Timely reporting, effective analyses and rapid distribution of surveillance data can assist in detecting the aberration of disease occurrence and further facilitate a timely response. In China, a new nationwide web-based automated system for outbreak detection and rapid response was developed in 2008. The China Infectious Disease Automated-alert and Response System (CIDARS) was developed by the Chinese Center for Disease Control and Prevention based on the surveillance data from the existing electronic National Notifiable Infectious Diseases Reporting Information System (NIDRIS) started in 2004. NIDRIS greatly improved the timeliness and completeness of data reporting with real time reporting information via the Internet. CIDARS further facilitates the data analysis, aberration detection, signal dissemination, signal response and information communication needed by public health departments across the country. In CIDARS, three aberration detection methods are used to detect the unusual occurrence of 28 notifiable infectious diseases at the county level and to transmit that information either in real-time or on a daily basis. The Internet, computers and mobile phones are used to accomplish rapid signal generation and dissemination, timely reporting and reviewing of the signal response results. CIDARS has been used nationwide since 2008; all Centers for Disease Control and Prevention (CDC) in China at the county, prefecture, provincial and national levels are involved in the system. It assists with early outbreak detection at the local level and prompts reporting of unusual disease occurrences or potential outbreaks to CDCs throughout the country.

OBJECTIVE: To understand the current status and influencing factors of job burnout in rural preschool teachers. METHODS: A stratified cluster random sampling method was used to investigate the job burnout and social support of 756 rural preschool teachers in Sichuan Province using the Maslach Burnout Inventory, Educators Survey and Social Support Revalued Scale. RESULTS: The positive rate of job burnout was 22.1%(167/756), and the positive rates of emotional exhaustion, reduced personal achievement, and depersonalization were 13.1%, 10.7% and 1.2%, respectively. The results of unconditional logistic regression analysis showed that post status, daily working hours, subjective support and utilization of support were all related to job burnout(P<0.05). Among them, in-post and daily working hours >10 hours were risk factors of job burnout, high subjective support and utilization of support were the protective factors of job burnout. CONCLUSION: The situation of job burnout in rural preschool teachers in Sichuan Province is not serious, post status, daily work hours and social support can affect their job burnout.

OBJECTIVEFor providing evidences for further modification of China Infectious Diseases Automated-alert and Response System (CIDARS) by comparing the early-warning performance of the temporal model and temporal-spatial model in CIDARS.

METHODSThe application performance for outbreak detection of temporal model and temporal-spatial model simultaneously running among 208 pilot counties in 20 provinces from 2011 to 2013 was compared; the 16 infectious diseases were divided into two classes according to the disease incidence level; cases data in nationwide Notifiable Infectious Diseases Reporting Information System was combined with outbreaks reported to Public Health Emergency Reporting System, by adopting the index of the number of signals, sensitivity, false alarm rate and time for detection.

RESULTSThe overall sensitivity of temporal model and temporal-spatial model for 16 diseases was 96.23% (153/159) and 90.57% (144/159) respectively, without significant difference (Z = -1.604, P = 0.109), and the false alarm rate of temporal model (1.57%, 57 068/3 643 279) was significantly higher than that of temporal-spatial model (0.64%, 23 341/3 643 279) (Z = -3.408, P = 0.001), while the median time for detection of these two models was not significantly different, which was 3.0 days and 1.0 day respectively (Z = -1.334, P = 0.182).For 6 diseases of type I which represent the lower incidence, including epidemic hemorrhagic fever,Japanese encephalitis, dengue, meningococcal meningitis, typhus, leptospirosis, the sensitivity was 100% for both models (8/8, 8/8), and the false alarm rate of both temporal model and temporal-spatial model was 0.07% (954/1 367 437, 900/1 367 437), with the median time for detection being 2.5 days and 3.0 days respectively. The number of signals generated by temporal-spatial model was reduced by 2.29% compared with that of temporal model.For 10 diseases of type II which represent the higher incidence, including mumps, dysentery, scarlet fever, influenza, rubella, hepatitis E, acute hemorrhagic conjunctivitis, hepatitis A, typhoid and paratyphoid, and other infectious diarrhea, the sensitivity of temporal model was 96.03% (145/151), and the sensitivity of temporal-spatial model was 90.07% (136/151), the number of signals generated by temporal-spatial model was reduced by 59.36% compared with that of temporal model. Compared to temporal model, temporal-spatial model reduced both the number of signals and the false alarm rate of all the type II diseases;and the median of outbreak detection time of temporal model and temporal-spatial model was 3.0 days and 1.0 day, respectively.

CONCLUSIONOverall, the temporal-spatial model had better outbreak detection performance, but the performance of two different models varies for infectious diseases with different incidence levels, and the adjustment and optimization of the temporal model and temporal-spatial model should be conducted according to specific infectious disease in CIDARS.

China ; Communicable Diseases ; Disease Notification ; Disease Outbreaks ; prevention & control ; Humans ; Models, Theoretical ; Population Surveillance ; methods ; Spatio-Temporal Analysis

OBJECTIVETo analyze the implement performance of China Infectious Diseases Automated-alert and Response System (CIDARS) of 31 provinces in mainland China, and to provide the evidences for further promoting the application and improvement of this system.

METHODSThe amount of signals, response situation and verification outcome of signals related to 32 infectious diseases of 31 provinces in mainland China in CIDARS were investigated from 2011 to 2013, the changes by year on the proportion of responded signals and timeliness of signal response were descriptively analyzed.

RESULTSA total of 960 831 signals were generated nationwide on 32 kinds of infectious diseases in the system, with 98.87% signals (949 936) being responded, and the median (the 25(th) percentile to the 75(th) percentile (P25-P75) ) of time to response was 1.0 (0.4-3.3) h. Among all the signals, 242 355 signals were generated by the fixed-value detection method, the proportion of responded signals was 96.37% (62 349/64 703), 98.75% (68 413/69 282) and 99.37% (107 690/108 370), respectively, and the median (P25-P75) of time to response was 1.3 (0.3-9.7), 0.8(0.2-4.9) and 0.7 (0.2-4.2) h, respectively. After the preliminary data verification, field investigation and laboratory test by local public health staffs, 100 232 cases (41.36%) were finally confirmed.In addition, 718 476 signals were generated by the temporal aberration detection methods, and the average amount of signal per county per week throughout the country were 1.53, and 8 155 signals (1.14%) were verified as suspected outbreaks. During these 3 years, the proportion of signal response was 98.89% (231 149/233 746), 98.90% (254 182/257 015) and 99.31% (226 153/227 715), respectively, and the median (P25-P75) of time to response was 1.1 (0.5-3.3), 1.0 (0.5-2.9) and 1.0 (0.5-2.6) h, respectively.

CONCLUSIONFrom 2011 to 2013, the proportion of responded signals and response timeliness of CIDARS maintained a rather high level, and further presented an increasing trend year by year. But the proportion of signals related to suspected outbreaks should be improved.

China ; Communicable Diseases ; Disease Notification ; Disease Outbreaks ; prevention & control ; Humans ; Population Surveillance ; methods

BACKGROUND: All Singaporean males undergo medical screening prior to compulsory military service. A history of possible food allergy may require referral to a specialist Allergy clinic to ensure that special dietary needs can be taken into account during field training and deployment. OBJECTIVE: To study the pattern of food allergy among pre-enlistees who were referred to a specialist allergy clinic to work up suspected food allergy. METHODS: Retrospective study of all pre-enlistees registered in the Clinical Immunology/Allergy New Case Registry referred to the Allergy Clinic from 1 August 2015 to 31 May 2016 for suspected food allergy. RESULTS: One hundred twenty pre-enlistees reporting food allergy symptoms other than rash alone were referred to the Allergy Clinic during the study period. Of these, 77 (64.2%) had food allergy. Among those with food allergy, mean age was 19.1 ± 1.5 years. They comprised predominantly Chinese (66.2%) and Malays (20.8%). The most commonly reported foods were shellfish/crustaceans (78%), peanut (15.6%), and egg (6.5%). Self-limiting oral allergy syndrome, OAS (itchy lips and throat with/without lip angioedema) was the most common manifestation (n = 33, 42.9%) followed by anaphylaxis (n = 23, 29.9%). Majority of OAS was from shellfish/crustacean (90.6%); of which shrimp (30.3%), crab (15.2%), and lobster (3.0%) were the most common. Mild childhood asthma (69.7%), allergic rhinitis (6.3%), and eczema (6.1%) were the most common atopic conditions among individuals with shellfish/crustacean OAS. This pattern was similar for shellfish/crustacean anaphylaxis. Skin prick tests were most commonly positive for shrimp (OAS 87.1% vs. anaphylaxis 100%), crab (OAS 95.8% vs. 90.9%), and lobster (OAS 91.7% vs. 63.6%). CONCLUSION: OAS to shellfish/crustaceans was more common than anaphylaxis among this study population of young males referred for food allergy symptoms other than rash alone.
Anaphylaxis ; Arachis ; Asian Continental Ancestry Group ; Asthma ; Eczema ; Exanthema ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Lip ; Male ; Mass Screening ; Military Personnel ; Ovum ; Pharynx ; Referral and Consultation ; Retrospective Studies ; Rhinitis, Allergic ; Shellfish ; Singapore ; Skin ; Specialization

BackgroundDepression presents a significant risk to the physical and mental health of the elderly. The relationship between sleep and depressive symptoms has become a major research focus. However， previous research findings on this relationship have yielded inconsistent conclusions. ObjectiveTo explore the relationship between sleep duration and depressive symptoms in the elderly， in order to provide insights into the prevention of depressive symptoms and delaying their progression in the elderly. MethodsData analysis involved 8 210 adults aged 60 years or older， utilizing data from the 2018 China Health and Retirement Longitudinal Study （CHARLS） survey. Participants were categorized into two groups those with depressive symptoms and those without- based on the Center for Epidemiologic Studies Depression-10 Scale （CESD-10） criteria. Logistic regression and restricted cubic spline models were used to analyze the association between sleep duration and depressive symptoms. ResultsThe 318 people with depressive symptoms were detected among the 8 210 elderly participants， with an average sleep duration of （6.14±2.05） hours per night. Restricted cubic spline models showed a non-linear association between sleep duration and depressive symptoms （χ²=412.670，P<0.01）. After adjusting for confounding factors， compared to the elderly with a sleep duration 7~7.9 hours， the risk of depressive symptoms in the elderly was 2.971 times higher （95% CI： 2.560~3.449， P<0.01） in those with a sleep duration <6 hours， 1.372 times higher （95% CI： 1.161~1.621， P<0.01） in those with 6~6.9 hours， and 1 185 times higher （95% CI： 1.009~1.393， P<0.05） in those with ≥8 hours. Subgroup analysis showed no correlation between sleep duration ≥8 hours and the risk of depressive symptoms across genders and the 60~69 age group （P>0.05）. ConclusionThere was an approximately nonlinear association between sleep duration and depressive symptoms， with differences by gender and age.［Funded by Sichuan Applied Psychology Research Center， Chengdu Medical College （number， CSXL-22226）］

ObjectiveTo observe the clinical efficacy and mechanism of Tongnao Yizhi Formula （通脑益智方， TYF） in treating vascular cognitive impairment no dementia （VCIND） with spleen and kidney depletion， phlegm and stasis obstructing collaterals syndrome. MethodsNinety-two VCIND patients with spleen and kidney depletion， phlegm and stasis obstructing collaterals syndrome were randomly divided into control group （42 cases） and treatment group （52 cases）. Both groups received routine basic treatment. The control group was given donapezil hydrochloride capsules orally， 5 mg each time， once at night， while the treatment group was given TYF orally， 1 dose per day. Both groups were treated continuously for 3 months. The scores of Mini-Mental State Examination （MMSE）， Vascular Dementia Assessment Scale-Cognitive Subscale （VaDAS-Cog）， Activity of Daily Living Scale （ADL）， and TCM syndrome scores （the primary symptoms such as sluggish thinking， forgetfulness， temperament changes， and language confusion， and secondary symptoms such as weakness of waist and knees， dizziness and headache， occasional tinnitus， fatigue， heaviness of limbs， insomnia and irritability， poor appetite and abdominal distension， numbness of face） were observed before and after treatment in both groups. The changes in gut microflora diversity and flora abundance structure as well as fecal short-chain fatty acids （SCFAs） levels including acetic acid， propionic acid， butyric acid， isobutyric acid， isovaleric acid， valeric acid， and caproic acid were compared between groups. The feces of 20 healthy subjects in the same period were included as reference. Safety was evaluated during the study. ResultsAfter treatment， both groups exhibited significant increases in MMSE scores and decreases in VaDAS-cog scores （P＜0.05 or P＜0.01）， and ADL scores in the treatment group significantly increased （P＜0.05）. Scores of symptoms including sluggish thinking， forgetfulness， temperament change， language confusion， heaviness of limbs， insomnia， irritability， poor appetite， abdominal distension， and facial numbness as well as the total score significantly decreased in both groups after treatment （P＜0.05 or P＜0.01）. When compared between groups， the treatment group showed substantial reductions in scores of weakness of waist and knees， tinnitus， fatigue， heaviness of limbs， insomnia， irritability， loss of appetite and abdominal distension （P＜0.05 or P＜0.01）. The gut microflora diversity analysis showed that the Shannon index of the treatment group significantly increased after treatment （P＜0.05）.PCoA analysis and ANOSIM test indicated significant differences between groups， suggesting changes in microflora species （P＜0.01）. After treatment， the relative abundance of Bacteroidetes and Fusobacteria in the treatment group increased， while the relative abundance of Actinobacteria， Verrucomicrobia and Cyanobacteria decreased （P＜0.05）； the relative abundance of Faecalibacterium prausnitzii， Bifidobacterium， Lactobacillus， and Ruminococcus increased significantly （P＜0.05）. Compared to the the gut microflora species diversity of the healthy people， it is indicated that the gut microflora structure in the treatment group was close to that of the healthy people， while there was no such trend in the control group. In the treatment group， acetic acid， propionic acid， and butyric acid in the treatment group were all higher after treatment （P＜0.05 or P＜0.01）. ConclusionsTYF can improve the cognitive ability and quality of life of VCIND patients with spleen and kidney depletion， phlegm and stasis obstructing collaterals syndrome， and this improvement may be related to regulating intestinal microecology.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.