1.Current status and influencing factors of astigmatism among children and adolescents aged 4-18 years in Yangpu District, Shanghai
Mengjia ZHANG ; Zuxian SUN ; Ying ZHAO ; Hong WANG ; Xiqian ZHU ; Jia WANG ; Jianxiu FENG ; Jie XIAO ; Minmin JIANG
International Eye Science 2026;26(8):1448-1456
AIM:To investigate the current status of astigmatism and its associated factors among children and adolescents from kindergarten through senior high school in Yangpu District, Shanghai, and to provide scientific evidence for the prevention and control of refractive errors.METHODS:A cluster sampling method was employed. From September to November 2024, students from 14 randomly selected schools in Yangpu District, Shanghai, were enrolled as study subjects. Autorefraction and ocular biometry were performed under non-cycloplegic conditions, and questionnaire surveys were administered. Comparisons of astigmatism degree, detection rate, and axis were made across age groups, educational stages, and sexes. Multiple linear and logistic regression analyses were conducted to identify factors associated with astigmatism.RESULTS:A total of 7 233 students aged 4-18 y were enrolled including 3 731 males, 3 502 females, with the mean age 10.13±4.18 y, astigmatism -0.76±0.82 D, and the detection rate(≤-1.00 D)was 29.23%. Both the degree and detection rate of astigmatism were correlated with age and educational stage, peaking in senior high school, with the most pronounced changes observed during primary school. Besides age, astigmatic refractive power was influenced by spherical equivalent(β=0.105, P<0.001), mean keratometry(β=-0.118, P<0.001), sex(with boys as the reference, girls: β=0.054, P<0.001), frequent sustained near work for 30-40 min(with “almost never” as the reference, β=-0.030, P=0.038), preterm birth(β=-0.023, P=0.044), maternal myopia(β=-0.028, P=0.020), and homework completion time on rest days(β=-0.035, P=0.041). The detection rate of astigmatism was associated with maternal myopia(OR=1.130, P=0.039), male sex(OR=0.773, P<0.001), shorter sleep duration on school days(OR=0.909, P=0.028), shorter sleep duration on rest days(OR=0.937, P=0.046), preterm birth(OR=1.382, P=0.012), frequent excessive head lowering(OR=1.216, P=0.045), homework completion time on rest days(OR=1.043, P=0.046), higher spherical equivalent(OR=0.891, P<0.001), and higher mean keratometry(OR=1.188, P<0.001).CONCLUSION:The degree and detection rate of astigmatism among children and adolescents from kindergarten to senior high school in Yangpu District, Shanghai are correlated with educational stage, and primary school may represent a critical period for astigmatism prevention and control. Male sex, maternal myopia, preterm birth, high-intensity near work, and insufficient sleep and other factors may be associated with the onset and progression of astigmatism. It is recommended that education and health departments strengthen visual health screening during primary school, while promoting behavioral interventions such as scientific eye-use habits and adequate sleep across different educational stages to delay the onset and progression of astigmatism.
2.A prospective cohort study on glycolipid metabolic abnormalities and incident colorectal cancer risk
Qiaoyi XU ; Ruilin CHEN ; Yijing XIE ; Shuo WANG ; Renjia ZHAO ; Siqi TANG ; Linyao LU ; Huangbo YUAN ; Tiejun ZHANG ; Yanfeng JIANG ; Kelin XU ; Zhenqiu LIU ; Xingdong CHEN ; Chen SUO
Shanghai Journal of Preventive Medicine 2026;38(6):409-417
ObjectiveTo investigate the associations of multiple glycolipid metabolic indicators and their cumulative abnormality burden with incident colorectal cancer risk in a general population-based prospective cohort, and to examine the mediating role of glycolipid metabolic abnormalities in the relationships between smoking, alcohol consumption, physical activity, and colorectal cancer incidence. MethodsA total of 17 897 eligible participants recruited from the Taizhou Cohort between 2011 and 2014 were included. Cox proportional hazards regression models were used to assess the associations of conventional and derived glycolipid indicators, as well as a glycolipid abnormality index constructed from total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, and insulin, with incident colorectal cancer risk. Restricted cubic spline models were applied to evaluate dose-response relationships for major indicators. Receiver operating characteristic curves were generated to compare predictive performance across indicators. Mediation analyses were conducted to assess the mediating effects of the glycolipid abnormality index on the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence. ResultsDuring a median follow-up of 11.2 years, 102 incident colorectal cancer cases were identified, with an incidence density of 51.2 per 100 000 person-years. After adjustment for potential confounders, Cox proportional hazards regression analyses showed that decreased high-density lipoprotein cholesterol was associated with a 1.74-fold higher risk of colorectal cancer (HR=1.74, 95%CI: 1.03‒2.95), elevated low-density lipoprotein cholesterol was associated with a 1.78-fold higher risk (HR=1.78, 95%CI: 1.05‒3.02), and abnormal fasting plasma glucose was associated with a 1.86-fold higher risk (HR=1.86, 95%CI: 1.15‒3.02). Triglycerides and fasting plasma glucose showed an approximately linear increasing association with colorectal cancer risk in multivariable restricted cubic spline models. The glycolipid abnormality index showed a clear gradient association with colorectal cancer risk; participants with three or more abnormal indicators had a 3.08-fold higher risk than those without abnormalities (HR=3.08, 95%CI: 1.60‒5.92). The area under the curve was 0.795, higher than that of individual glycolipid indicators and other combined indices, and gender-stratified analyses showed generally consistent patterns. Glycolipid metabolic abnormalities partially mediated the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence, with mediation proportions of 8.33%, 9.45%, and 9.04%, respectively. ConclusionGlycolipid metabolic abnormalities are associated with an increased risk of incident colorectal cancer. The glycolipid abnormality index shows an increasing relationship with colorectal cancer risk and demonstrates better discrimination, and it partially mediates the associations of smoking, alcohol consumption, and physical activity with colorectal cancer incidence in the overall population.
3.Epidemiological characteristics of other infectious diarrheal diseases and their pathogens in Yangpu District of Shanghai from 2005 to 2024
Shen CAO ; Lu ZHOU ; Qiaoli SUN ; Zhengxi ZHANG ; Zhiping XIAO ; Yihan LU
Shanghai Journal of Preventive Medicine 2026;38(6):432-439
ObjectiveTo elucidate the epidemiological characteristics, evolution of the pathogen spectrum, and spatial distribution patterns of other infectious diarrheal diseases (excluding cholera, typhoid fever, paratyphoid fever, and bacillary dysentery) in Yangpu District of Shanghai from 2005 to 2024, thereby providing a scientific basis for the formulation of targeted prevention and control strategies. MethodsInformation on other infectious diarrhea cases with a current address in Yangpu District of Shanghai, and onset dates from January 1, 2005 to December 31, 2024, was extracted from the Chinese Center for Disease Control and Prevention Information System. Data on cases, including gender, age, occupation, and pathogen testing results, were collected. Descriptive epidemiological methods were employed to analyze the temporal, spatial, and demographic distribution of reported incidence rates and the epidemiological characteristics of pathogens for other infectious diarrheal diseases in Yangpu District from 2005 to 2024. Spatial autocorrelation analyses of reported incidence rates for viral and bacterial diarrhea were conducted using Moran’s Index (Moran’s I). Local spatial autocorrelation analyses were performed using local indicators of spatial association (LISA), with a first-order Queen contiguity spatial weight matrix, and significance was tested via 999 random permutations. Time-series and radar chart analyses were used to examine the temporal patterns of other infectious diarrhea cases caused by major pathogens. ResultsFrom 2005 to 2024, a total of 5 211 cases of other infectious diarrhea were reported in Yangpu District. The cases were predominantly males (2 714 cases, accounting for 52.08%) and children under 5 years of age (1 639 cases, accounting for 31.45%). The primary occupational groups were scattered children (1 433 cases, accounting for 27.50%) and retired personnel (1 403 cases, accounting for 26.92%). The annual average reported incidence rate was 20.36/100 000, showing an overall fluctuating trend with peaks around 2009 and 2024. Peak incidence occurred in summer and autumn (July‒September), with the highest reported incidence rate observed in summer (June‒August) (7.31/100 000). Children under 5 years of age (116.00/100 000) and adults aged 60 and older (21.39/100 000) were the top two age groups in terms of reported incidence. Global spatial autocorrelation analyses showed that the reported incidence rates of viral diarrhea across the sub-districts in Yangpu District in 2020 exhibited a significant positive spatial correlation (Moran’s I =0.30, P=0.016). The spatial autocorrelation of reported incidence rates of viral diarrhea in each sub-district for the periods 2008‒2019 and 2021‒2024 was not statistically significant (all P>0.05). Local spatial autocorrelation analyses of viral diarrhea incidence in 2020 revealed that Xinjiangwancheng Sub-district exhibited a low‑low clustering trend (local Moran’s I =0.49, P=0.018), while Dinghai Road Sub-district exhibited a high‑high clustering trend (local Moran’s I =1.33, P=0.024). The global spatial autocorrelation of reported incidence rates of bacterial diarrhea across the sub-districts of Yangpu District from 2005 to 2024 was not statistically significant (all P>0.05). Among the 5 211 cases, 4 049 had definitive pathogen test results. Bacterial diarrhea accounted for a relatively high proportion (55.52%, 2 248/4 049). The pathogens with the highest proportions were rotavirus (32.33%, 1 309/4 049), Vibrio spp. (31.69%, 1 283/4 049), Salmonella spp. (19.63%, 795/4 049), and norovirus (9.16%, 371/4 049). The radar chart showed that diarrhea cases caused by norovirus had no obvious seasonality, rotavirus cases were mainly concentrated in winter, and cases caused by Salmonella spp. and Vibrio spp. were mainly concentrated in summer and autumn. Among cases under 20 years of age, rotavirus accounted for a relatively high proportion, especially in children under 5 years of age. Among cases aged 20 years and older, Vibrio spp. and Salmonella spp. accounted for relatively high proportions. ConclusionFrom 2005 to 2024, other infectious diarrhea in Yangpu District of Shanghai was most prevalent in summer and autumn. Children under 5 years of age and adults aged 60 years and older were high-risk groups. In 2020, Dinghai Road Sub-district was a high-risk area for viral diarrhea. Rotavirus, Vibrio spp., Salmonella spp., and norovirus were the dominant pathogens. Prevention and control efforts for other infectious diarrhea should be strengthened among key populations (e.g., children under 5 years of age and adults aged 60 years and older) and in high-risk areas such as Dinghai Road Sub-district. During summer and autumn, priority should be given to the prevention and control of bacterial diarrhea caused by Salmonella spp. and Vibrio spp., especially among individuals aged 20 years and older (particularly those aged 60 and above). During winter, priority should be given to the prevention and control of diarrhea caused by rotavirus infection among individuals under 20 years of age, particularly children under 5 years of age.
4.Mosquito ecology surveillance and analysis in Yangpu District, Shanghai from 2019 to 2023
Chonghua LU ; Jie ZHANG ; Lili ZONG
Shanghai Journal of Preventive Medicine 2025;37(5):425-429
ObjectiveTo delineate the species composition structure and seasonal density fluctuations of mosquito populations in Yangpu District, Shanghai, and to provide scientific insights for the prevention and control of vector-borne diseases. MethodsA total of 12 monitoring sites from different habitats were selected to conduct adult mosquito monitoring using the CO2 trap light method during 2019‒2023, elucidating the temporal and spatial distribution and change patterns of mosquito populations and densities in Yangpu District. ResultsFrom 2019 to 2023, a total of 1 321 female mosquitoes was captured, with an overall density of 0.16 case·(lamp·h)-1. The species identified were predominantly Culex pipiens pallens (87.28%), followed by Aedes albopictus (12.64%), and Culex tritaeniorhynchus (0.08%). Seasonal distribution showed a typical single-peak pattern, with June‒August being the peak period. In terms of habitat distribution, the highest mosquito population density was found in residential areas [0.18 case·(lamp·h)-1], followed by hospitals [0.13 case·(lamp·h)-1] and parks [0.11 case·(lamp·h)-1]. Culex pipiens pallens was the dominant species in all habitats, with a density of [0.14 case·(lamp·h)-1]. Notably, there was a statistically significant difference in the composition of Culex pipiens pallens and Aedes albopictus among the three habitats mentioned(χ2=38.396, P<0.001; χ2=36.790, P<0.001). The mosquito density of the 12 streets from high to low is Changhai Road, Pingliang, Yinhang, Xinjiangwan City, Yanji, Daqiao, Wujiaochang, Kongjiang, Changbai New Village, Jiangpu, Siping and Dinghai.The distribution of mosquito density was relatively balanced across different communities (H=1.559, P=1.000). ConclusionThe results of CO2 trap light monitoring reveals a relatively low density of adult mosquitoes in Yangpu District, with Culex pipiens pallens as the predominant species, and summer being the peak season for mosquitoes. In light of the threat of mosquito-borne diseases such as dengue fever, more effective and evidence-based mosquito control strategies, aligning with the distribution and behavioral patterns of mosquitoes, should be developed.
5.Network Pharmacology and in vitro Experimental Verification on Intervention of Oridonin on Non-Small Cell Lung Cancer.
Ke CHANG ; Li-Fei ZHU ; Ting-Ting WU ; Si-Qi ZHANG ; Zi-Cheng YU
Chinese journal of integrative medicine 2025;31(4):347-356
OBJECTIVE:
To explore the key target molecules and potential mechanisms of oridonin against non-small cell lung cancer (NSCLC).
METHODS:
The target molecules of oridonin were retrieved from SEA, STITCH, SuperPred and TargetPred databases; target genes associated with the treatment of NSCLC were retrieved from GeneCards, DisGeNET and TTD databases. Then, the overlapping target molecules between the drug and the disease were identified. The protein-protein interaction (PPI) was constructed using the STRING database according to overlapping targets, and Cytoscape was used to screen for key targets. Molecular docking verification were performed using AutoDockTools and PyMOL software. Using the DAVID database, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were conducted. The impact of oridonin on the proliferation and apoptosis of NSCLC cells was assessed using cell counting kit-8, cell proliferation EdU image kit, and Annexin V-FITC/PI apoptosis kit respectively. Moreover, real-time quantitative PCR and Western blot were used to verify the potential mechanisms.
RESULTS:
Fifty-six target molecules and 12 key target molecules of oridonin involved in NSCLC treatment were identified, including tumor protein 53 (TP53), Caspase-3, signal transducer and activator of transcription 3 (STAT3), mitogen-activated protein kinase kinase 8 (MAPK8), and mammalian target of rapamycin (mTOR). Molecular docking showed that oridonin and its key target molecules bind spontaneously. GO and KEGG enrichment analyses revealed cancer, apoptosis, phosphoinositide-3 kinase/protein kinase B (PI3K/Akt), and other signaling pathways. In vitro experiments showed that oridonin inhibited the proliferation, induced apoptosis, downregulated the expression of Bcl-2 and Akt, and upregulated the expression of Caspase-3.
CONCLUSION
Oridonin can act on multiple targets and pathways to exert its inhibitory effects on NSCLC, and its mechanism may be related to upregulating the expression of Caspase-3 and downregulating the expressions of Akt and Bcl-2.
Diterpenes, Kaurane/chemistry*
;
Carcinoma, Non-Small-Cell Lung/pathology*
;
Humans
;
Network Pharmacology
;
Lung Neoplasms/pathology*
;
Cell Proliferation/drug effects*
;
Apoptosis/drug effects*
;
Molecular Docking Simulation
;
Protein Interaction Maps/drug effects*
;
Cell Line, Tumor
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Signal Transduction/drug effects*
;
Gene Expression Regulation, Neoplastic/drug effects*
;
Reproducibility of Results
;
Gene Ontology
6.Melittin induces autophagy to alleviate chronic renal failure in 5/6-nephrectomized rats and angiotensin II-induced damage in podocytes
Yufan ZHANG ; Huaping XU ; Hongwei QIAO ; Ya ZHAO ; Minmin JIANG
Nutrition Research and Practice 2024;18(2):210-222
BACKGROUND/OBJECTIVES:
Chronic renal failure (CRF) is a complex pathological condition that lacks a cure. Certain Chinese medicines, such as melittin, a major component in bee venom, have shown efficacy in treating CRF patients. On the other hand, the mechanisms underlying the therapeutic effects of melittin are unclear.MATERIALS/METHODS: A 5/6 nephrectomy model (5/6 Nx) of renal failure was established on rats for in vivo assays, and mouse podocyte clone 5 (MPC5) mouse podocyte cells were treated with angiotensin II (AngII) to establish an in vitro podocyte damage model. The 24-h urine protein, serum creatinine, and blood urea nitrogen levels were evaluated after one, 2, and 4 weeks. Hematoxylin and eosin staining, Masson staining, and periodic acid-Schiff staining were used to examine the pathological changes in kidney tissues. A cell counting kit 8 assay was used to assess the cell viability. Reverse transcription polymerase chain reaction and Western blot were used to assess the mRNA and protein levels in the cells, respectively.
RESULTS:
In the rat 5/6 Nx, melittin reduced the 24-h urinary protein excretion and the serum creatinine and blood urea nitrogen levels. Furthermore, the renal pathology was improved in the melittin-treated 5/6 Nx rats. Melittin promoted podocin, nephrin, Beclin 1, and the LC3II/ LC3I ratio and inhibited phosphorylated mammalian target of rapamycin (mTOR)/mTOR in 5/6 Nx-induced rats and AngII-induced MPC5 mouse podocyte cells. Moreover, inhibiting autophagy with 3-MA weakened the effects of melittin on podocin, nephrin, and the LC3II/ LC3I ratio in podocytes.
CONCLUSION
Melittin may offer protection against kidney injury, probably by regulating podocyte autophagy. These results provide the theoretical basis for applying melittin in CRF therapy.
7.Awareness and influencing factors of chronic obstructive pulmonary diseases among residents in Yangpu District, Shanghai
Jingjing HU ; Yunlong ZHANG ; Xue HAN ; Ruihua FENG ; Xin GE ; Hongwei ZHANG
Shanghai Journal of Preventive Medicine 2024;36(1):53-58
ObjectiveTo understand the awareness of knowledge about chronic obstructive pulmonary disease (COPD) and influencing factors among residents in Yangpu District, Shanghai. MethodsWe used cluster random sampling method to conduct face-to-face questionnaire surveys on selected household residents in 12 streets of Yangpu District. The survey questions included their understanding of COPD name, lung function test, and COPD related knowledge. Multivariate logistic regression analysis was used to analyze the influencing factors of awareness rate. ResultsA total of 1 440 people were ultimately included in the analysis, and the awareness rates of COPD name, lung function test, and COPD awareness were 19.93%, 18.61%, and 14.95%, respectively. Among the people who knew the name of COPD, awareness rate of shortness of breath or dyspnea was the highest (84.12%) in the three main symptoms of COPD. Among the main risk factors of COPD, second-hand smoke(86.78%)and smoking (85.82%) were the highest. The main ways to obtain knowledge of COPD names were through television (12.60%) and the internet (11.97%). The results of multivariate logistic regression analysis showed that men were significantly higher than women in the awareness of COPD name, lung function test, and COPD knowledge, with the OR values of (OR=1.39, 95%CI:1.08‒1.79), (OR=1.47,95%CI:1.12‒1.92) and (OR=1.37,95%CI:1.02‒1.84), respectively. The awareness rate of COPD names and lung function tests was the highest among people aged ≥ 65 years old, while the awareness rate of COPD knowledge was the highest among people aged 35‒50 years old. The awareness rate of COPD names was the highest among people with college education or above, civil servants, teachers, and medical staff, people with an annual household income of 100 000‒200 000 yuan. ConclusionThe overall awareness rate of COPD names, lung function tests, and COPD related knowledge among residents in Yangpu District is still at a low level. We should intensify the promotion and education of COPD among key groups such as women, young people, and those with low income, in order to improve the overall awareness rate of COPD among the population.
8.Epidemiological characteristics of high-risk population for cardiovascular disease of Shanghai residents
Yuzhuo WANG ; Yang ZHENG ; Yingquan WANG ; Cui WU ; Haiyan GU ; Yiying ZHANG ; Yan XU ; Sen WANG ; Xin ZHANG ; Yu JIANG ; Jia ZHAO ; Yan SHI
Shanghai Journal of Preventive Medicine 2024;36(1):64-71
ObjectiveTo investigate the high-risk detection rate and aggregation of cardiovascular diseases(CVD) in 8 districts of Shanghai and influencing factors, and to provide scientific references for prevention and control of CVD. MethodsBased on the Cardiovascular Disease Screening and Management Program in Shanghai from 2016 to 2021, 104 685 participants aged 35 to 75 in 8 districts of Shanghai were selected for analysis. χ2 test and multivariate logistic regression were used for statistical analysis of the influencing factors of CVD and aggregation of CVD. ResultsThe proportion of high-risk CVD individuals in the population was 19.17%, including the high-risk individuals with hypertension (8.65%), dyslipidemia (6.33%), CVD history (5.58%), and WHO assessed risk ≥20% types (2.69%), respectively. Old age, overweight and obesity, central obesity, smoking, drinking, farmers, unmarried, and low family income were the risk factors of CVD, while high education level was the protective factor. In the participants, 16 323 people (81.34%) were classified as CVD high-risk groups; The number of aggregation of 1, 2 and ≥3 high risk types of CVD were 16 323(81.34%), 3 236(16.13%), 509(2.54%), respectively. Old age, low education level, low annual family income, farmers, unmarried, smoking, drinking, overweight, obesity and central obesity were associated with the risk of aggregation of high risk types of CVD, and the correlation strength increased with the increase of aggregation types. ConclusionThe prevention and control of CVD in Shanghai should focus on the hypertension, elderly, overweight, obesity, central obesity, smoking, drinking, low educated, low family income, farmers and unmarried people, and targeted intervention measures should be taken to reduce the risk of CVD among residents.
9.Comparative analysis of Aedes albopictus surveillance index in Yangpu District, Shanghai
Jie ZHANG ; Chonghua LU ; Xiaoyan LU ; Hongxia LIU
Shanghai Journal of Preventive Medicine 2024;36(2):173-178
ObjectiveTo analyze the interannual fluctuation, seasonal fluctuation, habitat distribution and the correlation of the 3 monitoring indicators of Aedes albopictus in Yangpu District of Shanghai from 2017 to 2021, and to provide a scientific basis for A. albopictus control and rational use of the indicators. MethodsThe density surveillance data of A. albopictus recorded by Breteau index (BI), Path index (PI) and the mosquito ovitrap index (MOI) from 2017 to 2021 in Yangpu District, Shanghai were compared. Microsoft Excel 2019 software was used for data summary and SPSS 25.0 software was used for statistical analysis. ResultsFrom 2017 to 2021, there were two months with BI>5, and the PI were all above the density control level of Class C, and there were nine months with MOI≥5. In 2017, BI was higher than in the other four years, with statistically significant differences (all P≤0.001). MOI in 2017 and 2020 was higher than in 2019 (P=0.029, P=0.004) and 2021 (P=0.005, P=0.001), with statistical significance. MOI for different types of habitats varied significantly, with a statistically significant difference (P=0.004). A linear correlation was observed between BI and PI (r=0.462, P=0.010). ConclusionBI, PI and MOI are used simultaneously to reflect the density of A. albopictus in Yangpu District of Shanghai. However, these three monitoring indicators show poor linear correlation. Comprehensively considering the scientific aspects of monitoring methods and seasonal fluctuations of indicators, it is suggested that MOI should be used as the main index to evaluate the density of A. albopictus. In the MOI, attention should be paid to factors such as the distribution of the habitats, the standardization of operating methods, and quality control, which are essential for enhancing the reliability of the MOI.
10.Hygienic investigation and analysis of escape room-style venues in Yangpu District, Shanghai
Huabin SONG ; Chunmei TAO ; Yan YANG ; Zhe SUN ; Chen ZHANG ; Xue HAN
Shanghai Journal of Preventive Medicine 2024;36(6):570-573
ObjectiveTo investigate and analyze the public health status of escape room-style venues in Yangpu District, Shanghai. MethodsReferring to the hygiene standards and testing methods for public places, an investigation of the current situation and environmental monitoring were conducted in 15 escape room-style venues in Yangpu District, which involved exploring the changes in physical, chemical, and microbial indicators before and after the game. ResultsThe hygiene condition of escape room-style venues in Yangpu District was generally good, with all 19 monitoring indicators not exceeding the indoor standards. The indoor carbon dioxide (CO2) and formaldehyde concentrations increased significantly after the game but did not exceed the standards. ConclusionThe hygiene condition of escape room-style venues in Yangpu District is good. However, potential public health risks were identified in four aspects: site selection and design, length of the game, cross-contamination, and training and management.

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