is an ancient parasitic disease that has severely impacted human health causing a substantial disease burden not only to the Chinese people but also residents of other countries such as the Philippines, Indonesia and, before the 1970s, Japan. Since the founding of the new People's Republic of China (P. R. China), effective control strategies have been implemented with the result that the prevalence of schistosomiasis japonica has decreased markedly in the past 70 years. Historically, the Dongting Lake region in Hunan province is recognised as one of the most highly endemic for schistosomiasis in the P.R. China. The area is characterized by vast marshlands outside the lake embankments and, until recently, the presence of large numbers of domestic animals such as bovines, goats and sheep that can act as reservoir hosts for Schistosoma japonicum. Considerable social, economic and environmental changes have expanded the Oncomelania hupensis hupensis intermediate snail host areas in the Dongting lake region increasing the potential for both the emergence of new hot spots for schistosomiasis transmission, and for its re-emergence in areas where infection is currently under control. In this paper, we review the history, the current endemic status of schistosomiasis and the control strategies in operation in the Dongting Lake region. We also explore epidemiological factors contributing to S. japonicum transmission and highlight key research findings from studies undertaken on schistosomiasis mainly in Hunan but also other endemic Chinese provinces over the past 10 years. We also consider the implications of these research findings on current and future approaches that can lead to the sustainable integrated control and final elimination of schistosomiasis from the P. R. China and other countries in the region where this unyielding disease persists.

Epidemic features of coronavirus disease 2019 in Hunan Province

OBJECTIVES

To explore and analyze the epidemic features of coronavirus disease 2019 (COVID-19) in Hunan Province from January 21, 2020 to March 14, 2020, as well as to investigate the COVID-19 epidemics in each city of Hunan Province.

METHODS

The epidemic data was obtained from the official website of Hunan Province's Health Commission. The data of each city of Hunan Province was analyzed separately. Spatial distribution of cumulative confirmed COVID-19 patients and the cumulative occurrence rate was drawn by ArcGIS software for each city in Hunan Province. Some regional indexes were also compared with that in the whole country.

RESULTS

The first patient was diagnosed in January 21, sustained patient growth reached its plateau in around February 17. Up to March 14, the cumulative confirmed COVID-19 patients stopped at 1 018. The cumulative occurrence rate of COVID-19 patients was 0.48 per 0.1 million person. The number of cumulative severe patients was 150 and the number of cumulative dead patients was 4. The mortality rate (0.39%) and the cure rate (99.6%) in Hunan Province was significantly lower and higher respectively than the corresponding average rate in the whole country (0.90% and 96.2%, Hubei excluded). The first 3 cities in numbers of the confirmed patients were Changsha, Yueyang, and Shaoyang. While sorted by the cumulative occurrence rate, the first 3 cities in incidence were Changsha, Yueyang, and Zhuzhou.

CONCLUSIONS

The epidemic of COVID-19 spread out smoothly in Hunan Province. The cities in Hunan Province implement anti-disease strategies based on specific situations on their own and keep the epidemic in the range of controllable.

[Challenges and countermeasures of schistosomiasis control in Hunan Province in the new era]

This paper describes the current epidemic characteristics and endemic status of schistosomiasis, analyzes the main challenges of schistosomiasis control and proposes the emphasis and interventions for future schistosomiasis control activities in Hunan Province, so as to provide insights into the elimination of schistosomiasis in Hunan Province.

[Effect of integrated schistosomiasis control measures in Hunan Province from 2004 to 2019]

OBJECTIVE

To examine the effect of the integrated schistosomiasis control measures in Hunan Province from 2004 to 2019, so as to provide insights into the development of the schistosomiasis elimination strategy.

METHODS

The integrated schistosomiasis control measures implemented by the health, agriculture, water resources, forestry, land and resources sectors were retrospectively collected in Hunan Province from 2004 to 2019, and the completion of each measure, cost of control measures, Schistosoma japonicum infections in humans and bovines, and snail status were analyzed each year. An index system for assessing the integrated schistosomiasis control effect was constructed using the Delphi method to calculate the integrated schistosomiasis control effect index. In addition, a cost-effect analysis was performed in terms of the decline in the prevalence of S. japonicum infections in humans and bovines, areas with snails in inner embankments, and areas with infected snails.

RESULTS

A total of 7 110 926 500 Yuan were invested into the integrated schistosomiasis control program of Hunan Province from 2004 to 2019. During the 16-year period, a total of 277 437.12 hm² snail habitats received molluscicidal treatments, 6 927 230 person-times given expanded chemotherapy, 2 116 247 bovine-times given expanded chemotherapy, 954 850 harmless toilets built, 290 359 bovines fenced, 136 666 bovines eliminated, 141 905 machines used to replace bovines, 39 048.63 hm² water lands improved as dry lands, 724.12 km irrigation regions improved, 3 994 300 populations covered with safe water, 191 102.89 hm² forests planted and 38 535.27 hm² lands leveled. The prevalence of S. japonicum infections was 4.29% in humans and 4.48% in bovines in Hunan Province in 2004, with 2 449.37 hm² snail habitats in inner embankments and 3 423.74 hm² infected snail areas. In 2019, the prevalence of S. japonicum infections reduced to 0 in both humans and bovines, and areas of snail habitats reduced to 540.92 hm² (77.92% reductions), while the areas with infected snails reduced to 0. The overall integrated schistosomiasis control effect index appeared a tendency towards a rise over years since 2004, and the integrated schistosomiasis control effect index was 97.35 in 2019; the annual mean costs for a 1% reduction in the prevalence of S. japonicum infections in 100 populations and 100 bovines were 70.11 Yuan and 4 204.78 Yuan, and the annual mean costs for a 1% reduction in the snail areas in inner embankments and infected snail areas were 2 010.20 Yuan and 1 298.09 Yuan, respectively.

CONCLUSIONS

The integrated control measures achieve remarkable effectiveness for schistosomiasis control in Hunan Province, with a remarkable decline in the prevalence of S. japonicum infections in humans and bovines and great shrinking of snail areas in inner embankments and infected snail areas. Adequate fund investment is required to improve the integrated schistosomiasis control measures and consolidate the control achievements.

[Moving towards a new era in elimination of schistosomiasis in Dongting Lake regions]

Hunan Province occupies a particular position in the history of the national schistosomiasis control programme of China. The province is hyperendemic for schistosomiasis, and achieves great successes and many experiences at various stages of the national schistosomiasis control programme of China. Recently, remarkable schistosomiasis control benefits have been achieved in Hunan Province because of the strong political will, increased financial support, intensification of the integrated control strategy and sustainable implementation of the four projects, including management of livestock and humans as sources of Schistosoma japonicum infections, snail control and capability building of schistosomiasis control institutions. In addition, a series of schistosomiasis control models have been created from the schistosomiasis control programme, and the concept of control-research combination and research serving for field control has been achieved, which provides the "Hunan experience" for the natonal schistosomiasis control programme of China. Based on the government-led multisectoralcollaboration principle, further actions are required with scientific control and joint prevention and control, implementation of the integrated strategy with emphases on controlling sources of S. japonicum infections and snails, adequate financial support, improved professional capability building, and innovative medical treatment-prevention combination patterns, so as to achieve the goal of schistosomiasis elimination in Hunan Province as soon as possible.

[Endemic situation of schistosomiasis in national surveillance sites of Hunan Province from 2015 to 2019]

OBJECTIVE

To analyze the changes in the endemic situation of schistosomiasis in national surveillance sites of Hunan Province, so as to provide scientific basis for the development of the schistosomiasis elimination programme in the province.

METHODS

According to the requirements of the National Guidelines for Schistosomiasis Surveillance in China (2014 version), a total of 41 national schistosomiasis surveillance sites were assigned in all disease-endemic counties (districts) across Hunan Province. During the period between 2015 and 2019, Schistosoma japonicum infections were monitored in local residents, mobile populations and livestock, and snail status was monitored. The morbidity due to schistosomiasis and snail status was compared between years.

RESULTS

The sero-prevalence of S. japonicum infections was 2.57% and 1.56% in local residents and mobile populations in national surveillance sites of Hunan Province from 2015 to 2019, respectively, and the sero-prevalence appeared a tendency towards a decline over years. A higher sero-prevalence rate of S. japonicum infections was seen in men than in women (P < 0.01). During the 5-year study period, the sero-prevalence rate of human S. japonicum infections appeared a tendency towards a decline in the marshland, embankment, inner embankment and hilly types of endemic areas over years. There were 44 and 19 egg -positives detected in local residents and 5 and 1 egg-positives in mobile populations in 2015 and 2016 respectively. A total of 9 346 domestic animals were monitored from 2015 to 2019, and 6 egg-positives were detected in 2015 and 2016 (all were bovine). A total of 0.155 billion m² settings were surveyed from 2015 to 2019, and the mean density of living snails appeared a tendency towards a decline over years, with a 45.79% reduction in 2019 as compared to 2015. However, no S. japonicum infections were identified in snails during the 5-year period. A total of 1 469 mixed snail samples were detected using loop-mediated isothermal amplification (LAMP), and 6 positive snail samples were identified in 2015 (one sample) and 2017 (5 samples).

CONCLUSIONS

The overall endemic situation of schistosomiasis appears a tendency towards a decline in Hunan Province, and the prevalence of S. japonicum infections is at a low level in humans and livestock; however, there is still a risk of schistosomiasis transmission. Improvements of health education, intensification of schistosomiasis examinations in mobile populations and reinforcement of the surveillance-response system is required to consolidate the achievements of schistosomiasis control in Hunan Province.

[Endemic situation of schistosomiasis in Hunan Province in 2019]

OBJECTIVE

To analyze the endemic situation of schistosomiasis in Hunan Province in 2019, so as to provide insights into the achievement of transmission interruption of schistosomiasis in the province in 2020.

METHODS

The data pertaining to Schistosoma japonicum infections in humans and livestock and snail status were captured from Hunan Province in 2019 and analyzed.

RESULTS

Schistosomiasis was endemic in 281 townships (towns) from 41 counties (districts) of 6 cities in Hunan Province by the end of 2019. A total of 991 900 persons received blood testing in Hunan Province in 2019, and 22 773 were positive for the blood testing, with sero-prevalence of 2.30%. All stool examinations were negative in 22 933 individuals detected. The high sero-prevalence was seen in Nanxian County, Anxiang County and Ziyang District. Currently, there were 5 034 cases with advanced schistosomiasis detected in Hunan Province, and they were predominantly identified in Yuanjiang City, Heshan District and Yueyang County. There were 44 963 bovines fenced in schistosomiasis-endemic villages in Hunan Province in 2019, which were predominantly distributed in Yuanjiang City, Hanshou County and Ziyang District, and no positives were detected in 1 996 bovines receiving blood testing or 20 684 bovines receiving stool examinations. In 2019, there were snail habitats of 1.73 billion m² found in Hunan Province, which were mainly found in Yuanjiang City, Hanshou County and Yueyang County.

CONCLUSIONS

The endemic situation of schistosomiasis further decreases in Hunan Province in 2019; however, there is still a risk of schistosomiasis transmission in local areas of the province.

[Application of the exponential smoothing model and ARIMA model in prediction of the endemic situation of schistosomiasis in Hunan Province]

OBJECTIVE

To predict the changes in the prevalence of Schistosoma japonicum infections in humans and livestock in Hunan Province using the exponential smoothing model and the ARIMA model.

METHODS

The data pertaining to S. japonicum infections in humans and livestock in Hunan Province from 1957 to 2015 were collected, and the exponential smoothing model and the ARIMA model were created using the software Eviews and PASW Statistics 18.0. In addition, the effectiveness of these two models for the prediction of S. japonicum infections in humans and livestock in Hunan Province from 2016 to 2018 was evaluated.

RESULTS

The exponential smoothing model and the ARIMA model had a high goodness of fit for prediction of S. japonicum infections in humans and livestock in Hunan Province from 1957 to 2015. There was a linear trend in the prevalence of S. japonicum infections in humans and livestock in Hunan Province from 1957 to 2015. The prevalence of S. japonicum infections in humans predicted with the Brown's linear trend and the prevalence of S. japonicum infections in livestock predicted with the Holt's linear trend in Hunan Province from 2016 to 2018 fitted better the actual data than the ARIMA model; however, prediction of the ARIMA model indicated that the endemic situation of schistosomiasis remained at a low level in Hunan Province.

CONCLUSIONS

At a low epidemic level, development of highly sensitive tools for monitoring schistosomiasis is urgently needed in Hunan Province to fit the current endemic situation, and the schistosomiasis control measures should be intensified to consolidate the control achievements.

[Survey of the capacity building of the county-level schistosomiasis diagnosis network laboratory in Hunan Province]

OBJECTIVE

To examine the construction and operation of the schistosomiasis diagnostic network platform in Hunan Province, so as to provide insights into the improvements of the schistosomiasis diagnostic network laboratory system in the province.

METHODS

According to the criteria and requirements for the construction of the county-level schistosomiasis diagnostic network laboratory in China, the establishment and operation of the laboratory were assessed using self-assessment and field review in national schistosomiasis surveillance sites of Hunan Province.

RESULTS

A total of 41 county-level schistosomiasis diagnostic network laboratories were built in national schistosomiasis surveillance sites of Hunan Province, and 36 met the requirements for the construction of the national schistosomiasis diagnostic network laboratory in China, which were approved for inclusion in the province-level schistosomiasis diagnostic network laboratory. During the six inter-laboratory comparisons performed by the national schistosomiasis diagnostic reference center of China, full consistency was achieved by 3 county-level schistosomiasis diagnostic network laboratories in Hunan Province, and the coincidence rates for re-review of serological and pathogenic detection samples were 98.40% and 100%, respectively.

CONCLUSIONS

The county-level schistosomiasis diagnostic network laboratory system has been preliminarily built and under effective operation in Hunan Province; however, the building capability remains to be improved.

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

BACKGROUND

A reasonable allocation of health resources is often characterized by equity and high efficiency. This study aims to evaluate the equity and efficiency of maternal and child health (MCH) resources allocation in Hunan Province, China.

METHODS

Data related to MCH resources and services was obtained from the Hunan maternal and child health information reporting and management system. The Gini coefficient and data envelopment analysis (DEA) were employed to evaluate the equity and efficiency of MCH resources allocation, respectively.

RESULTS

The MCH resources allocation in terms of demographic dimension were in a preferred equity status with the Gini values all less than 0.3, and the Gini values for each MCH resources' allocation in terms of the geographical dimension ranged from 0.1298 to 0.4256, with the highest values in the number of midwives and medical equipment (≥ CNY 10,000), which exceeds 0.4, indicating an alert of inequity. More than 40% regions in Hunan were found to be relatively inefficient with decreased return to scale in the allocation of MCH resources, indicating those inefficient regions were using more inputs than needed to obtain the current output levels.

CONCLUSIONS

The equity of MCH resources by population size is superior by geographic area and the disproportionate distribution of the number of medical equipment (≥ CNY 10,000) and midwives between different regions was the main source of inequity. Policy-makers need to consider the geographical accessibility of health resources among different regions to ensure people in different regions could get access to available health services. More than 40% of regions in Hunan were found to be inefficient, with using more health resources than needed to produce the current amount of health services. Further investigations on factors affecting the efficiency of MCH resources allocation is still needed to guide regional health plans-making and resource allocation.

A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China's Hunan Province

OBJECTIVE

Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China.

METHODS

Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods.

RESULTS

Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness.

CONCLUSIONS

Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.

Bioaccessibility and variation of arsenic species in polished rice grains by an in vitro physiologically based extraction test method

The bioaccessibility and speciation of arsenic (As) in rice grains have been investigated by the physiologically based extraction test (PBET) method. A total of 42 rice samples were collected from Hunan Province, a typical mine-impacted province in China. The bioaccessibility in the gastrointestinal tract was 71.7 ± 13.5% for the collected rice grains. Arsenite [As(III)] was the predominant As species in the simulated gastric and gastrointestinal solutions, followed by dimethylarsinic acid (DMA), arsenate [As(V)] and monomethylarsonic acid (MMA). The bioaccessible As(V) was irrelevant to As(V) in the rice grains, suggesting that interconversion between As(V) and other species was occurred in the simulated gastrointestinal tract. Monte-Carlo simulation was introduced to assess the health risk from exposure to inorganic As. The average values for target hazard quotient (THQ) and bioaccessible THQ were 2.704 and 1.637, respectively. The inclusion of bioaccessibility reduced the probability of non-carcinogenic health risk from 97.32% to 76.86%.

First report of Giardia duodenalis infection in bamboo rats

Background

The zoonotic parasite, Giardia duodenalis (syns. G. lamblia and G. intestinalis), has been widely reported in humans and animals, including rodents. The bamboo rat, a rodent species belonged to the subfamily Rhizomyinae, is farmed in China because of its medicinal and edible values. However, no information of G. duodenalis infection was available in bamboo rats prior to the present study. Here, the prevalence and genetic diversity of G. duodenalis in bamboo rats from Hunan Province of China were investigated.

Results

Of 480 faecal samples collected from six farms located in four cities (Wugang, Chenzhou, Huaihua and Jishou) of Hunan Province, 52 (10.8%) were positive for G. duodenalis infection by using a nested PCR approach targeting the beta giardin (bg) gene. Significant differences (P < 0.01) in prevalence were found among different age groups and geographical localities, and among different farms in Wugang city. Sequence analysis revealed existence of the zoonotic assemblage B and genetic diversity of G. duodenalis in these animals. Multilocus genotyping analysis also indicated broad genetic diversity of assemblage B isolates in these bamboo rats.

Conclusions

This is the first report of the infection and genetic variations of G. duodenalis in bamboo rats. These findings will provide basic data for implementing effective strategies to control giardiasis in bamboo rats.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3111-2) contains supplementary material, which is available to authorized users.

[Analysis of characteristics of medical assistance to advanced schistosomiasis patients in Hunan Province, 2015]

OBJECTIVE

To understand the current distribution and characteristics of advanced schistosomiasis patients who accepted medical assistance in Hunan Province in 2015, so as to provide the evidence for perfecting the policy and measures of the medical assistance to advanced schistosomiasis patients.

METHODS

The patients who had been diagnosed as advanced schistosomiasis were verified and confirmed according to the standard of the medical assistance to advanced schistosomiasis patients in Hunan Province in 2015. The epidemiological survey was conducted to investigate the demographic characteristics, history of diagnosis and treatment, and medical assistance to these persons.

RESULTS

There were 3 850 advanced schistosomiasis patients who accepted the medical assistance in Hunan Province in 2015, and among them, 2 664 patients were male (69.19%), and 1 186 were female (30.81%). Most of them (92.82%) came from the main schistosomiasis endemic areas, such as Yueyang, Changde and Yiyang. There were 2 369 cases of ascites (61.53%), 1 466 cases of splenomegaly (38.08%), 15 cases of colon proliferation and dwarf (0.39%). The mean age of advanced schistosomiasis patients who accepted the medical assistance was (62.94 ± 11.67) years old, with 64.31% of them being more than 60 years old. The age of initial diagnosis of advanced schistosomiasis was (53.85 ± 21.32) years old, and it was concentrated in 40-60 years old (68.57%). The mean duration of advanced schistosomiasis was (9.58 ± 10.06) years, and it was mainly distributed in 10 years (75.95%). The mean duration from initial diagnosis of schistosomiasis to advanced schistosomiasis was (22.33 ± 14.20) years. The priority of the medical assistance to advanced schistosomiasis patients was given to the county hospitals (76.57%); and the effective rate of assistance was 94.46%. Totally 86.57% of the patients with advanced schistosomiasis got the medical insurance (rural cooperative medical care, urban medical care, etc.).

CONCLUSIONS

The burden of the medical assistance to advanced schistosomiasis patients is still heavy because of many patients and low cure rate in Hunan Province. The ascites patients and high age patients should be the important objects of the medical assistance.

Third molar mineralization in relation to chronologic age estimation of the Han in central southern China

The purpose of this study is to provide a forensic reference data about estimating chronologic age by evaluating the third molar mineralization of Han in central southern China. The mineralization degree of third molars was assessed by Demirjian's classification with modification for 2519 digital orthopantomograms (1190 males, 1329 females; age 8-23 years). The mean ages of the initial mineralization and the crown completion of third molars were around 9.66 and 13.88 years old in males and 9.52 and 14.09 years old in females. The minimum ages of apical closure were around 16 years in both sexes. Twenty-eight at stage C and stage G and 38 and 48 at stage F occurred earlier in males than in females. There was no significant difference between maxillary and mandibular teeth in males and females except that stage C in males. Two formulas were devised to estimate age based on mineralization stages and sexes. In Hunan Province, the person will probably be over age 14, when a third molar reaches the stage G. The results of the study could provide reference for age estimation in forensic cases and clinical dentistry.

[A comparison of knowledge awareness rates and influencing factors of clonorchiasis among residents in 4 counties (cities) of Hunan Province]

OBJECTIVE

To understand the status of knowledge awareness rates and influencing factors of clonorchiasis among the residents in 4 counties (cities) of Hunan Province, so as to provide the references for formulating the prevention and control strategy of clonorchiasis in the province.

METHODS

A total of 1 224 subjects were selected by the multi-stage cluster sampling method and investigated with questionnaires and face-to-face interviews.

RESULTS

The clonorchiasis knowledge awareness rates of the residents were 15.67% in Yongzhou City, 9.94% in Yueyang City, 13.25% in Wangcheng County, and 21.96% in Tongdao County, respectively. In the whole province, the clonorchiasis knowledge awareness rates of the residents were 44.67%, 56.43%, 60.95%, and 42.46% in the etiology, clinical manifestations, epidemiological characteristics and daily prevention, respectively. The logistic regression showed that the influencing factors of clonorchiasis knowledge awareness rates were the daily dining place, whether or not having the medical personnel in the family, the degree of attention to the relevant news reports, and the history of parasitic diseases.

CONCLUSIONS

The level of clonorchiasis than that in other areas, but the overall level of clonorchiasis knowledge awareness of the residents in Hunan Province is not high. Therefore, the relevant authority should strengthen the health education in clonorchiasis prevention knowledge including personal daily food hygienic knowledge. knowledge awareness rate of the residents in the west-southern areas of Hunan Province is higher.

Arsenic speciation in locally grown rice grains from Hunan Province, China: Spatial distribution and potential health risk

Arsenic contaminations have been evaluated in rice grains from Hunan Province, China. Forty-three locally grown rice samples were collected from 40 counties. Arsenic species including As(III), As(V), MMA and DMA were separated and determined by HPLC-ICP-MS method. The mean concentration of total arsenic in rice samples was 129.4±49.2μg/kg, lower than the Chinese maximum contaminant levels of inorganic arsenic in rice (200μg/kg). The dominant species detected in rice samples was As(III), following DMA, As(V) and MMA. The Pearson's correlation analysis indicated significant positive relationships between As(III) and total arsenic (r=0.939, p<0.01), and DMA and total arsenic (r=0.761, p<0.01). However, the percentage of As(III) decreased with the total arsenic concentration in rice (r=-0.515, p<0.01). Spatial distribution map of total arsenic concentration in rice samples from Hunan Province was obtained using kriging interpolation. High levels of total arsenic in rice grains were observed in south and east regions associated with mining activities and urbanization process. The cancer risk and hazard quotient were employed to estimate the potential human health risk. The results suggested great carcinogenic risk and high potential non-carcinogenic risk to people consuming local rice in Hunan Province.

[Management strategy and technology of medical assistance to advanced schistosomiasis patients in Hunan Province]

The medical assistance to advanced schistosomiasis patients established by the Chinese government is a major public facility for patients with advanced schistosomiasis. Since the medical assistance to advance schistosomiasis patients in Hunan Province started ten years ago, a set of mature and operable programs with whole program management and related technologies has been developed. The author investigated the data on medical assistance to advanced schistosomiasis patients in Hunan Province during the last 10 years (from 2006 to 2015) retrospectively, and found that the program had high therapeutic effect and high satisfaction degree of both patients and the society. In order to improve the management of the medical assistance to advanced schistosomiasis patients and share our experiences of the whole program management and related technologies with the colleagues of other provinces, this paper mainly illustrates the experiences of the program, as well as the existing problems and related strategies.

[Investigation of direct medical expense for surgical patients with splenomegalic advanced schistosomiasis in Hunan Province from 2010 to 2014]

OBJECTIVE

To understand the direct medical expense for surgical patients with splenomegalic advanced schistosomiasis and its influencing factors, so as to provide evidences for relevant departments to improve the rescue strategy of advanced schistosomiasis.

METHODS

The data about the expenses of patients with splenomegalic advanced schistosomiasis hospitalized in Xiangyue Hospital affiliated to Hunan Institute of Schistosomiasis Control from January 2010 to August 2014 were collected, the hospitalization expense and hospital stays of the patients were analyzed, and the factors influencing the hospital expenses were analyzed by the univariate and multi-factor analyses.

RESULTS

From January 2010 to August 2014, totally 249 cases were hospitalized in the hospital, their average hospital stays and hospital expenses were 28.92 d and 18 896.13 Yuan, and both of them were increased year by year. Among all the kinds of expenses, the constitution ratios of the medicine expenses were the highest, and those in the 5 years were all above 44%. The results of the univariate and multi-factor analyses showed that the hospital stays, the amount of intraoperative bleeding, liver function classification, postoperative complications, age, portal hypertensive gastropathy were the influencing factors of the hospital expenses.

CONCLUSIONS

Presently, the burden of the direct hospital expenses of the patients with splenomegalic advanced schistosomiasis is still heavy. The government should further improve the proportion of the compensation of medical assistance and perfect the medical aid scheme. Meanwhile, the hospitals should strengthen the management and standardize medical behavior to reduce the hospitalization expenses of the patients.