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Background: Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China. Methods: A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18 years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours. Results: A total of 2029 factory workers were included. Mean age was 37.2 (±4.4) years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24–0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05–0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96–4.69 and AOR 2.19, 95% CI 1.33–3.60), local workers (AOR 2.11, 95% CI 1.01–4.42 and AOR 3.42, 95% CI 1.63–7.21), being single (AOR 2.04, 95% CI 1.39–3.01 and AOR 2.49, 95% CI 1.61–3.87), having sexual debut aged <18 years (AOR 5.98, 95% CI 3.28–10.89 and AOR 3.34, 95% CI 1.74–6.39), and substance use (AOR 2.01, 95% CI 1.38–2.93 and AOR 4.43, 95% CI 2.85–6.87) were associated with both having multiple sex partners and engaging in commercial sex in the past year. Conclusions: Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China. Sexual transmission has been the main mode of HIV transmission, and data on sexual risk behaviours among factory workers from various industries are scarce in China. Sexual risk behaviours that showed associations with certain characteristics and experience of sexual debut were prevalent among factory workers in Shenzhen, China. There are massive labour forces in China, indicating an urgent need to strengthen sexual health education and promote safer sexual behaviours among factory workers. [ABSTRACT FROM AUTHOR]

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Background: The Pittsburgh Sleep Quality Index (PSQI) has been a widely used instrument measuring sleep quality among people living with HIV (PLWH) in China while its psychometric properties have yet to be examined in this population. We aimed to assess the reliability and validity of the Chinese version of PSQI in PLWH and identify factors associated with sleep quality. Methods: This study was based on a longitudinal study of newly diagnosed PLWH, among whom the PSQI was used to measure sleep quality 5 years after HIV diagnosis (n = 386). To evaluate internal consistency, Cronbach's alpha and corrected item-total correlation were calculated. To assess construct validity, Pearson's correlation coefficients were calculated between PSQI scores and depression, anxiety, stress, and health-related quality of life (HRQoL). Known group validity was evaluated by comparing PSQI scores between participants with probable depression and those without. Binary logistic regression was conducted to identify factors associated with sleep disturbances. Results: The internal consistency Cronbach's alpha for the Chinese version of PSQI in PLWH was 0.713. Construct validity was established by significant relationships between PSQI and depression, anxiety, stress, and HRQoL. The PSQI scores in participants with probable depression were significantly higher than those without, indicating good known-group validity. Sleep disturbances were associated with less income, higher CD4 counts, antiretroviral treatment (ART) initiation, exercise, depression, and higher stress levels. Conclusions: The Chinese version of PSQI is feasible for use among Chinese PLWH. Over a third of PLWH reported sleep disturbances. More attention should be given to individuals with less income and on ART. Intervention aimed at improving mental health or facilitating exercise may improve sleep quality. [ABSTRACT FROM AUTHOR]

Background: Understanding parents' experiences is a prerequisite to developing interventions that are sensitive to needs of children and families. In China, little is known about parental experiences of having a young child with acute lymphoblastic leukemia (ALL). This phenomenological study aimed to describe parental experiences of having a young child with ALL in China. Method: Ten parents, recruited in central China using purposive sampling, participated in face-to-face, in-depth interviews using Haase's adaptation of Colaizzi's phenomenological method. Results: Five theme categories were identified: (a) The Cancer Diagnosis as a Terrible Disaster—The Sky is Falling, (b) Fighting the Beast, (c) Putting on a Happy Face and Other Coping Strategies, (d) Diagnosis Disclosure: If We Tell and How to Tell, and (e) Hope-Filled Expectations: Returning to Normal Life. Conclusion: Parents put their child's health as their top priority. They strive to manage uncertainty about prognosis and cope with enormous pressures caused by children's suffering, financial burden, and stigma. Parents also express their resilience and hope throughout their child's cancer journey. Support services to strengthen specific families' protective factors (i.e., family/community support, hope, and positive coping) are needed to foster resilience and quality of life. Health care professionals should systematically assess parents' needs, provide validated education materials, and implement tailored interventions across the cancer continuum. Public education and advocacy about cancer is also necessary to decrease cancer-related stigma, and provide financial aid and health care resources in pediatric oncology. [ABSTRACT FROM AUTHOR]

Since 2011, China has implemented a large‐scale public housing programme, constructing tens of millions of apartments to cope with increasing housing shortages and difficulties. Using the case study of Changsha, this study explored the likely fate of this inchoate but significant social policy initiative. We propose a ghettoisation framework for the underlying and interrelated socio‐economic mechanisms that produce and maintain the problem‐ridden public housing development. By applying the analysis framework, this study assessed the status of physical, economic and social decay in public rental housing in Changsha. It is concluded that Chinese public housing projects foster physical dilapidation, economic deprivation and social marginalisation and, at the extreme, may be turned into urban ghettos similar to those found in many other countries, if this downward spiral of physical, economic and social decay persists. Chinese city governments have been aware of the physical dilapidation of public rental housing and have endeavoured with physical improvement and upgradation and government procurement of operation and management services. However, these endeavours are doomed to eventually be fruitless without systematic amelioration of economic and social decay. This study can be applied to worldwide cities with public housing development programmes, by guiding policymakers to advocate for concentrated efforts in problem‐ridden projects and for broader, system‐wide reforms to prevent the worst case scenario of ghettoisation. [ABSTRACT FROM AUTHOR]

Green innovation (GI) is increasingly recognised as an effective strategy for tackling climate change, mitigating environmental issues, and promoting sustainable development. Using panel data of the Chinese listed firms from 2007 to 2019, this study adopts the difference-in-differences approach to assess the impact of the green finance policy (GFP) initiated by the Chinese government in 2012 on the green innovation performance of firms. The findings reveal that the GFP significantly boosts the green innovation performance of heavily polluting enterprises (HPEs). Notably, this effect is more pronounced in state-owned enterprises and firms with high dependence on external finance. Compared with penalty-based regulations, incentive-based and voluntary environmental regulations demonstrate more significant moderating effects on the relationship between the GFP and green innovation performance for HPEs. We also identify improved efficiency in the usage of green investments as a potential mechanism through which the GFP enhances the green innovation performance of HPEs. Further comparative analysis shows that green enterprises can achieve simultaneous improvement in both the quality and quantity of green innovation, whereas HPEs predominantly exhibit enhancements in innovation quantity. To maximise the GFP's positive effects, it is recommended to facilitate more targeted bank lending towards HPEs to support their structural transformation. Additionally, the coordinated deployment of diverse environmental policy instruments is advised to exploit their synergistic effects. • This paper confirms the positive relationship between Green Finance Policy (GFP) and the green innovation. • We develop a novel machine learning approach to enhance the accuracy of variable measurements. • Firms with different ownership structure and external finance reliance are impacted differently by the GFP. • Both incentive-based and voluntary environmental regulations have positive moderation effects. • GFP can improve the green innovation by enhancing the green investment efficiency. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence of current smoking among medical students in mainland China through a systematic search across 6 electronic databases for English or Chinese studies published before May 25, 2018. A total of 79 studies were included; 26 had a high risk of bias. The overall pooled prevalence of current smoking was 10.93% (7460/68 253; 95% confidence interval = 0.09%, 13.08%, I2 = 98.6%). This study found a decreasing prevalence of current smoking over the period studied (survey year range of 1988-2014). More specifically, the current smoking prevalence in males decreased progressively across time, while the prevalence in females remained relatively constant. The overall prevalence in the west was higher than in the middle or east of mainland China (P = .0061). The overall prevalence of current smoking increased with year in school (P = .0028). The present study provides a comprehensive synthesis of current smoking prevalence among medical students in mainland China. Although there have been some improvements in the status of tobacco use among medical students, given the leading role of physicians in tobacco control, sustained efforts are needed to curb the tobacco epidemic among medical students. [ABSTRACT FROM AUTHOR]

Newly-diagnosed people living with HIV (NPLWH) are at high risk of suicide. We aimed to evaluate the prevalence of suicidal behaviors among NPLWH, and explore the relationships between HIV-related stress, depression, anxiety, and social support and suicidal ideation after diagnosed with HIV infection. A cross-sectional study was conducted using a standard set of questionnaires during 1 March 2013 and 30 September 2014 in the HIV/AIDS Voluntary Counseling and Testing Clinic of the Changsha Center for Disease Control and Prevention. Among 557 NPLWH, 27.5% (n = 153) had lifetime suicidal ideation, and 25.0% (n = 139) had suicidal ideation after HIV diagnosis. The results of multiple regression analyses indicated that suicidal ideation after HIV diagnosis was associated with HIV-related clinical symptoms (OR = 2.50), HIV-related stress (OR = 3.64), the co-morbidity of positive depressive and anxiety symptoms (OR = 3.30), and social support (OR = 0.52). Overall, the prevalence of suicidal behaviors is high among NPLWH in Changsha emphasizing the need of suicidality monitoring and tracking, depression and anxiety screening, with an additional focus on stress management and social support enhancement in this vulnerable group. [ABSTRACT FROM AUTHOR]

Compared to inward foreign direct investment, outward foreign direct investment (OFDI) from China is a relatively new phenomenon. However, the volume of China's OFDI increased rapidly from 2004. There has been an increasing amount of literature on the motivations of China's OFDI, but few studies have focused on its location determinants. The present paper aims to fill this gap in the literature by focusing on two important location factors, natural resources and technology, which are the most important determinants of China's OFDI. We use a large panel dataset comprising 132 countries over the period 1991-2009 and the Tobit as well as the Heckman models to establish the relationship between the two location factors and China's OFDI. The empirical results suggest that although China's OFDI has been driven by the country's desire for a secure supply of natural resources and to attain advanced technology from the developed world, China's technology is also a critical attraction for the host developing economies. [ABSTRACT FROM AUTHOR]

Background: Understanding the mental health burdens faced by people living with HIV in China is instrumental in the development of successful targeted programs for psychological support and care. Methods: Using multiple Chinese and English literature databases, we conducted a systematic review of observational research (cross-sectional, case-control, or cohort) published between 1998 and 2014 on the mental health of people living with HIV in China. Results: We identified a total of 94 eligible articles. A broad range of instruments were used across studies. Depression was the most widely studied problem; the majority of studies reported prevalence greater than 60% across research settings, with indications of a higher prevalence among women than men. Rates of anxiety tended to be greater than 40%. Findings regarding the rates of suicidality, HIV-related neurocognitive disorders, and substance use were less and varied. Only one study investigated posttraumatic stress disorder and reported a prevalence of 46.2%. Conflicting results about health and treatment related factors of mental health were found across studies. Conclusions: Despite limitations, this review confirmed that people living with HIV are vulnerable to mental health problems, and there is substantial need for mental health services among this population. [ABSTRACT FROM AUTHOR]

Background: Being HIV-infected is a stressful experience for many individuals. To assess HIV-related stress in the Chinese context, a measure with satisfied psychometric properties is yet underdeveloped. This study aimed to examine the psychometric characteristics of a simplified Chinese version of the HIV/AIDS Stress Scale (SS-HIV) among people living with HIV/AIDS in central China. Method: A total of 667 people living with HIV (92% were male) were recruited from March 1st 2014 to August 31th 2015 by consecutive sampling. A standard questionnaire package containing the Chinese HIV/AIDS Stress Scale (CSS-HIV), the Chinese Patient Health Questionnaire-9 (PHQ-9), and the Chinese Generalized Anxiety Disorder Scale (GAD-7) were administered to all participants, and 38 of the participants were selected randomly to be re-tested in four weeks after the initial testing. Results: Our data supported that a revised 17-item CSS-HIV had adequate psychometric properties. It consisted of 3 factors: emotional stress (6 items), social stress (6 items) and instrumental stress (5 items). The overall Cronbach’s α was 0.906, and the test-retest reliability coefficient was 0.832. The revised CSS-HIV was significantly correlated with the number of HIV-related symptoms, as well as scores on the PHQ-9 and GAD-7, indicating acceptable concurrent validity. Conclusion: The 17-item Chinese version of the SS-HIV has potential research and clinical utility in identifying important stressors among the Chinese HIV-infected population and in understanding the effects of stress on adjustment to HIV. [ABSTRACT FROM AUTHOR]

The HIV/AIDS epidemic caused by commercial blood donation in rural Henan Province of China in the early- to mid-1990s is the largest known cohort in the world related to blood donation but is not fully described. The objectives of this study were to describe the epidemic, epidemiology, and social epidemiology of commercial blood donation and HIV/AIDS. Both qualitative and quantitative mixed methods were used. A village was randomly selected from the 38 key HIV/AIDS pandemic villages in Henan Province. “Demographic Data Form” was applied to collect demographic information of each resident. Focus groups were held for the managers, some residents, members of “HIV/AIDS Work-Team” (organized by the Henan Provincial Government) in the village. Every village physician, people living with HIV/AIDS (PLWHA), school header, and other stakeholders were interviewed individually. The social epidemiology of HIV/AIDS was analyzed under three perspectives of the framework: individual, social, and structural perspectives. In this village, there were 2335 residents, 484 (20.3%) were former donors, 107 (4.6%) were PLWHA, and 96.3% of PLWHA were infected through commercial blood donation. Individually, low education and plasma donation were the risky factors of HIV/AIDS infection. Socially, the epidemic was geography-, kinship-, and conformity-related. Structurally, the related macrostructure factor was policy endorsement of national blood products. The microstructure factors were poverty and value belief on male child in passing down generations. It is concluded that commercial blood donation and HIV/AIDS epidemic in the village are symbiotically related. The epidemic is temporary and socially determined. [ABSTRACT FROM PUBLISHER]

This article investigates the dynamic and long-run relationships between the monetary policy and asset prices in China using monthly data from June 2005 to February 2012. Johansen's cointegration approach based on the Vector Autoregression (VAR) and the Granger causality test are used to identify the long-run relationships and directions of causality between asset prices and monetary variables. Empirical results show that monetary policies have little immediate effect on asset prices, suggesting that Chinese investors may be ‘irrational’ and ‘speculative’. Instead of running away from the market, investors rush to buy houses or shares whenever tightening monetary actions are taken. Such seemingly irrational and speculative behaviour can be explained by various social and economic factors, including the lack of investment channels, market imperfections, cultural traditions, urbanization and demographic changes. The results have two important policy implications. First, China's central bank has not used and should not use interest rate alone to maintain macro-economic stability. Second, both monetary and nonmonetary policies should be deployed when asset bubbles loom large to avoid devastating consequences when they burst. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of the paper is to examine China's county-level fiscal difficulties. A large portion of China's counties (county-level cities) have to run with the shortage of financial resources and huge government debt. To make a suitable policy to solve this problem is a top priority. Design/methodology/approach – Using the first-hand survey data, the paper compares nine sample counties whose economic development level is different, sums up the difficulties county-level governments are facing and explores countermeasures from qualitative and quantitative approaches. Findings – By studying the survey data of nine sample counties (cities), it is found that county-level finance is facing the following problems: low-level fiscal revenue, high debt risk and large gap of fiscal revenue between different counties (cities). Based on these findings, the paper provides suggestions such as ensuring that the county-level government has sufficient fiscal resources and improving the transfer payment system. Originality/value – Data from three well-developed counties (county-level cities), three middle-income counties (county-level cities) and three backward counties made the paper's findings more comprehensive and realistic and suggestions more practical. [ABSTRACT FROM AUTHOR]

Nurses play a vitally important role in promoting equitable and essential care. China undertook bold reforms in its education and healthcare systems since 1990s. The effect of these reforms on the nursing workforce has not been assessed systematically. This study aims to assess the changing trends and the underlying challenges of the nursing workforce in Mainland China in the period of 1998–2018. Retrospective data analysis. Data were acquired from the National Health Statistics Yearbook from 1999 to 2019. Descriptive statistics were used to analyze the nature of the nursing workforce in terms of quantity, quality, and structure. Non-parametric tests were used to compare doctors and nurses in terms of number and work experiences. Global Moran's I index and hotspot analysis were applied to compare the equity in distribution of nurses at national and provincial levels. From 1998 to 2018, the number of nurses increased from 1.22 to 4.10 million with an average rate of increase of 6.3% per annum. The ratio of doctors to nurses changed from 1: 0.61 to 1: 1.14, reaching 1: 1 in 2013. The main educational level of registered nurses elevated to associated degree (48.9%), and nurses with advanced titles increased at the most rapid rate. In 2018, 60.3% of nurses were younger than 35 years old. The Global Moran's I index ranged from 0.211 to 0.198 (Z > 1.96, P < 0.05). Hotspot analysis showed the distribution of nurses was unequally concentrated in the northern region and with the highest distribution in Beijing. Great improvement on the scale and the quality of nursing workforce over the past 20 years has been witnessed in China. However, the shortage of nurses, outflow of younger nurses and the imbalance distribution of nursing workforce among the country are emerging challenges. Plans should not be ignored on continuously cultivating more qualified nurses, retaining younger nurses, attracting nurses to work in rural areas and the northeast region. Tweetable abstract: Numbers of Chinese nurses finally outstrip the number of doctors but do limited educational opportunities limits their contribution to the nation's health? New article in @ijnsjournal [ABSTRACT FROM AUTHOR]

Although some persistent organic pollutants (POPs) were prohibited or limited in use several decades ago, they are still frequently detected in the human body. The purpose of this study was to understand the levels and profiles of POPs in breast milk in China and assess their potential health risks among breastfed infants under six months of age. A literature review focused on China was performed for studies published from 2001 to 2020. The POP levels in breast milk along with other important variables were extracted, and then the average individual POP levels in breast milk were estimated. This review summarises the distribution of traditional and new POPs, including polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), legacy brominated flame retardants (BFRs), perfluorinated compounds (PFCs), and chlorinated paraffins (CPs) and reported notably high levels of short-chain chlorinated paraffins and 1,1-dichloro-2,2-bis (p -chlorophenyl) ethylene (p,p'-DDE) in breast milk. Although the levels of traditional POPs generally declined over time, especially p,p'-DDE and beta-hexachlorocyclohexane (β-HCH), women living in coastal areas, urban areas, and southern China still have a high body burden of certain POPs. In the present study, the estimated daily intake (EDI) of POPs through breastfeeding was used to evaluate the health risk for infants by comparing with acceptable levels. The findings suggested that infants born in coastal areas most likely suffered potential health risk from exposure to DDT, and the health risk of hexachlorobenzene (HCB) in infants in most nationwide regions remains a concern. More importantly, the EDI of PCBs for infants exceeds the safe limit on a national scale. Continuous surveillance of PCBs in breast milk is critical to evaluate the potential health effects on humans. Unlabelled Image • Levels and profiles of POPs in breast milk in China were reviewed. • p,p'-DDE and short-chain chlorinated paraffins are the dominant pollutants in breast milk. • The levels of traditional POPs declined over time, especially p,p'-DDE and β-HCH. • Women living in coastal areas, urban areas, and southern China have a high body burden of certain POPs. • Infants cannot suffer of a potential health risk through breastfeeding other than DDT, HCB, and PCBs. [ABSTRACT FROM AUTHOR]

Introduction: Concern over mental health morbidity affecting people living with HIV is increasing worldwide. The objective of this study was to describe the longitudinal trajectories of depression and anxiety, and mental health service utilization among people newly diagnosed with HIV. Methods: This was an observational cohort study that enrolled people newly diagnosed with HIV consecutively and followed them for one year in Changsha, China. Socio‐demographic, clinical and psychological data were collected at the baseline and at one‐year follow‐up. Participants were recruited between March 1, 2013 and September 30, 2014. The final follow‐up was in September 30, 2015. Results: Among 557 people newly diagnosed with HIV enrolled at the baseline, 410 (73.6%) completed the one‐year follow‐up survey (median (interquartile range) age at follow‐up: 29 (25, 39) years; 376 men (91.7%)), and were included in the analysis. 39.3% and 30.2% of the 410 participants were screened with significant symptoms of depression and anxiety at baseline respectively. An overall drop in the prevalence of each condition was found at follow‐up, however, 10.5% and 6.1% of participants were found to have persistent depression and anxiety. The results of mixed‐effect models showed that bisexuality, homosexual transmission, other clinical symptoms (for example, not on antiretroviral therapy (ART)), non‐disclosure, higher levels of HIV/AIDS‐related stress, and lack of social support were associated with significant symptoms of depression and anxiety. One year after diagnosis, 8.3% had visited healthcare providers for emotional or psychological problems. Conclusions: Despite the obvious need people newly diagnosed with HIV in China rarely seek professional help. Integrating depression and anxiety screening and referral into HIV care settings is warranted. [ABSTRACT FROM AUTHOR]

• The average on-schedule/timely vaccination decreased in Beijing, during 2020–2021. • The on-schedule vaccination of DTaP4 and MPSV-A1,2 decreased significantly. • The timely vaccination of for DTaP1-3 and "Four Vaccines"decreased significantly. The routine immunization program for children is a primary strategy and a core part of vaccination. Achieving and maintaining high level of vaccination coverage are important to reduce morbidity and mortality caused by vaccine-preventable diseases. In Beijing, annual coverage surveys have been conducted since 2005. It is necessary and possible to assess the level and trend of routine vaccination coverage of children in Beijing as well as the disruption of coronavirus disease 2019 (COVID-19) pandemic and provide the reference for the further improve the vaccination coverage. The data of 61,521 children aged 1–3 years in the vaccination coverage surveys during 2005–2021 were analyzed by Beijing Center for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the data and the difference of vaccination coverage within the time period. More than 99 % of participants had immunization cards and electronic immunization records. The concordance rate of both records were also over 99 %. During 2011–2019, the rates of on-time and in-time vaccination of each routine vaccine reached 96 % or more and increased significantly (all P values <0.05), compared with that of 2005–2010. All rates of the investigated vaccine, except for Bacillus Calmette-Guérin vaccine (BCG) and the first dose of hepatitis B vaccine (HepB), decreased in 2020–2021 significantly (all P values <0.05). For the causes of failing to vaccinate on time, delayed vaccination accounted for 47.82 %. The top two vaccines to be missed were the first dose of hepatitis A vaccine and the 4th dose of diphtheria-tetanus-acellular pertussis vaccine, accounting for 21.41 % and 20.79 %, respectively. The main reason for zero-dose/drop-out vaccination was "Guardians regarded the immunization service time as inappropriate", accounting for 72.27 %. The coverage level and service quality of routine immunization in Beijing were relatively high. However, as influenced by COVID-19 epidemics, both on-time and in-time vaccination rates decreased significantly, except for BCG and HepB. Under the background of COVID-19 pandemic, the keys to maintain high level of vaccination coverage include flexible immunization service time to ensure the guardians bringing their children for vaccination timely, and more attention from providers to the doses after children's first birthday. [ABSTRACT FROM AUTHOR]

Environmental pollution has become a global issue attracting ever-increasing attention. Green technology innovation (GTI) is considered an effective strategy in countering this problem and helping achieve sustainability goals. However, the market failure suggests that intervention from the government is necessary to promote the effectiveness of technological innovation and hence, its positive social impacts on emissions reduction. This study investigates how the environmental regulation (ER) influences the relationship between green innovation and CO 2 emissions reduction in China. Employing data from 30 provinces from the period 2003 to 2019, the Panel Fixed-effect model, the Spatial Durbin Model (SDM), the System Generalised Method of Moments (SYS-GMM) and the Difference-In-Difference (DID) models are applied to take issues relating to endogeneity and spatial impact into consideration. The results indicate that environmental regulations positively moderate the impact of green knowledge innovation (GKI) on CO 2 emissions reduction but have a much weaker moderation effect when green process innovation (GPI) is considered. Among different types of regulatory instruments, investment-based regulation (IER) is the most effective in promoting the relationship between green innovation and emissions reduction, followed by command-and-control-based regulation (CER). Expenditure-based regulation (EER) is less effective and can encourage short-termism and opportunistic behaviour among firms, who can accept the paying of fines as a cheaper cost over the short-term than investment in green innovation. Moreover, the spatial spillover effect of green technological innovation on carbon emissions in neighbouring regions is confirmed, in particular when IER and CER are implemented. Lastly, the heterogeneity issue is further examined by considering differences in the economic development and the industrial structure across different regions, and the conclusions reached remain robust. This study identifies that the market-based regulatory instrument, IER, works best in promoting green innovation and emissions reduction among Chinese firms. It also encourages GKI which may assist firms in achieving long-term sustained growth. The study recommends further development of the green finance system to maximise the positive impact of this policy instrument. • We investigate the moderating effect of environmental regulations on green innovation and CO 2 emissions reduction. • Different types of environmental regulations and green innovation are considered. • Command-and-control and investment-type regulations promote CO 2 emissions reduction. • Green Knowledge Innovation plays a crucial role in reducing CO2 emissions. • We prove the effectiveness of implementing synergistic market-based regulations in shaping environmental sustainability. [ABSTRACT FROM AUTHOR]

Background: Many COVID-19 survivors reported stigmatization after recovery. This study investigated the association between stigma (discrimination experiences, self-stigma and perceived affiliate stigma) and sleep quality among COVID-19 survivors six months after hospital discharge.Methods: Participants were recovered adult COVID-19 survivors discharged between February 1 and April 30, 2020. Medical staff of five participating hospitals approached all discharged COVID-19 period during this period. A total of 199 participants completed the telephone interview during July to September, 2020. Structural equation modeling was performed to test the hypothesize that resilience and social support would mediate the associations between stigma and sleep quality.Results: The results showed that 10.1% of the participants reported terrible/poor sleep quality, 26.1% reported worse sleep quality in the past week when comparing their current status versus the time before COVID-19. After adjusting for significant background characteristics, participants who had higher number of discrimination experience, perceived stronger self-stigma and stronger perceived affiliate stigma reported poorer sleep quality. Resilience and social support were positively and significantly associated with sleep quality. The indirect effect of self-stigma on sleep quality through social support and resilience was significant and negative. Perceived affiliate stigma also had a significant and negative indirect effect on sleep quality through social support and resilience.Conclusions: Various types of stigma after recovery were associated with poor sleep quality among COVID-19 survivors, while social support and resilience were protective factors. Resilience and social support mediated the associations between self-stigma/perceived affiliate stigma and sleep quality. [ABSTRACT FROM AUTHOR]