Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.

Background Exposure to volatile organic compounds (VOCs) has been observed in both living and working environments. Volatile organic compounds metabolites (VOCMs) in urine can be used to assess the exposure to VOCs and potentially cause adverse effects on human body. Objective To quantitatively evaluate urinary VOCMs and their associations with renal function damage, and further trace the characteristics of potential environmental exposure to provide scientific evidence for effective prevention measures. Methods The study included a total of 6028 samples from four cross-sectional studies in the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2018, with exposure and health outcomes matched. Generalized linear models were employed to assess the associations of urinary VOCMs (urinary creatinine adjusted) with urinary protein levels and estimated glomerular filtration rate (eGFR), with coviriables including gender, age, body mass index, education, smoking, alcohol consumption, exercise frequency, diabetes, and hypertension. Weighted quantile sum (WQS) approach was utilized to analyze the effects of mixed exposure and to rank the contribution of individual VOCMs. The associations between VOCMs and associated living environments and occupational exposure characteristics were further investigated. Results Among the enrolled study participants (n=6028), a total of 11 urinary VOCMs were measured, with 10 metabolites having a positive rate of over 80% (84.59%-99.99%). There were 604 individuals (10.0%) having urinary protein abnormalities and 2831 individuals (47.0%) with eGFR reduced. Through a single and a multiple generalized linear model, 5 VOCMs exhibited statistically significant associations with urinary protein abnormalities and/or reduced eGFR levels (P<0.05): N-acetyl-S-(N-methylaminocarbonyl)-L-cysteine (AMC), N-acetyl-S-(2-carboxyethyl)-L-cysteine (CEM), N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine (DHB), 2-hydroxy-2-phenylacetic acid (MAD), and N-acetyl-S-(4-hydroxy-2-butenyl)-L-cysteine (MB3). The WQS index indicated a significantly positive association between VOCMs and urinary protein abnormalities, and DHB contributed the most. The analysis on the potential sources of VOCs exposure showed that those who worked as a private entrepreneur or an employee (vs. government employees), rent houses (vs. owned real estate), had less number of rooms in the residence, fueled cars at self-service gas stations, and inhaled paint fumes in the past 48 h associated with higher VOCMs (P < 0.05) and DHB contributed the most. Conclusion Multiple VOCMs in urine are associated with significantly kidney function injuries. The mixture exposure to VOCMs is significantly associated with higher risks of urinary protein abnormalities. Occupational category, housing ownership, ways to fuel a car, and inhalation of paint odors are closely related with VOCMs levels.

Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales(CRE)in the intensive care units(ICUs).Methods From July 2023 to June 2024,active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals.ICU patients who underwent ac-tive screening from July 2023 to June 2024 were selected as the study group,while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group.Difference in CRE detection rates between the two groups of patients was compared.Results A total of 7 803 ICU patients were included in the study group,744 CRE strains were detected,with a detection rate of 9.53％,out of which 304 CRE strains were detected through routine detection(detection rate 3.90％),3 707 patients underwent active screen,440 CRE strains were detected(detection rate 11.87％).7 561 ICU patients were included in the control group,out of which 250 CRE strains were detected through routine detection,with a detection rate of 3.31％.There was a statistically significant difference in the overall detection rate of CRE between two groups of patients(x2=246.18,P＜0.001).In the study group,CRE detection rate of active screening(11.87％)was higher than that of routine detection(3.90％),with statistically significant difference(x2=264.26,P＜0.001).A total of 17 CRE strains were detected from the study group.The proportions of Klebsiella pneumoniae(80.92％vs 73.41％)and Serratia marcescens(2.30％vs0.23％)in the routine detection group were both higher than in the active screening group,while the proportion of Escherichia coli in the routine detection group was lower(8.22％vs 19.55％),all with statistically significant differences(all P＜0.05).Conclusion The prevalence of CRE in ICUs is relatively high,with a wide range of bac-terial species.Active screening can improve the detection rate of CRE.

Objective:To investigate the iodine nutrition level of different populations in Daxing District of Beijing, and to provide a basis for implementation of "tailored measures, classified guidance, and scientific iodine supplementation" for prevention and control of iodine deficiency disorders.Methods:From 2020 to 2023, Daxing District of Beijing was divided into 5 districts from April to September each year based on east, west, south, north, and center. One township (street) was selected from each district, and 20 pregnant women, 40 women of childbearing age, 40 adult males, and 40 non boarding children aged 8 to 10 from one primary school were selected from each township (street). At the same time, 100 pregnant women with current addresses in Daxing District, Beijing were selected from one obstetrics hospital in Daxing District every year. Once random urine sample was collected from all survey subjects, and the household edible salt samples were collected from children and 400 pregnant women for determination of urinary iodine and salt iodine levels.Results:From 2020 to 2023, a total of 3 022 urine samples were collected, including 920, 700, 702, and 700 samples from children aged 8 - 10, pregnant women, women of childbearing age, and adult males, respectively. The median urinary iodine levels were 181.1, 135.0, 144.0, and 140.0 μg/L, respectively. There were statistically significant differences in urinary iodine levels among children aged 8 - 10, pregnant women, and women of childbearing age in different years ( H = 77.88, 9.40, 22.11, P < 0.05). A total of 1 320 household edible salt samples were collected from children aged 8 - 10 and pregnant women. Among them, 920 salt samples were collected from children, the median salt iodine was 21.3 mg/kg, the iodized salt coverage rate was 88.48% (814/920), and the qualified iodized salt consumption rate was 80.76% (743/920). Four hundred salt samples were collected from pregnant women, the median salt iodine was 21.8 mg/kg, the coverage rate of iodized salt was 90.25% (361/400), and the consumption rate of qualified iodized salt was 77.50% (310/400). The results of correlation analysis showed there was no correlation between urinary iodine level of children aged 8 to 10 and pregnant women with their salt iodine level ( r = 0.06, 0.07, P = 0.055, 0.142). Conclusions:Pregnant women in Daxing District, Beijing are at a deficiency level in iodine nutrition, with children aged 8 - 10, women of childbearing age, and adult males all at an appropriate level of iodine nutrition. We should strengthen health education for pregnant women and ensure that they receive sufficient iodine nutrition. At the same time, relevant departments should increase the supervision and management of iodized salt.

Objective:To investigate the epidemiological and clinical characteristics of patients with psittacosis, in order to provide a basis for early diagnosis and prevention of the disease.Methods:Clinical data of psittacosis cases reported in 2023 from China Disease Prevention and Control Information System in Daxing District, Beijing were collected, and the patients' general information, epidemiological characteristics, clinical characteristics, imaging examination results, laboratory test results, treatment and prognosis were retrospectively analyzed.Results:A total of 7 cases of psittacosis were reported in Daxing District in 2023, with no clustered infection in households or workplaces. There were 4 males and 3 females, with a median age of 66 years old, and a range of 52 to 82 years old. Epidemiological investigation revealed that 6 patients had a clear history of contact with poultry (4 had first contact with parrots or pigeons, and 2 had long-term exposure to pigeons, parrots or wild birds). The onset time was concentrated in April and May. The primary clinical manifestations included high fever (6 cases), fatigue (4 cases), and chills (3 cases). The imaging examination results showed that inflammatory changes occurred in the unilateral lung of 6 patients, and both lungs were affected in 1 patients. Laboratory test results indicated elevated neutrophill percentage in 6 patients, decreased white blood cell counts in 2 patients, elevated white blood cell counts in 2 patients, and elevated C-reactive protein levels in 7 patients. Metagenomic next-generation sequencing test showed that all seven patients were positive for Chlamydia psittaci. All 7 patients were treated with quinolone or tetracycline antibiotics, with 6 cured and discharged, and 1 died. Conclusion:Psittacosis is usually manifested clinically as high fever, fatigue, and unilateral lung inflammation, often associated with poultry exposure.

Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales(CRE)in the intensive care units(ICUs).Methods From July 2023 to June 2024,active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals.ICU patients who underwent ac-tive screening from July 2023 to June 2024 were selected as the study group,while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group.Difference in CRE detection rates between the two groups of patients was compared.Results A total of 7 803 ICU patients were included in the study group,744 CRE strains were detected,with a detection rate of 9.53％,out of which 304 CRE strains were detected through routine detection(detection rate 3.90％),3 707 patients underwent active screen,440 CRE strains were detected(detection rate 11.87％).7 561 ICU patients were included in the control group,out of which 250 CRE strains were detected through routine detection,with a detection rate of 3.31％.There was a statistically significant difference in the overall detection rate of CRE between two groups of patients(x2=246.18,P＜0.001).In the study group,CRE detection rate of active screening(11.87％)was higher than that of routine detection(3.90％),with statistically significant difference(x2=264.26,P＜0.001).A total of 17 CRE strains were detected from the study group.The proportions of Klebsiella pneumoniae(80.92％vs 73.41％)and Serratia marcescens(2.30％vs0.23％)in the routine detection group were both higher than in the active screening group,while the proportion of Escherichia coli in the routine detection group was lower(8.22％vs 19.55％),all with statistically significant differences(all P＜0.05).Conclusion The prevalence of CRE in ICUs is relatively high,with a wide range of bac-terial species.Active screening can improve the detection rate of CRE.

Objective:To investigate the epidemiological and clinical characteristics of patients with psittacosis, in order to provide a basis for early diagnosis and prevention of the disease.Methods:Clinical data of psittacosis cases reported in 2023 from China Disease Prevention and Control Information System in Daxing District, Beijing were collected, and the patients' general information, epidemiological characteristics, clinical characteristics, imaging examination results, laboratory test results, treatment and prognosis were retrospectively analyzed.Results:A total of 7 cases of psittacosis were reported in Daxing District in 2023, with no clustered infection in households or workplaces. There were 4 males and 3 females, with a median age of 66 years old, and a range of 52 to 82 years old. Epidemiological investigation revealed that 6 patients had a clear history of contact with poultry (4 had first contact with parrots or pigeons, and 2 had long-term exposure to pigeons, parrots or wild birds). The onset time was concentrated in April and May. The primary clinical manifestations included high fever (6 cases), fatigue (4 cases), and chills (3 cases). The imaging examination results showed that inflammatory changes occurred in the unilateral lung of 6 patients, and both lungs were affected in 1 patients. Laboratory test results indicated elevated neutrophill percentage in 6 patients, decreased white blood cell counts in 2 patients, elevated white blood cell counts in 2 patients, and elevated C-reactive protein levels in 7 patients. Metagenomic next-generation sequencing test showed that all seven patients were positive for Chlamydia psittaci. All 7 patients were treated with quinolone or tetracycline antibiotics, with 6 cured and discharged, and 1 died. Conclusion:Psittacosis is usually manifested clinically as high fever, fatigue, and unilateral lung inflammation, often associated with poultry exposure.

Objective:To investigate the iodine nutrition level of different populations in Daxing District of Beijing, and to provide a basis for implementation of "tailored measures, classified guidance, and scientific iodine supplementation" for prevention and control of iodine deficiency disorders.Methods:From 2020 to 2023, Daxing District of Beijing was divided into 5 districts from April to September each year based on east, west, south, north, and center. One township (street) was selected from each district, and 20 pregnant women, 40 women of childbearing age, 40 adult males, and 40 non boarding children aged 8 to 10 from one primary school were selected from each township (street). At the same time, 100 pregnant women with current addresses in Daxing District, Beijing were selected from one obstetrics hospital in Daxing District every year. Once random urine sample was collected from all survey subjects, and the household edible salt samples were collected from children and 400 pregnant women for determination of urinary iodine and salt iodine levels.Results:From 2020 to 2023, a total of 3 022 urine samples were collected, including 920, 700, 702, and 700 samples from children aged 8 - 10, pregnant women, women of childbearing age, and adult males, respectively. The median urinary iodine levels were 181.1, 135.0, 144.0, and 140.0 μg/L, respectively. There were statistically significant differences in urinary iodine levels among children aged 8 - 10, pregnant women, and women of childbearing age in different years ( H = 77.88, 9.40, 22.11, P < 0.05). A total of 1 320 household edible salt samples were collected from children aged 8 - 10 and pregnant women. Among them, 920 salt samples were collected from children, the median salt iodine was 21.3 mg/kg, the iodized salt coverage rate was 88.48% (814/920), and the qualified iodized salt consumption rate was 80.76% (743/920). Four hundred salt samples were collected from pregnant women, the median salt iodine was 21.8 mg/kg, the coverage rate of iodized salt was 90.25% (361/400), and the consumption rate of qualified iodized salt was 77.50% (310/400). The results of correlation analysis showed there was no correlation between urinary iodine level of children aged 8 to 10 and pregnant women with their salt iodine level ( r = 0.06, 0.07, P = 0.055, 0.142). Conclusions:Pregnant women in Daxing District, Beijing are at a deficiency level in iodine nutrition, with children aged 8 - 10, women of childbearing age, and adult males all at an appropriate level of iodine nutrition. We should strengthen health education for pregnant women and ensure that they receive sufficient iodine nutrition. At the same time, relevant departments should increase the supervision and management of iodized salt.

Operation management is an important tool to promote the high-quality development of public hospitals in China.Since the founding of New China,based on China's economic and social development and medical and health system reform,the evolution of operation management of public hospitals in China can be divided into four stages,the system building stage(1949-1978),the liberalization and revitalization stage(1979-1996),the operation mechanism reform stage(1997-2020),and the new stage of high-quality development(2021 present).The development trend of public hospital operation management in future should deepen the public welfare-oriented public hospital operation management,explore the value-oriented medical operation management model based on high-quality development and the refined operation and management model of public hospitals,so as to promote the high-quality development of public hospitals in China.

Objective:To investigate the delay in medical care-seeking and diagnosis of human brucellosis cases in Daxing District, Beijing City, and analyze the relevant influencing factors.Methods:Retrospective analysis method was used to collect the information on brucellosis cases reported by the Infectious Disease Reporting Information Management System of the China Disease Prevention and Control Information System in Daxing District, Beijing City from January 1, 2013 to December 31, 2022. And the case information was reviewed, including demographic information, clinical manifestations, medical care-seeking, diagnosis, etc. Binary logistic regression was used to analyze the influencing factors of delayed diagnosis.Results:A total of 120 cases of brucellosis were included, including 91 males and 29 females, with a male-to-female ratio of 3.14 ∶ 1.00. The majority were aged 40 - 79 years, accounting for 81.7% (98/120). Farmers and unemployed household workers were the main occupations, accounting for 67.5% (81/120). The main clinical manifestations were fever (85.8%, 103/120), hyperhidrosis (65.8%, 79/120), fatigue (61.7%, 74/120), and muscle soreness (60.0%, 72/120). The delay rate of medical care-seeking was 33.3% (40/120), with a median medical care-seeking time of 6 days (interquartile range: 2 - 22 days, range: 0 - 727 days). The diagnosis delay rate was 50.8% (61/120), with a median diagnosis time of 10 days (interquartile range: 3 - 22 days, range: 0 - 1 530 days). The results of binary logistic regression analysis showed that the reasons for initial diagnosis were severe or recurrent symptoms ( OR = 6.76, 95% CI: 2.40 - 19.01), serological monitoring or other diseases ( OR = 36.00, 95% CI: 3.57 - 362.72), and delayed medical care-seeking ( OR = 4.30, 95% CI: 1.68 - 11.01) were risk factors for delayed diagnosis of brucellosis cases. The location of the diagnostic hospitals outside the city ( OR = 0.27, 95% CI: 0.08 - 0.92) was a protective factor for delayed diagnosis of brucellosis cases. Conclusions:The medical care-seeking and diagnosis of brucellosis cases in Daxing District, Beijing City have been delayed to varying degrees. The reasons of initial diagnosis are severe or recurrent symptoms, serological monitoring or other diseases, and medical care-seeking delay are the risk factors for the delayed diagnosis of brucellosis cases. The location of the diagnostic hospitals outside the city is a protective factor for delayed diagnosis of brucellosis cases.