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Understanding the Effects of Iatrogenic Management on Population Health: A Medical Innovation Perspective. 从医学创新的角度理解医源管理对人群健康的影响。

China CDC Weekly

Pub Date : 2023-07-07 DOI: 10.46234/ccdcw2023.118

Jian Yang, Shuduo Zhou, Xiangning Feng, Ying Chen, Yunxuan Hu, Ming Xu

In this paper, we introduce an iatrogenesis intervention framework guided by medical innovation, which encompasses the objectives, influences of medical innovation on iatrogenesis, factors affecting various types of iatrogenesis, and strategies for controlling iatrogenesis. Advancements in medical innovation across various domains can bridge the patient safety implementation gap by uncovering, characterizing, refining, accelerating, scaling, extending, and mobilizing the external and internal conditions and factors that influence the control and elimination of iatrogenesis. Iatrogenesis, or the adverse effects and risks associated with medical interventions, poses a significant challenge in global public health as it ranks as the fifth leading cause of death worldwide and a leading cause of death in numerous countries (1–2). Prior to the coronavirus disease 2019 (COVID-19) pandemic, 2.6 million deaths occurred annually due to safety lapses in hospitals in low-income countries, while nearly 15% of hospital expenditure and activity in developed nations were attributed to addressing treatment safety failures (3).

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引用次数: 0

Challenges and Responses of Left-Behind Elderly and Children in Rural China Amid the New Population Development Stage. 新人口发展阶段中国农村留守老人、留守儿童面临的挑战与对策

China CDC Weekly

Pub Date : 2023-07-07 DOI: 10.46234/ccdcw2023.117

Dianqi Yuan, Peisen Yang, Hanbing Yang, Huameng Tang, Chao Guo

The disparate economic growth in China has compelled numerous adults from rural areas to migrate to cities in search of more lucrative employment prospects (1). In the 7th National Census, it was reported that the floating population totaled 375,816,759, accounting for approximately 26.00% of the overall population. Such migratory patterns often result in leaving behind vulnerable groups, particularly children and older adults, in rural regions. Given the inadequately established care systems, these groups are particularly susceptible and have consistently been at the forefront of social security concerns in China (2). The inadequate public pension benefits and health insurance systems result in older adults relying heavily on their offspring, generally their sons, for their overall well-being (3). Migration has led to the rise of a vulnerable group known as the “rural left-behind older adults”, where older family members lack necessary support as their caretaker children move to urban areas. Simultaneously, the growth and well-being of children hinge on parental care, but employment constraints, limited financial resources, and rural residency restrictions often make it unfeasible for migrant workers to bring their children to the cities where they work (4). Consequently, these children are regularly left behind in their rural homes, becoming the “left-behind children in rural areas”. During the first meeting of the Financial and Economic Affairs Commission under the 20th Communist Party of China (CPC), Xi Jinping, General Secretary of the CPC Central Committee, accentuated that the country is entering a new stage of population development. This phase is characterized by declining birthrates, an aging population, and uneven population growth among regions. Additionally, the rural population characterized by an unbalanced age population structure, has been pronouncedly affected by the inconsistent economic development and these factors. Status of Imbalanced Age Structure and Increasing Burdens The 2020 Population Census reported that in China, the child-age dependency ratio was 26.24 per 100 working-age individuals, while the old-age dependency ratio was 19.74. Notably, rural areas displayed significantly higher dependency ratios in comparison to urban areas. In rural areas, the child-age dependency ratio was at 30.58 and the old-age dependency ratio was 28.13. Contrastingly, in urban areas, these ratios were 24.07 and 15.56, respectively. The heavily skewed age structure in rural areas has imposed a greater burden on the adult population due to these pronounced dependency ratios. Moreover, notable societal aging has been recorded in China, predicting a future transition from an aging society to an aged society, which may exacerbate the existing burdens. Concerns over declining fertility rates and rising populations of older adults are not unique to China. According to the World Population Ageing 2020 report and the United Nations Population Div

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引用次数: 0

The Impact of Low Fertility Rates on Labor Demand and Socioeconomic Development in China. 低生育率对中国劳动力需求和社会经济发展的影响。

China CDC Weekly

Pub Date : 2023-07-07 DOI: 10.46234/ccdcw2023.115

Yutong Wu, Binbin Su, Jun Li

The World Population Prospects report, published by the United Nations in 2022, revealed a decline in the global population growth rate (PGR) to less than 1% — the lowest recorded rate since 1950. Predictions suggest a further decrease to 0.5% by 2050, culminating in negative growth in more than 60 countries and intensifying the issue of population aging (1). China, a highly populous nation, is encountering even more acute challenges. By the conclusion of 2022, China’s population totaled approximately 1.412 billion, reflecting a decline of 850,000 from the prior year and a natural PGR of −0.06% (2). This negative growth, China’s first since the 1960s, indicates that the peak of China’s population was reached in 2021, with a slide into negative growth from 2022 onward. Examining the population structure between 2010 and 2022, there was a decrease in China’s working-age population (ages 15–64) from 74.5% to 68.2% and an increase in the over-65 demographic from 8.87% to 14.9%, whereas the under-15 age group experienced only negligible change. This scenario underscores the escalating trend of aging in China, propelled by persistently low fertility rates. China’s negative population growth poses challenges and opportunities for its socio-economic development. Firstly, changes in population size and structure will bring about major alterations in family dynamics and societal systems, significantly impacting social demands and resource allocation strategies. Additionally, the decline in the working-age population, being central to economic development, will notably curtail economic growth potential. Conversely, a reduced population size will increase per capita resource allocation in sectors like education and healthcare, presenting an opportunity to enhance the quality of life. These demographic changes can also spur a new wave of industrial revolution, creating novel development prospects.

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引用次数: 0

Medical Consultations Option and Influencing Factors for SARS-CoV-2 Infected Individuals - Beijing Municipality, China, December 2022. SARS-CoV-2感染者就诊选择及影响因素——北京市，中国，2022年12月

China CDC Weekly

Pub Date : 2023-06-30 DOI: 10.46234/ccdcw2023.111

Mingyue Li, Jue Liu, Ming Du, Chen Wang, Yafang Huang, Wentao Li, Tong Xiang, Jingwei Zhao, Xiaoli Zhu, Xinying Dong, Hao Wu, Shugang Li

What is already known about this topic?: In December 2022, China revised its epidemic prevention and control strategy, leading to an increase in coronavirus disease 2019 (COVID-19) cases and a peak in medical consultations. Government departments implemented relevant policies to coordinate and allocate medical resources throughout China. However, there is a scarcity of research on the status of medical consultations and the factors influencing them.

What is added by this report?: In the study population, over 80% of individuals with COVID-19 chose not to pursue medical care, while more than 70% of patients who sought treatment opted for primary healthcare facilities. The decision to consult medical professionals was influenced by various factors, such as age, education level, employment status, urban-rural distribution, and the presence of symptoms following COVID-19 infection.

What are the implications for public health practice?: The implementation of tiered diagnostic and treatment approaches, aligned with guidelines issued by governing bodies, is essential for mitigating the strain on medical resources. Primary healthcare institutions serve as "gatekeepers" for public health and should be further expanded in the future.

关于这个话题我们已经知道了什么?: 2022年12月，中国修订了疫情防控战略，导致2019冠状病毒病(COVID-19)病例增加，医疗咨询达到高峰。政府部门实施相关政策，协调和配置全国医疗资源。然而，关于医疗咨询的现状及其影响因素的研究却很少。这份报告增加了什么内容?在研究人群中，超过80%的COVID-19患者选择不寻求医疗服务，而超过70%的寻求治疗的患者选择初级卫生保健机构。年龄、受教育程度、就业状况、城乡分布、COVID-19感染后是否出现症状等因素影响了就诊决定。这对公共卫生实践有什么影响?*按照理事机构发布的准则实施分层诊断和治疗方法，对于减轻医疗资源压力至关重要。初级卫生保健机构是公共卫生的“看门人”，今后应进一步扩大。

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引用次数: 0

Detecting SARS-CoV-2 BA.2, BA.4, and BA.5 Variants Utilizing a Robust RT-RPA-CRISPR/Cas12a-Based Method - China, 2023. 利用基于RT-RPA-CRISPR/ cas12的稳健方法检测SARS-CoV-2 BA.2、BA.4和BA.5变体-中国，2023。

China CDC Weekly

Pub Date : 2023-06-30 DOI: 10.46234/ccdcw2023.113

Meihui Luo, Yang Pan, Yaqing He, Ruhan A, Changcheng Wu, Baoying Huang, Roujian Lu, Li Zhao, Bo Peng, Fei Ye, Huijuan Wang, Yuda Chen, Zhen Li, Daitao Zhang, Wenling Wang, Wenjie Tan

Introduction: Since 2019, numerous variants of concern for severe acute respiratory syndrome virus 2 (SARS-CoV-2) have emerged, leading to significant outbreaks. The development of novel, highly accurate, and rapid detection techniques for these new SARS-CoV-2 variants remains a primary focus in the ongoing efforts to control and prevent the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Reverse transcription-recombinase polymerase amplification combined with the clustered regularly interspaced short palindromic repeats-associated protein 12a (CRISPR/Cas12a) system was used to validate the detection of the Omicron BA.2, BA.4, and BA.5 variants of SARS-CoV-2.

Results: Our results demonstrate that the CRISPR/Cas12a assay is capable of effectively detecting the SARS-CoV-2 BA.2, BA.4, and BA.5 variants with a limit of detection of 10, 1, and 10 copies/μL, respectively. Importantly, our assay successfully differentiated the three SARS-CoV-2 Omicron strains from one another. Additionally, we evaluated 46 SARS-CoV-2 positive clinical samples consisting of BA.2 (n=20), BA.4 (n=6), and BA.5 (n=20) variants, and the sensitivity of our assay ranged from 90% to 100%, while the specificity was 100%.

Discussion: This research presents a swift and reliable CRISPR-based method that may be employed to track the emergence of novel SARS-CoV-2 variants.

自2019年以来，出现了许多与严重急性呼吸综合征病毒2 (SARS-CoV-2)有关的变体，导致重大疫情。为这些新的SARS-CoV-2变体开发新型、高度准确和快速的检测技术仍然是当前控制和预防2019年冠状病毒病(COVID-19)大流行工作的主要重点。方法:采用逆转录重组酶聚合酶扩增联合聚集规则间隔短回文重复序列相关蛋白12a (CRISPR/Cas12a)系统验证检测SARS-CoV-2的Omicron BA.2、BA.4和BA.5变异体。结果:CRISPR/Cas12a方法能够有效检测SARS-CoV-2 BA.2、BA.4和BA.5变体，检测限分别为10、1和10拷贝/μL。重要的是，我们的实验成功地区分了三种SARS-CoV-2 Omicron菌株。此外，我们评估了46份SARS-CoV-2阳性临床样本，包括BA.2 (n=20)、BA.4 (n=6)和BA.5 (n=20)变体，我们的检测灵敏度为90%至100%，特异性为100%。讨论:本研究提出了一种快速可靠的基于crispr的方法，可用于跟踪新型SARS-CoV-2变体的出现。

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引用次数: 0

Global Overview and Insights on Infodemiology and Infodemic Management. 信息流行病学和信息学术管理的全球概况和见解。

China CDC Weekly

Pub Date : 2023-06-30 DOI: 10.46234/ccdcw2023.112

Mingfan Pang, Yichi Zhang, Siyue Guo, Xinping Yang, Xiaopeng Qi

引用次数: 0

Persistent Urinary Tract Infection in Association with Community-Acquired NDM-5 Escherichia coli Clonal Group Following COVID-19 Infection - Beijing Municipality, China, 2023. 2019冠状病毒感染后持续尿路感染与社区获得性NDM-5大肠杆菌克隆群相关——中国北京市，2023

China CDC Weekly

Pub Date : 2023-06-30 DOI: 10.46234/ccdcw2023.110

Jiazhen Guo, Ran Duan, Dan Zhang, Peng Zhang, Shuai Qin, Yajuan Fang, Yingna Sun, Lianhe Lu, Huaiqi Jing, Xin Wang, Rongmeng Jiang, Biao Kan

What is already known about this topic?: The hospital-acquired infections caused by New Delhi metallo-beta-lactamase (NDM)-producing strains are typically attributed to a single clonal lineage.

What is added by this report?: In this study, we encountered a unique case of community-acquired NDM-5 Escherichia coli urinary tract infection (UTI) following coronavirus disease 2019 (COVID-19). The UTI persisted for a duration of at least 45 days. Genomic analyses revealed the presence of two NDM-5 strains, both sharing an identical chromosomal background but distinct, homologous, and recombined plasmids. This case suggests that a diverse range of resistance genes may be present within the human body, with drug-resistant strains undergoing continuous evolution during infection. The intestinal tract may have been its drug-resistant gene pool.

What are the implications for public health practice?: The observations presented in this case indicate that the endogenous acquisition of drug-resistant genes may also be an issue in managing multidrug-resistant organisms (MDRO). It is possible for continuous recombination to occur within carbapenem-resistant Enterobacteriaceae (CRE) during infection. In contrast to exogenously-acquired resistance, greater attention should be placed on the endogenous factors that contribute to the development of CRE within healthcare settings.

关于这个话题我们已经知道了什么?由新德里金属- β -内酰胺酶(NDM)产生菌株引起的医院获得性感染通常归因于单克隆谱系。这份报告增加了什么内容?在本研究中，我们遇到了一例独特的冠状病毒病2019 (COVID-19)后社区获得性NDM-5大肠杆菌尿路感染(UTI)。尿路感染持续了至少45天。基因组分析显示存在两种NDM-5菌株，它们具有相同的染色体背景，但具有不同的同源和重组质粒。该病例表明，人体内可能存在多种耐药基因，耐药菌株在感染期间不断进化。肠道可能是它的耐药基因库。这对公共卫生实践有什么影响?本病例的观察结果表明，耐药基因的内源性获得也可能是管理多重耐药生物(MDRO)的一个问题。在感染期间，碳青霉烯耐药肠杆菌科(CRE)可能发生连续重组。与外源性获得性耐药性相反，应更多地关注促成医疗保健环境中CRE发展的内源性因素。

{"title":"Persistent Urinary Tract Infection in Association with Community-Acquired NDM-5 Escherichia coli Clonal Group Following COVID-19 Infection - Beijing Municipality, China, 2023.","authors":"Jiazhen Guo, Ran Duan, Dan Zhang, Peng Zhang, Shuai Qin, Yajuan Fang, Yingna Sun, Lianhe Lu, Huaiqi Jing, Xin Wang, Rongmeng Jiang, Biao Kan","doi":"10.46234/ccdcw2023.110","DOIUrl":"https://doi.org/10.46234/ccdcw2023.110","url":null,"abstract":"What is already known about this topic?: The hospital-acquired infections caused by New Delhi metallo-beta-lactamase (NDM)-producing strains are typically attributed to a single clonal lineage.What is added by this report?: In this study, we encountered a unique case of community-acquired NDM-5 Escherichia coli urinary tract infection (UTI) following coronavirus disease 2019 (COVID-19). The UTI persisted for a duration of at least 45 days. Genomic analyses revealed the presence of two NDM-5 strains, both sharing an identical chromosomal background but distinct, homologous, and recombined plasmids. This case suggests that a diverse range of resistance genes may be present within the human body, with drug-resistant strains undergoing continuous evolution during infection. The intestinal tract may have been its drug-resistant gene pool.What are the implications for public health practice?: The observations presented in this case indicate that the endogenous acquisition of drug-resistant genes may also be an issue in managing multidrug-resistant organisms (MDRO). It is possible for continuous recombination to occur within carbapenem-resistant Enterobacteriaceae (CRE) during infection. In contrast to exogenously-acquired resistance, greater attention should be placed on the endogenous factors that contribute to the development of CRE within healthcare settings.","PeriodicalId":9867,"journal":{"name":"China CDC Weekly","volume":"5 26","pages":"565-571"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/b7/ccdcw-5-26-565.PMC10346097.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Suicide Prevention: More Actions Are Needed. 预防自杀：需要采取更多行动。

China CDC Weekly

Pub Date : 2023-06-23 DOI: 10.46234/ccdcw2023.106

Guoqing Hu

引用次数: 0

Prevalence and Associated Factors of Suicidal Behaviors Among Community-Dwelling Individuals with Serious Mental Disorders - Shandong Province, China, 2022. 重度精神障碍社区居民自杀行为患病率及相关因素分析——山东省，中国，2022。

China CDC Weekly

Pub Date : 2023-06-23 DOI: 10.46234/ccdcw2023.107

Meiqi Wang, Long Sun

What is already known about this topic?: Serious mental disorders (SMD) are significant risk factors for suicide, and individuals with SMD are crucial target populations for suicide prevention efforts. While numerous studies have examined the prevalence of suicidal behaviors among psychiatric inpatients, fewer reports have addressed the occurrence of such behaviors in community-based patients.

What is added by this report?: The prevalence of suicidal ideation, planning, and attempts among community-dwelling individuals with SMD was found to be 36.8%, 17.9%, and 15.0%, respectively. A significant association was observed between the severity of psychiatric symptoms and the presence of suicidal behaviors. Notably, patients within the 55-59 age range demonstrated the highest rates of both suicidal planning and attempts.

What are the implications for public health practice?: Particular attention to the risk of suicide is crucial, especially for community-dwelling individuals with SMD of middle age, those with religious beliefs, living alone, and exhibiting more severe depressive and psychiatric symptoms.

关于这个话题我们已经知道了什么?严重精神障碍(SMD)是自杀的重要危险因素，重度精神障碍患者是自杀预防工作的重要目标人群。虽然有许多研究调查了精神科住院患者中自杀行为的流行程度，但很少有报告涉及社区患者中此类行为的发生。这份报告增加了什么内容?社区生活的SMD患者有自杀意念、计划和企图的比例分别为36.8%、17.9%和15.0%。在精神症状的严重程度和自杀行为的存在之间观察到显著的关联。值得注意的是，55-59岁年龄段的患者表现出最高的自杀计划和企图率。这对公共卫生实践有什么影响?对自杀风险的特别关注是至关重要的，特别是对居住在社区的中年重度抑郁症患者、有宗教信仰的人、独居者和表现出更严重的抑郁和精神症状的人。

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引用次数: 1

Associations among Distress Rumination, Somatic Anxiety, and Suicidal Ideation in Chinese College Students - Shandong Province, China, 2019-2020. 中国大学生痛苦反刍、躯体焦虑与自杀意念的相关性研究——山东大学学报，2019-2020。

China CDC Weekly

Pub Date : 2023-06-23 DOI: 10.46234/ccdcw2023.108

Guoxiao Sun, Zhiyao Ma, Zongyu Liu, Jenny Huen, Bob Lew, Augustine Osman, Cunxian Jia

What is already known about this topic?: The literature has consistently demonstrated that distress rumination following a traumatic event has significant implications for mental health. However, the potential association between distress rumination and suicidality, as well as the underlying mechanisms driving this relationship, remains to be elucidated.

What is added by this report?: The current study demonstrated a significant, positive correlation between distress rumination and suicidal ideation in college students who have encountered traumatic events. The findings indicate that somatic anxiety serves as a mediator between distress rumination and suicidal ideation.

What are the implications for public health practice?: Interventions aimed at reducing somatic anxiety may contribute to a decrease in suicidal ideation. Assessing and addressing somatic anxiety symptoms in college students experiencing distressful rumination following traumatic events could potentially lower the risk of suicide.

关于这个话题我们已经知道了什么?文献一致表明，创伤事件后的痛苦反思对心理健康有重要影响。然而，痛苦反刍与自杀之间的潜在联系，以及驱动这种关系的潜在机制，仍有待阐明。这份报告增加了什么内容?当前的研究表明，在经历过创伤性事件的大学生中，痛苦反刍与自杀意念之间存在显著的正相关。研究结果表明，躯体焦虑在痛苦反刍与自杀意念之间起中介作用。这对公共卫生实践有什么影响?旨在减少躯体焦虑的干预措施可能有助于减少自杀意念。评估和处理创伤事件后经历痛苦反思的大学生的躯体焦虑症状可能会降低自杀的风险。

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引用次数: 1

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