Chronic hepatitis C is a major global health challenge. China has the world's largest burden of hepatitis C and related liver disease, with several groups having an increased risk of acquiring hepatitis C virus (HCV) infection. We undertook a systematic review in Chinese and English literature to determine the seroprevalence of anti-HCV among men who have sex with men (MSM), sex workers, people who use drugs (PWUD) and migrant workers in China. We searched three Chinese databases (CNKI, Wanfang and Chongqing VIP Information) and four English databases (Pubmed, EMBASE, Global Health and CINAHL) for studies published between 2010 and 2015. Included were 89 studies for MSM, 112 for sex workers, 11 for migrant workers, 94 for people who inject drugs (PWID) and 67 for non-injectors. Random-effect models pooled estimates of anti-HCV seroprevalence in each population and a meta-regression model examined the relationship between anti-HCV seroprevalence and injecting drug use. The overall pooled seroprevalence of anti-HCV among MSM was 0.67% (CI 95 0.51-0.86); for sex workers 0.65% (CI 95 0.53-0.77); for migrant workers 0.48 (CI 95 0.20-0.85); for IDUs 72.41% (CI 95 68.71-75.97); among non-injectors 25.07% (CI 95 21.51%-28.80%). Our meta-regression model predicted that the seroprevalence of anti-HCV among PWID increased by 8.6% for each 10% increase seroprevalence of reporting ever having injected drugs. Overall, seroprevalence of HCV infection is high among PWUD, especially those who inject. Lower HCV seroprevalence (<1%) was found among MSM, sex workers and migrant workers. Our estimates for IDU seroprevalence are higher than that from the national surveillance system, though estimates for other at-risk populations are similar.

Background and aim: Benchmarking is a management approach for implementing best medical practices at the lowest cost. The objectives of this study were to set achievable performance benchmarks for individual quality indicators to determine the predicted quality achievement related to better adherence, and to select optimal quality indicators for improving the quality of acute ischemic stroke care. Methods: We analyzed data on 500,331 patients diagnosed with acute ischemic stroke who were treated at 518 hospitals in China from January 2011 to May 2017. The primary outcome was independence (modified Rankin Scale score ≤2) at discharge. Data-driven achievable benchmarking used the “pared-mean” approach to set objective performance targets. Hierarchical logistic regression models were employed to evaluate the process–outcome association, as well as the predicted quality improvement if all hospitals were to operate at the benchmark level. Results: Of the overall population, 64.01% were independent patients at discharge. The performance benchmarks were >90% for most of the quality indicators. After adjusting for patient-level and hospital-level characteristics and unifying hospital performance to the benchmark level, the quality indicators with high increase in both overall adherence rate and independence rate were thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis. Conclusions: Performance targets for three acute treatments, including thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis, could best motivate improvements in both overall adherence rate and independence rate at discharge. The finding suggests that the above three types of acute treatment should be given priority to improve the quality of acute ischemic stroke care.

Measles is a highly contagious disease and remains a major cause of child mortality worldwide. While measles vaccine is highly effective, high levels of population immunity are needed to prevent outbreaks. Simple but accurate tools are needed to estimate the profile of population measles immunity by age to identify and fill immunity gaps caused by low levels of vaccination coverage. The measles immunity profile estimates and visualizes the percentage of each birth cohort immune or susceptible to measles based on measles vaccination coverage. Several tools that employed this approach have been developed in the past, including informal unpublished versions. However, these tools used varying assumptions and produced inconsistent results. We updated the measles population immunity profile methodology to standardize and better document the assumptions and methods; provide timely estimates of measles population immunity; and facilitate prompt actions to close immunity gaps and prevent outbreaks. We recommend assuming that the second dose of the measles-containing vaccine (MCV2) and doses given during supplementary immunization activities (SIAs) first reach children who have been previously vaccinated against measles, so that previously unvaccinated children are reached only when the coverage of MCV2 or SIA is higher than the coverage achieved by all previous measles vaccination opportunities. This updated method provides a conservative estimate of immunization program impact to assess measles outbreak risk and to facilitate early planning of timely preventive SIAs to close population immunity gaps.