The surveillance of infectious diseases relies on the identification of dynamic relations between the infectious diseases and corresponding influencing factors. However, the identification task confronts with two practical challenges: small sample size and delayed effect . To overcome both challenges to imporve the identification results, this study evaluated the performance of dynamic Bayesian network(DBN) in infectious diseases surveillance. Specifically, the evaluation was conducted by two simulations. The first simulation was to evaluate the performance of DBN by comparing it with the Granger causality test and the least absolute shrinkage and selection operator (LASSO) method; and the second simulation was to assess how the DBN could improve the forecasting ability of infectious diseases. In order to make both simulations close to the real-world situation as much as possible, their simulation scenarios were adapted from real-world studies, and practical issues such as nonlinearity and nuisance variables were also considered. The main simulation results were: ① When the sample size was large ( n = 340), the true positive rates (TPRs) of DBN (≥98%) were slightly higher than those of the Granger causality method and approximately the same as those of the LASSO method; the false positive rates (FPRs) of DBN were averagely 46% less than those of the Granger causality test, and 22% less than those of the LASSO method. ② When the sample size was small, the main problem was low TPR, which would be further aggravated by the issues of nonlinearity and nuisance variables . In the worst situation (i.e., small sample size, nonlinearity and existence of nuisance variables), the TPR of DBN declined to 43.30%. However, it was worth noting that such decline could also be found in the corresponding results of Granger causality test and LASSO method. ③ Sample size was important for identifying the dynamic relations among multiple variables, in this case, at least three years of weekly historical data were needed to guarantee the quality of infectious diseases surveillance. ④ DBN could improve the foresting results through reducing forecasting errors by 7%. According to the above results, DBN is recommended to improve the quality of infectious diseases surveillance.

Objective Many studies focused on reasons behind the increasing incidence and the spread of human brucellosis in mainland China, yet most of them lacked comprehensive consideration with quantitative evidence. Hence, this study aimed to further investigate the epidemic mechanism and associated factors of human brucellosis so as to provide thoughts for future countermeasures in China and the rest of the world. Methods Data of human brucellosis incidence and some associated factors in economy, animal husbandry, transportation as well as health and hygiene were collected at provincial level from 2005–2016. Time series plots were first used to visualize the annual incidence and annual rate of change of human brucellosis for each province, then cluster analysis categorized all the 31 provinces of mainland China based on their incidence time series during the study period. In addition, according to the characteristics of data, the dynamic panel data model in combination with supervised principal component analysis was proposed to explore effects of associated factors on human brucellosis. Results 1. The incidence rate of human brucellosis in mainland China increased three-fold from 1.41 per 100,000 people in 2005 to 4.22 per 100,000 people in 2014, though it went down a little in 2015 and 2016. Incidence rates in the north have always been higher than those in the south, but the latter also experienced an upward trend especially between 2012 and 2016. 2. The 31 provinces of mainland China were categorized into three clusters, and each cluster had its own characteristics of incidence time series. 3. The impact of health and hygiene situations on the prevention and control work of human brucellosis was still very limited and trivial (regression coefficient = -0.02). Therefore, it was plausible to presume that improving the personal average number of medical institutes and the proportion of rural medical expenditure might be helpful in preventing and controlling human brucellosis. Conclusions The epidemic status of human brucellosis has changed in both spatial and temporal dimensions in recent years in mainland China. Apart from traditional control measures, more attention should be paid to the improvement of medical healthcare especially in rural areas in the hope of enhancing the control effect.

Background: As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. Methods: Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. Results: A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. Conclusion: Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.

ObjectiveMany studies focused on reasons behind the increasing incidence and the spread of human brucellosis in mainland China, yet most of them lacked comprehensive consideration with quantitative evidence. Hence, this study aimed to further investigate the epidemic mechanism and associated factors of human brucellosis in China so as to provide suggestions on more effective countermeasures.MethodsData of human brucellosis incidence and some associated factors in economy, animal husbandry, transportation and health were collected at provincial level from 2005-2016. Time series plot and cluster analysis were first used to visualize incidence levels and categorize provinces based on their incidence level and epidemic trend of human brucellosis. Furthermore, according to the characteristics of data, the dynamic panel data model in combination with supervised principal component analysis was proposed to explore the effects of associated factors on human brucellosis.Results① The incidence rate of human brucellosis has increased threefold (from 1.41 in 2005 to 4.22 in 2016) in mainland China. Incidence rates in the north have always been higher than those in the south, but the latter also experienced an upward trend especially in the recent five years. ② The 31 provinces of mainland China were categorized into three clusters, and each cluster had its own characteristics of incidence level and epidemic trend. ③ Public health expenditure and rural medical expenditure proportion were potential protective factors of human brucellosis, with attribute risks of −0.74 and −1.04 respectively. Other factors (such as amount of sheep, total length of highways, etc.) exhibited relatively trivial effects.ConclusionsThe epidemic status of human brucellosis has changed in both spatial and temporal dimensions in recent years. Apart from those traditional control measures, more attention should be paid to the improvement of medical healthcare especially in rural areas in order to strengthen the control effect.

Background: Early detection of scoliosis is of great significance to patients with scoliosis and the whole society. This paper aims to learn the prevalence of scoliosis screening positive among students in primary and secondary schools, and to explore the influencing factors. Methods: In 2019, a stratified cluster sampling technique was employed in this school based cross-sectional study. Sampling covers all prefecture level cities in Zhejiang Province. Based on the whole class, at least 80 students in each grade of primary school, junior high school and senior high school were selected. Physical examination and scoliosis screening were performed in the school-based investigation. Distribution of demographic characteristics and nutritional status of children and adolescents with scoliosis screening positive were explored. Results: A total of 45547 students were screened. The overall prevalence of children and adolescents with scoliosis screening positive were 3.9%. Higher prevalence of scoliosis screening positive was found in students living in urban area (4.1%), female students (4.1%), students with low weight (5.3%) (p < 0.05), and the prevalence increased with age (p < 0.05). In logistic analysis, we found age (OR=1.145), gender (OR=1.118) and low weight (OR=1.480) were the influencing factors for prevalence of scoliosis screening positive (p < 0.05). Conclusions: There were no disparities between living areas, but there was significant difference between genders, among different ages, and among different nutritional status of children and adolescents with or without scoliosis screening positive. In multi analysis, age, gender, and low weight were the influencing factors for prevalence of scoliosis screening positive. Age and gender specific scoliosis screening strategy and nutritional public health policies for children and adolescent are need.