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BackgroundDespite increasing awareness, silica dust–induced silicosis still contributes to the huge disease burden in China. Worryingly, recent silica dust exposure levels and silicosis risk in Chinese noncoal mines remain unclear. ObjectiveWe aimed to determine recent silica dust exposure levels and assess the risk of silicosis in Chinese noncoal mines. MethodsBetween May and December 2020, we conducted a retrospective cohort study on 3 noncoal mines and 1 public hospital to establish, using multivariable Cox regression analyses, prediction formulas of the silicosis cumulative hazard ratio (H) and incidence (I) and a cross-sectional study on 155 noncoal mines in 10 Chinese provinces to determine the prevalence of silica dust exposure (PDE), free silica content, and total dust and respirable dust concentrations. The qualitative risk of silicosis was assessed using the International Mining and Metals Commission’s risk-rating table and the occupational hazard risk index; the quantitative risk was assessed using prediction formulas. ResultsKaplan-Meier survival analysis revealed significant differences in the silicosis probability between silica dust–exposed male and female miners (log-rank test χ21=7.52, P=.01). A total of 126 noncoal mines, with 29,835 miners and 4623 dust samples, were included; 13,037 (43.7%) miners were exposed to silica dust, of which 12,952 (99.3%) were male. The median PDE, free silica content, total dust concentration, and respirable dust concentration were 61.6%, 27.6%, 1.30 mg/m3, and 0.58 mg/m3, respectively, indicating that miners in nonmetal, nonferrous metal, small, and open-pit mines suffer high-level exposure to silica dust. Comprehensive qualitative risk assessment showed noncoal miners had a medium risk of silicosis, and the risks caused by total silica dust and respirable silica dust exposure were high and medium, respectively. When predicting H and I over the next 10, 20, and 30 years, we assumed that the miner gender was male. Under exposure to current total silica dust concentrations, median I10, I20, and I30 would be 6.8%, 25.1%, and 49.9%, respectively. Under exposure to current respirable silica dust concentrations, median I10, I20, and I30 would be 6.8%, 27.7%, and 57.4%, respectively. These findings showed that miners in nonmetal, nonferrous metal, small, and open-pit mines have a higher I and higher qualitative silicosis risk. ConclusionsChinese noncoal miners, especially those in nonmetal, nonferrous metal, small, and open-pit mines, still suffer high-level exposure to silica dust and a medium-level risk of silicosis. Data of both total silica dust and respirable silica dust are vital for occupational health risk assessment in order to devise effective control measures to reduce noncoal mine silica dust levels, improve miners’ working environment, and reduce the risk of silicosis.

Abstract Post-stroke depression is commonly experienced by stroke survivors and has a significant negative impact on the physical, cognitive, and social functioning of those affected. This study aims to investigate the prevalence of depressive symptoms and their associated factors in Chinese stroke patients. Research samples were selected from the China Health and Retirement Longitudinal Study 2018 survey. Depression was evaluated using the 10-item Center for Epidemiological Studies Depression Scale, with a score ≥ 10 defined as depression. Univariate and multivariable analyses were performed to examine the associations of depressive symptoms with demographics, family relationships, health status, and lifestyle. A total of 963 stroke patients were included and 57.8% of them had depressive symptoms. Depressive symptoms were significantly associated with female sex (OR 1.762, 95% CI 1.235–2.514), lower education level (non-formal education: OR 2.148, 95% CI 1.235–3.737, primary to secondary school education: OR 1.964, 95% CI 1.272–3.033), dissatisfaction with spouse (OR 1.912, 95% CI 1.075–3.401), dissatisfaction with life (OR 1.779, 95% CI 1.080–2.931), dissatisfaction with health (OR 1.592, 95% CI 1.138–2.226), pain (OR 1.392, 95% CI 1.005–1.928) and abnormal sleep (OR 1.557, 95% CI 1.126–2.152). The findings suggest the need for regular depression screening and evaluation after a stroke, and that a well-functioning support system, effective health management, and lifestyle modifications could potentially improve the mental state of stroke patients.

ObjectiveThe aging Chinese population is driving up health care costs, with hospitalizational accounting for a large portion of total health care costs. By 2012, hospitalization costs for people over 60 years of age exceeded outpatient costs, marking a change in the allocation of medical resources. Further research is needed on the factors influencing changes in hospitalizational costs and burden. This paper examines the costs and burden of hospitalization for older adults from a micro perspective, providing new evidence to explain how social, medical, family, personal, and geographic factors affect them.MethodsUtilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a linear regression model was constructed to investigate the impact of various factors on the hospitalization costs and burden among the older adult in China. To ensure the heterogeneity of the results, the sample was divided into subgroups based on different regions for comparative analysis. Additionally, collinearity among the variables was examined.ResultsThe average hospitalization costs for the older adult are $1,199.24, with a burden score of 0.5. Residence, type of chronic diseases, region, family size, type of health service facility, received distance, smoke and alcoholic significantly affect the out-of-pocket expenses for older adult hospitalizations. In terms of the burden of hospitalization for the older adult, Residence, health insurance, education, type of chronic diseases, region, family size, ethnic, type of health service facility, received distance, smoke, alcoholic and pension significantly impact the hospitalization burden for the older adult.ConclusionThis paper provides a new perspective to explain the factors influencing hospitalizational costs and burden in China. The policy recommendations include expanding health insurance coverage and promoting commercial insurance to enhance the accessibility and financial security of healthcare services. Strengthening primary care is suggested to reduce the burden on hospitals and lower the overall cost of hospitalization. Policies aimed at addressing regional healthcare disparities are proposed, along with targeted support for vulnerable groups, including subsidies and culturally sensitive services.

BackgroundFew studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. ObjectiveOur study aimed to investigate the association between inequalities in pain and all-cause mortality in China. MethodsLongitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model. ResultsA total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36%), and the common pain locations were the waist (3232/16,747, 19.3%), legs (2476/16,747, 14.78%) and head (2250/16,747, 13.44%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index –0.066, 95% CI –0.078 to –0.054). Educational level (36.49%), location (36.87%), and economic status (25.05%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95% CI 1.06-1.61). ConclusionsThe prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions.

Objective: To investigate the prevalence of subthreshold depression among Chinese college students and to explore the related factors. Methods: The research subjects were Chinese college students participating in the “2022 Psychology and Behavior Investigation of Chinese Residents (PBICR-2022)''. Data on respondents' general characteristics, quality of life, perceived pressure, family communication, perceived social support, self-efficacy, and depression status were gathered. To investigate the association between each variable and the risk of subthreshold depression, statistical analyses, including chi-square tests and rank sum tests were conducted. Furthermore, a binary stepwise logistic regression was employed to establish the regression model of the factors related to subthreshold depression among Chinese college students. Results: A prevalence of subthreshold depression of about 39.7 % was found among the 8934 respondents. Logistic regression analysis revealed that respondents who are female, have chronic diseases, are in debt, experience significant impacts from epidemic control policies, have lower self-assessed quality of life, experience challenges in family communication, perceive lower social support, have lower self-efficacy, and feel higher perceived pressure are more likely to develop subthreshold depression compared to the control group. (P

Lonicerae japonicae flos (LJF) and Lonicerae flos (LF) are traditional Chinese herbs that are commonly used and widely known for their medicinal properties and edibility. Although they may have a similar appearance and vary slightly in chemical composition, their effectiveness as medicine and their use in clinical settings vary significantly, making them unsuitable for substitution. In this study, a novel 2 × 3 six-channel fluorescent sensor array is proposed that uses machine learning algorithms in combination with the indicator displacement assay (IDA) method to quickly identify LJF and LF. This array comprises two coumarin-based fluorescent indicators (ES and MS) and three diboronic acid-substituted 4,4′-bipyridinium cation quenchers (Q1–Q3), forming six dynamic complexes (C1–C6). When these complexes react with the ortho-dihydroxy groups of phenolic acid compounds in LJF and LF, they release different fluorescent indicators, which in turn causes distinct fluorescence recovery. By optimizing eight machine learning algorithms, the model achieved 100% and 98.21% accuracy rates in the testing set and the cross-validation predictions, respectively, in distinguishing between LJF and LF using Linear Discriminant Analysis (LDA). The integration of machine learning with this fluorescent sensor array shows great potential in analyzing and detecting foods and pharmaceuticals that contain polyphenols.

BackgroundThe hierarchical medical system is an important measure to promote equitable healthcare and sustain economic development. As the population’s consumption level rises, the demand for healthcare services also increases. Based on urban and rural perspectives in China, this study aims to investigate the effectiveness of the hierarchical medical system and its relationship with economic development in China.Materials and methodsThe study analyses panel data collected from Chinese government authorities, covering the period from 2009 to 2022. According to China’s regional development policy, China is divided into the following regions: Eastern, Middle, Western, and Northeastern. Urban and rural component factors were downscaled using principal component analysis (PCA). The factor score formula combined with Urban–rural disparity rate (ΔD) were utilized to construct models for evaluating the effectiveness of the hierarchical medical system from an urban–rural perspective. A Vector Autoregression model is then constructed to analyze the dynamic relationship between the effects of the hierarchical medical system and economic growth, and to predict potential future changes.ResultsThree principal factors were extracted. The contributions of the three principal factors were 38.132, 27.662, and 23.028%. In 2021, the hierarchical medical systems worked well in Henan (F = 47245.887), Shandong (F = 45999.640), and Guangdong (F = 42856.163). The Northeast (ΔDmax = 18.77%) and Eastern region (ΔDmax = 26.04%) had smaller disparities than the Middle (ΔDmax = 49.25%) and Western region (ΔDmax = 56.70%). Vector autoregression model reveals a long-term cointegration relationship between economic development and the healthcare burden for both urban and rural residents (βurban = 3.09, βrural = 3.66), as well as the number of individuals receiving health education (β = −0.3492). Both the Granger causality test and impulse response analysis validate the existence of a substantial time lag between the impact of the hierarchical medical system and economic growth.ConclusionResidents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. The urban rural disparity in the hierarchical medical system is associated with the level of economic development of the region. When formulating policies for economically relevant hierarchical medical systems, it is important to consider the impact of longer lags.

Abstract In this letter, the authors develop a wide‐angle Fresnel infrared lens for detecting temperature inside closed switchgear. Based on the structural characteristics of closed switchgear, a frame structure for the lens and a single‐sided installation method were devised. A field test was conducted to simulate temperature diagnosis and monitoring. The results indicate that the lens described in this letter enables satisfactory observation of the internal temperature of closed high‐voltage switchgear.

Abstract In this study, a 34‐MW tubular hydro‐generator was selected as the study example. For the electromagnetic field–circuit coupling analysis model, the effects of the ideal DC voltage and current sources (i.e. two models of the rotor excitation power supply) on the no‐load voltage waveform quality and the damper winding loss calculation results were studied by considering the influence of the electromagnetic induction of the rotor excitation winding. The obtained results provide direct and effective theoretical support and technical reference for improving the accuracy and rationality of the calculation results of the electromagnetic performance parameters and the analysis, design, manufacturing and operating level of such generators.

The PB2 subunit of the RNA polymerase of influenza virus antagonizes interferon signalling. Here, the authors biochemically characterise the molecular interactions that mediate this, and how this impacts viral replication in the context of different influenza subtypes.

Abstract Background Understanding the intention of receiving COVID-19 vaccines is important to inform effective vaccination strategies. This study aimed to investigate such intention, identify the key influencing factors, and determine the most important intention predictors using a theoretically principled model. Methods An online, cross-sectional survey method was implemented in Macao in May 2021. People aged 18 years or above and residing in Macao for 12 months prior to the study were recruited through social media. Intention to receive COVID-19 vaccines and the main constructs of the protection motivation theory and the health belief model were the main measures encompassing threat appraisal, intrapersonal characteristics, cues to action, coping appraisal, past experiences and information seeking behavior. Descriptive statistics, Pearson correlation and multiple linear regression were used for data analysis. Results A total of 552 valid responses were received. Among the respondents, 79.5% aged between 25 and 54 years old, 59.4% were female, and 88% had a bachelor degree or above; 62.3% of the respondents indicated their intention to receive COVID-19 vaccination while 19.2% were hesitant and 18.5% did not have any intention. While 67.0% believed COVID-19 infection was life-threatening, only 19.0% thought they were at risk of getting infected. Control variables such as age, gender, education level, and having travel plans were significantly correlated with intention. Significant associations between intention with perceived severity, perceived susceptibility, maladaptive response reward, self-efficacy, response-efficacy, response cost, social attitude, social norm, past experience and information seeking behavior were identified (P

Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women of reproductive age and features complex pathological symptoms and mechanisms. Existing medical treatments have, to some extent, alleviated the deterioration of PCOS. However, these strategies only temporarily control symptoms, with a few side effects and no preventive effect. Phytochemicals extracted from medicinal herbs and plants are vital for discovering novel drugs. In recent years, many kinds of research have proven that phytochemicals isolated from traditional Chinese medicine (TCM) and medicinal plants show significant potential in preventing, alleviating, and treating PCOS. Nevertheless, compared to the abundance of experimental literature and minimal specific-topic reviews related to PCOS, there is a lack of systematic reviews to summarize these advancements in this promising field. Under this background, we systematically document the progress of bioactive phytochemicals from TCM and medicinal plants in treating PCOS, including flavonoids, polyphenols, and alkaloids. According to the literature, these valuable phytochemicals demonstrated therapeutic effects on PCOS supported by in vivo and in vitro experiments, mainly depending on anti-inflammatory, antioxidation, improvement of hormone disorder and insulin resistance (IR), and alleviation of hyperinsulinemia. Based on the current progress, future research directions should emphasize 1) exploring bioactive phytochemicals that potentially mediate bone metabolism for the treatment of PCOS; 2) improving unsatisfactory bioavailability by using advanced drug delivery systems such as nanoparticles and antibody-conjugated drugs, as well as a chemical modification; 3) conducting in-depth research on the pathogenesis of PCOS to potentially impact the gut microbiota and its metabolites in the evolution of PCOS; 4) revealing the pharmacological effects of these bioactive phytochemicals on PCOS at the genetic level; and 5) exploring the hypothetical and unprecedented functions in regulating PCOS by serving as proteolysis-targeting chimeras and molecular glues compared with traditional small molecule drugs. In brief, this review aims to provide detailed mechanisms of these bioactive phytochemicals and hopefully practical and reliable insight into clinical applications concerning PCOS.

BackgroundThe maldistributions of the health workforce showed great inconsistency when singly measured by population quantity or geographic area in China. Meanwhile, earlier studies mainly employed traditional econometric approaches to investigate determinants for the health workforce, which ignored spillover effects of influential factors on neighboring regions. Therefore, we aimed to analyze health workforce allocation in China from demographic and geographic perspectives simultaneously and then explore the spatial pattern and determinants for health workforce allocation taking account of the spillover effect.MethodsThe health resource density index (HRDI) equals the geometric mean of health resources per 1,000 persons and per square kilometer. First, the HRDI of licensed physicians (HRDI_P) and registered nurses (HRDI_N) was calculated for descriptive analysis. Then, global and local Moran's I indices were employed to explore the spatial features and aggregation clusters of the health workforce. Finally, four types of independent variables were selected: supportive resources (bed density and government health expenditure), healthcare need (proportion of the elderly population), socioeconomic factors (urbanization rate and GDP per capita), and sociocultural factors (education expenditure per pupil and park green area per capita), and then the spatial panel econometric model was used to assess direct associations and intra-region spillover effects between independent variables and HRDI_P and HRDI_N.ResultsGlobal Moran's I index of HRDI_P and HRDI_N increased from 0.2136 (P = 0.0070) to 0.2316 (P = 0.0050), and from 0.1645 (P = 0.0120) to 0.2022 (P = 0.0080), respectively. Local Moran's I suggested spatial aggregation clusters of HRDI_P and HRDI_N. For HRDI_P, bed density, government health expenditure, and GDP had significantly positive associations with local HRDI_P, while the proportion of the elderly population and education expenditure showed opposite spillover effects. More precisely, a 1% increase in the proportion of the elderly population would lead to a 0.4098% increase in HRDI_P of neighboring provinces, while a 1% increase in education expenditure leads to a 0.2688% decline in neighboring HRDI_P. For HRDI_N, the urbanization rate, bed density, and government health expenditure exerted significantly positive impacted local HRDI_N. In addition, the spillover effect was more evident in the urbanization rate, with a 1% increase in the urbanization rate relating to 0.9080% growth of HRDI_N of surrounding provinces. Negative spillover effects of education expenditure, government health expenditure, and elderly proportion were observed in neighboring HRDI_N.ConclusionThere were substantial spatial disparities in health workforce distribution in China; moreover, the health workforce showed positive spatial agglomeration with a strengthening tendency in the last decade. In addition, supportive resources, healthcare needs, and socioeconomic and sociocultural factors would affect the health labor configuration not only in a given province but also in its nearby provinces.

Macau, Hong Kong and Singapore are all facing increasing population aging. Those aged 65 and over make up the old-age population. The working-age population refers to the population aged 15 to 64. Conventionally, the burden of population aging is measured by the Old-Age Dependency Ratio, which is the ratio of the old-age population to the working-age population. As life expectancy rises, depending exclusively on age to calculate the burden of aging hinders the development of effective anti-aging strategies. The working-age population's education and the elderly's health affect the aging burden's support and generator, respectively. Including them in the calculation gives us a fuller view of the burden of aging.ObjectiveTo compare the population aging burden in Macau, Hong Kong, and Singapore by including working-age population education and elderly health.MethodsThe overall, working-age and old-age population and proportion, as well as the Old-Age Dependency Ratio of Macau, Hong Kong, and Singapore, were collected from the World Bank database. The life expectancy at 65 was extracted from the 2022 World Population Prospect. The tertiary education rate of the working-age population and the self-rated health status of the old-age population were retrieved from governments' statistical reports. We then calculated the Education-Health Adjusted Old-Age Dependency Ratio, a set of four equations showing the support of the working-age population on the old-age population, where OADRh_t and OADRuh_t represent the burden of healthy and unhealthy old-age population on the working-age population with tertiary education; similarly, OADRh_nt and OADRuh_nt indicate the burden placed on the working-age population without tertiary education by healthy and unhealthy old-age population. Lastly, for comparison with the conventional Old-Age Dependency Ratio, we generated the Weighted Education-Health Adjusted Old-Age Dependency Ratio.ResultsHong Kong has the greatest old-age population proportion and Old-Age Dependency Ratio, yet its growth rates are moderate and stable, ranging from 0 to 4% and 0 to 6%, respectively. Macau and Singapore experienced sharper changes in old-age population proportion and the Old-Age Dependency Ratio, with Macau's Old-Age Dependency Ratio varying between −2.66 and 8.50% and Singapore's ranging from −1.53 to 9.70%. Three cities showed different patterns in four Education-Health Adjusted Old-Age Dependency Ratio indicators. In Macau, the OADRh_nt and OADRuh_nt increased by 0.4 and 6.2, while the OADRh_t and OADRuh_t decreased by 13.5 and 15.3 from 2004 to 2016. In Hong Kong, only the OADRuh_t fell by 9.4, and the other three increased from 2003 to 2015. In Singapore, the OADRh_nt and OADRh_t increased by 3.8 and 1.0, while OADRuh_nt and OADRuh_t decreased by 1.2 and 3.9 from 2007 to 2011. The Weighted Education-Health Adjusted Old-Age Dependency Ratios are all smaller than the conventional Old-Age Dependency Ratio in the three regions, particularly in Singapore. The Weighted Education-Health Adjusted Old-Age Dependency Ratio of Singapore was reduced by 9.5 to 30.5% compared with the conventional Old-Age Dependency Ratio, that of Hong Kong reduced by 6.2 to 22.5%, and that of Macau reduced by 4.4 to 16.1%.ConclusionThis is the first study to compare the aging burden in Macau, Hong Kong, and Singapore in connection to working-age population education and elderly health. With the new assessment, the burden of population aging in three regions has been reduced, showing that improving the education of the working-age population and maintaining older people's wellbeing can assist authorities to deal with population aging, especially in Macau and Hong Kong.

Background: Metastatic colorectal cancer (mCRC) imposes a heavy tumor burden worldwide due to limited availability of therapeutic drugs. Aflibercept, a kind of recombinant protein of the anti-vascular endothelial growth factor (VEGF) family, has been approved in clinical application among mCRC patients since 2012. A comprehensive analysis of the efficacy, safety, and cost-effectiveness of aflibercept in mCRC treatment is necessary.Objective: To evaluate the efficacy, safety, and cost-effectiveness of aflibercept for the treatment of mCRC in order to provide a decision-making reference for the selection of targeted drugs for second-line treatment of mCRC in Hong Kong, Macao, and Taiwan regions of China and the selection of new drugs for medical institutions in these regions.Methods: A systematic retrieve on databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu, as well as relevant websites and databases of health technology assessment including the National Institute of Health and Clinical Optimization, Centre for Evaluation and Communication at the University of York, and the Canadian Agency for Medicines and Health Technology, was conducted. The literature was screened according to the inclusion and exclusion criteria, and data were extracted and analyzed by two authors, while the quality of the literature was assessed.Results: Finally, we included two HTA reports, 11 systematic reviews/meta-analyses, and two cost-effectiveness studies in the rapid health technology assessment. For mCRC patients receiving second-line treatment, aflibercept combined with FOLFIRI significantly increased progression-free survival (PFS) and overall survival (OS) and the objective response rate (ORR) also improved, compared with folinic acid + fluorouracil + irinotecan (FOLFIRI). In terms of safety, mCRC patients who received aflibercept combined with FOLFIRI therapy had a higher incidence of grade 3–4 adverse events than those who received FOLFIRI alone, including anti-VEGF–related adverse events (hypertension, hemorrhagic events, and proteinuria) and chemotherapy-related adverse events (diarrhea, weakness, stomatitis, hand-foot syndrome, neutropenia, and thrombocytopenia). In terms of cost-effectiveness, two economic studies conducted in the United Kingdom and Japan, respectively, found that compared with FOLFIRI, aflibercept combined with FOLFIRI had no cost-effectiveness advantage in mCRC patients receiving second-line treatment.Conclusion: Compared with FOLFIRI treatment, aflibercept combined with FOLFIRI for the second-line treatment of mCRC patients has better efficacy, worse safety, and is not cost-effective. More high-quality clinical studies are required for further exploration of aflibercept’s clinical value. Medical institutions in Hong Kong, Macao, and Taiwan regions of China should be cautious when using or introducing aflibercept plus FOLFIRI as a mCRC treatment.

Abstract Background Due to the increasing ageing population, neurocognitive disorders (NCDs) have been a global public health issue, and its prevention and early diagnosis are crucial. Our previous study demonstrated that there is a significant correlation between specific populations and NCDs, but the biological characteristics of the vulnerable group predispose to NCDs are unclear. The purpose of this study is to investigate the predictors for the vulnerable group by a multi‐omics analysis. Methods Multi‐omics approaches, including metagenomics, metabolomic and proteomic, were used to detect gut microbiota, faecal metabolites and urine exosome of 8 normal controls and 13 vulnerable elders after a rigorous screening of 400 elders in Macao. The multi‐omics data were analysed using R and Bioconductor. The two‐sided Wilcoxon's rank‐sum test, Kruskal–Wallis rank sum test and the linear discriminant analysis effective size were applied to investigate characterized features. Moreover, a 2‐year follow‐up was conducted to evaluate cognitive function change of the elderly. Results Compared with the control elders, the metagenomics of gut microbiota showed that Ruminococcus gnavus, Lachnospira eligens, Escherichia coli and Desulfovibrio piger were increased significantly in the vulnerable group. Carboxylates, like alpha‐ketoglutaric acid and d‐saccharic acid, and levels of vitamins had obvious differences in the faecal metabolites. There was a distinct decrease in the expression of eukaryotic translation initiation factor 2 subunit 1 (eIF2α) and amine oxidase A (MAO‐A) according to the proteomic results of the urine exosomes. Moreover, the compound annual growth rate of neurocognitive scores was notably decreased in vulnerable elders. Conclusions The multi‐omics characteristics of disturbed glyoxylate and dicarboxylate metabolism (bacteria), vitamin digestion and absorption and tricarboxylic acid cycle in vulnerable elders can serve as predictors of NCDs risk among the elderly of Macao. Intervention with them may be effective therapeutic approaches for NCDs, and the underlying mechanisms merit further exploration.

ObjectiveTo explore the influence of parents on the medication adherence of their children.Study DesignA cross-sectional online investigation.MethodsA questionnaire with 41 questions was designed based on the health belief model (HBM) distributed and collected online in 28 cities around China through multi-stage stratified sampling. The reliability of the questionnaire was assessed with Cronbach's α coefficient and split-half reliability, and its validity was evaluated with exploratory factor analysis and content validity index. The structural equation model (SEM) was constructed to explore the relationship between the parents' health beliefs and their children's medication adherence. Subgroup analysis was conducted to study the differences between parents with different demographic characteristics (male and female, rural and urban).Results573 questionnaires were included for analysis, with an effective rate of 62.97%. The Cronbach'α coefficient of the questionnaire was 0.821 > 0.6, the split-half reliability was 0.651 > 0.6, the I-CVI of each dimension were >0.78, and the S-CVI/AVE (I-CVI average) was 0.95 > 0.9. The result of the questionnaire exploratory factor analysis met the standard. According to the SEM, self-efficacy (λ = 0.177), perceived susceptibility (λ = −0.244), and perceived severity (λ = 0.243) were direct influencing factors of children's medication adherence. In the subgroup analysis, the model established by each subgroup was consistent with the model established by the overall sample. The absolute values of females' perceived susceptibility, severity, and self-efficacy for their children's medication adherence path coefficients were higher than males'.ConclusionParents' perceived severity and self-efficacy may positively impact on their children's medication adherence, while parents' susceptibility to children's medication non-adherence may negatively impact on children's medication adherence. Objective constraints, perceived barriers, and benefits may in directly impact on children's medication adherence. Women's health beliefs appear to have a more significant impact on their children's medication adherence than men's. It may be an effective strategy to increase their children's medication adherence by improving parents' health beliefs. Medical staff should explain medication adherence knowledge to the parents of children, and inform the children of the possible consequences of non-adherence with medication, to improve the subjective perception of parents on the severity of children's non-adherence with medication, and improve parents' self-efficacy in rational medication for children. In addition, attention should be paid to the mental health of the parents, and more social and psychological support.

BackgroundTo explore the prevalence and inequality of cognitive impairment among older adults in Macau and the contributions of influencing factors to inequality in cognitive impairment.MethodsThe Montreal Cognitive Assessment (MoCA) was used to measure the prevalence of cognitive impairment. Socioeconomic status scores were used to describe economic level of the subjects. The concentration index was applied to measure the inequality of cognitive impairment associated with socioeconomic status (SES) and decomposed into its influencing factors.ResultsThe prevalence of cognitive impairment was 44.35% in Macau. The concentration index of cognitive impairment among the elderly was −0.165 (95% CI: −0.232 to −0.098), indicating that the prevalence of cognitive impairment was concentrated in households with poor SES. Older age, poor SES, long or short sleep duration, other marital status, poor appetite, no tea/coffee drinking, no religious belief, and depression contributed positively to the inequality of cognitive impairment. Among these factors, SES made the largest contribution to inequality, accounting for 76.74%.ConclusionIn Macau, the prevalence of cognitive impairment among people aged 65 years and older is concentrated among those who are in poor economic conditions. Reducing the gap between the rich and the poor at the source, increasing educational level of low SES population and improving their access to healthcare services will help to improve the inequity of cognitive impairment.

Abstract Anti‐perovskites X3BA, as the electrically inverted derivatives of perovskites ABX3, have attracted tremendous attention for their good performances in multiple disciplines, especially in energy storage batteries. The Li/Na‐rich antiperovskite (LiRAP/NaRAP) solid‐state electrolytes (SSEs) typically show high ionic conductivities and high chemical/electrochemical stability toward the Li‐metal anode, illustrating their great potential for applications in the Li‐metal batteries (LMBs) using nonaqueous liquid electrolyte or all‐solid‐state electrolyte. The antiperovskites have been studied as artificial solid electrolyte interphase for Li‐metal anode protection, film SSEs for thin‐film batteries, and low melting temperature solid electrolyte enabling melt‐infiltration for the manufacture of all‐solid‐state lithium batteries. Transition metal‐doped LiRAPs as cathodes have demonstrated a high discharge specific capacity and good rate capability in the Li‐ion batteries (LIBs). Additionally, the underlying scientific principles in antiperovskites with flexible structural features have also been extensively studied. In this review, we comprehensively summarize the development, structural design, ionic conductivity and ion transportation mechanism, chemical/electrochemical stability, and applications of some antiperovskite materials in energy storage batteries. The perspective for enhancing the performance of the antiperovskites is also provided as a guide for future development and applications in energy storage.

Rural traditional Chinese medicine hospitals bear responsibilities of providing efficient medical services for rural residents. Efficiency assessments have previously been conducted in single province. This study aimed to investigate the technical efficiency of rural traditional Chinese medicine hospitals across China from 2013 to 2018, with the application of super slack-based measure data envelopment analysis. In total, 1219 hospitals covering 28 provinces were included as sample hospitals. Overall, hospitals performed technically less efficiently but presented with an increasing trend. Redundancy and insufficiency existed in health input and output variables, respectively. Notably, optimizing input variables was found to make more substantial improvement in hospital efficiency. Provincial and regional disparities were also observed in hospital efficiency. In conclusion, rural traditional Chinese medicine hospitals have experienced slight improvement in efficiency during the study period, however, their efficiency was still in a relatively low level with ample room for improvement. Meanwhile, regional coordinated development should also be noticed in this process.

Alveolar macrophage is the predominant cell type in the lung and is thought to be the major target for anti-inflammatory therapy in chronic obstructive pulmonary disease (COPD). Aromatherapy using natural essential oils with anti-inflammatory effects for inhalable administration is a potential complementary and alternative therapy for COPD treatment. The Gardenia jasminoides flower is famous for its fragrance in East Asia and is used for treating colds and lung problems in folk medicine. Therefore, in the present study, flower essential oils from two main medicinal gardenia varieties (G. jasminoides J. Ellis and G. jasminoides f. longicarpa Z.W. Xie & M. Okada) were extracted by hydro-distillation, and their chemical components were analyzed by GC-MS. The anti-inflammatory effects of the two essential oils and their main ingredients were further studied on lipopolysaccharide (LPS)-induced models in murine alveolar macrophages (MH-S). The results indicated that the chemical constituents of the two gardenia varieties were quite different. Alcohol accounted for 53.8% of the G. jasminoides essential oil, followed by terpenes (16.01%). Terpenes accounted for 34.32% of the G. jasminoides f. longicarpa essential oil, followed by alcohols (19.6%) and esters (13.85%). Both the two gardenia essential oils inhibited the LPS-induced nitric oxide (NO) release and reduced the production of tumor necrosis factor-α (TNF-α) and prostaglandin E2 (PGE2) in the MH-S cells. Linalool and α-farnesene dose-dependently reduced the NO release in the MH-S cells. Linalool and α-farnesene did not affect the PGE2 production but regulated the expression of TNF- α. In addition to linalool and α-farnesene, other components in the gardenia flower essential oils appeared to be able to act as anti-inflammatory agents and influence the PGE2 pathway.

Patients with walled-off necrosis (WON) are still challenging to treat safely and effectively. Recently, double-pigtail plastic stents (DPS), bi-flanged metallic stents (BFMS), and lumen-apposing metal stents (LAMS) have been employed with endoscopic ultrasound-guided (EUS-guided) drainage. However, there is little solid evidence to support the effectiveness and safety of using stents. This study aims to compare the outcomes of the LAMS and the PS. Till July 2022, a thorough database search was done, and studies that met the criteria were chosen. By using the RevMan software, the technical and clinical success and other secondary outcomes were calculated. Subgroup analysis was performed between the LAMS and the BFMS. Fifteen studies (two randomized controlled trials and thirteen observational) with 687 patients receiving metal stents and 771 patients receiving plastic stents were selected for final analysis. There was no significant risk of bias or publication bias. The odds ratios (OR) for technical and clinical success were 0.36 (95% confidence interval (95% CI) 0.08, 1.52) and 2.26 (95%CI 1.62, 3.15), respectively. The OR for overall adverse events was 0.74 (95% CI 0.41, 1.34). In subgroup analysis, the LAMS and the BFMS showed the same outcomes. Compared to DPS, LAMS had better clinical outcomes and fewer side effects when treating patients with WON. What is the best endoscopic treatment option for the walled-off necrosis (WON)? A brief comparison of lumen-apposing metal stents (LAMS), bi-flanged metallic stents (BFMS) and double-pigtail plastic stents (DPS) for the treatment of WON patients. How can we limit the adverse events and provide better treatment. [ABSTRACT FROM AUTHOR]