Objective To analyze the genetic characteristics of breakthrough varicella-zoster virus infection during the varicella outbreaks in Minhang District of Shanghai in 2013-2014. Methods Samples of the varicella-zoster liquid were collected from patients with chickenpox in Minhang District in 2013-2014 and used for the extraction of genomic DNA. The open reading frame ( ORF) of 22 and 62 regions were se-quenced and further analyzed by using bioinformatics methods. Results A total of 24 samples were success-fully collected and sequenced, and all of them were wild strains. Among the 24 varicella-zoster virus strains, 23 strains were highly homologous to the parental strain ( P-Oka) and the vaccine strain ( V-Oka) , indica-ting that they belonged to J genotype. Only one strain, whose genotype was between M and E, was highly ho-mologous to the mosaic( M) CA123 strain ( M1 genotype) , indicating that it might belong to M1 genotype. Conclusion The epidemic strains of varicella-zoster virus in Minhang District were mainly J genotype. Lo-cal epidemic of M and other genotypes of varicella-zoster virus also existed. There were some gene variations in different strains of J genotype. These varicella-zoster virus strains of non-vaccine genotypes might be one of the reasons causing the breakthrough cases of chicken pox.

Objective To evaluate the epidemiological efficacy of 23-valent pneumococcal poly-saccharide vaccine on the clinical symptoms and the incidence of respiratory tract infections in the elderly over 60 years old in Minhang District, Shanghai. Methods A prospective cohort study was conduct, in which the sample size was 1 200 for both inoculated and uninoculated groups. This study followed the two groups of subjects every quarter for a year. Clinical symptoms and the incidence of respiratory tract infectious diseases as well as the acute onset of chronic respiratory diseases were compared between the subjects of the two groups. Results Compared with the uninoculated group, less people in the inoculated group developed the clinical symptoms of respiratory tract infection (RR=0. 894, 95% CI: 0. 804-0. 994). Immunization with the 23-valent pneumococcal polysaccharide vaccine protected 57. 7% of the senior citizens (≥75 years old) from respiratory tract infections(95% CI:0. 207-0. 775). Conclusion The 23-valent pneumococcal polysaccharide vaccine can effectively reduce the incidence of respiratory tract infections in the elderly aged 60 years old and over and protects the elderly aged 75 years old and over from respiratory tract infections. Further studies on the immunological efficacy of 23-valent pneumococcal polysaccharide vaccine should be carried out by measuring the antibody titers before and after vaccination.

Objective To investigate the clinical significance of measuring resting energy expenditure (REE) for guiding an accurate nutritional support in elderly bedridden patients with nasal feeding.Methods The REE of 32 elderly bedridden patients with nasal feeding was assessed by using the Cosmed K4b2 portable telemetric gas analysis system.The waist-hip ratio, serum levels of albumin, transferrin, prealbumin and retinol-binding protein were determined to assess comprehensive nutrition status.The energy intakes were calculated, and the correlation of REE and the difference between the energy intakes and consumption with nutritional index were analyzed.Results The resting energy expendture was lower in the patients with waist-hip ratio≥0.95 than in patients with waist-hip ratio ＜0.95 (t=3.622, P＜0.01).The waist-hip ratio was reduced and serum albumin and transferrin levels were decreased along with the increase of REE in elderly patients (r=-0.55,-0.36 and-0.593, respectively, P=0.001, 0.043, ＜0.001).The difference between the energy intake and expenditure was higher in patients with waist-hip ratio≥0.95 than those with waist-hip ratio＜0.95 (t =5.643, P＜ 0.001).Serum albumin, prealbumin, transferrin and retinol-binding protein levels were increased along with the increase of the difference between the energy intake and expenditure, which showed the positive correlations (r=0.525, 0.409, 0.624, 0.414, respectively,P=0.002, 0.02, ＜0.001, 0.019).Conclusions Precise determination of REE and energy intake guided by REE are the important guarantees for the reasonable nutrition support in the elderly.

Objective To measure the titers of varicella live attenuated vaccines ( VarV) during the process of transportation and storage in different seasons and communities of Minhang Distract, Shang-hai, to evaluate the operation of cold chain system and the thermal stability of vaccines and to provide refer-ences for the management, introduction, research and development of vaccine in future.Methods Four communities with high outbreak rates of varicella during 2012 to 2013 and four communities with low out-break rates were randomly selected from 13 communities in Minhang District, Shanghai.The titers of VarVs were detected by using the quantitative plaque assay before and after 30 days of storage in November 2013 and February, May, August 2014.Results The overall rate of qualified VarVs was 90.63% with a geo-metric mean titer (GMT) of 3.67 (LgPFU/0.5 ml).96.88%of the VarVs produced by company C met the quality standard with a GMT of 3.89 ( LgPFU/0.5 ml) followed by those produced by company B with a rate of 91.67%and a GMT of 3.75 ( LgPFU/0.5 ml) .The rate of qualified VarVs produced by company A was the lowest, which was 80.00%, with GMT of 3.29 (LgPFU/0.5 ml).There were significant differences in the rates of qualified VarV among the three companies (χ2=8.288, P=0.016).The rate of qualified vac-cines in communities close to the Shanghai Minhang Center for Disease Control and Prevention ( Minhang CDC) was 91.67%, while 100%of the vaccine samples collected form the communities at a middling dis-tance from or far from the Minhang CDC met the quality standard.No significant difference in the rate of qualified vaccine was found among the three types of communities (χ2=3.441, P=0.179).The quarterly rates of qualified vaccines produced by B and C companies were 100%except for the third quarter.The rates of qualified vaccines produced by A, B and C companies in the third quarter were respectively 70.00%, 66.67%and 87.50%.No statistical differences in the quarterly rates of qualified vaccines were found among the three companies (χ2=1.25, P=0.7412;χ2=6.545, P=0.088; χ2=6.194, P=0.103).No statistical differences in the rates of qualified vaccines before and after 30 days of storage were found among the three companies (χ2=0.625, P=0.347;χ2=0.000, P=1.000;χ2=2.065, P=0.492).Conclusion A well-managed and-operated cold chain system was implemented in Minhang District in the storage and transport of vaccines as well as other related links.The thermal stability of vaccines produced by company C was better than those of the other two companies.A surveillance for the titers of vaccines produced by com-pany A should be strengthened.

Objective To explore the impacts of knowledge-attitude-practice (KAP) model for elderly patients with hypertension.Methods From February 2014 to February 2016, 180 hypertension patients admitted in Elderly Cardiovascular Department was selected as the research object, and according to random number table, they were divided into the observation group and the control group on average. The patients in the control group received routine nursing care, while the patients in the observation group were cared by KAP model based on routine nursing. Before and 6 months after intervention, the self-nursing ability measurement scale (ESCA) and self-designed hypertension disease cognitive scale were used to investigate the nursing ability and cognitive level of disease in two groups.Results After the intervention, the self-concept, self-protection responsibility, self-care skills, health knowledge level and self-nursing ability score in the observation group were significantly higher than those of the control group, and the difference was statistically significant (P<0.05). After the intervention, the scores of knowledge in the observation group were significantly higher than that of the control group in reasonable diet, work and rest, exercise, emotional control (P<0.05).Conclusions The KAP can effectively improve the nursing ability,treatment adherence and disease cognitive level of the hypertension patients.

OBJECTIVESTo survey on the vaccination of varicella live attenuated vaccine among 4-17 children in Minhang District, and analyze the protective effect against varicella.

METHODSWe collected outbreak chickenpox cases reported from infectious disease report system and surveillance units in Minhang district from 1st May in 2012 to 30th Apr in 2013. The 1: 3 matched case-control study was conducted to questionnaire the legal guardian of the cases and control group, and calculate the protective effect and effective term of protection. The survey included vaccination, chickenpox exposure history, previous history of varicella illness, suffering from the symptoms of chickenpox, the vaccinations brand, etc. The criteria of accepted case were those healthy students who were in the same class with those chickenpox cases. The accepted matched controlling data were those children who were from the same class with outbreak chickenpox cases without varicelliform eruption, similar live condition, the closest house, the same gender, the closest age. This study investigated 390 cases of patients and the control group included 1 170 cases. Chi-square test was used to compare the vaccination of cases and controls, as well as the incidence of chickenpox vaccination different brands VarV, Mantel-Haenzel chi-square test was applied to compare the protective effect of the two groups.

RESULTSVarV overall vaccination rate was 68.3% (1 065/1 560), among them, the case group coverage was 45.1% (176/390), significantly lower than the control group (76.0% (889/1 170)) (χ² = 128.55, P < 0.01). The coverage in children of 4-10 years old group was 88.4% (375/424), significantly higher than the 11-17 years old group (60.7% (690/1 136)) (χ² = 109.40, P < 0.01). The overall protective effect of VarV was 78.10% (71.82%-82.98%).Vaccinated group incidence ratio was 16.5% (176/1 065), significantly lower than the unvaccinated group (43.2% (214/495)) (χ² = 128.55, P < 0.01). The chickenpox risk of the children who were vaccinated was lower than those who were not, and the OR (95%CI) was 0.22(0.17-0.28) . Proportion of the fever and the typical symptoms of varicella zoster were 26.1% (46/176), 8.0% (14/176) in the children vaccinated VarV, significantly lower than children without VarV vaccination history (54.7% (117/214) , 18.2% (39/214) ) (χ² values were 32.33 and 8.67, respectively. P values both <0.01). The varicella incidence was 17.4% (139/797) in children vaccinated domestic VarV, and it was 13.8% (37/268) in the group of imported VarV (χ² = 1.92, P = 0.184) . The average duration of effective protection period for domestic and imported VarV was (6.2 ± 2.7), (6.3 ± 3.4) years (F = 2.24, P = 0.136).

CONCLUSIONSThe risk of varicella incidence and the proportion of fever or typical varicella zoster were lower in the one dose of VarV vaccinated; Effective protective effect was consistent in the children with domestic or imported VarV vaccination.

Adolescent ; Case-Control Studies ; Chickenpox ; Chickenpox Vaccine ; Child ; Child, Preschool ; China ; Disease Outbreaks ; Fever ; Humans ; Immunity, Active ; Incidence ; Risk ; Surveys and Questionnaires ; Treatment Outcome ; Vaccination ; Vaccines, Attenuated

Objectives To survey on the vaccination of varicella live attenuated vaccine among 4-17 children in Minhang District, and analyze the protective effect against varicella.Methods We collected outbreak chickenpox cases reported from infectious disease report system and surveillance units in Minhang district from 1st May in 2012 to 30th Apr in 2013.The 1∶3 matched case-control study was conducted to questionnaire the legal guardian of the cases and control group, and calculate the protective effect and effective term of protection.The survey included vaccination, chickenpox exposure history, previous history of varicella illness, suffering from the symptoms of chickenpox, the vaccinations brand, etc.The criteria of accepted case were those healthy students who were in the same class with those chickenpox cases.The accepted matched controlling data were those children who were from the same class with outbreak chickenpox cases without varicelliform eruption, similar live condition, the closest house, the same gender, the closest age.This study investigated 390 cases of patients and the control group included 1 170 cases. Chi-square test was used to compare the vaccination of cases and controls, as well as the incidence of chickenpox vaccination different brands VarV, Mantel-Haenzel chi-square test was applied to compare the protective effect of the two groups.Results VarV overall vaccination rate was 68.3%( 1 065/1 560 ) , among them, the case group coverage was 45.1% ( 176/390 ) , significantly lower than the control group (76.0%(889/1 170)) (χ2 =128.55,P<0.01) .The coverage in children of 4-10 years old group was 88.4%(375/424), significantly higher than the 11-17 years old group (60.7%(690/1 136)) (χ2 =109.40,P <0.01 ) .The overall protective effect of VarV was 78.10%( 71.82%-82.98%) .Vaccinated group incidence ratio was 16.5% ( 176/1 065 ) , significantly lower than the unvaccinated group ( 43.2%(214/495))(χ2 =128.55,P<0.01).The chickenpox risk of the children who were vaccinated was lower than those who were not,and the OR (95%CI) was 0.22(0.17-0.28).Proportion of the fever and the typical symptoms of varicella zoster were 26.1% ( 46/176 ) , 8.0% ( 14/176 ) in the children vaccinated VarV,significantly lower than children without VarV vaccination history ( 54.7%( 117/214 ) ,18.2%( 39/214))(χ2 values were 32.33 and 8.67,respectively.P values both <0.01).The varicella incidence was 17.4%(139/797 ) in children vaccinated domestic VarV, and it was 13.8%( 37/268 ) in the group of imported VarV(χ2 =1.92,P=0.184).The average duration of effective protection period for domestic and imported VarV was (6.2 ±2.7),(6.3 ±3.4) years(F=2.24,P=0.136).Conclusions The risk of varicella incidence and the proportion of fever or typical varicella zoster were lower in the one dose of VarV vaccinated; Effective protective effect was consistent in the children with domestic or imported VarV vaccination.

ABSTRACT:Objective To assess the effectiveness of the disease management model of stepped-nursing intervention in the metabolic control in patients with type 2 diabetes (DM2). Methods 114 patients with DM2 were randomized in experimental group and control group.The experimental group applied stepped-nursing model while the control group applied conventional nursing.Blood glucose,glycated hemoglobin A1c,body mass index (BMI),waist -hip ratio (WHR),blood pressure,lipids and control criteria were observed.Results BMI,glycated hemoglobin A1c,fasting blood sugar(FBS),triglycerides,systolic blood pressure (SBP)levels and diabetic knowledge score decreased significantly in the stepped-nursing group(P <0.05).The decrease levels in postprandial blood sugar(PBS),diastolic blood pressure (DBP),total cholesterol (TC),LDL cholesterol and WHR reduced,which showed no significant difference(P >0.05). The levels of HDL cholesterol were slightly improved,which showed no significant difference(P >0.05).Conclusion Stepped-nursing model is useful in overall treatment of patients with type 2 diabetes,it improves the condition of glycated hemoglobin A1c,SBP levels FBS and triglycerides and increases the command of diabetic knowledge.

Objectives To survey on the vaccination of varicella live attenuated vaccine among 4-17 children in Minhang District, and analyze the protective effect against varicella.Methods We collected outbreak chickenpox cases reported from infectious disease report system and surveillance units in Minhang district from 1st May in 2012 to 30th Apr in 2013.The 1∶3 matched case-control study was conducted to questionnaire the legal guardian of the cases and control group, and calculate the protective effect and effective term of protection.The survey included vaccination, chickenpox exposure history, previous history of varicella illness, suffering from the symptoms of chickenpox, the vaccinations brand, etc.The criteria of accepted case were those healthy students who were in the same class with those chickenpox cases.The accepted matched controlling data were those children who were from the same class with outbreak chickenpox cases without varicelliform eruption, similar live condition, the closest house, the same gender, the closest age.This study investigated 390 cases of patients and the control group included 1 170 cases. Chi-square test was used to compare the vaccination of cases and controls, as well as the incidence of chickenpox vaccination different brands VarV, Mantel-Haenzel chi-square test was applied to compare the protective effect of the two groups.Results VarV overall vaccination rate was 68.3%( 1 065/1 560 ) , among them, the case group coverage was 45.1% ( 176/390 ) , significantly lower than the control group (76.0%(889/1 170)) (χ2 =128.55,P<0.01) .The coverage in children of 4-10 years old group was 88.4%(375/424), significantly higher than the 11-17 years old group (60.7%(690/1 136)) (χ2 =109.40,P <0.01 ) .The overall protective effect of VarV was 78.10%( 71.82%-82.98%) .Vaccinated group incidence ratio was 16.5% ( 176/1 065 ) , significantly lower than the unvaccinated group ( 43.2%(214/495))(χ2 =128.55,P<0.01).The chickenpox risk of the children who were vaccinated was lower than those who were not,and the OR (95%CI) was 0.22(0.17-0.28).Proportion of the fever and the typical symptoms of varicella zoster were 26.1% ( 46/176 ) , 8.0% ( 14/176 ) in the children vaccinated VarV,significantly lower than children without VarV vaccination history ( 54.7%( 117/214 ) ,18.2%( 39/214))(χ2 values were 32.33 and 8.67,respectively.P values both <0.01).The varicella incidence was 17.4%(139/797 ) in children vaccinated domestic VarV, and it was 13.8%( 37/268 ) in the group of imported VarV(χ2 =1.92,P=0.184).The average duration of effective protection period for domestic and imported VarV was (6.2 ±2.7),(6.3 ±3.4) years(F=2.24,P=0.136).Conclusions The risk of varicella incidence and the proportion of fever or typical varicella zoster were lower in the one dose of VarV vaccinated; Effective protective effect was consistent in the children with domestic or imported VarV vaccination.

ABSTRACT:Objective To assess the effectiveness of the disease management model of stepped-nursing intervention in the metabolic control in patients with type 2 diabetes (DM2). Methods 114 patients with DM2 were randomized in experimental group and control group.The experimental group applied stepped-nursing model while the control group applied conventional nursing.Blood glucose,glycated hemoglobin A1c,body mass index (BMI),waist -hip ratio (WHR),blood pressure,lipids and control criteria were observed.Results BMI,glycated hemoglobin A1c,fasting blood sugar(FBS),triglycerides,systolic blood pressure (SBP)levels and diabetic knowledge score decreased significantly in the stepped-nursing group(P <0.05).The decrease levels in postprandial blood sugar(PBS),diastolic blood pressure (DBP),total cholesterol (TC),LDL cholesterol and WHR reduced,which showed no significant difference(P >0.05). The levels of HDL cholesterol were slightly improved,which showed no significant difference(P >0.05).Conclusion Stepped-nursing model is useful in overall treatment of patients with type 2 diabetes,it improves the condition of glycated hemoglobin A1c,SBP levels FBS and triglycerides and increases the command of diabetic knowledge.