The Characteristics of Human Resources and Related Research Activities among Basic Stem Cell Research Groups in China

BACKGROUND

This study aimed to evaluate the characteristics of faculty and research activities of basic stem cell research groups in China.

METHODS

A questionnaire was administered to persons who knew the information among 46 basic stem cell research groups in China. Multiple linear regression models and repeated-measures analyses of variance were used. Repeated-measures analyses of variance were used.

RESULTS

Of the 46 groups, 39.1% did not have any faculty recruited from abroad from 2009 to 2013, 37.0% did not have any faculty with junior-level title, 34.8% had ≤25.0% faculty with either M.D. or Ph.D. degree. Papers published in SCI journals per faculty and having faculty recruited from abroad were positively associated with research funding per faculty. The groups with faculty recruited from abroad had significantly higher research funding per faculty over time compared with the group without faculty recruited from abroad. Repeated-measures analyses of variance showed the group with faculty recruited from abroad had significantly higher research funding per faculty over time compared with the group without faculty recruited from abroad.

CONCLUSION

To increase the development of basic stem cell research, some characteristics of human resources should be improved, and the groups should recruit more faculty with overseas experience.

[Progress of research on influencing factors of condom use among female sex workers]

Heterosexual transmission has become the main route of HIV transmission in China. As the main body of commercial heterosexual transmission, female sex workers (FSW) have a high-risk behavior of inconsistent condom use that increase the risk of HIV infection and spread. This review summarizes associated factors of condom use among FSW such as demographic characteristics, condom negotiation, sexual partner type, sexual intercourse, violence and HIV testing, which can provide reference for the future prevention and research among the FSWs.

[Analysis on influencing factors of unprotected sexual behavior among men who have sex with men based on structural equation model]

Objective: To analyze the influencing factors and mechanism for unprotected sexual behavior of men who have sex with men (MSM) in China. Methods: MSM who are more than 16 years old and have had homosexual sexual behaviors in recent years were recruited from five cities (Tianjin, Harbin, Nanjing, Chongqing and Xi'an) with active MSM population during 2013-2014 through network, site recruitment and peer recommendation using convenient sampling method. 3 519 subjects were included in this study. The sexual behavior related information of MSM in five cities was investigated using questionnaires. The confirmatory factor analysis was used to construct the measurement model by using the robust estimation method based on the weighted least square method to estimate parameters, and the final model was determined through evaluation and modification. Results: A total of 3 519 subjects were (29.9±8.76) years old, with a clear sexual orientation of 3 223 (91.6%), and 2 287 (65.0%) were aware of free HIV/AIDS treatment policies. The proportion of using condom last time was 77.2% (n=2 718), and the proportion of using condom every time was 36.9% (n=1 299) and 43.2% (n=1 521) respectively for the past six months with fixed and temporary partners. Structural equation model provided a good fit, the root mean square error of approximation, comparative fit index and non-normed fit index was 0.07, 0.97, 0.95, respectively. Knowing AIDS knowledge, educational level and sexual orientation had direct effects on unprotected sexual behavior, and the path coefficients were 0.179,-0.049 and -0.159, respectively. While the role of interventions was indirect, the path coefficient was 0.147. Conclusion: Lower education and unclear sexual orientation are disadvantages for reducing unprotected sexual behavior. Interventions mainly affect the unprotected sexual behavior by improving the level of HIV/AIDS knowledge. Increasing the comprehensive knowledge of MSM through intervention should be highly valued.

Efforts, rewards and professional autonomy determine residents' experienced well-being

The well-being of residents, our future medical specialists, is not only beneficial to the individual physician but also conditional for delivering high-quality patient care. Therefore, the authors further explored how residents experience their own well-being in relation to their professional and personal life. The authors conducted a qualitative study based on a phenomenological approach. From June to October 2013, 13 in-depth interviews were conducted with residents in various training programs using a semi-structured interview guide to explore participants' experience of their well-being in relation to their professional life. The data were collected and analyzed through an iterative process using the thematic network approach. Effort-reward balance and perceived autonomy were dominant overarching experiences in influencing residents' well-being. Experiencing sufficient autonomy was important in residents' roles as caregivers, as learners and in their personal lives. The experienced effort-reward balance could both positively and negatively influence well-being. We found two categories of ways that influence residents' experience of well-being; (1) professional lives: delivering patient care, participating in teamwork, learning at the workplace and dealing with the organization and (2) personal lives: dealing with personal characteristics and balancing work-life. In residents' well-being experiences, the effort-reward balance and perceived autonomy are crucial. Additionally, ways that influence residents' well-being are identified in both their professional and personal lives. These dominant experiences and ways that influence well-being could be key factors for interventions and residency training adaptations for enhancing residents' well-being.

Flood-induced mortality across the globe: Spatiotemporal pattern and influencing factors

Impacts of floods on human society have been drawing increasing human concerns in recent years. In this study, flood observations from EM-DAT (Emergency Events Database) and DFO (Dartmouth Flood Observatory) datasets were analyzed to investigate frequency and intensity of floods, and flood-induced mortality, flood-affected population as well during 1975-2016 across the globe. Results indicated that: (1) occurrence rate of floods, flood-induced mortality and flood-affected population were generally increasing globally. However, flood-induced mortality and flood-affected people per flood event were in slight decrease, indicating that flood-induced mortality and flood-affected people due to increased floods exceeded those by individual flood event; (2) annual variation of mortality per flood event is highly related to floods with higher intensity. Specifically, the flood frequency and flood-induced mortality are the largest in Asia, specifically in China, India, Indonesia and Philippine; while significantly increased flood-affected population and mean annual mortality was detected in China, USA and Australia; (3) tropical cyclones (TC) are closely related to flood-induced mortality in parts of the countries along the western coast of the oceans. The frequency of channel floods in these regions is the largest and large proportion of flood-induced deaths and the highest flood-induced mortality can be attributed to TC-induced flash floods; (4) Population density and GDP per unit area are in significantly positive correlation with the number of flood-related victims per unit area, number of deaths and economic losses with exception of low-income countries. However, the flood-affected population and flood-induced mortality increase with decrease of per capita GDP; while the per capita economic loss increases with the increase of per capita GDP, indicating that the higher the population density and GDP per unit for a region, the higher sensitivity of this area to flood hazards.

Analysis of influencing factor of coexisting prediabetes and prehypertension in adult residents of Jilin Province

BACKGROUND

To explore the risk factors of coexisting prediabetes and prehypertension, to provide theoretical basis for early intervention.

METHODS

A multi-stage stratified random cluster sampling method was used to randomly select adult residents from Jilin Province in 2013 for questionnaire surveys, physical examinations, and laboratory tests.

RESULTS

The prevalence of coexisting prediabetes and prehypertension in Jilin Province was 11.3%. The binary Logistic regression results showed that age, sex, education, triglyceride (TG), BMI, waist circumference and alcohol consumption were the effects of factor coexisting prediabetes and prehypertension.

CONCLUSION

It is important to pay attention to the early stage of hypertension and diabetes, control the transition from prehypertension and prediabetes to hypertension and diabetes, and improve the health of residents.

Patterns of aged care use among older Australian women: A prospective cohort study using linked data

BACKGROUND

Women live longer than men and have an increased need for long-term care. The objective of this study was to identify patterns of aged care use among older Australian women and to examine how these patterns were associated with their demographic and health-related characteristics.

METHODS

The sample consisted of 8768 women from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who had survived to age 75-80 years. ALSWH survey and linked administrative aged care and death datasets from 2001 to 2011 were utilized. Patterns of aged care use were identified using a repeated measure latent class analysis.

RESULTS

We identified four patterns of aged care use over time, differentiated by timing of service onset, types of service use and time of death. Approximately 41% of the sample were non-users or using basic home and community care (HACC), while 24% were at high risk of using moderate to high-level HACC/community aged care package (CACP). Only 11% had a greater risk of using residential aged care (RAC) over time. Being widowed, residing in remote/regional areas, having difficulty in managing income, having a chronic condition, reporting poor/fair self-rated health, and lower SF-36 quality of life scores were associated with an increased odds of being a member of the following classes: 1) moderate to high-level HACC/CACP, 2) increasing RAC, and 3) early mortality, compared with the non-user class.

CONCLUSIONS

Distinct patterns of aged care use were identified. These results will facilitate future capacity planning for aged care systems in Australia.

A review on sediment bioflocculation: Dynamics, influencing factors and modeling

Sediment in a water column provides excellent substratum for microorganism colonization, and biological processes would alter the physical and chemical of sediment, resulting in substantial changes in sediment dynamics. The flocculation of sediment with biological processes are defined as sediment bioflocculation, which has been ubiquitously observed across aquatic ecosystems, activated sludge plants and bioflocculant applications, as a result of various processes involving particle aggregation and breakage under the complex effects of microorganisms and their metabolic products (e.g., extracellular polymeric substances EPS). EPS are complex high-molecular-weight mixtures of polymers, which are the primary components that hold microbial aggregates together by acting as a biological glue. Several mechanistic aggregation theories such as the alginate theory, adsorption bridging theory, divalent cation bridging theory, and Derjaguin-Landau-Verwey-Overbeek (DLVO) theory, and a number of influencing factors (e.g., sediment properties, microbial activity, EPS quantities and components, and external environment conditions) have been proposed to elucidate the role of microorganisms and EPS in sediment aggregation, promoting the investigation of the sediment bioflocculation evolution and kinetics models. However, due to the complex interrelationships of multiple physical, chemical, and biological processes and the incomprehensive knowledge of microorganisms and EPS, considerable research should be further conducted to fully understand their precise roles in the sediment bioflocculation process. In this study, a review of dynamic characterizations, mechanism, influencing factors and models of sediment bioflocculation are given to obtain a more comprehensive understanding of sediment bioflocculation dynamics.

The Influencing Factors of Serum Lipids among Middle-aged Women in Northeast China

BACKGROUND

Dyslipidemia is a common and serious health problem, especially in middle-aged women. We aimed to reveal quantile-specific associations of serum lipids [triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c) and high density lipoprotein cholesterol (HDL-c)] with influencing factors in middle-aged women.

METHODS

A sample of 5635 participants were enrolled from Jilin, China, in 2012. Quantile regression (QR) model was performed to identify factors which influenced serum lipids in different quantiles.

RESULTS

The influencing factors of TG, TC, LDL-c and HDL-c were different. Waist circumference (WC), menopause, smoking, diabetes and hypertension were positively associated with TG in almost all quantiles; Menopause and age were positively associated with TC in almost all quantiles. WC, living in urban areas and alcohol consumption were positively associated with TC in low and middle quantiles, diabetes was positively associated with TC from P50 to P95. The result of LDL-c was similar to TC; BMI was negatively associated with HDL-c from P50 to P90. WC and diabetes were negatively associated with HDL-c from P5 to P90.

CONCLUSION

Among middle-aged women, menopause, diabetes and WC were the main factors affecting the serum lipids. Postmenopausal women would get more risk in increasing the level of serum lipids.

Agricultural environmental total factor productivity in China under technological heterogeneity: characteristics and determinants

With limited resources, growing environment constraints and downward pressure on the economy, increasing agricultural environmental total factor productivity (AETFP) and its contribution to agricultural growth is significant for transforming agricultural development to make it more resource efficient and environment-friendly. This paper considered technological heterogeneity in different regions of China and measured AETFP in 30 provinces from 1997 to 2015 using the Metafrontier Malmquist-Luenberger (MML) productivity index. Multi-dimensional analysis was made on temporal and spatial characteristics, evolution patterns, and influencing factors of AETFP in China. The results showed that: (1) AETFP increased in the Ninth, Tenth, Eleventh, and Twelfth Five-Year Plan periods, with average annual growth rates of 0.76%, 0.88%, 1.17%, and 0.87%, respectively. (2) The average annual growth rate of AETFP in the eastern, central, and western regions decreased successively. The eastern region generally had played a leading role. The central region had a catch-up effect on environmental production technologies from the eastern region, while the western region lacked the catch-up effect. (3) The dynamic evolution of AETFP had prominent features. For the whole nation, the kernel density curve of AETFP continuously moved to the right. The main peak value continuously decreased and the width of the main peak continuously increased. The internal differences of AETFP in the eastern and western regions exhibited an increasing trend, while the internal differences of AETFP in the central region showed little change. (4) There was an inverted U-shaped relationship between agricultural economic growth and AETFP. Both the disaster rate and planting structure had a negative impact on AETFP with varying degrees of significance. Income gaps between urban and rural areas can partially offset the role of urbanization in promoting the growth of AETFP. The greater the income differences between urban and rural areas, the weaker the role of urbanization in promoting the growth of AETFP. These findings can help the government determine policies to change the agricultural development mode and formulate effective measures to improve AETFP.

The influence factors of neonatal respiratory distress syndrome in Southern China: a case-control study

Objective: To explore the relevant influencing factors of neonatal respiratory distress syndrome (NRDS) in southern China and provide scientific basis for improving the quality of life for neonates.Methods: A retrospective analysis of 320 cases with NRDS neonates admitted from January 2015 to December 2017 in a neonatal department of a Maternal and Child Health Hospital in South China was conducted. Three hundred twenty non-NRDS patients admitted to the same hospital during the same period were also included as control. The basic characteristics were compared and the risk and protective factors for NRDS were evaluated by logistic regression analysis.Results: Univariate analysis showed that the difference in age, gestational age, fetal sex, mode of delivery, asphyxia, intrauterine distress, and gestational diabetes in the case group and the control group were significantly different (p < .05). The multivariate logistic regression analysis revealed that the age of pregnant women (OR ± 1.539, 95% CI ± 1.427-1.660), intrauterine distress (OR ± 2.427, 95% CI ± 1.079-5.458), and gestational diabetes (OR ± 2.881, 95% CI ± 1.271-6.532) were independent risk factors for NRDS. Meanwhile, gestational age (OR ± 0.588, 95% CI ± 0.508-0.681) was an independent protective factor for NRDS.Conclusions: The age of pregnant women, intrauterine distress, and gestational diabetes can increase the risk of NRDS, while long gestational age can reduce the risk of NRDS. Early detection, early diagnosis and early treatment of children with NRDS have achieved the purpose of improving the quality of life of children.

[Effects of Occupational stress and related factors on depression symtoms of workers in electronic manufacturing industry]

Objective: To investigate the influence of depression symtoms and related occupational stress on workers in chip manufacturing industry. Methods: By using cluster sampling method, 2 251workers in electronic manufacturing industry were selected as study subjects in July-December 2016. The simple Occupational Stress Questionnnaire and The Chinese version of Effort-reword imbalance questionnaire (ERI) Questionnnaire were used to investigate and evaluate their job demand-control-support questionnaire (JDC) and ERI Occupational stress stiuation respctively. Depression symptoms were measured by the depression module of the patient health questionnaire (PHQ-9) . Results: Among the 2 251 workers, 77.03% workers were found high level of depression symptom.486 workers were the highest level depression.1 248 workers were the higher level depression. The scores of depression symptoms in the related influceing factors JDC and ERI occupational stress were different (P<0.05) . The multivariate logistic analysis results indicated the main positve factors of depression were above college degree, more than 1 years of working age and high input (P<0.05) . The main protective factors of depression were non migrant workers and high return (P<0.05) . Conclusion: The rate of depression of workers is relatively higher in chip manufacturing factory. Enterprises should pay special attention to workers who were above college degree, more than 1 years of working age and high input, ERI occupational stress.

[Analysis of the impact of job characteristics and organizational support for workplace violence]

Objective: To analyze the effect of job characteristics and organizational support for workplace violence, explore the influence path and the theoretical model, and provide a theoretical basis for reducing workplace violence. Methods: Stratified random sampling was used to select 813 medical staff, conductors and bus drivers in Chongqing with a self-made questionnaire to investigate job characteristics, organization attitude toward workplace violence, workplace violence, fear of violence, workplace violence, etc from February to October, 2014. Amos 21.0 was used to analyze the path and to establish a theoretical model of workplace violence. Results: The odds ratio of work characteristics and organizational attitude to workplace violence were 6.033 and 0.669, respectively, and the path coefficients were 0.41 and-0.14, respectively (P<0.05). The Fitting indexes of the model: Chi-square (χ(2)) =67.835, The ratio of the chi-square to the degree of freedom (χ(2)/df) =5.112, Good-of-fit index (GFI) =0.970, Adjusted good-of-fit index (AGFI) =0.945, Normed fit index (NFI) =0.923, Root mean square error of approximation (RMSEA) =0.071, Fit criterion (Fmin) =0.092, so the model fit well with the data. Conclusion: The job characteristic is a risk factor for workplace violence while organizational attitude is a protective factor for workplace violence, so changing the job characteristics and improving the enthusiasm of the organization to deal with workplace violence are conducive to reduce workplace violence and increase loyalty to the unit.

[Relationship between occupational stress and working ability of workers in a petroleum processing enterprise in high altitude area]

Objective: To investigate the relationship between occupational stress and working ability of workers in a petroleum processing enterprise in a high altitude area. Methods: A total of 728 workers in a petroleum processing enterprise at an altitude of 2850 m were subjected to a survey using Occupational Stress Inventory (OSI) , Work Ability Index (WAI) Scale, Occupational Role Questionnaire (ORQ) , Personal Strain Questionnaire (PSQ) , and Personal Resource Questionnaire (PRQ) from May 2014 to August 2016. Results: Of the 728 workers, 55 (7.6%) had a poor working ability, moderate in 262 (35.9%) , and good in 411 (56.5%). There were significant differences in WAI between the workers with different types of work, sexes, ages, and working years (P<0.05). There was a significant difference in WAI between different occupational stress groups (P<0.05). WAI was negatively correlated with ORQ score and PSQ score (r(s)=-0.387, P<0.05; r(s)=-0.467, P<0.05) and positively correlated with PRQ score (r(s)=0.343, P<0.05). The multiple linear regression analysis showed that high ORQ score and PSQ score were the inhibitory factors for high WAI (B=-0.058; B=-0.082) and high PRQ score was a contributing factor for high WAI (B=0.029) . Conclusion: Occupational stress is an influencing factor for the working ability of workers in the petroleum processing enterprise in the high altitude area. Hypoxia in high altitude area may further reduce the working ability. In order to reduce occupational stress and improve work ability, it should be considered to strengthen skills training, improve the working environment, and pay attention to mental health.

[Factors related to thyroid carcinoma in Zhejiang province: a matched case-control study]

Objective: To explore the influencing factors related to thyroid carcinoma. Methods: Matched by sex, age and original residential areas, 659 pairs of cases and controls were recruited and studied. Methods including both single factor analysis and multivariate conditional logistic regression analysis were carried out to identify the influencing factors. Results: Multivariate conditional logistic regression analysis showed that higher education, being diabetic, alcohol intake, tea drinking, occupational physical activity and the frequency of eating fishes/eggs etc., were potentially protective to thyroid carcinoma. Depression, personal history of CT examination and less salt intake seemed to be risk factors on thyroid carcinoma. For males, factors as alcohol intake, tea drinking, occupational physical activity and frequent egg-eating appeared protective. For females, higher education, diabetes, tea drinking, occupational physical activity, frequent consumption of fishes/eggs, short duration of menstruation appeared as possibly protective. Conclusion: Higher education, diabetes, alcohol intake, tea drinking, occupational physical activity, frequent consumption of fishes/eggs, depression, personal history of CT examination and less salt intake served as potential influencing factors to thyroid carcinoma.

[Analysis of the factors affecting the efficacy of (131)I remnant ablation in patients after thyroidectomy for papillary thyroid microcarcinoma]

Objective: To investigate the influential factors of efficacy of the first (131)I ablation therapy for thyroid remnant in papillary thyroid microcarcinoma (PTMC) patients after thyroidectomy. Methods: Eighty-nine PTMC patients who underwent twice (131)I ablation therapy and (131)I whole body follow-up scan ((131)I-WBS) within 5 to 8 months in our department from September 2007 to October 2016 were identified and enrolled in present study. Patients were divided into complete-ablation group and uncomplete-ablation group according to whether or not radioactivity was detected at the thyroid bed in (131)I-WBS. The χ(2) test and multi-variance Binary logistic regression were performed for the factors which might affect the therapeutic efficacy. Results: The first (131)I ablation therapy was successful in 41 of 89 patients (46.07%). Residual thyroid weight was found to be associated with therapeutic efficacy (P<0.05), while gender, age, surgical method, lesions'maximum diameter, with or without LN metastasis, with or without distant metastasis, time of operation from first (131)I treatment, lesions'number, thyroid stimulating hormone (TSH), thyroglobulin (Tg), the consistency of (131)I-WBS and (99)Tc(m)-pertechnatate, TNM stage, ATA risk, Tg/TSH ratio were not significant associated with therapeutic efficacy. Binary logistic regression analysis was performed in these respects and it indicated that residual thyroid weight and ATA risk were not statistically significant independent variable (P>0.05). Conclusions: Residual thyroid weight might affect efficacy of the first (131)I ablation therapy on thyroid remnant in PTMC patients after thyroidectomy, but it is not an independent factor. Multiple interrelated factors should be considered when predicting the efficacy of the first (131)I ablation therapy.

Blood Glucose Monitoring and Its Determinants in Diabetic Patients: A Cross-Sectional Study in Shandong, China

INTRODUCTION

The aim of this study was to explore the status of blood glucose monitoring and its determinants in diabetic patients in Shandong Province, China.

METHODS

This was a cross-sectional survey conducted from 31 August to 12 October 12, in Shandong Province. A multi-stage stratified cluster sampling method was used to select participants. A total of 2183 diabetic patients were included in the analysis. Frequencies and proportions were used to describe the data, and multiple binary logistic regressions were performed to determine factors associated with blood glucose monitoring.

RESULTS

Of the participants, 51.4% tested their blood glucose level more than once a month. The multivariate logistic regression model showed that seven variables were significantly associated with the frequency of blood glucose monitoring: education level, residence, household income, self-reported health, physical examination, anti-diabetic drug or insulin injection, and comorbidity.

CONCLUSIONS

The level of blood glucose monitoring among diabetic patients in Shandong Province is low. Based on these results we recommend that the cost of blood glucose monitoring by professionals in laboratories be reimbursed or at least reduced and that diabetic patients be encouraged to undergo regular physical examinations.

Distributions, influencing factors, and risk assessment of Dechlorane Plus and related compounds in surficial water and sediment from the Jiulong River Estuary, Southeast China

Dechloranes, a type of additive polychlorinated flame retardant, which include Dechlorane (Dec) Plus (DP), Dec 602, Dec 603, and Dec 604, were detected in surficial water and sediment from the Jiulong River Estuary (JRE). The total concentration of dechloranes in the water and sediments ranged from 1.4 to 4.1 ng/L and 9.3 to 36.2 ng/g dry weight, respectively. The distribution patterns of dechloranes in the water and sediments were both dominated by DP. The average values of the anti-DP fractional abundances (f_anti) in the water and sediment samples both were fell in the range of commercial DP mixtures. The relationships of DP in the water with suspended particulate matter (SPM), total organic carbon (TOC), and tides indicated that the combined actions of these environmental factors influenced the distribution of DP in the JRE. The deleterious risk associated with exposure to dechloranes via the water for adults was very low, suggesting that exposure of the local population of dechloranes via water is relatively safe in the JRE.

Identifying factors associated with depression among men living with HIV/AIDS and undergoing antiretroviral therapy: a cross-sectional study in Heilongjiang, China

BACKGROUND

Depression is common among people living with HIV/AIDS; however, studies focusing on the depression of men living with HIV/AIDS are limited. Therefore, we examined the prevalence of depression and its associated factors among men living with HIV/AIDS in China.

METHODS

A cross-sectional questionnaire survey was conducted in Harbin, China between March and August in 2013. Two-hundred twenty participants completed the Burns Depression Checklist, the Berger HIV Stigma, and the SPIEGEL questionnaire. We also investigated demographics, family support, hostility, and the antiretroviral therapy side effects of men living with HIV/AIDS.

RESULTS

More than 40% of respondents had depressive symptoms and worry about the health was the major symptom of depression (40.9%). The logistic regression model indicated that bad sleep quality (OR = 3.452), hostility (OR = 1.120), perceived discrimination (OR = 1.110), and antiretroviral therapy side effects (OR = 1.083) were positively associated with depression. Family support (OR = 0.860) was negatively associated with depression for men living with HIV/AIDS. Demographic variables, HIV infection route, disease duration, and CD4+ cell count had no significant associations with depression.

CONCLUSION

Although China's work of national HIV prevention and treatment has made much progress during the past several years, the prevalence of depression among men living with patients with HIV/AIDS is still prominent. The strongest factor associated with depression among men living with HIV/AIDS was sleep quality. Future studies should explore the effects of interventions for depression among PLWHA.

Prevalence and influencing factors of the high nil-control spot count in T-SPOT.TB: A matched case-control study

BACKGROUND

T-SPOT.TB may yield indeterminate results, including high nil responses and insufficient mitogen responses. We explored the incidence and risk factors of high nil responses.

METHODS

A 1:1 matched case-control study of patients who underwent T-SPOT.TB tests in Peking Union Medical College Hospital from Jan 1, 2015 to Apr 30, 2017 was conducted. High nil responses were defined as >10 spots in negative control wells. Cases and controls were matched based on when the tests were performed. Demographic, clinical and laboratory data were obtained from the Medical Record System.

RESULTS

A total of 644 out of 36,316 (1.76%, 95% CI: 1.63%-1.90%) patients presented with high nil responses (280 cases and 280 controls were enrolled). Multivariate analysis revealed that male (OR = 1.882, 95% CI: 1.222-2.899), Behcet's disease (OR = 7.764, 95% CI: 1.714-35.167), heavy use of corticosteroids within a month (OR = 0.357, 95% CI: 0.138-0.921, for >1000 mg group) and hypoalbuminemia (OR = 0.385, 95% CI: 0.241-0.615) are significantly associated with high nil responses.

CONCLUSIONS

High nil responses in T-SPOT.TB assays are quite rare. Male gender and Behcet's disease are suggested as independent risk factors, while recent excessive use of corticosteroids and hypoalbuminemia seem to be independent protective factors.

The prevalence of and factors associated with willingness to utilize HTC service among college students in China

BACKGROUND

College students in China are emerging as one of the most vulnerable groups to contract HIV, because they are in a sexually active age group and also because of their open attitude toward sex and high risk sexual behaviors. This study aimed to explore the prevalence of willingness among college students to utilize HIV testing and counseling (HTC) service and the factors that may affect willingness, including predisposing, enabling and need factors, based on the Andersen's behavioral model.

METHODS

A cross-sectional study was conducted from October 6, 2016 to December 31, 2016 in Hubei University of Science and Technology in China. After signing informed consent, college students completed a self-designed online questionnaire distributed via  https://www.wjx.cn/ voluntarily, anonymously and confidentially. Pearson's chi-square test and Logistic regression models were chosen to analyze the factors associated with willingness to utilize HTC service.

RESULTS

Out of 3314 college students in the sample, 2583 (77.9%) expressed their willingness to utilize HTC service. After adjustment, those with low levels of discrimination towards people living with HIV (PLHIV) (OR = 1.41, 95%CI:1.17-1.68), being more knowledgeable about free HTC service centers (OR = 1.44, 95%CI:1.17-1.77), having recognized the necessity to provide HTC service in the local university (OR = 2.20, 95%CI:1.73-2.80), and having a higher HIV risk perception (OR = 1.64, 95%CI:1.37-1.95) were more willing to utilize HTC service, compared with their respective counterparts.

CONCLUSIONS

In order to improve their willingness to utilize HTC service and finally to achieve the goal of zero-AIDS, a comprehensive intervention measure should be taken to publicize HTC service, eliminate stigma and discrimination against PLHIV, recruit and train peer volunteers to serve in the local university, and increase self-perceived risk of HIV infection.

[Analysis on prevalence of physical fitness and related influencing factors among Chinese Han students aged 13-18 years in 2014]

Objective: To analyze the prevalence of physical fitness among Chinese Han students aged 13-18 years in 2014, and explore related influencing factors. Methods: This study recruited 106 881 Han students aged 13-18 years who had taken physical fitness test from Chinese National Survey on Students' Constitution and Health in 2014. After the exclusion of 1 047 students without complete records of physical fitness test, 105 834 students were included in the final analysis. According to the National Student Physical Health Standard modified in 2014, seven indicators including body mass index, vital capacity, 50-m run, sit-and-reach, standing broad jump, pull-ups/curl-ups and endurance run were tested to calculate the total score of students' physical fitness. Students with score ≥60 were regarded as qualified students. Multivariate non-conditional logistic regression model was used to analyze influencing factors of physical fitness. Results: Among Chinese Han students aged 13-18 years, the total score was 70.1±10.7 and the qualified rate was 83.9% (n=88 813). Boys (83.5% (44 197/52 910)) had a lower qualified rate of physical fitness than girls (84.3% (44 616/52 924)) (P<0.001), and 13-15 age group (86.5% (46 255/53 465)) was higher than the 16-18 age group (81.3% (42 558/52 369)) (P<0.001). Except for 16-18-year-old boys from central region, normal body mass index, eastern region, good socioeconomic status, enough PE class, exercise time ≥1 h/d, homework time ≥2 h/d, TV time <1 h/d were all related to high qualified rates of physical fitness (P<0.05). Conclusion: Chinese Han students aged 13-18 years were in good physical condition. The qualified rates of physical fitness were significantly different by gender and age groups. Nutritional status, region, socioeconomic status, PE class, exercise time per day, homework time per day, and TV time per day were related factors of physical fitness.

Estimation of personal ozone exposure using ambient concentrations and influencing factors

Evidence is limited regarding whether ambient monitoring can properly represent personal ozone exposure. We conducted a longitudinal panel study to measure personal exposure to ozone using real-time personal ozone monitors. Corresponding ambient ozone concentrations and possible influencing factors (meteorological conditions and activity patterns) were also collected. We used linear mixed-effect models to analyze personal-ambient ozone concentration associations and possible influencing factors. Ambient ozone concentrations were around two to three times higher than personal ozone (43.1 μg/m³ on average) and their correlations were weak with small slopes (0.35) and marginal R square (R_M²) values (0.24). Larger R_M² values were found under high temperature (>29.5 °C), low humidity (<62.1%), good ventilation conditions (>4 h) and for individuals spent longer time outdoors (>0.6 h). In final model, personal ozone exposure was positively associated with ambient concentrations and ventilation conditions, but inversely correlated with ambient temperature and humidity. The models explained >50% of personal ozone concentration variabilities. Our results highlight that ambient ozone concentration alone is not a suitable surrogate for individual exposure assessment. Meteorological conditions (temperature and humidity) and activity patterns (windows opening and outdoor activities) that affecting personal ozone exposure should be taken into account.

[Screening results and influencing factors of upper gastrointestinal carcinoma and precancerous lesions in Feicheng City]

Objective: To clarify the situation of the detection of upper gastrointestinal cancer and precancerous lesions in the Feicheng city and discuss the possible influencing factors. Methods: A cluster sampling method was used to determine the participants. A unified questionnaire was used to investigate the basic information including history of alcohol intake, smoking and chinese tea, as well as other eating habits, medical history of digestive tract and cancer. Endoscopy was used to to screen the patients with upper gastrointestinal cancer and precancerous lesions. Influential factors were explored by non-conditional logistic regression model. Results: 911 of 7 291participants were positive, and the total detection rate was 12.49%. The total positive detection rate of male and female was 17.94% and 8.71%, respectively (P<0.001). Multivariate logistic regression analysis showed that the sex (OR=0.527, 95%CI: 0.440-0.631), age (OR=2.037, 95%CI: 1.849-2.245), smoking (OR=1.240, 95%CI: 1.014-1.516) and alcohol consumption (OR=1.232, 95%CI: 1.012-1.500) , meat and protein intake (OR=0.794, 95%CI: 0.638-0.987) and drink tea (OR=1.233, 95%CI: 1.056-1.440) may be influencing factors of the total detection rate of upper gastrointestinal cancer and precancerosis. Conclusions: In Feicheng city, intake of meat and protein is the protective factor of the upper gastrointestinal cancer and precancerous lesions. Men, aged, smoking, drinking and tea will increase the risk of upper gastrointestinal cancer and precancerous lesions.

[Establishment of grading model of knee osteoarthritis based on clinical research system]

OBJECTIVE

The factors influencing the grade of knee osteoarthritis were screened by ordered Logistic regression analysis. The classification model of knee osteoarthritis was established, which provided tool for the evaluation of clinical classification of knee osteoarthritis.

METHODS

A total of 753 cases of knee osteoarthritis from Wangjing Hospital, China Academy of Chinese Medical Sciences were treated with single factor and multivariate Logistic regression analysis from September 18, 2014 to April 26, 2016. The model formula was constructed and evaluated.

RESULTS

In this study, it was found that 13 factors associated with knee osteoarthritis grading. Old age, obesity, long course of disease, recurrence, lower limb deformity, quadriceps muscle atrophy, WOMAC index, TCM syndrome score, VAS score and grading degree were positively correlated. One knee pain, limited pain range, knee activity and grading degree were negatively correlated. The knee osteoarthritis grading model was constructed and the evaluation test was effective(Training set AUC=0.860, test set AUC=0.879).

CONCLUSIONS

In this study, a classification model of knee osteoarthritis was established which has a good ability to predict the classification of knee osteoarthritis under preliminary evaluation.

Accuracy and the factors influencing the accuracy of death certificates completed by first-year general practitioners in Thailand

Background

Although death certificates (DCs) provide valuable health information which may help to guide local health policies and priorities, there is little information concerning their validity in Thailand. First-year general practitioners (GPs) have a major role in DC completion, especially in provincial general hospitals. The aim of this study was to evaluate the accuracy and factors influencing the accuracy of DCs completed by first-year GPs in Thailand, compared with the cause of death (COD) derived from medical records by experts.

Methods

This retrospective study was conducted at 14 provincial general hospitals in Thailand during the June 2011 to May 2012 study period. Medical records and DCs completed by first-year GPs who graduated from 16 Thai medical schools were sampled. The cause of death recorded on the DCs was compared with the medical conditions and histories derived from patient medical records. A cross-sectional survey of the 210 GPs who completed the DCs reviewed in this study was also conducted. Respondent GPs’ demographic characteristics, factors associated with COD, and COD coding system were evaluated.

Results

Five hundred and sixty-three medical records and corresponding DCs were included. Of those, 36.9% of DCs were found to be correct. Common mistakes included incorrect sequence of events leading to death (32.4%), and mode of death use (26.2%). Of the 210 GPs, 155 questionnaires were completed and returned. The mean time spent on recording COD and completing DCs in the medical school curriculum was 2.1 ± 0.9 h and only 27.7% of participants had experience in completing DCs by themselves during medical school. Mean medical school GPA was significantly higher in the correctly completed DC GPs group than in the incorrectly completed DC GPs group (3.3 ± 0.4 vs. 3.2 ± 0.3; p = 0.03). However, no significant difference was found for other factors associated with COD between groups.

Conclusions

This is the first study documenting gaps and disparities in DC accuracy, and factors influencing completion of DCs among first-year GPs in Thailand, based on a clinical assessment of medical records. GPs made errors on 63.1% of DCs. This finding suggests that proven education, system-related support, and additional training interventions specific to DC completion are required.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3289-1) contains supplementary material, which is available to authorized users.

[Investigations on in-hospital mortality in pancreatic surgery : Results of a multicenter observational study]

BACKGROUND

The rate of hospital mortality (in-hospital mortality) after complex pancreatic resections cannot be used as a decision-making criterion with no further analysis and specification. Such analysis has to provide a risk-adjusted benchmarking including a continuous evaluation taking into account the frequency of a surgical procedure and its competent perioperative management.

MATERIAL AND METHODS

As part of the Prospective Evaluation study Elective Pancreatic surgery (PEEP), overall 2003 patients were enrolled over a 3-year time period from 01 January 2006 to 12 December 2008, who underwent elective pancreatic surgery in 27 surgical departments. Included in the study were only hospitals which perform pancreatic resections. In addition to the analysis of the current situation of the operative treatment of pancreatic diseases, the complex aspects of the in-hospital mortality as a main outcome parameter were investigated.

RESULTS

Out of all enrolled patients (n = 2003), 75 patients (3.7%) died during the hospital stay. In the group of 1045 patients with partial pancreaticoduodenectomy (PD), 43 patients did not survive the hospital stay (4.1%). Similarly, such low in-hospital mortality rates were observed after total pancreatoduodenectomy (3.8%) and after left-sided resection of the pancreas (1.9%). With respect to a univariate risk stratification, advanced age and an American Society of Anaesthesiologists (ASA) score of 3 and 4 had a significant impact on in-hospital mortality. Multivariate regression analysis within the PD group revealed an increased need for blood transfusions and a delay in oral feeding as factors closely associated with specific complications with a significant impact on in-hospital mortality. Significant differences in the in-hospital mortality rates were found when comparing hospital volume groups, such as 10-20 vs. >20 cases/year for the 831 Kausch-Whipple procedures for adenocarcinoma and chronic pancreatitis.

DISCUSSION

An adequate in-hospital mortality rate in the continuous benchmarking represents an acceptable quality level of structural and therapeutic predictions in pancreatic resections. The participation of surgical departments with complex oncosurgical interventions in clinical multicenter observational studies as a contribution to research on surgical care appears reasonable and recommendable since the results of such studies can provide a contribution to decision-making processes in daily surgical practice.

Health promoting lifestyles and influencing factors among empty nesters and non-empty nesters in Taiyuan, China: a cross-sectional study

Background

In China, the problems of population aging and empty nesting have become important issues which will affect the social stability and economic development. The aim of this study was to explore the health promoting lifestyles and influencing factors among empty nesters and compare with non-empty nesters to find out their differences, so as to provide a scientific evidence for people to formulate health management strategies for elderly.

Methods

A cross-sectional survey which used a stratified random cluster sampling method, was conducted among 500 elders in six districts of Taiyuan, China, there were 288 empty nesters and 212 non-empty nesters. The general information and health- promoting lifestyles were investigated by using the self-made General Information Questionnaire and Health Promoting Lifestyle Scale(HPLP). Two-sample t-test and Chi-square test were used to compare the sociodemographic factors, HPLP scores of empty nesters to non-empty nesters; Multiple stepwise linear regression was performed to estimate influencing factors related to the HPLP of empty nesters and non-empty nesters.

Results

The current findings showed that there were differences between the empty nesters and non-empty nesters in gender, resident, marital status, education and income, self-care ability, source of income, relationship with spouse and social activities (P < 0.05). Empty nesters were mostly male, married, had a higher education level, self-care ability and income and lived in urban compared with non-empty nesters. The health promoting lifestyles of the elderly in this survey were in the medium level, the highest score for all dimensions in both groups was in nutrition, whereas health responsibility was executed worst. The HPLP and six subscales scores of the empty nesters were higher than non-empty nesters, there were significant differences in total score of HPLP, self-realization and health responsibility (P < 0.01). Multiple regression analysis showed that the main predictive factors for the empty nesters were education, self-care ability and resident, whereas the main predictive factors for the non-empty nesters were parents-child relationship, source of income and age; social activity was the common factor for two group.

Conclusion

The health promoting lifestyles of the empty nesters was better than that of the non-empty nesters. Health responsibility, interpersonal relations and stress management were key dimensions to be improved. Except social activity, education, self-care ability and resident were the unique influencing factors of health-promoting lifestyles for empty nesters, while the parents-child relationship, income and age were unique factors for non-empty nesters. The main target of Intervention strategy for elderly health promoting lifestyles should be the enhance of health responsibility, interpersonal relations and stress management by improving social activities, parent-child relationship, education and income of elderly.

[Analysis of the First Diagnosis Symptom and Its Influencing Factors in 500 Patients with Lung Cancer]

背景与目的

肺癌的发病率与死亡率不断升高，本研究探讨初诊肺癌患者临床特征，特别是首诊症状对诊断及后续治疗选择的影响。

方法

回顾性分析自2017年3月-2017年5月我院胸内科门诊就诊的500例肺癌患者，分析其临床特征包括首发症状、分期、生物标志物、病理等对后续治疗选择影响。

结果

女性（53.3%）、腺癌（74.4%）、吸烟者（58%）多见，大部分患者（98.2%）体力状态评分为0分-1分。生物标志物检测58.2%（n=291），其中表皮生长因子受体（epidermal growth factor receptor, EGFR）突变61.2%（178/291），间变性淋巴瘤激酶（anaplasticlymphoma kinase, ALK）融合基因阳性4.1%（12/291）。不同吸烟状况、是否有症状、病理分型、疾病分期和是否有突变是影响后续治疗的主要因素。

结论

就诊时有典型症状的患者确诊时间更短，吸烟状况、肺癌相关症状、病理、疾病分期及突变状况是影响后续治疗的主要因素。

Identifying ways to increase seasonal influenza vaccine uptake among pregnant women in China: A qualitative investigation of pregnant women and their obstetricians

BACKGROUND

Pregnant women are at higher risk for complications from influenza infection. Nevertheless, seasonal influenza vaccination among pregnant women in China is low. A better understanding of perceptions of pregnant women and their physicians, and factors influencing decisions about receiving seasonal influenza vaccine could be used to develop effective strategies for improving seasonal influenza vaccine uptake during pregnancy.

METHODS

We recruited pregnant women from 9 hospitals located in 5 cities across China to participate in focus group interviews. Obstetricians from the same hospitals were recruited for one on one in-depth interviews. We collected information about perceptions of barriers and motivating factors for utilizing seasonal influenza vaccine during pregnancy. We systematically analyzed the information using qualitative methods.

RESULTS

We conducted 18 focus groups with 108 pregnant women and interviewed 18 obstetricians. Awareness about the use of influenza vaccine during pregnancy was minimal in both subject groups. None of the pregnant women had received influenza vaccine during pregnancy and none of the obstetricians had recommended influenza vaccine for their patients. Both groups noted insufficient knowledge about influenza infection and benefits of the vaccine, concerns about vaccine safety, and lack of local data related to vaccine use in Chinese pregnant women. Obstetricians cited the lack of a national policy as a major barrier to recommending seasonal influenza vaccine to pregnant women. Pregnant women cited not receiving a recommendation for vaccination from healthcare workers as an additional barrier.

CONCLUSION

Our findings highlight the immediate need to increase awareness and knowledge about the risks of influenza infection and the benefits and safety of seasonal influenza vaccination among both pregnant women and obstetricians in China. Obstetricians interviewed stated that the development and implementation of a national policy prioritizing pregnant women for seasonal influenza vaccination would facilitate their willingness to recommend seasonal influenza vaccine to pregnant women.

Utilization of psychiatric rehabilitation services and influencing factors among people with psychotic disorders in rural communities of Guangxi, China

Objectives

To identify the rate and predictors of utilization of rehabilitation services among people with psychotic disorders in rural communities of Guangxi.

Study design

A cross-sectional survey was conducted among individuals with schizophrenia or other psychoses (severe mental disorder, ICD10: F20–F29), aged over 15 years, and their care-givers in Guangxi, China. Trained village doctors located individuals known to them and suspected as having schizophrenia or other psychoses within the target areas and recruited them into the study. Data on demographic characteristics, clinical symptoms and functions, treatment history, and reasons, if any, for non-utilization of mental health service were collected. Logistic regression was used to determine associated factors for utilization of mental health services.

Results

A total of 424 individuals experiencing psychosis (mean age 41.4 ± 13.0 years, 60.6% male) and 319 caregivers (mean age 55.3 ± 14.2 years) were interviewed. The median duration of disease was 13.4 years. 83.0% of patients had never used rehabilitation services. Greater use of rehabilitation was associated with having a non-organic disorder (OR = 11.6, 95% CI = 1.6–86.0) and living with a caregivers (OR = 3.2, 95% CI = 1.2–8.3). The top three reasons for not using rehabilitation services were lack of awareness (57.1%), lack of money (14.2%) and lack of belief in the service (12.8%).

Conclusions

These findings indicate a high unmet need for psychiatric rehabilitation services among people with psychotic disorders in rural areas of Guangxi. Strategies such as outreach programme and collaborative and partnership network with the local community are needed to encourage people with psychotic disorders in rural communities to increase their utilization of rehabilitation services.

Gastrointestinal bleeding after emergency coronary intervention in elderly patients: Influencing factors and preventive measures

AIM

To analyze the factors influencing gastrointestinal hemorrhage (GIB) after percutaneous coronary intervention (PCI) in elderly patients and explore possible preventive measures.

METHODS

Fifty-six elderly patients who underwent emergency PCI at our hospital between July 2016 and May 2017 were included. Based on the occurrence of GIB or not, the patients were divided into an observation group and a control group. The patients in the observation group developed GIB in 6 months after PCI, and the control group did not. Univariate and multivariate analyses were performed to identify factors influencing GIB after emergency PCI.

RESULTS

Univariate analysis demonstrated that coronary artery triple vessel disease, right coronary artery disease, operative time, intraoperative use of heparin, ACEI/ARB drugs, and preventative proton pump inhibitors were significantly associated with GIB after emergency PCI (χ² = 7.286, 10.196, 3.420, 4.578, 6.475, 4.968, P < 0.05). Operative time, use of ACEI/ARB drugs, diuretics, and prophylactic proton pump inhibitors, coronary artery triple vessel disease, and intraoperative heparin were identified to be independent risk factors for GIB after emergency PCI (P < 0.05)

CONCLUSION

Operative time, use of ACEI/ARB drugs, diuretics, and prophylactic proton pump inhibitors, coronary artery triple vessel disease, and intraoperative heparin are independent risk factors for GIB after emergency PCI in elderly patients.

[Research progress on unprotected anal intercourse and its influencing factors in men who have sex with men]

The prevalence of HIV infections continues to rise among Chinese MSM. This population is prone to has high-risk behaviors including having multiple sexual partners, unprotected anal intercourse (UAI), etc. This paper summarizes the situation of UAI and related influencing factors, including age, educational level, number of sexual partners, recreational drug abusing and related status of discrimination, etc. The purpose of this article is to provide reference for targeted intervention and prevention of HIV among MSM population.

Archaeal community compositions in tilapia pond systems and their influencing factors

Archaea, like the bacterial communities are gradually being realized as key players in the biogeochemical progress of water ecosystems. In this study, tilapia aquaculture ponds were used for an in-depth understanding of archaeal community compositions in water and surface sediment. Some of the main functions, as well as the communities' response patterns, to time variations, pond differences and some physio-chemical parameters were investigated. The results revealed the dominant phylum in both the water and surface sediment, as Euryarchaeota, while, the most abundant classes were: Halobacteria and Methanomicrobia respectively. Significant differences in the archaeal community compositions in the water and surface sediment, were observed in the early stages of cultivation, which became minimal at the later stage of the GIFT tilapia cultivation. Additionally to the differences in the most abundant classes, more OTUs were observed in water samples than in surface sediment samples. The methane generation could be attributed to the large proportion of methanogens found in both pond water and in the surface sediment. Furthermore, the archaeal community compositions in water and the surface sediment were shaped mainly by temporal variations and pond differences respectively. In the pond water, the archaeal community compositions were highly co-related to the concentration changes of ammonia, sulfate and total nitrogen; while in the surface sediment, the correlation to the content changes was significant in total phosphorus. The archaeal community compositions in surface sediment should be considered as an indicator for future environmental capacity studies in aquaculture.

Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

Background

Hospital length of stay (LOS) after primary total knee arthroplasty (TKA) has decreased obviously following the implementation of enhanced recovery after surgery (ERAS) program in the last few years. However, there are still some patients that cannot be discharged at early time for a variety of reasons, and it is necessary to explore factors leading to prolonged LOS. Therefore, the purpose of this study was to identify the complete preoperative, perioperative, and postoperative factors associated with prolonged postoperative LOS (PLOS) after primary TKA in a detailed ERAS program.

Methods

In a consecutive series from July 2015 to March 2017, all patients who underwent unilateral elective primary TKA were included in the retrospective study. A PLOS greater than 3 days was considered a prolonged PLOS. Multivariable logistic regression analysis was performed to identify patient characteristics and relevant preoperative, perioperative, and postoperative variables that were associated with prolonged PLOS and postoperative complications.

Results

A total of 241 patients were included with a mean PLOS of 3.8 days. Prolonged PLOS was significantly associated with preoperative valgus deformity of the knee (OR 4.95, 95%CI 1.56–15.77, P = 0.007), increased serum level of interleukin-6 on postoperative day 1 (OR 1.01, 95%CI 1.00–1.03, P = 0.039), increased visual analogue scale pain score and serum level of C-reactive protein on postoperative day 3 (OR 2.56, 95%CI 1.28–5.13, P = 0.008; OR 1.01, 95%CI 1.00–1.03, P = 0.019), increased day to achieve 90° active knee flexion after surgery (OR 2.19, 95%CI 1.27–3.79, P = 0.005), and postoperative wound complications (OR 8.58, 95%CI 2.10–35.03, P = 0.003) and other minor complications (OR 6.04, 95%CI 2.40–15.19, P < 0.001). Preoperative pulmonary infection (OR 2.75, 95%CI 1.20–6.28, P = 0.016), American Society of Anesthesiologists score 3/4 (OR 2.14, 95%CI 1.01–4.52, P = 0.046), and utilization of catheter after surgery (OR 2.53, 95%CI 1.23–5.19, P = 0.012) were significantly associated with postoperative complications.

Conclusions

Multiple factors were associated with prolonged PLOS and postoperative complications after TKA in the ERAS program. It is important to recognize all the factors to try to maximize the use of medical resources and ultimately optimize the care of our patients.

Influencing factors of domestic waste characteristics in rural areas of developing countries

Waste management in rural areas has become a major challenge for governments of developing countries. The success of waste management decisions directly lies in the accuracy and reliability of the data on which choices are based; many factors influence these data. Here, we examined the factors influencing domestic waste in rural areas of developing countries (RADIC), using both field surveys and by reviewing previous literature. The social factors included population, education and culture. There was a positive linear relationship between waste generation amount and population size (R² = 0.9405). Environmental education, training and demonstration projects played a positive role in improving people's awareness of the benefits of recycling and reducing waste. Traditional and national cultures, consumption and living habits contributed to variations in the generation and composition of domestic waste. Generally, practices related to conservation of and reverence for nature and green consumption encourage people to reduce, reuse and recycle waste in their daily life. Economic factors included household income and expenditure, energy and fuel structure, and types of industry that occurred in villages. A Kuznets inverted "U" curve relationship existed between domestic waste generation and people's income in rural areas of China. However, the waste generation rate had a linear relationship with the gross national income per capita in RADIC. The composition, bulk density and calorific value of domestic waste were variously affected by the energy and fuel structure and the types of industry that occurred. The natural factors included geography and climate (including rainfall, humidity, temperature and harvest seasons). The moisture content of waste was directly influenced by rainfall and humidity. Temperature affected waste characteristics by influencing residential heating modes. The waste characteristics were also influenced by the mixing of agricultural and aquacultural waste into domestic waste in the harvesting season. In different geographies, significant differences of domestic waste characteristics were observed as a result of comprehensive effects caused by multiple factors. Other factors included the administrative levels of communities and survey methods. The characteristics of domestic waste in towns or central villages were similar with those in cities, but were different from those in common villages (the smallest type of community). The domestic waste sampled in households indicated a lower rate of generation and lower ash content than when the waste was sampled at transfer stations or dumping sites. Based on the above analysis, the factors influencing domestic waste must be considered in order to optimize the design of waste management strategies in the RADIC. Furthermore, it is valuable and important to obtain more accurate data about waste characteristics.

Greenhouse gases emission from the sewage draining rivers

Carbon dioxide (CO₂), methane (CH₄) and nitrous oxide (N₂O) concentration, saturation and fluxes in rivers (Beitang drainage river, Dagu drainage rive, Duliujianhe river, Yongdingxinhe river and Nanyunhe river) of Tianjin city (Haihe watershed) were investigated during July and October in 2014, and January and April in 2015 by static headspace gas chromatography method and the two-layer model of diffusive gas exchange. The influence of environmental variables on greenhouse gases (GHGs) concentration under the disturbance of anthropogenic activities was discussed by Spearman correlative analysis and multiple stepwise regression analysis. The results showed that the concentration and fluxes of CO₂, CH₄ and N₂O were seasonally variable with >winter>fall>summer, spring>summer>winter>fall and summer>spring>winter>fall for concentrations and spring>summer>fall>winter, spring>summer>winter>fall and summer>spring>fall>winter for fluxes respectively. The GHGs concentration and saturation were higher in comprehensively polluted river sites and lower in lightly polluted river sites. The three GHGs emission fluxes in two sewage draining rivers of Tianjin were clearly higher than those of other rivers (natural rivers) and the spatial variation of CH₄ was more obvious than the others. CO₂ and N₂O air-water interface emission fluxes of the sewage draining rivers in four seasons were about 1.20-2.41 times and 1.13-3.12 times of those in the natural rivers. The CH₄ emission fluxes of the sewage draining rivers were 3.09 times in fall to 10.87 times in spring of those in the natural rivers in different season. The wind speed, water temperature and air temperature were related to GHGs concentrations. Nitrate and nitrite (NO₃^-+NO₂^--N) and ammonia (NH₄⁺-N) were positively correlated with CO₂ concentration and CH₄ concentration; and dissolved oxygen (DO) concentration was negatively correlated with CH₄ concentration and N₂O concentration. The effect of human activities on carbon and nitrogen cycling in river is great.

Microbiological and environmental significance of metal-dependent anaerobic oxidation of methane

Anaerobic oxidation of methane (AOM) can be coupled to the reduction of sulfate, nitrate and nitrite, which effectively reduces methane emission into the atmosphere. Recently, metal-dependent AOM (metal-AOM, AOM coupled to metal reduction) was demonstrated to occur in both environmental samples and enrichment cultures. Anaerobic methanotrophs are capable of respiration using Fe(III) or Mn(IV), whether they are in the form of soluble metal species or insoluble minerals. Given the wide distribution of Fe(III)/Mn(IV)-bearing minerals in aquatic methane-rich environments, metal-AOM is considered to be globally important, although it has generally been overlooked in previous studies. In this article, we discuss the discovery of this process, the microorganisms and mechanisms involved, environmental significance and factors influencing metal-AOM. Since metal-AOM is poorly studied to date, some discussion is included on the present understanding of sulfate- and nitrate-AOM and traditional metal reduction processes using organic substrates or hydrogen as electron donors. Metal-AOM is a relatively new research field, and therefore more studies are needed to fully characterize the process. This review summarizes current studies and discusses the many unanswered questions, which should be useful for future research in this field.

Multiple constraints compromise decision-making about implantable medical devices for individual patients: qualitative interviews with physicians

Background

Little research has examined how physicians choose medical devices for treating individual patients to reveal if interventions are needed to support decision-making and reduce device-associated morbidity and mortality. This study explored factors that influence choice of implantable device from among available options.

Methods

A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites. They were asked how they decided what device to use in a given patient, sources of information they consulted, and how patients were engaged in decision-making. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team.

Results

Twenty-two physicians from five Canadian provinces (10 cardiovascular, 12 orthopedic; 8, 10 and 4 early, mid and late career, respectively) were interviewed. Responses did not differ by specialty, geographic region or career stage. Five major categories of themes emerged that all influence decision-making about a range of devices, and often compromise choice of the most suitable device for a given patient, potentially leading to sub-optimal clinical outcomes: lack of evidence on device performance, patient factors, physician factors, organizational and health system factors, and device and device market factors. In the absence of evidence from research or device registries, tacit knowledge from trusted colleagues and less-trusted industry representatives informed device choice. Patients were rarely engaged in decision-making. Physician preference for particular devices was a barrier to acquiring competency in devices potentially more suitable for patients. Access to suitable devices was further limited to the number of comparable devices on the market, local inventory and purchasing contract specifications.

Conclusions

This study revealed that decision-making about devices is complex, cognitively challenging and constrained by several factors limiting access to and use of devices that could optimize patient outcomes. Further research is needed to assess the impact of these constraints on clinical outcomes, and develop interventions that optimize decision-making about device choice for treating given patients.

Electronic supplementary material

The online version of this article (10.1186/s12911-017-0577-3) contains supplementary material, which is available to authorized users.

Characteristics of ambient ozone (O3) pollution and health risks in Zhejiang Province

Troposphere ozone, which is from secondary formation processes, has been increasing dramatically during the last decades in China, inducing high health risks. In this study, temporal and spatial distribution of O₃ was studied among 13 sites of three cities during 2014-2016. The objectives were to clarify the characteristics of the ambient pollution of O₃ under the influence from other pollutants and meteorological parameters and the health outcomes from exposure to O₃. The concentrations of O₃ during summer were much higher than those during winter, and the concentrations in downtown areas were higher than in rural or mountain areas. PM_2.5, NO₂, SO₂, and wind speed (WS) were negatively correlated with O₃, and CO, temperature (T), and relative humidity (RH) were positively correlated with O₃. In multivariable analysis, two separate factors-solar radiation and atmospheric diffusion status, affected the O₃ levels. The concentrations of O₃ reached the highest level at 15:00 and the lowest value at about 6:00-8:00, with the similar trend to T and WS, and opposite to RH. According to the dose-response model, relative risks (RRs) and population attributable fractions (PAFs) with confidence intervals (CIs) for chronic obstructive pulmonary disease (COPD) from exposure to O₃ were 1.0612 (CI 1.0607-1.0616) and 5.32% (CI 5.29-5.36%), respectively, attributable to 2000 deaths in Zhejiang Province in 2014.

[Present situation and influencing factors on classroom mobile phone dependence syndrome in college students]

Objective: To explore the current situation and influencing factors on Classroom Mobile Phone Dependence Syndrome (CMPDS) among college students, and to provide scientific basis for guiding college students to use mobile phones reasonably and healthily. Methods: Stratified cluster sampling method was used. Students from different majors and different grades in Lanzhou University were included as the research objects. Classes were recognized as a unit in receiving basic field investigation in this questionnaire related study. Informed consent principles were followed and process of survey was anonymously carried out. Results: The overall rate of CMPDS in college students was 8.7%, including 'mild rate' as 6.6% and 'seriously mild rate' as 2.1%. No significant differences were found on genders or grades. Factors as shopping in the classroom shopping (OR=3.720), being bored on courses (OR=1.740), WiFi coverage (OR=1.787), time of practice in the classrooms (OR=1.514), and the total time of daily mobile phone use (OR=1.513) etc, appeared as risk factors related to CMPDS among the college students. However. shooting courseware (OR=0.579) appeared as a protective factor. Conclusions: Rate of CMPDS was high in college students and we suggested to form a joint task force among the college authority, teachers and students to work on the related problems. Hopefully, the serious CMPDS condition will be minimized and both physical and mental health of the college students be improved.

The association between second-hand smoke exposure and depressive symptoms among pregnant women

Tobacco smoking and depression are strongly associated, but the possible association between second-hand smoke (SHS) exposure and depression is unclear. This study aimed to examine the possible relation between SHS exposure and depressive symptoms among pregnant women. A cross-sectional survey was conducted in Shenzhen, China, using a multistage sampling method. The univariable and multivariable logistic regression models were used to explore the associations between SHS exposure and depressive symptoms. Among 2176 pregnant women, 10.5% and 2.0% were classified as having probable and severe depressive symptoms. Both binary and multinomial logistic regression revealed that there were significantly increased risks of severe depressive symptoms corresponding to SHS exposure in homes or regular SHS exposure in workplaces using no exposure as reference. In addition, greater frequency of SHS exposure was significantly associated with the increased risk of severe depressive symptoms. Our findings suggest that SHS exposure is positively associated with depressive symptoms in a dose-response manner among the pregnant women.

Research on the influencing factors of reverse logistics carbon footprint under sustainable development

With the concerns of ecological and circular economy along with sustainable development, reverse logistics has attracted the attention of enterprise. How to achieve sustainable development of reverse logistics has important practical significance of enhancing low carbon competitiveness. In this paper, the system boundary of reverse logistics carbon footprint is presented. Following the measurement of reverse logistics carbon footprint and reverse logistics carbon capacity is provided. The influencing factors of reverse logistics carbon footprint are classified into five parts such as intensity of reverse logistics, energy structure, energy efficiency, reverse logistics output, and product remanufacturing rate. The quantitative research methodology using ADF test, Johansen co-integration test, and impulse response is utilized to interpret the relationship between reverse logistics carbon footprint and the influencing factors more accurately. This research finds that energy efficiency, energy structure, and product remanufacturing rate are more capable of inhibiting reverse logistics carbon footprint. The statistical approaches will help practitioners in this field to structure their reverse logistics activities and also help academics in developing better decision models to reduce reverse logistics carbon footprint.

Factors influencing adsorption and desorption of trimethoprim on marine sediments: mechanisms and kinetics

Adsorption-desorption behavior of ionic antibiotics in natural aquatic environment is complex, especially in coastal or estuary area where influencing factors such as pH and salinity usually varied in a wide range. In this study, batch-type and stirred flow chamber (SFC) experiments were carried out to simulate the sorption-desorption behavior of trimethoprim (TMP) in seawater-sediment system. Equilibrium and kinetic modeling were carried out to determine the rate and extent of TMP sorption on two marine sediments with different properties. Sediment BHB (K _d , 6.40 L kg^-1) has a greater sorption capacity compared with sediment LZB (K _d , 3.40 L kg^-1), which is related to the higher content of organic carbon and clay of sediment BHB. Adsorption of TMP varied in the pH range of 6.9 to 8.1 with maximum adsorption at pH 7.4. Increasing salinity and presence of phosphate and nitrate led to decreased TMP sorption. Attenuated total reflection Fourier transform infrared (ATR-FTIR) analysis demonstrated the formation of hydrogen bond between TMP and marine sediments. Adsorption of TMP on marine sediments was a non-equilibrium process that can be described with second-order kinetic model. Our analysis suggested that chemical non-equilibrium was the rate controlling process and intraparticle diffusion was also involved in TMP adsorption. A moderate desorption percentage (16.4-22.8% for LZB and 32.5-42.0%for BHB) was observed. Overall, the results showed that environmental factors and time-dependent processes need to be considered in modeling the fate and transport of TMP in coastal/estuarine waters.

Is environmental sustainability a strategic priority for logistics service providers?

Despite an increasing number of third-party logistics service providers (3PLs) regard environmental sustainability as a key area of management, there is still great uncertainty on how 3PLs implement environmental strategies and on how they translate green efforts into practice. Through a multiple case study analysis, this paper explores the environmental strategies of a sample of medium-sized 3PLs operating in Italy and the UK, in terms of environmental organizational culture, initiatives, and influencing factors. Our analysis shows that, notwithstanding environmental sustainability is generally recognised as a strategic priority, a certain degree of diversity in the deployment of environmental strategies still exists. This paper is original since the extant literature on green strategies of 3PLs provides findings predominantly from a single country perspective and mainly investigates large/multinational organizations. It also provides indications to help managers of medium-sized 3PLs in positioning their business. This is particularly meaningful in the 3PL industry, where medium-sized organizations significantly contribute to the generated turnover and market value.

Spatiotemporal analysis of tuberculosis incidence and its associated factors in mainland China

Spatiotemporal analysis is an important tool to monitor changes of tuberculosis (TB) epidemiology, identify high-risk regions and guide resource allocation. However, there are limited data on the contributing factors of TB incidence. This study aimed to investigate the spatiotemporal pattern of TB incidence and its associated factors in mainland China during 2005-2013. Global Moran's I test, Getis-Ord Gi index and heat maps were used to examine the spatial clustering and seasonal patterns. Generalized Linear Mixed Model was applied to identify factors associated with TB incidence. TB incidence presented high geographical variations with two main hot spots, while a generally consistent seasonal pattern was observed with a peak in late winter. Furthermore, we found province-level TB incidence increased with the proportion of the elderly but decreased with Gross Demographic Product per capita and the male:female ratio. Meteorological factors also influenced TB incidence. TB showed obvious spatial clustering in mainland China and both the demographic and socio-economic factors and meteorological measures were associated with TB incidence. These results provide the related information to identify the high-risk districts and the evidence for the government to develop corresponding control measures.

Policies, Socioeconomic, Institutional and Biophysical Factors Influencing the Change from Rice to Sugarcane in Nong Bua Lamphu Province, Thailand

For the past decade, Thailand pursued a strategy of promoting biofuel crop production, including sugarcane, to meet the ever increasing energy demand and to increase the income of farmers. This study analyzed the influence of policy instruments implemented to promote the sugarcane cultivation, farm household socioeconomic levels, biophysical, and institutional factors driving the conversion of rice fields into sugarcane farms. Primary information was collected from 230 farm households through a structured questionnaire. Relevant policy documents published by the responsible government agencies were the main sources of secondary information collected for policy analysis. The analyses revealed that farmers in the study area converted 25-75% of their rice fields into sugarcane farms as a result of implementation of policy instruments that made sugarcane financially far more attractive than rice. The results of the regression analysis showed that eight variables were found significant and positively influenced the conversion of rice fields into sugarcane farms. These were access to extension services, information, sugarcane loading stations, and ground water for irrigation, and duration of experience in sugarcane farming as well as household head's age and education. Irrespective of landholding size, the majority of farmers were not concerned about food security. In view of the finding, if feasible, in the form of additional price supports and commercial cane sugar index-based pricing strategies to promote sugarcane production should benefit all concerned farmers. Likewise, attention should be paid to deliver essential extension and marketing services in an effective way, particularly to those farmers who are not receiving such services.

Improving local health workers' knowledge of malaria in the elimination phase-determinants and strategies: a cross-sectional study in rural China

BACKGROUND

The current stage of malaria elimination in China requires experienced local health workers with sufficient knowledge of malaria who help to keep the public health system vigilant about a possible resurgence. However, the influencing factors of local health workers' knowledge level are not fully comprehended. This study aims to explore the factors with heavy impact on local health worker's knowledge of malaria and propose corresponding suggestions.

METHODS

Underpinned by stratified sampling method, a cross-sectional survey was carried out between November 2014 and April 2016. Chi square test was performed to identify the factors with potential influence on health workers' knowledge level of malaria. Bivariate logistic regression was employed to explore the relationship between the predictors and local health workers' knowledge level of malaria. Layered Chi square test was used to calculate the homogeneity of the interaction between training approaches and the percentage of participants with high-level knowledge.

RESULTS

The endemic type of county and type of organization played the most significant role in influencing local health workers' knowledge level regarding malaria in the sample population. The participants from Type 1 and Type 2 counties were 4.3 times (4.336 and 4.328, respectively) more likely to have high-level knowledge of malaria than those who work in Type 3 counties. The probability of having high-level knowledge amongst the participants from county-level facilities (county hospitals and CDCs) were more than 2.2 times higher than those who work in villages. Other socio-demographic factors, such as education and work experience, also affected one's knowledge regarding malaria. Amongst the six most-used training approaches, electronic material (OR = 2.356, 95% CI 1.112-4.989), thematic series (OR = 1.784, 95% CI 0.907-3.508) and supervision (OR = 2.788, 95% CI 1.018-7.632) were proven with significant positive impact on local health workers' knowledge of malaria.

CONCLUSION

Village doctors and who served in Type 3 counties were identified as the ones in urgent need of effective training. Three types of training approaches, including electronic material, thematic series and supervision, were proven to be effective in improving local health workers' knowledge. Nevertheless, the coverage of these training approaches was still limited. This study suggests expanding the coverage of training, especially the three particular types of training, to local health workers, particularly to the target populations (village doctors and who served in Type 3 counties). Online training, small group discussion and targeted skill development may be the directions for the future development of training programmes.

Factors associated with liver dysfunction in patients with acute pancreatitis

AIM

To identify the factors associated with liver dysfunction in patients with acute pancreatitis (AP).

METHODS

One hundred and twenty-six patients with AP admitted to our hospital were selected from March 2014 to March 2015 and divided into three groups according to the severity of liver dysfunction: a mild group, a moderate group, and a liver failure group. Clinicla data of patients, including disease etiology, CT examination results, and biochemical indexes, were collected to calculate the modified computed tomography severity index (MCTSI) score, Ranson score and bedside index for severity in acute pancreatitis (BISAP) score, which were then compared among the three groups.

RESULTS

The percentages of patients with severe AP, moderately severe AP, and mild AP differed significantly maong the three groups (P < 0.05). Spearman correlation analysis showed a positive correlation between the severity of AP and that of liver dysfunction (r = 0.271, P = 0.017). Ranson, BISAP, and MCTSI scores differed significantly maong the three groups (P < 0.05). Biliary AP was the most common etiology, followed by alcoholic AP. There was no significant difference in the distribution of biliary AP, alcoholic AP, and hypertriglyceridemia among the three groups.

CONCLUSION

Liver dysfunction in AP patients is caused by many factors, and the severity of AP is positively related to the degree of abnormal liver function. BISAP scoring system can accurately predict the occurrence of liver dysfunction in patients with AP.

[Analysis of dietary pattern and diabetes mellitus influencing factors identified by classification tree model in adults of Fujian]

Objective: To find out the dietary patterns and explore the relationship between environmental factors (especially dietary patterns) and diabetes mellitus in the adults of Fujian. Methods: Multi-stage sampling method were used to survey residents aged ≥18 years by questionnaire, physical examination and laboratory detection in 10 disease surveillance points in Fujian. Factor analysis was used to identify the dietary patterns, while logistic regression model was applied to analyze relationship between dietary patterns and diabetes mellitus, and classification tree model was adopted to identify the influencing factors for diabetes mellitus. Results: There were four dietary patterns in the population, including meat, plant, high-quality protein, and fried food and beverages patterns. The result of logistic analysis showed that plant pattern, which has higher factor loading of fresh fruit-vegetables and cereal-tubers, was a protective factor for non-diabetes mellitus. The risk of diabetes mellitus in the population at T2 and T3 levels of factor score were 0.727 (95%CI:0.561-0.943) times and 0.736 (95%CI: 0.573-0.944) times higher, respectively, than those whose factor score was in lowest quartile. Thirteen influencing factors and eleven group at high-risk for diabetes mellitus were identified by classification tree model. The influencing factors were dyslipidemia, age, family history of diabetes, hypertension, physical activity, career, sex, sedentary time, abdominal adiposity, BMI, marital status, sleep time and high-quality protein pattern. Conclusion: There is a close association between dietary patterns and diabetes mellitus. It is necessary to promote healthy and reasonable diet, strengthen the monitoring and control of blood lipids, blood pressure and body weight, and have good lifestyle for the prevention and control of diabetes mellitus.