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BACKGROUND: This study aimed to investigate the biomechanical effects of different interventions on astronauts lumbar intervertebral discs in a microgravity environment during spaceflight and in a gravity environment when the astronaut returns.METHODS: A finite element model of the L4L5 lumbar segment was developed with eight loading schemes representing different interventions. The loading schemes included no intervention, wearing a penguin suit, sleeping in a fetal position, wearing a penguin suit combined with sleeping in the fetal position, reclining for 4 or 16 h/d, and maintaining upright posture for 4 or 16 h/d.RESULTS: Without intervention, the microgravity environment led to increased central pore pressure, radial displacement, and water content in the lumbar intervertebral disc. Wearing a penguin suit combined with sleeping in the fetal position can reduce disc pore pressure, axial stress, radial displacement, and water content to 0.156 MPa, 11.50 kPa, 0.538 mm, and 1.390%, respectively. When astronauts return to the gravity environment, staying upright for 4 h can reduce the pore pressure, axial stress, radial displacement, and water content of the intervertebral disc to 0.222 MPa, 10.72 kPa, 0.373 mm, and 0.219%, respectively.CONCLUSION: This study showed that wearing a penguin suit and sleeping in the fetal position both have the potential to protect the lumbar intervertebral disc from the negative effects caused by microgravity. Remaining in the upright posture for 4 h per day may help squeeze out the water in the intervertebral disc safely when astronauts return to the gravity environment.Zhang S, Wang K, Zhu R, Jiang C, Niu W. Penguin suit and fetal position finite element model to prevent low back pain in spaceflight. Aerosp Med Hum Perform. 2021; 92(5):312318.

Background China is making efforts to promote the equalization of National Essential Public Health Services (NEPHS) for internal migrants. Studies have demonstrated that the impacts of social capital on health services are different among subgroups of people. Clarifying these differences will help China accurately promote the equalization of NEPHS for the internal migrants and provide reference for other countries. Methods Data from the China Migrant Dynamic Survey of 2017, involving 130,642 migrants in 31 provinces were used to clarify the complex relationship between social capital and the utilization of NEPHS. Social capital was divided into regional cognitive social capital (RCSC), regional structural social capital (RSSC), individual cognitive social capital (ICSC), and individual structural social capital (ISSC). Then, multi-level logistic regression was conducted to analyze their impacts on the utilization of NEPHS of the migrants, and whether such impacts are moderated by sex and education. Results (1) There are significant differences in the levels of CSC, SSC, and NEPHS utilization between different sexs and educational subgroups of the migrants, among which the educational difference is more prominent. (2) An interaction exists between the levels and dimensions of social capital and NEPHS projects. Also, the impact of SSC on NEPHS is always greater than that of CSC at the same level. (3) The effects of RCSC, RSSC, ICSC, and ISSC on NEPHS utilization by migrants are not moderated by sex. However, a high education could weaken the relationship between RCSC and health education, ISSC and health education, and RSSC and health records but strengthen the correlation between RSSC and health education. Conclusion Social capital plays an important role in the access of migrants to NEPHS. Governments should vigorously promote the construction of regional social capital, encourage migrants to actively participate in community activities, especially pay attention to the enhancement of the migrants with low SES to the destination identity.

Background Injuries are of growing public health concern in China, and the trends of urban-rural injury mortality disparity for the last decade are still being explored. This study aims to analyze trends in injury mortality disparity between urban and rural areas of China by region, sex, and age from 2010 to 2016. Methods Using data from the Disease Surveillance Points system (DSPs) collected by the Chinese Center for Disease Control and Prevention (CDC) from 2010 to 2016, injury age-standardized mortality rates (ASMRs) and rate ratios (RRs) were calculated for different groups. Chi-square tests were used to compare differences in rates between urban and rural residents. The time trends of injury ASMRs were assessed via the annual percentage change (APC), and RRs were used to analyze urban-rural mortality disparity. Results The crude injury mortality rate of rural areas was 1.5 times higher than that of urban areas. The urban-rural RR of injury ASMR decreased from 1.8 to 1.5 (APC = 5.0%) over time, from 2.0 to 1.7 (APC = 4.7%) for eastern regions, from 1.9 to 1.5 (APC = 5.4%) and from 1.6 to 1.3 (APC = 4.5%) among males and females, respectively. Further decreases were from 2.0 to 1.4 (APC = 7.8%), from 1.9 to 1.6 (APC = 6.4%), and from 1.8 to 1.2 (APC = 5.7%) in the 5–14, 45–64, and 65+ year age groups, respectively. The urban-rural RRs of ASMRs for fall, drowning and suicide decreased from 1.3 to 1.2 (APC = − 3.0%), from 2.3 to 1.6 (APC = − 13.8%) and from 2.1 to 1.6 (APC = − 9.9%,), respectively. Conclusions The urban-rural injury mortality disparity was large, but showed a significant decreasing trend in China. Residents of eastern regions, males/females, 5–14/45+ year age groups in the urban-rural injury mortality disparity all decreased gradually during the investigated period.

IntroductionTelemedicine and blood pressure (BP) self-monitoring conduces to management of hypertension. Recent hypertension guidelines highly recommended single pill combination (SPC) for the initial treatment of essential hypertension. Based on this fact, an SPC-based telemedicine titration regimen with BP self-monitoring could be a better way in managing hypertension. This trial aims to elucidate whether telemedicine combined with BP self-monitoring is superior to self-monitoring alone during hypertension management.Methods and analysisThis study will be a multicentred, open-labelled, randomised controlled trial. A minimum sample of 358 hypertensive patients with uncontrolled BP from four centres will be included. The intervention group will include BP self-monitoring and tele-monitoring plus a free SPC-based telemedicine titration therapy for 6 months, they will be recommended to take BP measurements at least once every 7 days, in the meantime, researchers will call to give a consultation on lifestyle or titration advice once a fortnight. The control group will be required to self-monitor BP at the same time interval as intervention group, without any therapy change. Primary outcome of the trial will be the difference in systolic blood pressure at 6-month follow-up between intervention and control group, adjusted for baseline variables. Secondary outcomes such as BP control rate, major adverse cardiovascular events, medication adherence, quality of life will be investigated.Ethics and disseminationEthics approval was granted by Ethical Committee of Shanghai Tenth People’s Hospital (SHSY-IEC-4.1/20-194/01). The results will be disseminated in peer-reviewed literature, and to policy-makers and healthcare partners.Trial registration numberChiCTR2000037217.

Background: Research suggests that young working students are at higher risk for substance use. However, most studies have focused on students from middle-class families, with few investigations co...

Background and objective The objective of this study was to investigate the effect of incorporating various passive elements, which could represent combined or individual effects of intervertebral disc, facet articulation and ligaments, on the prediction of lumbar muscle activation and L4-L5 intradiscal pressure. Methods The passive elements representing the intervertebral disc, facet articulations, and ligaments were added to the existed lumbar musculoskeletal model with nonlinear rotational stiffness or force-strain relationships. The model was fed with kinematics of trunk flexion, extension, axial rotation and lateral bending to calculate muscle activation and L4-L5 intradiscal pressure. Results In the trunk axial rotation, the intradiscal pressure values predicted by the models with elements representing facet articulation were much higher than that predicated by models removing these elements. In the trunk flexion, the models with passive elements showed lower muscle activation of extensors than model with no passive elements. At the end of trunk flexion, extension, axial rotation and lateral bending, the intradiscal pressure values predicted by model with intact passive elements were 120.6%, 92.5%, 334.8% and 74.9% of the values predicted by model with no passive elements, respectively. Conclusions Caution must be taken while modeling facet articulation as elements with rotational stiffness, as they may lead to overestimation of intradiscal pressure in trunk axial rotation. The inclusion of ligaments as spring-like elements may improve the simulation of flexion-relaxation phenomenon in trunk flexion. Future models considering detailed properties of passive elements are needed to allow more access to understanding the mechanics of the lumbar spine.

Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively.Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR).Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system.Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.

BACKGROUND CONTEXT Anterior vertebral body osteophytes are common with degeneration but their biomechanical influence on the whole lumbar spine remains unclear. PURPOSE To investigate the biomechanical influence of anterior vertebral body osteophytes on the whole lumbar spine. STUDY DESIGN/SETTING This is a study using finite element analysis. OUTCOME MEASURES Intersegmental rotation, maximum Mises stress, and intradiscal pressure on the intervertebral discs of different lumbar levels were calculated. METHODS A finite element model of an intact lumbar spine was constructed and validated against in vitro studies. The modified models, which had different degrees of anterior vertebral body osteophyte formation (OF) in combination with disc space narrowing, were applied with physiological loadings. RESULTS The lumbar levels with various degrees of OF altered the kinematics of these levels, which also affected the whole lumbar spine. In flexion and lateral bending, the segment that was one level inferior to the vertebra with OF showed a trend towards increased range of motion. On the intervertebral discs that were one level inferior to the OF level, a trend towards increase in the maximum von Mises stress was found on the annulus. CONCLUSIONS Segments adjacent to levels with anterior vertebral body osteophytes showed increased intersegmental rotation and maximum stress. Further clinical observation should be performed to verify the results in vivo.

The objective of this study was to investigate the effect of dropping height on the forces of joints and muscles in lower extremities during landing. A total of 10 adult subjects were required to landing from three different heights (32 cm, 52 cm, and 72 cm), and the ground reaction force and kinematics of lower extremities were measured. Then, the experimental data were input into the AnyBody Modeling System, in which software the musculoskeletal system of each subject was modeled. The reverse dynamic analysis was done to calculate the joint and muscle forces for each landing trial, and the effect of dropping-landing on the results was evaluated. The computational simulation showed that, with increasing of dropping height, the vertical forces of all the hip, knee, and ankle joints, and the forces of rectus femoris, gluteus maximus, gluteus medius, vastii, biceps femoris and adductor magnus were all significantly increased. The increased dropping height also resulted in earlier activation of the iliopsoas, rectus femoris, gluteus medius, gluteus minimus, and soleus, but latter activation of the tibialis anterior. The quantitative joint and muscle forces can be used as loading conditions in finite element analysis to calculate stress and strain and energy absorption processes in various tissues of the lower limbs.

Recent developments in the treatment of HIV-1 have improved the disease prognosis from a terminal disease to a chronic disease. The number of HIV-1-infected patients who require surgery has become more common. The main threat to HIV-1-infected patients following surgery is the development of sepsis. In this study, we collected a large number of clinical recordings of HIV-1-infected patients from two hospitals in China, specializing in HIV-1 treatment in order to summarize the risk indicators of sepsis in HIV-1-infected patients. We compared the significant risk indicators between the sepsis and non-sepsis groups. Using logistic regression based on the indicators of four separate surgery-based diseases, we generally found that low CD4 and hypoalbuminemia counts prior to surgery were the significant risk factors for developing sepsis. The morbidity of sepsis in trauma patients was approximately 10 times higher than the dysfunction group, whereas the tumor and the infection groups were approximately 1.5 and 2 times higher, respectively. Based on the comparison between the sepsis and non-sepsis groups for each surgery-based disease, we found that the severity of trauma is a critical risk factor for trauma patients; therefore, limiting the size of the wound during surgery is crucial. HIV-1-infected patients often develop postoperative sepsis due to immunodeficiency and complications due to the surgery. We hope that this study can help to reduce the risk of developing sepsis due to surgery and improve the survival rate of HIV-1-infected patients.

To investigate the relationship between the environmental tobacco smoke (ETS) and lung cancer by Meta-analysis.We used "lung cancer/lung neoplasm", "non-smoking/non-smoker", "China/Chinese", "case-control/case control", "risk factor", "environmental tobacco smoke/passive smoking" as key words, to search papers in databases including Chinese BioMedical Literature (CBM), China National Knowledge Internet (CNKI), Wanfang, Vip Citation Databases (VIP), PubMed and Web of Science databases, and collected the case-control studies on ETS and lung cancer among Chinese non-smokers from January 1999 to December 2013. A total of 129 research papers were collected. RevMan 5.2 software was used to calculate combined odds radio (OR) and 95% CI.Qualified 18 literatures were included, total cases 6 145 and controls 8 132. Consolidated results showed that ETS exposure could increase the risk of lung cancer, combined OR (95% CI) = 1.52 (1.42-1.64). Stratified analysis showed that ETS exposure was found to be significantly associated with an increasing risk of the lung cancer on non-smoking women and men, and combined OR (95% CI) were 1.58 (1.42-1.75) and 1.34 (1.08-1.65), respectively; the ETS exposure from family or the working environment could increase the risk of lung cancer, and combined OR (95% CI) were 1.48 (1.20-1.82) and 1.38 (1.13-1.69) respectively; childhood exposure and adult exposure were no significant statistical significance, and combined OR (95% CI) were 1.37 (0.98-1.91), and 1.34 (0.97-1.85) respectively.Environmental tobacco smoke exposure was a significant risk factor of lung cancer among non-smokers in China.

(1) To systematically review peak vertical ground reaction force (PvGRF) during two-leg drop landing from specific drop height (DH), (2) to construct a mathematical model describing correlations between PvGRF and DH, and (3) to analyze the effects of some factors on the pooled PvGRF regardless of DH.A computerized bibliographical search was conducted to extract PvGRF data on a single foot when participants landed with both feet from various DHs. An innovative mathematical model was constructed to analyze effects of gender, landing type, shoes, ankle stabilizers, surface stiffness and sample frequency on PvGRF based on the pooled data.Pooled PvGRF and DH data of 26 articles showed that the square root function fits their relationship well. An experimental validation was also done on the regression equation for the medicum frequency. The PvGRF was not significantly affected by surface stiffness, but was significantly higher in men than women, the platform than suspended landing, the barefoot than shod condition, and ankle stabilizer than control condition, and higher than lower frequencies.The PvGRF and root DH showed a linear relationship. The mathematical modeling method with systematic review is helpful to analyze the influence factors during landing movement without considering DH.

China has a competing situation in that the increase of alcohol consumption and the lowering rates of traffic injuries caused by drink driving coexist. In addition, the zero tolerance law was announced in January 2013. Under the above complex background, this study aims to unveil the truth about drink driving and the effects of the related policies in China.This research was a retrospective examination of the data from the National Disease Surveillance System in Shandong Province of China from 2011 to 2013. Descriptive statistics were used to find the summary of mortality caused by drink driving and the traits of the deceased subjects.The drink driving situation in China was found to be much more alarming than the initial official prediction. In this research, the rate should be around 18.45% to 26.61%, compared to only 4.02% to 4.80% from the Ministry of Public Security. However, with the introduction of the zero tolerance law at the beginning of 2013, a significant change was observed; that is, a sharp decrease in traffic fatalities caused by drink driving between 2012 and 2013, with a drop of 6.81% (from 25.26% to 18.45%). According to the data, more attention should be paid to young adults, male drivers, those with low education, and the unemployed because the drink driving deaths increased for these populations during 2011 to 2013.In reality, the drink driving situation in China is much more serious than official prediction and the laws were efficient.

Injuries are a growing public health concern in China, accounting for more than 30% of all Person Years of Life Lost (PYLL) due to premature mortality. This study analyzes the trend and disease burden of injury deaths in Chinese population from 2004 to 2010, using data from the National Disease Surveillance Points (DSPs) system, as injury deaths are classified based on the International Classification of Disease-10(th) Revision (ICD-10). We observed that injury death accounted for nearly 10% of all deaths in China throughout the period 2004-2010, and the injury mortality rates were higher in males than those in females, and higher in rural areas than in urban areas. Traffic crashes (33.79-38.47% of all injury deaths) and suicides (16.20-22.01%) were the two leading causes of injury deaths. Alarmingly, suicide surpassed traffic crashes as the leading cause of injury mortality in rural females, yet adults aged 65 and older suffered the greatest number of fatal falls (20,701 deaths, 2004-2010). The burden of injury among men (72.11%) was about three times more than that of women's (28.89%). This study provides indispensible evidence that China Authority needs to improve the surveillance and deterrence of three major types of injuries: Traffic-related injury deaths should be targeted for injury prevention activities in all population, people aged 65+ should be encouraged to take individual fall precautions, and prevention of suicidal behavior in rural females should be another key priority for the government of China.

BACKGROUND: Primary health care and patient triage are two basic functions of rural hospitals. As a routine test, the diagnostic radiology is still unavailable in some rural hospitals in China. Therefore, high-level hospitals are often the first choice of rural residents when they feel unwell. It brings serious social problems. This study was designed to propose an on-the-job drilling schema with integration of practical medical recordings and experienced radiological doctors as tutors to improve skills in diagnostic radiology of rural physicians. METHODS: The information technology was used to help the contact between rural doctors and tutors. In a longitudinal pre/post-test control study design, a cohort of 20 young physicians, each of whom was working in a rural hospital and had a work experience less than two years, were established as the trial group over one year. Another 20 similar counterparts were established as the control group. Participants' performances were evaluated in four categories at five-time point (TP). RESULTS: The trial group significantly outscored the control group on the style of writing at the second TP (d = 2.28); on the accuracy of the image description at final TP (d = 1.11); on the accuracy of the diagnosis at the fourth TP (d = 3.62); and on the correct treatment selection at the third TP (d = 6.45). The aspects with the most improvement were the accuracies of the diagnosis and the treatment selection. CONCLUSION: This study provided the detailed evidences that applying the on-the-job drilling schema has a significant effect on the skills improvement in diagnostic radiology of rural physicians. It was also concluded that the educational intervention based on practical cases was better than that only based on didactic slides presentation.

The People's Republic of China has significantly improved the general health of its people by a concerted effort in primary health care but trauma care and its prevention remains a problem. This paper provides an overview of the strengths and weaknesses of the trauma-care system in China and proposes a strategy for its future development. This includes public-health legislation, the integration of military and civilian practice to provide comprehensive care from the scene of the incident through to rehabilitation, medical audit, the introduction of postgraduate trauma-management training courses and international academic exchanges.

A good knowledge of midfoot biomechanics is important in understanding the biomechanics of the entire foot, but it has never been investigated thoroughly in the literature. This study carried out in vitro experiments and finite element analysis to investigate the midfoot biomechanics. A foot-ankle finite element model simulating the mid-stance phase of the normal gait was developed and the model validated in in vitro experimental tests. Experiments used seven in vitro samples of fresh human cadavers. The simulation found that the first principal stress peaks of all midfoot bones occurred at the navicular bone and that the tensile force of the spring ligament was greater than that of any other ligament. The experiments showed that the longitudinal strain acting on the medial cuneiform bone was -26.2±10.8 μ-strain, and the navicular strain was -240.0±169.1 μ-strain along the longitudinal direction and 65.1±25.8 μ-strain along the transverse direction. The anatomical position and the spring ligament both result in higher shear stress in the navicular bone. The load from the ankle joint to five branches of the forefoot is redistributed among the cuneiforms and cuboid bones. Further studies on the mechanism of loading redistribution will be helpful in understanding the biomechanics of the entire foot.