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Abstract In this paper, we propose an efficient target detection algorithm, ASF-Sim-YOLO, to address issues encountered in escalator step defect detection, such as an excessive number of parameters in the detection network model, poor adaptability, and difficulties in real-time processing of video streams. Firstly, to address the characteristics of escalator step defects, we designed the ASF-Sim-P2 structure to improve the detection accuracy of small targets, such as step defects. Additionally, we incorporated the SimAM (Similarity-based Attention Mechanism) by combining SimAM with SPPF (Spatial Pyramid Pooling-Fast) to enhance the model’s ability to capture key information by assigning importance weights to each pixel. Furthermore, to address the challenge posed by the small size of step defects, we replaced the traditional CIoU (Complete-Intersection-over-Union) loss function with NWD (Normalized Wasserstein Distance), which alleviated the problem of defect missing. Finally, to meet the deployment requirements of mobile devices, we performed channel pruning on the model. The experimental results showed that the improved ASF-Sim-YOLO model achieved an average accuracy (mAP50) of 96.8% on the test data set, which was a 22.1% improvement in accuracy compared to the baseline model. Meanwhile, the computational complexity (in GFLOPS) of the model was reduced to a quarter of that of the baseline model, while the frame rate (FPS) was improved to 575.1. Compared with YOLOv3-tiny, YOLOv5s, YOLOv8s, Faster-RCNN, TOOD, RTMDET and other deep learning-based target recognition algorithms, ASF-Sim-YOLO has better detection accuracy and real-time processing capability. These results demonstrate that ASF-Sim-YOLO effectively balances lightweight design and performance improvement, making it highly suitable for real-time detection of step defects, which can meet the demands of escalator inspection operations.

Abstract Background Delays in malaria treatment can not only lead to severe and even life-threatening complications, but also foster transmission, putting more people at risk of infection. This study aimed to investigate the factors influencing treatment delays among malaria patients and their health-seeking behaviour. Methods The medical records of 494 patients diagnosed with malaria from 6 different malaria-endemic provinces in China were analysed. A bivariate and multivariable regression model was used to investigate the association between delays in seeking treatment and various factors. A Sankey diagram was used to visualize the trajectories of malaria patients seeking medical care. Total treatment delays were categorized as patient delays and doctor delays. Results The incidence of total delays in seeking malaria treatment was 81.6%, of which 28.4% were delayed by patients alone and 34.8% by doctors alone. The median time from the onset of symptoms to the initial healthcare consultation was 1 day. The median time from the initial healthcare consultation to the conclusive diagnosis was 2 day. After being subjected to multiple logistic regression analysis, living in central China was less likely to experience patient delays (OR = 0.43, 95% CI 0.24–0.78). The factors significantly associated with the lower likelihood of doctor delays included: age between 30 to 49 (OR = 0.43, 95% CI 0.23–0.81), being single/divorce/separated (OR = 0.48, 95% CI 0.24–0.95), first visiting a county-level health institution (OR = 0.25, 95% CI 0.14–0.45), first visiting a prefectural health institution (OR = 0.06, 95% CI 0.03–0.12) and first visiting a provincial health institution (OR = 0.05, 95%CI 0.02–0.12). Conversely, individuals with mixed infections (OR = 2.04, 95% CI 1.02–4.08) and those experiencing periodic symptoms (OR = 1.71, 95% CI 1.00–2.92) might face increased doctor delays. Furthermore, higher financial burden and complications were found to be associated with patient delays. Doctor delays, in addition to incurring these two consequences, were associated with longer hospital stays. Conclusion There was a substantial delay in access to health care for malaria patients before China was certified malaria free. Region, marital status, periodic symptoms and the level of health institutions were factors contributing to delays in treatment-seeking among malaria patients.

Abstract Background Shared decision making (SDM) improves the health status of patients with chronic diseases, especially in the condition of poly-medicated patients. This study aims to find the factors associated with participation of patients with chronic diseases in SDM on medication. Methods A total of 1,196 patients with chronic diseases were selected in Hubei Province of China using cluster sampling methods. The random forest method was applied to rank the importance of independent variables by Mean Decrease Gini and out-of- bag (OOB) curve. Multivariate logistic regression was used to explore the independent variables’ effect direction and relative hazard. Results In this study, 5.18% of patients used patient-directed decision making (PDM, a decision-making model led by patients), 37.79% of patients used SDM (a collaborative decision-making model by patients and doctors), and 57.02% of patients used doctor-directed decision making (DDM, or paternalistic decision making, a decision-making model led by doctors). The random forest analysis demonstrated that the top 5 important factors were age, education, exercise, disease course, and medication knowledge. The OOB curve showed that the error rate reached minimum when top 5 variables in importance ranking composed an optimal variable combination. In multivariate logistic regression, we chose SDM as a reference group, and identified medication knowledge (OR = 2.737, 95%CI = 1.524 ~ 4.916) as the influencing factor between PDM and SDM. Meanwhile, the influencing factors between DDM and SDM were age (OR = 0.636, 95%CI = 0.439 ~ 0.921), education (OR = 1.536, 95%CI = 1.122 ~ 2.103), exercise (OR = 1.443, 95%CI = 1.109 ~ 1.877), disease course (OR = 0.750, 95%CI = 0.584 ~ 0.964), and medication knowledge (OR = 1.446, 95%CI = 1.120 ~ 1.867). Conclusion Most Chinese patients with chronic diseases used DDM during their medication decision-making, and some patients used PDM and SDM. The participation in SDM should be taken seriously among elderly patients with lower education levels. The SDM promotion should focus on transformation of patients’ traditional perception and enhance their medication knowledge.

Abstract Background Shared decision-making(SDM) is recognized as an important means of managing polypharmacy among older people with chronic diseases. However, no studies have quantitatively measured the effect of SDM on polypharmacy. The objective of this study was to compare the impact of SDM and other factors on polypharmacy in inpatients and community patients. Additionally, the study aimed to compare the impact of different decision types on polypharmacy in community patients. Methods This is a population-based multicenter retrospective study conducted in Hubei Province, China. A cluster sampling approach was used to recruit 536 chronic disease inpatients from March to April 2019, and 849 community patients were recruited from April to June 2021. Propensity score weighting was used to control the confounding variables and determine the net effect of SDM on polypharmacy. Results Among the 536 hospitalized patients, the prevalence of polypharmacy was 56.3%. A high level of SDM was significantly associated with a lower risk of polypharmacy. Patients with chronic illnesses aged 76 years and older and with an annual family income of 24,001–36,000 yuan were associated with a lower likelihood of polypharmacy (p

This paper concentrates on the elevator passenger detection task, a pivotal element for subsequent elevator passenger tracking and behavior recognition, crucial for ensuring passenger safety. To enhance the accuracy of detecting passenger positions inside elevators, we improved the YOLOv8 network and proposed the SC-YOLOv8 elevator passenger detection network with soft-pooling and attention mechanisms. The main improvements in this paper encompass the following aspects: Firstly, we transformed the convolution module (ConvModule) of the YOLOv8 backbone network by introducing spatial and channel reconstruction convolution (SCConv). This improvement aims to reduce spatial and channel redundancy in the feature extraction process of the backbone network, thereby improving the overall efficiency and performance of the detection network. Secondly, we propose a dual-branch SPP-Fast module by incorporating a soft-pooling branch into the YOLOv8 network’s SPP-Fast module. This dual-branch SPP-Fast module can preserve essential information while reducing the impact of noise. Finally, we propose a soft-pooling and multi-scale convolution CBAM module to further enhance the network’s performance. This module enhances the network’s focus on key regions, allowing for more targeted feature extraction, thereby further improving the accuracy of object detection. Additionally, the attention module enhances the network’s robustness in handling complex backgrounds. We conducted experiments on an elevator passenger dataset. The results show that the precision, recall, and mAP of our improved YOLOv8 network are 94.32%, 91.17%, and 92.95%, respectively, all surpassing those of the original YOLOv8 network.

Abstract. In China, the level of ambient fine particulate matter (PM2.5) pollution far exceeds the air quality standards recommended by the World Health Organization. Moreover, the health effects of PM2.5 exposure have become a major public health issue. More than half of PM2.5-related excess deaths are caused by cardiopulmonary disease, which has become a major health risk associated with PM2.5 pollution. In this review, we discussed the latest epidemiological advances relating to the health effects of PM2.5 on cardiopulmonary diseases in China, including studies relating to the effects of PM2.5 on mortality, morbidity, and risk factors for cardiovascular and respiratory diseases. These data provided important evidence to highlight the cardiopulmonary risk associated with PM2.5 across the world. In the future, further studies need to be carried out to investigate the specific relationship between the constituents and sources of PM2.5 and cardiopulmonary disease. These studies provided scientific evidence for precise reduction measurement of pollution sources and public health risks. It is also necessary to identify effective biomarkers and elucidate the biological mechanisms and pathways involved; this may help us to take steps to reduce PM2.5 pollution and reduce the incidence of cardiopulmonary disease.

Abstract Background Early accurate diagnosis and risk assessment for malaria are crucial for improving patients’ terminal prognosis and preventing them from progressing to a severe or critical stage. This study aims to describe the accuracy of the initial diagnosis of malaria cases with different characteristics and the factors that affect the accuracy in the context of the agenda for a world free of malaria. Methods A retrospective study was conducted on 494 patients admitted to hospitals with a diagnosis of malaria from January 2014 through December 2016. Descriptive statistics were calculated, and decision tree analysis was performed to predict the probability of patients who may be misdiagnosed. Results Of the 494 patients included in this study, the proportions of patients seeking care in county-level, prefecture-level and provincial-level hospitals were 27.5% (n = 136), 26.3% (n = 130) and 8.3% (n = 41), respectively; the proportions of patients seeking care in clinic, township health centre and Centres for Disease Control and Prevention were 25.9% (n = 128), 4.1% (n = 20), and 7.9% (n = 39), respectively. Nearly 60% of malaria patients were misdiagnosed on their first visit, and 18.8% had complications. The median time from onset to the first visit was 2 days (IQR: 0-3 days), and the median time from the first visit to diagnosis was 3 days (IQR: 0–4 days). The decision tree classification of malaria patients being misdiagnosed consisted of six categorical variables: healthcare facilities for the initial diagnosis, time interval between onset and initial diagnosis, region, residence type, insurance status, and age. Conclusions Insufficient diagnostic capacity of healthcare facilities with lower administrative levels for the first visit was the most important risk factor in misdiagnosing patients. To reduce diagnostic errors, clinicians, government decision-makers and communities should consider strengthening the primary care facilities, the time interval between onset and initial diagnosis, residence type, and health insurance status.

IntroductionSelf-medication has a high prevalence in the middle-aged and elderly population in China. Despite the published evidence demonstrating the economic benefits of self-medication, limited research has addressed the relationship between self-medication and individual medical expenditures, especially within the Chinese population. This study examined the effect of self-medication on individual medical expenditures in China and analyzed the heterogeneity between outpatient and inpatient cases.MethodsWe conducted a panel data analysis using data from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Two-part mixed-effect models were implemented to estimate the effect of self-medication on total outpatient and inpatient expenses and out-of-pocket (OOP) costs, where mixed-effects logit regression was used as the first part, and generalized linear mixed models with log link and gamma distribution was used as the second part.ResultsWe identified 72,041 responses representing 24,641 individuals, of which 13,185 responses incurred outpatient expenses and 9,003 responses incurred inpatient costs. Controlling for all covariates, we found that self-medication behaviors were significantly associated with a higher probability of outpatient service utilization (OR = 1.250, 95% CI = 0.179 to 0.269; P < 0.001), but displayed no significant association with outpatient expenses. Respondents who had taken self-medication were less likely to use inpatient services (OR = 0.865, 95% CI = −0.201 to −0.089; P < 0.001), and their inpatient expenses were significantly reduced by 9.4% (P < 0.001). Inpatient OOP costs were significantly reduced by 10.7% (P < 0.001), and outpatient OOP costs were significantly increased by 11.3% (P < 0.001) among respondents who had self-medicated.ConclusionsThis study allowed us to identify the economic value of self-medication among the middle-aged and elderly population in China. Future work should guide the middle-aged and elderly to take responsible self-medication to reduce their economic burden.

Abstract Adverse drug reactions (ADRs) may be a serious public health problem and have received widespread attention in recent years. This study has analyzed the factors leading to the occurrence of serious ADRs (SADRs), determined the factors affecting the prognosis of patients with severe adverse reactions at different levels of medical institutions, and finally made corresponding recommendations for the monitoring, prevention, and treatment of SADRs. We used descriptive analysis and chi-square test to analyze the year, age, gender, proportion of SADRs, and the results of the ADRs in the report. Use the logistic regression to analyze the factors affecting the prognosis of SADRs in different levels of medical institutions. A total of 387 642 people’s 394 037 ADRs were collected from the Henan Provincial Adverse Drug Reaction Monitoring Center from 2016 to 2020. Among them 35 742 cases of serious ADRs (9.1%), 96.1% were eventually relieved or cured, but 39 cases of SADRs caused death. The main causes of death included hemorrhages, organ failure, and allergies. Age, number of medication and illnesses, level of medical institution, history of adverse reactions, and type and method of medication were all factors that affected the severity of ADR. The prognosis of SADRs is worse than normal ADRs. The ADRs in autumn and winter and new adverse reactions are unique risk factors found in this study. The elderly and patients with multiple diseases or taking multiple drugs should pay attention to their adverse reactions. They should be closely observed within a week after taking the medicine. The supervision of patients with a history of allergies and new adverse reactions should be strengthened by primary medical institutions, and in nonprimary medical institutions should paid attention with past medical histories, and use imported drugs and biological agents with caution to ensure the safety and health of patients.

Abstract Background Adult child are used to taking the responsibility of taking care of their older parents in Chinese culture. However, the migration of adult child is not uncommon now in the context of urbanization in China. The purpose of this study is to explore the impact of child’s migration on health status and health care utilization of older parents with chronic diseases left behind. Methods The data of the 2015 nationally representative longitudinal survey of the aged population in China were used in this study. Binary logistic regression was used to evaluate the impact of adult child’s migration on health status and health care utilization of older parents with chronic diseases left behind. Results About a quarter of the respondents (25.5%) had at least one migrant child. Most of the respondents (86.6%) rated their health as poor, and 42.0% of them suffered from physical limitations. Nearly half of the respondents (45.0%) had depressive symptoms, but the vast majority (88.2%) were generally satisfied with their lives. Only a quarter of the respondents received outpatient treatment in the past month while only one fifth of them received inpatient visits in the past year. After controlling for other demographic and socioeconomic variables, it was found in this study that those who with migrant child were more likely to report poor self-rated health (OR = 1.26; 95% CI 1.01–1.58), not satisfied with general life (OR = 1.28; 95% CI 1.03–1.59) and seek outpatient visits (OR = 1.22; 95% CI 1.03–1.43) than those who without migrant child. Conclusion Our study found that there is a negative association between migration of adult child and physical health, mental health and health care utilization of older parents with chronic diseases left behind, which means a comprehensive effect on their health status. Further health policies should focus on improving the well-being of older parents with chronic diseases left behind.

Background: Esophageal Squamous Cell Cancer (ESCC) is an aggressive disease associated with a poor prognosis. As a newly defined form of regulated cell death, ferroptosis plays a crucial role in cancer development and treatment and might be a promising therapeutic target. However, the expression patterns of ferroptosis-related genes (FRGs) in ESCC remain to be systematically analyzed.Methods: First, we retrieved the transcriptional profile of ESCC from TCGA and GEO datasets (GSE47404, GSE23400, and GSE53625) and performed unsupervised clustering to identify different ferroptosis patterns. Then, we used the ssGSEA algorithm to estimate the immune cell infiltration of these patterns and explored the differences in immune cell abundance. Common genes among patterns were finally identified as signature genes of ferroptosis patterns.Results: Herein, we depicted the multi-omics landscape of FRGs through integrated bioinformatics analysis and identified three ESCC subtypes with distinct immune characteristics: clusters A-C. Cluster C was abundant in CD8+ T cells and other immune cell infiltration, while cluster A was immune-barren. By comparing the differently expressed genes between clusters of diverse datasets, we defined a gene signature for each cluster and successfully validated it in the TCGA-ESCC dataset.Conclusion: We provided a comprehensive insight into the expression pattern of ferroptosis genes and their interaction with immune cell infiltration. Additionally, we established a gene signature to define the ferroptosis patterns, which might be used to predict the response to immunotherapy.

Background: Short-term fine particulate matter (PM2.5) exposure and increased circulatory mortality have been well documented. However, there are inconsistent findings on mortality effects of traffic-related pollutants from the perspective of sources or constituents. Few studies have examined such associations using source and constituents simultaneously, and even less are based on large-scale, nationally representative data. We aimed to conduct a comprehensive analysis to investigate source- and constituent-specific mortality effects due to traffic-related PM2.5 pollution in China. Methods: We extracted daily mortality data in 280 counties from the China Disease Surveillance Points system (DSPs) from January 2013 to December 2018. Daily concentrations of traffic-related PM2.5 and specific constituents were simulated using the Community Multiscale Air Quality (CMAQ) model. The downscaling and adjustment methods were carried out to generate a refined exposure assessment. We estimated the circulatory mortality risk using a standard two-stage approach, combining generalized linear model (GLM) with a quasi-Poisson distribution and random-effects meta-analysis. Results: We observed that traffic-related PM2.5 and specific constituents were significantly associated with increased circulatory mortality. An increase of interquartile range of traffic-related PM2.5, elemental carbon (EC), organic carbon (OC), and nitrate (NO3−) were associated with elevated circulatory mortality risks of 1.80 % (95 % confidence interval, CI: 1.27, 2.33), 1.85 % (1.33, 2.37), 1.42 % (0.90, 1.94), and 1.10 % (0.55, 1.66) at 3-day moving average (lag 0-2 days), respectively. We also found relatively high associations between traffic-related PM2.5 and EC exposures and cardiovascular mortality, and OC exposure and cerebrovascular mortality. Moreover, our stratified analysis demonstrated such mortality risks tended to be stronger in males, individuals age 65 years or older, and during the cold season. Conclusion: Our findings provided robust evidence on significant associations of traffic-related PM2.5 and specific constituents with circulatory mortality. Further emissions abatement from the transportation sector and corresponding pollutants should merit a particular focus in China.

Previous studies showed different risk effects on exposure of fine particulate matter (PM2.5) mass for cardiovascular disease (CVD) globally, which is likely due to different constituents of PM2.5. This study aimed to investigate the association between short-term exposure of PM2.5 constituents and hospital admissions of CVD. Daily counts of city-specific hospital admissions for CVD in 18 cities in China between 2014 and 2017 were extracted from the national Urban Employee Basic Medical Insurance database and the Beijing Municipal Commission of Health and Family Planning Information Center database. Directly measured PM2.5 constituents, including ions and polycyclic aromatic hydrocarbons, were collected by the Chinese Environmental Public Health Tracking system. We used the time-stratified case-crossover design to estimate the association between PM2.5 constituents and hospital admissions of CVD. Concentrations of ions accounted for the majority of the detected constituents. Excess risk (ER) of average ions concentrations for CVD was highest as 2.30% (95% CI: 1.62–2.99%) for NH4+, whose major sources are residential and agricultural emissions. This was followed by 1.85% (1.30–2.41%) for NO3- (generally from vehicles), 0.95% (0.28–1.63%) for SO42- (often from fossil fuel burning) respectively. The association for ions were generally consistent with ischemic heart disease (IHD) and ischemic stroke, e.g., NH4+ was associated with IHD (2.50%; 1.52–3.48%) and ischemic stroke (1.77%; 0.65–2.9%). For polycyclic aromatic hydrocarbons (PAHs), mainly from coal and vehicle-related oil combustion, the constituents were all associated with ischemic stroke but not for IHD. The ER for ischemic stroke was highest at 1.69% (0.99–2.39%) for indeno (123-cd) pyrene. Thus, in terms of the subtypes of CVD, the risks of hospital admissions varied with exposure to different PM2.5 constituents. Exposed to NH4+ had the highest risk to IHD and ischemic stroke, whereas PAHs were predominately associated with ischemic stroke only.

BackgroundMalaria burden is still worrisome, while empirical evidence from malaria-eliminated countries including China may provide inspiration for the world.ObjectiveThis study aimed to investigate China's malaria hospitalization costs and explore its determinants.MethodsStratified multistage sampling across provincial, municipal, and county hospitals was conducted in 2017. All the malaria medical records were retrieved from 2014 to 2016 in 70 hospitals. Parametric and non-parametric methods were employed to estimate hospitalization costs, and the non-parametric bootstrap was used to compare hospitalization costs among sample areas and assessed the uncertainty of its differences. Quantile regressions were conducted to identify the determinants of hospitalization costs.ResultsThe median hospitalization costs of 1633 malaria inpatients were 628 USD. Medication and laboratory tests accounted for over 70% of total expenditure. The median reimbursement rate was 41.87%, and this number was even lower in higher-level hospitals (

Objective: Traditional Chinese medicine (TCM) injection is widely used, but its adverse drug reaction (ADR) may be a serious public health concern in primary medical institutions. This research will explore the safety of TCM injections and provide clinical recommendations at the primary medical institutions.Method: ADR data were collected by the Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 were analized Descriptive statistics, chi-square analysis, binary logistic regression, and Mantel-haenszel hierarchical analysis were used to identify the risk factors associated with the rational use of TCM injections in primary medical institutions.Results: A total of 30,839 cases were collected in this study, 4905 cases (15.90%) were SADRs. Patients using TCM injections in primary medical institutions were more likely to cause SADRs (OR = 1.149, 95% CI: 1.061–1.245). Aged over 60 years (OR = 1.105, 95% CI: 1.007–1.212), non-essential drugs (OR = 1.292, 95% CI: 1.173–1.424), autumn (OR = 1.194, 95% CI: 1.075–1.326) and TCM injections with safflower (OR = 1.402, 95% CI: 1.152–1.706), danshen (OR = 1.456, 95% CI: 1.068–1.984) and medication reasons with chemotherapy (OR = 2.523, 95% CI: 1.182–5.386) and hypertension (OR = 1.495, 95% CI: 1.001–2.233) were more likely to suffer SADR in primary medical institutions.Conclusion: In general, the number of reported cases of TCM injection was declining over time, but the proportion of SADRs in primary medical institutions increased. In the future, it is necessary to continue to restrict TCM injections at the macro policy level, and vigorously promote the varieties in the essential drug list. At the micro level, it is necessary to intervene in specific populations, specific diseases and specific drugs, first start with them, step by step, and effectively prevent SADR occurrences in primary medical institutions.

Abstract Background This study aimed to reveal the effects of the connectedness of primary health care (PHC) workers in social networks on their job burnout. Methods Cross-sectional survey data of rural PHC workers in China were analyzed. A total of 663 respondents were enrolled. Chi-square and cumulative logistic regression were used to determine the effects of the connectedness of PHC workers in social networks on their job burnout. Results PHC workers in rural China had high levels of emotional exhaustion (24.1%), depersonalization (15.7%), and lack of personal accomplishment (34.7%). More than half of the participants were in the middle connectedness level in terms of their advisory (70.4%) and friendship (70.3%) networks. The degree of emotional exhaustion seemed to increase when participants had a low connectedness in their friendship networks (β = 0.769, 95% CI = 0.080–1.458, P = 0.029). Respondents with the middle level of connectedness in advisory networks had higher levels of depersonalization (β = 0.739, 95% CI = 0.130–1.348, P = 0.017) and lack of personal accomplishment (β = 0.583, 95% CI = 0.111–1.055, P = 0.015) than those with the high degree of connectedness in advisory networks. Conclusions The connectedness of PHC workers in social networks influenced their job burnout. Thus, organizations should establish an informal communication platform and information feedback mechanism, promote and manage friendship networks, and help PHC workers overcome emotional exhaustion. Managers should also encourage individuals with a high level of connectedness in advisory networks play the role of “opinion leader” so that they can help others mitigate burnout.

In this report, a series of novel piperidine-substituted thiophene[3,2-d]pyrimidine derivatives were designed to explore the hydrophobic channel of the non-nucleoside reverse transcriptase inhibitors binding pocket (NNIBP) by incorporating an aromatic moiety to the left wing of the lead K-5a2. The newly synthesized compounds were evaluated for anti-HIV potency in MT-4 cells and inhibitory activity to HIV-1 reverse transcriptase (RT). Most of the synthesized compounds exhibited broad-spectrum activity toward wild-type and a wide range of HIV-1 strains carrying single non-nucleoside reverse transcriptase inhibitors (NNRTI)-resistant mutations. Especially, compound 26 exhibited the most potent activity against wild-type and a panel of single mutations (L100I, K103N, Y181C, Y188L and E138K) with an EC50 ranging from 6.02 to 23.9 nmol/L, which were comparable to those of etravirine (ETR). Moreover, the RT inhibition activity, preliminary structure–activity relationship and molecular docking were also investigated. Furthermore, 26 exhibited favorable pharmacokinetics (PK) profiles and with a bioavailability of 33.8%. Taken together, the results could provide valuable insights for further optimization and compound 26 holds great promise as a potential drug candidate for the treatment of HIV-1 infection.

Abstract Background China launched the National Malaria Elimination Programme (NMEP) in 2010 and set the goal that all health facilities should be able to diagnose malaria. Additionally, hospitals at all levels could treat malaria by 2015. To provide a reference for the control of imported malaria, a study was conducted on the distribution of malaria patients seeking care in different types of health facilities. Methods There were two data sources. One was obtained through the Infectious Diseases Information Reporting Management System (IDIRMS), which only contained the name of health facilities and the number of cases. The other was obtained through multistage stratified cluster sampling. Descriptive statistical analysis was used to investigate the distribution of malaria patients attending different types of health facilities (hospitals, township hospitals, and Centers for Disease Control and Prevention), hospital tiers (county-level, prefecture-level, and provincial-level), and hospital levels (primary, secondary, and tertiary). Chi-square test was also used to compare the proportions of patients seeking care outside their current residence region between different types of hospitals. Point maps were drawn to visualize the spatial distribution of hospitals reporting malaria cases, and flow maps were created to show the spatial flow of malaria patients by using the ArcGIS software. Results The proportions of malaria patients who sought care in hospitals, township hospitals, and Centers for Disease Control and Prevention were 81.7%, 14.7%, and 3.6%, respectively. For those who sought care in hospitals, the percentages of patients who sought care in provincial-level, prefecture-level and county-level hospitals were 17.4%, 60.5% and 22.1%, correspondingly; the proportions of patients who sought care in tertiary hospitals, secondary hospitals, and primary hospitals were 59.8%, 39.9%, and 0.3%, respectively. Moreover, the proportions of patients seeking care in hospitals within county and prefectural administrative areas were 18.2%, 63.4%, respectively. Conclusion During the implementation of NMEP, malaria patients tended to seek care in tertiary hospitals and prefecture-level hospitals, and more than half of patients could be treated in hospitals in prefecture-level areas. In the current phase, it is necessary to establish referral system from county-level hospitals to higher-level hospitals for malaria treatment.

Introduction: Antipsychotic drugs are the main therapy for schizophrenia and have been widely used in mental disorder fields. However, the research on the safety of antipsychotic drugs in the real-world is rare. The purpose of this research is to evaluate the safety of antipsychotic drugs based on real-world data.Methods: ADR reports collected by the Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 were analyzed. We described the safety of antipsychotic drugs by descriptive analysis and four signal mining methods. Meanwhile, the risk factors for serious adverse reactions of antipsychotics were identified.Results: A total of 3363 ADR reports related to antipsychotics were included. We found that the number of adverse drug reaction reports and the proportion of serious adverse reactions have increased year by year from 2016 to 2020. Most adverse drug reactions occurred within 3 months after taking the medicine. The symptoms caused by typical antipsychotics and atypical antipsychotics were different and dyskinesia was more common in typical antipsychotics. Most patients improved or recovered after treatment or intervention while only one patient had sequelae. Low-level hospitals, psychiatric hospitals, youth, and old age could increase the risk of serious adverse reactions. Four off-label signals were found through signal mining, including amisulpride-pollakiuria, ziprasidone-dyspnoea, quetiapine-urinary incontinence, olanzapine-hepatic function abnormal.Conclusion: We found that most ADRs occurred within 3 months after taking the medicine, so close observation was required for patients during the first 3 months of treatment. The ADRs of antipsychotics involved multiple organ-system damages but were not serious. It might be recommended to take alternative drugs after a serious ADR occurred. The symptoms caused by typical APDs and atypical APDs were different. For patients with typical APDs, dyskinesia was more common and should be given special attention. Statistics showed that low-level hospitals, psychiatric hospitals, youth, and old age were risk factors for serious ADRs. The four off-label signals obtained by signal mining should be paid special attention, including amisulpride-pollakiuria, ziprasidone-dyspnoea, quetiapine-urinary incontinence, and olanzapine-hepatic function abnormal.

Background: Within China's hierarchical medical system, many patients seek medical care in different hospitals independently without integrated management. As a result, multi-hospital visiting is associated with fragmented service utilization and increased incidence of polypharmacy behaviors, especially for patients with chronic disease. It has been confirmed that factors from the perspective of patients may cause polypharmacy behaviors in Chinese community patients; whether having a usual primary care provider for chronic disease patients could reduce the polypharmacy behaviors and the effect size remains unanswered, and that is what our study aimed to answer.Methods: Our study adopted a cluster sampling method to select 1,196 patients with hypertension or diabetes and measured some information about them. The propensity score weighting method was adopted to eliminate the influence of confounding bias, and then a multivariate logistic regression model was conducted to test the relationship between having a usual primary care provider and polypharmacy behaviors.Results: Patients without usual primary care providers were significantly correlated with polypharmacy behaviors (OR = 2.40, 95%CI: 1.74–3.32, p

Introduction: Monoclonal antibody (mAb) is an important treatment option for cancer patients and has received widespread attention in recent years. In this context, a comparative safety evaluation of mAbs and traditional anticancer drugs in real-world is warranted.Methods: ADR reports submitted to Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 for individuals taking antineoplastic drugs were included. Data were analyzed with respect to demographic characteristics, disease types, polypharmacy, past history of ADRs, system organ class, name of suspected drugs per ADR report, severity, result, impact on the primary disease, and biosimilars.Results: A total of 15,910 ADR reports related to antineoplastic drugs were collected, 575 (3.61%) cases were related to mAbs. Female had more reports of ADRs than male. The ADRs of non-mAbs mainly occurred in 1–3 days after injection (4,929, 32.15%), whereas those of mAbs mainly occurred on the same day (297, 51.65%). Serious ADRs accounted for 30.26% (n = 174) of mAb-related reports and 34.46% (n = 5,285; four death cases) of non-mAb-related reports, respectively. A total of 495 (86.08%) reports were related to the branded drugs of mAbs. In general, our findings indicate that the female, the population aged 60–79 years, people with a single disease, people who have no ADRs in the past and people who have received treatment regimens were less likely to be affected by the primary disease after receiving mAbs therapy. The signal mining method produced 14 signals, only Sintilimab-Hepatic failure was off-label ADR.Conclusion: This study partly confirmed the safety profile of mAbs. It is unlikely to affect groups such as the female, the population aged 60-79 years, people with a single disease, people who have no ADRs in the past and people who have received treatment regimens. Combined drugs have little effect on the primary disease. By conducting signal mining method, 14 signals were produced, and only one of them was off-label ADR.

Ginseng is a perennial herb with a long growth cycle and is known to easily accumulate pesticides during its growth process, seriously threatening people's health. Therefore, to ensure safe consumption, it is necessary to detect and monitor pesticide residues in ginseng. In this study, a novel analysis method was established for simultaneous determination of 31 pesticides in ginseng by high-performance liquid chromatography-mass spectrometry. Ginseng samples were extracted using acetonitrile, cleaned up by primary secondary amine (PSA) solid-phase extraction column eluted with acetonitrile-toluene, and then detected in multiple reaction mode (MRM). The calibration curves of target compounds were linear in the range of 0.005–1.0 mg/L, with correlation coefficients greater than 0.9921. The limits of detection of all the pesticides in ginseng were between 4.4×10−5 and 1.6 × 10−2 mg/kg. For fresh ginseng, the average recoveries ranged from 72.1 to 111.6%, and the relative standard deviations were 1.3–12.2%. For dry ginseng, the average recoveries were 74.3–108.3%, and the relative standard deviations were 0.9–14.9%. The residual concentrations of some pesticides in real samples were greater than the maximum residue limit (MRL) for European Union (EU). The method established here is rapid and simple with high sensitivity and good reproducibility, which is sensitive in the residue analysis of many pesticides in ginseng.

Introduction: The prevalence of polypharmacy is gradually increasing in geriatrics, which may contribute to adverse effects, such as potential drug–drug and drug–disease interactions. These side effects remain an important challenge in patient safety, which has a significant impact on mortality and incidence rate.Aims: Therefore, this study aims to understand the epidemiology of polypharmacy and identify factors that have an impact on the management of potentially inappropriate prescribing.Methods: This study is a cross-sectional study, analyzing the prescription data from 720 hospitalized patients aged 50+ with a random cluster sampling method. We used inverse probability treatment weighting (IPTW) method to group and match polypharmacy and non-polypharmacy patients, and logistic regression was conducted to explore the factors associated with polypharmacy.Results: The prevalence of polypharmacy accounted for 50.14% among the old patients in this study. Female patients (67.34%) have more polypharmacy than male patients, and key predictors associated with polypharmacy in the logistic regression model included the following: domicile (AOR = 0.63, 95% CI 0.42–0.95), annual income (AOR = 0.38, 95% CI 0.20–0.70), the number of chronic diseases (AOR = 3.68, 95% CI 2.69–5.06), taking Chinese medicine (AOR = 1.70, 95% CI 1.22–2.36), decision involvement (AOR = 1.49 95% CI 1.10–2.03), and depression (AOR = 1.42, 95% CI 1.03–1.96).Conclusion: Polypharmacy is common among the participants with chronic diseases in Hubei province, China. The study emphasizes that gerontology practitioners should be prudent in applying clinical guidelines to provide personalized, comprehensive assessment of decision making of prescriptions, especially in socioeconomically deprived areas.

IntroductionAdverse drug reactions (ADRs) in pediatric cancer patients have not yet received due attention in the world. Antineoplastic drugs are frequently related to ADRs. Few studies focus on the ADR and the intervention measures in pediatric cancer patients.MethodsADR reports submitted to Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 for individuals aged from birth to 17 years (including 17 years) were included. Data were analyzed with respect to gender, age, disease types, past history of ADR, occurrence time of ADR, polypharmacy, route of administration, off-label drug use, name of suspected drugs per ADR report, and severity of ADR reports.ResultsA total of 431 ADR reports related to antineoplastic drugs in pediatric patients were collected, 31.55% were serious ADRs (SADRs). The median age of patients was six years (inter quartile range, IQR: 3-11), the age groups with higher reporting rates were concentrated in 1-3-year-olds (130). Past history of ADR, occurrence time of ADR and polypharmacy were statistically associated with SADR. Myelosuppression was the most frequent ADR (15.55%), cytarabine was the most frequent drug (26.22%). The signal mining method produced 14 signals, three signals were off-label ADRs.ConclusionsThis study described the characteristics of ADRs in pediatric cancer patients. By conducting signal mining method, three off-label ADRs need further study. We should pay more attention to these ADRs and develop relative management strategies. More researches are needed to achieve a better understanding of the characteristics of ADRs in pediatric cancer patients of China.

In this study, privileged boronic acid ester was introduced into the right wing of etravirine (ETR) to obtain a series of novel boronate-containing derivatives. These newly synthesized derivatives were evaluated for their anti-HIV potency in MT-4 cells using the MTT method, and their inhibitory activity to HIV-1 reverse transcriptase (RT) was assayed by the ELISA method. Most of the synthesized compounds displayed promising antiviral activity against the wild-type and a wide range of HIV-1 mutant strains. In particular, 4a exhibited the most potent activity against the wild-type and a panel of single mutations (L100I, K103N, Y181C, and E138K) with EC50 values ranging from 0.005 to 0.648 μM, which were much superior to those of nevirapine (EC50 = 0.151 μM). Moreover, 4b turned out to be an effective inhibitor against the double-mutant strains F227L + V106A and RES056 with EC50 values of 3.21 and 2.30 μM, respectively. RT inhibition activity and molecular docking were also investigated.

HIV-1 non-nucleoside reverse transcriptase inhibitors (NNRTIs) area key component of the current HIV-1 combination drug regimens. Although they exhibit potent anti-HIV-1 activity and modest toxicity, the emergence of mutant strains limits their application in clinical. Our previous research efforts contributed to the identification of compound K-5a2, which exhibits nanomolar activity in HIV-1-infected MT-4 cells. In this study, K-5a2 was shown to have a high level of anti-HIV-1 activity against various lab-adapted strains and clinical isolate strains, being comparable to ETR. Moreover, we showed the feasibility of K-5a2 as a preclinical anti-HIV-1 candidate by establishing its synergistic or additive anti-HIV-1 activity in combination with other representative anti-HIV-1 drugs and candidates. In addition, K-5a2 exhibited no inhibitory activity to the primary CYP isoforms and favorable pharmacokinetics. Taken together, its robust anti-HIV-1 potency, synergistic or additive effects with other anti-HIV drugs, and favorable pharmacokinetic and safety profiles make K-5a2 a potent alternative drug for HIV/AIDS treatment.

Background:Cancer poses a serious threat to one’s health, which caused significant economic burden on the family and society. Poor availability and affordability resulted in some essential medicines failing to meet the basic health needs of this group of patients. The objective of this study was to evaluate the availability, prices and affordability of 32 anticancer essential medicines in Hubei Province, China.Methods: Data on the availability and price related information of 32 essential anticancer medicines in the capital and five other cities of Hubei Province were collected. A total of 28 hospitals were sampled, which included 13 tertiary hospitals and 15 secondary hospitals. We used the standard methods developed by the World Health Organization and Health Action International to compare the differences in drug price, availability and affordability between secondary hospitals and tertiary hospitals.Results: Overall, the availability of medicine was higher in tertiary hospitals. The average availability of originator brand (OBs) was 13.70% (tertiary hospitals) VS 6.67% (secondary hospitals), and lowest-priced generic (LPGs) was 62.83% (tertiary hospitals) VS 42.92% (secondary hospitals). The MPR value of most sampled medicines in secondary hospitals were less than 1. In contrast, the MPR of Cytarabine (17.15), Oxaliplatin (12.73) were significantly higher than the international reference price. The top three OBs’ total expenses for 30-days treatment were Irinotecan, Oxaliplatin, Bicalutamide. Further, their affordability was relative low, as the costs for one course using these medicines were much higher than 20% of the minimum family monthly income.Conclusion: Though the “Zero Mark-Up” and “Centralized procurement policy of anti-tumor drugs” policies have been implemented in China, the availability issue yet to be addressed. High price and low affordability were the major barriers to the access of essential anticancer medicines. Measures should be taken to provide sufficient, available and affordable medicines to patients in need.

Abstract Background Community-based blood pressure (BP) monitoring plays an important role in national hypertension management in China. However, the utilisation of this service, together with its associations on hypertension treatment and BP control has not been fully investigated. Methods The study population was from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. Cross-sectional data of 2487 hypertensive persons were included as subjects. Stratified sample households were selected from 450 villages or communities of 150 counties from 28 provinces. Finally, 21,097 individuals were interviewed successfully. The main outcome was hypertension control (having average BP under 140-90 mmHg). The main independent variable was utilisation of community-based BP monitoring service (having BP examination once a season or more). The mediators were hypertension treatment (currently taking any antihypertensive medicine) and lifestyle factors (alcohol intake, physical activity, smoke). We performed chi-square and binary logistic regression to analyse associations of BP monitoring with hypertension treatment and blood pressure control. The mediation model was examined by the Sobel test. Results Mean age of the population was 64.2 (0.24). The percentage of males was 42.8%. Prevalence of community-based BP monitoring was 32.1%. Patients who used this service had higher odds of hypertension treatment (β = 1.259, P

As edge computing attains tremendous popularity, IoT devices always outsource their data to nearby edge servers for storing and pre-processing, which improves the efficiency of data processing and reduces the required network resources. For privacy-preserving, sensitive data is mostly encrypted before outsourcing. Nevertheless, large volumes of data in edge computing usually comes from multiple data sources, which means that they are encrypted with different secret keys, making it difficult for edge server to query and process. Existing solutions are mostly proposed for this problem in cloud computing, but they do not take into account that the limitations of computing and storage capabilities of edge devices will prevent them from performing computationally expensive operations. In this paper, we propose a lightweight privacy-preserving equality query scheme (LPEQ) in edge computing for the first time, which allows authorized users to perform equality query efficiently and privately on the encrypted data outsourced by multiple IoT devices. We also introduce a formal security model and prove that the LPEQ meets secure requirements against curious entities under this model. Meanwhile, our theoretical analyses and experimental evaluations demonstrate that the LPEQ performs better efficiency in terms of computation and communication while retaining privacy-preserving properties. Therefore, it is practical for applications in edge computing.

Objectives In order to understand the influencing factors of the medication-taking behaviour in patients with chronic diseases, reveal the deep-seated causes underlying the phenomenon of polypharmacy, explore the formation rules of the risk perception of polypharmacy and how risk perception affect the medication decision-making behaviour of patients with chronic diseases.Design A qualitative descriptive design was used. Study data were collected through semi-structured interviews with patients and physicians. We used the grounded theory approach to refine influencing factors, followed by interpretative structural modelling that analysed the interaction between these factors.Setting Patients from two hospitals, two nursing homes and two communities. Physicians from two community hospitals in Wuhan, China.Participants Patients with chronic diseases with high willingness to cooperate and good communication ability. Physicians with rich experience in the treatment of chronic diseases.Results Twenty-nine interviews were conducted (20 patients and 9 physicians). A total of 35 influencing factors of the medication-taking behaviours in patients with chronic diseases were extracted from the interview data, further integrated into 10 integrated influencing factors and ultimately clustered into three aspects: ‘medication benefit’, ‘medication risk’ and ‘medication strategy’. Medication risk can be divided into four specific dimensions: economic risk, physical risk, psychosocial risk and time risk. 10 integrated influencing factors constituted the interpretative structural model of the medication decision-making behaviours in patients with chronic diseases.Conclusions The causes underlying the medication decision-making behaviour of patients with chronic diseases are complex, involving a series of influencing factors such as their risk perception of the medication-taking behaviour. In order to alleviate the adverse effects of polypharmacy on patients’ health and medical costs, further safety measures should be proposed to improve the medication-taking behaviour in patients with chronic diseases based on the relationship and internal mechanism of the influencing factors of the medication decision-making behaviour.

Location data have great value for facility location selection. Due to the privacy issues of both location data and user identities, a location service provider can not hand over the private location data to a business or a third party for analysis or reveal the location data for jointly running data analysis with a business. In this paper, we propose a newly constructed PSI filter that can help the two parties privately find the data corresponding to the items in the intersection without any computations and, subsequently, we give the PSI filter generation protocol. We utilize it to construct three types of aggregate protocols for facility location selection with confidentiality. Then we propose a ciphertext matrix compressing method, making one block of cipher contain lots of plaintext data while keeping the homomorphic property valid. This method can efficiently further reduce the computation/communication cost of the query process—the improved query protocol utilizing the ciphertext matrix compressing method is given followed. We show the correctness and privacy of the proposed query protocols. The theoretical analysis of computation/communication overhead shows that our proposed query protocols are efficient both in computation and communication and the experimental results of the efficiency tests show the practicality of the protocols.

Abstract Background Etravirine (ETV) was approved as the second generation drug for use in individuals infected with HIV-1 in 2008 by the U.S. FDA with its unique antiviral activity, high specificity, and low toxicity. However, there are some shortcomings of the existing synthetic routes, such as the long reaction time and poor yield. Results This article describes our efforts to develop an efficient, practical, microwave-promoted synthetic method for one key intermediate of ETV, which is capable of being operated on a scale-up synthesis level. Through this optimized synthetic procedure, the amination reaction time decreased from 12 h to 15 min and the overall yield improved from 30.4 to 38.5%. Conclusion Overall, we developed a practical synthesis of ETV via a microwave-promoted method, and the synthetic procedure could be amenable to scale-up, and production costs could be significantly lowered.

Abstract Introduction Within China’s multi-tiered medical system, many patients seek care in higher-tiered hospitals without a referral by a primary-care provider. This trend, generally referred to as patient self-referral behavior, may reduce the efficiency of the health care system. This study seeks to test the hypothesis that having a usual primary care provider could reduce patients’ self-referral behavior. Methods We obtained medical records of 832 patients who were hospitalized for common respiratory diseases from township hospitals in Qianjiang District of Chongqing City during 2012–2014. Logit regressions were performed to examine the association between having a township hospital as a usual provider and self-referring to a county hospital after being discharged from a township hospital, while controlling for patients’ gender, age, income, education, severity of disease, distance to the nearest county hospital and the general quality of the township hospitals in their community. A propensity score weighting approach was applied. Results We found that having a usual primary care provider was associated with a lower likelihood of self-referral (odds ratio = 0.58, 95% confidence interval [CI] =0.41–0.82), and a 9% (95% CI: -14%, − 3%) reduction in the probability of patients’ self-referral behavior. Discussion/conclusion The results suggest that establishing a long-term relationship between patients and primary care providers may enhance the patient-physician relationship and reduce patients’ tendency for unnecessary use of medical resources.

Abstract Background Apart from its direct impact on public health and well-being, malaria had placed significant socioeconomic burden on both individuals and whole health systems. This study was conducted to investigate the hospitalization cost of malaria and explore the inter-province variation during the National Malaria Elimination Programme in China. Methods Information on medical expenditure for malaria treatment was extracted from inpatient medical records in Henan, Hainan and Guangxi Province. The costs were adjusted to the price in 2014 and converted to USD (United States Dollars). Non-parametric and parametric methods were employed to estimate hospitalization costs and non-parametric bootstrap method was used for the comparison of hospitalization costs among sample provinces and to estimate the uncertainty of differences in inter-province hospitalization costs. Results The hospitalization cost and daily cost of 426 malaria inpatients were 929.8 USD and 143.12 USD respectively. The average length of stay was 11.95 days. The highest cost of hospitalization services occurred in tertiary hospitals (956 USD per episode). Whereas the lowest ones occurred in internal departments (424 USD). Medications, laboratory tests and supportive resources for treatment were the most important components of hospitalization costs, respectively responsible for 45.31, 24.70, and 20.09% of the total hospitalization costs. The hospitalization cost per episode in Henan Province was significantly higher than that in Hainan an in Guangxi Province, with incremental costs of 713 USD (95% confidence interval 419.70, 942.50) and of 735.58 USD (95% CI 606.50, 878.00), respectively. The differences in the daily costs between Henan and Hainan along with Guangxi provinces were 75.33 USD (95% CI 40.33, 96.67) and 93.56 USD (95% CI 83.58, 105.28), respectively. Conclusions Although the prevalence of malaria cases has considerably declined, the direct hospitalization costs of malaria in the household remain high and the inter-province variations need to be seriously considered in the formulation the further interventions regarding hospitalization cost control. This study suggests that economic risk protection mechanisms targeting at malaria inpatients should be redesigned. The drug price addition policy in public hospitals should be gradually reformed or abolished coupling with increasing government subsidies along with the charges for treatment services to reduce the hospitalization cost. The policy for cost control in the provincial hospitals should be implemented in comparison with the policy in other provinces, where the status of economic and geography are similar.

Abstract Background The current stage of malaria elimination in China requires experienced local health workers with sufficient knowledge of malaria who help to keep the public health system vigilant about a possible resurgence. However, the influencing factors of local health workers’ knowledge level are not fully comprehended. This study aims to explore the factors with heavy impact on local health worker’s knowledge of malaria and propose corresponding suggestions. Methods Underpinned by stratified sampling method, a cross-sectional survey was carried out between November 2014 and April 2016. Chi square test was performed to identify the factors with potential influence on health workers’ knowledge level of malaria. Bivariate logistic regression was employed to explore the relationship between the predictors and local health workers’ knowledge level of malaria. Layered Chi square test was used to calculate the homogeneity of the interaction between training approaches and the percentage of participants with high-level knowledge. Results The endemic type of county and type of organization played the most significant role in influencing local health workers’ knowledge level regarding malaria in the sample population. The participants from Type 1 and Type 2 counties were 4.3 times (4.336 and 4.328, respectively) more likely to have high-level knowledge of malaria than those who work in Type 3 counties. The probability of having high-level knowledge amongst the participants from county-level facilities (county hospitals and CDCs) were more than 2.2 times higher than those who work in villages. Other socio-demographic factors, such as education and work experience, also affected one’s knowledge regarding malaria. Amongst the six most-used training approaches, electronic material (OR = 2.356, 95% CI 1.112–4.989), thematic series (OR = 1.784, 95% CI 0.907–3.508) and supervision (OR = 2.788, 95% CI 1.018–7.632) were proven with significant positive impact on local health workers’ knowledge of malaria. Conclusion Village doctors and who served in Type 3 counties were identified as the ones in urgent need of effective training. Three types of training approaches, including electronic material, thematic series and supervision, were proven to be effective in improving local health workers’ knowledge. Nevertheless, the coverage of these training approaches was still limited. This study suggests expanding the coverage of training, especially the three particular types of training, to local health workers, particularly to the target populations (village doctors and who served in Type 3 counties). Online training, small group discussion and targeted skill development may be the directions for the future development of training programmes.

This paper proposes and demonstrates a 31.25 Gbps two-dimensional eight level pulse amplitude modulation with trellis coded modulation (2D-PAM8-TCM) transmission in intensity modulation and direct detection based short reach system. In this system, the commercial directly modulated laser and photodiode with trans-impedance amplifier (PIN-TIA) with a combined modulation bandwidth of ~16 GHz are used as transmitter and receiver, respectively. For 2D-PAM8-TCM signals, except for regular 8-state convolutional encoder, both 16-state and 32-state encoders are provided. Considering the coding gain and the complexity of convolutional encoder, the 16-state one is recommended. Moreover, instead of Viterbi decoder, the M-algorithm is utilized at the receiver side to reduce decoder complexity. It is experimentally demonstrated that 2D-PAM8-TCM scheme can achieve 2.5 b per symbol and ~0.5 dB sensitivity improvement (bit error rate @3.8 × 10-3) over a 20 km standard single mode fiber in comparison with conventional PAM4. Thanks to no additional digital signal processing in receiver side except M-algorithm, this scheme is simple and effective, which can be considered as an attractive technique for future short reach system.

Introduction This study aimed to assess the prevalence of hypertension and to explore the disparities of its risk factors among urban and rural elderly. Method Data of hypertensive patients were collected from the China Health and Retirement Longitudinal Study (CHARLS) 2015. Stratified sample households were selected from 450 villages or communities of 150 counties from 28 provinces. Multivariable logistic regression was performed to analyze the factors correlated with hypertension. Results Prevalence of HBP was 47.6% (95% CI [45.2%–50.1%]) in total and it was close between urban and rural population (48.6% vs 47.2%). Factors associated with HBP were different between urban and rural areas. In urban areas, hypertension was significantly associated with literacy and diabetes in both genders, high BMI level and smoke quitters in males, and physical activity and dyslipidemia in females. In rural areas, hypertension was significantly associated with older age, higher BMI level in both males and females, and dyslipidemia in males. Conclusions The prevalence are about the same among urban and rural residents, but their risk factors vary from each other. Disparity in the risk factors between urban and rural population should be taken into consideration for further intervention.

Background Since 2009, community-based hypertension monitoring service (CBHMS) has been provided free of charge by the Chinese government as part of the national Essential Public Health Services (EPHS) policy. This study aimed to examine the disparity in the utilization of CBHMS between urban and rural community-dwelling middle-aged and older adults with hypertension. Methods Subjects were 3,479 community-residing hypertensive patients, identified from the China Health and Retirement Longitudinal Study (CHARLS), 2015, a nationally representative survey of Chinese residents aged 45 years and older. The utilization of CBHMS was defined as having one’s blood pressure (BP) examined at least once a season by community or village doctors. Rates of CBHMS use of urban and rural residents with hypertension were compared by using chi-square test. Multiple logistic regression analyses were conducted to examine factors associated with the utilization of CBHMS of hypertensive patients. Results CBHMS was significantly more likely to be used by rural than urban middle-aged and older residents with hypertension (38.6% vs. 25.1%, P

Background: This study aimed to identify the characteristics of item nonresponse and examine the factors affecting the refusal or failure to respond of patients with chronic disease in rural China. Methods: A cross-sectional survey data from patients with chronic disease from rural China were analyzed. A total of 1,099 patients were enrolled. Chi-square test and cumulative logistic regression determined the predictors of having item nonresponse. Results: The respondents in central provinces (OR = 2.311, 95%CI = 0.532~1.144, P < 0.001) with over eight household members (OR = 0.067, 95%CI = -1.632~-0.349, P = 0.002), multiple chronic diseases (OR = 0.301, 95%CI = -1.673~-0.727, P < 0.001), and low health knowledge level (OR = 2.112, 95%CI = 0.405~1.090, P < 0.001) had more item nonresponse numbers. Compared with the participants with high school education level and above, the item nonresponse number seemed to increase when the participants were illiterate (OR = 2.159, 95%CI = 0.254~1.285, P = 0.003), had primary school education (OR = 2.161, 95%CI = 0.249~1.294, P = 0.004) and junior school education (OR = 2.070, 95%CI = 0.160~1.296, P = 0.012). Conclusion: This study indicates the influencing factors of the item nonresponse in survey of patients with chronic disease in rural China. This study contributes to investigation practice and highlights that health institutions should improve the quality of follow-up services. Moreover, the government should pay more attention to the care of vulnerable groups, especially patients with chronic disease in rural areas.

BackgroundThe general benefit of physical activity (PA) to one's mental health has been widely acknowledged. Nevertheless, the specific type and amount of PA that associates with lower risk of depression in China awaits further investigation. The present study was conducted on middle- and older-aged Chinese population with two objectives: 1) to understand the patterns of PA; 2) to measure the associations between depression and PA at different levels from various aspects.MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS, 2015), we selected 9118 community residents aged 45 years and older. Depressive symptoms were measured by 10-item Center for Epidemiologic Studies (CES-D 10). Multivariate logistic regression model was performed to examine the association between risk of depression and PA from four aspects including intensity, frequency, duration, and volume.ResultsSpending 1-2 days/week (OR = 0.58, 95% CI: 0.36, 0.91), less than 30 minutes each time (OR = 0.66, 95% CI: 0.42, 1.03) or 150-299 min/week (OR = 0.49, 95% CI: 0.28, 0.87) on Moderate Physical Activity (MPA) was associated with lower odds of depression in women. Spending 3-5 days/week (OR = 1.98, 95% CI: 1.29, 3.05) or 6-7 days/week (OR = 1.50, 95% CI: 1.07, 2.11), 4 hours and longer each time (OR = 1.65, 95% CI: 1.18, 2.32), 300 min/week or longer (OR = 1.65, 95% CI: 1.22, 2.24) on Vigorous Physical Activity (VPA) in total, or 2250 Metabolic Equivalent of Task (OR = 1.73, 95% CI: 1.26, 2.38) on Moderate-to-Vigorous PA was associated with higher risk of depression in men.ConclusionsThe association between depression and PA depended largely on intensity and gender. Lower frequency, shorter duration, and moderate amount of MPA was associated with lower risk of depression in women. Risk of depression was higher in men who spent higher frequency, longer duration, and overlong time on VPA.

A novel three-dimensional (3D) elliptical vibration turning device which is on the basis of the leaf-spring-flexure-hinges-based (LSFH-based) double parallel four-bar linkages (DPFLMs) has been proposed. In order to evaluate the performance of the developed 3D elliptical vibration cutting generator (EVCG), the off-line tests were carried out to investigate the stroke, dynamic performance, resolution, tracking accuracy and hysteresis along the three vibration axes. Experimental results indicate that the maximum stroke of three vibration axes can reach up to 26 μm. The working bandwidth can reach up to 1889 Hz. The resolution and hysteresis tests show that the developed 3D EVCG has a good tracking accuracy, relative high resolution and low hysteresis, which is appropriate for micro/nano machining. Kinematical modeling is carried out to investigate the tool vibration trajectory. Experimental results shown that the simulation results agree well with the experimental one, which indicate that the developed 3D EVCG can be used as an option for micro/nano machining.

BACKGROUND: In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance. METHODS: The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region. RESULTS: China's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%. CONCLUSIONS: The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.