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Objective: While growing psychological health issues among pregnant women during the COVID-19 pandemic have been clearly validated, most research was conducted in countries with relatively lax quarantine measures. This study aimed to compare the prevalence of prenatal depression among pre-, peak-, and post-COVID-19 in Beijing, the region with a stringent response policy in China. We also explore predictors of prenatal depression throughout the outbreak., Methods: We investigated prenatal depression among 742 pregnant women who received antenatal checkups in Beijing from March 28, 2019 to May 07, 2021 using the Edinburgh Postnatal Depression Scale and associative demographic, pregnancy-related, and psychosocial characteristics were measured. The phase was divided into pre-, peak-, and post-COVID-19 in light of the trajectory of COVID-19. Pearson's Chi-square test was used after the examination of confounders homogeneity. The bivariable and multivariable logistic regression was conducted to explore predictors., Results: The pooled prevalence of prenatal depression was 11.9% throughout the COVID-19 pandemic. Rates at different phases were 10.6%, 15.2%, and 11.1% respectively and no significant difference was observed. Multivariable logistic regression revealed that history of mental illness, number of boy-preference from both pregnant women and husband's family, social support, occupation, and living space were independent predictors of prenatal depression in Beijing., Conclusion: Our data suggested that the impact of this pandemic on prenatal depression in Beijing appears to be not significant, which will strengthen confidence in adhering to current policy for decision-makers and provide important guidance for the development of major outbreak control and management policies in the future. Our findings may also provide a more efficient measure to identify high-risk pregnant women for professionals and help raise gender equity awareness of pregnant women and their husbands' families. Future studies should focus on the value of targeted care and family relations on the mental health of pregnant women., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 WANG et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In the context of global warming, frequent heat wave disasters have seriously threatened the safety of human life and property. The urban agglomeration, as the main region with a high concentration of population and economy, is susceptible to heat weaves due to the existing urban heat island effect. In this study, we investigated the temporal and spatial characteristics of heat waves (heat index, HI) in China from 2000 to 2020 and assess the vulnerability of 19 urban agglomerations to heat waves from the perspective of exposure, sensitivity and adaptability. The results show that: (1) In the past 20 years, the frequency and intensity of HI (greater than 26.67 °C) both showed an upward trend. (2) Shandong Peninsula, Central Henan, Yangtze River Delta, Middle Reaches of Yangtze River, and Mid-southern Liaoning urban agglomerations always maintain a high vulnerability. (3) From 2000 to 2020, the vulnerability of Beijing-Tianjin-Hebei, Yangtze River Delta, Chengdu-Chongqing, Middle reaches of Yangtze River, Guangdong-Fujian-Zhejiang, Harbin-Changchun and Mid-southern Liaoning urban agglomerations were always dominated by exposure. The vulnerability of Shandong Peninsula, Beibu Gulf and Central Henan urban agglomeration has always been dominated by sensitivity. The vulnerability of North Tianshan Mountain, Lanzhou-Xining, Guanzhong and Hu-Bao-E-Yu urban agglomeration has always been dominated by inadequate adaptability. (4) Recently, the factors that contributed most to exposure, sensitivity and adaptability were population density, the proportion of outdoor workers and water supply, with contribution rates of 38%, 55% and 26%, respectively. This study can provide a scientific basis for the rational allocation of resources among urban agglomerations, effectively formulating policies and guiding population migration from high temperature disasters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: We explored the impact of medical service fee adjustments on the choice of medical treatment for hypertensive patients in Beijing. We hope to provide decision-making reference to promote the realization of hierarchical diagnosis and treatment in Beijing., Methods: According to the framework of modeling simulation research and based on the data of residents and medical institutions in Beijing, we designed three models of residents model, disease model and hospital model respectively. We then constructed a state map of patients' selection of medical treatment and adjusted the medical service fee to observe outpatient selection behaviors of hypertensive patients at different levels of hospitals and to find the optimal decision-making plan., Results: The simulation results show that the adjustment of medical service fees can affect the proportion of patients seeking medical treatment in primary and tertiary hospitals to a certain extent, but has little effect on the proportion of patients receiving medical treatment in secondary hospitals., Conclusions: Beijing can make adjustments of the current medical service fees by reducing fees in primary hospitals and slightly increasing fees in tertiary hospitals, and in this way could increase the number of patients with hypertension in the primary hospitals., (© 2023. BioMed Central Ltd., part of Springer Nature.)

During the period of 2015-2018, Chinese government had made great efforts to mitigate air pollutants, such as air quality monitoring, energy structure adjustment, and pollutant emission reduction from industry, transportation and household sectors. With the special investment of 152 billion Chinese Yuan (CNY) in the Beijing-Tianjin-Hebei (BTH) and surrounding "2 + 26" regions, the annual local concentrations of PM 2.5 , PM 10 , SO 2 and NO 2 decreased from 77, 132, 38 and 46 μg/m 3 to 60, 109, 20 and 43 μg/m 3 . It was estimated that the improvement in air quality avoided 27,021 (95 % CIs 12,548-39,738) premature deaths attributed to air pollution exposure based on an exposure-response function, including 45 %, 17 % and 15 % of cardiopulmonary, lung cancer and respiratory morality cases. Air pollution reduction was also effective in reducing work time loss, which reduced the total working time loss by 3.8 × 10 7 (95 % CIs 1.8 × 10 7 -5.6 × 10 7 ) h, and the per capita working time loss by 0.28 (95 % CIs 0.13-0.41) h/capita by 2018. From the economic aspect, air pollution control actions in those regions saved 95.6 (95 % CIs 44.2-141) billion CNY economic loss by using the value of statistical life (VSL). The total benefit-cost ratio was 63.7 % (95 % CIs 29.4 %-93.7 %). The cost-effectiveness in Beijing and Tianjin were relatively low due to the regional contribution from other cities of the air pollution transmission channel. Despite the uncertainties, the results clearly show the significance of the environmental, health and economic benefits of actions in the BTH and surrounding "2 + 26" regions for combating air pollution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: Rural areas in China are more vulnerable to COVID-19 pandemic than urban areas, due to their far fewer health care resources. Village doctors, as rural grassroots health workers in China, have been actively engaged in the pandemic prevention and control. This study aims to describe the roles of village doctors in rural China, and the challenges they have faced during the prevention and control of the COVID-19 pandemic., Setting: This study was conducted in three towns in Huairou District, Beijing, China., Design: We carried out semi-structured interviews with 75 key informants. All the interviews were audio-recorded and transcribed verbatim. We employed thematic analysis to define themes and sub-themes from the qualitative data., Results: We reported four themes. First, the village doctor guided the village committee to carry out decontamination, monitored home-isolated residents, and disseminated knowledge on prevention of the COVID-19 pandemic during the rural pandemic prevention and control. Second, they took pandemic prevention measures in village clinics, distributed pandemic prevention materials, and undertook pre-screening triage. Third, village doctors provided basic medical care, including treatment of common diseases as well as the purchase and delivery of medicines to villagers. Fourth, village doctors faced difficulties and challenges, such as inadequate medical skills, aging staff structure, and lack of pandemic prevention materials., Conclusions: Despite many difficulties and challenges, village doctors have actively participated in rural pandemic prevention and control, and made outstanding contributions to curbing spread of COVID-19 pandemic in rural areas. Village doctors provide basic health care while participating in various non-medical tasks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Zhao, Zhang, Yang and Yang.)

Background: Vascular endothelial dysfunction, arteriosclerosis and atherosclerotic plaque are well-known risk factors for cardiovascular disease (CVD). Studies on vascular health markers have been well-established, however, there is still a lack of related research on combined vascular structure and function indicators., Method: Beijing vascular health stratification (BVHS) is an evaluation system aiming at vascular health, combined the endothelial function, arteriosclerosis, atherosclerotic plaque and vascular lumen stenosis to comprehensively assess the vascular health and grade it. This study will explore the predictive value of the combined evaluation of vascular structure and function for cardiovascular events and assess the predictive value of BVHS and compare it with the existing risk assessment systems. A total of 1500 subjects will be enrolled into the prospective cohort study from a community and will be followed up for at least 3 years from July 1, 2020 to June 30, 2023. Subjects aged 40 or above, without coronary heart disease, stroke or peripheral artery disease, with written informed consent will be included; subjects with end-stage hepatorenal diseases (uremia, renal failure, cirrhosis, liver failure), mental disorders or cognitive disorders, with any other factors that the researcher thinks are not suitable for the study will be excluded. Traditional cardiovascular risk factors will be collected as adjusted confounders., Discussion: BVHS is a potential and scientific vascular health evaluation system. The study will be the first to grade vascular health by combing various vascular indicators and explore the prediction value and compare with other risk prediction system in general Chinese population., Trial Registration: The trial is registered on http://www.chictr.org.cn/ (ChiCTR2000034085)., (© 2021. The Author(s).)

Although anthropogenic emissions decreased, polluted days still occurred in the Beijing-Tianjin-Hebei (BTH) region during the initial outbreak of the coronavirus disease (COVID-19). Analysis of the characteristics and source distribution of large-scale air pollution episodes during the COVID-19 outbreak (from 23 January to April 8, 2020) in the BTH region is helpful for exploring the efficacy of control measures and policy making. The results indicated that the BTH region suffered two large-scale air pollution episodes (23-28 January and 8-13 February), which were characterized by elevated PM 2.5 , SO 2 , NO 2 , and CO concentrations, while the O 3 concentration decreased by 1.5%-33.9% (except in Shijiazhuang, where it increased by 16.6% during the second episode). These large-scale air pollution episodes were dominated by unfavorable meteorological conditions comprising a low wind speed and increased relative humidity. The transport pathways and source distribution were explored using the Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT), potential source contribution function (PSCF), and concentration weighted trajectory (CWT) models. The air pollution in the BTH region was mainly affected by local emission sources during the first episode, which contributed 51.6%-60.6% of the total trajectories in the BTH region with a PM 2.5 concentration ranging from 146.2 μg/m 3 to 196.7 μg/m 3 . The short-distance air masses from the southern and southwestern areas of the BTH region were the main transport pathways of airflow arriving in the BTH region during the second episode. These contributed 51.9%-57.9% of the total trajectories and originated in Hebei, Henan, central Shanxi, and Shaanxi provinces, which were the areas contributing the most to the PM 2.5 level and exhibited the highest PSCF and CWT values. Therefore, on the basis of local emission reduction, enhancing regional environmental cooperation and implementing a united prevention and control of air pollution are effective mitigation measures for the BTH region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Arteriosclerosis can be reflected in various aspect of the artery, including atherosclerotic plaque formation or stiffening on the arterial wall. Both arteriosclerosis and atherosclerosis are important and closely associated with cardiovascular disease (CVD). The aim of the study was to evaluate the association between systemic arteriosclerosis and multi-site atherosclerotic plaques., Methods: The study was designed as an observational cross-sectional study. A total of 1178 participants (mean age 67.4 years; 52.2% male) enrolled into the observational study from 2010 to 2017. Systemic arteriosclerosis was assessed by carotid femoral artery pulse wave velocity (CF-PWV) and multi-site atherosclerotic plaques (MAP, > = 2 of the below sites) were reflected in the carotid or subclavian artery, abdominal aorta and lower extremities arteries using ultrasound equipment. The associations were assessed by multivariable logistic regression., Results: The prevalence of CF-PWV > 12 m/s and MAP were 40.2% and 74.4%. Atherosclerotic plaques in 3 sites were more common in male compared with that in female (48.9% versus 36.9%, p < 0.05). All CVD factors were worse in participants with MAP than that with <=1 site. Participants with CF-PWV > 12 m/s corresponded to a mean 82% probability of MAP with age and sex-adjusted. Patients with peripheral artery disease showed the highest odds ratio (OR) (3.88) for MAP, followed by smoking (2.485), CF-PWV > 12 m/s (2.25), dyslipidemia (1.89), male (1.84), stroke (1.64), hypoglycemic agents (1.56) and age (1.09) (all p < 0.001)., Conclusions: MAP was highly prevalent in this cohort, with male showing a higher prevalence than female. Higher systemic arteriosclerosis was independently associated with MAP, which indicating the supplementary value of arteriosclerosis for the earlier identification and intervention on MAP., Trial Registration: Clinical Trial, URL: http://www.clinicaltrials.gov . Unique identifier: NCT02569268 .

Large amounts of air pollutants emitted from massive coal combustion result in the air quality deterioration and threaten public health in China. To improve air quality, the Chinese government released the coal cap policy to reduce coal consumption. So it is important and necessary to understand the possible environmental impact and relevant health benefits from the coal cap policy. The purpose of this paper is to quantify the air quality improvement and to evaluate the health benefits from the implementation of the coal cap policy, with the Beijing-Tianjin-Hebei (BTH) region as the study area. The results showed that the emissions of SO 2 , NOx, CO, VOCs, PM 10 , and PM 2.5 could be reduced by 20-40% in the BTH region in 2020 and all pollutants from industrial boilers notably decreased. Under the coal cap policy, the PM 2.5 concentration in the whole region would fall by 11.27%, and the total economic benefit from health impacts could achieve 26.61 (13.29 to 39.14) billion RMB (3.9 billion USD) in the BTH region in 2020, accounting for 0.43% (0.21 to 0.63%) of regional GDP in 2013. This study demonstrated the quantification of environmental effect and health benefit from the coal cap policy, which could be used for the complete cost-benefit analysis and provide the sufficient support for policy makers to implement the coal cap policy in the BTH region and other areas of China.