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Background: We investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations., Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011-2015) and four in ELSA (2001-2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength., Findings: Lower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline., Interpretation: Lower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

While the agricultural green transformation has garnered significant attention on the political stage as a crucial strategy for climate change mitigation and sustainable development, there remains a notable gap in our understanding of the prevailing logics that shape organizational decisions on this change in emerging economies. Drawing on the institutional logics perspective, this study explores the impact of state logic (manifested through green credit policy) and market logic (manifested through analyst attention) on agriculture-related firms' (ARFs') green transformation, as well as the moderating effects of organizational transparency and environmental, social, and governance (ESG) level. Using longitudinal data on 201 publicly listed ARFs in China from 2008 to 2020, we find that both state and market logics exert unique effects on facilitating the green transformation of ARFs. More notably, a complementarity between the two logics in offering value for ARFs' green transformation is revealed. This complementary effect becomes more pronounced for organizations with a higher level of transparency or a superior ESG profile. Our study contributes to the neo-institutional perspective of organizational green transformation, a better understanding of conflicting institutional logics in emerging economies, and research on agricultural sustainability., 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 © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Community-based sexual health services are recommended to increase sexually transmitted disease (STD) testing among men who have sex with men (MSM). Pilot study data from multiple sites found that MSM in Guangzhou who use public STD clinics were found to have different sociodemographic characteristics, lower community engagement, and increased social cohesion, compared to MSM who use MSM-led clinics., Competing Interests: The authors have declared no competing interests exist., (Copyright: © 2024 Huon 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.)

Based on city-level panel data spanning 2008 to 2021, this study investigates the impact of government environmental attention (GEA) on green total factor productivity (GTFP). The findings suggest that increased GEA substantially enhances the growth of GTFP. After conducting robustness and endogeneity tests, the study's results consistently show reliability and robustness. Further analysis elucidates several mechanisms through which GEA influences GTFP, including fostering green technology innovation, optimizing resource allocation, and promoting upgrades in industrial structure. Heterogeneity analyses reveal that the impact of GEA on GTFP is notably pronounced in eastern cities, as well as in cities characterized by low resource dependency, mature industrial development, and high market competition. Conversely, the influence of GEA on GTFP is less discernible in cities prioritizing economic development goals, possibly due to differing policy orientations and resource allocation strategies. This study offers a novel perspective on understanding how GEA shape green development and provides empirical support for policy formulation., 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 © 2024 Elsevier Ltd. All rights reserved.)

China's poultry industry faces challenges in adopting and sustaining cage-free systems for poultry production. Effective interventions are crucial to support producers transitioning from cages to alternative systems or maintaining cage-free systems to improve animal welfare. However, little is known about how Chinese poultry producers perceive animal welfare in relation to cage-free systems and the importance of animal welfare in poultry production. Through a qualitative interview study with 30 Chinese farm owners, managers and senior managers from large-scale egg and broiler farms using cages and non-cage systems (collectively referred to as "producers"), this paper explores Chinese poultry producers' attitudes and perceptions regarding animal welfare and welfare in different poultry housing systems. Template analysis was used to analyse the data from semi-structured interviews, which generated themes related to the participants' awareness and understanding of the concept of animal welfare, the factors that impacted their choices of different housing systems, and the perceived priorities in poultry production. The responses revealed that the participating producers had a strong awareness and knowledge of animal welfare. However, the participants' understanding of the term is heterogeneous: generally, egg producers emphasised natural behaviours, whereas broiler producers prioritised health and productivity. Nevertheless, profitability, leadership, and organisational policies primarily influenced housing system choices rather than animal welfare values. Economic motives drove egg producers towards cage-free systems, prompted by consumers' and companies' demand for cage-free eggs committed to transitioning away from cages by 2025. In conclusion, tailored interventions for different poultry sectors within China are necessary. While animal welfare values matter, economic incentives seem more promising for steering the shift towards and maintaining cage-free poultry production., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yang 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.)

Objectives: With increasing life expectancy and rapid ageing, there is an expanding number of older people who have functional declines, greater needs for care and support and who are at increased risk of insufficient social interaction. Longitudinal investigations on the interplay between loneliness, social isolation and care dependence remain limited. This study thus aimed to investigate the longitudinal reciprocal association between social isolation/loneliness and care dependence among older adults in Latin America and China., Methods: We analysed data from the population-based cohorts from the 10/66 Dementia Research Group (DRG) project (baseline 2003-07 and follow-up 2007-2010). The 10/66 DRG study recruited and followed up older adults aged 65 years or above in 11 catchment areas in Latin America and China. A total of 15,027 older adults from Latin America and China (mean age = 73.5, standard deviation = 6.5) were included in our analyses. Cross-lagged panel models were used to investigate potential reciprocal associations., Results: Loneliness was positively associated with care dependence at baseline (β = 0.11, p < 0.001 in Latin America; β = 0.16, p < 0.05 in China]. Social isolation consistently had a stronger positive association with care dependence across all study sites in both waves. Longitudinally, care dependence positively predicted loneliness (β = 0.10, p < 0.001) and social isolation (β = 0.05, p < 0.001) in Latin American study sites but not in China. Yet there was no statistical evidence of lagged effects of loneliness and social isolation on care dependence in all study countries., Conclusions: Older people with care dependence are at risk of developing loneliness and social isolation. It is crucial to develop complex care models using a societal approach to address social and care needs holistically, especially for the older group with declining functional capacity. Future longitudinal research is required to explore the causal mechanisms of relationships and cultural differences, in order to inform the development of culturally appropriate care models., (© 2024 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Nut-based products are a good source of high-quality plant protein in addition to mono- and polyunsaturated fatty acids, and may aid low-glycaemic dietary strategies important for the prevention of type 2 diabetes (T2D). In particular, they may be advantageous in populations susceptible to dysglycaemia, such as Asian Chinese. The present study aimed to compare effects of a higher-protein nut bar (HP-NB, also higher in total fibre and unsaturated fats, comprising mixed almonds and peanuts) vs. an isoenergetic higher-carbohydrate cereal bar (HC-CB) within the diet of 101 Chinese adults with overweight and normo- or hyperglycaemia. Ectopic pancreas and liver fat were characterised using magnetic resonance imaging and spectroscopy (MRI/S) as a secondary outcome. Participants were randomized to receive HP-NB or HC-CB daily as a 1 MJ light meal or snack replacement, in addition to healthy eating advice. Anthropometry and clinical indicators of T2D risk were assessed fasted and during an oral glucose tolerance test (OGTT), pre- and post-intervention. No significant difference was observed between diet groups for body weight, body mass index, waist or hip circumference, blood pressure, glucoregulatory markers, lipid profile or inflammatory markers over 12 weeks (all, p > 0.05). No difference was observed between glycaemic subgroups or those with normal versus high ectopic organ fat. Although HP-NB can attenuate postprandial glycaemia following a meal, no effects were observed for either fasting or glucose-mediated outcomes following longer-term inclusion in the habitual diet of Chinese adults with overweight, including at-risk subgroups.

Despite suicide in younger population having become a severe public health issue, information on the prevalence of suicidality among Chinese children and adolescents is still limited. This study aims to estimate the prevalence of suicidal ideation, suicide plans, and suicide attempts in Chinese children and adolescents aged under 18 years. A meta-analysis was conducted based on English and Chinese publications from January 1, 2010 to December 31, 2020 using random-effects models. Based on 132 eligible studies with a combined total of 1,103,309 Chinese children and adolescents below 18 years old, the pooled prevalence of the overall suicidal ideation, suicide plans, and suicide attempts were 15.4% (95% CI [14.3, 16.6]), 6.4% (95% CI [5.5, 7.4]) and 3.5% (95% CI [3.1, 4.1]), respectively. The subgroup analyses showed that there were significant variations of prevalence of suicidal risks across genders, school stages, and geographical areas in mainland China. It was the first systematic review and meta-analysis to show suicidality among younger population aged below 18 years is prevalent in mainland China. This study suggests that gender-age-region-specific prevention and intervention programs should be urgently needed to reduce suicidal risks among Chinese children and adolescents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Eating healthier is associated with a range of favorable health outcomes. Our previous model estimated the impact of dietary changes on life expectancy gains but did not consider height, weight, or physical activity., Objectives: We aimed to estimate the increase in life expectancy resulting from the transition from typical national dietary patterns to longevity-optimizing dietary changes, more feasible dietary modifications, and optimized vegan dietary changes in China, France, Germany, Iran, Norway, the United Kingdom, and the United States., Methods: Our modeling study used data from meta-analyses presenting dose-response relationships between intake of 15 food groups and mortality. Background mortality data were from the Global Burden of Disease Study. We used national food intake data and adjusted for height, weight, and physical activity level., Results: For 40-y-olds, estimated life expectancy gains ranged from 6.2 y (with uncertainty interval [UI]: 5.7, 7.5 y) for Chinese females to 9.7 y (UI: 8.1, 11.3 y) for United States males following sustained changes from typical country-specific dietary patterns to longevity-optimized dietary changes, and from 5.2 y (UI: 4.0, 6.5 y) for Chinese females to 8.7 y (UI: 7.1, 10.3 y) for United States males following changes to optimized vegan dietary changes., Conclusions: A sustained change from country-specific typical dietary pattern patterns to longevity-optimized dietary changes, more feasible dietary changes, or optimized vegan dietary changes are all projected to result in substantial life expectancy gains across ages and countries. These changes included more whole grains, legumes, and nuts and less red/processed meats and sugars and sugar-sweetened beverages. The largest gains from dietary changes would be in the United States., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Understanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults' preferences for long-term caregivers., Study Design: This is a cross-sectional study., Methods: A national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50-70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models., Results: Older adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance., Conclusion: QoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite that the heavy metals in urban soils pose a threat to public health, the critical factors that influence their concentrations in urban soils are not well understood. In this study, we conducted a survey of surface soil samples from urban green spaces in Shanghai, to analyze the concentrations of the key heavy metals. The results showed that Zn was the most abundant metal with an average concentration of 122.99 mg kg -1 , followed by Pb (32.72 mg kg -1 ) and Cd (0.23 mg kg -1 ). All concentrations were found to be below the risk screening values defined by the National Environmental Quality Standards for soils of development land in China (GB36600-2018), indicating no current risk in Shanghai. However, there was a clear accumulation of heavy metals, as the mean concentrations were significantly higher than the background values. Furthermore, we explored the relationships between key heavy metals with population density, GDP and green space area. Both Spearman correlation and Random Forest analysis indicated that per capita green space area (pGSA) and population density were the most crucial factors influencing the status of heavy metals in urban soils, unlike edaphic factors e.g. SOM content in farmland soils. Specifically, there was a significantly positive linear correlation between heavy metal concentrations and population density, with correlation coefficients ranging from 0.3 to 0.4. However, the correlation with pGSA was found to be non-linear. The nonlinear regression analysis revealed threshold values between heavy metals concentrations and pGSA (e.g Zn 22.22 m 2 , Pb 24.92 m 2 , and Cd 25.92 m 2 ), with a sharp reduction in heavy metal concentrations below the threshold and a slow reduction above the threshold. It suggests that an increase in per capita green space area can mitigate the accumulation of heavy metals caused by growing population density, but the effect is limited after the threshold. Our findings not only provide insights into the distribution patterns of heavy metals in the urban soils at the local scale, but also contribute to the urban greening at the global scale and offer guidance for city planning in the face of increasing population densities over the coming decades., 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 © 2024 Elsevier Ltd. All rights reserved.)

Background: Appraisals are central to posttraumatic stress disorder (PTSD). Yet, few studies have examined how culture influences the associations between different types of trauma-related appraisals and PTSD symptoms. Objective: This study investigated cultural influences on appraisals of control and their associations with PTSD symptoms. Method: European Australian ( n  = 140, M age = 35.80, SD  = 12.44; 21 men, 97 women, 20 gender diverse/prefer not to report) and Chinese Australian ( n  = 129, M age = 30.16, SD  = 8.93, 21 men, 97 women, 20 gender diverse/prefer not to report) trauma survivors completed measures of appraisals, cultural values, and PTSD symptoms. Results: Findings showed that the Chinese Australian group was associated with greater Chinese cultural beliefs about adversity (i.e. emphasizing the value of adversity and people's ability to overcome adversity) and fewer fatalism appraisals (i.e. appraising one's destiny as externally determined), which in turn were atemporally associated with fewer PTSD symptoms; these atemporal indirect associations were moderated by self-construal and holistic thinking. The Chinese Australian group also reported fewer secondary control appraisals (i.e. attempts to change aspects of the self and accept current circumstances), which were atemporally associated with greater PTSD symptoms. In contrast, the European Australian group was associated with fewer primary control appraisals (i.e. perceived ability to personally change or control a situation), which were atemporally associated with greater PTSD symptoms. Conclusion: These findings highlight the importance of considering the influence of culture on appraisals in PTSD. However, it must be noted that causal relationships cannot be inferred from cross-sectional mediation analyses and thus, future longitudinal research is needed.

This study investigates the impact of renewable and non-renewable energy sources on carbon emissions in the context of China's 14th Five-Year Plan (2021-2025). The plan emphasises a "Dual-control" strategy of simultaneously setting energy consumption limits and reducing energy intensity for GDP (gross domestic product) in order to meet the targets of the five-year plan. Using a comprehensive dataset of Chinese energy and macroeconomic information spanning from 1990 to 2022, we conduct a Granger causality analysis to explore the relationship between energy sources and the level of air pollution. Our findings reveal a unidirectional link, wherein renewable energy contributes to a reduction in air pollution, while non-renewable energy sources lead to an increase. Despite the government's investment in renewable energy, our results show that China's economy remains heavily reliant on traditional energy sources (e.g., fossil fuels). This research is the first systematic examination of the interplay between energy usage and carbon emissions in the Chinese context. Our findings provide valuable insights for policy and market strategies aimed at promoting carbon neutrality and driving technological advancements in both government and industries., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Catastrophic health expenditures (CHE) can trigger illness-caused poverty and compound poverty-caused illness. Our study is the first regional comparative study to analyze CHE trends and health inequality in eastern, central and western China, exploring the differences and disparities across regions to make targeted health policy recommendations., Methods: Using data from China's Household Panel Study (CFPS), we selected Shanghai, Henan and Gansu as representative eastern-central-western regional provinces to construct a unique 5-year CHE unbalanced panel dataset. CHE incidence was measured by calculating headcount; CHE intensity was measured by overshoot and CHE inequality was estimated by concentration curves (CC) and the concentration index (CI). A random effect model was employed to analyze the impact of household head socio-economic characteristics, the household socio-economic characteristics and household health utilization on CHE incidence across the three regions., Results: The study found that the incidence and intensity of CHE decreased, but the degree of CHE inequality increased, across all three regions. For all regions, the trend of inequality first decreased and then increased. We also revealed significant differences across the eastern, central and western regions of China in CHE incidence, intensity, inequality and regional differences in the CHE influencing factors. Affected by factors such as the gap between the rich and the poor and the uneven distribution of medical resources, families in the eastern region who were unmarried, use supplementary medical insurance, and had members receiving outpatient treatment were more likely to experience CHE. Families with chronic diseases in the central and western regions were more likely to suffer CHE, and rural families in the western region were more likely to experience CHE., Conclusions: The trends and causes of CHE varied across the different regions, which requires a further tilt of medical resources to the central and western regions; improved prevention and financial support for chronic diseases households; and reform of the insurance reimbursement policy of outpatient medical insurance. On a regional basis, health policy should not only address CHE incidence and intensity, but also its inequality., 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 © 2023 Wang, Guo, Qin, Nicholas, Maitland and Liu.)

This paper explores how ideas and practices of elder-care may be changing for the new Chinese middle class. This paper draws on in-depth interviews with the members of different generations of ten middle class families in the Chinese city of Tianjin. It explores how increased resources but also increased pressure are affecting the care of older people and the expectations around elder-care. Thematic analysis of transcripts entered into NVIVO revealed three findings. Firstly, that the generation born in the 1950s and 1960s are often negotiating their care responsibilities between their parents and their grandchildren. Secondly, the only viable elder-care solution for many families is to buy in support from an unregulated market-based home care sector. Thirdly driven by an increasingly postmodern culture, filial piety may be changing from a normative expectation to a set of new practices based on familial reciprocity. The paper concludes by reflecting on the issues that will arise from the proposed raising of the retirement age in China, and the increasing geographic dispersal of generations. Flexible working policies as well as investment in a regulated home care sector are recommended as solutions to be explored., Competing Interests: Enter: The authors have declared that no competing interests exist., (Copyright: © 2023 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.)

Heavy metals contamination in sediment poses serious threats to bacterial communities that play critical roles in sediment biogeochemical processes. However, the physicochemical factors and the major heavy metals fractions that affect sediment bacterial communities are still unclear. Here, we performed heatmap and redundancy analyses to examine the effects of physico-chemical characteristics and heavy metals fractions on the sediment bacterial community from rivers in the UK (River Tyne and Ouseburn) and India (River Ganga and Yamuna). The results revealed that physicochemical characteristics and heavy metals fractions altered the diversity, richness, and structures of the bacterial community. Moreover, the fractions of Co, Zn, Pb, Cr, and Cu played significant roles in shaping the bacterial community structure, and physicochemical variables, particularly NH 4 + -N and NO 2 - -N, also influenced the bacterial diversity and structure. Firmicutes showed strong associations with both physicochemical factors and heavy metals fractions. Chloroflexi and Actinobacteriota can be used as biomarkers for Zn contamination. Overall, our study identified the significance of sediment chemical characteristics and heavy metals fractions in determining the bacterial community structure as well as bioremediation and environmental management of metals contaminated sites., 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 Elsevier Ltd. All rights reserved.)

Antibiotic resistance genes (ARGs) in drinking water sources suggest the possible presence of resistant microorganisms that jeopardize human health. However, explanations for the presence of specific ARGs in situ are largely unknown, especially how their prevalence is affected by local microbial ecology, taxa assembly and community-wide gene transfer. Here, we characterized resistomes and bacterial communities in the Taipu River catchment, which feeds a key drinking water reservoir to a global megacity, Shanghai. Overall, ARG abundances decreased significantly as the river flowed downstream towards the reservoir (P < 0.01), whereas the waterborne bacteria assembled deterministically (|βNRI| > 2.0) as a function of temperature and dissolved oxygen conditions with the assembly-dominant taxa (e.g. Ilumatobacteraceae and Cyanobiaceae) defining local resistomes (P < 0.01, Cohen's D = 4.22). Bacterial hosts of intragenomic ARGs stayed at the same level across the catchment (60 ∼ 70 genome copies per million reads). Among them, the putative resistant pathogens (e.g. Burkholderiaceae) carried mixtures of ARGs that exhibited high transmission probability (transfer counts = 126, P < 0.001), especially with the microbial assembly-dominant taxa. These putative resistant pathogens had densities ranging form 3.0 to 4.0 × 10 6 cell/L, which was more pronouncedly affected by resistome and microbial assembly structures than environmental factors (SEM, std-coeff β = 0.62 vs. 0.12). This work shows that microbial assembly and resistant pathogens play predominant roles in prevelance and dissemination of resistomes in receiving water, which deserves greater attention in devisng control strategies for reducing in-situ ARGs and resistant strains in a catchment., Competing Interests: Declaration of Competing Interest Dong Wu reports financial support was provided by National Natural Science Foundation of China. Dong Wu reports financial support was provided by Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education. Dong Wu reports financial support was provided by Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health. Bing Xie, Kai Yang reports financial support was provided by National Key Research and Development Program of China. Bing Xie reports financial support was provided by National Natural Science Foundation of China., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Over 26 million recovered COVID-19 patients will suffer from discrimination in work, education and social interactions. We analyzed the determinants of discrimination against recovered COVID-19 patients and suggest policy recommendations to reduce such discrimination., Methods: Twenty-seven Chinese cities were selected randomly based on their geographical location and GDP rank. One hundred adults were interviewed in each city with an equal number of men and women and three urban residents for every two rural residents. A multiple ordered logistic regression model was used to assess the associations between potential determinants and the COVID-19 discrimination level., Results: Of 2377 participants, 79.76% displayed discrimination toward recovered COVID-19 patients. The female discrimination level was 1.25 times that of males; the discrimination level increased with age; and was occupation-specific, with physicians' (OR = 0.352) and students' (OR = 0.553) discrimination level lower than that of farmers. The discrimination level of participants from the central regions was 1.828 times, and the eastern region 1.504 times, that of participants from western region. The participants' discrimination level was lower when they scored higher in transmission knowledge, prevention knowledge and other COVID-19 knowledge, treatment methods and quarantine time., Conclusion: Sex, age, occupation, infections of relatives and friends, regions and scores on COVID-19 knowledge were determinants of discrimination level against recovered COVID-19 patients. In contrast with qualitative studies, our quantitative study recommends targeted education campaigns, focusing on physicians, women, older people and certain occupations. Only the COVID-19 vaccination program for the whole population will resolve the COVID-19 discrimination problem.

Plant materials used in the construction of segments and beacon towers of the ancient Great Wall in northwestern China contain untapped potential for revealing local paleoclimatic and environmental conditions. For the first time, we characterize the molecular preservation and stable carbon and nitrogen isotope compositions of AMS-dated common reeds (Phragmites) collected from ancient Great Wall fascines in today's Gansu and Xinjiang using a combination of chromatographic techniques and isotope analyses. Our molecular data, along with Scanning Electron Microscopy, demonstrate excellent preservation of these ancient reeds, which were harvested from nearby habitats during periods of significant expansion of Imperial China when climate conditions sustained sizeable oases in the region. Stable isotope data capture differential rates of environmental change along the eastern margin of the Tarim Basin since the Han Dynasty (170 BC), implying that significant surface-water hydrological changes occurred only after the Song Dynasty (1160 AD) due to regional climate change. This study reveals the wealth of environmental and climate information obtainable from these site-specific organic building materials and establishes the foundation for further applications of advanced molecular, biochemical, and isotopic technologies to study these common and widely-distributed organic archaeological materials., (© 2022. The Author(s).)

Transition metal pollution in rivers in South Asia is more serious than in other regions because of the lack of adequate freshwater management measures. Water quality criteria (WQC) for South Asia is urgently needed to protect regional aquatic environments because of the occurrence of transboundary rivers. The present study established non-parametric kernel density estimation species sensitivity distribution (NPKDE-SSD) models and then derived the acceptable hazardous concentration for protection of 95% of all aquatic species (HC5) and WQC of six typical transition metals in South Asia. The results showed that the order of acute and chronic WQC was Mn > Fe > Cd > Zn > Cu > Hg and Cu > Fe > Cd, respectively. A risk assessment of these metals in the Indus River, the Ganges River, the Brahmaputra River, the Meghna River, and the Bagmati River was also carried out. Based on the results, these major rivers in South Asia were highly polluted with transition metals, with significant ecological risks for a large number of aquatic species. This study can contribute to a better understanding of ecological risks in South Asia and provide a scientific basis for the updating of water quality standards and the increase in overall water quality.

The exposure-lag response of air temperature on daily COVID-19 incidence is unclear and there have been concerns regarding the robustness of previous studies. Here we present an analysis of high spatial and temporal resolution using the distributed lag non-linear modelling (DLNM) framework. Utilising nearly two years' worth of data, we fit statistical models to twelve Italian cities to quantify the delayed effect of air temperature on daily COVID-19 incidence, accounting for several categories of potential confounders (meteorological, air quality and non-pharmaceutical interventions). Coefficients and covariance matrices for the temperature term were then synthesised using random effects meta-analysis to yield pooled estimates of the exposure-lag response with effects presented as the relative risk (RR) and cumulative RR (RR cum ). The cumulative exposure response curve was non-linear, with peak risk at 15.1 °C and declining risk at progressively lower and higher temperatures. The lowest RR cum at 0.2 °C is 0.72 [0.56,0.91] times that of the highest risk. Due to this non-linearity, the shape of the lag response curve necessarily varied by temperature. This work suggests that on a given day, air temperature approximately 15 °C maximises the incidence of COVID-19, with the effects distributed in the subsequent ten days or more., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Polycyclic aromatic hydrocarbons (PAHs), nitrated-PAHs (NPAHs) and oxygenated-PAHs (OPAHs) are environmental pollutants with adverse effects on human health. The correlation between the concentrations of PAHs, NPAHs and OPAHs in human plasma and the methylation level of mitochondrial DNA (mtDNA) was investigated using data from 110 plasma samples collected in Tianjin, China. The median concentrations of PAHs, NPAHs and OPAHs were 16.0 (IQR: 14.4-20.7) ng/mL, 82.2 (IQR: 63.1-97.6) ng/mL and 49.6 (IQR: 28.6-53.8) ng/mL, and the mean proportions were 13.4%, 56.5% and 30.1%, respectively. Bisulfite-PCR pyrosequencing was used to measure the methylation level of MT-CO1 and tRNA-Leu. The methylation levels of two mitochondrial genes (MT-CO1, tRNA-Leu) including four CpG sites (MT-CO1-P1, MT-CO1-P2, tRNA-Leu-P1 and tRNA-Leu-P2) were 0.67% ± 1.38%, 13.54% ± 2.59%, 7.23% ± 5.35% and 1.64% ± 2.94%, respectively. To the best of our knowledge, this is the first time that significant correlations were found between PAHs and their derivatives exposure and mtDNA methylation levels., (Copyright © 2022. Published by Elsevier Inc.)

A study on the value accounting of forest carbon sink services can promote the rapid development of the carbon sink market and help better understand the impact of forest carbon sinks on climate change and economic development. However, few studies have evaluated the value of China's current forest carbon sink services. Based on research on carbon peak and carbon neutrality, according to the characteristics of China's forest ecosystems and forest resource inventory data, the stock volume method was used to measure the amount and value of forest carbon sinks in China in 2009-2013 and 2014-2018. The results showed that: (1) the physical amount of forest carbon aggregates in China increased from 2009 to 2013 and from 2014 to 2018. The carbon storage of natural and plantation forests both showed an upward trend. Among them, the growth rate of the carbon storage of plantation forests was higher than that of natural forests. (2) The state, adjoint, and coupling equations of forest carbon sinks were employed to ascertain the best price for China's forest carbon sinks in 2020. The results showed that the price of China's forest carbon sinks was slightly higher than the internationally accepted carbon sink price, reflecting that the changes in the value of China's forest carbon sinks and international carbon sinks were roughly the same. (3) We obtained an appropriate accounting model for China's forest carbon sinks. (4) The value of China's forest carbon sinks increased from 2009 to 2013 and from 2014 to 2018. Although the price of carbon sinks has declined, the overall forest resource stock has increased, especially in plantation forests. The increase in the value of carbon sinks was as high as 24.7%, resulting in an overall increase in the value of forest carbon sinks, which was also in line with the physical amount of forest carbon sinks. The measurement conclusions were consistent. Several key points to note based on these findings are as follows: (1) China's current forest carbon sink transactions are all project-level certified emission reduction transactions, and diversified non-market means should be constructed to comprehensively promote carbon sink transactions. (2) China's current carbon sink transactions are mainly clean development mechanism projects, with few transactions between enterprises, and the carbon trading market situation is not optimistic. (3) The key to effective forest carbon sequestration trading is the accurate accounting of forest carbon storage and carbon sequestration value. Thus, it is of great significance to establish a forest carbon sequestration measurement method that is economical, simple, and accurate. (4) The physical amount and value of carbon sequestration of China's forest resources are rising, and the contribution rate is increasing year by year. However, there is still a gap in per capita forest area and storage compared with those in other countries worldwide. Thus, China must be vigilant in times of peace and further strengthen the protection and construction of forest resources., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

There has been extensive research on antibiotics exposure in adults by biomonitoring, but the biological mechanisms and potential risks to human health remain limited. In this study, 102 adults aged 26-44 years in Tianjin were studied and 23 common antibiotics in urine were analyzed by Liquid chromatography-mass spectrometry (LC-MS). All antibiotics were detected in urine, with an overall detection frequency of 40.4% (the detection frequencies of phenothiazines, quinolones, sulfonamides, tetracyclines, and chloramphenicol were 77%, 54%, 24%, 28%, and 49%, respectively.). Ofloxacin and enrofloxacin had the highest detection frequencies (85% and 81%), with median concentrations of 0.26 (IQR: 0.05-1.36) and 0.09 (IQR: 0.03-0.14) ng/mL, respectively. Based on health risk assessment, the predicted estimated daily exposures (EDEs) ranged from 0 μg/kg/day to 13.98 μg/kg/day. The hazard quotient (HQ) values of all the antibiotics except ofloxacin and ciprofloxacin were bellow one, which are considered safe. For all blood samples, the mitochondrial DNA (mtDNA) methylation levels in the MT-ATP6 (ranging between 3.86% and 34.18%) were slightly higher than MT-ATP8 and MT-ND5 (ranging between 0.57% and 9.32%, 1.08% and 19.62%, respectively). Furthermore, mtDNA methylation from MT-ATP6, MT-ATP8 and MT-ND5 were measured by bisulfite-PCR pyrosequencing. The association (P < 0.05) was found between mtDNA methylation level (MT-ATP8 and MT-ND5) and individual antibiotics including chlorpromazine, ciprofloxacin, enrofloxacin, norfloxacin, pefloxacin, sulfaquinoxaline, sulfachloropyridazine, chloramphenicol, and thiamphenicol, indicating that persistent exposure to low-dose multiple antibiotics may affect the mtDNA methylation level and in turn pose health risks., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems., Objectives: This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China., Methods: This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45 years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed., Results: Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3-13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were 'not enough money' and 'illness is not serious, don't need treatment', respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs., Conclusion: This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Currently there are various issues that exist in the medical institutions in China as a result of the price-setting in DRGs, which include the fact that medical institutions tend to choose patients and that the payment standard for complex cases cannot reasonably compensate the cost. Objective: The main objective is to prevent adverse selection problems in the operations of a diagnosis-related groups (DRGs) system with the game pricing model for scientific and reasonable pricing. Methods: The study proposes an improved bargaining game model over three stages, with the government and patients forming an alliance. The first stage assumes the alliance is the price maker in the Stackelberg game to maximize social welfare. Medical institutions are a price taker and decide the level of quality of medical service to maximize their revenue. A Stackelberg equilibrium solution is obtained. The second stage assumes medical institutions dominate the Stackelberg game and set an optimal service quality for maximizing their revenues. The alliance as the price taker decides the price to maximize the social welfare. Another Stackelberg equilibrium solution is achieved. The final stage establishes a Rubinstein bargaining game model to combine the Stackelberg equilibrium solutions in the first and second stage. A new equilibrium between the alliance and medical institutions is established. Results: The results show that if the price elasticity of demand increases, the ratio of cost compensation on medical institutions will increase, and the equilibrium price will increase. The equilibrium price is associated with the coefficient of patients' quality preference. The absolute risk aversion coefficient of patients affects government compensation and total social welfare. Conclusion: In a DRGs system, considering the demand elasticity and the quality preference of patients, medical service pricing can prevent an adverse selection problem. In the future, we plan to generalize these models to DRGs pricing systems with the effects of competition of medical institutions. In addition, we suggest considering the differential compensation for general hospitals and community hospitals in a DRGs system, in order to promote the goal of hierarchical diagnosis and treatment., 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 © 2021 Duan, Lin and Jiao.)

Surface runoff is the main cause of farmland nitrogen (N) losses in plain areas, which adversely affect water quality. The impact of fertilization on N runoff loss often varies. A meta-analysis was performed using 245 observations from 31 studies in China, to estimate the response of N loss in both paddy and upland fields subjected to different fertilization strategies, and investigate the link between N runoffs, soil properties, as well as precipitation in the planting season. The results showed that compared to the control (without fertilization), N losses subjected to fertilization increased from 3.31 kg/ha to 10.03 kg/ha and from 3.00 kg/ha to 11.24 kg/ha in paddy and upland fields respectively. Importantly, paddy N loss was significantly correlated with fertilizer type and N application rate (predictors); in upland fields N application rate and seasonal precipitation were the main driving factors. For the N application rate, N loss increased with increase in rates for both paddies and upland fields. Moreover, the N loss from upland fields increased with the precipitation during planting season. Between the three fertilizers used in paddies, the increase in loss of CRF (controlled release fertilizer) or OF (organic fertilizer) was lower than that of CF (inorganic chemical fertilizer) with the lowest value in CRF. Subset analysis showed that the effect of CRF and OF in paddies was not affected by the predictors, revealing the steadily controlling property of CRF and OF in paddies. Also, all the predictors had an insignificant impact to N loss risk in paddies during the high application rate. Overall, the results confirm the importance of N dosage in N runoff loss from farmland. Fertilizer type is a key consideration for N loss control in paddies, while the seasonal precipitation should not be ignored in upland fields., 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 © 2021 Elsevier B.V. All rights reserved.)

Clarifying the properties/features of nutrient loss from farmland surface runoff is essential for the mitigation of nutrient losses. Plough pan formation underneath topsoil is a common feature of long-term paddy soils that significantly affects water movement and nutrient runoff loss, especially during the upland season of paddy-upland rotation. To characterize the nutrients that are lost from wheat fields of paddy-wheat rotation with runoff, a field experiment was conducted in a wheat field using a simulated rainfall system from November 2019 to May 2020 in Nanjing, China. The aim of this study was to investigate the temporal characteristics of nitrogen (N) and phosphorus (P) loss under different rainfall intensities (low, 30 mm h -1 ; middle, 60 mm h -1 ; high, 90 mm h -1 ). The results showed that the time interval from the beginning of rain to the occurrence of runoff (time to runoff, Tr) was negatively correlated with "rainfall intensity" (Ri) (P＜0.01) but unaffected by soil moisture. Different rainfall intensities had no effect on the runoff coefficient (the ratio of the runoff volume over the precipitation, 0.14-0.17). The N and P loss concentrations in the nutrient discharge followed a power-function relationship that decreased over time (P＜0.01), and the peak nutrient concentration appeared during the initial runoff period (0-5 min). The N and P loss rates were the highest during the middle-to-late discharge period (15-30 min) for all intensities. In terms of cumulative nutrient losses, the amounts of TN lost were similar for all rainfall intensities, while TP significantly increased with intensity. The results revealed that nitrate-nitrogen (NO X - -N) and particulate phosphorus (PP) were the predominant forms of N and P losses. Overall, during the initial runoff period, nutrient concentration peaks, whereas the nutrient loss rate is the highest during the middle-late phase of the phenomenon., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Ticks are known as vectors of several pathogens causing various human and animal diseases including Lyme borreliosis, tick-borne encephalitis, and Crimean-Congo hemorrhagic fever. While China is known to have more than 100 tick species well distributed over the country, our knowledge on the likely distribution of ticks in the future remains very limited, which hinders the prevention and control of the risk of tick-borne diseases. In this study, we selected four representative tick species which have different regional distribution foci in mainland China. i.e., Dermacentor marginatus, Dermacentor silvarum, Haemaphysalis longicornis and Ixodes granulatus. We used the MaxEnt model to identify the key environmental factors of tick occurrence and map their potential distributions in 2050 under four combined climate and socioeconomic scenarios (i.e., SSP1-RCP2.6, SSP2-RCP4.5, SSP3-RCP7.0 and SSP5-RCP8.5). We found that the extent of the urban fabric, cropland and forest, temperature annual range and precipitation of the driest month were the main determinants of the potential distributions of the four tick species. Under the combined scenarios, with climate warming, the potential distributions of ticks shifted to further north in China. Due to a decrease in the extent of forest, the distribution probability of ticks declined in central and southern China. In contrast with previous findings on an estimated amplification of tick distribution probability under the extreme emission scenario (RCP8.5), our studies projected an overall reduction in the distribution probability under RCP8.5, owing to an expected effect of land use. Our results could provide new data to help identify the emerging risk areas, with amplifying suitability for tick occurrence, for the prevention and control of tick-borne zoonoses in mainland China. Future directions are suggested towards improved quantity and quality of the tick occurrence database, comprehensiveness of factors and integration of different modelling approaches, and capability to model pathogen spillover at the human-tick interface., (Copyright © 2021 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.)

Background: Catastrophic health expenditures (CHE) are out-of-pocket payments (OOP) that exceed a predefined percentage or threshold of a household's resources, usually 40 %, that can push households into poverty in China. We analyzed the trends in the incidence and intensity, and explored the determinants, of CHE, and proposed policy recommendation to address CHE., Methods: A unique 5-year national urban-rural panel database was constructed from the China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in the net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence., Results: CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tend, falling from 14.7 to 8.7 % for total households, 12.5-6.6 % in urban and 16.8-10.9 % in rural areas. CHE intensity decreased in rural (24.50-20.51 %) and urban (22.31-19.57 %) areas and for all households (23.61-20.15 %). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65 + years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head's sex and health insurance., Conclusions: The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key intervention strategy to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.

Maternal vaginal/rectal colonization of group B streptococcus (GBS) is a main risk for neonatal invasive infection. Efficient determination of GBS colonization in pregnant women is crucial. This study aimed to investigate the prevalence of GBS carriage and evaluate the diagnostic performance of six methodologies for GBS screening conducted in China, including blood agar plate, liquid chromogenic medium, and loop-mediated isothermal amplification (LAMP) without pre-enrichment, chromogenic agar plate with pre-enrichment, and GBS antigen detection without and with pre-enrichment in comparison with the standard reference method (Lim broth-enriched subculture with plating on 5% sheep blood agar). Vaginal/rectal swabs were collected from 1,281 pregnant women at 35-37 weeks of gestation. Of them, 309 were taken in triplicate, one for Lim broth-enriched subculture, one for blood agar plate, and the third for GBS antigen detection (Reagent W); 177 were acquired in duplicate, one for Lim broth-enriched subculture and the other for GBS antigen detection (Reagent H); 502 were obtained in duplicate, one for Lim broth-enriched subculture and the other for liquid chromogenic medium; 158 were collected in duplicate, one for Lim broth-enriched subculture and the other for LAMP; and 135 were inoculated in Lim broth-enriched for GBS antigen detection (Reagent W) and subculture with chromogenic agar plate and 5% blood agar plate. The overall prevalence of GBS carriage was 10.1% (130/1,281, 95% CI: 8.5-12.1%) according to the standard reference method. Compared with the standard reference method, the LAMP had excellent performance of sensitivity (100%, 95%CI: 83.4-100%), specificity (94%, 95%CI: 88.1-97.1%), and Yoden index (0.940); as well as the blood agar plate with sensitivity (81.5%, 95%CI: 61.3-93.0%), specificity (100%, 95%CI: 98.3-100.0%), and Yoden index (0.815). The other four methods were not sufficient to reach the threshold in terms of sensitivity or specificity compared to the standard reference method. Furthermore, for LAMP, results can be obtained within 0.5-1 h, while for blood agar plate, which needed 24-48 h, and further identification was required. Our data suggested that the performance of LAMP was highly comparable to the standard Lim broth-enriched subculture and LAMP is considered as an alternative for fast and accurate GBS screening., 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 © 2021 Gao, Deng, Huang, Chang, Zhong, Xie, Guan and Liu.)

Nut-based products may aid low-glycaemic dietary strategies that are important for diabetes prevention in populations at increased risk of dysglycaemia, such as Asian Chinese. This randomised cross-over trial assessed the postprandial glycaemic response (0-120 min) of a higher-protein nut-based (HP-NB) snack formulation, in bar format (1009 kJ, Nutrient Profiling Score, NPS, -2), when compared with an iso-energetic higher-carbohydrate (CHO) cereal-based bar (HC-CB, 985 kJ, NPS +3). It also assessed the ability to suppress glucose response to a typical CHO-rich food (white bread, WB), when co-ingested. Ten overweight prediabetic Chinese adults (mean, sd: age 47⋅9, 15⋅7 years; BMI 25⋅5, 1⋅6 kg/m 2 ), with total body fat plus ectopic pancreas and liver fat quantified using dual-energy X-ray absorptiometry and magnetic resonance imaging and spectroscopy, received the five meal treatments in random order: HP-NB, HC-CB, HP-NB + WB (50 g available CHO), HC-CB + WB and WB only. Compared with HC-CB, HP-NB induced a significantly lower 30-120 min glucose response ( P < 0⋅05), with an approximately 10-fold lower incremental area under the glucose curve (iAUC 0-120 ; P < 0⋅001). HP-NB also attenuated glucose response by approximately 25 % when co-ingested with WB ( P < 0⋅05). Half of the cohort had elevated pancreas and/or liver fat, with 13-21 % greater suppression of iAUC 0-120 glucose in the low v. high organ fat subgroups across all five treatments. A nut-based snack product may be a healthier alternative to an energy equivalent cereal-based product with evidence of both a lower postprandial glycaemic response and modulation of CHO-induced hyperglycaemia even in high-risk, overweight, pre-diabetic adults., (© The Author(s) 2021.)

Background: Investigations on the potential effects of high air pollution exposure before pregnancy on adverse pregnancy outcomes are limited, and it is unknown whether air quality standards looser than that set by World Health Organization (WHO) still can provide sufficient protection pregnant women from adverse pregnancy outcomes., Objectives: To evaluate the potential effects of high ambient air pollution around pregnancy on preterm birth (PTB) and low birth weight (LBW), and assess the risk of PTB and LBW associated with air pollutants with reference to different air quality standards of WHO and China., Methods: Our study leveraged 10,960 pregnant women from the Project ELEFANT. Daily average particulate matter with an aerodynamic diameter of ≤2.5 μm (PM 2.5 ) and ≤10 μm (PM 10 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), carbon monoxide (CO) and ozone (O 3 ) concentrations were collected based on Chinese Air Quality Reanalysis datasets. Hazard ratios (HR) of PTB and LBW were estimated for maternal PM 2.5 , PM 10 , NO 2 , SO 2 , CO and O 3 exposures and related proportions of days with daily average air pollution concentrations exceeding air quality standards of WHO and China around pregnancy using Cox proportional hazards regression models with adjustment for potential confounders., Results: Ambient PM 2.5 , PM 10 , NO 2 , SO 2 and CO exposure during the before pregnancy and pregnancy period were both significantly and positively associated with increased risk of PTB, PTB subtypes and LBW. A 10% increase in proportion of days with daily average PM 2.5 exceeding 25 μg/m 3 over the entire pregnancy was most apparently associated with risk of PTB (HR, 12.66; 95% CI, 8.20-19.53) and LBW (HR, 17.42; 95% CI, 6.88-44.10) among all PM 2.5 proportion variables based on different air quality standards., Conclusion: Air quality standards of WHO are necessary to be implemented to control for risks of adverse pregnancy outcomes associated with ambient air pollution in areas with high air pollution levels., Competing Interests: Declaration of competing interest The authors declared that they have no conflicts of interest to this work., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Polymorphisms in mitochondrial DNA (mtDNA) have been linked to a range of diseases. Here we investigate the relationship between mtDNA D-loop region polymorphisms, mtDNA haplotype and polycystic ovary syndrome (PCOS), as well as the correlation of D-loop variants and clinical characteristics of PCOS, in a Chinese population. The mtDNA D-loop of whole blood samples from 421 PCOS patients and 409 controls underwent next generation sequencing. The variants G207A (P BH ＜0.05), 16036GGins (P BH ＜0.05) and 16049Gins (P BH ＜0.001) were associated with decreased risk of PCOS. No variants were associated with PCOS, and within the PCOS group, no statistical significance was found between D-loop polymorphisms and clinical characteristics. Patient haplotype was identified from D-loop single nucleotide polymorphisms and analysis suggested that haplotype A15 (P adjusted ＜0.01) was significantly associated with decreased risk of PCOS. In conclusion, mtDNA D-loop alterations and haplotype appear to confer resistance to PCOS in Chinese women., (Copyright © 2020 Elsevier B.V. and Mitochondria Research Society. All rights reserved.)

Background: High-density lipoprotein cholesterol (HDL-C) hypolipidemia, a major type of dyslipidemia, has been associated with many kinds of diseases, such as stroke, coronary heart disease, obesity and diabetes, and has displayed an increasing prevalence in China. This study explores the risk factors of HDL-C hypolipidemia and makes recommendations for controlling and preventing HDL-C hypolipidemia and the diseases caused by it., Methods: Using a retrospective cohort study design, 26,863 urban adults without dyslipidemia, diabetes, cardiovascular and cerebrovascular diseases, hepatosis, renal insufficiency and thyroid diseases were enrolled in the study between 2010 and 2015. Data on each individual were collected at the 2010 baseline year and at a follow-up medical check. A Cox regression model was constructed to evaluate the influence of potential risk factors on the outcome event- HDL-C hypolipidemia., Results: The incidence of HDL-C hypolipidemia was 5.7% (1531/26863). Sex, age, body mass index (BMI), HDL-C, triglyceride (TG) and urea nitrogen (UN) were significant risk factors of HDL-C hypolipidemia. Men were more likely to develop HDL-C hypolipidemia than women during follow-up medical checks (HR = 1.258, P = 0.014). The incidence of HDL-C hypolipidemia in the over 65 years old group was higher than that of the ≤65 age group (HR = 1.276, P = 0.009). The incidence of HDL-C hypolipidemia increased with increasing BMI (HR = 1.030, P = 0.002), TG (HR = 1.321, P = 0.001) and UN (HR = 1.054, P = 0.019), while falling with increasing HDL-C in the baseline year (HR = 0.002, P < 0.001)., Conclusions: Men, aged over 65, with high BMI were at the highest risk of developing HDL-C hypolipidemia. Measures should be taken to prevent HDL-C hypolipidemia even for healthy urban adults whose blood biochemical indicators were in the normal range when their level of TG, UN and HDL-C are closed to the border of the normal value range.

Background: As a common medical emergency in individuals with diabetes, hypoglycemia events can impose significant demands on hospital resources. Based on diabetes patients with and without hypoglycemia, we assess the cost of hypoglycemic events on China's hospital system., Method: Our study sample comprised 7110 diabetes episodes, including 1417 patients with hypoglycemia (297 patients with severe and 1120 with non-severe hypoglycemia) and 5693 diabetes patients without hypoglycemia. Data on patient social-demographics, length of hospital stay, and hospitalization costs were collected on each patient from Health Information System in Shandong province, China. The additional hospital costs caused by hypoglycemia were assessed by the cost difference between diabetes patients with and without hypoglycemia, including severe and non-severe hypoglycemia. China-wide hospital costs of hypoglycemia were estimated based on adjusted additional hospital costs, comprising inspection, treatment, drugs, materials, nursing, general medical costs, and other costs, caused by hypoglycemia, the prevalence of diabetes and hypoglycemia events, and the rates of hospitalization. Multiple sensitivity analyses were conducted to assess the impact of variations in the key input parameters on the primary estimates., Results: Total hospital costs for patients with hypoglycemia (US$3020.61) were significantly higher than that of patients without hypoglycemia (US$1642.91). The average additional cost caused by hypoglycemia was US$1377.70, with higher average costs of US$1875.89 for severe hypoglycemia and lower average costs of US$1244.76 for non-severe hypoglycemia. The additional hospital cost caused by severe and non-severe hypoglycemia patients was higher for the 60 to 75 year old group, married patients and patients accessing free medical services. Generally, hypoglycemic patients with Urban and Rural Resident Basic Medical Insurance incurred higher additional hospital costs than patients with Urban Employees Basic Medical Insurance. Based on these estimates, the total annual additional hospital costs arising from hypoglycemia events in China were estimated to be US$67.52 million. Sensitivity analyses suggested that the costs of hypoglycemia events ranged up to US$49.99 million to 67.52 million., Conclusion: : Hypoglycemic events imposed a substantial cost on China's hospital system, with certain subgroups of patients, such as older patients and those with free health insurance, using medical resources more intensively to treat hypoglycemia events. We recommend more effective planning of prevention and treatment regimes for hypoglycemia patients; further reform to China's health insurance schemes; and better hospital cost control for those accessing free hospital services., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

A novel sulphate-reducing, Gram-stain-negative, anaerobic strain, isolate XJ01 T , recovered from production fluid at the LiaoHe oilfield, PR China, was the subject of a polyphasic study. The isolate together with Desulfovibrio oxamicus NCIMB 9442 T and Desulfovibrio termitidis DSM 5308 T formed a distinct, well-supported clade in the Desulfovibrionaceae 16S rRNA gene tree. The taxonomic status of the clade was underscored by complementary phenotypic data. The three isolates comprising the clade formed distinct phyletic branches and were distinguished using a combination of physiological features and by low average nucleotide identity and digital DNA-DNA hybridization values. Consequently, it is proposed that isolate XJ01 T represents a novel genus and species for which the name Cupidesulfovibrio liaohensis gen. nov., sp. nov. is proposed with the type strain XJ01 T (=CGMCC 1.5227 T =DSM 107637 T ). It is also proposed that D. oxamicus and D. termitidis be reclassified as Cupidesulfovibrio oxamicus comb. nov. and Cupidesulfovibrio termitidis comb. nov., respectively.

Group B Streptococcus (GBS) is an important etiological agent of maternal and neonatal infections as well as postpartum women and individuals with impaired immunity. We developed and evaluated a rapid classification method for sequence types (STs) of GBS based on statistic models with Matrix-Assisted Laser Desorption/Ionization Time-of Flight Mass Spectrometry (MALDI-TOF/MS). Whole-cell lysates MALDI-TOF/MS analysis was performed on 235 well-characterized GBS isolates from neonatal invasive infections in a multi-center study in China between 2015 and 2017. Mass spectra belonging to major STs (ST10, ST12, ST17, ST19, ST23) were selected for model generation and validation. Recognition and cross validation values were calculated by Genetic Algorithm-K Nearest Neighbor (GA-KNN), Supervised Neural Network (SNN), QuickClassifier (QC) to select models with the best performance for validation of diagnostic efficiency. Informative peaks were further screened through peak statistical analysis, ST subtyping MSP peak data and mass spectrum visualization. For major STs, the ML models generated by GA-KNN algorithms attained highest cross validation values in comparison to SNN and QC algorithms. GA-KNN models of ST10, ST17, and ST12/ST19 had good diagnostic efficiency, with high sensitivity (95-100%), specificity (91.46%-99.23%), accuracy (92.79-99.29%), positive prediction value (PPV, 80%-92.68%), negative prediction value (NPV, 94.32%-99.23%). Peak markers were firstly identified for ST10 (m/z 6250, 3125, 6891) and ST17 strains (m/z 2956, 5912, 7735, 5218). Statistical models for rapid GBS ST subtyping using MALDI-TOF/MS spectrometry contributes to easier epidemical molecular monitoring of GBS infection diseases., 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 © 2021 Huang, Gao, Chen, Zhong, Li, Guan, Deng, Xie, Ji, McIver, Chang and Liu.)

Background: Vaccinations are an effective choice to stop disease outbreaks, including COVID-19. There is little research on individuals' COVID-19 vaccination decision-making., Objective: We aimed to determine individual preferences for COVID-19 vaccinations in China, and to assess the factors influencing vaccination decision-making to facilitate vaccination coverage., Methods: A D-efficient discrete choice experiment was conducted across six Chinese provinces selected by the stratified random sampling method. Vaccine choice sets were constructed using seven attributes: vaccine effectiveness, side-effects, accessibility, number of doses, vaccination sites, duration of vaccine protection, and proportion of acquaintances vaccinated. Conditional logit and latent class models were used to identify preferences., Results: Although all seven attributes were proved to significantly influence respondents' vaccination decision, vaccine effectiveness, side-effects and proportion of acquaintances vaccinated were the most important. We also found a higher probability of vaccinating when the vaccine was more effective; risks of serious side effects were small; vaccinations were free and voluntary; the fewer the number of doses; the longer the protection duration; and the higher the proportion of acquaintances vaccinated. Higher local vaccine coverage created altruistic herd incentives to vaccinate rather than free-rider problems. The predicted vaccination uptake of the optimal vaccination scenario in our study was 84.77%. Preference heterogeneity was substantial. Individuals who were older, had a lower education level, lower income, higher trust in the vaccine and higher perceived risk of infection, displayed a higher probability to vaccinate., Conclusions: Preference heterogeneity among individuals should lead health authorities to address the diversity of expectations about COVID-19 vaccinations. To maximize COVID-19 vaccine uptake, health authorities should promote vaccine effectiveness; pro-actively communicate the absence or presence of vaccine side effects; and ensure rapid and wide media communication about local vaccine coverage., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

As of now, circular economic production models of the circular economy (CEPMs), which include circular economy, bioeconomy, and circular bioeconomy, are among the main tools characterizing development policies in different countries. During the last five years, policies and strategies regarding CEPMs have promoted and contributed to the development of research on this topic. The evolution and most relevant aspects of the three CEPMs previously mentioned have been analyzed from a sample of 2190 scientific publications obtained from the Scopus database. Bibliometric analysis has been used to evaluate the approach of these models in agriculture and to introduce the ways in which they address the management of agricultural waste biomass (AWB). Results show that the circular economy is the most studied and prioritized model in China and most European countries, with the UK leading the way. Germany leads in topics related to the bioeconomy. The management policies and strategies of the circular bioeconomy are key to promoting research focused on AWB valorization since bioenergy and/or biofuel production continue to be a priority.

(1) Background: The management of multiple chronic diseases challenges China's health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants' HRQOL, and χ 2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old ( P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases ( P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants ( P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants ( P < 0.001), and daily tooth-brushing for middle ( P < 0.05) and young-old participants ( P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients ( P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

Background: Studies investigating the impact of fine particulate matter (PM 2.5 ) exposure during pregnancy upon adverse birth outcomes have primarily been performed in Western nations with low ambient PM 2.5 levels. We examined associations between high levels of PM 2.5 exposure during pregnancy and risk of adverse birth outcomes by timing and level of exposure in a Chinese population., Methods: We analysed data from 10,738 live births within the Project ELEFANT study based in Tianjin, China. Personal mean daily PM 2.5 exposures were estimated using data from 25 local monitoring sites across the city, used to compute the days exceeding 50, 100, 150, 200 and 250 μg/m 3 . Relative risk of pre-term birth (<37 weeks) and low birthweight (<2500 g) were estimated by generalized additive distributed lag models, adjusted for maternal age, sex, region, paternal smoking, parity, maternal occupation, season, temperature and dew point., Results: A dose-response was exhibited for PM 2.5 exposure and relative risk (RR) of adverse birth outcomes, with exposure in the second and third trimesters of pregnancy associated with greatest risk of adverse birth outcomes. The RRs of pre-term birth with exposures of >50, >150 and > 250 μg/m 3 PM 2.5 in the third trimester were 1.09 (95%CI: 1.03-1.16), 1.30 (1.09-1.54) and 2.73 (2.03-3.66) respectively. For low birthweight, exposures of >50, >150 and > 250 μg/m 3 PM 2.5 in the third trimester were associated with RRs of 0.99 (0.88-1.11), 1.37 (1.04-1.81) and 3.03 (1.75-5.23) respectively., Conclusions: Exposure to high levels of PM 2.5 from the second trimester onwards was most strongly associated with increased risk of pre-term birth and low birthweight, with a dose-response relationship. Our data demonstrates the need to account for both level and timing of exposure in analysis of PM 2.5 -associated birth outcomes., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: It remains controversial to claim blood pressure (BP) as a leading risk factor for high risk of death in peritoneal dialysis patients, and less is known about the relationship between BP and mortality in Chinese peritoneal dialysis patients., Methods: From Zhejiang Renal Data System in China, we collected data on patients treated and followed up at 98 peritoneal dialysis centres from 2008 to 2016. The associations of BP parameters [SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP)] with all-cause and cardiovascular mortality were examined. We fitted Cox models for mortality with penalized splines using nonparametric smoothers. Several sensitivity analyses were performed to confirm the robustness of our primary findings., Results: A total of 7335 Chinese peritoneal dialysis patients were included. During a median follow-up of 35.8 months, 1281 (17.5%) patients died. SBP, DBP, MAP follow a U-shaped pattern of both all-cause and cardiovascular mortality. PP presents a reverse L-shaped association with all-cause mortality. Either a higher (SBP >141, DBP >85 or MAP >102 mmHg) or lower (SBP <119, DBP <67 or MAP <88 mmHg) BP tends to have a significantly higher all-cause and cardiovascular mortality risk. Higher PP (>60 mmHg) is related to a higher risk of all-cause mortality, but not cardiovascular mortality. These associations remain the same in our competing risk analysis and subgroup analyses., Conclusion: These data indicate U-shaped associations of SBP, DBP and MAP with all-cause mortality and cardiovascular mortality, respectively, and a reverse L-shaped association of PP with all-cause mortality. Further studies are needed to reliably establish the optimal BP targets for better hypertension control in peritoneal dialysis patients.

Background: While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions., Objectives: The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China., Design: A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective., Settings: Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China., Participants: A total of 7,653 immobile stroke patients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017., Methods: To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months., Results: Compared to routine care, the intervention program decreased the total costs of stroke patients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥-517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemic patients and tertiary hospitals patients while for hemorrhagic patients and non-tertiary hospital patients only the health-related quality of life improved significantly., Conclusions: Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an intervention program provided significant cost saving, but mainly in ischemic patients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally., Competing Interests: Declaration of Competing Interest We declare no competing interests relevant to this manuscript., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Data sources PubMed, EMBASE and China National Knowledge Infrastructure. Manual review of reference list of included studies.Study selection Cross-sectional studies or the first evaluation of longitudinal studies that were conducted on patients (<18 years old) with a known diagnosis of type 1 diabetes mellitus (DM). The primary outcome was prevalence of dental caries.Data extraction and synthesis Selection of studies, data extraction and risk of bias assessment was performed, independently, by two members of the review team. Inter-rater reliability (kappa = 0.68) was provided. Disagreements were resolved by consensus. The modified Newcastle-Ottawa scale, modified specifically to this review, was used to assess study quality and bias. Where appropriate, data was pooled and analysed using a random-effects model. Subgroup analyses were carried out where possible.Results Four hundred and eighty-eight potential articles were screened; 83 full-text articles were reviewed, with ten (involving a total of 538 patients) included in the meta-analysis. Seven studies were adjudged to be of high quality and three of low quality using the modified Newcastle-Ottawa scale. Overall, pooled prevalence of dental caries, among children and adolescents with type 1 DM, was 67% (95%CI: 0.56-0.77%; I2 = 83%; p<0.01). Subgroup analyses (geographic location and diabetic control) highlighted pooled prevalence was highest at 84% (95%CI: 0.67-0.94%; I2 = 49%; p = 0.16) in South America and 66% (95%CI: 0.43-0.83%; I2 = 87%; p<0.01) in those with bad diabetic control.Conclusions Caries prevalence is high among children and adolescents with type 1 DM. Diabetic children and adolescents need to be regularly screened for dental disease. Consistent preventive measures are required, from all healthcare professionals involved in the care of these patients, to ensure a balance in struck between optimum oral health and diabetic control for these patients.

This paper responds to the increasing concern regarding the role of non-human life in shaping urban space by exploring the public perception of urban companion animals during the coronavirus disease 2019 (COVID-19) outbreak in China. We argue that the public's perception of urban companion animals during emerging infectious disease outbreaks is related to medical and life science issues and reflects the political, economic, and emotional struggles involved in human-animal multispecies cohabitation. We find that the public has mainly followed and reconstructed medical discourses about the risk of companion animal-to-human transmission and discussed sustainable ethical animal practices in urban public health emergency management during the COVID-19 outbreak. Concerns regarding the risk of companion animal-related infection reflect the increasing prominence of more-than-human families, the pet industry, and multispecies leisure conflicts in public space in Chinese cities. The public's attention to animal ethics has prompted Chinese policy makers to adopt a more morally acceptable model for urban public health emergency management that can be sustained and supported by responsible non-governmental organizations and ethical urban residents., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Migrant workers are a susceptible population to the hepatitis b virus (HBV) and a vulnerable spot in China's immunization procedures. There is no free HBV immunization program for migrant workers in China, so understanding migrant workers' motivation to receive the HBV vaccine is the first step in designing effective immunization policies., Methods: A fully specified protection motivation theory (PMT) model of HBV vaccination intention among migrant workers was specified. Data were collected through a cross-sectional survey of 406 migrant workers in three migrant-dense industries in Tianjin, China. Principal component factor analysis was used to produce PMT factors and nested binary logistic regression modeling was applied to assess the associations between protection motivation and HBV vaccination intention of migrant workers., Results: The nested binary logistic regression model suggested that the severity factor and self-efficacy factor were positively related to HBV vaccination intention (OR = 2.15, 95% CI: 1.25-3.71; OR = 2.75, 95% CI: 1.62-4.66) while the response costs was negatively related to the HBV vaccination motivation (OR = 0.50, 95% CI: 0.29-0.83). The socio-demographic variables showed that younger, married and good self-rated health status participants were statistically associated with the intention of taking the HBV vaccine. Sex, education level and income group were not significantly associated with vaccination intention. The migrant-industry variables showed that migrant location had a strong effect on migrant workers' vaccination intention., Conclusion: Socio-demographic, migrant-industry variables and PMT factors (severity, self-efficacy and response costs) were statistically associated with migrant workers' intention to vaccinate. Our results suggest that health policy makers should provide more information to migrants on HBV severity; inform migrant workers on where, when and how to get the HBV vaccine; tap into work organizations as a location for vaccinations; and identify migrant worker subgroups for targeted interventions.

Long-term exposure to the ambient fine particulate matter (PM 2.5 ) is the major public health risk factor in China. Several past studies have assessed premature mortalities associated with PM 2.5 in China at varying levels of temporal and spatial scales using different methodological approaches. However, recently developed global exposure mortality model [GEMM NCD + LRI and GEMM 5-COD] provides a much more sophisticated methodology in capturing mortality due to PM 2.5 -exposure than the commonly accepted integrated exposure-response (IER) model, which this study applied to China. This study provides a comparative assessment of the excess long-term PM 2.5 -attributed nonaccidental deaths as well as cause-specific deaths for 349 cities in mainland China during five years (from 2015 to 2019) and compares the results with the spatial resolution scale of 0.1° × 0.1° across overall China. The results demonstrate that the national annual average PM 2.5 concentration declined from 51.9 ± 18.2 μg/m 3 in 2015 to 39.0 ± 13.2 μg/m 3 in 2019, and the overall annual negative trend was around -3.1 ± 2.2 μg/m 3 /year [-5.6 ± 3.4%/year] across China. Consequently, the number of PM 2.5 -related deaths decreased by 383 thousand [95% CI: 331-429] to 1755 thousand [95% Confidence Interval: 1470-2025; GEMM NCD + LRI]; 315 thousand [95% CI: 227-370] to 1380 thousand [95% CI: 948-1740; GEMM 5-COD] and 125 thousand [95% CI: 64-140] to 876 thousand [95% CI: 394-1262; IER] in 2019, derived from the pre-established models (GEMM and IER). The estimate PM 2.5 -attributed death with a spatial resolution of 0.1° × 0.1° was 2419 thousand [95% CI: 2041-2771; GEMM NCD + LRI], 1918 thousand [95% CI: 1333-2377; GEMM 5-COD] and 1162 thousand [95% CI: 534-1611; IER] in 2015, which is about 11-16% higher value than the city-level health risk assessment study. The estimated deaths by GEMM NCD + LRI and GEMM 5-COD were 104% and 61% higher than the estimated by IER, highlighting that total premature mortalities associated with PM 2.5 were substantially left behind based on the pre-existing model. The "other noncommunicable diseases" mortality, which IER method doesn't account for, was 375 thousand in 2019, 68 thousand less than in 2015. Such significant mortality was previously overlooked in estimation methods, which should now be considered for the air pollution-related policy development in China. The high number of premature deaths in central and northern parts of China, calls for the need for the Government to quickly impose even more stringent and effective pollution control measures., (Copyright © 2020 Elsevier B.V. All rights reserved.)

To explore whether and how anthropogenic activities related to surface water regulation (i.e., dam construction) disturb soil ecosystems in the surrounding uplands, a long-term monitoring program was conducted from 1998 to 2017 in the Three Gorges Reservoir Region, China. The Three Gorges Dam (TGD) is the largest hydraulic engineering project in the world. We present a direct, ecosystem-scale demonstration of changes in the soil organic carbon (SOC) content in the TGD watershed before and after the surface water was reshaped. The average SOC content decreased from 12.9 to 9.5 g/kg between 2004 and 2012 and then recovered to 13.8 g/kg in 2017. Dynamics of SOC were partly attributed to shifts in the composition of soil microbial communities responsible for carbon biogeochemistry. The shifts in microbial taxa were associated with the changed microclimate affected by the TGD as well as global and regional climate variability. The microclimate, soil microorganisms, and plant organic carbon input explained 40.2% of the variation in the SOC content. This study revealed that dam construction was an important and indirect driver for the SOC turnover, and the subsequent effects on the upland soil ecosystem must be considered when large-scale disturbance activities (such as dam construction) are conducted in the future.