Contribution of Particulates to Airborne Disease Transmission and Severity: A Review

The emergence of coronavirus disease 2019 (COVID-19) has catalyzed great interest in the spread of airborne pathogens. Airborne infectious diseases are classified into viral, bacterial, and fungal infections. Environmental factors can elevate their transmission and lethality. Air pollution has been reported as the leading environmental cause of disease and premature death worldwide. Notably, ambient particulates of various components and sizes are harmful pollutants. There are two prominent health effects of particles in the atmosphere: (1) particulate matter (PM) penetrates the respiratory tract and adversely affects health, such as heart and respiratory diseases; and (2) bioaerosols of particles act as a medium for the spread of pathogens in the air. Particulates contribute to the occurrence of infectious diseases by increasing vulnerability to infection through inhalation and spreading disease through interactions with airborne pathogens. Here, we focus on the synergistic effects of airborne particulates on infectious disease. We outline the concepts and characteristics of bioaerosols, from their generation to transformation and circulation on Earth. Considering that microorganisms coexist with other particulates as bioaerosols, we investigate studies examining respiratory infections associated with airborne PM. Furthermore, we discuss four factors (meteorological, biological, physical, and chemical) that may impact the influence of PM on the survival of contagious pathogens in the atmosphere. Our review highlights the significant role of particulates in supporting the transmission of infectious aerosols and emphasizes the need for further research in this area.

Predicting delirium and the effects of medications in hospitalized COVID-19 patients using machine learning: A retrospective study within the Korean Multidisciplinary Cohort for Delirium Prevention (KoMCoDe)

Objective

Delirium is commonly reported from the inpatients with Coronavirus disease 2019 (COVID-19) infection. As delirium is closely associated with adverse clinical outcomes, prediction and prevention of delirium is critical. We developed a machine learning (ML) model to predict delirium in hospitalized patients with COVID-19 and to identify modifiable factors to prevent delirium.

Methods

The data set (n = 878) from four medical centers was constructed. Total of 78 predictors were included such as demographic characteristics, vital signs, laboratory results and medication, and the primary outcome was delirium occurrence during hospitalization. For analysis, the extreme gradient boosting (XGBoost) algorithm was applied, and the most influential factors were selected by recursive feature elimination. Among the indicators of performance for ML model, the area under the curve of the receiver operating characteristic (AUROC) curve was selected as the evaluation metric.

Results

Regarding the performance of developed delirium prediction model, the accuracy, precision, recall, F1 score, and the AUROC were calculated (0.944, 0.581, 0.421, 0.485, 0.873, respectively). The influential factors of delirium in this model included were mechanical ventilation, medication (antipsychotics, sedatives, ambroxol, piperacillin/tazobactam, acetaminophen, ceftriaxone, and propacetamol), and sodium ion concentration (all p < 0.05).

Conclusions

We developed and internally validated an ML model to predict delirium in COVID-19 inpatients. The model identified modifiable factors associated with the development of delirium and could be clinically useful for the prediction and prevention of delirium in COVID-19 inpatients.

Factors Shaping Medical Students' Intentions Toward Neurosurgery: A Cross-Sectional Study

Background Choosing a medical specialty poses a significant challenge for students, with initial fascinations often evolving during their academic journey. Despite its inherent appeal, neurosurgery faces hesitancy among undergraduate students, potentially due to perceived difficulties and time demands. This study aims to investigate the factors influencing medical students' intentions toward neurosurgery at two institutions in the eastern province of Saudi Arabia. Methodology A cross-sectional study design was employed, utilizing a validated, anonymous questionnaire distributed electronically to medical students and interns in the eastern province of Saudi Arabia. The questionnaire comprised two sections, namely, demographic and academic profiles, and participants' intentions, knowledge, and attitudes toward neurosurgery. Data analysis involved descriptive statistics, and chi-square tests to explore relationships and identify significant predictors. Results Of the participants, 197 (34.1%) expressed interest in neurosurgery, but only 94 (16.3%) had a comprehensive understanding of the field. Motivations included high income, specialty prestige, and positive impact on patients, while stress and work-life balance were common deterring factors. Age and academic years were associated with a gradual decrease in interest, except for initial medical school students. Participants were attracted to innovative technological aspects, while high competition and neurophobia were deterring factors. Conclusions This study provides a comprehensive analysis of determinants influencing medical students' and interns' interest in neurosurgery. Early exposure, clinical training, and personal motivations play significant roles in shaping career preferences. Challenges, such as perceived difficulties and concerns related to work-life balance, need targeted interventions to enhance neurosurgery's attractiveness. Considerations extend beyond technical and academic facets to encompass personal and lifestyle dimensions.

Understanding cross-data dynamics of individual and social/environmental factors through a public health lens: explainable machine learning approaches

Introduction

The rising prevalence of obesity has become a public health concern, requiring efficient and comprehensive prevention strategies.

Methods

This study innovatively investigated the combined influence of individual and social/environmental factors on obesity within the urban landscape of Seoul, by employing advanced machine learning approaches. We collected 'Community Health Surveys' and credit card usage data to represent individual factors. In parallel, we utilized 'Seoul Open Data' to encapsulate social/environmental factors contributing to obesity. A Random Forest model was used to predict obesity based on individual factors. The model was further subjected to Shapley Additive Explanations (SHAP) algorithms to determine each factor's relative importance in obesity prediction. For social/environmental factors, we used the Geographically Weighted Least Absolute Shrinkage and Selection Operator (GWLASSO) to calculate the regression coefficients.

Results

The Random Forest model predicted obesity with an accuracy of >90%. The SHAP revealed diverse influential individual obesity-related factors in each Gu district, although 'self-awareness of obesity', 'weight control experience', and 'high blood pressure experience' were among the top five influential factors across all Gu districts. The GWLASSO indicated variations in regression coefficients between social/environmental factors across different districts.

Conclusion

Our findings provide valuable insights for designing targeted obesity prevention programs that integrate different individual and social/environmental factors within the context of urban design, even within the same city. This study enhances the efficient development and application of explainable machine learning in devising urban health strategies. We recommend that each autonomous district consider these differential influential factors in designing their budget plans to tackle obesity effectively.

Factors associated with lymphedema self-management behaviours among breast cancer survivors: A cross-sectional study

AIMS AND OBJECTIVES

The purpose of this empirical study was to explore the current status and associated factors of lymphedema self-management behaviours among Chinese breast cancer survivors.

BACKGROUND

Breast cancer-related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self-management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self-management behaviours can help to develop targeted intervention programs.

DESIGN

A multicentre cross-sectional study.

METHODS

From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self-reported questionnaires were used to measure socio-demographic characteristics, disease-and treatment-related characteristics, lymphedema self-management behaviours, lymphedema knowledge, illness perception, self-efficacy, self-regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist.

RESULTS

Breast cancer survivors reported moderate level of lymphedema self-management behaviours. Promotion of lymph reflux management was ranked the least performed self-management behaviours, while the affected limb protection management ranked the most. 36.2% of self-management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self-efficacy, emotional illness representation and social support.

CONCLUSIONS

Lymphedema self-management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self-management varied with different socio-demographic characteristics, along with different levels of knowledge, self-efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self-management behaviours.

RELEVANCE TO CLINICAL PRACTICE

This study addressed that breast cancer survivors' lymphedema self-management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self-management performance and adherence.

An Age-Stratified Cross-Sectional Study of Physical Activity and Exercise Adherence of Stroke Survivors in Rural Regions

Objective

To describe the Physical Activity and Exercise (PAE) adherence of stroke survivors in rural regions, additionally, to analyze the influential factors through age stratification.

Methods

This is a cross-sectional study. Totally, 596 stroke patients (65.70±10.76 years) from three rural regions were selected, PAE scale was used for measuring compliance. The influential factors among different age groups were explored separately. This study adheres to the EQUATOR checklist, SROBE.

Results

Only 17.8% (106) of participants regularly participated in PAE. Altogether, 42.45% were classified as a young-middle age group, and the rest 57.55% were in the old age group. Positive attitudes and better PAE-relevant knowledge were protective factors for adherence in the young and middle-aged group (OR=0.683; 95% CI 0.173~0.588 and OR=0.939; 95% CI 0.013~0.114), as well as in the old group (OR=0.704; 95% CI 0.193~0.534 and OR=0.929; 95% CI 0.035~0.118); having no home rehabilitation equipment was a strong risk factor for younger patients (OR=16.078; 95% CI 1.235~4.320); however, without hemiplegia can positively affect their adherence (OR=0.891; 95% CI 0.045~0.229). In addition, the presence of a spouse can lead to a better compliance among old patients (OR=0.436; 95% CI -0.496~-0.165).

Conclusion

It is necessary to improve the knowledge of physical activity in rural stroke patients of all ages. It is of great significance to install home rehabilitation equipment to promote exercise for young and middle-aged stroke patients. While for the old stroke patients, we strongly suggest focusing on the role of spouses, which would be more useful in low-income regions.

A study of factors influencing long-term glycemic variability in patients with type 2 diabetes: a structural equation modeling approach

Aim

The present study aims to utilize structural equation modeling (SEM) to investigate the factors impacting long-term glycemic variability among patients afflicted with type 2 diabetes.

Method

The present investigation is a retrospective cohort study that involved the collection of data on patients with type 2 diabetes mellitus who received care at a hospital located in Chengdu, Sichuan Province, over a period spanning from January 1, 2013, to October 30, 2022. Inclusion criteria required patients to have had at least three laboratory test results available. Pertinent patient-related information encompassing general demographic characteristics and biochemical indicators was gathered. Variability in the dataset was defined by standard deviation (SD) and coefficient of variation (CV), with glycosylated hemoglobin variation also considering variability score (HVS). Linear regression analysis was employed to establish the structural equation models for statistically significant influences on long-term glycemic variability. Structural equation modeling was employed to analyze effects and pathways.

Results

Diabetes outpatient special disease management, uric acid variability, mean triglyceride levels, mean total cholesterol levels, total cholesterol variability, LDL variability, baseline glycated hemoglobin, and recent glycated hemoglobin were identified as significant factors influencing long-term glycemic variability. The overall fit of the structural equation model was found to be satisfactory and it was able to capture the relationship between outpatient special disease management, biochemical indicators, and glycated hemoglobin variability. According to the total effect statistics, baseline glycated hemoglobin and total cholesterol levels exhibited the strongest impact on glycated hemoglobin variability.

Conclusion

The factors that have a significant impact on the variation of glycosylated hemoglobin include glycosylated hemoglobin itself, lipids, uric acid, and outpatient special disease management for diabetes. The identification and management of these associated factors can potentially mitigate long-term glycemic variability, thereby delaying the onset of complications and enhancing patients' quality of life.

Age-specific differences in hypertension combination management and associated factors influencing treatment choice

The current hypertension guideline emphasizes combination therapy, especially single-pill combination therapy (SPC). However, few studies compared the prevalence and factors associated with initial therapy choice across heterogeneous age groups in a current population. First, the authors consecutively identified 964 treatment naïve hypertensive patients in a large academic hospital from 01/31/2019 to 01/31/2020. All patients were grouped into (1) young aged, age < 55; (2) middle-aged, 55≤age < 65; and (3) older aged, age ≥65. The multivariable regression model examined the factors associated with the combination therapy by age group. Overall, 80 (8.3%) were young, 191 (19.8%) were middle, and 693 (71.9%) were older aged. Compared with older age, younger patients were more likely to be male, highly educated, regularly exercised, have metabolic syndrome, and less likely to have cardiovascular-related comorbidities, with a lower systolic but higher diastolic pressure. Only one in five patients used SPC, and the prevalence decreased with age. Besides hypertension grade, young patients without catheterization or echo test were less likely to receive multiple therapies, while older patients who were male with lower weight and lower risk levels were less likely to receive multiple therapies. In conclusion, combination therapy, especially SPC, was underused in the targeted hypertensive population. Our contemporary population study showed that young patients (<55) without a history of catheterization or echo examination and male older-aged (≥65) patients with low-risk classification were the population most likely to be neglected. Such information can help triage medical care resources in improving SPC use.

User Compliance With the Health Emergency and Disaster Management System: Systematic Literature Review

BACKGROUND

Health-related hazards have a detrimental impact on society. The health emergency and disaster management system (Health EDMS), such as a contact-tracing application, is used to respond to and cope with health-related hazards. User compliance with Health EDMS warnings is key to its success. However, it was reported that user compliance with such a system remains low.

OBJECTIVE

Through a systematic literature review, this study aims to identify the theories and corresponding factors that explain user compliance with the warning message provided by Health EDMS.

METHODS

The systematic literature review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. The search was performed using the online databases Scopus, ScienceDirect, ProQuest, IEEE, and PubMed, for English journal papers published between January 2000 and February 2022.

RESULTS

A total of 14 papers were selected for the review based on our inclusion and exclusion criteria. Previous research adopted 6 theories when examining user compliance, and central to the research was Health EDMS. To better understand Health EDMS, based on the literature reviewed, we mapped the activities and features of Health EDMS with the key stakeholders involved. We identified features that require involvement from individual users, which are surveillance and monitoring features and medical care and logistic assistance features. We then proposed a framework showing the individual, technological, and social influencing factors of the use of these features, which in turn affects compliance with the warning message from Health EDMS.

CONCLUSIONS

Research on the Health EDMS topic increased rapidly in 2021 due to the COVID-19 pandemic. An in-depth understanding of Health EDMS and user compliance before designing the system is essential for governments and developers to increase the effectiveness of Health EDMS. Through a systematic literature review, this study proposed a research framework and identified research gaps for future research on this topic.

The oral manifestations and related mechanisms of COVID-19 caused by SARS-CoV-2 infection

Coronavirus disease 2019 (COVID-19) was reported to be associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and patients present mostly with respiratory symptoms. There have been an increasing number of reports on oral manifestations, and some of these signs are informative in terms of identifying SARS-CoV-2 infection. The goal of present study was to review and synthesize the clinical characteristics and underlying mechanisms of COVID-19 oral manifestations, as well as to evaluate the factors influencing SARS-CoV-2 infectivity, in order to conduct further in-depth investigations and help clinicians diagnose COVID-19 patients exhibiting oral symptoms.

A Systematic Review on Modeling Methods and Influential Factors for Mapping Dengue-Related Risk in Urban Settings

Dengue fever is an acute mosquito-borne disease that mostly spreads within urban or semi-urban areas in warm climate zones. The dengue-related risk map is one of the most practical tools for executing effective control policies, breaking the transmission chain, and preventing disease outbreaks. Mapping risk at a small scale, such as at an urban level, can demonstrate the spatial heterogeneities in complicated built environments. This review aims to summarize state-of-the-art modeling methods and influential factors in mapping dengue fever risk in urban settings. Data were manually extracted from five major academic search databases following a set of querying and selection criteria, and a total of 28 studies were analyzed. Twenty of the selected papers investigated the spatial pattern of dengue risk by epidemic data, whereas the remaining eight papers developed an entomological risk map as a proxy for potential dengue burden in cities or agglomerated urban regions. The key findings included: (1) Big data sources and emerging data-mining techniques are innovatively employed for detecting hot spots of dengue-related burden in the urban context; (2) Bayesian approaches and machine learning algorithms have become more popular as spatial modeling tools for predicting the distribution of dengue incidence and mosquito presence; (3) Climatic and built environmental variables are the most common factors in making predictions, though the effects of these factors vary with the mosquito species; (4) Socio-economic data may be a better representation of the huge heterogeneity of risk or vulnerability spatial distribution on an urban scale. In conclusion, for spatially assessing dengue-related risk in an urban context, data availability and the purpose for mapping determine the analytical approaches and modeling methods used. To enhance the reliabilities of predictive models, sufficient data about dengue serotyping, socio-economic status, and spatial connectivity may be more important for mapping dengue-related risk in urban settings for future studies.

Rural residents' willingness to participate in basic medical insurance and influential factors: A survey of three provinces in China

Background

Rural residents' participation in medical insurance has a significant relationship to the affordability of their medical care. This study aims to investigate the willingness of rural residents to participate in basic medical insurance for urban and rural residents and its determinants so as to enhance their willingness to participate in medical insurance.

Methods

Data were obtained from 1,077 validated questionnaires from rural residents. Chi-square test and multiple logistic regression analysis were adopted to analyze determinants of rural residents' willingness to participate in basic medical insurance for urban and rural residents.

Results

94.3% of respondents were willing to participate in basic medical insurance for urban and rural residents and this was associated with the familiarity with the medical insurance policies [OR = 2.136, 95% CI (1.143, 3.989)], the reasonability of medical insurance premiums [OR = 2.326, 95% CI (0.998, 5.418)], the normality of doctors' treatment behavior [OR = 3.245, 95% CI (1.339, 7.867)] and the medical insurance's effectiveness in reducing the economic burden of disease [OR = 5.630, 95% CI (2.861, 11.079)].

Conclusion

Even though most respondents were willing to participate in basic medical insurance for urban and rural residents, some aspects need to be improved. The focus should be on promoting and regulating the behavior of medical staff. Financing policies and reimbursement of treatment costs need to be more scientifically developed. A comprehensive basic healthcare system needs to be optimized around the core function of "hedging financial risks".

Factors that influence genetic counselors' participation in research

Genetic counselors have skills and expertise in genetics and patient care that make them an asset to research and research teams. However, the National Society of Genetic Counselors (NSGC) found in 2020 that more than half of practicing genetic counselors do not participate in research activities. Information describing factors that influence their research participation is lacking in the literature. This study ascertained genetic counselors' workplace and graduate training experiences to provide insight into factors that increase or decrease participation in research activities. A survey was distributed through the NSGC Student Research Survey Program. Practicing genetic counselors that graduated in or before 2020 were eligible to participate. The survey included questions about demographics, implementation of student research projects, research-specific resources in their graduate programs, perceived barriers and motivations, and current research activities. Interestingly, the majority of respondents participated in research activities between 2017 and 2021; the most common activities included: recognizing a gap(s) in knowledge (68%) and presenting an abstract or poster (64%). Factors that most significantly influenced genetic counselors' research participation included their interest in research (p = 0.0037), their motivation to do research (p = 0.0014), and their perceived intimidation by the research process (p < 0.001). These results provide insight into solutions for the workplace and graduate programs that could increase genetic counselors' research participation.

Quantification and influencing factors of perioperative hidden blood loss in patients undergoing laparoscopic ovarian cystectomy for benign ovarian tumours

This retrospective, monocentric study quantified hidden blood loss (HBL) and investigated its influencing factors in benign ovarian tumour patients undergoing laparoscopic ovarian cystectomy. Data from 153 patients who underwent laparoscopic ovarian cystectomy were retrospectively reviewed. HBL was calculated using the formula derived from 'Nadler' and 'Cross'. Pearson correlation was carried out to measure the association between HBL and potential risk factors. The average HBL was 280.22 ± 168.42 mL, accounting for 84.13 ± 19.20% of total blood loss (TBL) (347.48 ± 179.05 mL), which was a change of almost fourteen-fold relative to median visible blood loss [20.00 mL (10.00 mL, 57.5 mL)]. Surgical time, number of excisional tumours and preoperative albumin values were risk factors for HBL. HBL represents a large proportion more than 80% of TBL in patients undergoing laparoscopic ovarian cystectomy. Collectively, HBL is helpful for estimating intraoperative blood loss and better guidance of haemostatic agents, which reduces postoperative complications and expedites postoperative recovery. Additionally, the estimation of HBL also contributes to the summary, reflection and improvement of surgical technique.IMPACT STATEMENTWhat is already known on this subject? There has been a growing number of surgical patients with perioperative anaemia, which appears to be inconsistent with measured levels of visible intraoperative blood loss and postoperative drainage. This substantial but easily underestimated blood loss is known as hidden blood loss. To date, no published articles have evaluated HBL and its related risk factors in benign ovarian tumour patients undergoing laparoscopic ovarian cystectomy.What the results of this study add? HBL accounts for a large amount of TBL in laparoscopy for benign ovarian tumours. Surgical time, number of excisional tumours and preoperative albumin values are risk factors for HBL.What the implications are of these findings for clinical practice and/or further research? The management of HBL is important for the administration of perioperative blooding loss. In this context, HBL can be applied to estimate intraoperative blood loss and be better guidance of haemostatic agents to reduce postoperative complications and hasten postoperative rehabilitation. Additionally, the estimation of HBL also contributes to the summary, reflection and improvement of surgical technique.

Impact of public health education on the health status of the older migrant population

Background

Due to an increasing aging population, China has experienced a rapid expansion in its internal older migrant population who face greater health risks and who have a relatively high demand for health education. Public health education is an important means of preventing diseases and promoting health. However, many studies have focused on the utilization, with few studies examining the impact of public health education on the health of the older migrant population in China.

Objectives

This study analyzed the impact of public health education on the health of the older migrant population in China.

Methods

Based on data obtained from the National Migrant Population Health and Family Planning Dynamic Monitor Survey (2018), logistic models and propensity score matching were used to analyze the impact of public health education on the health of the older migrant population.

Results

The self-assessed health of China's older migrant population was good, and the acceptance rate of public health education was 40.81%. The public health status of the older migrant population receiving public health education significantly improved (p < 0.05). After correcting for endogeneity among the variables, public health education increased the probability of improving the older migrant population's self-assessed health by 5.4-6.1% (p < 0.01). Heterogeneity analysis found that public health education had a greater impact on the health of older men with an education level of middle school and below, and especially on the older migrant population in the eastern region of China.

Conclusions

Public health education positively affected the health status of the older migrant population. The characteristics and preferences of the older migrant population involving different genders, regions, and educational levels need to be considered, public health education needs to be standardized, and appropriate education methods need to be adopted that suit the older migrant population. Reference suggestions are provided for improving the health level of the older migrant population.

Classification of the loosening zones and estimation of the loosening pressures of tunnels in layered jointed rock strata

Due to the complexity of tunnels, accurate prediction of their loosening pressures in layered jointed rock strata is a very difficult engineering task. To recognize loosening patterns and estimate loosening pressures, numerical tests were employed in areas where tunnels were excavated in layered jointed rock strata. A total of 12 influential factors, including joints, tunnel depth, and strata, were considered in each of the numerical models. Three loosening patterns were found in the numerical testing: a ringent trumpet-shaped boundary, an arch-shaped boundary, and a closing-trend trumpet-shaped loosening zone. Empirical expressions for the loosening zone boundaries were further established and, in the form of the 12 influential factors, considered in the simulation. Given the boundary function, the loosening pressures were further deduced, which were categorized according to loosening pattern, i.e., ringent trumpet shape or arch shape, and the excavation condition of whether or not the embedded depth was deeper than the soft layer. Two case studies were used to test this method. The newly-proposed method was found to perform better than existing methods, with loosening pressure values that were slightly larger than, but very close to, actual measured field data.

Supervision behaviours of customs supervisors on solid waste import in Shanghai, People's Republic of China

Waste management is a key challenge the world currently faces. Solid waste imports (SWIs) are counteractive to the construction of ecological civilization. The comprehensive prohibition of "foreign waste" (FW) imports (FWIs) is an iconic measure to promote ecological civilization and ecological environment safety. Strengthening the People's Republic of China (PRC)'s supervision of SWI (SSWIs) is an important means of implementing the comprehensive prohibition of FWIs, while existing research has paid little attention to the behaviour of SSWIs. This paper firstly analyses the influential factors of the behaviour of SSWIs based on the theory of planned behaviour (TPB), and five corresponding research hypotheses are put forward accordingly. Then, it uses 262 micro questionnaires regarding the behaviour of SSWIs in the Port of Waigaoqiao in Shanghai, PRC, and constructs a structural equation model based on the TPB to identify the influential factors and effects of the behaviour of SSWIs. Some interesting findings are observed in this research. Firstly, it indicates that attitude, subjective norms (SNs) and perceived behavioural control (PBC), all indirectly act upon supervision behaviour by influencing supervision intention. Secondly, PBC acts directly on the behaviour of SSWIs, which is consistent with the TPB. Thirdly, the direct effects on supervision intention from strongest to weakest are SNs, attitude, and PBC, respectively. The conclusion provides important policy enlightenment for the supervision optimization of the behaviour of SSWIs. The supervision intention can be motivated from various angles by strengthening the attitude, SNs and PBC of customs supervisors, subsequently strengthening their supervision intention and behaviour.

[Snacking behaviors of Chinese female adults aged 18 to 49 years old in 2004-2015]

OBJECTIVE

To describe shift in snacking behavior among Chinese female adults aged 18 to 49 years old in 2004-2015, and to analyze the contribution of snacks to energy and nutrients among them.

METHODS

The present study used data from "China Health and Nutrition Health" where a multistage stratified cluster design was employed to select a stratified probability sample. A total of 12 523 female participants aged 18-49 years old who participated in surveys conducted in 2004-2015 with completed data of demographic characteristics and dietary measurementswere selectedas subjects. There were 2376, 2149, 2142, 2844 and 3012 subjects in waves of 2004, 2006, 2009, 2011, and 2015, respectively. Multivariate Logistic regression model was used to analyze the relationship between socioeconomic factors and snack consumption. Generalized linear model was used to analyze the energy and nutrient intake of snack consumers and non-snack consumers, as well as the contribution of snacks to energy and nutrients.

RESULTS

The consumption rate of snacking for women aged 18 to 49 years old had an increasing trend over time(P&lt;0.05), and the rate was 14.24% in 2015, 3.5 times as high as that in 2004. Participants aged 18 to 29 years old whose snake consumption rates were relatively higher compared to those of other aged groups in general waves; also, female adults from the higher education group, the higher yearly income group, and the higher urbanicity index group, and those with the history of smoking or the alcohol use tended to consumed snacks. The change of the influential factors in relation to the consumption of the participant&apos;s snack was observed, and age, income level, education level, living area, and the behavior of smoking and drinking were all important factors of snacking. The daily energy and nutrient intake of female snack consumers aged 18 to 49 years old was higher than that of non-snack consumers. The contribution rate of snacks to energy and nutrients varies significantly between survey years; and the contribution of snacks to energy and main nutrients was more than 20% in 2011.

CONCLUSION

Snacks have become an important part of the diet of Chinese women aged 18 to 49 years old. Future health promotion programs should be targeted on nutrition education and intervention to guide a reasonable diet structure.

Analysis of the factors influencing parents' support for child safety seat legislation in Nanjing

OBJECTIVE

Although the use of child safety seats can effectively ensure the safety of children in cars, the utilization rate of such seats in China is still low (<5%, 2021). Therefore, it is urgent to promote the use of child safety seats. The goal of this study was to examine the factors affecting parents' support for child safety seat legislation.

METHODS

Data were collected via 1200 questionnaires distributed in several community hospitals in Nanjing. We used the data to do a multivariate logistic regression analysis to find the influencing factors of parental support for child safety seat legislation.

RESULTS

On the whole, the respondents had low support for legislation mandating the installation of child safety seats. Although only 5.83% of the respondents expressed opposition to the relevant legislation, more than 40% expressed a neutral attitude rather than a supportive attitude. Multinomial logistic regression analyses revealed that gender, monthly household income, educational level, number of children in the family, comprehension of child safety seat-related publicity information, and cognition of children's riding safety significantly affected parents' support for child safety seat legislation. In addition to gender and cognition of children's riding safety, other influential factors had significant positive impacts on legislative support for compulsory installation of child safety seats.

CONCLUSION

These results have implications for making more effective recommendations to advance child safety seat legislation and keep child passengers safe.

[Concentration of osteopontin in human milk and associated factors in Chinese populations from 2011 to 2013]

OBJECTIVE

To analyze content of human milk osteopontin(OPN) and to explore associated factors in Chinese populations.

METHODS

The samples and data were extracted from the database for human milk composition in China between 2011 and 2013. A sub-sample of 459 mothers was randomly selected after stratification according to lactation stage, and human milk OPN concentrations were determined by ultra performance liquid chromatography-tandem mass spectrometer(UPLC/MS).

RESULTS

The average OPN concentration(M(P25, P75)) in breast milk was 44.0(30.1-72.0) mg/L within 0-330 days postpartum. OPN concentrations were independent of lactation stage, which were 45.6(31.8, 80.7) mg/L in colostrum, 41.3(29.2, 70.0) mg/L in transitional milk and 46.9(30.2, 71.9) mg/L in mature milk, corresponding to 0.40%、0.42% and 0.65% of the total milk protein content(OPN/protein%). The percentage of OPN to total protein in milk showed an increasing trend with lactation progression(r=0.21, P&lt;0.001). Multivariate analysis showed that sleep quality of mothers within one week prior to milk collection was correlated with the breast milk OPN level(P=0.04). The OPN level in breast milk from mothers with good sleep quality was significantly higher than that from mothers with poor sleep quality(46.5 mg/L vs.34.7 mg/L). The median level of milk OPN concentration in mothers from Yunnan was higher than mothers from Beijing(50.5 mg/L vs.36.1 mg/L, P=0.03). Maternal age, mode of delivery, prepregnancy body mass index, weight gain during pregnancy, passive smoking and outdoor activities 24 hours prior to milk collection were not correlated with milk OPN concentration. OPN concentration in breast milk was not related to preterm birth. Also, milk OPN concentration did not correlate with diarrhoea, respiratory disease, or allergic disease in infants during two weeks before milk collection.

CONCLUSION

The concentration of OPN in breast milk of Chinese woman may be similar among different lactation stages. Geographic region and sleep quality of mothers may be related to the milk OPN concentration.

Willingness and influential factors of parents of 3-6-year-old children to vaccinate their children with the COVID-19 vaccine in China

The impact of Coronavirus disease 2019 (COVID-19) on children aged 3-6 can be severe. Vaccination for COVID-19 is one of the most important primary preventative measures to reduce disease transmission. Parents are hesitant to vaccinate their children against COVID-19 because it was reported in the news that some adults have had adverse reactions to the vaccine. This study aims to investigate the willingness of Chinese parents of 3-6 year old children to vaccinate them with the COVID-19 vaccine and identify what factors influence their decisions. A survey was conducted using a two-stage stratified random sampling method from December 2020 to February 2021. We used univariate analysis and multivariate binary logistic analysis to explore potential factors that may determine the acceptance of the COVID-19 vaccine. Of the 468 parents who participated, 86.75% were willing to vaccinate their children with the COVID-19 vaccine. Parents who were female (OR = 2.591; 95% CI: 0.432-4.689), recognized their children in the high-risk category (OR = 2.494; 95% CI:1.244-5.002), often followed-up with COVID-19 vaccine-related information (OR = 9.065; 95% CI: 3.220-28.654), believed in the safety of the COVID-19 vaccine (OR = 3.068; 95% CI: 1.313-7.168), or thought the COVID-19 vaccine could prevent COVID-19 (OR = 13.750; 95% CI: 2.516-75.140) were more willing to vaccinate their children. To ease parents' hesitation about vaccines, the authority organization should release updated information on the safety and reliability of vaccines, target gender-specific health education for parents, and ask the media to report scientifically support information.

Incident Factors in the Sustainable Development of Digital Teaching Competence in Dual Vocational Education and Training Teachers

For years the technological revolution has been transforming all facets of our society. Teaching could obviously not be an exception but is quite the opposite because of its role in training the individuals of that society. Teachers at all levels of education are subjected to an adaptation process to develop the digital skills necessary for this transformation. This process must be permanent as there are still major deficiencies in teachers' ICT knowledge and rejection of their application. This study aims to see whether the inadequacy of digital teaching skills also occurs in the Dual Vocational Training modality. To this end, a descriptive quantitative method has been carried out in a sample of teachers from the Professional Formation Dual system in the Autonomous Community of Andalusia. The results show an insufficient level of digital skills that is therefore improvable, finding some factors that influence, to some extent, the various components of digital competence such as prior teacher training, the locality in which their school resides or the category of teaching to which he belongs. Therefore, it is advised to continue to promote in-service training in digital competence for in-service teachers in order to achieve sustainable educational development.

Intergenerational differences and influential factors of basic public health service utilization for floating population

OBJECTIVES

The Fourth Plenary Session of the 19th Central Committee of the Communist Party of China put forward the idea of "promoting the equalization of basic public services". The utilization of basic public health services by the floating population is an important indicator to measure the equalization of basic public health services. This study aims to understand the intergenerational differences in the utilization of basic public health services between the older generation and the new generation of floating population, and to analyze the influential factors.

METHODS

We employed the personal questionnaire (A) of the national health and family planning dynamic monitoring survey on floating population in 2017. Pearson Chi-square test, bi-grouping logistic regression, and Poisson regression were applied to analyze the basic situation of the floating population and the intergenerational differences in the use of basic public health services between the new and old generations.

RESULTS

The proportions of the new generation and the old generation who had established the residents' health records in the inflow area were 36.42% and 34.96%, respectively, with the significant difference (P<0.01). In the new generation, 74.07% of the floating population received at least one health education, 5.33 percentage higher than that in the old generation. The proportion of the old generation in the health education of chronic disease prevention and control was significantly higher than that of the new generation (P<0.01). The proportions of the other eight kinds of health education were significantly lower than those of the new generation (all P<0.05).

CONCLUSIONS

Although the coverage of basic public health services for the two generations of floating population is obviously different, the utilization of basic public health services of the floating population is still at a low level both in the new generation and in the old generation. There is an urgent need to improve the utilization of public health services for the whole floating population according to the characteristics of generations.

The influential factors and intervention strategies that engage malignant cancer patients in health-promoting behaviors during PICC line maintenance

OBJECTIVE

To analyze the influential factors and intervention strategies involved in engaging health-promoting behaviors (EHPD) during peripheral central venous catheter (PICC) line maintenance in malignant tumor patients.

METHODS

120 patients with malignant tumors who underwent PICC line maintenance in our hospital were prospectively analyzed. They were divided into a low and moderate level group (HPLP-II score ≤137) and a high level group (HPLP-II score >137) according to their Health Promoting Lifestyle Profile II (HPLP-II) questionnaire scores. Single-factor and multifactor analyses were performed to identify the factors influencing the patients' engagement in self-health-promoting behaviors. The one hundred and twenty patients with malignant tumors were randomly divided into two groups (n=60 in each group). The control group and the intervention group underwent routine nursing care and patient education. The two groups were compared in terms of the changes in their HPLP-II scores, their Cancer Patients PICC Self-management Scale (CPPSM) scores, their SAS and their SDS scores before and after the intervention, as well as their maintenance compliance rates, their complication rates during catheter placement, and their lack of PICC maintenance.

RESULTS

Literacy, place of residence, duration of catheter use, self-management abilities of PICCs, social support, and anxiety were risk factors (OR>1, P<0.05). Compared with their pre-intervention scores, the HPLP-II and CPPSM scores were increased in both groups (P<0.05), and the SAS and SDS scores were decreased in both groups after the intervention (P<0.05), and the intervention group had higher scores than the control group (P<0.05). The intervention group exhibited a higher maintenance compliance rate than the control group (P<0.05). The incidence of complications and the lack of PICC maintenance in the intervention group were lower than they were in the control group (P<0.05).

CONCLUSION

The influential factors during PICC maintenance for EHPD in malignant cancer patients include literacy, place of residence, duration of PICC use, etc. Patient education can promote patients' EHPD and self-management abilities, relieve their anxiety and depression, reduce their complications, and improve their compliance.

[Investigation and analysis of oral health status of the elderly in nursing homes in Taiyuan]

OBJECTIVES

This study aims to investigate awareness of oral health care and health status among elderly people in nursing homes in Taiyuan. Strategies for preventing and treating oral diseases and improving the quality of life of the elderly in nursing homes were formulated on the basis of analyzed data.

METHODS

A total of 359 participants from 48 nursing homes in six districts were selected randomly. Awareness, attitude, and behavior with regard to oral health care among the elderly were investigated through a survey using questionnaires and oral health examinations. Data were statistically analyzed with SPSS 20.0.

RESULTS

Among the elderly in the nursing homes in Taiyuan, awareness and behavior with regard to oral health care were deficient and inappropriate, and thus professional guidance was needed. In addition to method and time of brushing teeth and bad oral habits, the oral health status of the elderly was statistically affected by age and education. Compared with the data of the Fourth National Oral Epidemiological Investigation, the number of elderly people aged 55-64 or 65-74 years who brush their teeth every day and accept oral diagnosis and treatment was lower. However, the ratios of edentulous and missing teeth without treatment were higher than the national average level for the same age groups.

CONCLUSIONS

The awareness and attitude of the elderly in nursing homes with regard to oral health care are unsatisfactory, and their oral health status is poor. Education on oral health care, development of good oral care habits, and regular oral health examination are essential to the maintenance of oral health in elderly people.

Exploring the Influential Factors on Readers' Continuance Intentions of E-Book APPs: Personalization, Usefulness, Playfulness, and Satisfaction

With the rapid development of mobile devices, users can now read on the screen. Electronic reading (e-reading) has become a common reading style with the growth in online learning or electronic learning (e-learning). E-book applications (APPs) are widely developed and applied for reading on a screen. However, it is difficult for readers to change their reading habits or preference from paper-printed books to digital devices. The study of readers' continuance intention to use e-book APPs is the first step to improving e-reading. This study focuses on the influential factors on undergraduates' continuance intention of e-book APPs, which analyzed and summarized the literature related to the electronic book (e-book) applications (APPs) and undergraduates' continuous intention, combined with the characteristics of the e-book APPs, introduced relevant theories and variables, and established the factors that influence undergraduates' continuous intention of using e-book APPs. On this basis, the paper analyzed the relationship between various influencing factors and their influence on continuous intention. A model composed of five hypotheses was constructed to test the factors influencing undergraduates' continuous intention in e-book APPs. The results indicated that of all research variables, satisfaction is the most important factor that affects continuous intention; Perceived usefulness and perceived playfulness have an indirect effect on continuous intention through satisfaction; personalization has direct effects on perceived usefulness and perceived playfulness, so it also has an indirect effect on continuous intention. The findings of the study will be helpful for designers and developers of e-book APPs and provide e-book APP suggestions for readers as well.

Influential Factors of Burnout among Village Doctors in China: A Cross-Sectional Study

(1) Background: The heavy workload and understaffed personnel of village doctors is a challenge to the rural healthcare system in China. Previous studies have documented the predictors of doctors’ burnout; however, little attention has been paid to village doctors. This study aims to investigate the prevalence and influential factors of burnout among village doctors. (2) Methods: Data was collected by a self-administered questionnaire from 1248 village doctors who had worked at rural clinics for more than a year. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) with three dimensions—emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). A logistic regression model was applied to estimate the influential factors of burnout. (3) Results: The prevalence of overall burnout was 23.6%. Being male (OR = 0.58, 95%CI: 0.41–0.82), poor health status (OR = 0.80, 95%CI: 0.67–0.94), low income (OR = 0.62, 95%CI: 0.40–0.95), and a poor doctor–patient relationship (OR = 0.57, 95%CI: 0.48–0.67) were significantly related to burnout. Conclusion: Burnout is prevalent among Chinese village doctors. Policies such as increasing village doctors’ income and investing more resources in rural healthcare system should be carried out to mitigate and prevent burnout.

Influence factors of extra-articular manifestations in rheumatoid arthritis

Background and objective

Extra-articular manifestations (EAMs) are serious outcomes or complications of rheumatoid arthritis (RA) with increasing mortality and morbidity. The purpose was to explore the factors influencing EAMs, tissue-specific/systemic EAMs, and the concurrence of several EAMs.

Patients and methods

In total, 519 inpatients with RA were enrolled. The clinical characteristics, laboratory parameters, and medications of RA patients and the details of EAMs were recorded carefully. Differences between groups were examined by a Chi-square test, independent samples t test, one-way analysis of variance, Mann-Whitney U test, and Kruskal-Wallis H test. Binary and ordinal logistic regression analyses were performed to determine the relationship between influential factors and EAMs, tissue-specific/systemic EAMs, and the concurrence of several EAMs.

Results

The morbidity of EAMs was 44.70%. Male sex, age, and traditional Chinese medicine (TCM) were independent influential factors of EAMs, and a number of statistically significant influence factors were found in the multivariate analysis of tissue-specific/systemic EAMs. Finally, age, CRP levels, number of RA-affected types of joints, and TCM were the factors that independently influenced the concurrence of several EAMs.

Conclusion

Influential factors identified in this study could be recommended in clinical work, which is hopeful to decrease the morbidity and mortality of EAMs in RA.

Evaluating influential factors of acupuncture for tension-type headache: A protocol for systematic review and meta-analysis

BACKGROUND

Acupuncture has been recommended for the treatment of tension-type headache (TTH). However inconsistent findings on the efficacy of acupuncture impacts on the uptake of this effective therapy for TTH. This systematic review aims to 1) Evaluate the efficacy of acupuncture for TTH; and 2) Clarify the factors contributing to conflicting findings through conducting a meta-analysis and meta-regression of randomized controlled trials.

METHODS

Comprehensive literature search will be performed on PubMed, EMBASE, CINAHL, ProQuest, Cochrane Central Register of Controlled Trials, Acubriefs, ScienceDirect, Scopus, AMED, and 4 leading Chinese databases of the China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data, and CBM (SinoMed). We will include Randomized controlled Trials or controlled trials of patients with TTH that compared acupuncture with sham interventions. The primary outcome is the number of days on headache (within 4 weeks) at the end of the treatment and follow-ups. Secondary outcomes include intensity of pain, frequency of attack, and the adverse effects resulting from the intervention. We will use pre-defined sub-group analysis and meta-regression to explore the influential factors of acupuncture effects. Heterogeneity assessment will be performed before carrying out meta-analysis, whereas the subgroup analyses and meta-regression will be used in verifying the possible factors of heterogeneity when significant heterogeneity detected.

RESULTS

Review Manager 5.3 software will be used for meta-analysis. The synthesis will be performed by generating forest plots. Meta-regression will be used to understand influential factors for acupuncture in patients with TTH.

CONCLUSION

By utilizing techniques of meta-regression, this study will provide evidence toward to a more focused understanding of influential factors for acupuncture in patients with TTH. This systematic review will provide quality evidence for the optimization of acupuncture therapeutic regimen. It will facilitate the development of clinical practice guideline on acupuncture for TTH.

Psychological status of the staff in a general hospital during the outbreak of coronavirus disease 2019 and its influential factors

OBJECTIVES

To understand the psychological status of the staff in a general hospital during the coronavirus disease 2019 and its influential factors, and to provide references for the mental health services to hospital staff.

METHODS

Using star platform of questionnaire, the staff in the general hospital were investigated via Depression, Anxiety, Stress Scale (DASS-21), Social Support Rating Scale (SSRS) and Simplified Coping Style Questionnaire (SCSQ). The influential factors were discussed by descriptive analysis, rank sum test, single factor analysis, correlation analysis and multiple factors binary logistic regression analysis.

RESULTS

A total of 2 060 valid questionnaires were collected. The negative emotions of nurses and cleaners were the most obvious. The depression scores, anxiety scores and stress scores for nurses and cleaners were 5.06±7.47, 6.36±7.84, 9.75±8.65, and 6.72±8.84, 4.51±6.56, 9.69±9.56, respectively. Multivariate binary logistic regression analysis showed that staff types, education levels, job status, economic situation and concerns on the supplies of protective goods were the main influential factors for depression; staff types, contacting status with infected patients, economic situation, concerns on the supplies of protective goods, history of disease were the main influential factors for anxiety; contacting status with infected patients, economic situation, concerns on the supplies of protective goods were the main influential factors for stress.

CONCLUSIONS

There are differences in psychological characteristics among different groups of staff in the general hospital under the outbreak. Thus psychological protection and intervention measures should be formulated according to different groups and work status.

Influential Factors Affecting Protective Coping Behaviors of Flood Disaster: A Case Study in Shenzhen, China

As the risk of urban flooding increases worldwide, floods seriously endanger the safety of people's lives and property. Understanding the protective coping behaviors of the public in flood disasters is crucial to the implementation of effective flood mitigation measures and flood risk management. In this study, influential factors affecting protective coping behaviors in the face of flood disasters were identified, and the effects of these factors were discussed as well. Shenzhen City in China was selected as the study area, in which a questionnaire survey of 339 respondents was carried out in three flood-prone districts. Correlation analysis was conducted to preselect potential influential factors. Then, two linear regression models were established to identify main influential factors and to explore the interaction effects of these factors. The results indicated that age, monthly income, flood experience, trust in government and insurance willingness were main influential factors of protective coping behaviors. Trust in government had the highest positive correlation coefficient, while monthly income and age were negatively associated with protective coping behaviors. The interaction between insurance willingness and monthly income jointly affected protective coping behaviors of the public. The findings of this study could help authorities better understand the public's intention to cope with flood and design effective risk reduction measures, not only for Shenzhen, but also for many other similar cities that facing with the same situation.

Structural Equation Modeling of Drivers' Situation Awareness Considering Road and Driver Factors

Driver’s situation awareness (SA) is one of the key elements that affect driving decision-making and driving behavior. SA is influenced by many factors, and previous studies have focused only on individual factors. This study presents a comprehensive study to explore the path relationships and influence mechanism between SA and all influential factors, including road characteristics, driver characteristics and states, distracting elements, and cognitive ability. A structural equation model that relates SA to its influential factors is developed. A total of 324 valid questionnaires were collected to analyze and identify the relationships between the factors. The results show that the preceding influential factors have significant effects on SA, which is consistent with previous research. Based on path coefficients, positive effects were: cognitive abilities (0.500), driver state (0.360), age (0.277), driving experience (0.198), and gender (0.156). Negative effects were: distracting elements (−0.253) and road characteristics (−0.213). The results of this comprehensive study provide a valuable reference for the development of driver training programs and driving regulations.

Factors influencing breast cancer awareness: a cross-sectional study in China

Aim: This study aimed to explore the factors that influence breast cancer awareness. Materials & methods: A community-based cross-sectional study was conducted between January and April 2019 in Changchun, Jilin Province, China. Results: A total of 274 women were recruited for this cross-sectional study. Participants had a moderate level of breast cancer awareness (median = 76.50 [68.75, 84.00]). Women in the action/maintenance stages reported higher breast cancer awareness (p = 0.044). Women's breast cancer awareness was positively associated with high health information literacy level, husbands' higher educational degrees, seeing doctors after detecting abnormal breast changes and living within a short distance from the nearest hospital. Conclusion: History of screening and higher health information literacy levels are important positive factors linked to higher breast cancer awareness.

Characteristics and Influencing Factors of Real-Life Violence Exposure Among Chinese College Students

This study aimed to explore the characteristics and influencing factors of violence exposure in real life among Chinese college students. A sample of 375 college students was randomly selected to complete three questionnaires. The results indicated that participants had higher scores as victims and witnesses on violence exposure in community than they did in family. Male students had higher scores than females in both family and community violence exposure. Subjects with lower father's education level scored significantly higher than others in family violence exposure by victimization and community violence exposure by witnessing and victimization. Participants growing up in rural areas had significantly higher scores than others in family violence exposure by victimization and community violence exposure by witnessing. Finally, those subjects with siblings reported higher scores than those from only child families in family violence exposure by witnessing. Multiple regression analysis showed that deviant behaviors of peers, gender, and single-child status were significant influencing factors of respondent violence exposure. More efforts should be taken to effectively cope with existing violence exposure in college students and minimize the potential of future exposure.

Effects of Using Hospital Information Systems on Nurses' Individual Performance: A Study on Influential Factors

We investigated the use of hospital information systems (HIS) among nurses and its effect on their individual performance. We combined UTAUT and Delone & McLean models and developed a questionaire and collected 173 questionaires from nurses. We found that effort expectancy, information quality, performance expectancy and system quality positively influence nurses' intention to use HIS. In addition, nurses' intention to use and facilitators conditions positively direct their actual use. Information quality, service quality and system quality significantly increase nurses' satisfaction with HIS. Lastly, nurses' satisfaction with HIS and their actual use positively improves their individual performance in working with HIS.

Analysis of hidden blood loss and its influential factors in myomectomy

OBJECTIVE

This study was performed to quantify hidden blood loss (HBL) and explore its influential factors in myomectomy.

METHODS

Two hundred nine patients who underwent myomectomy by laparotomy or laparoscopy from 1 January 2017 to 31 December 2018 were analyzed. Each patient's estimated blood volume and total blood loss (TBL) were calculated by the Nadler formula and Gross formula, respectively. The HBL was calculated by subtracting the visible blood loss (VBL) from the TBL. A multivariate linear stepwise analysis was applied to identify the influential factors of HBL in myomectomy.

RESULTS

The mean perioperative VBL and estimated TBL during myomectomy were 137.81 ±104.43 and 492.24 ± 225.00 mL, respectively. The mean HBL was 354.39 ± 177.69 mL, which accounted for 71.52% ± 15.75% of the TBL and was two to three times higher than the VBL. The duration of surgery, number of removed leiomyomas, and location of removed leiomyomas were independent risk factors for HBL in myomectomy.

CONCLUSIONS

HBL accounted for a significant percentage of TBL in myomectomy. A full understanding of the HBL in perioperative blood management may improve patients' postoperative rehabilitation.

FOODLIT-PRO: Food Literacy Domains, Influential Factors and Determinants-A Qualitative Study

Poor eating habits are increasing the prevalence of weight-related issues, such as diabetes and cardiovascular diseases. Given the demand to improve individuals’ food knowledge and competencies aiming at healthier behaviours, the current investigation explores the concept of food literacy. Considering the lack of a shared understanding of food literacy, this study aims to explore food literacy’s domains, influential factors and determinants. Using a qualitative deductive-dominant content analysis, 30 experts from food-related fields were interviewed. The obtained outcomes were compared to available food literacy frameworks. Agreement among inter-raters was nearly perfect (k = 0.82). Yielding a total of 184 codes nested within 19 categories, identified domains were Origin, Safety, Choice and Decision, Select and Acquire, Plan, Preserve, Prepare, Cook, and Knowledge; influential factors included Nutrition, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, and Social and Cultural; External determinants were “Access to Food-Related Information”, “Perishable and/or Unreliable Food-Related Information”, “Family Dynamic and/or Identity”, and “Professionals’ Unpreparedness on Food-Related Expertise”, and Internal determinants included “Prioritise Food”, “Convenience and Practicality”, “Time and Financial Management”, “Previous Food-Related Habits”, and “Innate and Learned Flavour Preferences”. In conclusion, more than half of the identified attributes (62.5%) are corroborated by the current literature. However, the manifested content unmatched with the current frameworks of food literacy literature express food-literacy-related fields of action, knowledge, competencies, and determinants that have not yet been explored. As such, this study provides new and useful information concerning food literacy definition and development, by identifying its domains, factors of influence, and potential determinants. Moreover, this work paves the way for new measurements and interventions within this field.

Coping strategies and associated factors among older Chinese people living with HIV/AIDS

Coping strategies play a prominent role in maintaining mental health, but little is known about the main coping strategies and potential influential factors among older Chinese adults with HIV/AIDS. Cross-sectional data of 254 older with HIV/AIDS aged 50 ~ 84 years (160 males and 94 females) from Hunan, China were analyzed to evaluate influential factors associated with coping strategies. The scores of all participants in the different sub-scales of confrontation, avoidance and acceptance-resignation were 15.16 ± 4.03, 16.44 ± 2.70, and 11.06 ± 4.00, respectively. For the confrontation coping strategy, higher scores were obtained by those with a higher education level, non-sexually transmitted HIV, and a first diagnosis at less than 50 years old. Avoidance as a coping strategy was significantly associated with a longer period living with the diagnosis. The participants who were females, unemployed, annual income less than 1000 yuan, had lived with HIV for a longer period, and had disclosed their infection status to their family members were more likely to adopt the acceptance-resignation coping strategy in response to HIV/AIDS. These preliminary findings can provide evidence for effective interventions to improve coping capacity and psychological status in this population.

Analysis of factors influencing parents' willingness to accept the quadrivalent influenza vaccine for school-aged children in the Nanhai District, China

Recently, China has attached great importance to promoting immunization, prompting the media, scholars, and public to focus on its coverage and efficacy. This study aimed to understand the factors influencing parental willingness to have their school-aged children vaccinated with quadrivalent influenza vaccines (QIVs). A cross-sectional study through face-to-face interviews was conducted between September and December 2018. Forty-four kindergartens and primary and junior high schools were randomly selected via stratified three-stage cluster sampling. Of 4,430 participants, 24.6% reported having heard of QIV and 24.2% reported having previously received information on QIV. Of these, 42.8% expressed willingness to obtain the QIV for their children. A junior college degree (adjusted odds ratio [aOR] = 1.447; 95% confidence interval [95% CI]: 1.202-1.742), higher influenza knowledge level (medium level, aOR = 1.150, 95% CI, 1.006-1.314; high level, aOR = 1.332, 95% CI, 1.045-1.697), and previous influenza information (aOR = 2.241; 95% CI, 1.604-3.130) were positively correlated with vaccination willingness. In contrast, no previous QIV-related information (aOR = 0.490; 95% CI, 0.418-0.575), no perceived susceptibility of children to influenza (aOR = 0.576; 95% CI, 0.489-0.680), fear of side effects (aOR = 0.599; 95% CI, 0.488-0.735), concern that vaccines need to be carefully administered (aOR = 0.728; 95% CI, 0.593-0.894), and mistrust of new vaccines (aOR = 0.730; 95% CI, 0.628-0.849) were pivotal barriers hindering parents from having their children vaccinated. This study provides baseline information for future immunization programs and delivery, with the ultimate goal of increasing vaccine uptake and minimizing school-wide influenza outbreaks.

Research on Total Factor Productivity and Influential Factors of the Regional Water-Energy-Food Nexus: A Case Study on Inner Mongolia, China

With the supply of water, energy and food facing severe challenges, there has been an increased recognition of the importance of studying the regional water–energy–food nexus. In this paper, Inner Mongolia, including 12 cities in China, was selected as a research case. A super-efficiency slack based measure (SBM) model that considered the undesirable outputs was adopted to calculate the regional total factor productivity (TFP) and the Malmquist–Luenberger index was used to investigate the change trend of the TFP from 2007 to 2016 based on understanding the water–energy–food nexus. Finally, influential factors of the TFP were explored by Tobit regression. The results show that the 12 Inner Mongolia cities are divided into higher, moderate and lower efficiency zones. The higher efficiency zone includes Ordos, Hohhot, Xing’an, and Tongliao, and the lower efficiency zone includes Chifeng, Xilin Gol, Baynnur, Wuhai and Alxa. There is a serious difference in TFP between Inner Mongolia cities. During the study period, the TFP of the water–energy–food nexus in Inner Mongolia cities shows a rising trend, which is mainly driven by the growth of technical progress change. However, the average ML values of the lower and moderate efficiency zones were inferior to the higher efficiency zone in six of the ten years, so the difference between Inner Mongolia cities is growing. According to the Tobit regression, the mechanization level and degree of opening up have positive effects on the TFP, while enterprise scale and the output of the third industry have negative effects on the TFP. Government support does not have any significant impact on the TFP. Finally, suggestions were put forward to improve the TFP of the water–energy–food nexus in Inner Mongolia cities.

Hidden blood loss during perioperative period and the influential factors after surgery of thoracolumbar burst fracture: A retrospective case series

Surgical therapy is vital for thoracolumbar burst fracture in restoring vertebral height, correcting kyphosis, decompressing nervous, and maintaining stability. Patients have unexpectedly lower hemoglobin levels postoperatively, which is remarkably inconsistent with the measured blood loss. However, hidden blood loss (HBL) is often neglected.To investigate HBL during perioperative period and determine its influential factors after surgery.A total of 68 patients who underwent surgery in our institution between January 2015 and January 2017 were included in the study. The demographic information, including the patients' age, gender, weight, height, duration of symptoms, surgery approach, time of operation, volume of drainage, classification of fracture, percentage of vertebral height loss and restoration, was collected. HBL was calculated according to the Gross formula. Influential factors were further analyzed using multivariate linear regression analysis.The mean HBL was 303.5 (range 18.4-803.5) mL, accounting for 67.5% of total blood loss. It indicated that the amount of HBL was much higher than we expected. Multiple and stepwise regression analysis revealed that blood loss, preoperative activated partial prothrombin time (APPT), percentage of anterior and medium vertebral height restoration were positively correlated with HBL. The association between HBL and the influential factors was analyzed based on the regression model equation: HBL = [1 + e [216.737 + 0.627*blood loss + 10.817*APTT + 207.549*anterior height restoration + 20.002*medium height restoration]]-1.HBL during perioperative period accounted for a substantial portion of the total blood loss and was much larger than what we thought. The blood loss, preoperative APPT, percentage of anterior and medium vertebral height restoration were positively correlated with HBL. Therefore, more attention needs to be paid to HBL to ensure patients' safety.

[Spatio-temporal characteristics of the expansion of poplar plantation in West Dongting Lake wetland, China.]

The rapid expansion of poplar plantation and its impacts on the wetland ecosystem have become a critical issue in West Dongting Lake ecosystem management. In the study, we explored the spatio-temporal characteristics of poplar plantation distribution in West Dongting Lake from 2000-2014 using Landsat imagery, topographic and hydrological data. Results showed that the area of the poplar plantation increased from 3233.5 hm² to 10915.6 hm² during the period of 2000 to 2011 (i.e. mean growth rate was 698.4 hm²·a^-1), and the highest growth rate happened during the period of 2004 to 2007 (1000.6 hm²·a^-1). Then, from 2011 to 2014, the expansion rate recorded a net loss, with the total poplar plantation area decreasing to 10153.1 hm² in 2014. Reed marsh, open water and mudflat, and wet meadows contributed to the expansion of poplar plantation, which accounted for 41.8%, 37.0% and 21.2%, respectively. Failure policy incentives, as well as the market need for economic interests were the key drivers of the popular plantation expansion, and meanwhile, operation of the Three Gorges Dam that lowered down the flooding water level, as well as the sediment deposition within the lake bed offered favorable environment for popular tree growth. The project of "returning forest to wetland" after 2013 was the main reason for the decreased poplar plantation area in 2014.

[Optimization of acupoint application scheme in the treatment of bronchial asthma based on the orthogonal design method]

OBJECTIVE

To study the primary and secondary factors of the allergic history, the frequency of acupoint application and the time of acupoint application in the treatment of bronchial asthma and optimize its scheme.

METHODS

Eighty patients of bronchial asthma were selected as the subjects in the orthogonal trial. The herbal medicines were the empirical formula of acupoint application (prepared at the ratio as 2:2:1:1:1:1:1:1:1 of semen brassicae, rhizome corydalis, unprocessed radix kansui, asarum sieboldii, ephedra, semen lepidii, syzygium aromaticum, cortex cinnamomi and fructus gleditsiae) and used on bilateral Feishu (BL 13), Xinshu (BL 15), Geshu (BL 17) and Shenshu (BL 23). Firstly, two groups were divided according to allergic history (40 cases with allergic history and 40 cases without allergic history), and then four subgroups were divided on the basis of the two main groups, 10 cases in each one. Through studying three factors and two levels, i.e. allergic history (Factor A:A_Ⅰ:with allergic history; A_Ⅱ:without allergic history), the frequency of acupoint application (Factor B:B_Ⅰ:4 times; B_Ⅱ:10 times, in which, in the group of 4-time applications, the application was given once every 10 days; in the group of 10-time applications, the application was given once every 4 days); and the time of application (Factor C:C_Ⅰ:4 h; C_Ⅱ:8 h), the optimal scheme was screened on the basis of the attack frequency before and after treatment and the score of the asthma quality life questionnaire (AQLQ) before treatment and 6 months after treatment in the patients of each group.

RESULTS

① The orthogonal trial indicated that the best optimal scheme was A_ⅠB_ⅡC_Ⅰ, meaning the patients with allergic history were treated with acupoint application for 10 times, remained for 4 h. ②Factor B (frequency of acupoint application) and C (time of acpoint application) were the significant influential factors of AQLQ scores (both P<0.05). ③The comparison of the attack frequency and AQLQ score before and after treatment in all of the patients showed that the different combinations of factor levels induced the different impacts on the asthma attack frequency and AQLQ scores. Except in the group No.1 and the group No.5, the improvements were all significant in the rest groups, indicating the significant differences (P<0.05, P<0.01).

CONCLUSIONS

Acupoint application reduces apparently the attack frequency of asthma in the patients and improves the living quality. The primary and secondary relationship among the allergic history, the frequency of acupoint application and the time of acupoint application for the impacts on the therapeutic effects are:the frequency of acupoint application > the time of acupoint application > the allergic history. The best optimal scheme is AⅠBⅡCⅠ, meaning the patients with allergic history are treated with acupoint application for 10 times, remained for 4h.

Statistical analysis of factors affecting re-operative times in paediatric patients with scar deformity after deep second-degree burn injury

Deep second-degree burn injuries pose a challenge for treating scar deformity in developing paediatric patients. Some patients underwent several re-operations during their development. There was no literature reporting which factors affect re-operative times. In this article, we intend to analyse possible influential factors that are responsible for re-operative times in paediatric patients with scar deformity after deep second-degree burn injuries. From 2010 to 2016, 177 paediatric cases with a history of deep second-degree burn injury who underwent re-operation once, twice, and equal to or more than thrice were recruited to this study, with age ranging from 0 to 18 years. The following factors were analysed: age, gender, size of scar, method for reconstruction, location, postoperative anti-scar treatment, preschool group, school group, combined deformity, and combined method for reconstruction. One-way ANOVA and multi-way ANOVA analysis were used as statistical tools to analyse the above factors and re-operative times. There were 83 male cases and 94 female cases, with an average age of 7.47 years. Statistical significance was achieved for the size of scar (P = 0.000), operation method (P = 0.001), and combined deformity (P = 0.026) under 1-way ANOVA in different re-operative times. The operation methods for the head and neck area (P < 0.05) and the lower extremities (P < 0.05) are critical factors for multi-factor variance analysis in different re-operative times. Multivariate logistic regression analysis also demonstrated that the size of scar was an independent risk factor for the number of operations. Combined operative method was a protective risk factor for the number of operations. There was no statistical significance obtained for other factors. Size of scar, operation method, and combined operation method are the risk factors for re-operative times, while operation methods for the head and neck area and lower extremities are the critical factors for re-operative times. We can use the combined method to resolve scar-related problems in order to reduce re-operative times.

The quantification and assessment of depression and anxiety in patients with postoperative gastroparesis syndrome

Background

This study aimed to analyze the stage-situation depression and anxiety as well as independent influential factors in patients with postsurgical gastroparesis syndrome (PGS) and to provide dependent indications for treatment.

Patients and methods

The self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to test the depression and anxiety of 53 patients with PGS, who were treated in the Department of Gastroenterological Surgery of Gansu Provincial Hospital from January 2012 to October 2016. A comparison between the SDS or SAS scores of patients with PGS and without PGS was undertaken; then, we retrospectively analyzed the factors influencing depression and anxiety in PGS patients.

Results

The patients with PGS’ mean scores of depression and anxiety were 49.92±11.37 and 50.91±6.57, respectively, which were higher than that of patients without PGS in the Chinese population (P<0.05). The results of multivariate logistic regression analysis indicated that the independent influential factors of depression and anxiety in patients with PGS included course of disease, pancreatic juice leakage, preoperative outflow tract obstruction, postoperative abdominal infection, and anastomotic complication (P<0.05). Patients with a disease course longer than 30 days; with pancreatic juice leakage; and who suffered from preoperative outflow tract obstruction, postoperative abdominal infection, and anastomotic complication had higher ratios of depression and anxiety.

Conclusion

Depression and anxiety are clearly evident in patients with PGS, and we should pay attention to this phenomenon and provide appropriate treatment.

Cox Regression and Parametric Models: Comparison of How They Determine Factors Influencing Survival of Patients with Non-Small Cell Lung Carcinoma

Background and objectives: The present study of survival rate of patients with non-small cell carcinoma (NSCLC) compared the efficiency of Cox semi-parametric vs. parametric models in determination of influencing factors. Methods: In this retrospective cohort study, data were gathered from 190 patients with a confirmed diagnosis of NSCLC referred to Shahid Sadoughi and Shohadaye Kargar Hospitals in Yazd, Iran during 2005 to 2014. To identify and compare factors influencing the survival rate, a Cox semi-parametric model was fitted to the data. Data analysis was performed using the R software version R3.3.1, and the significance level was set at 0.05. Results: The average age was 64.5 years. About 40% of patients had stage 4 disease. The median survival was 8 months. After comparing the models, the more efficient was the log-normal distribution (AIC=889.3829), with which disease stage, type of therapy, and age were significant factors. Among the different types of therapy, chemotherapy and radiotherapy yielded higher survival rates, and increased age was associated with lower survival. Conclusion: The most efficient model was a log-normal model. Implementation of optimal therapies at early stages can improve the survival of patients.

Hidden Blood Loss and Its Influential Factors After Laparoscopy-Assisted Gastrectomy for Gastric Cancer

INTRODUCTION

Laparoscopy-assisted gastrectomy (LAG) is a minimally invasive procedure for the treatment of gastric cancer. It is generally thought that a minimally invasive technique results in less visible blood loss during the surgery. Nevertheless, a meaningful perioperative hidden blood loss (HBL) is often ignored. In this study, we investigated the amount of HBL and the influential factors after LAG for gastric cancer.

METHODS

A retrospectively analyzed clinical data of 62 consecutive patients who underwent laparoscopy-assisted total or distal gastrectomy at our center from May 2016 to May 2017. The HBL was calculated according to Gross's and Nadler's formula. The data of patient gender, age, height, weight, body mass index, preoperative and postoperative hematocrit, postoperative drainage, albumin loss, diabetes mellitus, and hypertension were analyzed by multivariate linear regression analysis. The type of surgical reconstruction was analyzed by one-way analysis of variance. The difference between the preoperative blood pressure and postoperative blood pressure was measured by paired sample t-test and boxplot.

RESULTS

The HBL was 322.2 ± 195.9 mL (64.3% ± 14.1% in total blood loss [TBL]), the TBL was 475.6 ± 222.8 mL, and the hemoglobin (HB) loss was 15.0 ± 8.7 (11.5% ± 6.1% of HB level loss). Multivariate linear regression analysis revealed that gender, hypertension, and albumin loss between preoperation and postoperation are influential factors of HBL in patients after LAG for gastric cancer. Compared to male patients, female patients are positively associated with HBL.

CONCLUSION

In our study, we found HBL is a significant segment of TBL and is much larger than what we considered previously in LAG for gastric cancer. Gender, hypertension, and albumin loss are significantly correlated with HBL. Therefore, paying attention to HBL is significant for promoting clinical treatment and ensuring patients' safety.

[An Exploration of the Pain Management Knowledge of Emergency Room Staffs and Factors of Influence]

BACKGROUND

Pain has been integrated as the fifth vital sign that is a common health problem for emergency room patients. Although prior studies have addressed the effects of the pain-management knowledge of emergency room staffs on the quality of pain care, there is a dearth of research on pain management knowledge and on the factors that influence this knowledge.

PURPOSE

To explore the knowledge of emergency room staffs regarding pain management and the factors that influence this knowledge.

METHODS

This cross-sectional study used a self-developed questionnaire to survey a convenience sample of 201 physicians and nurses from three emergency rooms in northern Taiwan.

RESULTS

The average score for pain-management knowledge was 63.28 out of 100. Demographic variables including education level, professional specialty, and sources of pain education had significant effects on participants' pain-management knowledge.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The knowledge of emergency room staffs regarding pain management must be reinforced further in order to improve care quality. The factors identified that influence this knowledge may be referenced by hospitals in developing / revising pain-related continuing education, in developing pain management guidelines, and in setting the directions for future research on pain management.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China

OBJECTIVE

Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception.

METHODS

A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis.

RESULTS

The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients.

CONCLUSION

This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.