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Objectives The objective of this study was to explore the phenomenon and determinants of healthcare service utilization in Chinese older adults with multimorbidity. Methods We adopted a mixed-methods explanatory design from July 2022 to May 2023. The quantitative research was a social network analysis to explore the phenomenon of healthcare service utilization in target participants. The quantitative results were further interpreted as the participant's propensity for healthcare services and the potential for information sharing between healthcare providers through shared patients. Logistic regression was conducted to identify individual determinants for healthcare service utilization. The quantitative research was followed by qualitative interviews with stakeholders to deeply understand the phenomenon of interest from the individual, healthcare system, and societal perspectives. Results We recruited 321 participants for the quantitative study. They preferred using medication services from primary healthcare providers, pharmacists at private pharmacies, and hospital specialists, and preferred using other services from hospital specialists. Dense relationships arose from shared patients among healthcare providers across various professions and settings, making it possible to share patient information. Primary healthcare providers were particularly important in the process, as they were closely related to others through patient sharing. Health status was identified through logistic regression and qualitative interviews as an individual determinant for healthcare service utilization. More determinants were explored in qualitative interviews with 30 stakeholders, including trust, resource allocation, healthcare accessibility, medical treatment process, and healthcare awareness. Discussion Strategies should be proposed to intervene with patients' nonoptimal propensity toward healthcare services and promote information sharing among healthcare providers. [ABSTRACT FROM AUTHOR]

Aims: Adherence to diet and exercise recommendations is crucial among metabolic syndrome (MetS) individuals. However, no studies have focused on comprehensive behavioural changes of diet and exercise among individuals with MetS. The present study aimed to explore determinants of adherence to diet and exercise behaviours among people with MetS based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model. Methods and results: A cross-sectional study was conducted in a health promotion centre of a large and general university hospital in Zhejiang Province, China, in 2021. A total of 241 individuals with MetS completed all scales. The mediation model was tested using structural equation modelling with bootstrapped samples. In the regression-based path analysis, MetS knowledge (β = 0.140), socioeconomic status (β = 0.162), and social support (β = 0.143) directly positively influenced diet behaviour. In addition, social support indirectly positively influenced exercise behaviour through coping and adaptation (β = 0.090). The final theoretical model showed a good fit (root mean square error of approximation = 0.057, comparative fit index = 0.946). Conclusion: Factors associated with diet behaviour were knowledge of MetS, socioeconomic status, and social support. Adaptation may be a mediator between social support and exercise behaviour. Intervention programmes targeting increased adherence to diet and exercise could include these factors for individuals with MetS. Graphical Abstract [ABSTRACT FROM AUTHOR]

Background and Aims Mercury (Hg) is an extremely toxic pollutant, especially in the form of methylmercury (MeHg), whereas selenium (Se) is an essential trace element in the human diet. This study aimed to ascertain whether addition of Se can produce rice with enriched Se and lowered Hg content when growing in Hg-contaminated paddy fields and, if so, to determine the possible mechanisms behind these effects. Methods Two cultivars of rice (Oryza sativa, japonica and indica) were grown in either hydroponic solutions or soil rhizobags with different Se and Hg treatments. Concentrations of total Hg, MeHg and Se were determined in the roots, shoots and brown rice, together with Hg uptake kinetics and Hg bioavailability in the soil. Root anatonmy was also studied. Key Results The high Se treatment (5 μg g–1) significantly increased brown rice yield by 48 % and total Se content by 2·8-fold, and decreased total Hg and MeHg by 47 and 55 %, respectively, compared with the control treatments. The high Se treatment also markedly reduced ‘water-soluble’ Hg and MeHg concentrations in the rhizosphere soil, decreased the uptake capacity of Hg by roots and enhanced the development of apoplastic barriers in the root endodermis. Conclusions Addition of Se to Hg-contaminated soil can help produce brown rice that is simultaneously enriched in Se and contains less total Hg and MeHg. The lowered accumulation of total Hg and MeHg appears to be the result of reduced bioavailability of Hg and production of MeHg in the rhizosphere, suppression of uptake of Hg into the root cells and an enhancement of the development of apoplastic barriers in the endodermis of the roots. [ABSTRACT FROM AUTHOR]

Hydroponic experiments were conducted to investigate the effect of radial oxygen loss (ROL) and external aeration on iron (Fe) plaque formation, and arsenic (As) accumulation and speciation in rice (Oryza sativa L.). The data showed that there were significant correlations between ROL and Fe concentrations in Fe plaque produced on different genotypes of rice. There were also significant differences in the amounts of Fe plaque formed between different genotypes in different positions of roots and under different aeration conditions (aerated, normal, and stagnant treatments). In aerated treatments, rice tended to have a higher Fe plaque formation than in a stagnant solution, with the greatest formation at the root tip decreasing with increasing distances away, in accordance with a trend of spatial ROL. Genotypes with higher rates of ROL induced higher degrees of Fe plaque formation. Plaques sequestered As on rice roots, with arsenate almost double that with arsenite, leading to decreased As accumulation in both roots and shoots. The major As species detected in roots and shoots was arsenite, ranging from 34 to 78% of the total As in the different treatments and genotypes. These results contribute to our understanding of genotypic differences in As uptake by rice and the mechanisms causing rice genotypes with higher ROL to show lower overall As accumulation. [ABSTRACT FROM PUBLISHER]