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This study was set to investigate the prevalence of problematic internet use (PIU) among college students and the possible factors related to this disorder. About 4400 college students, ranging from freshmen to juniors, from eight different universities in Wuhan, China were surveyed. Young's Diagnostic Questionnaire for Internet Addiction (YDQ) and the Zung Self-rating Depression Scale were used to define PIU and depression accordingly. Data was analysed with "chi-squared" testing and logistic regression. Out of the 3496 participants, 9.58% (male 13.54%, female 4.88%) met the criteria of PIU. Factors such as heavy internet use habits, poor academic achievement, lack of love from the family, etc. were found to be significantly associated with PIU. About 48.51% (1696) of the students were light internet users, who use the internet less than 5 h/week, while 16.36% (572) were heavy users who use it more than 15 h/week, though heavy users were more likely to develop PIU. Also, 25.53% of the students with depression developed PIU, in comparison with 8.91% of PIU among those without depression (p less than 0.001). Being male, frequent internet use, poor academic achievement, poor family atmosphere and lack of love from parents were predictors of PIU among college students. The habit and purpose of using the internet is diverse, which influences the susceptibility of PIU as well. There was a correlation between depression and the development of PIU as well. (Contains 4 tables.)

Purpose: Currently, there are no reliable preoperative methods for predicting component separation (CS) during incisional hernia repair. By quantitatively measuring preoperative computed tomography (CT) imaging, we aimed to assess the value of hernia defect size, abdominal wall muscle quality, and hernia volume in predicting CS. Methods: The data of 102 patients who underwent open Rives-Stoppa retro-muscular mesh repair for midline incisional hernia between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into two groups: "CS group" patients who required CS to attempt fascial closure, and "non-CS" group patients who required only Rives-Stoppa retro-muscular release to achieve fascial closure. Hernia defect width, hernia defect angle, rectus width, abdominal wall muscle area and CT attenuation, hernia volume (HV), and abdominal cavity volume (ACV) were measured on CT images. The rectus width to defect width ratio (RDR), HV/ACV, and HV/peritoneal volume (PV; i.e., HV + ACV) were calculated. Differences between the indices of the two groups were compared. Logistic regression models were applied to analyze the relationships between the above CT parameters and CS. Receiver operator characteristic (ROC) curves were generated to evaluate the potential utility of CT parameters in predicting CS. Results: Of the102 patients, 69 were in the non-CS group and 33 were in the CS group. Compared with the non-CS group, hernia defect width (P < 0.001), hernia defect angle (P < 0.001), and hernia volume (P < 0.001) were larger in the CS group, while RDR (P < 0.001) was smaller. The abdominal wall muscle area in the CS group was slightly greater than that in the non-CS group (P = 0.046), and there was no significant difference in the CT attenuation of the abdominal wall muscle between the two groups (P = 0.089). Multivariate logistic regression identified hernia defect width (OR 1.815, 95% CI 1.428–2.308, P < 0.001), RDR (OR 0.018, 95% CI 0.003–0.106, P < 0.001), hernia defect angle (OR 1.077, 95% CI 1.042–1.114, P < 0.001), hernia volume (OR 1.002, 95% CI 1.001–1.003, P < 0.001), and CT attenuation of abdominal wall muscle (OR 0.962, 95% CI 0.927–0.998, P = 0.037) as independent predictors of CS. Hernia defect width was the best predictor for CS, with a cut-off point of 9.2 cm and an area under the curve (AUC) of 0.890. The AUCs of RDR, hernia defect angle, hernia volume, and abdominal wall muscle CT attenuation were 0.843, 0.812, 0.747, and 0.572, respectively. Conclusion: Quantitative CT measurements are of great value for preoperative prediction of CS. Hernia defect size, hernia volume, and the CT attenuation of abdominal wall muscle are all preoperative predictive indicators of CS. [ABSTRACT FROM AUTHOR]

Purpose: The supply of non-iodized salt and the water improvement project have been conducted to reduce the iodine concentration in drinking water in areas with elevated water iodine. We aimed to assess the impact of water iodine concentration (WIC) on the iodine intake of pregnant women in areas with restricted iodized salt supply, and determine the cutoff values of WIC in areas with non-iodized salt supply. Methods: Overall, 534 pregnant women who attended routine antenatal outpatient visits in Zibo Maternal and Child Health Hospital in Gaoqing County were recruited. The 24-h urine iodine excretion (UIE) in 534 samples and the iodine concentration in 534 drinking water samples were estimated. Urinary iodine excretion, daily iodine intake, and daily iodine intake from drinking water (WII) were calculated. The relationship between WIC and daily iodine take was analyzed. Results: The median WIC, spot urine iodine concentration (UIC), and 24-h UIE were 17 (6, 226) μg/L, 145 (88, 267) μg/L, and 190 (110, 390) μg/day, respectively. A significant positive correlation was found between WIC and UIE (R2 = 0.265, p < 0.001) and UIC (R2 = 0.261, p < 0.001). The contribution rate of WII to total iodine intake increased from 3.0% in the group with WIC of < 10 μg/L to 45.7% in the group with WIC of 50–99 μg/L. Conclusion: The iodine content in drinking water is the major iodine source in pregnant women living in high-water iodine areas where iodized salt supply is restricted. The contribution rate of daily iodine intake from drinking water increases with the increase in water iodine concentration. [ABSTRACT FROM AUTHOR]

Cardiovascular disease has become the most serious health threat and represents the major cause of morbidity and mortality in China, as in other industrialized nations. During the past few decades, China's economic boom has tremendously improved people's standard of living but has also changed their lifestyle, increasing the prevalence of cardiovascular disease, the so-called 'disease of modern civilization'. This new trend has attracted a significant amount of research. Many of the studies conducted by Chinese investigators are orientated towards understanding the molecular mechanisms of cardiovascular disease. At the molecular level, the long-standing consensus is that cardiovascular disease is associated with a sequence mutation (genetic anomaly) and expression deregulation (epigenetic disorder) of protein-coding genes. However, new research data have established the non-protein-coding genes microRNAs (miRNAs) as a central regulator of the pathogenesis of cardiac disease and a potential new therapeutic target for cardiovascular disease. These small non-coding RNAs have also been subjected to extensive, rigorous investigations by Chinese researchers. Over the years, a large body of studies on miRNAs in cardiovascular disease has been conducted by Chinese investigators, yielding fruitful research results and a better understanding of miRNAs as a new level of molecular mechanisms for the pathogenesis of cardiac disease. In this review, we briefly summarize the current status of research in the field of miRNAs and cardiovascular disease in China, highlighting the advances made in elucidating the role of miRNAs in various cardiac conditions, including cardiac arrhythmia, myocardial ischaemia, cardiac hypertrophy and heart failure. We have also examined the potential of miRNAs as novel diagnostic biomarkers and therapeutic targets. [ABSTRACT FROM AUTHOR]

Abstract: The Ministry of Environmental Protection in China is responsible for regulatory control on radiation protection from naturally occurring radioactive material (NORM). The natural radiation caused by human activities is a major contributor to public and occupational exposure in China. This paper introduces the first national census on pollution sources (target year 2007) in China, and describes NORM sites in Baotou, Inner Mongolia, one of the largest rare earth deposits in China. The ores are rich in radioactive elements, with a concentration of ThO2 of 0.01–0.05% and concentration of U3O8 of 0.0005–0.002%. The large amount of NORM residues is regulated and controlled. After treatment of the waste water, it is discharged into tailing ponds and then pumped directly to milling plants for re-use. The waste gas after off-dust cleaning is discharged into the environment. A substantial amount of blast furnace iron slag from the waste treatment is transformed into cement, concrete, and bricks, or used directly for highway construction. This raises a serious environmental concern. As a result, environmental radiation monitoring and assessment have been introduced recently. Regulatory control of NORM is very important in order to take effective measures to lower the dose. [Copyright &y& Elsevier]

Oral Diseases (2012) 18, 586-594 Objective: To assess the effect of two oral bacteria Streptococcus sanguinis and Porphyromonas gingivalis upon platelet aggregation. Materials and Methods: Streptococcus sanguinis, P. gingivalis, S. sanguniis + P. gingivalis were added to platelet-rich plasma and platelet aggregation measured using a platelet aggregometer. Platelets were passed through a flow chamber with S. sanguinis, P. gingivalis or a biofilm of S. sanguinis and P. gingivalis coated with saliva. Platelet adhesion to the chamber was observed under a fluorescence microscope for 15 min. The positive control was platelets treated with adrenaline; the negative control was platelets treated with phosphate-buffered saline. Results: The mean (± s.e.) aggregation magnitude of S. sanguinis and P. gingivalis was 77.7 ± 7.4% and 79.3 ± 9.9%, respectively. The aggregation magnitude of S. sanguinis + P. gingivalis was 51.3 ± 12.9%, which was significantly lower than that for S. sanguinis/ P. gingivalis ( P < 0.05). In the flow chamber system, platelets adhered to S. sanguinis/P.gingivalis respectively within 3 min, and reached a plateau at 5-15 min. Under the condition of the S. sanguinis- and P. gingivalis-saliva biofilm, platelet adhesion to the biofilm was significantly reduced at 5-15 min ( P < 0.05). Conclusions: In the static or dynamic flow system, platelets adhered to S. sanguinis or P. gingivalis. However, if S. sanguinis was mixed with P. gingivalis, the aggregation magnitude (%) was significantly reduced. [ABSTRACT FROM AUTHOR]

The goal of this study is to understand the evolution relationship of the members of the B-hordein gene family in hull-less barley by analysis of their structure and to explore their utility in grain quality improvement. Six copies of the B-hordein gene ( Hn1- Hn3, Hn7- Hn9) were cloned from six hull-less barley cultivars collected from Qinghai-Tibet Plateau and molecularly characterized. Comparison of their predicted polypeptide sequences with the published data suggested that they all share the same basic protein structures. In addition, we found that the C-terminal end sequences of all B-hordeins shared a similar feature. In the six clones and the other three published genes ( Hn4, Hn5, and Hn6) from hull-less barley, Hn2 and Hn7 contained the identical C-terminal end sequence DIMPVDFWH. Hn3, Hn4, Hn5, Hn8 and Hn9 also shared the common sequence DIMPPDFWH, which was similar to that of a B-hordein reported previously. Both Hn1 and Hn6 exhibited differences in their C-terminal end sequences, and they clustered into different subgroups. The B-hordeins with identical C-terminal end sequences were clustered into the same subgroup, so we believe that B-hordein gene subfamilies possibly can be classified on the basis of the conserved C-terminal end sequences of predicted polypeptide. Phylogenetic analysis also indicated that there is a relatively weak identity between our predicted B-hordeins and those reported from H. chilense and H. brevisubulatum. All of our nine predicted B-hordeins were clustered together and other B-hordeins formed another cluster. The possible use of these genes in relation to barley quality is discussed. [ABSTRACT FROM AUTHOR]

In recent decades, with the support and traction of a number of key policy steps, the scale of China's sports industry has achieved a new leap. The optimization of industrial structure has made new progress. From "nascent" to "strong", China's sports industry grows in importance of the national economy. In the meantime, sport is a significant way to promote health. With the rapid growth of people's requirements for sport and health, it is urgent to re-evaluate the past development path and formulate new directions so as to continuously improve and optimize the system. This study systematically sorts out China's sports industry documents at different stages, and describes the focus of each stage and the overall evolution track. On this basis, text mining and quantitative evaluation being used to extract high-frequency words of sports industry documents, and a sports industry document evaluation system including 9 first-level indicators and 47 second-level indicators is established. In this study, text similarity analysis is used to realize intelligent PMC index analysis, which effectively improves the analysis efficiency and makes up for the deficiency of simple qualitative analysis. According to the study, China's sports industry policies are scientific and effective. Combining with the development direction of industrial transformation, it provides ideas for the future adjustment and optimization of sports industry evolution path., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Pan, Ma. 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.)

This study investigates the inequities in life expectancy among individuals aged 65 and above in urban and rural areas of Zhejiang Province, China, with a primary focus on promoting health equity among the older adults population. The objective is to analyze the trends and factors contributing to the urban-rural gap in life expectancy and to propose strategies for reducing this disparity. Data from the 2010 and 2020 statistical records and census data were analyzed using cohort life tables and gray correlation analysis. Results indicate an overall increase in life expectancy among the older adults, with a more pronounced improvement in rural areas, thereby narrowing the urban-rural gap from 1.53 years in 2010 to 1 year in 2020. Income inequality emerges as the primary factor influencing life expectancy, followed by educational attainment, with variations across different age groups and gender. This underscores the importance of tailored interventions that consider the specific needs of older adults individuals in diverse geographical areas and age brackets to extend life expectancy and promote health equity. By tackling these unfair differences, health equity can be ensured and the overall well-being of the older population in both urban and rural areas can be improved., 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 © 2025 Chen, Fan, Shen, Chen, Pan, Chen, Zhong and Li.)

Purpose: To investigate the prevalence, features, and risk factors of macular retinoschisis (MRS) in highly myopic eyes and their morphological features in a Chinese population., Design: Population-based, cross-sectional study. From the Beijing Eye Study 2011, a total of 213 highly myopic eyes from 129 participants were included., Methods: All participants underwent spectral-domain optical coherence tomography with a macula cube scan of 30°×30°centered in the fovea. High myopia was defined as a refractive error ≤-6 diopters or an axial length ≥26.0 mm. MRS presence and its subtypes were assessed based on location, and affected retinal layers were evaluated. Prevalence, features, and associated factors of MRS and its subtypes in highly myopic population were assessed., Results: Of 213 highly myopic eyes (129 participants), MRS was observed in 48 eyes, with a prevalence of 22.5% (95% CI, 16.9-28.6) per eye, or 36 participants with 27.9% (95% CI, 20.5-35.7) per subject. In addition to well-documented factors such as older age and higher myopia, the prevalence of MRS was found to be related with a higher intraocular pressure (P = .013, odds ratio [OR], 1.25; 95% CI, 1.05-1.48), a thinner subfoveal choroidal thickness (P = .006, OR, 0.86; 95% CI, 0.77-0.96), a wider Gamma zone (P = .003, OR, 1.99; 95% CI, 1.05-3.11), the presence of glaucoma (P = .010, OR, 3.37; 95% CI, 1.34-8.48), and the presence of epiretinal membrane (P = .023, OR, 3.13; 95% CI, 1.17-8.36) after multivariate analysis. Eyes with advanced high myopia (P = .021) and wider gamma zone (P = .005) were more likely to develop foveal MRS. Eyes with glaucoma tended to have a higher prevalence of outer retinal MRS compared with inner retinal MRS (60.9% vs 36.0%), although the difference was not statistically significant (P = .06). MRS located in the foveal region or affecting the outer retina was related with a significantly worse best-corrected visual acuity (BCVA) compared with MRS that was perifoveally located or affected other regions (P < .05)., Conclusions: The prevalence of MRS was 27.9% among the elderly highly myopic population. MRS occurring in the foveal region or involving the outer retina demands increased vigilance due to its significant impact on BCVA. The findings contribute to a deeper understanding of MRS, offering insights into its mechanisms and vision prognosis., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Schizophrenia is a severe mental illness associated with significantly elevated mortality rates. However, factors related to the mortality risk among people with schizophrenia in low and middle-income countries remain to be examined. This study aims to explore the clinical factors for all-cause mortality in people with schizophrenia., Methods: We conducted a 9-year retrospective cohort study on people with schizophrenia in Guangzhou, China. Cox proportional hazards regression analysis and competing risk analysis was used to identify clinical factors associated with all-cause mortality and specific-cause mortality. A propensity score matching method was performed to minimize the impact of confounding factors., Results: The overall age-standardized mortality rate in people with schizophrenia between 2013 and 2021 was 1606.04 per 100,000 person-years. We found that medical expenses not covered by medical insurance (adjusted hazard ratio [aHR]: 2.49 [95 % CI: 2.21-2.82]), relatively-stable (aHR: 1.18 [95 % CI: 1.01-1.38]) and unstable illness (aHR: 2.65 [95 % CI: 1.90-3.68]), history of non-continuous treatment (aHR: 1.35 [95 % CI: 1.25-1.46]), and no treatment history (aHR: 1.41 [95 % CI: 1.29-1.55]) were associated with a higher risk of all-cause mortality. Frequent hospital stays (once: aHR: 0.46 [95 % CI: 0.42-0.50], more than once: aHR: 0.23 [95 % CI: 0.21-0.26]) and a family history of mental disorders (aHR: 0.50 [95 % CI: 0.40-0.64]) were associated with a lower risk of mortality., Conclusion: We identified clinical factors associated with all-cause mortality. Targeted interventions should be developed to reduce the mortality risk in people with schizophrenia., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest with the materials presented., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Introduction: Retirement represents a significant life transition and is associated with individual health outcomes. Previous studies on the health effects of retirement have yielded inconsistent conclusions. This study aimed to estimate the impact of retirement on the body mass index (BMI) and BMI-defined overweight and obesity., Methods: Between 2012 and 2015, this study included 88,471 public sector participants from the Chinese Hypertension Survey (CHS) while excluding those working in the private sector. By utilizing the fuzzy regression discontinuity design (FRDD), this research evaluated the direct impact of retirement on the BMI, as well as on the overweight and obesity rates. Additionally, the study examined variations in the effects of retirement among groups stratified by sex and educational attainment., Results: The fully adjusted model suggested that retirement did not have a significant impact on the BMI or overweight and obesity rates of the overall population. Notably, retirement significantly impacted the male participants, resulting in an increase in their BMI of 2.18 (95% CI 0.23-4.13), but did not affect the BMI of the female participants. Furthermore, individuals with lower educational backgrounds experienced more pronounced BMI changes upon retirement., Conclusions: On average, retirement has no significant impact on the BMI and overweight and obesity rates. Retirement leads to an increase in the BMI among men but does not affect that in women. When considering adjustments to existing retirement policies, the differential health effects of retirement across various populations should be taken into account., Competing Interests: Declarations. Ethics approval and consent to participate: The Ethics Committee of Fuwai Hospital (Beijing, China) approved the study. Informed consent was obtained from each participant included in this study. Consent for publication: Informed consent for publication was obtained from all participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Laparoscopic surgery is increasingly used for rectal cancer, but the long-term oncological outcomes for low rectal cancer have not been fully established. We aimed to evaluate the 3-year survival outcomes of laparoscopic surgery versus open surgery in the treatment of low rectal cancer., Methods: This multicentre, randomised, controlled, non-inferiority trial was conducted at 22 tertiary hospitals in China. Individuals aged 18-75 years with histologically confirmed cT1-2N0, cT3-4aN0, or cT1-4aN1-2 rectal adenocarcinoma within 5 cm from the dentate line were eligible for inclusion. Participants were randomly assigned (2:1) to undergo laparoscopic surgery or open surgery. Central randomisation was conducted using a web response system, and was stratified by clinical stage, age, sex, BMI, and American Society of Anesthesiologists classification. Investigators, patients and statisticians were not masked to group allocation. The primary outcome was 3-year disease-free survival, defined as the time from the date of surgery to the date of locoregional recurrence, distant metastasis, or death from any cause, whichever occurred first. Non-inferiority was defined as a lower limit of one-sided 97·5% CI for group difference (laparoscopic surgery group minus open surgery group) of greater than -10%. The primary analyses were performed in the modified intention-to-treat population, which excluded patients with distant metastasis discovered during surgery and those who did not undergo surgery or underwent local resection only. The trial is registered with ClinicalTrials.gov, NCT01899547, and has been completed., Findings: Between Nov 12, 2013, and June 6, 2018, 1070 patients were enrolled and randomly assigned to treatment. 1039 patients (685 in the laparoscopic surgery group and 354 in the open surgery group; median age 57 years, IQR 50 to 64; 620 [60%] male and 419 [40%] women) were included in the modified intention-to-treat analysis. 3-year disease-free survival was 81·4% (95% CI 78·2 to 84·1) in the laparoscopic surgery group and 79·8% (75·2 to 83·6) in the open surgery group (hazard ratio [HR] 0·92, 95% CI 0·69 to 1·23; p=0·56). The difference between groups was 1·60% (one-sided 97·5% CI -3·34 to ∞, p<0·0001 for non-inferiority). 3-year overall survival was 91·7% (95% CI 89·3 to 93·5) in the laparoscopic surgery group and 93·7% (90·6 to 95·8) in the open surgery group (HR 1·34, 95% CI 0·82 to 2·19; p=0·24). 3-year locoregional recurrence was 3·7% (95% CI 2·5 to 5·3) and 2·3% (1·1 to 4·3), respectively (HR 1·64, 95% CI 0·74 to 3·63; p=0·22). 5-year overall survival was 84·6% (95% CI 81·5 to 87·1) and 86·6% (82·5 to 89·8) in the open group (HR 1·16, 95% CI 0·82 to 1·64; p=0·41)., Interpretation: Laparoscopic surgery performed by experienced surgeons is non-inferior to open surgery for 3-year disease-free survival among patients with low rectal cancer. These results support the use of laparoscopic surgery for low rectal cancer., Funding: The Key Clinical Specialty Discipline Construction Program of the National Health and Family Planning Commission of China; Minimally Invasive Medical Center Construction Program, Fujian Province, China; and Joint Funds for the Innovation of Science and Technology, Fujian Province, China., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: This study aimed to investigate the relationship between hemoglobin and serum iron levels and mortality risk in patients with coronary artery disease (CAD)., Methods: We analyzed data from 3224 patients with CAD using Cox proportional hazards regression models to assess the association of hemoglobin and serum iron levels with cardiovascular and all-cause mortality from the Guangdong coronary artery disease cohort., Results: Over a median follow-up period of 8.9 years, 636 patients died, including 403 from cardiovascular causes. Higher hemoglobin and serum iron levels were linked to a reduced risk of cardiovascular and all-cause mortality. Patients in the highest quartiles of hemoglobin and serum iron levels had multivariable-adjusted hazard ratios (HRs) of 0.62 (95% CI, 0.46-0.85) and 0.51 (95% CI, 0.37-0.69) for cardiovascular mortality and 0.64 (95% CI, 0.50-0.83) and 0.67 (95% CI, 0.53-0.85) for all-cause mortality, compared with those in the lowest quartile. A one-standard-deviation increase in hemoglobin and serum iron levels corresponded to a 19% and 24% reduction in cardiovascular mortality risk and a 19% reduction in all-cause mortality risk for both factors. Restricted cubic spline analysis revealed L-shaped and U-shaped associations between hemoglobin and serum iron levels and cardiovascular and all-cause mortality, respectively., Conclusions: Hemoglobin and serum iron levels were significantly associated with lower risks of cardiovascular and all-cause mortality in patients with CAD. Further research is needed to evaluate the effects of iron supplementation in these patients.

Objective: In this retrospective analysis, we explored the clinical characteristics and risk factors of secondary infections in patients with severe heatstroke with the aim to gain epidemiological insights and identify risk factors for secondary infections., Method: The study included 129 patients with severe heatstroke admitted to the General Hospital of the Southern Theater Command of the PLA between January 1, 2011, and December 31, 2021. Patients were divided into an infection group (n = 24) and a non-infection group (n = 105) based on infection occurrence within 48 h of intensive care unit (ICU) admission. Clinical indicators, infection indicators, and clinical outcomes within 24 h of ICU admission were collected and compared between the groups. Independent risk factors for infection in patients with severe heatstroke were analyzed using univariate and multivariate analyses. A nomogram model was constructed, evaluated, and validated., Result: Among the 129 patients with heatstroke, 24 developed secondary infections. Infections occurred between days 3 and 10 post-ICU admission, primarily affecting the lungs. Multivariate analysis identified vasopressor use, serum creatinine level, and gastrointestinal dysfunction at admission as independent risk factors, while elevated lymphocyte count (odds ratio [OR] = 0.167; 95% confidence interval [CI] 0.049-0.572; P = 0.004) was protective against severe heatstroke. Infected patients required longer durations of mechanical ventilation (OR = 2.764; 95% CI, 1.735-4.405; P = 0.044) and total hospital stay than those in the non-infection group. The nomogram model demonstrated clinical feasibility., Conclusion: Increased lymphocyte count is an independent protective factor against infections in patients with severe heatstroke. Vasopressor use, gastrointestinal dysfunction, and elevated serum creatinine levels are independent risk factors. These indicators can aid clinicians in assessing infection risk in patients with severe heatstroke., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this study, experiments were conducted on soil samples collected from depths of 0-15 cm, 15-30 cm, and 30-50 cm at the National Long-term Scientific Research Base for the Comprehensive Management of Rocky Desertification in the Wuling Mountains. The aim was to determine the physicochemical indexes and explore the nature and spatial heterogeneity of the soil of the planted mixed forests within the rocky desertification area of the Wuling Mountain. Various analytical methods were employed, including descriptive statistical analysis, correlation analysis, analysis of variance, principal component analysis, spatial interpolation analysis, and kriging interpolation, to fit the optimal model of the semi-variance function of soil physicochemical properties and analyze the model's parameters. The results indicated that soil physical and chemical properties varied with depth and were generally correlated. The relationship between soil organic matter and total nitrogen content was the closest. Additionally, there was a certain degree of correlation between soils at different depths in the vertical profile, generally the correlation between layer B (15-30 cm) and layer C (30-50 cm) > that between layer A (0-15 cm) and layer B (15-30 cm) > that between layer A (0-15 cm) and layer C (30-50 cm). The weighting coefficients of the principal components of soil physicochemical properties indicated that soil organic matter, nitrogen, phosphorus, potassium, pH, total porosity, and capillary porosity are key factors in the soil properties of karst desertification areas. The spatial variability of soil physicochemical properties at different depths ranged from 21.91 to 87.59 m, and the abutment ratio (Co/Co+C) of these properties ranged from 12.99% to 89.53%. Using kriging interpolation in ArcGIS, the spatial distribution pattern of soil physical and chemical properties was mapped, revealing that these indicators were distributed with heterogeneous patches of various sizes and shapes. Therefore, the degree of rocky desertification significantly influences the spatial distribution pattern of soil physical and chemical properties., Competing Interests: The authors declare that they have no competing interests., (© 2024 Pan et al.)

Aquaculture pond sediments act as hotspots for methane (CH 4 ) emissions; however, knowledge gaps on the regulation of microorganisms hinder our further understanding of methane dynamics in aquaculture pond sediment. Using field sampling and molecular analysis, we examined CH 4 fluxes, the methanogenic community composition, and their interaction with methanotrophs to comprehensively understand the methane cycling in sediments of aquaculture ponds in northern China. Compared with a fishing pond without feed inputs, the abundances of methanogens mcrA and methanotrophs pmoA genes increased significantly in aquaculture ponds sediments. The dominant methanogens were Methanothrix, Methanoregula, and Methanolinea, and the α-diversity indices of methanogens demonstrated higher levels in 0-5 cm surface sediment. The methanotrophs were dominated by Methylocystis, Methylocaldum, and Methylobacter, and the α-diversity indices of methanotrophs showed no significant difference. The total organic carbon (TOC) contents and oxidation reduction potential (ORP) were the key factors driving methanogenic and methanotrophic communities on methane cycle in aquaculture sediment. The inter-domain ecological network (IDEN) analysis revealed that total number of network nodes, links, connectances, and links per species in the aquaculture sediments presented relatively higher levels, whereas the IDEN modules were fewer. The methanogens dominated in the networks and the interaction of methanogens and methanotrophs was more competitive and complex in aquaculture sediments. These findings highlight the marked methane production in aquaculture sediment, primarily due to the abundance, diversity, and competitive advantage of methanogens over methanotrophic communities., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interests. All authors declare no competing personal relationships that may be perceived as influencing their work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This study presents the spatial distribution and chemical speciation of carbon (C), nitrogen (N) and phosphorus (P) in sediments, and traces the origins of sedimentary organic matter (SOM) with CN isotopes composition and elemental ratios in the northern Beibu Gulf. The spatial distribution of biogenic elements was significantly related to the grain size composition and terrestrial inputs. The liable nitrogen (LN) accounted for 20.74 ± 14.84 % of total nitrogen (TN), and organic matter-sulfide form-N (OSF-N) was the dominant part among four LN forms. The bio-available P (BAP) accounted for 76.49 ± 5.92 % of total phosphorus (TP), and the average proportions of P fractions followed the order of organic P (OP) > Fe-bound P (FeP) > authigenic P (CaP) > detrital P (De-P) > exchangeable P (Ex-P). The SOM was mainly derived from terrestrial sources in Lianzhou Bay and Maowei Sea, whereas marine phytoplankton primarily contributed to the SOM in other coastal bays., 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. Published by Elsevier Ltd.)

Backgrounds: Obstructive sleep apnea syndrome (OSA) is increasingly encountered by anesthesiologists in clinical practice. However, research on managing these patients among anesthesiologists in China is scarce. This study aims to investigate the knowledge, attitudes, and perioperative management strategies for OSA patients among Chinese anesthesiologists., Methods: In this cross-sectional study, anesthesiologists from various hospitals across China were invited to complete a thirty-eight-item online questionnaire survey between October 1 and November 1, 2022. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) scale was utilized to measure their knowledge and attitudes., Results: A total of 470 valid participants were recruited for this research, resulting in a valid response rate of 73.3%. (1) While the majority of participants acknowledged the importance of identifying OSA during perioperative management, only 58.3% felt confident in managing OSA patients; (2) Anesthesiologists with higher professional titles and longer work experience exhibited greater confidence in managing OSA patients; (3) Just under half of the participants were familiar with the STOP-Bang and Berlin questionnaires. Anesthesiologists with over 20 years of work experience were more likely to use the STOP-Bang and Berlin questionnaires compared to those with less than 10 years of work experience (OR = 3.166, P < 0.001); (4) 71.1% of participants expressed approval regarding the preparation of sugammadex for muscle relaxation reversal, while only 32.8% approved the safety of opioid use for postoperative analgesia in OSA patients., Conclusion: The study displayed that Chinese anesthesiologists have inadequate knowledge and perioperative management of OSA than expected. However, they have positive attitudes towards the assessment and management of OSA. The study highlights the need for high-quality training to identify and manage OSA among Chinese anesthesiologists., Competing Interests: Declarations Ethics approval This study was approved by the Ethics Committee of West China Hospital, Sichuan University (protocol number 2022.416). Informed consent was obtained from all participants. All participants volunteered to participate and could withdraw from the study at any time. Participants were informed that their personal information would be kept confidential. De-identified data were stored in a locked cabinet in the laboratory. Consent for publication All the participants included signed the consent for publication. Conflict of interest The authors declare no conflict of interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background and Objectives: Malnutrition is associated with a higher risk of osteoporosis. We aim to assess the relationship between serum albumin with geriatric nutritional risk index and osteopenia in Chinese elderly men., Methods and Study Design: This is a nested case-control study from a prospective cohort enrolled 1109 individuals who were followed for seven years. Demographic data, medical history, signs and symptoms, and laboratory parameters were collected and analysed. Nutritional status and Geriatric Nutritional Risk Index (GNRI) were assessed. The nutrition-related indexes predictive value for osteopenia development was analyzed through multivariate Cox regression analysis and by creating a receiver operating characteristic curve (ROC), calculating the area under the curve (AUC). Kaplan-Meier (K-M) method was further used to find the nutritional status level in the elderly men., Results: The ALB and GNRI correlated with the risk of osteopenia in Chinese elderly men. After adjusting for all covariates, people with higher ALB level (HR: 0.821; 95% CI: 0.790-0.852) and higher GNRI score (HR: 0.889; 95% CI: 0.869-0.908) had a smaller risk of osteopenia. ROC analysis showed that the AUC for ALB was 0.729 (p<0.05) and for the GNRI score was 0.731 (p<0.05). K-M curve indicated a significant difference in ALB level (p<0.001) and GNRI score (p<0.001) in the respective subgroups., Conclusions: This study found that lower ALB level and lower GNRI score are associated with a higher prevalence of osteopenia among elderly men in China., Competing Interests: The authors declare that they have no conflict of interest

In environmental protection, government and market forces must work together. However, existing literature often separates the two and discusses their roles independently. Therefore, this study incorporates both the market and government into a unified analytical framework. It redefines government force as environmental regulation and market force as allocation efficiency in environmental protection. The study empirically examines the synergistic emission reduction effects of active government and efficient market on air pollution, using data from 272 prefectural-level cities in China from 2003 to 2019. The results show: (1) Both government and market interventions can significantly reduce air pollution levels, and their combination achieves a synergistic emission reduction effect.(2) Within this synergy, government intervention remains dominant, while the market plays a supportive role. (3) Analyzing the heterogeneous effects under different scenarios reveals that collaboration and mutual monitoring between the government and the market can effectively counteract the adverse effects of economic policy uncertainty and corruption on the environment. Furthermore, when a single entity undertakes environmental protection, it may encounter issues of diminishing effectiveness over time. However, the synergistic effects of government and market cooperation can mitigate these challenges. (4) The synergy exhibits a threshold effect based on the varying strengths of government and market forces. (5) Public participation enhances the synergistic emission reduction effect of government and market, acting as a vital complement to their environmental protection efforts. This study provides new empirical evidence on the synergistic effect of current environmental protection measures in improving air pollution control., 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.)

The mastitis caused by Klebsiella pneumoniae (K. pneumoniae) is increasing in the dairy cows. To investigate the epidemic of K. pneumoniae of China, 131 strains were isolated from 495 clinical mastitis milk samples (26.5%) from 14 provinces in China. Among the isolates, K57 was the dominant serotype (45.0%) and 19 (14.5%) isolates were identified as hypervirulent K. pneumoniae (hvKP). The mrkA, entB, wabG and fimH genes were prevalent virulence genes while rmpA, magA, and ycf were not found in K. pneumoniae. Furthermore, K. pneumoniae had serious antibiotic resistance and multiple β-lactamase genes, including blaTEM, blaSHV, blaNDM, blaCTX-M, blaDHA, and blaKPC. Biofilm was an important factor in bacterial resistance and persistent infection, and 77.1% isolates could form biofilm. Although acylated homoserine lactone (AHL, a Gram-negative bacterial quorum sensing signal molecule) was not confirmed among the K. pneumoniae isolates, exogenous AHLs could reduce the biofilm formation ability of the K. pneumoniae strains. Three new ST types (ST6781, ST6782, and ST6783) were first identified in this study. The MLST phylogenetic tree showed the distribution of mastitis associated K. pneumoniae strains had no regular pattern, which confirmed high genomic diversity of mastitis associated K. pneumoniae. In conclusion, the high rate of isolation and serious antibiotic resistance of K. pneumonia were found in this study and indicated a potential threat to public health from the food chain., Competing Interests: Declarations Ethical approval This study does not contain any experiments with human participants or animals. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: Voice disorders are common in children and have a negative impact on their quality of life. However, presently, voice assessment and therapy are inaccessible in most pediatric departments of Mainland China. Thus, referring pediatric patients with voice disorders to otolaryngology is warranted for prompt and appropriate treatment. The purpose of this study is to investigate referral patterns and their influencing factors for pediatricians' managing children with dysphonia in Southwestern Mainland China., Study Design: Observational study., Methods: A 28-item questionnaire was designed by multidisciplinary experts, and an anonymous survey was performed online via Wenjuanxing between September 8, 2021 and October 8, 2021. The statistical analyses were performed using the independent sample median test, the linear/logistic regression model, the Kruskal-Wallis test, and Spearman's correlation test to determine any statistically significant relationships between the variables of interest., Results: Predominantly recruited from institutions in Southwestern China, 368 pediatricians were surveyed. (1) The majority of the pediatricians reported that ≤10% of children sought medical help for voice disorders; (2) only 22.1% of the pediatricians' hospitals had equipment for evaluating voice disorders; (3) 74.6% of the pediatricians would refer children with dysphonia to otolaryngology, and the older pediatricians were more likely to refer their patients than were the younger pediatricians (P = 0.022); (4) in the group that would make a referral (n = 250), the pediatricians who had worked longer (P = 0.037) and practised in the Grade-A tertiary hospitals (P = 0.044) were more likely to trust their experience as a reason for making a referral. For each year worked the probability of referring children with dysphonia depending on the pediatrician's experience increased by 3.4%., Conclusion: Although the pediatricians encountered some barriers to diagnosing voice disorders, their attitude towards making referrals was positive. The age and work duration of the pediatricians and the hospital grade were the influencing factors in the referral patterns. Further publicity of vocal hygiene, ongoing education among Chinese pediatricians and the improvement of referral systems may be most useful for better managing children with dysphonia., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The Chinese species of the ripiphoride genus Ripiphorus Bosc d'Antic, 1791 are taxonomically reviewed. A new species, R. curvispinus Pan, sp. nov., is discovered from Beijing and distinguished from its congeners by the distinctly curved metatibial inner spur. The difference between R. curvispinus Pan sp. nov. and R. chalcidoides (Gressitt, 1941) is confirmed using phylogenetic analysis and molecular species definition based on mtDNA COI sequences. Furthermore, Ripiphorus subdipterus Fabricius, 1792 is newly recorded for China. All Ripiphorus species occurring in China are described, illustrated and keyed.

Ancistria Erichson, 1845 is poorly known from China, with only five species recorded. Three new species and one newly recorded species for China were discovered from the Nanling Mountain Range and Lingnan area, i.e., A. limbata Pan, sp. nov., A. longior Pan, sp. nov., A. nanlingensis Pan, sp. nov. and A. bicolorata Burckhardt & Ślipiński, 1995, which are described and illustrated in this paper. A key to the known Chinese species of Ancistria is also provided.

Opatrini Brullé, 1832 is the most species-rich tribe in the subfamily Blaptinae Leach, 1815. In this study, a preliminary phylogenetic relationship among 14 species of five genera of Opatrini is hypothesized based on mitochondrial gene (COI) fragment. Based on the phylogenetic topology and the results of three molecular species delimitation analyses, three larval specimens are assessed for the adults. Additionally, the larvae of these three species are described and illustrated: Gonocephalum bilineatum (Walker, 1858), Gonocephalum gracile (Bates, 1879), and Mesomorphus latiusculus Chatanay, 1917.

Anatoripidius cylindricus gen. & sp. nov., a new genus and species of Ripidiinae Gerstaecker, 1855 from Guangdong, China, is described and illustrated. The new genus is distinguished from other ripidiine genera by the combined characters that include postocular ommatidia missing, mouthparts strongly reduced, 11-segmented antennae, and others dealing with hind wings, and tarsal formula. A key to the extant genera of Ripidiini from the Palaearctic and Oriental regions is presented. Furthermore, Ripidius longicollis (Schilder, 1923) is newly recorded for the mainland of China, as well as redescribed and illustrated.

Background: Greenspace is an important modifiable environmental factor that is associated with health and well-being. Although previous research has shown that exposure to greenspace is beneficial for cardiovascular diseases, studies have rarely focused on early subclinical health outcomes such as electrocardiogram (ECG) abnormality., Methods: We developed a longitudinal study using data from the China National Stroke Screening Survey (2013-2019). Monthly exposure to greenspace was assessed by the Normalized Difference Vegetation Index (NDVI) values. ECG abnormality was diagnosed by physicians based on the results of the 12-lead electrocardiogram. We used fixed-effects logistic regression with participant-specific intercepts to estimate the association between exposure to greenspace and ECG abnormalities., Results: A total of 132,108 visits from 61,029 participants with ≥ 2 ECG measurements were included. At baseline, the lag-1 month average NDVI value was 0.29 (SD = 0.15). In the fully adjusted model, per 0.1-unit increment in lag-1 month average NDVI value was associated with a 3.0% (95% CI -1.6 ∼ 7.4%) decreased risk of ECG abnormality. In urban areas, the decreased risk associated with per 0.1-unit increment in NDVI was 14.81% (95% CI 9.38 ∼ 19.92%)., Conclusion: Our study found that higher exposure to greenspace was associated with a decreased risk of ECG abnormality, especially in urban areas. Our findings suggested that monthly exposure to greenspace might be beneficial to cardiovascular health, and greenspace provision and maintenance could be considered an important public health intervention in urban planning., (© 2024. The Author(s).)

Objective: To investigate indications and surgical procedures of keratoplasty in a tertiary comprehensive hospital in northern part of China over a 20-year period., Methods: All patients undergoing keratoplasty between January 1, 2002 to December 31, 2021 in a tertiary comprehensive hospital in northern part of China were retrospectively reviewed. The annual proportion of keratoplasty indications and surgical procedures was recorded and analyzed., Results: A total of 8266 keratoplasty procedures were included. Leading indications were keratoleukoma (n = 2108, 25.50%), followed by regraft (n = 1453 ,17.58%), corneal endothelial dysfunction (n = 1085, 13.13%), and keratoconus (n = 922,11.15%). A decreasing trend was observed for keratoleukoma (P < 0.01) and an increasing trend for corneal endothelial dysfunction (P < 0.01), regraft (P = 0.012), corneal limbal dermoids (P < 0.01) and congenital corneal opacity (P < 0.01). From 2002 to 2021, the proportion of penetrating keratoplasty (PK) had decreased from 73.95% (2002 to 2006) to 53.49% (2017 to 2021). On contrary, anterior lamellar keratoplasty (ALK) (459-705, 26.05-31.96%, P = 0.034) and endothelial keratoplasty (EK) (0-321, 0.00-14.55%, P < 0.01) became more prevalent from 2002 to 2021. For cases with corneal endothelial dysfunction, EK became the preferred technique (74.72%) in the recent 5 years., Conclusion: Over the past 20 years, keratoleukoma and regraft have been the leading indications for keratoplasty. A noticeable shift in surgical preference from PK to DSAEK and ALK is evident, with key indications for keratoplasty including keratoleukoma, regraft, limbal dermoids, endothelial dysfunction, and keratoconus, respectively., (© 2024. The Author(s).)

Background: Schizophrenia is associated with a high mortality rate due to the high risk of suicide. However, there is still a lack of evidence on the gender-specific risk factors for suicide among people with schizophrenia. In this study, we aimed to measure the sociodemographic and clinical correlates of suicide deaths in different genders among people with schizophrenia., Methods: Data on patients with schizophrenia from 2013 to 2021 in Guangzhou, China were obtained from the National Information System for Psychosis (NISP), involving a total of 33,080 patients. Cox regression and Fine-Gray models were used to explore the sociodemographic and clinical risk factors for suicide mortality in different genders., Results: The overall age-standardized mortality rates due to suicide were 133.89 (95% CI: 124.31-143.47) per 100,000 person-years for females and 163.25 (95% CI: 152.92-173.59) per 100,000 person-years for males. To be specific, lack of medical insurance, history of non-treatment, and history of suicidal behavior was associated with a higher risk for suicide mortality for females, while an age of 35-54, being hospitalized once, and the age of onset being > 28 years were linked to lower risk for suicide mortality for males. For both genders, a lower risk for suicide mortality was observed in patients at an older age (≥ 55 years) and with a history of hospitalization more than once, and a higher suicide mortality risk was found in married patients and those residing in rural areas., Conclusion: The present study found that gender differences should be taken into account in the development of suicide prevention programs for people with schizophrenia, and future research is still required to verify our preliminary results., (© 2024. The Author(s).)

Rationale: Spirometry reference equations that are derived from a large, nationally representative general population are warranted in China, and the impact of using prebronchodilator (pre-BD) and post-BD spirometry reference values has yet to be assessed in Chinese populations. Objectives: To present the pre-BD and post-BD spirometry reference values for Chinese adults using the China Pulmonary Health (CPH) Study. Methods: A reference population of 17,969 healthy, nonsmoking participants in the CPH Study was used to calculate the pre- and post-BD reference values for FEV 1 , FVC, and FEV 1 /FVC ratio. Pre- and post-BD reference values were applied to the entire CPH population ( N  = 50,991) to illustrate the divergence between the use of different references in determining disease prevalence and severity grading. Measurements and Main Results: The prevalences of airflow limitation were 5.36% using the pre-BD reference and 8.02% using the post-BD reference. Individuals who had a post-BD FEV 1 /FVC ratio lower than the post-BD reference value but higher than the pre-BD reference value were found to have significantly higher rates of self-reported respiratory symptoms and significantly lower values on spirometry indicators than those whose post-BD FEV 1 /FVC ratio was greater than the post-BD reference value. An additional 3.51% of participants were identified as having grade II-IV chronic obstructive pulmonary disease using the post-BD FEV 1 predicted values. Conclusions: This study generated and applied pre- and post-BD spirometry reference values in a nationally representative Chinese adult population. Post-BD reference values may serve as an additional criterion in identifying individuals at risk for obstructive pulmonary diseases, and their diagnostic and prognostic values should be further investigated.

In this study, a new species of the genus Boulenophrys is described from northwestern Guangdong, within the Nanling Moutains. The new species can be distinguished from all known congeners by a combination of morphological characteristics and the mitochondrial genetic divergence. The new species is found to breed in winter season which was not common in most amphibian groups but also present in some Boulenophrys congeners. We further discuss the inadequate surveys for these species due to the oversight of such multi-seasonal breeding pattern.

Study Objective: HR18034, composed of the ropivacaine encapsulated in multi-lamellar, concentric circular structure liposomes as the major component and a small amount of free ropivacaine, has performed well in animal experiments and phase I clinical trials. This trial was to investigate the efficacy, safety, pharmacokinetic profile and the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy compared with ropivacaine., Design: A multicenter, randomized, double-blind trial., Setting: 19 medical centers in China., Patients: 85 patients undergoing hemorrhoidectomy between October 2022 to November 2022., Interventions: Patients were randomly divided into HR 18034 190 mg group, 285 mg group, 380 mg group and ropivacaine 75 mg group, receiving single local anesthetic perianal injection for postoperative analgesia., Measurements: The primary outcome was the area under the resting state NRS score -time curve within 72 h after injection. The second outcomes included the proportion of patients without pain, the proportion of patients not requiring rescue analgesia, cumulative morphine consumption for rescue analgesia, etc. Safety was evaluated by adverse events incidence and plasma ropivacaine concentrations were measured to explore the pharmacokinetic characteristics of HR18034., Main Results: The areas under the NRS score (at rest and moving states)-time curve were significantly lower in HR 18034 380 mg group than ropivacaine 75 mg at 24 h, 48 h, and 72 h after administration. However, this superiority was not observed in HR18034 190 mg group and 285 mg group. There was no difference in cumulative morphine consumption for rescue analgesia between HR 18034 groups and ropivacaine group., Conclusions: HR 18034 380 mg showed superior analgesic efficacy and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2023. Published by Elsevier Inc.)

Background: General hospitals in China have been establishing General Practice Departments (GPD). Although General Practice Nurses (GPNs) are an important part of this medical system, their training has not been synchronised. This study explored the working status of nurses in GPDs in general hospitals in Beijing to provide a theoretical basis for the training and development of GPNs in China., Methods: We conducted in-depth, individual interviews with outpatient nurses at 19 hospitals in Beijing between March and April 2021. We employed a qualitative analysis to interpret participant narratives and used a codebook thematic analysis to analyse the interview data and extract themes., Results: The analysis revealed four themes: (i) a lack of full-time GPNs in GPDs of most tertiary hospitals, (ii) the inability of GPNs to fully express their potential and skills owing to their limited roles, (iii) insufficient standardised patient education provided by nurses in GPDs, and (iv) a lack of systematic and relevant training for nurses working in general practice settings., Conclusions: To promote the development of GPNs, GPDs in general hospitals in China should hire full-time GPNs, define their job duties in alignment with their values, and provide standardised training to strengthen their core competencies., (© 2024. The Author(s).)

The impact of watershed comprehensive management (WCM) on per- and polyfluoroalkyl substances (PFAS) pollution in rapidly urbanizing areas remains unclear. In a typical rapidly urbanizing watershed of Shenzhen, China, we investigated temporal variations in contamination level, primary source and ecological risk of 50 emerging and legacy PFAS, as well as the replacement trends of emerging PFAS before and after WCM during a six-year sampling campaign. We found that large-scale dredging was a non-negligible factor in abnormally increased PFAS concentrations (6.43 %-456.16 %) during WCM through their release from river sediments. To better characterize the diverse and complex PFAS contamination, a novel pollution assessment method, PFAS "diversity", was adopted based on a modified Shannon-Weiner diversity index and Pielou evenness index, reflecting numbers of PFAS detected and how evenly each PFAS contributed to the total PFAS concentrations at specific sampling sites. Importantly, we found that the Pielou evenness index can indicate and quantify abnormal pollution sources (especially point sources) along the river. The results revealed that WCM did not effectively reduce total PFAS concentrations and diversity in the rapidly urbanizing watershed but obviously improved point source pollution. Furthermore, 6:2 polyfluorinated phosphate diesters and hexafluoropropylene oxide dimer acid (GenX) that posed high ecological risks emerged and the number of sampling sites with high risk increased from 16 to 20 after WCM. Finally, we summarize several important issues related to PFAS contamination during WCM and propose specific countermeasures, such as adopting environmental dredging and reducing the proportion of ecological water replenished by wastewater treatment plant effluent for better control of PFAS pollution. Our study highlighted the limited effectiveness of WCM in mitigating PFAS pollution and the importance of emerging contaminant regulation in rapidly urbanizing watersheds during WCM., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nan Xu reports financial support was provided by National Natural Science Foundation of China. Nan Xu reports financial support was provided by Shenzhen Fundamental Research Program. 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. If there are other authors, they 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: The implementation of a zero-COVID policy for 3 years in China during the COVID-19 pandemic significantly impacted a broad spectrum of acute respiratory tract infections (ARTIs). The epidemiological characteristics of ARTI pathogens in children following the cessation of the zero-COVID policy remain unclear., Methods: Etiologically diagnostic data from 82,708 children with ARTIs at the Children's Hospital of Soochow University during 2016-2023 were analyzed for 8 pathogens (human respiratory syncytial virus [HRSV], influenza A [FluA], FluB, human parainfluenza virus [HPIV], adenovirus [ADV], human rhinovirus [HRV], bocavirus [BoV], and mycoplasma pneumoniae [MP]). The changes in respiratory infections in Suzhou, China during the first year (2020, Phase I) and the second and third years of the pandemic (2021-2022, Phase II) and the first year after the end of zero-COVID policy (2023, Phase III) versus that in the pre-pandemic years (2016-2019) were compared., Results: When compared with the average pre-pandemic levels, the pathogen-positive rate decreased by 19.27% in Phase I (OR: 0.70; 95% CI: 0.67-0.74), increased by 32.87% in Phase II (OR: 1.78; 95% CI: 1.72-1.84), and increased by 79.16% in Phase III (OR: 4.58; 95% CI: 4.37-4.79). In Phase I, the positive rates of HRSV, FluA, ADV, and MP decreased by 26.72, 58.97, 72.85, and 67.87%, respectively, and the positive rates of FluB, HPIV, HRV, and BoV increased by 86.84, 25, 32.37, and 16.94%, respectively. In Phase III, the positive rates of HRSV, FluA, FluB, HPIV, ADV, and HRV increased by 39.74, 1046.15, 118.42, 116.57, 131.13, and 146.40%, respectively, while the positive rate of BoV decreased by 56.12%. MP was inhibited during the epidemic, and MP showed a delayed outbreak after the ending of the zero-COVID policy. Compared with the average pre-pandemic levels, the MP-positive rate in Phase III increased by 116.7% (OR: 2.86; 95% CI: 2.74-2.99), with the highest increase in 0-1-year-old children., Conclusion: The strict and large-scale implementation of the zero-COVID policy in the early stages of the COVID-19 pandemic was the main driving factor for the sharp reduction in the rate of children's respiratory pathogenic infections. The termination of this policy can cause a resurgence or escalation of pathogenic infections., 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 © 2024 Xu, Pan, Dong, Zhang, Xu, Wang, Wang, Li, Jiang and Hao.)

Background: Indoor environmental factors, such as pet ownership, presence of cockroaches, mattress quality, fuel usage (gas or electricity), use of biomass for cooking and heating, exposure to tobacco smoke or household molds can significantly affect the sleep quality of children with chronic cough. However, data regarding the effects of indoor environmental conditions on sleep in this population are limited. This study aimed to assess the prevalence of abnormal sleep behaviors and to establish associations between indoor environmental factors and sleep behaviors among children with chronic cough in Wuxi, China., Methods: A cross-sectional design was employed in this study, involving children aged 3-18 years. Data on sociodemographic factors, allergies, home environmental exposures, and sleep characteristics of the participants were collected using paper-based questionnaires. The association between indoor environmental factors and sleep behaviors in children with chronic cough was analyzed using logistic regression models., Results: The findings demonstrated that the prevalence of chronic cough among children in Wuxi was 15.50%. The chronic cough group exhibited a significantly higher incidence of eczema, wheezing, rhinitis, food allergy, and nasosinusitis than the non-chronic cough group. In addition, children with chronic cough also tended to have a family history of sleep disorders and adenoid hypertrophy (P < 0.01). After adjusting for confounding factors, a significant association was observed between bruxism (teeth grinding) and chronic cough (sometimes: odds ratio [OR] = 1.04; confidence interval [CI] = 1.01-1.08; always: OR = 1.11; CI = 1.04-1.19; P < 0.01). Among children with chronic cough, recent home decoration was associated with sleepwalking (OR = 1.04; CI = 1.00-1.07; P < 0.05), mold exposure was associated with bruxism (OR = 1.15; CI = 1.0-1.31; P < 0.05), and carpet use at home was associated with apnea (OR = 1.09; CI = 1.02-1.17; P < 0.05), twitching during sleep (OR = 1.13; CI = 1.00-1.27; P < 0.01) and morning headache (OR = 1.14; CI = 1.05-1.23; P < 0.01)., Conclusion: Children with chronic cough are more prone to some abnormal sleep behaviors than children without chronic cough. Household decoration within a year, household mold exposure, and carpet use were all significantly positively associated with abnormal sleep behaviors in children with chronic cough. Our study provides novel insights into the impact of the indoor environment on children's sleep and the occurrence of chronic cough, offering guidance for tailored health promotion programs for families., (© 2024. The Author(s).)

Peer victimization (PV) is a common and serious problem in school contexts, which hinders adolescents' emotional development and social adaptation. The present study aimed to test the longitudinal relationship between PV and the increase of depressive symptoms (DSs) among Chinese mid-late adolescents using a two-wave longitudinal design and examine the buffering effects of self-compassion (SC) and parental autonomy support (PAS) on this relationship. A relatively large sample of Chinese high school students ( N = 722, 52.1% boys; age at Time 2 = 16.23 years old, SD = 0.79) were surveyed annually at two time points. The results showed that PV at Time 1 positively predicted DSs at Time 2 after controlling for the DSs at Time 1. In addition, SC and PAS moderated the longitudinal relationship between PV and the development of DSs, while such moderating effects only existed in girls but not in boys. Specifically, the positive relationship between PV and DSs was non-significant among girls with higher levels of SC or PAS. Our findings highlighted that SC and PAS might be important protective factors buffering against DSs for victimized girls., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Background: There is a high incidence of cervical cancer in Xinjiang. Genetic variation in human papillomavirus may increase its ability to invade, spread, and escape host immune response., Methods: HPV16 genome was sequenced for 90 positive samples of HPV16 infection. Sequences of the E4, E5 and L2 genes were analysed to reveal sequence variation of HPV16 in Xinjiang and the distribution of variation among the positive samples of HPV16 infection., Results: Eighty-one of the 90 samples of HPV16 infection showed variation in HPV16 E4 gene with 18 nucleotide variation sites, of which 8 sites were synonymous variations and 11 missense variations. 90 samples of HPV16 infection showed variation in HPV16 E5 and L2 genes with 16 nucleotide variation sites (6 synonymous, 11 missense variations) in the E5 gene and 100 nucleotide variation sites in L2 gene (37 synonymous, 67 missense variations). The frequency of HPV16 L2 gene missense variations G3377A, G3599A, G3703A, and G3757A was higher in the case groups than in the control groups., Conclusions: Phylogenetic tree analysis showed that 87 samples were European strains, 3 cases were Asian strains, there were no other variations, and G4181A was related to Asian strains. HPV16 L2 gene missense variations G3377A, G3599A, G3703A, and G3757A were significantly more frequent in the case groups than in the control groups., (© 2024. The Author(s).)

The early diagnosis and treatment of foreign body aspiration (FBA) can significantly improve the overall prognosis of children. There are significant differences in the epidemiology and clinical characteristics of FBA in different regions. Therefore, we conducted a real-world study in the western region of China with over 4000 patients. The aim of this study was to improve the understanding of FBA in terms of its types, the specific months of its occurrence, and the distribution of primary caregiver characteristics in western China. We collected the clinical and epidemiological data of children who were diagnosed with FBA in our hospital over the past 20 years through a big data centre. We matched the data of healthy children who underwent routine physical examinations at the paediatric health clinic during the same period to analyse the differences in the data of actual guardians. A total of 4227 patients from five provinces were included in this study. Foreign bodies were removed by rigid bronchoscopy in 99.4% (4202/4227) of patients, with a median age of 19 months and a median surgical duration 16 min. January was the most common month of onset for 1725 patients, followed by February, with 1027 patients. The most common types of foreign objects were melon peanuts, seeds and walnuts, accounting for 47.2%, 15.3%, and 10.2%, respectively. In the FBA group, the proportion of grandparents who were primary caregivers was 70.33% (2973/4227), which was significantly greater than the 63.05% in the healthy group (2665/4227) (P < 0.01). FBA most commonly occurs in January and February. More than 60% of FBAs occur between the ages of 1 and 2 years, and the incidence of FBA may be greater in children who are cared for by grandparents. A rigid bronchoscope can be used to remove most aspirated foreign bodies in a median of 16 min., (© 2024. The Author(s).)

Lipid profiles are influenced by both noise and genetic variants. However, little is known about the associations of occupational noise and genetic variants with age-related changes in blood lipids, a crucial event in the initiation and evolution of atherosclerotic cardiovascular diseases. We aimed to evaluate the associations of blood lipid change rates with occupational noise and genetic variants in stress hormone biosynthesis-based genes. This cohort was established in 2012 and 2013 and was followed up until 2017. A total of 952 participants were included in the final analysis and all of them were categorized to two groups, the exposed group and control group, according to the exposed noise levels in their working area. Single nucleotide polymorphisms (SNPs) in stress hormone biosynthesis-based genes were genotyped. Five physical examinations were conducted from 2012 to 2017 and lipid measurements were repeated five times. The estimated annual changes (EACs) of blood lipid were calculated as the difference in blood lipid levels between any 2 adjacent examinations divided by their time interval (year). The generalized estimating equations for repeated measures analyses with exchangeable correlation structures were used to evaluate the influence of exposing to noise (versus being a control) and the SNPs mentioned above on the EACs of blood lipids. We found that the participants experienced accelerated age-related decline in high-density lipoprotein cholesterol (HDL-C) levels as they were exposed to noise (β = -0.38, 95% confidence interval (CI), -0.66 to -0.10, P = 0.007), after adjusting for work duration, gender, smoking, alcohol consumption, and pack-years. This trend was only found in participants with COMT-rs165815 TT genotype (β = -1.19, 95% CI, -1.80 to -0.58, P < 0.001), but not in those with the CC or CT genotypes. The interaction of noise exposure and rs165815 was marginally significant (P interaction  = 0.010) after multiple adjustments. Compared with DDC-rs11978267 AA genotype carriers, participants carrying rs11978267 GG genotype had decreased EAC of triglycerides (TG) (β = -5.06, 95% CI, -9.07 to -1.05, P = 0.013). Participants carrying DBH-rs4740203 CC genotype had increased EAC of total cholesterol (TC) (β = 1.19, 95% CI, 0.06 to 2.33, P = 0.039). However, these findings were not statistically significant after multiple adjustments. These results indicated that Occupational noise exposure was associated with accelerated age-related decreases in HDL-C levels, and the COMT-rs165815 genotype appeared to modify the effect of noise exposure on HDL-C changes among the occupational population., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

This study explores the disparities in older adults' self-rated health within the urban landscape of China. Drawing on the 1% national population survey of China in 2015, it highlights how variations in city development contribute to geographical health disparities among older residents. In the era of the decentralized fiscal system, a crucial mechanism identified is the role of cities' local fiscal revenue in connecting their socioeconomic development and the health status among older adults. Despite efforts by cities in lower socioeconomic positions to increase fiscal expenditure and address deficits through central transfer payments, they prove inadequate in effectively mitigating population health disparities. The prioritization of economic growth and neglect of public service provision responsibilities are fundamental causes within this fiscal framework. The findings underscore the urgent need for increased central transfer payments in public services to address the growing disparities in older adults' health., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The rapid development of the telecommunications industry in the post-COVID-19 era has brought tremendous pressure to employees making them a high-risk group for job burnout. However, prior research paid less attention to the burnout of employees. Furthermore, social support and gender have separate effects on job burnout. This study explores the mechanism of stress perception on job burnout and examines the roles of social support and gender amid it., Method: This cross-sectional study was conducted from June 2023 to August 2023 in mainland China. A total of 39,507 were recruited by random sampling and online questionnaires, and 28,204 valid questionnaires were retained. SPSS (version 26.0) and PROCESS (Model 4 & 7) were used for correlation analysis, mediation analysis, and mediated moderation analysis., Result: Stress perception can positively predict the level of job burnout of employees in the telecommunications industry, and social support plays a partial mediating role, accounts for 8.01% of the total effect, gender moderates the first half of the path in this mediation model. At the same pressure level, female can perceive more social support than male., Conclusions: Under high pressure background, employees' job burnout varies depending on gender and the perception of social support. Therefore, telecommunications industry managers should adopt decompression measures and targeted social support resources for different groups., (© 2024. The Author(s).)

Background: Acute respiratory distress syndrome (ARDS) is a severe complication that can lead to fatalities in multiple trauma patients. Nevertheless, the incidence rate and early prediction of ARDS among multiple trauma patients residing in high-altitude areas remain unknown., Methods: This study included a total of 168 multiple trauma patients who received treatment at Shigatse People's Hospital Intensive Care Unit (ICU) between January 1, 2019 and December 31, 2021. The clinical characteristics of the patients and the incidence rate of ARDS were assessed. Univariable and multivariable logistic regression models were employed to identify potential risk factors for ARDS, and the predictive effects of these risk factors were analyzed., Results: In the high-altitude area, the incidence of ARDS among multiple trauma patients was 37.5% (63/168), with a hospital mortality rate of 16.1% (27/168). Injury Severity Score (ISS) and thoracic injuries were identified as significant predictors for ARDS using the logistic regression model, with an area under the curve (AUC) of 0.75 and 0.75, respectively. Furthermore, a novel predictive risk score combining ISS and thoracic injuries demonstrated improved predictive ability, achieving an AUC of 0.82., Conclusions: This study presents the incidence of ARDS in multiple trauma patients residing in the Tibetan region, and identifies two critical predictive factors along with a risk score for early prediction of ARDS. These findings have the potential to enhance clinicians' ability to accurately assess the risk of ARDS and proactively prevent its onset., Competing Interests: The authors declare that they have no competing interests., (© 2024 Tu et al.)

Introduction: The health impact of retirement is controversial. Most previous studies have been based on self-reported health indicators or the endpoints of some chronic diseases (e.g., morbidity or mortality), but objective physiological indicators (e.g., blood pressure) have rarely been used. The objective of this study is to elucidate the health effects of retirement on blood pressure, thereby offering empirical evidence to facilitate the health of retirees and to optimize retirement policies., Methods: From 2012 to 2015, 84,696 participants of the Chinese Hypertension Survey (CHS) were included in this study. We applied the fuzzy regression discontinuity design (FRDD) to identify retirement's causal effect on systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure. We also explored the heterogeneity in the effects of retirement across different sex and education level groups., Results: Based on the fully adjusted model, we estimated that retirement increased SBP by 5.047 mm Hg (95% CI: -2.628-12.723, P value: 0.197), DBP by 0.614 mm Hg (95% CI: -3.879-5.108, P value: 0.789) and pulse pressure by 4.433 mm Hg (95% CI: -0.985-9.851, P value: 0.109). We found that retirement led to a significant increase in male participants' SBP and pulse pressure as well as a possible decrease in female participants' blood pressure. Additionally, the blood pressure levels of low-educated participants were more vulnerable to the shock of retirement., Conclusion: Retirement is associated with an increase in blood pressure level. There is a causal relationship between the increase in blood pressure levels of men and retirement. Policy-makers should pay extra attention to the health status of men and less educated people when adjusting retirement policies in the future., (© 2024. The Author(s).)

Salmonella, which is widely distributed in nature, is an important zoonotic pathogen affecting humans, livestock, and other animals. Salmonella infection not only hinders the development of livestock and poultry-related industries but also poses a great threat to human health. In this study, we collected 1,537 samples including weak chicks, dead embryos, fecal samples and environmental samples from 2020 to 2023 (for a period of 1 to 2 months per year) to keep a long-term monitor the prevalence of Salmonella in an intensive laying hen farm, 105 Salmonella strains were isolated with an isolation rate of 6.83% (105/1,537). It revealed a significant decrease in prevalence rates of Salmonella over time (P < 0.001). Before 2020, the predominant serotype was S. Enteritidis. S. Kentucky was first detected in November 2020 and its proportion was gradually found to exceed that of S. Enteritidis since then. S. Kentucky isolates were distributed in various links of the four regions in the poultry farm. A total of 55 S. Kentucky strains, were assigned to ST198 based on whole genome sequencing. Among them, 54 strains were resistant to 12 to 16 antibiotics, indicating that they were extensively drug-resistant (XDR). Seventeen antimicrobial resistance genes were detected in 55 S. Kentucky isolates. For most of these isolates, antibiotic resistance phenotypes were concordant with their genotypes. All S. Kentucky strains isolated from this farm in 2020 to 2023 showed a high similarity based on their core-genome SNP-based phylogeny. The traceability analysis revealed that S. Kentucky was introduced to the farm through newly purchased flocks. The long-term existence of XDR S. Kentucky ST198 poses a substantial risk because of the multiage management and circulation of workers in this poultry farm. Thus, this study is the first to report extensively drug-resistant S. Kentucky ST198 detected in this intensive poultry farm in China., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Staphylococcus aureus is one of the most prevalent pathogens in bovine mastitis, which leads to substantial financial losses for the dairy industry., Results: In this study, S. aureus (n = 72) was isolated from 18 dairy farms in 15 provinces across China in 2021. The identification of these isolates at the species level was achieved by employing 16S rRNA sequencing. An isothermal amplification method for auxiliary detection of S. aureus was established, which can be employed not only for laboratory detection but also for point-of-care testing (POCT). Molecular characteristics of S. aureus mastitis in Chinese dairy cows were determined through MLST and spa typing. Finally, methicillin-resistant Staphylococcus aureus (MRSA) and MRSA resistance genes were detected using MIC and PCR amplification techniques. 72 isolates were identified as 12 sequence types (STs) and 7 clonal complexes (CC). ST1/CC1 was the dominant prevalent accounting for 33.3 % of the total, and exhibiting a wide distribution range. In terms of spa types, t114 was the dominant type, accounting for 31.9 % of the total, followed by t529 as the second major type. Four S. aureus strains were classified as MRSA according to their levels of oxacillin resistance (MIC ≥4 μg/mL). Among these four MRSA strains, one of them was found to be mecA positive. However, the presence of drug-resistance genes mecA and mecC was not detected in the remaining three MRSA strains, indicating the possible existence of new resistance genes., Conclusions: Our study investigated the prevalence of S. aureus mastitis in dairy cows in China, while also examined the molecular characteristics and MRSA strains. This information will help with the clinical monitoring, prevention, and control of S. aureus mastitis in dairy cattle., 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. Published by Elsevier Ltd.)

Background: Early identification of patients at risk of osteopenia is an essential step in reducing the population at risk for fractures. We aimed to develop and validate a prediction model for osteopenia in Chinese middle-aged and elderly men that provides individualized risk estimates., Methods: In this prospective cohort study, 1109 patients who attend regular physical examinations in the Second Medical Centre of Chinese PLA General Hospital were enrolled from 2015.03 to 2015.09. The baseline risk factors included dietary habits, exercise habits, medical histories and medication records. Osteopenia during follow-up were collected from Electronic Health Records (EHRs) and telephone interviews. Internal validation was conducted using bootstrapping to correct the optimism. The independent sample T-test analysis, Mann&#95;Whitney U test, Chi-Square Test and multivariable Cox regression analysis were utilized to identify predictive factors for osteopenia in Chinese middle-aged and elderly men. A nomogram based on the seven variables was built for clinical use. Concordance index (C-index), receiver operating characteristic curve (ROC), decision curve analysis (DCA) and calibration curve were used to evaluate the efficiency of the nomogram., Results: The risk factors included in the prediction model were bone mineral density at left femoral neck (LNBMD), hemoglobin (Hb), serum albumin (ALB), postprandial blood glucose (PBG), fatty liver disease (FLD), smoking and tea consumption. The C-index for the risk nomogram was 0.773 in the prediction model, which presented good refinement. The AUC of the risk nomogram at different time points ranged from 0.785 to 0.817, exhibiting good predictive ability and performance. In addition, the DCA showed that the nomogram had a good clinical application value. The nomogram calibration curve indicated that the prediction model was consistent., Conclusions: Our study provides a novel nomogram and a web calculator that can effectively predict the 7-year incidence risk of osteopenia in Chinese middle-aged and elderly men. It is convenient for clinicians to prevent fragility fractures in the male population., (© 2024. The Author(s).)

Background: Alcohol consumption by children and adolescents is receiving increasing attention. It may cause dyslipidemia, a risk factor for cardiovascular disease. However, the association between alcohol consumption and blood lipids in children and adolescents is unclear, and so we aimed to characterize this association., Methods: Data from the China Health and Nutrition Survey were extracted from children and adolescents aged 7-18 years for whom information was available on alcohol consumption. The population was divided into drinking and nondrinking groups. The χ2, Student's t, or Mann-Whitney U test was used to compare groups. Univariate and multivariate linear regression and propensity score matching (PSM) analysis were used to identify the association between alcohol consumption and blood lipids., Results: This study included 408 children and adolescents with 35 drinkers and 373 nondrinkers. The drinkers had significantly lower values of total cholesterol (TC) (3.8 mmol/L for nondrinkers versus 3.5 mmol/L for drinkers, p = 0.002) and high-density lipoprotein cholesterol (HDL-C) (1.3 mmol/L for nondrinkers versus 1.2 mmol/L for drinkers, p = 0.007), but not for low-density lipoprotein cholesterol (LDL-C) (2.1 mmol/L for nondrinkers versus 2.0 mmol/L for drinkers, p = 0.092) or triglyceride (TG) (0.9 mmol/L for nondrinkers versus 0.8 mmol/L for drinkers, p = 0.21). The univariate and multivariate analyses led to the same conclusions. After PSM there was still a significant negative association between alcohol consumption and TC or HDL-C., Conclusion: Alcohol consumption in children and adolescents exhibited significant negative associated with TC and HDL-C, but not with LDL-C or TG. These findings need to be confirmed in future prospective research, and the health effects of blood lipid changes caused by drinking in children and adolescents need to be clarified., (© 2024. The Author(s).)

Introduction: Most people with schizophrenia in China are supported by their family members in community. The patient's family is confronted with severe care burden and pressure, which directly affects the caregiver's own health and social life, and indirectly affects the patient's rehabilitation. Adequate family resources can reduce the burden and pressure on families. But there is an absence of systematic family resource indicators for people with schizophrenic disorder in China., Objectives: This study aimed to develop a set of family resource indicators for people with schizophrenic disorder in China., Design: Preliminary family resource indicators were generated and refined by literature review and an expert consultation meeting. Two rounds of email-based Delphi survey were carried out to identify family resource indicators., Setting: Two rounds of email-based Delphi survey were performed from July to September 2021 in Beijing, China., Participants: There were 15 mental health doctors from community health service centres and four psychiatrists from tertiary hospitals, and two primary care researchers from universities in the first and second rounds Delphi survey., Results: All the 21 experts participated in both rounds of Delphi survey. A total of 46 indicators achieved consensus for inclusion in the final set of indicators after two rounds of Delphi survey. The final set of indicators was grouped into 10 domains: financial support (three indicators), psychological and spiritual support (eight indicators), medical treatment (three indicators), information and education (three indicators), structural support (two indicators), external family resources included social resources (five indicators), cultural resources (two indicators), economic resources (seven indicators), environmental resources (four indicators) and medical resources (nine indicators)., Conclusions: A set of 46 family resource indicators for people with schizophrenic disorder in community was identified by an iterative Delphi process in Beijing, China. However, the indicators still need to be validated by testing in further studies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)