Association between ambient temperature and mammalian-related injuries in Guangzhou, China, 2014-2019

BACKGROUND

Meteorological factors are associated with various health outcomes. However, it remains uncertain whether ambient temperature affects animal aggressive behaviors and causes mammalian-related injuries (MRI) in humans. The study aimed to examine the effect of daily mean temperature on MRI in Guangzhou, China.

METHODS

Individual cases of MRI were obtained from Guangzhou Injury Surveillance System during 2014-2019. A combination of a distributed lag nonlinear model and conditional quasi-Poisson regression, implemented within a time-stratified case-crossover design, was employed to evaluate the association between temperature and MRI. Subgroup analyses were conducted by sex, age group, education level, and types of mammals.

RESULT

This study included 24,206 MRI cases among which 89.7 % were caused by cats or dogs. We observed a nonlinear relationship between daily mean temperature and MRI. The impact of high temperatures was most pronounced on the current day and remained statistically significant on the next day. Compared with the reference temperature with a minimum risk of injuries (9.3 °C, approximately 2nd percentile of temperature), 75th percentile of temperature (27.4 °C) exerted the greatest relative risk (RR) of injuries (RR = 1.45, 95 % CI: 1.25-1.68) over lag 0-1 days. In subgroup analyses, the effects of high temperatures among males and females were similar. Individuals aged 15-34 years and 35-59 years were more susceptible to MRI at high temperatures compared to other age groups. The risk of injuries caused by cats or dogs consistently increased with high temperatures. We did not find significant impacts of low temperatures.

CONCLUSION

Short-term heat exposure plays an important role in the occurrence of MRI. The findings highlight the importance of enhancing public awareness regarding the high temperature-associated hazards posed by mammals. There is a need for enhanced regulations and measures on the management for cats and dogs to mitigate the harm caused in hot seasons.

Healthy lifestyles and rapid progression of carotid plaque in population with atherosclerosis: A prospective cohort study in China

Background

Healthy lifestyles are effective means to reduce major cardiovascular events. However, little is known about the association of healthy lifestyles with development of carotid atherosclerosis at the early stage of cardiovascular diseases (CVDs).

Methods

We enrolled participants from Fujian province in the China PEACE MPP project. We calculated a healthy lifestyle score by adherence to non-smoking, sufficient physical activity, healthy diet and healthy body mass index. Cox proportional hazards regression models and restricted cubic splines (RCS) were used to explore the association between the healthy lifestyles and rapid progression of carotid plaque.

Results

8379 participants were included (mean age: 60.6 ± 8.3 years, 54.6 % female), with a median follow-up of 1.2 years (inter quartile range: 1.0-1.6). RCS showed a significant inverse association between the healthy lifestyle score and progression of carotid plaque. Participants with "intermediate" (HR: 0.72 [95 % confidence interval (CI): 0.65-0.80]) or "ideal" (HR: 0.68 [0.59-0.78]) adherence to healthy lifestyles had a lower risk of progression of carotid plaque compared to those with "poor" adherence. Age, sex, occupation, income, residence type and metabolic status were significant factors influencing the relationship. Farmers benefited more in non-smoking and sufficient physical activity compared to non-farmers, and participants with lower income or without dyslipidaemia benefited more in sufficient physical activity and healthy diet compared to their counterparts (p-for-interaction < 0.05).

Conclusions

Healthy lifestyles were associated with lower risk of progression of carotid plaque in populations with atherosclerosis. Promotion of healthy lifestyles from the early stage of carotid atherosclerosis could reduce the burden of CVDs in China.

Reflections on peripartum hysterectomy: A 10-year retrospective observational study in Northeast China

OBJECTIVE

To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China.

METHODS

This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed.

RESULTS

Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies.

CONCLUSION

Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high-risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH.

Traffic-related pollution and symptoms of depression and anxiety among Chinese adults: A population-based study

BACKGROUND

Limited understanding exists regarding the associations of traffic-related pollution with depression and anxiety symptoms in individuals residing within low- and middle-income countries.

METHODS

Data for this study were extracted from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey, implemented between June 20 and August 31, 2023. We determined residential proximity to major roadways through self-reports and evaluated depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), along with anxiety symptoms assessed through the Generalized Anxiety Disorder-7 (GAD-7). We examined the associations between residential proximity to major roadways and depression and anxiety symptoms using logistic regressions and generalized linear models, while controlling for potential confounding variables.

RESULTS

This study comprised a total of 22,723 participants. The adjusted odds ratios (OR) for depression symptoms were 1.34 (95 % confidence interval (CI) 1.20, 1.51), 1.29 (95 % CI 1.17, 1.43), 1.34 (95 % CI 1.20, 1.49), and 1.32 (95 % CI 1.17, 1.49) among individuals residing within <50 m, 50-100 m, 101-200 m, and 201-300 m, respectively, in comparison to those residing >300 m from a major roadway. Individuals residing <50 m, 50-100 m, 101-200 m, and 201-300 m from a major roadway exhibited adjusted OR for anxiety symptoms of 1.49 (95 % CI 1.30, 1.69), 1.21 (95 % CI 1.07, 1.37), 1.38 (95 % CI 1.21, 1.56), and 1.38 (95 % CI 1.20, 1.59), respectively, in contrast to those residing >300 m.

CONCLUSIONS

This study provides valuable insights into the associations between environmental factors and mental health. The findings underscore the importance of integrating environmental considerations into comprehensive mental health frameworks, especially for individuals residing near high-traffic areas.

Long-term effects of various experiences of parental migration on adult health: A nationwide survey in China

BACKGROUND

Despite numerous literature studies on the short-term effects of diverse experiences of being left-behind, migrant, or both on children, the research on their long-term effects remains inadequate. The purpose of current study is to explore the long-term impact of being left-behind, migrant or experiencing both during childhood on health in adulthood. Simultaneously, we investigate the impact of psychological resilience on adults in the presence of diverse experiences of parental migration.

METHOD

A total of 2,371 samples were selected from 28 provinces in China, consisting of 656 participants who had been left behind but never migrated (PLBNM), 205 participants who had migrated but never been left behind (PMNLB), 265 participants who had both been left behind and migrated (PLBM), and 1,245 participants who had no left-behind/migrant experiences (NLBM). The mental health, health condition, and psychological resilience were measured using the 12-item General Health Questionnaire (GHQ-12), Self-Rated Health, and the Connor-Davidson Resilience Scale (CD-RISC), respectively.

RESULTS

The results of the regression model indicated that PLBNM (OR = 2.10, 95% CI [1.59, 2.77], p < .001), PMNLB (1.93, [1.27, 2.94], p < .01), and PLBM (2.01, [1.37, 2.94], p < .001) displayed lower self-rated health compared to NLBM. However, only PLBNM (1.29, [1.05, 1.58], p < .05) reported higher mental health problems compared to NLBM. Our results also showed a strong association between psychological resilience and adults' lower self-rated health (0.72, [0.64, 0.82], p < .001).

CONCLUSION

The negative long-term impact of various experiences regarding being left-behind, migrant, or both, on adult's mental health and self-rated health were more pronounced. The Chinese government ought to create unique policy frameworks that offer assistance to those adults.

Type 1 and type 2 diabetes mortality burden: Predictions for 2030 based on Bayesian age-period-cohort analysis of China and global mortality burden from 1990 to 2019

AIMS

This study assessed diabetes (type 1 and type 2) mortality in China and globally from 1990 to 2019, predicting the next decade's trends.

MATERIALS AND METHODS

Data came from the Global Burden of Disease (GBD) database. The annual percentage change (AAPC) in age-standardized mortality rates (ASMR) for diabetes (type 1 and type 2) during 1990-2019 was calculated. A Bayesian age-period-cohort (BAPC) model predicted diabetes (type 1 and type 2) mortality from 2020 to 2030.

RESULTS

In China, type 1 diabetes deaths declined from 6,005 to 4,504 cases (AAPC -2.827), while type 2 diabetes deaths rose from 64,084 to 168,388 cases (AAPC -0.763) from 1990 to 2019. Globally, type 1 diabetes deaths increased from 55,417 to 78,236 cases (AAPC 0.223), and type 2 diabetes deaths increased from 606,407 to 1,472,934 cases (AAPC 0.365). Both China and global trends showed declining type 1 diabetes ASMR. However, female type 2 diabetes ASMR in China initially increased and then decreased, while males had a rebound trend. Peak type 1 diabetes deaths were in the 40-44 age group, and type 2 diabetes peaked in those over 70. BAPC predicted declining diabetes (type 1 and type 2) mortality burden in China and globally over the next 10 years.

CONCLUSIONS

Type 2 diabetes mortality remained high in China and globally despite decreasing type 1 diabetes mortality over 30 years. Predictions suggest a gradual decrease in diabetes mortality over the next decade, highlighting the need for continued focus on type 2 diabetes prevention and treatment.

Patterns of unhealthy lifestyle and their associations with depressive and anxiety symptoms among Chinese young adults: A latent class analysis

BACKGROUND

There is little evidence on the association between patterns of unhealthy lifestyle and mental health among young adults.

METHOD

This study included a total of 28,978 young adults aged 18 to 44 years old in Guangdong province in south China, which was conducted from September to December in 2022. We used latent class analysis to classify the patterns of unhealthy lifestyle among young adults and used multiple logistic regression to explore their associations with depressive and anxiety symptoms.

RESULT

The weighted prevalence of depressive and anxiety symptoms were 28.0 % and 19.5 %, respectively. The cumulative effect of unhealthy lifestyles on depressive and anxiety symptoms was significant. Five patterns of unhealthy lifestyle were classified. Compared to the relatively healthy lifestyle class, the class with more unhealthy lifestyles (OR = 6.54, 95 % CI: 5.70-7.51) and insufficient sleep (OR = 6.16, 95 % CI: 4.92-7.70) had higher risk for depressive and anxiety symptoms. Meaningfully, having adequate mental health literacy could reduce the risk of depressive and anxiety symptoms from unhealthy lifestyle by half.

LIMITATIONS

The cross-section design study limited causal inferences, and the self-report information may lead to recall bias.

CONCLUSIONS

Unhealthy lifestyles have a negative impact on depressive and anxiety symptoms through independent, cumulative and combined effects, and they could be interrelated. Unhealthy lifestyle patterns differed in younger population by socio-demographic characteristics and mental health literacy. Health-care professionals and policymakers may provide programs to intervene multiple unhealthy lifestyles and improve mental health literacy by integrating healthy lifestyle education to promote youngers' mental health.

Loneliness, Living Alone, and Risk of Cardiovascular Disease Among Older Adults in China

BACKGROUND

Older adults are prone to live alone and feel lonely. The main objective of this study was to assess the associations of loneliness and living alone with cardiovascular disease (CVD) among community-dwelling older individuals in China.

METHODS

We conducted a longitudinal analysis on 3 661 participants aged older than 65 years from the latest 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards models were used to assess the associations of loneliness and living alone with CVD risk, with adjustment for confounding factors.

RESULTS

A total of 616 incident CVD cases were identified during follow-up. Participants who reported feeling lonely experienced a 28% increased risk of developing CVD after adjustment for sociodemographic characteristics, lifestyle factors, and baseline health status (adjusted hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.01-1.62; ptrend = .046). In contrast, no significant association was observed between living alone and CVD risk. Subgroup analyses showed that among those individuals who lived alone, often feeling lonely doubled the risk of CVD compared to never being lonely (HR: 2.17, 95% CI: 1.20-3.93; ptrend = .007).

CONCLUSIONS

Loneliness was an independent risk factor for CVD among Chinese older adults. Our findings underscore the importance of addressing loneliness in the prevention of CVD among older individuals, especially those who live alone.

Examining the Impact of Long-Term Care Insurance on the Care Burden and Labor Market Participation of Informal Carers: A Quasi-Experimental Study in China

OBJECTIVES

Existing evidence from high-income countries suggests that policies aimed at enhancing access to formal care can reduce the burden on informal carers and facilitate their reentry into the labor market. However, there is limited evidence regarding the specific carers who have been most affected by such insurance. This study focuses on China's long-term care insurance (LTCI) and examines its effects on informal care burden and the labor market participation of different types of informal carers.

METHODS

Drawing data from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015, and 2018, we employ a staggered difference-in-differences (DID) model with propensity score matching to analyze the impact of LTCI. To explore time-varying DID estimates, we adopted the DID event study design.

RESULTS

Our study demonstrates that LTCI substantially alleviates the burden on informal carers while markedly boosting labor market participation. Notably, we found a more pronounced decrease in care burden among spouses, amounting to a reduction of 8.5 hr per month. Concurrently, LTCI's impact on enhancing labor market participation was more significant among younger household members, reflected in an average income increase of 4,534 yuan per year. Furthermore, subgroup analysis highlights that LTCI primarily benefits informal carers providing care for older people with low income or those who were farmers or previously engaged in informal sectors.

DISCUSSION

Our study demonstrates that LTCI has led to a reduction in care burdens and an enhancement in labor market participation. The impact is especially pronounced for informal carers of older people with low income or those with backgrounds in farming or informal work sectors.

Psychometric properties of the Chinese version of the 15-item Need for Closure Scale: Scale validation and associations with mental health

BACKGROUND

Need for closure (NFC) has been found to be implicated in different forms of psychopathology. The 15-item Need for Closure Scale (NFCS) is an efficient and easy tool for assessing individuals' NFC in Western contexts. However, the psychometric properties of the 15-item NFCS have not yet been validated in Chinese populations.

METHODS

Two different samples of university students from China were recruited in this study. The first sample (N = 5080, 49.9% females) was used to conduct exploratory factor analysis and reliability analysis. The second sample (N = 3968, 64.2% females) was used to perform confirmatory factor analysis, exploratory structural equation modeling (ESEM), and bifactor models, followed by tests of measurement invariance and criterion validity.

RESULTS

The full scale showed good internal consistency. The bifactor-ESEM result with a general factor and four specific factors was chosen as our final model. Strong measurement invariance across sex and ethnicity groups was supported. Evidence was obtained for the criterion validity of NFCS scores with respect to depression, anxiety, and psychological distress.

CONCLUSION

The Chinese NFCS appears to be a valid and reliable instrument for measuring the NFC, which could promote both the assessment and research of the NFC in Chinese populations.

Prevalence and risk factors of osteoporotic fracture among the elderly population in China: a multicenter cross-sectional study

PURPOSE

Prevalence of osteoporotic fracture (OPF) is increasing with ageing, resulting in a significant financial burden for healthcare. However, research on the nationwide epidemiological data of OPF in Chinese elderly is still scarce. The aim of this study was to investigate the prevalence and risk factors of OPF in Chinese population aged 60 years or order.

METHODS

A cross-sectional survey was conducted in an elderly Chinese population in five centres. Questionnaire investigation and imaging examination were taken in all participants to identify OPF prevalence and risk factors. Diagnosis of OPF was determined based on imaging of vertebral fractures or history of fall-related fractures. We then used multivariate logistic regression model to analyze the associations between the potential risk factors and OPF.

RESULTS

The overall prevalence of OPF in population aged 60 years or older was 24.7% (1,071/4,331), showing an increasing trend with age (P < 0.001). The prevalence of OPF was geographically distinct (P < 0.001), but similar between men and women (P > 0.05). Up to 96.8% of OPFs consisted of vertebral fractures, especially involving T11, T12, and L1 segments. Advanced age (≥ 80), vision loss, severe hearing loss, multiple exercise forms, chronic kidney disease, osteoarthritis, and trauma-related vertebral fractures were significantly associated with risk factors, while education level and vitamin D supplementation were associated with protective factors of OPF.

CONCLUSION

High prevalence of OPF is a serious threat to bone health among elderly people in China. There is an urgent need for effective strategies to diagnose, prevent, and treat OPF in elderly adults.

Case fatality of repeated suicidal acts among suicide attempters in rural China: a retrospective cohort study

Background

Individuals presenting to hospital due to suicide attempt are at high risk for repeated suicidal act, yet there are meager data on the extent to which repeated suicidal acts result in death.

Methods

This retrospective cohort study was based on a general hospital self-harm register system in a rural county in China. Identified individuals who attempted suicide were contacted and followed up for up to 8 years. Main outcomes over follow-up were: 1) suicide death, 2) nonlethal suicide attempt, and 3) suicidal acts including suicide death and nonlethal attempt. Incidence densities, correlates, and case fatality of repeated suicidal acts were estimated.

Findings

A total of 1086 individuals (two-thirds females, mean age 40.6 years) with a suicide attempt presenting to hospital (index attempt) were identified and followed up, with most of the index attempts by pesticide ingestion (79%). Over follow-up, there were 116 suicidal acts carried out by 108 individuals (69 females, 39 males), including 34 suicide deaths (21 females, 13 males), yielding a high case-fatality of 29.3%. During follow-up, suicide death rates were also high overall and in the first year of follow-up (846.7 and 1787.2 per 100,000 person years). Over follow-up, pesticide was the most common method (47/116) of repeated suicidal act and yielded a higher case-fatality than other methods (46.8% vs 17.4%, χ2 = 11.68, P < 0.001). The incidence densities of repeated suicidal acts and nonlethal attempts were low compared to rates reported in previous literature.

Interpretation

Incidence densities of repeated suicidal acts in a rural China cohort were low compared to previous studies. However, rates of suicide deaths over follow-up were high, a result driven by the high case-fatality of suicidal acts and attributable to the common use of pesticides. Reducing suicidal acts with pesticides is a key target for suicide prevention in rural China.

Funding

Beijing Municipal High Rank Public Health Researcher Training Program, Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, and Beijing Hospitals Authority's Ascent Plan.

Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study

Objective

We assessed financial toxicity (FT) among Chinese patients with cancer and investigated associated risk factors guided by a multilevel conceptual framework.

Methods

Applying multistage stratified sampling, we selected six tertiary and six secondary hospitals across three economically diverse provinces in China. From February to October 2022, 1208 patients with cancer participated. FT was measured using the COmprehensive Score for financial Toxicity (COST), with 28 potential risk factors identified at multilevel. Multiple regression analysis was used for risk factor identification.

Results

FT prevalence was 82.6% (95% confidence interval [CI]: 80.5%, 84.8%), with high FT (COST score ≤ 18.5) observed in 40.9% of participants (95% CI: 38.1%, 43.7%). Significant risk factors included younger age at cancer diagnosis, unmarried status, low annual household income, negative impact of cancer on participants' or family caregiver's work, advanced cancer stage, longer hospital stay for cancer treatment or treatment-related side effects, high perceived stress, poor emotional/informational support, lack of social medical insurance or having urban and rural resident basic medical insurance, lack of commercial medical insurance, tertiary hospital treatment, and inadequate cost discussions with healthcare providers (all P < 0.05).

Conclusions

Cancer-related FT is prevalent in China, contributing to disparities in cancer care access and health-related outcomes. The risk factors associated with cancer-related FT encompasses multilevel, including patient/family, provider/practice, and payer/policy levels. There is an urgent need for collective efforts by patients, healthcare providers, policymakers, and insurers to safeguard the financial security and well-being of individuals affected by cancer, promoting health equities in the realm of cancer care.

Religion, Psychological Strain, and Suicidality in China: A Preliminary Study

BACKGROUND

There is a lack of religiosity studies in China especially in relation to mental health and suicidality. In this research, we focus our studies on medical workers of which some studies reported to have higher stress, and to pilot our studies in this adult age-group.

DATA AND METHODOLOGY

Data were obtained by a questionnaire survey in a large public hospital in a big metropolitan city of China. The final sample consisted of 1012 respondents with 237 (23.4%) being male and 775 (76.6%) being female. The respondents were of three groups: (1) Believers (n = 34; 3.5%); (2) Non-Believers or Atheists (n = 547; 55.8%); and (3) Agnostics or Fence-Sitters (n = 400; 40.8%). Suicidality was measured by the NCS-Suicidality Scale, and standard measures were employed for other major variables.

FINDINGS

In line with other recent studies in China, the religion rate among the urban adults remained low (3.5%). However, about 40.8% of the respondents chose "don't know" and could be fence-sitters on the issue of religious belief. Many of them are involved in various folk beliefs which may not be considered as religious. The religious believers were at higher risk of suicidality and depression than the atheists and the fence-sitters. However, the fence-sitters were higher than the believers and atheists on psychological strains, and they were higher on depression compared to the atheists.

CONCLUSION

The religious believers and religious fence-sitters have higher psychopathologic risks and suicidal risk than the atheist group. Religion as of low prevalence in Chinese societies is a social value deviant from the norm and its practitioners are likely to be marginalized or stigmatized. The Strain Theory of Suicide is used for detailed explanations.

The relationship between public risk preference and the underuse or overuse of preventive health services in the information age

The underuse or overuse of preventive health services by individuals is an outward behavioural reflection of their attitude towards disease risk, and they are strongly influenced by their information-acquisition ability. Therefore, we try to explore the relationship among the public risk preference, information-acquisition ability and underuse or overuse of preventive health services, in order to provide decision-making basis in the Information Age. The survey surveyed 2,211 respondents aged ≥ 18 in China from September to December 2019. Taking cancer screening as an example, the multiple price list (MPL) test and item response theory (IRT) model were used to measure individual risk preference and information-acquisition ability. The Logit model and Tobit model were used to estimate the relationship between risk preference, information-acquisition ability and underuse or overuse of preventive health services. Risk-seeking individuals were more likely to underuse preventive health services, while risk-averse individuals were more likely to overuse such services. Information-acquisition ability may improve the underuse of preventive health services in risk-seeking individuals but exacerbate the overuse of preventive health services in risk-averse individuals. Among the investigated information channels, the Internet is the most effective way for the public to obtain information. It is necessary to change the public's incorrect perception of disease risks and risks associated with preventive health services. In the rapid development of the Information Age, improving public information-acquisition ability is a practicable way to correct the negative relationship between risk preference and individuals' underuse or overuse of preventive health services.

Quantifying greenhouse gas emissions mitigation potential in China's agricultural plastic greenhouses

To promote sustainable intensification and provide guidance for decisionmakers, we must understand the potential for mitigating greenhouse gas emissions in greenhouse cultivation. Therefore, this study aimed to evaluate the greenhouse gas emission mitigation potential of agricultural plastic greenhouses in China using a combination of life cycle assessment, data envelopment analysis, and scenario analysis. We found that: (1) In China, the mean mitigation potential for greenhouse gas emission intensity related to the crop production inputs of agricultural plastic greenhouses is 1.67 kt CO2-eq/km2, demonstrating a remarkable mitigation rate of 47 %. This mitigation potential, driven mostly by fertilizer use, exhibited a spatial pattern characterized by high mitigation rates in the southern regions compared to those in the northern regions; (2) in scenarios S1 and S2, the greenhouse gas emission intensity mitigation potential of greenhouse construction materials was 0.645 kt CO2-eq/km2 and 0.968 kt CO2-eq/km2, respectively, with steel being the primary contributor to mitigation; (3) under scenarios S1 and S2, the greenhouse gas emission mitigation rates for China's agricultural plastic greenhouses were 42 % and 48 %, respectively. This study highlights the greenhouse gas emission mitigation potential of China's agricultural plastic greenhouses. To ensure sustainability in plastic greenhouses, emphasis should be placed on optimizing fertilizers and extending the lifespan of construction materials.

Spousal health, marital satisfaction, and older Chinese adults' sleep: The moderating role of psychological resilience

PURPOSES

This study aims to examine the moderating role of psychological resilience in the association between two common marital relationship stressors (poor spousal health and low marital satisfaction) and sleep (sleep quality and sleep duration) among older adults in China.

METHODS

This study used four waves of data from the Chinese Longitudinal Healthy Longevity Survey (2008-2018) (N = 8769), and mixed-effects logistic models were used.

RESULTS

Poor spousal health and low marital satisfaction were independently associated with increased odds of poor sleep quality and short sleep duration, and decreased odds of long sleep duration. Greater psychological resilience was associated with increased odds of good sleep quality and decreased odds of short sleep duration, but had no significant effect on long sleep duration. In addition, psychological resilience moderated the odds of poor spousal health and low marital satisfaction on the risk of short sleep duration among older Chinese adults.

CONCLUSION

The findings provide novel evidence for the increased importance of marital stress and psychological resilience on sleep health in later life. Policy interventions are needed to support vulnerable older adults who experience poor spousal health and/or low marital satisfaction.

Associations between environmental perception and self-rated health in the city hierarchy of China: Findings from a national cross-sectional survey

Identifying environmental determinants of health and clarifying their variations is crucial for health promotion in different cities by providing tailored intervention strategies. Although the association between perceived urban environment and health (e.g., self-rated health) has been repeatedly explored, most studies have focused on cities of a specific size, and it is still unknown whether either significant environment variables or the magnitude of the association would vary across different-sized cities. This study investigated how perceived urban environment variables significantly associated with individuals' self-rated health varied from small cities to mega cities in China, based on a national survey including 5963 valid respondents. The results showed that the relationship between self-rated health and city size was U-shaped, with respondents in medium and large cities reporting a low-level self-rated health. Perceived greenness, public facilities, housing supply, and medical services were positively and significantly associated with self-rated health, with the odds ratio (OR) of 1.37 (95%CI: 1.29-1.46), 1.27 (95%CI: 1.19-1.35), 1.14 (95%CI: 1.09-1.20), and 1.17 (95%CI: 1.10-1.24), respectively. Furthermore, the magnitude of the association was significantly larger in mega cities. These findings provide useful evidence for promoting public health in cities of different sizes for achieving health equity and indicate that smaller cities and their health-supportive environment need further attention.

Novel Patterns in High-Resolution Computed Tomography in Whipple Pneumonia

With the use of metagenomic next-generation sequencing, patients diagnosed with Whipple pneumonia are being increasingly correctly diagnosed. We report a series of 3 cases in China that showed a novel pattern of movable infiltrates and upper lung micronodules. After treatment, the 3 patients recovered, and lung infiltrates resolved.

Why is tinnitus a problem? A large-scale qualitative evaluation of problems reported by tinnitus patients in mainland China

OBJECTIVES

The lived experience of tinnitus has biopsychosocial characteristics which are influenced by sociocultural factors. The main purpose of this study is to investigate how tinnitus affects people in their everyday life in China. A deductive qualitative analysis examined whether an a priori Western-centric conceptual framework could extend to an Asian context.

DESIGN

A large-scale prospective survey collected patient-reported problems associated with tinnitus in 485 adults attending four major ENT clinics in Eastern and Southern mainland China.

RESULTS

The evidence suggests that patients in China express a narrower range of problem domains associated with the lived experience of tinnitus. While 13 tinnitus-related problem domains were confirmed, culture-specific adaptations included the addition uncomfortable (a novel concept not previously reported), and the potential exclusion of concepts such as intrusiveness, loss of control, loss of peace and loss of sense of self.

CONCLUSIONS

The sociocultural context of patients across China plays an important role in defining the vocabulary used to describe the patient-centred impacts of tinnitus. Possible explanatory factors include cultural differences in the meaning and relevance of certain concepts relating to self and in help-seeking behaviour, low health literacy and a different lexicon in Chinese compared to English to describe tinnitus-related problems.

Longitudinal investigation of factors influencing mental health during centralized quarantine for COVID-19

BACKGROUND

Centralized quarantine was applied in response to the coronavirus disease 2019 outbreak. The present study aimed to investigate changes in psychological status of isolated individuals before and after quarantine.

METHODS

Between August 2020 and July 2021, 648 participants completed the following psychometric evaluations before and after centralized quarantine: 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder for anxiety, the Chinese version of the Connor Davidson Resilience Scale for psychological resilience, the Chinese version of the Simplified Coping Style Questionnaire for coping style, Jiang's revised Chinese version of the Perceived Social Support Scale for social support and the Chinese version of the Impact of Events Scale for stress.

RESULTS

At the beginning of centralized quarantine, 83.2% (n=539) of participants had no depressive mood, 11% (n=71) had mild depressive mood and 5.8% (n=38) had moderate-severe depressive mood. At the end of quarantine, 80.8% (n=524) of participants had no depressive mood, 13% (n=84) had mild depressive mood and 6.2% (n=41) had moderate-severe depressive mood. At the beginning of the centralized quarantine, 86.7% (n=562) of participants had no anxiety, 9.6% (n=62) had mild anxiety and 3.7% (n=24) had moderate-severe anxiety. At the end of quarantine, 85.8% (n=556) of participants had no anxiety, 11.6% (n=75) had mild anxiety and 2.6% (n=17) had moderate-severe anxiety. After 2 weeks of centralized quarantine, anxiety (t=2.175, p<0.05), stress (t=7.453, p<0.01) and three stress subscale scores (p<0.01) decreased significantly; psychology resilience (t=-3.63, p<0.01), tenacity (t=-4.747, p<0.01), active coping style (t=-3.83, p<0.01) and support outside family (t=-3.07, p<0.05) all increased significantly. No significant change was observed in depression, strength, optimism, passive coping style or support inside family. Depression and anxiety scores associated significantly with resilience, stress, coping styles and social support scores. Anxiety (B=0.488, β=0.413, p<0.01), psychological resilience (B=-0.047, β=-0.203, p<0.01) and stress (B=1.475, β=0.167, p<0.1) scores before centralized quarantine were associated with depression after quarantine. Depression (B=0.323, β=0.422, p<0.01), psychological resilience (B=-0.022, β=-0.123, p<0.01) and stress (B=1.408, β=0.207, p<0.01) scores before quarantine also influenced anxiety levels after quarantine. A cross-lagged panel model indicated that depression, anxiety, resilience and stress scores at the first assessment were predictive of depression and anxiety levels at the second assessment.

CONCLUSIONS

Good mental health during centralized quarantine was associated with high scores of psychological resilience, impact of events, coping styles and social support and did not become worse in settings where adequate support was available.

Improving health and reducing health inequality: An innovation of digitalization?

RATIONALE

The association between digitalization and individual health has attracted increasing attention from both scholars and policymakers. Existing research, however, has not agreed on whether digitization can improve health or reduce health inequality.

OBJECTIVE

The purpose of this study is to clarify whether and how the development of digitalization may be related to health and health disparities.

METHODS

We rely on China Family Panel Studies (CFPS) surveys from 2012 to 2018 to obtain a sample of 82,471 observations to explore the impact of digitalization on self-rated health and health inequality and its transmission mechanisms. The hypotheses are tested by Ordinary Least Squares Modeling.

RESULTS

As expected, digitalization is significantly and positively correlated with self-rated health. Furthermore, the development of digitalization has led to a notable decrease in health inequality. The influencing mechanisms of digitalization include income, healthcare consumption and health behaviors. Both dimensions of digitalization-internet development and digital finance-generate significant effects and the effects of internet development are greater.

CONCLUSIONS

This study is the first to systematically investigate the impact of digitalization development on health and health inequality. Our findings provide evidence for the health promotion theory by clarifying the benefits of digitalization in improving residents' health and reducing health inequality. Therefore, utilizing the tools of digitalization efficiently could be a focus of policymakers aiming to accomplish the SDGs' health targets.

Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12-18 in China: a cross-sectional study

The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.

Epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China: a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death. China has the largest population of patients with traumatic spinal cord injury. Previous studies of traumatic spinal cord injury in China have mostly been regional in scope; national-level studies have been rare. To the best of our knowledge, no national-level study of treatment status and economic burden has been performed. This retrospective study aimed to examine the epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China at the national level. We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China. Patient epidemiological and clinical features, treatment status, and total and daily costs were recorded. Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program. The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall (annual percentage change, -0.5% and 2.1%, respectively). A total of 10,053 (74.7%) patients underwent surgery. Only 2.8% of patients who underwent surgery did so within 24 hours of injury. A total of 2005 (14.9%) patients were treated with high-dose (≥ 500 mg) methylprednisolone sodium succinate/methylprednisolone (MPSS/MP); 615 (4.6%) received it within 8 hours. The total cost for acute traumatic spinal cord injury decreased over the study period (-4.7%), while daily cost did not significantly change (1.0% increase). Our findings indicate that public health initiatives should aim at improving hospitals' ability to complete early surgery within 24 hours, which is associated with improved sensorimotor recovery, increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

China's Fossil Fuel CO2 Emissions Estimated Using Surface Observations of Coemitted NO2

Accurate estimates of fossil fuel CO2 (FFCO2) emissions are of great importance for climate prediction and mitigation regulations but remain a significant challenge for accounting methods relying on economic statistics and emission factors. In this study, we employed a regional data assimilation framework to assimilate in situ NO2 observations, allowing us to combine observation-constrained NOx emissions coemitted with FFCO2 and grid-specific CO2-to-NOx emission ratios to infer the daily FFCO2 emissions over China. The estimated national total for 2016 was 11.4 PgCO2·yr-1, with an uncertainty (1σ) of 1.5 PgCO2·yr-1 that accounted for errors associated with atmospheric transport, inversion framework parameters, and CO2-to-NOx emission ratios. Our findings indicated that widely used "bottom-up" emission inventories generally ignore numerous activity level statistics of FFCO2 related to energy industries and power plants in western China, whereas the inventories are significantly overestimated in developed regions and key urban areas owing to exaggerated emission factors and inexact spatial disaggregation. The optimized FFCO2 estimate exhibited more distinct seasonality with a significant increase in emissions in winter. These findings advance our understanding of the spatiotemporal regime of FFCO2 emissions in China.

The development and challenges of public health nursing education in China from 1912 to 1949: A historical study

OBJECTIVE

To examine the development and challenges of public health nursing education in China during the period of the Republic of China (1912-1949).

METHODS

This study utilized a historical research design that combined a social framework and a policy framework to explore the early history of public health nursing education in China. Historical data were collected from periodicals, newspapers, archives, books and other sources.

RESULTS

Public health was integrated into the nursing school curriculum for the first time during the period of the Republic of China, and health facilities and nursing schools conducted early explorations of public health nurse training. However, public health nursing education faced difficulties in terms of the curriculum, personnel training, and the localization of education.

CONCLUSIONS

The achievements and difficulties associated with public health nursing education in China during the period of the Republic of China provide a historical reference for the integration of public health into current basic nursing education and the compatibility between the training of public health nurses and practical needs. Comparative studies of early public health nursing education across countries are expected to offer a better understanding of current public health nursing education.

A survey of skin failure perceptions amongst pressure injury management staff in China: A cross-sectional study

This study sought to evaluate the perceptions of pressure injury (PI) management staff regarding skin failure (SF). Additionally, an analysis of influencing factors based on the collected data was conducted to establish a foundation for targeted SF training. A descriptive, cross-sectional survey was undertaken in October-November 2023, utilising a convenience sampling method involving selected management staff of PI from 16 provinces in China. A total of 501 nursing participants were included, exhibiting an overall perception level that was moderately low. Although the majority were aware of the possibility of SF (n = 417, 83.23%), only 60% reported an understanding of the fundamentals of SF, with the lowest level of comprehension observed in differentiating between SF and PI (n = 212, 42.31%). Overall attitudes were generally positive. Regarding behaviour, active learning was more prevalent (n = 340, 67.86%), but training is less (n = 287, 57.29%). Family education (n = 401, 80.04%) and nursing record monitoring (n = 426, 85.03%) demonstrated better behaviour. Further analysis revealed that training (t = 13.937, p < 0.001) and professional title (F = 4.681, p = 0.010) had a significant effect on participants' perceptions. These findings underscore that there remains a substantial lack of perception about SF amongst participants. Overall, participants exhibited a positive attitude towards SF, highlighting the need for future improvements in SF training.

Construction and evolutionary factors of spatial correlation network of China's provincial tourism resource conversion efficiency

Research objective

To explore the spatial correlation network characteristics and formation mechanisms of tourism resource conversion efficiency, and provide reference for the collaborative improvement of tourism resource conversion efficiency at the provincial level in China.

Research methods

Non parametric SBM efficiency measurement method and social network analysis method. Research hypothesis: The spatial network correlation characteristics of tourism resource conversion efficiency are obvious, and regional connections are close.

Research findings

(i) during the research period, the spatial connection strength of China's tourism resource conversion efficiency continued to increase and the spatial network structure of tourism resource conversion efficiency tended to become more complex and significantly more stable. (ii) A spatially linked network with a stable tourism resource conversion efficiency structure formed in China. The number of network relations and density of the network fluctuated and increased, while the network efficiency continued to decrease; however, a strong small-world nature was observed. (iii) The economic development level difference matrix, tourism industry agglomeration difference matrix, human capital difference matrix, and marketization degree difference matrix significantly and positively affected spatial association relationship establishment, while the provincial adjacency matrix significantly and negatively affected such relationships.

First Report of Dickeya dadantii Causing Potato Blackleg in Fujian Province China

Blackleg and soft rot are harmful diseases in potato (Solanum tuberosum) caused by Pectobacterium spp. and Dickeya spp. (Czajkowski et al. 2015). The occurrence of potato blackleg was serious in potato-producing areas around Xiapu County in Fujian Province, China, in 2021 (6 ha) and 2022 (7 ha), with an incidence of approximately 5%, which reached nearly 23%. Three diseased plants were collected to isolate the pathogen. Single colonies from each sampled plant were isolated and streaked onto fresh plates. DNA from three colonies from different plants was PCR amplified with primer pair 27F/1492R (Lane 1991) for the 16S rRNA gene. Since the sequences were identical, we selected strain M2-3 for further analysis. The strain M2-3 was gram-negative, pectolytic on CVP, grew at 37°C and 5% NaCl. The bacterium was positive for phosphatase activity, erythromycin sensitivity, indole production, gelatin liquefaction, malonic utilization, and acid production from, melibiose, raffinose, and arabinose. The bacterium was negative for sucrose, α-methyl glucoside, sorbitol, trehalose, lactose, and sodium citrate (Fujimoto et al. 2018;),although sucrose and lactose did not provide the expected results, there are exception in all species. The genome of strain M2-3 was sequenced and deposited in the NCBI database under accession numbers: CP077422. An Average Nucleotide Identity (ANI) analysis showed that M2-3 clustered with other D. dadantii strains and has a 98.39% identity with D. dadantii strain DSM 18020 (CP023467). The housekeeping genes (recA, dnaX, acnA, gapA, icd, mdh, mtlD and pgi) were amplified with primer pairs designed previously(Fujimoto et al. 2018; Ma et al. 2007) and sequenced. A multilocus sequence analysis (MLSA) was performed by concatenating the 8 gene sequences and constructing a maximum likelihood phylogenetic tree using PhyloSuite version 1.2.1 (Zhang et al. 2020) and IQ-tree version 1.6.8 (Nguyen et al. 2015) software. Strain M2-3 was clustered together with Dickeya dadantii. For the pathogenicity test, three plants per treatment, totaling nine plants, were used. Bacterial suspensions (1×10^8 CFU/mL) were made in a 10mM PBS buffer. 10 μL of M2-3, D. dadantii type strain 18020 (positive control), and buffer (negative control) were injected into the plant stems near the base. Water stains appeared at the site of inoculation after 2 days and they gradually became black and rotten. The leaves became yellow and wilted, and the petiole base rotted within 5 days of inoculation completing the Koch postulate. According to average nucleotide identity and housekeeping gene sequence analysis, strain M2-3 was identified as Dickeya dadantii. Previous studies have reported several pathogens that cause potato blackleg in China, including P. atrosepticum, P. carotovorum, P. brasiliense, P. parmentieri, P. polaris, and P. punjabense (Li-ping et al. 2020; Wang et al. 2021). To the best of our knowledge, this study is the first to report potato blackleg disease caused by Dickeya dadantii in Fujian Province, China. This finding suggests that this pathogen may cause a threat to potato production in Fujian Province.

How enterprises' public welfare low-carbon behavior affects consumers' green purchase behavior

The Chinese economy has undergone high-speed, high-quality growth, and the concept of low-carbon technology has gained popular support. Businesses and consumers must jointly endeavor to achieve low-carbon economic development. Moreover, it is important to investigate whether enterprises' low-carbon behavior is correlated with consumers' green consumption behavior. We built a theoretical model to depict the relationship between corporate public welfare low-carbon behavior, consumers' green purchase intention, and green purchase behavior. We then divided corporate public welfare low-carbon behavior into three dimensions. We proposed hypotheses, collected data through a questionnaire survey, and analyzed the data using statistical analysis software of SPSS 26.0 and AMOS 24.0. Public welfare low-carbon behavior was significantly correlated with consumers' green purchase intention, and public welfare low-carbon participation and public welfare low-carbon motivation were significantly correlated with green purchase intention. Finally, we proposed suggestions from three perspectives: the public welfare low-carbon mechanism, public welfare low-carbon participation, and public welfare low-carbon motivation. The results provide theoretical support for research methods related to the low-carbon growth of enterprises and green consumption, as well as guidance and decision-making support for enterprises in carrying out cause marketing.

Mapping Blood Lead Levels in China during 1980-2040 with Machine Learning

Lead poisoning is globally concerning, yet limited testing hinders effective interventions in most countries. We aimed to create annual maps of county-specific blood lead levels in China from 1980 to 2040 using a machine learning model. Blood lead data from China were sourced from 1180 surveys published between 1980 and 2022. Additionally, regional statistical figures for 15 natural and socioeconomic variables were obtained or estimated as predictors. A machine learning model, using the random forest algorithm and 2973 generated samples, was created to predict county-specific blood lead levels in China from 1980 to 2040. Geometric mean blood lead levels in children (i.e., age 14 and under) decreased significantly from 104.4 μg/L in 1993 to an anticipated 40.3 μg/L by 2040. The number exceeding 100 μg/L declined dramatically, yet South Central China remains a hotspot. Lead exposure is similar among different groups, but overall adults and adolescents (i.e., age over 14), females, and rural residents exhibit slightly lower exposure compared to that of children, males, and urban residents, respectively. Our predictions indicated that despite the general reduction, one-fourth of Chinese counties rebounded during 2015-2020. This slower decline might be due to emerging lead sources like smelting and coal combustion; however, the primary factor driving the decline should be the reduction of a persistent source, legacy gasoline-derived lead. Our approach innovatively maps lead exposure without comprehensive surveys.

Understanding the effects of flash drought on vegetation photosynthesis and potential drivers over China

Flash droughts characterized by rapid onset and intensification are expected to be a new normal under climate change and potentially affect vegetation photosynthesis and terrestrial carbon sink. However, the effects of flash drought on vegetation photosynthesis and their potential dominant driving factors remain uncertain. Here, we quantify the susceptibility and response magnitude of vegetation photosynthesis to flash drought across different ecosystems (i.e., forest, shrubland, grassland, and cropland) in China based on reanalysis and satellite observations. By employing the extreme gradient boosting model, we also identify the dominant factors that influence these flash drought-photosynthesis relationships. We show that over 51.46 % of ecosystems across China are susceptible to flash drought, and grasslands are substantially suppressed, as reflected in both sensitivity and response magnitude (with median gross primary productivity anomalies of -0.13). We further demonstrate that background climate differences (e.g., mean annual temperature and aridity) predominantly regulate the response variation in forest and shrubland, with hotter/colder or drier ecosystems being more severely suppressed by flash drought. However, in grasslands and croplands, the differential vegetation responses are attributed to the intensity of abnormal hydro-meteorological conditions during flash drought (e.g., vapor pressure deficit (VPD) and temperature anomalies). The effects of flash droughts intensify with increasing VPD and nonmonotonically relate to temperature, with colder or hotter temperatures leading to more severe vegetation loss. Our results identify the vulnerable ecological regions under flash drought and enable a better understanding of vegetation photosynthesis response to climate extremes, which may be useful for developing effective management strategies.

Occurrence, Spatial Distribution, and Bioaccumulation of Dissolved Synthetic Musks in Freshwaters across China

Commercial chemicals, such as synthetic musks, are of global concern, but data on their occurrence and spatial distribution in aquatic environments of large scale are scarce. Two sampling campaigns were conducted in the present study to measure freely dissolved synthetic musks in freshwaters across China using passive samplers, along with biological coexposure at selected sites. Polycyclic musks (PCMs) dominated synthetic musks, with a detection frequency of 95%. Higher concentrations of PCMs were observed in densely populated Mid, East, and South China compared to less populated regions, indicating the significance of anthropogenic activities for synthetic musks in water. The concentration ratios of galaxolide (HHCB)/tonalide (AHTN) were significantly higher in low-latitude areas than in high-latitude areas from June to September, suggesting that solar radiation played an important role in the degradation of HHCB/AHTN. Significant correlations were found between dissolved concentrations of HHCB and AHTN and their lipid-normalized concentrations in coexposed fish and clam. The estimated hazard quotients for HHCB and AHTN in freshwater fish consumed by humans were less than 0.01 at all sampling sites except the Yangtze River Basin. These results help to understand the environmental fate and ecological risks of synthetic musks on a large geographical scale.

The mental workload of ICU nurses performing human-machine tasks and associated factors: A cross-sectional questionnaire survey

AIMS

To assess the level of mental workload (MWL) of intensive care unit (ICU) nurses in performing different human-machine tasks and examine the predictors of the MWL.

DESIGN

A cross-sectional questionnaire study.

METHODS

Between January and February 2021, data were collected from ICU nurses (n = 427) at nine tertiary hospitals selected from five (east, west, south, north, central) regions in China through an electronic questionnaire, including sociodemographic questions, the National Aeronautics and Space Administration Task Load Index, General Self-Efficacy Scale, Difficulty-assessing Index System of Nursing Operation Technique, and System Usability Scale. Descriptive statistics, t-tests, one-way ANOVA and multiple linear regression models were used.

RESULTS

ICU nurses experienced a medium level of MWL (score 52.04 on a scale of 0-100) while performing human-machine tasks. ICU nurses' MWL was notably higher in conducting first aid and life support tasks (using defibrillators or ventilators). Predictors of MWL were task difficulty, system usability, professional title, age, self-efficacy, ICU category, and willingness to study emerging technology actively. Task difficulty and system usability were the strongest predictors of nearly all typical tasks.

CONCLUSION

ICU nurses experience a medium MWL while performing human-machine tasks, but higher mental, temporal, and effort are perceived compared to physical demands. The MWL varied significantly across different human-machine tasks, among which are significantly higher: first aid and life support and information-based human-machine tasks. Task difficulty and system availability are decisive predictors of MWL.

IMPACT

This is the first study to investigate the level of MWL of ICU nurses performing different representative human-machine tasks and to explore its predictors, which provides a reference for future research. These findings suggest that healthcare organizations should pay attention to the MWL of ICU nurses and develop customized management strategies based on task characteristics to maintain a moderate level of MWL, thus enabling ICU nurses to perform human-machine tasks better.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Rural revitalization in China: Measurement indicators, regional differences and dynamic evolution

It is crucial to scientifically assess China's rural revitalization and grasp its evolution laws. This paper constructs an indicator system to measure the level of rural revitalization in China from 2011 to 2021 using the entropy weight method. Then, we explore the spatial and temporal divergence and dynamic evolutionary characteristics of rural revitalization using the Dagum Gini coefficient and Kernel density. We found that the level of rural revitalization in China is low but fluctuating and increasing. Regionally, eastern China scores higher than central, western and northeastern China. In terms of dimensions, ecological livability scores are higher than prosperous industry, effective governance, affluent living and civilized countryside in that order. The regional differences in the level of rural revitalization are mainly reflected between regions, especially between eastern and western China, but the gap between regions is narrowing year by year. And the results of the Kernel density show that the level of rural revitalization in China shows a slow and balanced growth, but the eastern China shows a polarization growth. These findings can provide a comprehensive and objective outline of the advantages and shortcomings of rural revitalization development in China, and provide a policy reference for the comprehensive and stable promotion of rural revitalization construction.

Unmasking the challenges in ideological and political education in China: A thematic review

China's distinctive educational approach, particularly its emphasis on ideological and political education, has garnered considerable academic attention for its impact on shaping individual values, fostering citizenship, and maintaining social stability. Despite the Chinese government's prioritization of ideological and political education, academic research in this field appears constrained, with existing studies predominantly focusing on normative and descriptive aspects. Normative research delineates how ideological and political education should be executed, while descriptive research illustrates its practical implementation. The effectiveness of these approaches is significantly diminished if they are not adequately interconnected-when only the current reality is explained without providing tools for improvement or when prescribed steps for improvement lack a basis in specific contexts. This paper conducts a comprehensive review of research on ideological and political education using ATLAS. ti 9 for thematic analysis. The review aims to unveil the intricate landscape of current research in China and address key questions: What are the primary trends in the literature on ideological and political education between 2021 and July 2023? What challenges does ideological and political education face? Through a direct exploration of these issues, this paper seeks to optimize the ideological and political education system, elevate its adaptability and effectiveness, and open avenues for research, fostering a more dynamic, inclusive, and resilient development of ideological and political education.

Taxonomic resurrection of Saxifraga lancangensis (Saxifragaceae)

BACKGROUND

Accurate species delimitation is fundamental for testing evolutionary theory and provides essential implications for conservation management. The arctic-alpine genus Saxifraga L. (Saxifragaceae) is taxonomically complex and many species have not been critically assessed. The taxonomic and phylogenetic status of Saxifraga lancangensis Y.Y.Qian, considered as a synonym of Saxifraga mengtzeana Engl. & Irmsch. in previous studies, is re-evaluated in light of new evidence presented here.

RESULTS

Evidence from morphological comparison and sequencing of plastid genome indicate that S. lancangensis belongs to Saxifraga sect. Irregulares Haw., and is closely related to Saxifraga geifolia Balf.f., and S. mengtzeana. However, S. lancangensis can be diagnosed by its petals with red and clawless base, leaf blade orbicular and leaf margin shallowly dentate.

CONCLUSIONS

The morphological and molecular evidence support the resurrection of S. lancangensis as a distinct species. An updated morphological description based on protologue and fresh material, diagnostic characters, and original photographs of the resurrected species are presented.

Parental psychological control and children's self-esteem: A longitudinal investigation in children with and without oppositional defiant problems

Oppositional defiant problems are among the most prevalent psychological problems among children and adolescents from China and across the world. Still little is understood about how self-esteem, in conjunction with parenting experiences, develops in children with oppositional defiant problems. We addressed this gap of knowledge in a two-year longitudinal study. Specifically, we explored how parental psychological control predicts children's self-esteem levels over time, and in turn, how children's self-esteem levels predict parental psychological control. We collected data in Chinese children (ages 8 to 13 at T1) with (N = 224) and without (N = 217) oppositional defiant problems, and tested three-wave cross-lagged panel models. Multigroup analyses showed that the associations between parental psychological control and children's self-esteem were the same for children with and without oppositional defiant problems. Results for the total sample revealed bi-directional associations between maternal psychological control and children's self-esteem. Children who perceived more psychological control from their mothers were likely to exhibit lower self-esteem over time, and vice versa, children with lower self-esteem were likely to perceive more maternal psychological control over time. Conversely, a unidirectional paternal effect was observed in father-child dyads. Our findings help understand the parent-child dynamics that shape the psychological development of children with oppositional defiant problems.

Ethnic disparities in the prevalence of diabetes and its association with sleep disorder among older adults in rural southwest China

OBJECTIVES

This study aimed to examine ethnic disparities in the prevalence of diabetes and its association with sleep disorders among the older adults Han and ethnic minority (Bai, Ha Ni, and Dai) population in rural southwest China.

METHODS

A cross-sectional survey of 5,642 was conducted among the rural southwest population aged ≥60 years, consisting of a structured interview and measurement of fasting blood glucose, height, weight, and waist circumference. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality.

RESULTS

The overall prevalence of diabetes and sleep disorder was 10.2% and 40.1%, respectively. Bai participants had the highest prevalence of diabetes (15.9%) and obesity (9.9%)(P < 0.01), while Ha Ni participants had the lowest prevalence of diabetes (5.1%) and obesity (3.4%)(P < 0.01). The highest prevalence of sleep disorder (48.4%) was recorded in Bai participants, while Dai participants had the lowest prevalence of sleep disorder (25.6%)(P < 0.01). In all four studied ethnicities, females had a higher prevalence of sleep disorder than males (P < 0.01), and the prevalence of sleep disorder increased with age (P < 0.01). The results of multivariate logistic regression analysis indicated older adults with sleep disorder had a risk of developing diabetes (P < 0.05). Moreover, the higher educational level, family history of diabetes, and obesity were the main risk factors for diabetes in participants (P < 0.01).

CONCLUSION

There are stark ethnic disparities in the prevalence of diabetes and sleep disorders in southwest China. Future diabetes prevention and control strategies should be tailored to address ethnicity, and improving sleep quality may reduce the prevalence of diabetes.

Isolation and Genomic Characterization of Kadipiro Virus from Mosquitoes in Yunnan, China

Background: Kadipiro virus (KDV) is a species of the new 12 segmented RNA virus grouped under the genus Seadornavirus within the Reoviridae family. It has previously been isolated or detected from mosquito, Odonata, and bat feces in Indonesia, China, and Denmark, respectively. Here, we describe the isolation and characterization of a viral strain from mosquitoes in Yunnan Province, China. Methods: Mosquitoes were collected overnight using light traps in Shizong county, on July 17, 2023. Virus was isolated from the mosquito homogenate and grown using baby hamster kidney and Aedes albopictus (C6/36) cells. Preliminary identification of the virus was performed by agarose gel electrophoresis (AGE). The full-genome sequences of the strain were determined by full-length amplification of cDNAs and sequenced using next-generation sequencing. Results: We isolated a viral strain (SZ_M48) from mosquitoes (Culex tritaeniorhynchus Giles) that caused cytopathogenic effects in C6/36 cells. AGE analysis indicated a genome consisting of 12 segments of double-stranded RNA that demonstrated a "6-5-1" pattern, similar to the migrating bands of KDV. Phylogenetic analysis based on the full-genome sequence revealed that SZ_M48 is more clustered with KDV isolates from Hubei and Shangdong in China than with Indonesian and Danish strains. The identity between SZ_M48 and SDKL1625 (Shandong, China) is slightly lower than that of QTM27331 (Hubei, China), and the identity with JKT-7075 (Indonesia) and 21164-6/M.dau/DK (Denmark) is the lowest. Conclusion: The full-genome sequence of the new KDV strain described in this study may be useful for surveillance of the evolutionary characteristics of KDVs. Moreover, these findings extend the knowledge about the genomic diversity, potential vectors, and the distribution of KDVs in China.

The experiences of Chinese colorectal cancer survivors in marital intimacy after ostomy creation: A qualitative study

Background

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally. The disease and its treatment significantly impact marital intimacy, particularly among individuals who have undergone ostomy creation. Therefore, it is necessary to explore their experiences.

Objective

This study aimed to explore the experiences of colorectal cancer survivors in marital intimacy after ostomy creation and clarify the domain and sub-domain of marital intimacy in CRC survivors with ostomy.

Method

This study used a qualitative descriptive design, and participants were selected by purposive sampling from two hospitals in Henan province, China. Sixteen patients participated in this research, and the data were collected through an in-depth interview from June 27 to September 27, 2023. Colaizzi's method was used to analyze the data.

Results

Five themes emerged from data analysis, including physical intimacy, psychological intimacy, social intimacy, spiritual intimacy, and operational intimacy.

Conclusion

By profiling the experiences of CRC survivors in marital intimacy after ostomy creation, the domain and sub-domain of marital intimacy were clarified in this cohort and revealed that ostomy had a severe effect on marital intimacy among colorectal cancer survivors. The results from this study could be used by nurses, midwives, and other healthcare professionals to design specific interventions covering all aspects of marital intimacy. Also, the findings will guide the development of a particular instrument for marital intimacy in CRC survivors with ostomy.

Mortality Burden of Liver Cancer in China: An Observational Study From 2008 to 2020

Background and Aims

China accounts for nearly half of liver cancer deaths globally. A better understanding of the current liver cancer mortality will be helpful to establishing priorities for intervention and to decreasing the disease burden of liver cancer. The study aimed to explore and predict the mortality burden of liver cancer in China.

Methods

Data were extracted from the Disease Surveillance Point system of the Chinese Center for Disease Control and Prevention from 2008 to 2020. Crude and age-standardized liver cancer mortality rates were reported by sex, urban or rural residence, and region. Trends in liver cancer mortality rates from 2008 to 2020 were estimated as average annual percentage change (AAPC). The changing trend of live cancer mortality in the future is also predicted.

Results

In 2020, the crude mortality of liver cancer was 25.57/100,000, and males and people lived in rural areas had higher age-standardized liver cancer mortality rates than females and people lived in people in urban areas. Crude mortality and age-standardized mortality rates in southwest provinces (Guangxi, Sichuan, Tibet) and in a northeast province (Heilongjiang) were higher than that in other provinces, and age-specific mortality rates increased with age. From 2008 to 2020, liver cancer mortality rates decreased, but people under 50 years of age had a higher AAPC than those over 50 years of age, possibly because of the adoption of hepatitis B virus vaccination in newborns and children. Furthermore, the mortality of liver cancer in 2021-2030 is predicted to have a downward trend.

Conclusions

Liver cancer mortality rates declined in China from 2008 to 2020. Future interventions to control liver cancer mortality need to focus on people of male sex, older age, and living in rural areas or less developed provinces.

Does Participating in New Rural Cooperative Medical Insurance Change Catastrophic Health Expenditure? Evidence from the China Household Income Project

A primary goal of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection against health care costs and alleviate the financial burdens of rural residents in China. This article examines whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above). The analysis utilized data from the 2007 China Household Income Project survey in rural areas and an instrumental variable estimation method in Anhui and Sichuan provinces, which exhibited heterogeneity in the NRCMI implementation schedule. The results show that NRCMI participation was not associated with changes in the CHE incidence among families. The finding is consistent with the prior literature using quasi-experimental study designs. This study provides empirical evidence for policymakers, highlighting that the impact of NRCMI participation on financial protections is limited despite its extensive population coverage. The limited effects are probably due to the low reimbursement rate and increased utilization of expensive health care services.

Understanding the Institutional Logics of China's Community-Based Intervention for Older People

Community-based policies have gained global popularity, signaling a paradigm shift from individual responsibility for healthy aging to an approach involving community-based intervention. Learning from Western experience, China has also experimented with this form of intervention. It has policy interventions aimed at providing community-based facilities and services that enable older people to age in place. However, the institutional foundations of Chinese communities differ greatly from those in Western countries. Implementing a critical realist case study focusing on a community-based program in Beijing, this study aims to examine the institutional logics that contribute toward a contextually appropriate community-based policy intervention in China. We identified three institutional logics. First, the Confucian moral obligation of benevolence requires authorities to provide social welfare for vulnerable citizens. Second, China's community-based interventions are state-led territorialized provisions prioritizing communities rather than individuals. Third, community-based social policies are subordinate to economic growth objectives. This study contributes to the understanding of contextually appropriate community-based policy interventions in China.

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990-2017

BACKGROUND

The United Nations (UN) Sustainable Development Goal - 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990-2017.

METHODS

We obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR.

RESULTS

First, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was - 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR.

CONCLUSION

The decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.

Compliance and alternative behaviors of heavy gamers in adolescents to Chinese online gaming restriction policy

Background and aims

In 2021, China implemented a policy to prevent adolescents from excessive online gaming, with the goal of encouraging healthier leisure activities.

Methods

Three months after this policy was implemented, we conducted a study involving 430 Chinese adolescents who regularly played online games for over two hours daily before the policy. We collected their responses to the restriction, including their compliance with the policy, engagement in undesirable alternative behaviors (e.g., watching short videos), and engagement in desirable alternative behaviors (e.g., playing sports). We also collected data on individual factors, parental technology interference, and feelings of restriction to use as predictors for behaviors, including those related to violating the restriction or watching short videos.

Results

A small percentage of heavy gamers violated the restriction by renting others' game accounts (3%) or using a family member's identity (14%), while 59% of the sample shifted to watching short videos. Heavy gamers who lived in rural areas, spent more time on online games prior to the policy, did not feel restricted from playing online games, and experienced parental technology interference were more likely to violate the restriction. Females or those lacking stable hobbies were more inclined to watch short videos.

Conclusions

Although the policy restricted heavy gaming, it has also led to increased short video use. Policymakers could explore alternative approaches, such as developing infrastructure that supports outdoor leisure activities in rural areas, encouraging parents to model responsible technology use behaviors, and guiding adolescents to cultivate positive hobbies in their leisure time.

What's good for the gander is even better for the goose: Women buying commercial sex in China

Research about the commercial sex industry rarely examines the women who are the clients purchasing sexual services. Examining how this challenges gender stereotypes through the undoing gender framework reveals how gender norms can be reshaped through contextual changes. Based on 3 years of ethnographic data from a high-end bar in Tianjin, interviews with 27 female clients and 47 MSWs paint a complex picture of how some women adopted ungendered strategies regarding sexuality. As women take control of their own sexual behavior, they free themselves of some traditional societal expectations about their identity. Primarily motivated by pleasure and control, purchasing sex becomes a means for women to experience empowerment and self-confidence by breaking with traditional gender norms and expectations. Undoing gender involves expanding gendered repertoires, with women finding empowerment in adopting a masculine model of sexuality. However, social stigma and personal efficacy indicate that gender deconstruction is a gradual process. The research contributes to understanding complex gender dynamics and sexual behaviors within commercial sex transactions, shedding light on societal norms and individual agency.

Early change of retinal nerve fiber layer in children with type 1 diabetes mellitus in northern China

OBJECTIVES

This study aimed to identify discrepancies in the retinal nerve fiber layer (RNFL) between type 1 diabetes mellitus (T1DM) children without retinopathy and healthy subjects in northern China.

METHODS

This was a cross-sectional hospital-based study carried out from Jan 2019 until Jul 2021 at the department of pediatrics in Tianjin medical university general hospital. Children with T1DM but no retinal disease were screened. RNFL thickness was obtained via spectral domain optical coherence tomography. Disease duration, HbA1c, 25-hydroxyvitamin D level, insulin regimen, and diet control status were also collected.

RESULTS

A total of 20 children with T1DM and 20 matched health participants were enrolled. The mean age in the T1DM group was 10.3 ± 2.8 years, and the median duration of diabetes was 1 (range 1-3) year. Children with T1DM had thinner average RNFL than control subjects (105 ± 6 vs. 110 ± 11 μm, p=0.008), especially in temporal and nasal parts. There was a significant negative association between HbA1c levels and the RNFL thickness in the T1DM group (B (95 % confidence interval): -4.313 (-7.055 to -1.571); p=0.005).

CONCLUSIONS

In our study, the decreased thickness of RNFL was negatively associated with elevated HbA1c in children with early stages of T1DM.

Access to innovative anticancer medicines in China: a national survey on availability, price and affordability

OBJECTIVES

This study aimed to investigate the availability, price, and affordability of nationally negotiated innovative anticancer medicines in China.

DESIGN

Retrospective observational study based on data from a nationwide medical database.

DATA SOURCES/SETTING

Quarterly data about the use of innovative anticancer medicines from 2020 to 2022 were collected from the Chinese Medicine Economic Information Network. This study covered 895 public general hospitals in 30 provincial administrative regions in China. Of the total hospitals, 299 (33.41%) were secondary and 596 (66.59%) were tertiary.

MAIN OUTCOME MEASURES

The adjusted WHO and Health Action International methodology was used to calculate the availability and affordability of 33 nationally negotiated innovative anticancer medicines in the investigated hospitals. Price is expressed as the defined daily dose cost.

RESULTS

On average, the total availability of 33 innovative anticancer medicines increased annually from 2020 to 2022. The median availability of all investigated medicines in tertiary hospitals from 2020 to 2022 was 24.04%, 33.60% and 37.61%, respectively, while the indicators in secondary hospitals were 4.90%, 12.54% and 16.48%, respectively. The adjusted prices of the medicines newly put in Medicare (in March 2021) decreased noticeably, with the decline rate ranging from 39.98% to 82.45% in 2021 compared with those in 2020. Most generic brands were priced much lower than the originator brands. The affordability of anticancer medicines has improved year by year from 2020 to 2022. In comparison, rural residents had lower affordability than urban residents.

CONCLUSIONS

The overall accessibility of 33 nationally negotiated innovative anticancer medicines improved from 2020 to 2022. However, the overall availability of most anticancer medicines in China remained at a low level (less than 50%). Further efforts should be made to sufficiently and equally benefit patients with cancer.