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Clinical, epidemiological, and genomic evidence on mpox in mainland China, 2022-2025: a scoping review.

BACKGROUND: Since 2022, mpox has expanded globally with sustained human-to-human transmission and increasing evidence of MPXV genomic diversification. In mainland China, mpox evidence has accumulated rapidly, but clinical, epidemiological, and genomic findings remain fragmented. METHODS: We conducted a scoping review of PubMed, CNKI, and WanFang databases up to March 2, 2026, and integrated literature-derived evidence with public MPXV sequences from GenBank, GenBase, and GISAID. Literature-derived data were used to map clinical-epidemiological characteristics, study-level genomic evidence, sequencing coverage, and reported lineage distribution. Curated public MPXV sequences were used for phylogenetic reconstruction, amino acid mutation profiling, and APOBEC-like substitution analysis. RESULTS: Fifty-eight studies were included: 32 addressed clinical or epidemiological evidence only, 25 addressed genomic evidence only, and one contributed to both domains. Fourteen hospital-based studies summarized 951 cases, showing that reported cases were concentrated among young adult men, with frequent MSM exposure (798/897, 89.0%; 95% CI 86.7-90.9%) and HIV co-infection (469/951, 49.3%; 95% CI 46.1-52.5%). Public sequence curation identified 231 unique mainland China MPXV sequences, of which 230 were used for phylogenetic and mutation analyses. Literature-based genomic evidence comprised 26 genomic studies, 37 study-level genomic records, and 31 reported-case units, including 414 sequenced cases among 530 reported cases (78.1%; 95% CI 74.4-81.4%). Clade IIb predominated among sequenced cases (412/414, 99.5%; 95% CI 98.3-99.9%), with C.1.1 and C.1 most frequently represented. Within the available dataset, public genomes represented multiple lineages and were unevenly distributed across regions and time. Mutation analysis revealed dispersed amino acid variation and a predominance of G>A and C>T transitions (73.0%). After collapsing recurrent substitutions to unique genomic sites, the proportion of G>A/C>T transitions decreased to 35.8% and further to 17.8% under a strict APOBEC3 motif definition, indicating that the observed mutation spectrum includes both shared lineage-associated substitutions and sequence-context-based APOBEC-like patterns. CONCLUSION: Available evidence indicates multi-lineage MPXV circulation and in mainland China, but interpretation remains constrained by uneven sequencing and lack of individual-level clinical-genomic linkage. Integrated genomic surveillance and standardized data linkage are needed to better characterize MPXV transmission and evolution.

APOBEC‑like substitutions↗

Epidemics of procedures: growth in admissions to hospital in Western Australia, 1972 to 1977.

Admissions to hospital, associated with procedures, increased by 20% in Western Australia between 1972 and 1977. This increase in hospital-based procedures appeared to be widespread, both in terms of types of procedures and in terms of age groups of patients. For some procedures the increase was so large as to imitate an "epidemic". Manpower data indicate a parallel growth in practising clinical specialists and the increase in admissions to hospitals. Some suggestions are made about this association and possible causal factors.

Adolescent↗

Oral health services: a Delphi technique estimation of their role in adult inpatient rehabilitation programs.

This report presents the results of an investigation into one possible administrative route that would increase the accessibility and availability of dental services for the handicapped. Specifically, this paper assesses the desirability of, perceived level of need for, and feasibility of incorporating a dental service into the total hospital rehabilitation program for adults. The Delphi technique, a method of gathering the opinions of experts through a sequentially designed set of questionnaires, was used to ascertain the views of ten chairpersons of physical medicine and rehabilitation units. The results of this discussion indicate that the perceived need is great, that access to care is difficult, and that a feasible solution would be to establish a hospital-based dental service, preferably convenient to the rehabilitation dormitory, which would provide a full range of dental services.

Administrative Personnel↗

Conservatorship: an involuntary legal status for 'gravely disabled' mentally disordered persons.

Since 1969 in California, conservatorship has been the only form of civil, longterm involuntary psychiatric legal process. It does not require hospital-based treatment. This paper reports a preliminary study of this process through a retrospective analysis of conservatorship records in Sacramento County, California, from 1969 through 1976. There is a steady overall increase in the incidence of conservatorships each year. A dramatic decrease in state hospital admissions preceded this increase. Referrals were predominantly (69 percent) from the private sector. Once the first legal step was taken 87 percent of the patients completed the process and were placed on full conservatorship. Median age was 50; 52 percent were male and 90 percent were white. The relative proportion of single persons was high (45 percent). Diagnoses of schizophrenia and organic brain syndrome accounted for 86 percent of conservatees. About half (52 percent) terminate conservatorship after one year. No data were found which could be related to the character of treatment of conservatees. Future research in this area is urgently needed.

California↗

Simultaneous nosocomial and community outbreak of epidemic keratoconjunctivitis with types 8 and 19 adenovirus.

In a simultaneous community and nosocomial (hospital-based) epidemic of keratoconjunctivitis lasting one year, 97 patients had clinical findings characteristic of EKC. Seventy-one percent of the cases were confirmed by laboratory tests including viral isolation, antibody response detected by complement fixation and hemagglutination inhibition tests, or immunofluorescent detection of adenovirus antigen in conjunctival scrapings. The community epidemic was a mixed adenovirus type 19 and type 8 outbreak. The nosocomial outbreak was due primarily to adenovirus type 8 (91%). The epidemiologic data of the nosocomial epidemic were representative of the population involved. The community outbreak was primarily in young individuals between 11 and 40 years of age. The secondary household attack rates were 20% and essentially were equal in both epidemics. The primary mode of spread in the nosocomial outbreak was by contamination of the examiner's fingers. In the community epidemic the mode of spread was believed to be close personal contact in a young and active age group.

Adenoviridae Infections↗

Medical and educational malpractice issues in patient education.

This paper discusses the concept of educational malpractice as a cause of prolonged patient morbidity equal in magnitude to medical malpractice. Statements by national groups sanctioning and urging increased patient education efforts are reviewed. An example of specially designed problem-oriented patient education materials development, the concept of an "Educational Prescription," the place for the "Educational Prescription" in problem-oriented medical records, and the value of hospital-based patient education as a cost-containment activity.

Hospitals↗

Hospital case mix and average charge per case: an initial study.

The use of case mix to explain hospital costs has been refined in previous research on the cost of hospital-based health care. This study demonstrates the significance of hospital case mix in explaining charges for health care treatment. By assuming that the variables which influence cost should also influence charges, an evaluative function is added to the basic investigative analysis potential of the hospital production process model. The relationship between case mix and charges is found to be weaker than the relationship between case mix and costs. This difference is qualified by methodological variation and possibly explained by cross-subsidization of patient services and lack of adequate controls on charge determination. Further, the relationship between case mix and charges is found to differ between Medicare and Blue Cross patients. This evidence suggests that hospital accounting may not be recovering costs evenly and equitably from clients.

Blue Cross Blue Shield Insurance Plans↗

Pharmacist-managed patient assessment and medication refill clinic.

The effectiveness of a pharmacist in determining the appropriateness of prescription renewal for patients appearing at a hospital-based refill clinic was investigated. In part 1, data were collected on the clinic as it traditionally functioned with staff physicians evaluating the patients. In parts 2 and 3, data were collected with the pharmacist assuming the assessment function. In part 2, a physician reviewed the pharmacist's decisions before the patient left. In part 3, the pharmacist functioned without supervision and the physician reviewed patient records retrospectively. Physician agreement with the pharmacist's decisions was the primary criterion for determining effectiveness, and was found to be 99% in part 2, for a total of 105 patients. In part 3, physician agreement remained at the 99% level for a total of 106 patients. Patient waiting time was about the same in each part of the study because of clinic procedures beyond the pharmacist's control. A pharmacist can be cost-effective in this role if the task is combined with regular pharmaceutical functions.

Cost-Benefit Analysis↗

Heart risks identified by program.

Hospital-based cardiac stress test has permitted the identification of persons with serious risk of heart problems without the need for excessive costs.

Community-Institutional Relations↗

A ladder curriculum in clinical microbiology.

A continuum of four microbiology courses for medical technology majors has been developed by the Medical Laboratory Science Program at Northeastern University. Using a system approach to curriculum design, the academic and clinical faculty identified career-entry capabilities, delineated appropriate subject content, and developed an instructional system which placed individual topics into one of four courses in the ladder curriculum: a basic, second-year, university-based clinical microbiology course stressing microbial technique and common organism identification; third-year microbiology and cellular physiology courses developing theoretical aspects; a fourth-year, hospital-based clinical microbiology rotation emphasizing isolation and identification techniques for significant pathogens; and a fourth-year, university-based, didactic course covering host defense-organism virulence interactions, infectious disease principles, and new techniques and unusual isolates as reported in the recent journal literature. Based on four years of experience with this system and in light of the publication of the 1978 American Society for Medical Technology (ASMT) Competency Statements, the Northeastern Medical Laboratory Science Program faculty is currently reexamining the continuum to insure completeness and appropriateness of overall subject content, to provide reinforcement, and to remove unnecessary duplication among the courses in the curriculum.

Certification↗

Measuring hospital medical staff organizational structure.

Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance.

Analysis of Variance↗

Slide- tape sequence: a teaching aid in instrumentation.

A study at Wayne State University involving 34 medical technology students was conducted in an effort to provide supportive evidence for the use of selected audiovisual material in the teaching of instrumentation. The study did not conclusively demonstrate the effectiveness of a slide-tape sequence in this university instrumentation course. However, the methodology and evaluative procedures may prove helpful to universities and hospital-based programs in determining the usefulness of their audiovisual material.

Audiovisual Aids↗

Rape: an organized approach to evaluation and treatment.

Rape is a rapidly spreading form of violence. The physician must examine and treat the victim and establish an adequate record for legal purposes. Treatment of the victim includes follow-up for late-emerging ego disruption and is greatly aided by employing the assistance of organized agencies such as a hospital-based Social Service or a Rape Crisis Center. It is also important that the victim receive adequate protection against venereal disease and pregnancy.

Female↗

Cancer registries in Australia.

Cancer registries are at an early stage of development in Australia. Population-based registries are located in New South Wales Registry and Western Australia, and of these, only the New South Wales Registry is fully functioning. A hospital-based registry is maintained in Victoria. We have a national cancer registry in principle but it will not be functional for many years. Preliminary statistics for New South Wales indicate a cancer pattern similar to Caucasian populations. Some epidemiologic surveys have been undertaken.

Australia↗

Health information for patients: The hospital library's role.

Libraries today, including most hospital-based patients' libraries, are involved only peripherally in providing patient health science information. Hospital libraries should collaborate with health professionals in getting health information to patients--along with the library's more traditional roles of providing recreational reading for patients and serving the informational needs of the physician and medical staff. The library should act as the center for educational materials and programs within the hospital. Many health agencies, health educators, physicians, and librarians have been discussing the need for patient health education, but there are few effectively organized or established education centers. This paper discusses an overview of patient health education and intellectural freedom, proposes a new role for the existing hospital library in patient health education, and suggests guidelines for establishing a patient education center.

Health Education↗

AMTEC: a cooperative effort in medical technology education.

A committee in the St. Louis Metropolitan area has been established to promote communication and cooperation among the area's existing hospital-based programs in medical technology. Area Medical Technology Education Coordinators (AMTEC) was established three years ago primarily to facilitate the administrative functions of medical technology education and to serve as an instrument for the exchange of ideas. Its primary undertaking has been the central processing of applications to the area programs, as an aid in the admission process. In addition, a continuing education program sponsored by the committee has been established, and various "curriculum sharing" activities have been sponsored for the students enrolled in the schools. Future plans for the committee include sponsoring an on-going evaluation process of graduates by employers, and establishing a criterion-referenced question pool. The authors describe the experiences of the committee to date and plans for the implementation of future goals.

Medical Laboratory Science↗

Improving physician performance by continuing medical education.

In 1973 the division of continuing medical education of the University of Saskatchewan initiated a 3-year study to determine the effect of hospital-based education on the prescribing accuracy of physicians. This study was undertaken in response to an urgent need to develop more effective methods of continuing medical education and improved techniques of measuring their effectiveness. The educational program focused on common prescribing problems that had previously been defined by experts in the field. Problem frequency was determined by the monitoring of hospital records prior to institution of the educational program and at 3, 6 and 12 months after the program had concluded; this was found to be a satisfactory method of identifying educational needs and is considered to provide a measure of the quality of medical care. Fifteen physicians at three rural hospitals participated in the study. Seventeen physicians at two similar hospitals served as controls. The average problem frequency for topics selected at the study hospitals was reduced by 63% (the percentage of possible improvement), whereas at the control hospitals the frequency of the same problems declined by 32% over the same period. The results of this study provide evidence that an intensive, problem-based program on therapeutics can improve physician performance.

Drug Prescriptions↗