It is a major public health task to promote the construction of modern disease prevention and control system in the prevention and control of the novel coronavirus pneumonia epidemic. In this study, we identified the current situation and challenges in the construction of disease prevention and control system in Shanghai, including the infrastructures, disciplines, human resources, information system, operational mechanism, and legalization. It is proposed that we should promote the construction of modern disease prevention and control system in Shanghai, which is aimed to improve the capacity in the disease prevention and control services, response to the major epidemics and public health emergencies, and scientific research in public health, in accordance with municipal functional orientation large-scale metropolitan public health security requirements in Shanghai. Moreover, we should promote policy-making, including upgrading infrastructures, facilitating discipline construction and scientific research innovation, optimizing development environment for human resources, accelerating comprehensive information construction, improving systems and mechanisms, and strengthening legal governance.

Objective To analyze the staff structure, turnover and income of human resources in disease control and prevention institutions(CDCs)at different levels in China, to identify the existing problems, and to make policy recommendations accordingly. Methods A questionnaire survey was used to collect the data on the staff of CDCs at different levels in China from 2016 to 2018. Descriptive analysis and trend analysis were conducted on the number of staff, recruitment and turnover, income and other indicators in the three years. Results A total of 606 CDCs were included in the study. The proportion of job openings was 11.97% in 2018. Although the median proportion of professional personnel and health professional personnel in the CDCs reached the national standard(85% and 70%, respectively), a considerable number of institutions failed to meet the national standard. From 2016 to 2018, staff turnover in the CDCs has been increasing, with a minimum of 0.73(in 2016, municipal CDCs)and a maximum of 10.52(in 2018, provincial CDCs). In the staff who quit the CDCs, the proportion of junior professionals was the highest, while that of medium and senior professional increased gradually. Of them, the proportion of staff with graduate education in eastern China and provincial CDCs was higher than that of undergraduate education, while the proportion of staff with graduation education in other regions also increased. From 2016 to 2018, the average annual income in the CDCs in most regions did not reach the national average wage level of urban employees in health, social security and social welfare field in the same period. In county and district level CDCs in central and western China, personal income in 2018 was even less than the national average wage level in 2016. Conclusion Human resources in the CDCs at different levels in China remains insufficient and unbalanced, which warrants a"supporting policy"mechanism for public health personnel. The loss of the personnel in the CDCs continues to increase, in which the loss of senior professionals become increasingly serious. It raises a new concern to establish and improve the incentive mechanism of public health personnel. Furthermore, personal income in the CDCs is lower than the local average level. It is necessary to set personal income reasonably according to local economic level.

Objective To analyze the current situation of financing in disease control and prevention constitutions in China, to identify existing problems, to explore potential reasons, and to make policy recommendations accordingly. Methods Financial related indicators, including revenue and expense of disease control and prevention institutions, were collected through questionnaire survey. Moreover, some disease control and prevention institutions were selected for on-site survey. Results The proportion of public health institutions in the Total Health Expenditure had fallen from 7.0% in 2014 to 5.6% in 2018. The proportion of financial compensation in the operation of disease control and prevention institutions was less than 50%. The gap between revenue and expenditure had not been covered completely after the cancellation of three categories of administrative charges. In addition, financing mechanism of public health service funds remained unclear. Conclusion We recommend the strategies, including optimizing financing structure, increasing investment in disease control and prevention, increasing the level of financial guarantee, improving the mechanism of public health service funds, and multi-channel financing.

In China, rural doctors and primary health institutions take important responsibilities as the basic of public health system.They play the fundamental role in the construction of public health system in the rural area. However, primary public health is facing the challenge of poor infrastructure, weak human resources, and inefficient services in most areas. We employed field investigation and literature review to identify major problems on the implementation of primary health service and the development of rural doctors' team. The recommendation in this study might provide scientific evidence to improve the construction of public health system and policy-making in rural area in China.

Objective To determine the association between global epidemic of COVID-19 and local situation of imported cases from abroad to Shanghai, and then to predict the risk of imported COVID-19 epidemic from December 2020 through March 2021. Methods A retrospective analysis on the imported COVID-19 cases from abroad to Shanghai was conducted. The correlation between global and country-specific confirmed COVID-19 cases(weekly confirmed cases per 100 000 population)and imported cases(weekly reported)in Shanghai was determined. Compared to the risk in November 2020, country-specific risk of imported cases to Shanghai was assessed to calculate the possible number of imported case in the near future using SEIR model. Results The number of imported case of COVID-19 from abroad to Shanghai increased along with the global epidemic, with several peaks accordingly. However, the imported cases did not accumulate, as potential epidemic has been always effectively contained through timely implementation of prevention and control measures. The number of weekly imported cases in Shanghai was significantly correlated with the number of global weekly confirmed cases per 100 000 population(r_Spearman = 0.349, P = 0.029), and also correlated with weekly reported cases in certain countries(P < 0.05), such as the UK and France. Using the number of imported cases from abroad to Shanghai in November as baseline, the estimated monthly number of imported cases in Shanghai might increase in the following four months. Conclusion The risk of imported COVID-19 cases from abroad to Shanghai may increase in the near future. Prediction of imported case would provide scientific evidence for optimizing prevention and control measures and reserving medical resources for the imported epidemic.

Objective To analyze the epidemiological characteristics of COVID-19 cases reported in Xianyang City from January to February 2020. Methods We retrospectively studied 17 COVID-19 patients diagnosed in Xianyang Central Hospital. The patients were characterized clinically and epidemiologically. Results The 17 patients included 10 male and 7 female, with an average age of(39.59±17.31)years. The median interval of time between onset and diagnosis was four days(1-10 days), whereas the median duration of COVID-19 was 16 days(3-23 days). Of the patients, six were mild, 10 were pneumonia, and one was severe. A total of 15 patients had fever as the onset, accompanied by fatigue, sore throat, sputum, vomit, muscle soreness; the other two patients were asymptomatic. There were no complications documented in all the patients. Patients had low levels of white blood cells and lymphocytes. Chest CT scan showed diverse diffuse ground-glass shadow. Eleven patients had travel history in Wuhan before the onset, four patients had contact with people who had travel history or residence history in Wuhan, and the other two patients did not report epidemiological exposure history. In addition, four of the 17 patients were clustered cases. Conclusion General population is susceptible to COVID-19. The majority of the confirmed cases have epidemiological exposure history. Routine examination, including white blood cell, lymphocyte count and CT scan may facilitate early diagnosis.

Objective To understand the cognition，attitude and awareness on the prevention and control of COVID-19 among recent international travellers back to China（hereinafter referred to as the inbound group）and local residents（domestic group），and to provide scientific evidence for further prevention and control of the epidemic. Methods Using a questionnaire website，a questionnaire entitled “Investigation and analysis of residents’ knowledge，attitude，and practice on COVID-19”was prepared，with the targeted population of the survey being international travelers back to China and local residents who had been quarantined at home for 14 days in Jinqiao Town. Cluster sampling was used to conduct the survey through WeChat. The two groups were then compared using chi-square test by using SPSS 23.0. Results Between the two groups，the awareness on the respiratory droplet transmission and inactivation effectiveness by alcohol，peracetic acid and ultraviolet ray on the SARS-CoV-2 were statistically different（P < 0.05）. In the attitude towards prevention and control measures，there was significant difference between the two groups in selecting prevention and control plans for the whole population during the outbreak（P < 0.05）. In the comparison of behavior，there was a statistical difference between the two groups（P < 0.05）whether to maintain a distance of more than 1 meter in social communication. Regarding the choice of quarantine methods（stay-at-home，intensive quarantine and no quarantine），the difference between two groups was statistically significant（P < 0.05）. Conclusion In terms of the knowledge of COVID-19，attitude towards prevention and control measures，and their own behavior，there are some differences between the inbound group and domestic group.

Objective To explore the impact of the two-child policy on the fertility level of residents in Yangpu District. Methods Birth registry data were collected from the residents of Yangpu District in Shanghai during January 2015 to December 2018 for the analysis of birth characteristics and its variation after the two-child policy implementation. Results The total fertility rate was higher than 1 only in 2016 that was 1.04, whereas it was about 0.8 in other three years. The number of the second child increased which was inspired by the policy. However, the increment in the number of second child was far less than the decrease in the first child. From 2015 through 2018, the proportion of second children in the total births with local household registration accounted for 18.84%, 20.03%, 26.29% and 24.35%, respectively. From January 2015 to August 2016, the proportion of second children was on the rise slowly, in which the annual percent change(APC)value was 0.34%(P > 0.05). From September 2016 to May 2017, the proportion of second children had shown an obvious increase, and the APC value was 3.97%(P < 0.05). From June 2017 to December 2018, the proportion of second children was on a downward trend, in which the APC value was -0.97%(P < 0.05). Conclusion Favorable fertility policy may not reverse the fertility level in Yangpu District, which remains at a very low level.

Objective We aimed to assess the association between urinary bisphenol A(BPA)concentrations and gestational age in pregnant women. Methods A total of 248 pregnant women were recruited from a maternal and child care hospital in Shanghai. A questionnaire survey was completed to collect socio-demographic information and spot urine samples were collected during pregnancy. Gas chromatography-tandem mass spectrometry(GC-MS/MS)was used to measure BPA concentrations in urine samples. Linear relationship between urinary BPA level and gestational age was assessed by using generalized additive models. Multivariate regression model was used to evaluate associations of prenatal BPA exposure with gestational age. Results BPA was detected in all the urine samples. Median value and geometric mean of urinary BPA levels were 0.85 μg/L and 1.21 μg/L, respectively. Linear relationship between urinary BPA concentration and gestational weeks was confirmed(non-linear P > 0.05). Positive association between urinary BPA level and gestational age was indicated(regression coefficient, β = 0.19;95%CI:0.04-0.35;P = 0.016). However, it was only observed in girls, stratified by sex of newborns(β = 0.18;95%CI:0.03-0.34;P = 0.020). After stratification by trimester, no significant association was found in the second or the third trimesters. Conclusion Pregnant women are extensively exposed to BPA. Urinary BPA exposure during pregnancy may extend gestational age, especially in girls.

Objective To explore the association between daily diet and physical activity with myopia in middle school students in Shanghai, so as to provide evidence for the prevention of myopia. Methods A stratified cluster random sampling of 795 students from two middle schools and one high school in Jiading District of Shanghai was selected. Data was extracted from 2017 adolescent health related behaviors surveillance in Shanghai. Results The reported rate of myopia among middle and high school students was determined to be 57.2%. The proportion of middle school students reporting no drinking soda, no eating desserts and no eating fried foods during the past week were 45.2%, 16.4% and 31.1%, respectively. The proportion of reporting eating fresh fruit, eating vegetables, drinking a cup of milk or yogurt among middle school students every day were 45.8%, 73.2% and 40.7%, respectively. The proportion of physical activity over 60 minutes and moderate intensity exercise over 30 minutes every day were 25.6% and 15.4%, respectively. The proportion of no drinking soda, no eating fried foods, eating fresh fruit every day, eating vegetables every day, and physical activity over 60 minutes during the past week in the non-myopia group were significantly higher than those in the myopia group(P < 0.01). Middle school students eating fresh fruit every day and physical activity over 60 minutes every day were determined to be protective factors for myopia(P < 0.01). Conclusion The proportions of Middle and high school students in Shanghai reporting healthy diet and physical activity are relatively low. Healthy diet and sufficient physical activity may be protective against myopia.