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This study used a consensual qualitative research method to explore academic adaptation experiences of international students (N = 13) from East Asian countries at a U.S. university. The analysis yielded five domains from the data (challenges, feelings, strategies, suggestions, and self-reflections). Implications for college counselors, university administrators, and future research are discussed.

Aim: This study aimed to evaluate the cost‐effectiveness of hepatitis E vaccination strategies in chronic hepatitis B (CHB) patients. Methods: Based on the societal perspective, the cost‐effectiveness of three hepatitis E vaccination strategies—vaccination without screening, screening‐based vaccination, and no vaccination—among CHB patients was evaluated using a decision tree–Markov model, and incremental cost‐effectiveness ratios (ICERs) were calculated. Values for treatment costs and health utilities were estimated from a prior investigation on disease burden, and values for transition probabilities and vaccination‐related costs were obtained from previous studies and government agencies. Sensitivity analyses were undertaken for assessing model uncertainties. Results: It was estimated that CHB patients superinfected with hepatitis E virus (HEV) incurred significantly longer disease course, higher economic burden, and more health loss compared to those with HEV infection alone (all p < 0.05). The ICERs of vaccination without screening and screening‐based vaccination compared to no vaccination were 41,843.01 yuan/quality‐adjusted life year (QALY) and 29,147.32 yuan/QALY, respectively, both lower than China's per‐capita gross domestic product (GDP) in 2018. The screening‐based vaccination reduced the cost and gained more QALYs than vaccination without screening. One‐way sensitivity analyses revealed that vaccine price, vaccine protection rate, and decay rate of vaccine protection had the greatest impact on the cost‐effectiveness analysis. Probabilistic sensitivity analyses confirmed the base‐case results, and if the willingness‐to‐pay value reached per‐capita GDP, the probability that screening‐based vaccination would be cost‐effective was approaching 100%. Conclusions: The disease burden in CHB patients superinfected with HEV is relatively heavy in China, and the screening‐based hepatitis E vaccination strategy for CHB patients is the most cost‐effective option. [ABSTRACT FROM AUTHOR]

The EG.5.1 variant of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has been prevalent since mid‐July 2023 in the United States and China. The variant BA.2.86 has become a major concern because it is 34 mutations away from the parental variant BA.2 and >30 mutations from XBB.1.5. There is an urgent need to evaluate whether the immunity of the population and current vaccines are protective against EG.5.1 and BA.2.86. Based on a cohort of two breakthrough‐infected groups, the levels of neutralizing antibodies (NAbs) against different subvariants were measured using pseudovirus‐based neutralization assays. XBB.1.5, EG.5.1, and BA.2.86 are comparably immune‐evasive from neutralization by the plasma of individuals recovered from BA.5 infection (BA.5‐convalescent) or XBB.1.9.2/XBB.1.5 infection following BA.5 infection (BA.5‐XBB‐convalescent). NAb levels against EG.5.1 and BA.2.86 subvariants remained >120 geometric mean titers (GMTs) in BA.5‐XBB‐convalescent individuals 2 months postinfection but were <40 GMTs in BA.5‐convalescent individuals. Furthermore, the XBB‐targeting messenger RNA (mRNA) vaccine RQ3033 induced higher levels of NAbs against XBB.1.5, EG.5.1, and BA.2.86 than against BA.5‐XBB infection. The results suggest that BA.2.86 and EG.5.1 are unlikely to cause more severe concerns than the currently circulating XBB subvariants and that the XBB.1.5‐targeting mRNA vaccine tested has promising protection against EG.5.1 and BA.2.86. [ABSTRACT FROM AUTHOR]

Pregnant women's influenza vaccination uptake was low, although being recommended as a priority. We conducted a cross-sectional questionnaire survey in China from June to July 2021. Hierarchical regression analysis and structural equation modeling were performed based on the extended theory of planned behavior, in which attitudes, subjective norms, perceived behavioral control, and intention each affect vaccine hesitancy; response efficacy, knowledge, vulnerability, and severity were added as extended dimensions; vaccination history played as a moderator. Totally, 1283 pregnant women participated in this study. The intention existed as a mediator between attitude [βindirect = 0.142 (95% confidence interval (CI): 0.084, 0.206), P < 0.001], subjective norms [βindirect = 0.568 (95%CI: 0.424, 0.754), P < 0.001], perceived behavioral control [βindirect = 0.070 (95%CI: 0.025, 0.118), P = 0.004] and vaccine hesitancy. Further, indirect effect differences between the two dimensions of attitude (P < 0.001), perceived behavioral control (P < 0.001), and subjective norms were each statistically significant. Vaccination history did not moderate the association between attitude (P = 0.679), subjective norms (P = 0.645), and hesitancy. The subjective norms dimension has a strong association with influenza vaccine hesitancy. Vaccination history was limited to reduce hesitancy. [ABSTRACT FROM AUTHOR]

Exploring the health risks of diseases attributed to PM2.5 and SO2 exposure and analyzing the differences in their distribution over emissions can provide useful insights for decision-makers to reduce premature mortality due to PM2.5 and SO2 exposure. This study used exposure-response functions, health risk inequality curve (HRICU, based on Lorenz curve), and the health risk inequality coefficient (HRICO, based on Gini coefficient) to estimate population health risks of PM2.5 and SO2 exposure in China from 2013 to 2017 based on a full-coverage, high-precision PM2.5 and SO2 concentration and emission dataset. The inequality in the distribution of premature mortality was explored in terms of pollutant emissions. The results showed that (1) premature mortalities from cardiovascular disease (CVD) and respiratory disease (RD) due to PM2.5 and SO2 exposure decreased by 21% and 54%, respectively, from 2013 to 2017. (2) At a national scale, the HRICO value for the distribution of PM2.5 and SO2 health risks on emissions were lower than 0.10 and 0.20, respectively. (3) More than 20% of provinces had HRICO values above 0.1 for PM2.5 or SO2. The provinces near the national borders generally had higher HRICO for PM2.5, while the province with the most severe inequity in the distribution of SO2 health risks on emissions appeared in Xinjiang Uygur Autonomous Region, Ningxia Hui Autonomous Region, and Hainan Province. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is one of the top ten health threats. We aimed to (1) assess parental Category B vaccines hesitancy and associated sociodemographic factors in China, and (2) explore the association between attitude toward vaccines and self-reported hesitant behavior. A cross-sectional study was performed through a web-based anonymous online questionnaire survey between 9 February and 7 April 2021. Chinese parents aged ≥ 18 years with one child aged < 6 years were included to assess vaccine hesitancy using the vaccine-hesitancy scale (VHS). Structural equation model was used to determine relationships between variables. Of 2952 Chinese parents included in the analysis, 17.5% were highly hesitant in Category B vaccines. Parents who were younger, less educated, engaged in health-related occupations, and had been vaccinated against influenza in the past year were more hesitant when vaccinating their children (P < 0.001). VHS score accuracy to identify vaccine-hesitant behavior was acceptable, and the optimal cutoff was 37.50 (with 61.96% parental vaccine hesitancy). Parents who lack confidence or believe vaccines were risk were more likely to show vaccine hesitant behavior (P < 0.001). In China, effective interventions need to be implemented to eliminate parental Category B vaccines hesitancy. [ABSTRACT FROM AUTHOR]

This study aimed to examine childhood vaccination delay, explore the association between vaccination delay and parental vaccine hesitancy, and assess childhood vaccination delays during the coronavirus disease (COVID)-19 pandemic in China. This cross-sectional survey was conducted in Wuxi City. Participants were recruited from local vaccination clinics. Questionnaires were used to collect information about socio-demographics, vaccine hesitancy, and immunization clinic evaluations. Vaccination records were obtained from the Jiangsu Information Management System of Vaccination Cases. Overall, 2728 participants were included. The coverage for seven category A vaccines (Expanded Program on Immunization (EPI)) was more than 95% at 24 months. The proportion of children vaccinated in a timely manner was the highest for the first dose of the hepatitis B vaccine (91.6%) and the lowest for the Bacillus-Calmette-Guerin vaccine (44.6%). More than 50% of the planned vaccinations were delayed in February and March 2020. The Vaccine Hesitancy Scale scores were not associated with vaccination delay (P = 0.842). Children's vaccination delays were negatively associated with parents who reported convenient access to clinics and satisfaction with immunization services (P = 0.020, P = 0.045). EPI is highly successful in China. Despite vaccination delays due to the COVID-19 pandemic, coverage was recovered after lockdown restrictions were eased. [ABSTRACT FROM AUTHOR]

Background: Thiopurine methyltransferase (TPMT) polymorphism is one of the causes of the toxicity of thiopurines, but this is rarely seen in Asian populations. Rather, the nucleoside diphosphate‐linked X‐component motif 15 (NUDT15) gene is frequently linked to mercaptopurine (MP) intolerance and myelotoxicity in children with acute lymphoblastic leukemia (ALL) in East Asians; however, little is known about the NUDT15 polymorphism in healthy children, especially in ethnic minorities in China. Methods: A total of 162 cases of healthy children with Bai nationality were enrolled for NUDT15 genotyping. Results: Three coding variants were identified in the NUDT15 gene including rs186364861, rs746071566 and rs116855232. Notably, the rs746071566 and rs116855232 in NUDT15 showed much higher frequencies in healthy children with Bai nationality compared with healthy East Asian populations, suggesting a concentrated distribution of these variants in the Bai ethnic group. Conclusions: This finding reveals the genetic polymorphism of NUDT15 in children with Chinese Bai nationality, providing a biological genetic background for the individualized therapy of thiopurines for children with Bai nationality in China. [ABSTRACT FROM AUTHOR]

Consumer citizenship behavior is widely considered to be vital to business success. However, the role of resource uniqueness and service quality in encouraging citizenship behavior in tourism settings has not been well understood. Grounded on a framework integrating the Stimulus-Organism-Response Model and Social Exchange Theory, this study examines whether tourism resource uniqueness and service quality affect tourists' citizenship behaviors (i.e., word-of-mouth recommendations and providing feedback) through the mediating effect of tourist emotion (i.e., positive and negative emotions). A total of 321 samples collected from three types of scenic spots in China were analyzed using structural equation modeling and Bootstrapping procedures. Results suggest that both tourism resource uniqueness and service quality positively predict positive emotion and negatively influence negative emotion, which is further positively and negatively associated with word-of-mouth recommendation and providing feedback, respectively. Moreover, both positive emotion and negative emotion mediate the effects of tourism resource uniqueness and service quality on tourists' citizenship behaviors. Findings provide evidence that both resource uniqueness and service quality are critical to understand tourists' citizenship behavior, and offer important marketing implications for destinations to manage tourist emotional experiences. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to (1) assess parental hesitancy about category A (Expanded Program on Immunization (EPI)) and B (non-EPI) vaccines, (2) assess parental willingness for COVID-19 and influenza vaccinations, and (3) explore the association of vaccination hesitancy of parents and healthcare workers (HCWs). Methods: The study was performed in Wuxi, eastern China between 21 September 2020 and 17 October 2020. Parents of children aged <18 years and HCWs were recruited from the selected immunization clinics. Vaccine hesitancy was assessed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy survey (VHS) by summing the total score for 10 items (maximum 50 points). Results: A total of 3009 parents and 86 HCWs were included in the analysis. The category A VHS scores were significantly higher than the category B VHS scores (p = 0.000). Overall, 59.3% and 52.4% of parents reported willingness to avail COVID-19 and influenza vaccination for their children, respectively; 51.2% of the HCWs wanted to be vaccinated against COVID-19. Parental category B VHS scores were associated with HCW category B VHS scores (r = 0.928, p = 0.008). Conclusions: In China, parents are more hesitant about category B vaccines than category A vaccines. More than 40% of parents showed hesitancy and a refusal to use COVID-19 and influenza vaccines. [ABSTRACT FROM AUTHOR]

Assessment of vaccine literacy is essential for understanding people's ability to access various vaccine information to meet health demands. Few studies have examined the role of vaccine literacy in vaccine hesitancy, which is a psychological state. This study aimed to validate the applicability of the HLVa-IT (Vaccine Health Literacy of Adults in Italian) scale in Chinese settings and to explore the association between vaccine literacy and vaccine hesitancy. From May to June 2022, we conducted an online cross-sectional survey in mainland China. Potential factor domains were obtained by the exploratory factor analysis. Cronbach's alpha coefficient, composite reliability values, and square root values of average variances extracted were calculated to determine the internal consistency and discriminant validity. The association between vaccine literacy, vaccine acceptance, with vaccine hesitancy was assessed using logistic regression analysis. Totally, 12,586 participants completed the survey. Two potential dimensions, the functional and the interactive/critical, were identified. Cronbach's alpha coefficient and composite reliability values were >0.90. The square root values of average variances extracted exceeded the related correlations. The functional dimension (adjusted odds ratio (aOR): 0579; 95 % Confidence Interval (CI); 0.529, 0.635), interactive (aOR: 0.654; 95%CI: 0.531, 0.806)/critical (aOR: 0.709; 95%CI: 0.575, 0.873) dimension were significantly and negatively associated with vaccine hesitancy. Similar results were also found in different vaccines acceptance subgroups. This report is limited by the convenience sampling method. The modified HLVa-IT is suitable for use in Chinese settings. Vaccine literacy was negatively associated with vaccine hesitancy. • The negative association between vaccine literacy and vaccine hesitancy was found. • This study validated the usefulness of the HLVa-IT vaccine literacy scale in Chinese sittings. • Low functional scale scores mean more likely to be hesitant in all vaccine acceptance. [ABSTRACT FROM AUTHOR]

• Rainfall and distance from rivers make the most contributions to gully erosion in southern China. • Boruta algorithm was used to evaluate the relative importance of influential factors to gully erosion. • 10.61% and 2.73% of southern China is threated by gully erosion at a moderate and high risk. • Moderate and high susceptible areas mainly locate in and around Guangdong Province. Gully erosion, a dominant limiting factor in promoting ecosystem services and functions, is caused by a wide range of geo-environmental factors. However, limited information is available on the gully erosion mechanisms at a regional scale. Herein, susceptibility of a particular type of large-scale gullies across southern China were analyzed based on the 2005 National Survey on Soil and Water Loss. Specifically, frequency ratio model was used to determine the thresholds of 18 geo-environmental factors, including topography (elevation, slope gradient, slope aspect, slope length, hypsometric integral), distance from primary and tertiary rivers, climate (average annual temperature, precipitation, and rainfall erosivity), lithology, soil texture, soil moisture, vegetation index (NDVI, FVC, and EVI), as well as human activity (LULC and population density), followed by evaluating their relative importance by Boruta algorithm, and modelling the gully susceptibility modelling by random forest. The gully susceptibility was showed to be determined by comprehensive effect of all the 18 factors, with the top three important factors including average annual precipitation (9.97%), rainfall erosivity (9.60%), and distance from primary rivers (9.43%), whose thresholds were 1701 ∼ 1872 mm, 5967 ∼ 15676 MJ·mm·(ha·h·a)-1, and 20000 ∼ 50000 m, respectively. Moreover, the random forest model with its AUC value ranging from 0.96 to 0.99 performed excellently in the spatial modelling of gully susceptibility. Collectively, the very low, low, moderate, and high susceptibility to these gullies occupied 65.30%, 21.36, 10.61% and 2.73% of southern China, in which the moderate and high susceptibility level were mainly clustered in and around Guangdong Province. [ABSTRACT FROM AUTHOR]

• Benggang has been widely translated into "Collapsing gully" and "Gully." • Benggang can be regarded as a specific large-scale gully. • The mechanism of gullies varying with regional soil-lithologic-environmental conditions. The most dominant fragmented erosional landform, usually termed as "Benggang" or "Collapsing gully", has been highlighted as a national concern in China due to its serious impacts on ecosystem and social services in tropical and subtropical regions. To facilitate the investigation and prevention of Benggang, a comparative study relating to Benggang and similar erosional landforms around the world has been made by reviewing the relevant research. According to its definition, threshold-dependent process, and geomorphological character, Benggang could be regarded as a large-scale gully. The formation and development of such gully are determined by thickness of the weathering mantle. Specifically, the subtropical–tropical climatic condition accelerates weathering process and provides erosion force, while the appropriate lithology and geomorphology determine the formation and distribution of the thick weathering mantle. In general, the driving forces and formation mechanisms of gullies with regional characteristics around the world are determined by the spatial variation of soil, lithologic and environmental conditions. In order to highlight soil erosion in southern China and promote the establishment of a global research network of gully erosion, it would be better to regard Benggang as a specific large-scale gully instead of a unique erosion type in a global perspective. Futhermorer, to tackle this urgent environmental problem, it is necessary to continue efforts for a better understanding of the erosion mechanisms and implementations of effective control of Benggang. This study would facilitate the investigation and preventation of Benggang, and benefit the promotion of ecosystem services and functions in southern China. [ABSTRACT FROM AUTHOR]

HPV vaccine uptake remains low in China, especially among girls. Recently, China has initiated a pilot program on HPV immunization for girls 9-14. From November to December 2021, a cross-sectional study was conducted among parents of girls 9-14 in China through a web-based anonymous online questionnaire survey. Descriptive epidemiological analysis was used to analyze parental acceptability. Hierarchical regression analysis and structural equation modeling were to determine associated factors. A total of 5623 participants were included in the analysis. 21.2% girls had received HPV vaccine, and 94.3% parents intended to receive vaccination for their daughters, the Kappa values between them was -0.016. 31.9% of vaccinated mothers had received HPV vaccine for their daughters, vaccination history had a positive impact on behavior ( β  = 0.048). Attitude ( β  = 0.186), subjective norms ( β  = 0.148) and perceived behavioral control ( β  = 0.648) had a positive impact on intention. Vaccination intention mediated the relationships between attitude ( β  = 0.044), subjective norms ( β  = 0.035), and perceived behavioral control ( β  = 0.154) with behavior. There is a gap between vaccination intention and behavior in parents of girls 9-14. Perceived behavior control had a strong association on HPV vaccination behavior.

Evidence for the validity and reliability of the World Health Organization's 10-item vaccine hesitancy scale (VHS) in different settings is not sufficient, especially for criteria validity. This study aimed to assess the validity and reliability of the VHS using child vaccination data in China. A cross-sectional survey was performed with parents of 19-48-month-old children at six vaccination clinics in Wuxi City between September and October 2020. The VHS was revised to category A (expanded program on immunization, EPI) VHS and category B (Non-EPI) VHS. Factor analysis was used to confirm the latent domain and to assess the model structure. The average variance extracted (AVE) was calculated to assess convergent validity, and Cronbach's α and composite reliability (CR) were used to determine internal consistency. The association between VHS scores and children's vaccination status was examined to assess criteria validity using logistic regression. The survey response rate was 75.3% (n = 802). Two factors were identified, explaining 64.60% and 63.34% of the common variance in categories A and B VHS, respectively. The Cronbach's α of > 0.7 and CR of >0.7 in the scale indicated the VHS has acceptable internal consistency. The AVE values indicated that convergent validity was not ideal for the VHS. There were no statistically significant associations between VHS scores and vaccination status, indicating that the criterion validity was not ideal. The VHS needs improvement before becoming a standard survey tool.

Background: Vaccine hesitancy was listed as one of the top 10 issues threatening global health in 2019. The objectives of this study were to (a) use an extended protection motivation theory (PMT) with an added trust component to identify predictors of vaccine hesitancy and (b) explore the predictive ability of vaccine hesitancy on vaccination behavior., Methods: We conducted an online questionnaire from February 9 to April 9, 2021, in China. The target population was Chinese residents aged 18 and over. A total of 14,236 responses were received. Structural equation modeling was used to test the extended PMT model hypotheses., Results: A total of 10,379 participants were finally included in this study, of whom 52.0% showed hesitancy toward vaccination. 2854 (27.5%) participants reported that they got flu shots in the past year, and 2561 (24.7%) participants were vaccinated against COVID-19. 2857 (27.5%) participants engaged in healthcare occupation. The model explained 85.7% variance of vaccine hesitancy. Self-efficacy was the strongest predictor, negatively associated with vaccine hesitancy ( β  = -0.584; p < .001). Response efficacy had a negative effect on vaccine hesitancy ( β  = -0.372; p < .001), while threat appraisal showed a positive effect ( β  = 0.104; p < .001). Compared with non-health workers, health workers showed more vaccine hesitancy, and response efficacy was the strongest predictor ( β  = -0.560; p < .001). Vaccine hesitancy had a negative effect on vaccination behavior ( β  = -0.483; p < .001), and the model explained 23.4% variance of vaccination behavior., Conclusions: This study demonstrates that the extended PMT model is efficient in explaining vaccine hesitancy. However, the predictive ability of vaccine hesitancy on vaccination behavior is limited.

This study aimed to estimate the disease burden and health-related quality of life (HRQOL) among patients with severe hand, foot, and mouth disease (HFMD) in Jiangsu Province, China. We analyzed the surveillance data of HFMD cases in Jiangsu Province from 2009 to 2020. Moreover, a cross-sectional study was conducted in Nanjing and Suzhou, China, between January 2017 and May 2018. Patients with severe HFMD and their parents were recruited from selected hospitals. Questionnaires and hospital management systems were used to collect data on direct economic burden. The HRQOL of children was assessed using the TNO-AZL Preschool Quality of Life (TAPQOL) scale. A total of 1,348,737 confirmed cases of HFMD were reported to the NNDRS in Jiangsu province during 2009-2020. Of these, 9,622 were severe cases, with 62 (.64%) of these being fatal. From January 2017 to May 2018, data was collected from 362 severe HFMD cases using a structured questionnaire. The median per capita direct economic burden was RMB 16142.88, and was associated with the region and length of hospital stay ( P  < .05). The direct economic burden for all cases of severe HFMD in Jiangsu province between 2017 and 2018 was approximately RMB 16.64 million. Finally, the median (IQR) of the TAPQOL scale for children with severe HFMD was 69.23 (56.20, 82.27). Severe HFMD infection is a relatively large burden for individuals, and the burden of EV-A71 infection was seen to be even greater for the population. Prevention of severe HFMD should strengthen hygiene habits and targeted measures for EV-A71 vaccination.

Background: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases., Objective: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices., Methods: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior-in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation-to test the validity of the theoretical framework., Results: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (β=-0.052, P<.001) and subjective norms (β=-0.028, P=.006) with perceived behavioral control were significant., Conclusions: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior., (©Liuqing Yang, Lili Ji, Qiang Wang, Yan Xu, Guoping Yang, Tingting Cui, Naiyang Shi, Lin Zhu, Shixin Xiu, Hui Jin, Shiqi Zhen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 20.06.2022.)

This study aimed to assess the cost-effectiveness of various public health measures in dealing with coronavirus disease 2019 (COVID-19) in China. A stochastic agent-based model was used to simulate the progress of the COVID-19 outbreak in scenario I (imported one case) and scenario II (imported four cases) with a series of public health measures. The main outcomes included the avoided infections and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to assess uncertainty. The results indicated that isolation-and-quarantine averted the COVID-19 outbreak at the lowest ICERs. The joint strategy of personal protection and isolation-and-quarantine averted one more case than only isolation-and-quarantine with additional costs. The effectiveness of isolation-and-quarantine decreased with lowering quarantine probability and increasing delay time. The strategy that included community containment would be cost-effective when the number of imported cases was >65, or the delay time of the quarantine was more than 5 days, or the quarantine probability was below 25%, based on current assumptions. In conclusion, isolation-and-quarantine was the most cost-effective intervention. However, personal protection combined with isolation-and-quarantine was the optimal strategy for averting more cases. The community containment could be more cost-effective as the efficiency of isolation-and-quarantine drops and the imported cases increases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Shi, Huang, Yang, Cui, Ai, Ji, Xu, Ahmad, Bao and Jin.)

This study evaluated different varicella vaccination strategies in Jiangsu province, China. A decision-tree Markov model was used to evaluate the cost effectiveness of various varicella vaccination strategies for children, including direct and selective vaccination (serotesting pre-vaccination). A cohort of one-year-old children was followed through 60 one-year Markov cycles. The parameter estimation was based on field work, the literature, and statistical yearbooks. We calculated the incremental cost-utility ratio (ICUR) using the saved quality-adjusted life year (QALY). One-way and probability sensitivity analyses were performed to assess uncertainty. Among 100,000 cohort members, one-dose and two-dose direct vaccination averted 8061 and 10,701 varicella cases, respectively, compared with no vaccination. Furthermore, compared with no vaccination, one-dose and two-dose direct vaccination saved one QALY at the ICUR of USD 21,401.33 and USD 35,420.81, respectively, at less than three times the per capita gross domestic product (USD 47,626.86) of Jiangsu. The ICURs of the one-dose and two-dose selective strategies versus no vaccination were USD 42,623.62 and USD 51,406.35 per QALY gained, respectively. The cost effectiveness results were most sensitive to the QALY loss of outpatients and vaccine prices. Thus, in Jiangsu, one-dose and two-dose direct varicella vaccination in children could be cost effective at the willingness to pay threshold of three times provincial GDP per capita from a societal perspective. The findings were sensitive to the vaccine price and health utility of varicella cases.

Background: COVID-19 has posed a global threat due to substantial morbidity and mortality, and health education strategies need to be adjusted accordingly to prevent a possible epidemic rebound., Objective: This study aimed to evaluate the perceptions of COVID-19 among individuals coming to, returning to, or living in Jiangsu Province, China, and determine the impact of the pandemic on the perceptions of the public., Methods: In this study, an online questionnaire was distributed to participants between February 15 and April 21, 2020. The questionnaire comprised items on personal information (eg, sex, age, educational level, and occupation); protection knowledge, skills, and behaviors related to COVID-19; access to COVID-19-related information; and current information needs. Factors influencing the knowledge score, skill score, behavior score, and total score for COVID-19 were evaluated using univariate and multivariate analyses. The time-varying reproduction number (R t ) and its 95% credible interval were calculated and compared with the daily participation number and protection scores., Results: In total, 52,066 participants were included in the study; their average knowledge score, skill score, behavior score, and total score were 25.58 (SD 4.22), 24.05 (SD 4.02), 31.51 (SD 2.84), and 90.02 (SD 8.87), respectively, and 65.91% (34,315/52,066) had a total protection score above 90 points. For the knowledge and skill sections, correct rates of answers to questions on medical observation days, infectiousness of asymptomatic individuals, cough or sneeze treatment, and precautions were higher than 95%, while those of questions on initial symptoms (32,286/52,066, 62.01%), transmission routes (37,134/52,066, 71.32%), selection of disinfection products (37,390/52,066, 71.81%), and measures of home quarantine (40,037/52,066, 76.90%) were relatively low. For the actual behavior section, 97.93% (50,989/52,066) of participants could wear masks properly when going out. However, 19.76% (10,290/52,066) could not disinfect their homes each week, and 18.42% (9589/52,066) could not distinguish differences in initial symptoms between the common cold and COVID-19. The regression analyses showed that the knowledge score, skill score, behavior score, and total score were influenced by sex, age, educational level, occupation, and place of residence at different degrees (P<.001). The government, television shows, and news outlets were the main sources of protection knowledge, and the information released by the government and authoritative medical experts was considered the most reliable. The current information needs included the latest epidemic developments, disease treatment progress, and daily protection knowledge. The R t in the Jiangsu Province and mainland China dropped below 1, while the global R t remained at around 1. The maximal information coefficients ranged from 0.76 to 1.00, which indicated that the public's perceptions were significantly associated with the epidemic., Conclusions: A high proportion of the participants had sufficient COVID-19 protection knowledge and skills and were able to avoid risky behaviors. Thus, it is necessary to apply different health education measures tailored to work and study resumption for specific populations to improve their self-protection and, ultimately, to prevent a possible rebound of COVID-19., (©Tingting Cui, Guoping Yang, Lili Ji, Lin Zhu, Shiqi Zhen, Naiyang Shi, Yan Xu, Hui Jin. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.11.2020.)

Background/aims: To investigate associations be- tween serum trypsinogen-2, pancreatitis and pancreatic cancer (PC) and determine cutoff values for PC diagnosis., Methodology: We recruited 88 patients from Internal Medicine/Surgical Departments of General Military Hospital of Beijing PLA between 12/2009 and 6/2010. Serum samples were collected preoperatively from 23 PC patients, 30 pancreatitis patients and 35 healthy controls. Enzyme-linked immunosorbent assay was used to detect trypsinogen-2 semiquantitatively., Results: Serum trypsinogen-2 levels of PC and pancreatitis patients were significantly higher than those of controls (51.2 ± 80.3, 107.7 ± 98.1 vs. 1.0 ± 0.5, p = 0.03, p < 0.001) and significantly higher in pancreatitis vs. PC patients (107.7 ± 98.1 vs. 51.2 ± 80.3, p = 0.01). Higher Balthazar CT grades correlated with higher trypsinogen-2 in pancreatitis group. ROC curves for trypsinogen-2 revealed optimal cutoff value 1.8 as lower PC detection limit with 95.7% sensitivity and 91.4% specificity, and optimal cutoff value 19.9 for upper PC detection limit with 87.0% sensitivity and 97.1% specificity. Trypsinogen-2 levels correlated with pancreatic injury level. An AUC of 0.73 (95% Cl: 0.59-0.84, p = 0.002) distinguished PC from pancreatitis., Conclusion: Serum trypsinogen-2 is associated with PC and pancreatitis. Levels between 1.8 μg/L and 19.9 μg/L strongly suggest PC. Detection of serum trypsinogen-2 may provide simple, sensitive, specific non-invasive initial screening for early PC diagnosis.

The time to flowering and maturity are ecologically and agronomically important traits for soybean landrace and cultivar adaptation. As a typical short-day crop, long day conditions in the high-latitude regions require soybean cultivars with photoperiod insensitivity that can mature before frost. Although the molecular basis of four major E loci (E1 to E4) have been deciphered, it is not quite clear whether, or to what degree, genetic variation and the expression level of the four E genes are associated with the time to flowering and maturity of soybean cultivars. In this study, we genotyped 180 cultivars at E1 to E4 genes, meanwhile, the time to flowering and maturity of those cultivars were investigated at six geographic locations in China from 2011 to 2012 and further confirmed in 2013. The percentages of recessive alleles at E1, E2, E3 and E4 loci were 38.34%, 84.45%, 36.33%, and 7.20%, respectively. Statistical analysis showed that allelic variations at each of four loci had a significant effect on flowering time as well as maturity. We classified the 180 cultivars into eight genotypic groups based on allelic variations of the four major E loci. The genetic group of e1-nf representing dysfunctional alleles at the E1 locus flowered earliest in all the geographic locations. In contrast, cultivars in the E1E2E3E4 group originated from the southern areas flowered very late or did not flower before frost at high latitude locations. The transcriptional abundance of functional E1 gene was significantly associated with flowering time. However, the ranges of time to flowering and maturity were quite large within some genotypic groups, implying the presence of some other unknown genetic factors that are involved in control of flowering time or maturity. Known genes (e.g. E3 and E4) and other unknown factors may function, at least partially, through regulation of the expression of the E1 gene.