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Background: The incidence of duodenal adenocarcinoma is increasing, with limited studies on this disease published. This multicenter retrospective study aimed to analyze the clinicopathologic features of duodenal adenocarcinoma and identify prognostic factors for postoperative survival., Methods: Demographic characteristics, clinicopathologic features, treatment outcomes, and survival of patients with duodenal adenocarcinoma undergoing surgical treatment at 16 Chinese medical centers from 2012 to 2023 were retrospectively analyzed., Results: Among the 2,189 patients with duodenal adenocarcinoma included, 50.07% had extra-ampullary duodenal adenocarcinoma and 49.93% had peri-ampullary duodenal adenocarcinoma. The 1-, 3-, and 5-year overall survival rates for patients who underwent radical surgery were 91.78%, 69.30%, and 55.86%, respectively. The median overall survival was 73 months (range, 64-84), and the median progression-free survival was 64 months (range, 52-76). No differences in survival were observed between the laparotomy and minimally invasive surgery groups (log-rank P = .562); furthermore, no significant between-group differences in operation time, lymph node dissection, postoperative complications, or in-hospital mortality were observed (P > .05). The minimally invasive surgery group experienced less intraoperative blood loss (250 mL vs 100 mL, P < .001), fewer intraoperative blood transfusions (24.97% vs 18.84%, P = .002), and shorter hospital stays (28 days vs 23 days, P < .001). Multivariate Cox regression analysis revealed that advanced age, advanced stage, longer operation time, intraoperative blood transfusion, and postoperative hemorrhage were independent risk factors for poor prognosis., Conclusion: Radical surgery was associated with favorable overall survival among patients with duodenal adenocarcinoma, and no difference in survival was observed between patients with extra-ampullary duodenal adenocarcinoma and peri-ampullary duodenal adenocarcinoma. Minimally invasive surgery is a reliable alternative for duodenal adenocarcinoma treatment., Competing Interests: Conflicts of Interest/Disclosure The authors have no relevant financial disclosures., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Anthropometric measurement provides a simple, noninvasive approach to evaluate obesity in pregnant women. We aimed to develop a predictive model utilizing anthropometric index for gestational diabetes mellitus (GDM), the most common obesity-related complications during pregnancy., Methods: A prospective cohort of 4709 women was enrolled in Qingdao, China. Logistic regression model was constructed to determine the association of body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) in the first trimester (<14 weeks' gestation) with GDM. The discrimination ability for GDM was assessed using areas under the receiver operating characteristic (ROC) curve (AUC). Delong tests were performed to compare AUC values between different measures., Results: The GDM incidence was 19.50%. GDM risk increased with VAT during early pregnancy, and the risk increased by 117% (OR = 2.17, 95% CI: 1.23-2.83) to 326% (OR = 4.26, 95% CI: 2.29-7.91) in pregnant women with the second quartile or above after adjusting for confounders (all p <.05). Combined index using VAT and BMI demonstrated superior predictive power for GDM compared with BMI alone ( p <.05), but didn't differ from VAT ( p> .05). Overall, VAT was positively correlated with GDM occurrence, outperforming BMI, WHR, WHtR and SAT in the predicative model. A first-trimester VAT cutoff of 27.05 mm might be promising for GDM risk stratification., Conclusions: First-trimester routine ultrasound screening may facilitate earlier identification and intervention of GDM. Pregnant women with VAT above the optimal threshold (27.05 mm) might benefit from targeted GDM monitoring.

Background: In contemporary society, physical appearance significantly influences individuals' social interactions and career achievements. Although some studies suggest that physical exercise may positively impact physical appearance, most rely on subjective self-assessment data. In contrast, third-party evaluations are widely regarded as more objective and reliable. Thus, this study aims to explore the effects of physical exercise on physical appearance, as assessed by third-party evaluations, and to examine its heterogeneity., Methods: This study utilized third-party physical appearance evaluation data from 25,460 respondents in the 2018 China Family Panel Studies (CFPS) and assessed the impact of physical exercise on physical appearance using multiple linear regression and instrumental variable analysis. Furthermore, the heterogeneity in the effects of physical exercise was investigated using subgroup regression and quantile regression analyses., Results: The findings indicate that physical exercise substantially enhances physical appearance, with its effects varying significantly across different populations. Specifically, women, urban residents, and those with lower appearance scores experience more pronounced enhancement from physical exercise compared to men, rural residents, and those with higher scores. Additionally, the effect of age on the impact of physical exercise on appearance exhibits an inverted U-shaped relationship. Middle-aged adults (40-59 years) experience the most significant improvements, while benefits are lower for adolescents (10-20 years), young adults (20-39 years), and older adults (60-80 years)., Conclusions: This study systematically reveals the positive impact of physical exercise on physical appearance, demonstrating that regular exercise can significantly enhance individual appearance scores. This finding contributes to a broader understanding of the multifaceted benefits of physical exercise., Competing Interests: Declarations. Ethics approval and consent to participate: The China Family Panel Studies (CFPS) received ethical approval from the Biomedical Ethics Review Committee at Peking University, identified by the approval code IRB00001052-14010, and obtained informed consent from all participants included in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Telemedicine has demonstrated efficacy as a supplement to traditional in-person care when treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent., Objective: This study evaluated the clinical outcomes, health-seeking behaviors, and cost of telemedicine integrated into care for children with short stature in China., Methods: Our study involved 1241 individuals diagnosed with short stature at the pediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care (IPC; 1183 patients receiving only in-person care) and telemedicine integrated care (TIC; 58 patients receiving both in-person and virtual care) groups. For both groups, the initial 71.43% (average of 58 percentages, with each percentage representing the ratio of patients in the treatment group) of visits were categorized into the pretelemedicine phase. We used propensity score matching to select individuals with similar baseline conditions. We used 7 variables such as age, gender, and medical insurance for the 1:5 closest neighbor match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in the standard height percentage. Health-seeking behavior was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both between different groups and between different visit modalities of the TIC group in the post-telemedicine phase., Results: In terms of clinical effectiveness, we demonstrated that the increase in height among the TIC group (Δz TIC =0.74) was more substantial than that for the IPC group (Δz IPC =0.51, P=.01; paired t test), while no unfavorable changes in other endpoints such as BMI or insulin-like growth factor 1 (IGF-1) levels were observed. As for health-seeking behaviors, the results showed that, during the post-telemedicine phase, the IPC group had a visit interval of 71.08 (IQR 50.75-90.73) days, significantly longer than the prior period (51.25 [IQR 34.75-82.00] days, P<.001; U test), whereas the TIC group's visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the 2 groups nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had a higher average total cost, elevated medical and labor expenses, and greater medical cost compared with virtual visits., Conclusions: We contend that the rise in medical visits facilitated by integrating telemedicine into care effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize a crucial treatment opportunity for children with short stature, thus attaining superior results., (©Yipei Wang, Pei Zhang, Yan Xing, Huifeng Shi, Yunpu Cui, Yuan Wei, Ke Zhang, Xinxia Wu, Hong Ji, Xuedong Xu, Yanhui Dong, Changxiao Jin. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.11.2024.)

Knowledge on the variation of yield and water use efficiency under different mulching methods is important for guiding rained maize production in the Loess Plateau area. In this study, eight different plastic film mulching methods was established to analyze the maize growth, soil water content and soil temperature changes of dryland maize, and increase yield and water use efficiency (WUE). The field experiment was conducted in 2019, and eight treatments were set up, including a traditional flat planting without mulching (CK), ridge-furrow with ridges mulching black plastic film and furrows mulching straw (HJ), ridge-furrow with ridges mulching black plastic film and furrows bare (HL), ridge-furrow with ridges mulching liquid plastic film and furrows mulching straw (YJ), ridge-furrow with ridges mulching liquid plastic film and furrows bare (YL), ridge-furrow with ridges mulching biodegradable plastic film and furrows mulching straw (SJ), ridge-furrow with ridges mulching biodegradable plastic film and furrows bare (SL) and ridge-furrow with ridges bare and furrows mulching straw (NJ). Furthermore, the AHP-TOPSIS was employed to evaluate the optimal mulching method for maize. The results showed that compared with CK and NJ treatment, the soil water content and soil storage were significantly changes with other treatments in the reproductive period of maize. Among the six mulching methods, maize yield in HJ, HL, YJ, YL, SJ, and SL treatments were 46.28%, 61.95%, 70.30%, 51.02%, 52.02% and 53.53% significantly greater than CK treatment. In addition, dryland maize WUE was 66.53% and 84.01% higher in the YJ and YL treatments with ridges mulching liquid plastic film than in the CK treatment, respectively. The optimal treatments of economic benefits were YL and HJ. Through AHP-TOPSIS comprehensive analysis, the optimal mulching methods were YL and HJ treatment. Current field trials indicate that YL treatment could serve as a promising option to improve dryland maize yield, WUE, and reducing environmental risks in the Loess Plateau of China., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Zhang 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.)

Objective: This study aimed to develop and validate an instrument to assess the health literacy of parents of children with asthma in a Chinese context., Methods: The preliminary Parental Health Literacy Scale for Children with Asthma (PHLSCA) was developed based on a literature review and refined to 45 items through two rounds of expert consultation using the Delphi method. A total of 481 parents of children with asthma were recruited from seven hospitals across four provinces in China between February and April 2019. Principal component analysis (PCA) and confirmatory factor analysis were conducted to evaluate the structural and construct validity of the scale., Results: The development and validation processes led to a 38 items scale comprising three subscales, namely: Health Knowledge (11 items), Health Skills (19 items) and Health Behavior (8 items). The scale demonstrated good reliability, with an internal consistency of Cronbach's α = 0.956 and a split-half reliability of r  = 0.887 ( p  < 0.01). The Item Content Validity Index (I-CVI) ranged from 0.81 to 1.00, and the Scale-CVI was 0.842. The correlation coefficients and factor analysis results indicated good construct validity, with the factors explaining 59.33% to 62.90% of the variance in each subscale., Conclusions: The final version of the questionnaire (PHLSCA) has been demonstrated to be a valid and reliable tool for assessing the health literacy of parents of Chinese children with asthma.

Background: Externalizing problem behaviors can significantly and negatively impact adolescents' learning, daily life, and future socialization. While physical exercise is believed to inhibit adolescents' externalizing problem behaviors, the extent of its effect and the mediating mechanisms remain unclear., Methods: This study is based on data from the 2018 China Family Panel Studies (CFPS). The CFPS project employed the Externalizing Problem Behaviors Scale (EPBS), the Rosenberg Self-Esteem Scale (RSES), and the Self-Control Scale (SCS) to measure adolescents' externalizing problem behaviors, self-esteem, and self-control. Additionally, physical exercise was measured by collecting data on the time and frequency of adolescents' physical exercise. Parent-child relationships were evaluated using a composite variable that included four dimensions: frequency of quarrels, frequency of heart-to-heart talks, parental awareness of their children's whereabouts, and children's trust in their parents. Based on data collection and variable construction, this study employed multiple linear regression, propensity score matching, and quantile regression to analyze the impact of physical exercise on adolescents' externalizing problem behaviors and the heterogeneity of these effects. Additionally, the Bootstrap mediation effect test was employed to explore the mediating roles of parent-child relationships, self-esteem, and self-control in this process., Results: The analysis demonstrates that physical exercise significantly inhibits adolescents' externalizing problem behaviors ( β = -0.095, p < 0.01), although the effect varies significantly among different populations. Compared to males ( β = -0.077, p < 0.1), rural residents ( β = -0.065, p > 0.1), individuals with poorer family economic status ( β = -0.080, p < 0.1), and those with more severe problem behaviors ( τ = 0.75, β = -0.086, p < 0.05), physical exercise yields a more pronounced inhibitory effect on females ( β = -0.113, p < 0.01), urban residents ( β = -0.134, p < 0.01), individuals with better family economic status ( β = -0.115, p < 0.01), and those with milder problem behaviors ( τ = 0.25, β = -0.112, p < 0.01). Furthermore, through enhancements in parent-child relationships (CI: -0.015; -0.002), self-esteem (CI: -0.019; -0.003), and self-control (CI: -0.055; -0.025), physical exercise indirectly mitigates adolescents' externalizing problem behaviors., Conclusion: Physical exercise significantly reduces adolescents' externalizing problem behaviors, with effects differing across various groups. Parent-child relationships, self-esteem, and self-control mediate this relationship, underscoring the positive influence of exercise on adolescent behavior., 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 Cui, Xing, Gu, Zhou, Zhang and Bu.)

The struggle women face in balancing work and family roles is a significant factor contributing to the decline in their fertility intentions. Therefore, work-family conflict serves as a crucial determinant influencing women's fertility intentions. This study aims to explore the internal mechanism between work-family conflict and the fertility intentions of Chinese women, using data obtained from 334 questionnaires. Data analysis was conducted using Mplus 8.0. The following conclusions were drawn: (1) There is a negative correlation between work-family conflict and women's fertility intentions. (2) Fertility attitudes play a mediating role in the relationship between work-family conflict and women's fertility intentions. (3) The relationship between work-family conflict and women's fertility intentions is moderated by income class. (4) The relationship between work-family conflict and women's fertility intentions is moderated by women's child-rearing burden. The findings of this study provide a foundation for governments at all levels to formulate population policies., (© 2024. The Author(s).)

Based on morphological and phylogenetic evidence, two novel species of Melampsora were discovered on Hypericum pseudohenryi in China and have been thoroughly characterized. One of these species, designated as M. danbaensis, exhibits distinct features such as aecia of Uredo-type, typically appearing in gregarious or grouped arrangements, and presenting a shallowly pulvinate structure. Aeciospores exhibit tremendous variations in size, ranging in shape from globose to ellipsoidal and bearing pronounced verrucose texture. Telia resemble crusts one-spore deep, covering nearly the entire abaxial leaf surface, with sessile teliospores reaching sizes of up to 65.8 µm, and exhibiting a clavate to cylindrical shape. Another species, designated as M. hyperici-pseudohenryi, is distinguished by Uredo-type uredinia, which are hypophyllous, scattered or grouped, and interspersed with numerous paraphyses. Its urediniospores tend to be globose, ellipsoidal or obovoid, echinulate, and are accompanied by clavate to capitate paraphyses reaching lengths up to 77.6 µm. Phylogenetically, both species form a novel monophyletic clade within the Melampsora genus, with robust support demonstrated by a high Maximum likelihood bootstrap support (MLBS) value of 100% and a Bayesian posterior probability (BPP) of 1. This study enriches our understanding of the diversity and geographical distribution of Melampsora species that infect Hypericum plants in China., (© 2024. The Author(s).)

After the ultralow emission transformation of coal-fired power plants, cement production became China's leading industrial emission source of nitrogen oxides. Flue gas dust contents at the outlet of cement kiln preheaters were as high as 80-100 g/m 3 , and the calcium oxide content in the dust exceeded 60%. Commercial V 2 O 5 (-WO 3 )/TiO 2 catalysts suitable for coal-fired flue gas suffer from alkaline earth metal Ca poisoning of cement kiln flue gas. Recent studies have also identified the poisoning of cement kiln selective catalytic reaction (SCR) catalysts by the heavy metals lead and thallium. Investigation of the poisoning process is the primary basis for analyzing the catalytic lifetime. This review summarizes and analyzes the SCR catalytic mechanism and chronicles the research progress concerning this poisoning mechanism. Based on the catalytic and toxification mechanisms, it can be inferred that improving the anti-poisoning performance of a catalyst enhances its acidity, surface redox performance-active catalytic sites, and shell layer protection. The data provide support in guiding engineering practice and reducing operating costs of SCR plants. Finally, future research directions for SCR denitrification catalysts in the cement industry are discussed. This study provides critical support for the development and optimization of poisoning-resistant SCR denitrification catalysts., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Background: Interprofessional teamwork improves patient care quality, safety, and health outcomes. Interprofessional education (IPE) is crucial in today's medical education to prepare students for the workforce as integral members of a collaborative team. The diversity of IPE learners indicates the importance of exploring the relationship between learning styles and attitudes toward IPE. The purpose of this study was to investigate the relationship between learning styles and attitudes toward IPE., Methods: A cross-sectional study was conducted between August 2023 and September 2023 in 49 colleges located in the south-eastern region of China. A convenience sampling approach was employed, selecting 500 students majoring in Clinical Medicine and Nursing. The students completed an online questionnaire, which included sociodemographic characteristics, educational characteristics, interprofessional educational characteristics, learning styles, and the readiness for interprofessional learning scale, and Kolb's learning style inventory. Descriptive statistics, Spearman's correlation, and multiple linear regression analysis were used to analyze the data., Results: The most learners are diverger (93.2%), followed by assimilator (3.4%), accommodator (2.6%), and Converger (0.8%). The total score on the RIPLS was 69.70 (7.42), ranging from 48 to 88. A statistical relationship could be established between learning styles and attitudes toward IPE., Conclusion: Abstract conceptualization and active experimentation learning modes and convergers were closely linked with positive attitudes toward IPE. Gender, age, and study stress can affect attitudes toward IPE. This study highlights the need for medical education curricula to integrate innovative teaching methods such as PBL, role-playing, scenario simulation and clinical early exposure to strengthen professional identity, and improve abilities related to interprofessional learning., (© 2024. The Author(s).)

Background: Herpes zoster is more prevalent among the older adult due to the age-related immune decline, leading to significant pain and complications. Although vaccination effectively prevents viral infections, vaccine hesitancy remains a major barrier to achieving high vaccination rates.To address this, we conducted a qualitative survey using Vaccine Hesitancy Determinants Matrix and 5C model to understand and improve vaccination rates in this group., Methods: Descriptive qualitative research design based on the philosophical underpinnings of naturalistic inquiry and purposive sampling methodology was conducted on adults aged 50 and above, as well as community health workers. Data were collected through semi-structured, in-depth personal interviews. The interview outline was constructed following a comprehensive review of the literature and consideration of the theoretical framework., Results: Seventeen adults over 50 years and four community healthcare workers were included in this study. The study found that information asymmetry in immunization planning was evident at all stages of vaccine supply, dissemination and demand. The main manifestations included limited access to authoritative information, insufficient community awareness of herpes zoster as a route of vaccination, insufficient vocational training, significant gaps in vaccine knowledge, and high levels of complacency among individual residents., Conclusion: Herpes zoster vaccine hesitancy is prevalent among middle-aged and older adults in China due to information asymmetry, vaccine complacency, inadequate community services, and other multiple layers of factors. Public health strategies should aim to reduce cognitive biases and information gaps by disseminating diverse and credible vaccine information through social media, medical institutions, and offline channels to promote higher vaccination rates., 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 Wang, Xing, Zhang, Dai, Li, Shang, Hu, Zhang and Fang.)

Background: Individuals with sensory processing sensitivity (SPS) tend to be overreactive in response to negative environmental stimuli. More is known about the positive relationship between SPS and quality of life (QoL); nevertheless, less is known regarding the roles of resilience and social determinants in this association. This research aimed to investigate the potential mediation effect of resilience and the moderation effect of social determinants on the relationship between SPS and QoL in a large sample of Chinese cancer patients., Methods: We used the most recent datasets from an ongoing project conducted in southwest China. A two-stage random sampling strategy with a probability proportionate to sample size (PPS) design was adopted. The associations between resilience, SPS, and QoL were evaluated using a linear regression model. Path analysis was adopted to examine the mediation of resilience., Results: Resilience was positively associated with quality of life, while increased sensory processing sensitivity was negatively associated with quality of life. The restricted cubic spline analysis revealed that as resilience increased, the coefficients of quality of life rapidly increased across all domains. Conversely, the coefficients for quality of life gradually decreased with the escalation of sensory processing sensitivity. Resilience was a significant mediator, accounting for 21.88% of the total SPS-QoL association. The mediation effect of resilience varied across ethnicity and sex., Conclusion: Sensory processing sensitivity was significantly associated with quality of life in cancer patients, and promoting resilience could mitigate this negative impact. However, the effect of resilience varies across sex and ethnicity. Therefore, targeted resilience promotion interventions, especially those integrating social characteristics, should be considered for implementation., (© 2024. The Author(s).)

This study aimed to investigate the gap between adaptive functioning and cognitive functioning, especially verbal and nonverbal intelligence quotient (IQ) in Chinese children with ASD. We systematically explored cognitive functioning, ASD severity, early signs of developmental abnormalities, and socioeconomic factors as mediating factors of adaptive functioning. We enrolled 151 children (age: 2.5?6 years) with ASD and categorized them into one group with IQ ≥ 70 and another with IQ < 70. The two groups were calibrated for age, age at diagnosis, and IQ, and the relationship of adaptive skills with vocabulary acquisition index (VAI) and nonverbal index (NVI) were separately analyzed. Results show that the gap between IQ and adaptive functioning was significant in children with ASD having IQ ≥ 70, with both VAI and NVI showing statistically significant differences (all P < 0.001). VAI correlated positively with scores for overall adaptive skills and specific domains, whereas NVI had no significant correlations with adaptive skill scores. Age of first walking unaided had an independent positive correlation (all P < 0.05) with scores of adaptive skills and specific domains. IQ-adaptive functioning gap is significant in children with ASD having IQ ≥ 70, suggesting that defining "high-functioning autism" merely on the basis of IQ is not appropriate. Verbal IQ and early signs of motor development are specific and possible predictors of adaptive functioning in children with ASD, respectively., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To investigate the clinical features and risk factors of Sjogren's Syndrome (SS) patients suffering from oral candidiasis and to provide a foundation for the prevention and treatment of oral candidiasis in SS patients., Methods: The medical records of 479 SS patients admitted to the Second Hospital of Shanxi Medical University from 2018 to 2020 were analysed to determine the clinical characteristics and risk factors that influence the occurrence of oral candidiasis infection in SS patients., Results: Patients with oral candidiasis were older than those without oral candidiasis (P < 0.05). Male SS patients had greater oral candidiasis rates (P < 0.05). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were both shown to be adversely associated with oral Candida infections (P < 0.001). Logistic regression revealed that a low UWS was an independent risk factor for oral Candida infections in SS patients (OR: 0.004, P = 0.023). Greater WBC counts (OR: 1.22, P < 0.001), lower haemoglobin levels (OR: 0.97, P = 0.007), lower serum albumin levels (OR: 0.88, P < 0.001), lower IgG levels (OR: 0.91, P = 0.011), lower IgA levels (OR: 0.75, P = 0.011), and lower IgM levels (OR: 0.91, P = 0.015) were found in patients with oral Candida infections. Patients on immunosuppressive medications (OR: 0.32, P = 0.011), particularly rapamycin (P < 0.001), had a decreased rate of oral Candida infections., Conclusions: Patients with oral candidiasis were older than those without oral candidiasis. Male SS patients are more likely to have oral candidiasis. Individuals with lower UWS and SWS are more susceptible to oral Candida infection. Oral Candida infections in SS patients depend on their immunological status. Rapamycin may increase the abundance of Treg cells to reduce oral Candida infection in SS patients., (© 2024. The Author(s).)

Understanding the mechanisms controlling forest carbon accumulation is crucial for predicting and mitigating future climate change. Yet, it remains unclear whether the dominance of ectomycorrhizal (EcM) trees influences the carbon accumulation of entire forests. In this study, we analyzed forest inventory data from over 4000 forest plots across Northeast China. We find that EcM tree dominance consistently exerts a positive effect on tree, soil, and forest carbon stocks. Moreover, we observe that these positive effects are more pronounced during unfavorable climate conditions, at lower tree species richness, and during early successional stages. This underscores the potential of increasing the dominance of native EcM tree species not only to enhance carbon stocks but also to bolster resilience against climate change in high-latitude forests. Here we show that forest managers can make informed decisions to optimize carbon accumulation by considering various factors such as mycorrhizal types, climate, successional stages, and species richness., (© 2024. The Author(s).)

To investigate the progress of disparities in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), gonorrhea, and syphilis among children and adolescents aged 6-22 years in China during 2013-2021. A total of 614 325 cases data were extracted from the Chinese Information System for Infectious Diseases Control and Prevention during 2013-2021. Puberty health education data were drew from the Student Health Surveillance in 2021. Disparity patterns and average annual percentage changes (AAPCs) in sexually transmitted infections (STIs) incidence or new cases in China were examined using descriptive statistics and joinpoint regression. The incidence across 345 cities was stratified by gross domestic product (GDP). Between 2013 and 2021, there were 614 325 reported cases of HIV/AIDS, gonorrhea, and syphilis among children and adolescents aged 6-22, with an annual average incidence of 24.0967 per 100 000. The expansion of HIV/AIDS has halted, yet the surge in gonorrhea and syphilis remains notably pronounced. The ratio of male to female AIDS incidence increased from 2.75 (2.60, 2.90) to 7.13 (6.68, 7.62), but that of syphilis changed from 0.33 (0.32, 0.34) to 0.56 (0.55, 0.57). Students and out-of-school individuals aged 13-15 experienced a notably high increase in STI cases, surpassing other age groups, with an average annual percentage increase of 29.2% and 26.3%, respectively. Nonstudents consistently had a higher incidence rate than students, with an IRR reaching 31.80 (31.24, 32.37) in 2021. A noticeable clustering pattern of new cases emerged in the southeastern region of the Heihe-Tengchong line, extending inland from the coastal areas. Districts and counties with lower rates of puberty sexual health education tended to have higher average STI incidence rates. At the prefecture and city levels, there was a noticeable upward trend on average STI incidence rates in cities with per capita GDPs. Strategies to address those disparities include promoting equitable health education, and widespread sexual health education, particularly in areas with limited access to education and experiencing rapid economic development. The effectiveness of sexual health education intervention needs to be further evaluated in well-designed studies., (© 2024 Wiley Periodicals LLC.)

The ubiquitous application of phthalate esters (PAEs) as plasticizers contributes to high levels of marine pollution, yet the contamination patterns of PAEs in various shellfish species remain unknown. The objective of this research is to provide the first information on the pollution characteristics of 16 PAEs in different shellfish species from the Pearl River Delta (PRD), South China, and associated health risks. Among the 16 analyzed PAEs, 13 were identified in the shellfish, with total PAE concentrations ranging from 23.07 to 3794.08 ng/g dw (mean = 514.35 ng/g dw). The PAE pollution levels in the five shellfish species were as follows: Ostreidae (mean = 1064.12 ng/g dw) > Mytilus edulis (mean = 509.88 ng/g dw) > Babylonia areolate (mean = 458.14 ng/g dw) > Mactra chinensis (mean = 378.90 ng/g dw) > Haliotis diversicolor (mean = 335.28 ng/g dw). Dimethyl phthalate (DMP, mean = 69.85 ng/g dw), diisobutyl phthalate (DIBP, mean = 41.39 ng/g dw), dibutyl phthalate (DBP, mean = 130.91 ng/g dw), and di(2-ethylhexyl) phthalate (DEHP, mean = 226.23 ng/g dw) were the most abundant congeners. Notably, DEHP constituted the most predominant fraction (43.98 %) of the 13 PAEs detected in all shellfish from the PRD. Principal component analysis indicated that industrial and domestic emissions served as main sources for the PAE pollution in shellfish from the PRD. It was estimated that the daily intake of PAEs via shellfish consumption among adults and children ranged from 0.004 to 1.27 μg/kg bw /day, without obvious non-cancer risks (< 0.034), but the cancer risks raised some alarm (2.0 × 10 -9 -1.4 × 10 -5 ). These findings highlight the necessity of focusing on marine environmental pollutants and emphasize the importance of ongoing monitoring of PAE contamination in seafood., 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 B.V. All rights reserved.)

The Yangtze River Delta (YRD), one of the most economically developed and industrialized regions in China, is confronted with challenges arising from rapid urbanization, particularly environmental pollution. The collection of surface water and sediment samples from forty-nine sites in the YRD was conducted to analyze 2378-substituted polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) congeners. The detected concentrations of PCDD/Fs were 0-5.3 pg TEQ/L in water and 0.12-1493 pg TEQ/g dw in sediment. The PCDD/Fs contamination in the sediment was widespread in the YRD. There were variations in the congener characteristics of PCDD/Fs in surface water and sediment. The proportion of OCDD was significantly lower in surface water samples compared to sediment, while the less chlorine-substituted homologs were found in larger proportions. To understand the partitioning and behavior of dioxins within the water-sediment system, we calculated the organic carbon normalized partition coefficients and fugacity fraction (ff) of PCDD/F congeners. The results revealed that the PCDD/Fs had not attained a state of distributional equilibrium, and the non-specific hydrophobic effect seemed minimally influential on their partitioning between sediment and water. The average ff values, which varied between 0.06 and 0.63, indicated differing migration directions for the PCDD/F congeners. Source identification analysis provided evidence that the dioxins in the river water were primarily attributed to industrial thermal processes. Iron and steel smelting, along with pesticide production and use, were likely responsible for the sediment contamination. This comprehensive analysis underscores the complex nature of PCDD/Fs pollution in the YRD and highlights the necessity for targeted environmental management strategies., 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 Inc. All rights reserved.)

This study assesses the association of short-term exposure to PM 2.5 (particles ≤2.5 μm) on infectious diseases among Chinese children and adolescents. Analyzing data from 507 cities (2008-2021) on 42 diseases, it focuses on PM 2.5 components (black carbon (BC), ammonium (NH 4 + ), inorganic nitrate (NO 3 - ), organic matter (OM), and sulfate (SO 4 2- )). PM 2.5 constituents significantly associated with incidence. Sulfate showed the most substantial effect, increasing all-cause infectious disease risk by 2.72 % per interquartile range (IQR) increase. It was followed by BC (2.04 % increase), OM (1.70 %), NO 3 - (1.67 %), and NH 4 levels could substantially reduce infectious disease incidence, particularly in China's middle-northern regions. It highlights the necessity of stringent air quality standards and targeted disease prevention, aligning PM + (0.79 %). Specifically, sulfate and BC had pronounced impacts on respiratory diseases, with sulfate linked to a 10.73 % increase in seasonal influenza risk and NO 3 - to a 16.39 % rise in tuberculosis. Exposure to PM 2.5 also marginally increased risks for gastrointestinal, enterovirus, and vectorborne diseases like dengue (7.46 % increase with SO 4 2- ). Sexually transmitted and bloodborne diseases saw an approximate 6.26 % increase in incidence, with specific constituents linked to diseases like hepatitis C and syphilis. The study concludes that managing PM 2.5 levels could substantially reduce infectious disease incidence, particularly in China's middle-northern regions. It highlights the necessity of stringent air quality standards and targeted disease prevention, aligning PM 2.5 management with international guidelines for public health protection., 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 B.V. All rights reserved.)

Purpose: Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder affecting children. This study aims to characterize factors associated with the development and progression of severe forms of paediatric OSA., Methods: This study included children admitted to Children's Hospital of Chongqing Medical University, a tertiary children's hospital in southwest China between January 2020 and December 2020 with a discharge diagnosis of OSA. Each patient underwent polysomnography examination, following assessments of apnoea-hypopnea index (AHI) and lowest oxygen saturation (LSaO 2 ) by standardized techniques. Demographic and clinical information was collected from the hospital's electronic medical records. Associations between OSA severity and various factors were first examined in a univariate logistic model, with subsequent multivariate analysis to further identify independent risk factors., Results: A total of 263 children were identified during the study period. Among patients presenting with OSA, 51.3% had mild and 48.7% had moderate to severe symptoms according to standardized guidelines. The incidence of mild and moderate to severe hypoxemia in our population was 39.2% and 60.8%, respectively. Allergic rhinitis (AR; adjusted odds ratio (aOR) = 1.75, 95% CI 1.03-2.96) and male gender (aOR = 1.77, 95% CI 1.03-3.06) were significantly associated with moderate-to-severe OSA (all P-values < 0.05) after adjustment for covariates. AR was also the only significant predictor of hypoxemia (P < 0.05)., Conclusion: Our results suggest that male gender and presence of AR may be associated with an increased likelihood of moderate-to-severe OSA in children. These findings underscore the importance of timely intervention and individualized management for at-risk individuals., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Despite the increasing emphasis on rehabilitation training after orthopedic surgery, little is known about the pain caused by the procedure itself. Clinical practice is driven by beliefs in pain management., Aims: This study aimed to explore the perspective of pain management during rehabilitation training after orthopedic trauma in China and its influencing factors from different perspectives in traditional Chinese medicine and Western medicine, respectively., Design: A phenomenological qualitative study involving semi-structured interviews., Settings:   METHODS: A qualitative study was conducted with 16 medical workers working in the Rehabilitation Medicine Department in eastern China from July 2022-February 2023. A directed method to thematic analysis was used to code the transcribed data and identify themes., Results: Four main themes emerged. (1) Inconsistent perspectives and practice: Chinese doctors majoring in Western medicine felt sympathy, helpless, and had a lack of knowledge and misconception about pain. Traditional Chinese medicine deemed that pain is a protective mechanism and attached importance to holism and unique means. (2) Consistent outcome: Insufficient pain management will have a series of negative consequences for patients' recovery, forming a vicious cycle. (3) Expectations: Though they are not optimistic about traditional analgesics, enhancement, cooperation and ideal analgesic methods still be expressed, and (4) Concept transformation: Conducting nitrous oxide is a process not only to promote analgesic technology but also to promote the awareness and concept of pain management., Conclusions: Our study emphasized that medical workers should be aware of the importance of pain management at the same time while treating the disability. The study provides insight into pain management experiences within different educational backgrounds. The findings enable professionals to recognize the importance of pain management and its influencing factors to provide feasible and effective pain management strategies., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Beyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown., Objective: This study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels., Methods: The Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference., Results: A total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6% during 2020 but rebounded by 56.9% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95% CI 0.53-0.87), but rebounded in 2021., Conclusions: The COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections., (©Li Chen, Liping Wang, Yi Xing, Junqing Xie, Binbin Su, Mengjie Geng, Xiang Ren, Yi Zhang, Jieyu Liu, Tao Ma, Manman Chen, Jessica E Miller, Yanhui Dong, Yi Song, Jun Ma, Susan Sawyer. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 15.05.2024.)

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Understanding the interactions between microorganisms, soil extracellular enzymes, and mangroves is crucial for conserving and restoring mangrove ecosystems. However, the unique environments associated with mangroves have resulted in a lack of pertinent data regarding the interactions between these components. Root, stem, leaf, and soil samples were collected at three distinct stages of mangrove succession. Stoichiometry was employed to analyze the carbon, nitrogen, and phosphorus contents of these samples and to quantify extracellular enzyme activities, microbial biomass, and various physicochemical factors in the soil. The results showed that the trends of C, N, and P in the mangrove plants were consistent. Microbial biomass carbon (MBC), microbial biomass nitrogen (MBN), and microbial biomass phosphorus (MBP) were the highest in the Kandelia obovate community. Catalase (CAT) and β-D-G showed the highest content in K. obovate and Bruguiera gymnorrhiza, whereas cellulase showed the opposite trend. Urease was least abundant in the K. obovate community, whereas neutral protease (NPR) and acid phosphatase (ACP) were most abundant. The overall soil environment in mangroves exhibited a state of N limitation, with varying degrees of limitation observed across different succession stages. The demand for P became more intense in the later stages of succession, particularly in the K. obovate and B. gymnorrhiza communities. In conjunction with correlation analysis, it indicated that the input of mangrove plant litter had a significant regulatory influence on the C, N, and P contents in the soil. There was a significant positive correlation between MBC, MBN, and MBP, indicating synergistic effects of C, N, and P on soil microorganisms. Therefore, evaluating the nutrient ratios and sufficiency of mangroves allowed us to comprehensively understand the present environmental conditions. This study aims to develop sustainable management strategies for the conservation and restoration of mangroves., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Health literacy measurement lays a solid foundation to identify associations with health outcomes and monitor population health literacy levels over time. In mainland China, most existing health literacy instruments are either knowledge-based or practice-based, making health literacy results incomparable between China and other countries. This study aimed to examine the reliability and validity of the 12-item Health Literacy Population Survey (HLS 19 -Q12) in a general population of Chinese adults., Methods: A cross-sectional study was conducted to recruit primary carers of students from 11 schools in Zhengzhou, Henan Province, using convenience cluster sampling. Participants completed an online self-administered survey that collected information on key sociodemographics, health literacy (HLS 19 -Q12 and a comparison tool: Health Literacy Questionnaire (HLQ)), and health-related outcomes. Using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist as a guideline, we tested internal consistency, test-retest reliability, content validity, structural validity, concurrent predictive validity, and convergent validity of the HLS 19 -Q12., Results: Overall, 14,184 participants completed the full survey. The HLS 19 -Q12 showed excellent internal consistency (Cronbach's α = 0.93), moderate test-retest reliability (intra-class correlation coefficient = 0.54), satisfactory content validity (based on the 12-matrix health literacy model), and strong structural validity (comparative fit index = 0.94, Tucker and Lewis's index of fit = 0.93, root mean square error of approximation = 0.095). Concurrent predictive validity results showed health literacy was associated with both health determinants and health-related outcomes. The HLS 19 -Q12 had weak to strong correlations (coefficients = 0.24 to 0.42) with the nine scales of the HLQ. Respondents had an average score of 81.6 (± 23.0) when using the HLS 19 -Q12, with 35.0% and 7.5% having problematic and inadequate levels of health literacy, respectively., Conclusions: The HLS 19 -Q12 is a reliable and valid instrument to measure health literacy in our sample. Further validation is needed with a more nationally representative sample of Chinese adults. The HLS 19 -Q12 could be used as a comprehensive, skills-based, and easy-to-administer health literacy assessment tool integrated into population surveys and intervention evaluations., (© 2024. The Author(s).)

Background: An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities., Methods and Findings: This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China's Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility., Conclusions: A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen 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.)

Ultra-low emission (ULE) technology retrofits significantly impact the particulate-bound mercury (Hg) emissions from coal-fired power plants (CFPPs); however, the distribution and bioavailability of Hg in size-fractioned particulate matter (PM) around the ULE-retrofitted CFPPs are less understood. Here, total Hg and its chemical speciation in TSP (total suspended particles), PM 10 (aerodynamic particle diameter ≤ 10 µm) and PM 2.5 (aerodynamic particle diameter ≤ 2.5 µm) around a ULE-retrofitted CFPP in Guizhou Province were quantified. Atmospheric PM 2.5 concentration was higher around this ULE-retrofitted CFPP than that in the intra-regional urban cities, and it had higher mass Hg concentration than other size-fractioned PM. Total Hg concentrations in PM had multifarious sources including CFPP, vehicle exhaust and biomass combustion, while they were significantly higher in autumn and winter than those in other seasons (P < 0.05). Regardless of particulate size, atmospheric PM-bound Hg had lower residual fractions (< 21%) while higher HCl-soluble fractions (> 40%). Mass concentrations of exchangeable, HCl-soluble, elemental, and residual Hg in PM 2.5 were higher than those in other size-fractioned PM, and were markedly elevated in autumn and winter (P < 0.05). In PM 2.5 , HCl-soluble Hg presented a significantly positive relationship with elemental Hg (P < 0.05), while residual Hg showed the significantly positive relationships with HCl-soluble Hg and elemental Hg (P < 0.01). Overall, these results suggested that atmospheric PM-bound Hg around the ULE-retrofitted CFPP tends to accumulate in finer PM, and has higher bioavailable fractions, while has potential transformation between chemical speciation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

There are many factors that affect the yield of Chinese chestnut (Castanea mollissima), with single nut weight (SNW) being one of the most important. Leaf length is also related to Chinese chestnut yield. However, the genetic architecture and gene function associated with Chinese chestnut nut yield have not been fully explored. In this study, we performed genotyping by sequencing 151 Chinese chestnut cultivars, followed by a genome-wide association study (GWAS) on six horticultural traits. First, we analyzed the phylogeny of the Chinese chestnut and found that the Chinese chestnut cultivars divided into two ecotypes, a northern and southern cultivar group. Differences between the cultivated populations were found in the pathways of plant growth and adaptation to the environment. In the selected regions, we also found interesting tandemly arrayed genes that may influence Chinese chestnut traits and environmental adaptability. To further investigate which horticultural traits were selected, we performed a GWAS using six horticultural traits from 151 cultivars. Forty-five loci that strongly associated with horticultural traits were identified, and six genes highly associated with these traits were screened. In addition, a candidate gene associated with SNW, APETALA2 (CmAP2), and another candidate gene associated with leaf length (LL), CRYPTOCHROME INTERACTING BASIC HELIX-LOOP-HELIX 1 (CmCIB1), were verified in Chinese chestnut and Arabidopsis (Arabidopsis thaliana). Our results showed that CmAP2 affected SNW by negatively regulating cell size. CmCIB1 regulated the elongation of new shoots and leaves by inducing cell elongation, potentially affecting photosynthesis. This study provided valuable information and insights for Chinese chestnut breeding research., Competing Interests: Conflict of interest statement. The authors declare that they have no competing interests., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Society of Plant Biologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: This study aimed to compare the prevalence of oral frailty among community-dwelling older people in Nanjing, China with the usage of different measurements, and to investigate the potential risk factors of oral frailty., Design: Cross-sectional study., Setting and Participants: A total of 338 community-dwelling older people in Nanjing, China were recruited., Methods: Oral frailty was measured based on the Oral Frailty Index-8 (OFI-8) scale and other measurement methods including the number of natural teeth (TN), repetitive saliva-swallowing test (RSST), and oral diadochokinesis (ODK). The chi-square test and the binary logistic regression analysis were performed to identify potential risk factors for oral frailty., Results: There were 310 participants included in the analysis. Prevalence of oral frailty by using the OFI-8, OFI-8 + TN, OFI-8 + ODK, OFI-8 + TN + ODK and RSST measurement methods were 69.0%, 27.4%, 51.9%, 21.0% and 2.9%, respectively. Passive smoking (OR = 2.04; 95%CI 1.03-4.03), being widowed/unmarried (OR1 = 2.53; 95%CI 1.25-5.10; OR2 = 2.94; 95%CI 1.12-7.77), pre-frailty (OR = 1.76; 95%CI 1.03-3.01), frailty (OR = 3.01; 95%CI 1.39-6.54), and aged 80 years and above (OR = 3.99; 95%CI 1.35-11.81) were found to be risk factors of oral frailty by the usage of the four kinds of measurement methods., Conclusions and Implications: The definition and diagnostic criteria of oral frailty are strongly needed to be unified in future research. Only subjective assessment is not enough for assessing oral frailty. Among objective indicators, RSST is not suitable as a screening method for oral frailty. In addition, objective indicators including TN and ODK should be valued for early screening and preventive interventions. The risk factors of oral frailty include physical frailty, passive smoking, and being widowed., (© 2024. The Author(s).)

This study explores the impact of bank market structure on firm innovation in China using a two-way fixed effects model. Our analysis is based on a dataset comprising 2,412,316 firm-city level observations. Our findings suggest that there exists a U-shaped relationship between bank market structure and firm innovation in China. Specifically, we identify that the financing channel is a crucial pathway through which bank market structure influences firm innovation. Moreover, our results indicate that this relationship is mainly driven by small firms and innovative firms, and is more pronounced in regions with stronger intellectual property rights protection or greater openness to foreign markets. In sum, this study contributes to the existing literature by advancing our understanding of the impact of bank market structure on innovation in Chinese firms., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Shang 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.)

The care for people with dementia (PwD) in low- and middle-income countries (LMICs) is dominated by home care and supplemented sporadically by public care provided using public resources. In the context of community resources cannot meet the demand for high-quality services for PwD, dementia-friendly communities (DFCs) provide ideas for alleviating this situation by integrating resources from multiple stakeholders. However, there is still a considerable gap between the capacity of services and the demand of PwD. Based on the experience of elderly services and DFCs construction in Nanjing, China, this study developed a stakeholder collaboration model and clarified the collaborative relationship among stakeholders such as the government, communities, and medical institutions in meeting the needs of PwD. This work summarizes the partnerships and specific actions of stakeholders and highlights the importance of facilitating resource integration to provide comprehensive services., Competing Interests: Declaration of competing interest The authors of this article declare that they have no competing interest and have no financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study investigated the performance of the MC-100i, a pre-commercial digital morphology analyzer utilizing a convolutional neural network algorithm, in a multicentric setting involving up to 11 tertiary hospitals in China., Methods: Blood smears were analyzed by MC-100i, verified by morphologists, and manually differentiated. The classification performance on WBCs and RBCs was evaluated by comparing the classification results using different methods. The PLT and PLT clump counting performance was also assessed. The total assay time including hands-on time was evaluated., Results: The agreements between pre- and post-classification were high for normal WBCs (κ > 0.96) and lower for overall abnormal WBCs (κ = 0.90). The post-classification results correlated well with manual differentials for both normal and abnormal WBCs (r > 0.93), except for basophils (r = 0.8480) and atypical lymphocytes (r = 0.8211). The clinical sensitivity and specificity of each RBC abnormality after verification were above 90 % using microscopy reviews as the reference. The PLTs counted by the MC-100i before and after verification correlated well with those measured by the PLT-O mode (r = 0.98). Moreover, PLT clumps were successfully classified by the analyzer in EDTA-dependent pseudothrombocytopenia blood samples., Conclusions: The MC-100i is an accurate and reliable digital cell morphology analyzer, offering another intelligent option for hematology laboratories., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

With improvements in urban waste management to promote sustainable development, an increasing number of waste types need to be sorted and treated separately. Due to the relatively low amount of waste generated in small- and medium-sized cities, separate treatment facilities for each waste type lack scale, waste is treated at a high cost and low efficiency. Therefore, industrial symbiosis principles are suggested to be used to guide collaborative waste treatment system of multi-source solid wastes, and co-incineration is the most commonly used technology. Most existing studies have focused on co-incineration of one certain waste type (such as sludge or medical waste) with municipal solid waste (MSW), but the systematic design and the comprehensive benefits on a whole city and park level have not been widely studied. Taking the actual operation of a multi-source waste co-incineration park in south-central China as an example, this study conducted a detailed analysis of the waste-energy-water metabolism process of MSW, sludge, food waste, and medical waste co-incineration. The environmental and economic benefits were evaluated and compared with the single decentralized waste treatment mode. The results showed that the multi-source waste co-incineration and clustering park operating model was comprehensively superior to the single treatment mode, greenhouse gases and human toxicity indicators were decreased by 11.87% and 295.74%, respectively, and the internal rate of return of the project was increased by 29.35%. This mainly benefits from the synergy of technical system and the economies of scale. Finally, this research proposed policy suggestions from systematic planning and design, technical route selection, and an innovative management mode in view of the potential challenges., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Government purchase of social forces to participate in old age care services can release the burden of social care. Current research on performance evaluation in this field mainly focussed on the establishment of appropriate evaluation indices. However, discussion on the policy implementation deviation is scarce. This study aimed to evaluate the performance of China's local government purchase of old age care services, analyse the characteristics of related policies and explore their deviation., Methods: The persons who participated in the Training of the Trainer (ToT) organized by the Red Cross Society were enrolled. The policy documents were obtained from the official websites. The K-means cluster was used to determine the project performance grades. We compared the project performance grades between service objects and undertakers with different characteristics utilizing the non-parametric test. Based on the framework of 'Collaborative Participation - Project Performance Objective', we analysed the content of relevant policy aiding by NVivo 12., Results: Data of project performance were collected from 306 participants. The standardized mean score of the efficiency dimension was the lowest (0.70 ± 0.24). The projects were divided into four grades: poor (17.0%), average (27.5%), good (12.4%) and excellent (43.1%). There were statistically significant differences in project performance grades only between advanced ageing groups (Z = 2.429, P = 0.015). As well, the policy also mentioned that the services focus should be tilted towards the oldest old. The purchasers mainly involved the Ministry of Civil Affairs and Health management departments in the policy. Respite services were less mentioned in the responsibilities of the undertakers. The requirement for efficiency and effectiveness was mentioned in less than half of the policy documents., Conclusion: Policy attention is needed for the responsibilities and functions of the intermediate purchasing force, as well as more precise directions and responsibilities of undertakers. The purchasers and undertakers should improve management abilities and capacity of old age care services and focus on associated factors to achieve the best marginal benefit. In addition, the embedded performance evaluation needs to be updated periodically to bridge the deviation between policy implementation and policy formulation., (© 2024. The Author(s).)

Disruption of thyroid homeostasis has been indicated in human studies on the effects of per- and polyfluoroalkyl substances (PFASs). However, limited research exists on this topic within the general Chinese population. Based on a substantial and representative sample of the Chinese adult population, our study provides insight into how PFASs specifically affect thyroid homeostasis. The study included 10 853 participants, aged 18 years and above, sampled from nationally representative data provided by the China National Human Biomonitoring (CNHBM). Weighted multiple linear regression and restricted cubic spline (RCS) models were used to explore the associations between eight individual PFAS concentrations and total thyroxine (T4), total triiodothyronine (T3), and the T4/T3 ratio. Bayesian kernel machine regression (BKMR) and quantile-based g-computation (qgcomp) were employed to explore the joint and independent effects of PFASs on thyroid homeostasis. Both individual PFASs and PFAS mixtures exhibited a significant inverse association with serum T3 and T4 levels, and displayed a positive association with the T4/T3 ratio. Perfluoroundecanoic acid (PFUnDA) [-0.07 (95 % confidence interval (CI): -0.08, -0.05)] exhibited the largest change in T3 level. PFUnDA also exhibited a higher weight compared to other PFAS compounds in qgcomp models. Additionally, a critical exposure threshold for each PFAS was identified based on nonlinear dose-response associations; beyond these thresholds, the decreases in T3 and T4 levels plateaued. Specifically, for perfluoroheptane sulfonic acid (PFHpS) and 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA), an initial decline in hormone levels was observed, followed by a slight increase when concentrations surpassed 0.7 ng/mL and 2.5 ng/mL, respectively. Sex-specific effects were more pronounced in females, and significant associations were observed predominantly in younger age groups. These insights contribute to our understanding of how PFAS compounds impact thyroid health and emphasize the need for further research and environmental management measures to address these complexities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Despite the practical importance of addressing the drug user's sleep problems to enhance the efficacy of treatment and rehabilitation, little is known about whether and how history of childhood maltreatment relates to this issue. This study takes an evolutionary perspective to investigate the associations between history of childhood maltreatment and sleep problems in adults with drug abuse via their emotion regulation difficulties, future-oriented coping, and anxiety. Methods: Participants were 604 male adults with drug abuse between the ages of 18-58 years ( M  = 36.20, SD  = 8.17) in a drug rehabilitation centre in China. In addition to bivariate correlation analysis, path analysis was conducted to examine goodness-of-fit of the conceptual model, controlling for the effect of demographic characteristics. Results: Thirty-two percent of participants ( n  = 194) reported poor sleep quality (PSQI > 5), whereas sleep disturbance (81.3%), daytime dysfunction (77.3%), and sleep latency (66.5%) were the three most common problems among them. Correlation analysis supported the hypothesised positive correlations between poor sleep quality and childhood maltreatment, emotion regulation difficulties, and anxiety, and a negative correlation with future-oriented coping. Results of path analysis showed a significant indirect effect of childhood maltreatment on sleep problems via both emotion regulation difficulties and anxiety, whereas such effects via both future-oriented coping and anxiety were statistically nonsignificant. Conclusions: The findings suggest life history theory is applicable to understanding drug users' sleep problems, and interventions regarding both emotion regulation difficulties and anxiety can lessen the risk posed by childhood maltreatment on sleep problems.

Background: Physical resilience is an emerging concept that describes an individual's capacity to recover from stressors. However, few instruments are currently available for assessing physical resilience., Objective: To develop a scale to assess physical resilience in older adults., Design: Development of a clinical scale., Setting and Participants: A total of 172 hospitalized older adults were recruited., Measurements: This study comprised two stages. First, a pool of physical resilience scale items was created through a literature review, and the Delphi method was used to establish an initial scale. Second, the initial physical resilience scale was tested on hospitalized older adults., Results: Five primary and 19 secondary items were identified after reviewing the literature. After two rounds of expert consultations, three primary and 16 secondary items were determined. The overall Cronbach's alpha for the scale was 0.760. Except for items N2, N4, N5, N8, and N14, Pearson's correlation between the scores of the remaining items and the total score ranged from 0.407 to 0.672. Except for items N2, N4, and N5, the corrected item-total correlation results ranged from 0.301 to 0.580, indicating good consistency between each item and the overall scale. Factor analysis showed that except for N7, the factor loadings of the remaining items were between 0.584 and 0.844. After expert discussions, items N2, N4, N7, and N14 were included in the scale, and items N5 and N8 were removed., Conclusion: A 14-item physical resilience scale, CHEES, was developed to assess physical resilience levels in older adults., Competing Interests: All the authors declare no conflicts of interest in the present study

The fintech (financial technology) employment market presents significant barriers to entry, including rigorous selection criteria based on factors such as profitability, risk, security, and confidentiality, which limit students' opportunities to enter the industry. The negative impact of the COVID-19 pandemic has further exacerbated the challenges faced by the fintech employment market in China. Consequently, it is crucial to assist fintech students in enhancing their professional abilities to navigate the job market successfully. Virtual reality is gaining increasing importance in educational fields due to its immersive virtual simulation capabilities. In this study, a hybrid fintech course was designed based on the principles of outcome-based education theory and the flipped classroom model. The project objective was to provide students with virtual training and project-based assessments that facilitate a seamless transition from theoretical knowledge to practical application in the industry. To evaluate the effectiveness of hybrid education, a comparative user experiment was conducted involving 60 participants (students) from Guangdong University of Finance. The study used median data, average data, and the entropy weight method for analysis. The results indicated that hybrid education has a positive impact on individual-level critical thinking, communication, and teamwork skills. We believe that our study can provide critical data references for global online/hybrid education researchers and contribute to the education field., (© 2023. The Author(s).)

Background: The increasing prevalence of multimorbidity has created a serious global public health problem in aging populations. Certain multimorbidity patterns across different age ranges and their association with health status remain unclear. The main aim of this study is to identify multimorbidity patterns discrepancies and associated health status between younger-old and oldest-old., Methods: The Ethics Committee of Nanjing Medical University approved the study protocol (No.2019-473). Convenience sampling method was used to recruit older adults aged ≥ 60 years with multimorbidity from July to December 2021 from 38 Landsea long-term care facilities in China. The multimorbidity patterns were analyzed using network analysis and two-step cluster analysis. One-Way ANOVA was utilized to explore their association with health status including body function, activity of daily living, and social participation. A Sankey diagram visualized the flow of health status within different multimorbidity patterns. This study is reported following the STROBE guidelines., Results: A total of 214 younger-old (60-84 years) and 173 oldest-old (≥ 85 years) were included. Leading coexisting diseases were cardiovascular disease (CD), metabolic and endocrine disease (MED), neurological disease (ND), and orthopedic disease (OD). Cluster 1 (53, 24.8%) of CD-ND (50, 94.3%; 31, 58.8%), cluster 2 (39, 18.2%) of MED-ND-CD (39, 100%; 39, 100%; 37, 94.9%), cluster 3 (37, 17.3%) of OD-CD-MED-ND (37, 100%; 33, 89.2%; 27, 73.0%; 16, 43.2%), and cluster 4 (34, 15.9%) of CD-MED (34, 100%; 34, 100%) were identified in the younger-old. In the oldest-old, the primary multimorbidity patterns were: cluster 1 (33, 19.1%) of CD-respiratory disease-digestive disease-urogenital disease (CD-RD-DSD-UD) (32, 97.0%; 9, 27.3%; 8, 24.2%; 7, 21.2%), cluster 2 (42, 24.3%) of ND-CD-MED (42, 100%; 35, 83.3%; 14, 33.3%), cluster 3 (28, 16.2%) of OD-CD-MED (28, 100%; 25, 89.3%; 18, 64.3%), and cluster 4 (35, 20.2%) of CD-MED (35, 100%; 35, 100%). Younger-old with CD-ND or MED-ND-CD, and oldest-old with ND-CD-MED have worse health status compared with other multimorbidity patterns (e.g., CD-MED and OD-CD-MED)., Conclusion: Discrepancies in common patterns of multimorbidity across age groups suggest that caregivers in long-term care facilities should consider changes in multimorbidity patterns with ageing when developing prevention plans for individualized management. Neurological disease concurrent with other diseases was the major determinant of health status, especially for the oldest-old. Interventions targeting multimorbidity need to be focused, yet generic. It is essential to assess complex needs and health outcomes that arise from different multimorbidity patterns and manage them through an interdisciplinary approach and consider their priorities to gain high-quality primary care for older adults living in long-term care facilities., (© 2023. The Author(s).)

In this work, 45 cosmetic samples were collected from China, and 27 target per- and polyfluoroalkyl substances (PFAS) were analyzed by ultrahigh-performance liquid chromatography-high resolution mass spectrometry. PFAS were found in all samples, including the products marketed for pregnant women, and the total concentrations of PFAS measured in each sample were in the range of 4.05 - 94.9 ng/g. Short-chain perfluorinated carboxylic acids were the dominant compounds contributing to over 60% of the total content. Perfluorobutanoic acid, with high placental transfer efficiency, was the major PFAS in cosmetics for pregnant women. Three emerging PFAS, 2-perfluorohexyl ethanoic acid, 3-perfluoropentyl propanoic acid (5:3) and perfluoro-2-propoxypropanoic acid, were also identified in the cosmetic samples at quantifiable levels. Significantly, positive correlations between individual PFAS were observed, indicating that there may be a common source for PFAS in these samples. Statistical analyses suggested that using plastic containers and precursor substances may be potential sources of PFAS in terminal products, and product aging may increase PFAS levels. From the PFAS analysis of the cosmetics, the margin of safety (MoS) and hazard quotient (HQ) were calculated to assess human health risks through dermal exposure by using these products. Although the MoS and HQ values obtained were deemed acceptable, the cumulative effect caused by composite and long-term exposure to these contaminants needs to be given greater attention by health authorities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Few studies focused on the equity of hypertension prevalence before and after the diagnostic threshold change. The study aimed to analyze the 130/80 mmHg hypertension diagnostic threshold on the equity of hypertension prevalence in China. The baseline survey data from the China Health and Retirement Longitudinal Study (CHARLS) conducted from 2011 to 2012 were utilized to evaluate the impact of the 130/80 mmHg diagnostic threshold on the equity of hypertension prevalence in China using the concentration index and its decomposition which was an index reflecting the health inequality caused by social and economic factors. The prevalence of hypertension was 41.56% and 57.33% under the diagnostic thresholds of 140/90 mmHg and 130/80 mmHg, respectively. The concentration index for hypertension prevalence in China was -0.017 (95%CI: -0.028, -0.006) under the 140/90 mmHg threshold and -0.010 (95%CI: -0.018, -0.002) under the 130/80 mmHg threshold. Concentration index decomposition analysis of hypertension prevalence diagnosed at both diagnostic thresholds showed that age, BMI, and economic status contributed more to the inequitable situation of hypertension prevalence. Higher age, higher BMI, and poorer economic status increased the inequity of hypertension prevalence. No significant difference in the increase in hypertension among individuals of different economic status after implementing the blood pressure control standard (130/80 mmHg), and the prevalence of hypertension in the region did not show a significant bias towards the low economic status population. Therefore, implementing this standard will not increase the risk of hypertension prevalence biased toward people of low economic status. Implementing the 130/80 mmHg diagnostic threshold will not increase the risk of hypertension prevalence biased towards people of low economic status., (© 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Urban lakes were critical in aquatic ecology environments, but how environmental factors affected the distribution and change characteristics of algal communities in urban lakes of Xi'an city was not clearly. Here, we investigated the algal community structure of six urban lakes in Xi'an and evaluated the effects of water quality parameters on algae. The results indicated that the significant differences on physicochemical parameters existed in different urban lakes. The maximum concentration of total phosphorus in urban lakes was (0.18 ± 0.01) mg/L and there was a phenomenon of phosphorus limitation. In addition, 51 genera of algae were identified and Chlorella sp. was the dominant algal species, which was affiliated with Chlorophyta. Network analysis elucidated that each lake had a unique algal community network and the positive correlation was dominant in the interaction between algae species, illustrating that mature microbial communities existed or occupied similar niches. Redundancy analysis illustrated that environmental factors explained 47.35% variance of algal species-water quality correlation collectively, indicating that water quality conditions had a significant influence on the temporal variations of algae. Structural equation model further verified that algal community structure was directly or indirectly regulated by different water quality conditions. Our study shows that temporal patterns of algal communities can reveal the dynamics and interactions of different urban ecosystem types, providing a theoretical basis for assessing eutrophication levels and for water quality management., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Background: Although the health of the floating elderly population is an important part of active and healthy ageing, it is neglected in current Chinese society. Based on the general consensus that social interaction can affect the health of the floating population, this study explored whether the interaction type, mode and frequency influenced the health of the floating elderly population in China and investigated the variability of these influential effects., Methods: This study used the China Migrant Population Dynamic Survey Data 2017 and selected 5239 floating elderly individuals over 60 years old. Self-rated health was used to assess the comprehensive health status of respondents. Social interaction was measured by the interaction type, mode and frequency. Descriptive statistical analysis was used to analyse the health and social interaction status. An ordinal probit model was used to estimate the influential effects and differences on health caused by social interaction. The 2SLS model was used to examine the mutual causality relationship between interaction frequency and health, and a robustness test was conducted., Results: A total of 44.6% interacted with local residents, 14.2% participated in interaction activities based on geographical relations, and only 4.3% and 7% participated in interactions based on business and interest, respectively. Interacting with natives improved individuals' self-rated health by 18.5%; specifically, geographical interaction increased self-rated health by 40.9%, occupational interaction increased it by 25.2%, interest-based interaction increased it by 41.2%, and interaction frequency improved the self-rated health (β = 0.128). In addition, sex, education level, personal income, and floating into the eastern region had a positive effect on individuals' health. However, age, spouse and hukou exerted a negative effect., Conclusions: This study demonstrated that interacting with local residents could improve the health of floating elderly population, and revealed that interest-based interaction and their frequency had a positive impact on health. The government should speed up the construction of the voluntary service system and encourage the floating elderly population to realize their personal value in social interaction. In addition, the reform of the hukou system should be further promoted, so as to remove institutional barriers to the social interaction., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Complete ammonia oxidation (comammox) is one of the most important biogeochemical processes, with recent studies showing that comammox process dominates nitrification in many ecosystems. However, the abundance, community and driving factor of comammox bacteria and other nitrifying microorganisms in plateau wetland is still unclear. Here, the abundances and community features of comammox bacteria, ammonia-oxidizing archaea (AOA) and ammonia-oxidizing bacteria (AOB) in the wetland sediments of western China plateaus were examined using qPCR and high-throughput sequencing. The results indicate that comammox bacteria were more abundant than AOA and AOB, and dominated the nitrification process. Compared with low-elevation samples (below 3000 m: samples 6-10, 12, 13, 15, 16), the abundance of comammox bacteria was much higher at high-elevation samples (above 3000 m: samples 1-5, 11, 14, 17, 18). The key species of AOA, AOB, and comammox bacteria were Nitrososphaera viennensis, Nitrosomonas europaea, and Nitrospira nitrificans, respectively. The key factor affecting comammox bacteria community was elevation. Elevation could increase the interaction links of key species Nitrospira nitrificans, resulting in high comammox bacterial abundance. The results of this study advance our knowledge of comammox bacteria in natural ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Influenza vaccination uptake among young children has been poor in China, but it is unclear how it changed during the COVID-19. This study aimed to investigate the uptake status and reasons of childhood influenza vaccination during the pandemic in China., Methods: A mixed-methods study combining a questionnaire survey and semi-structured interviews was conducted in Anhui, Shaanxi, and Guangdong provinces between September and November 2021. 2081 caregivers completed the valid questionnaire. 38 caregivers participated in interviews, and data were analyzed thematically, using deductive and inductive coding., Results: A total of 2081 caregivers completed the valid questionnaire, and 38 caregivers participated in interviews. Among the caregivers, a total of 1796 were in the age group for high-risk groups in the 2019-2020 flu season, and 46.10% reported that their children received influenza vaccination in the 2019-2020 flu season; 43.63% said that they vaccinated their children against influenza in the 2020-2021 flu season. Many caregivers indicated that the adoption of nonpharmacologic interventions (NPIs) during COVID-19 reduced the risk of influenza infection for children. Most caregivers consider the severity of influenza to be low, and some confused the common cold with influenza. Meanwhile, some caregivers lack confidence in the vaccine's effectiveness and importance. They thought that vaccines are not effective in preventing the constantly mutating virus. Despite clear perceptions about the severity of influenza and the effectiveness of the vaccine, we found that most caregivers did not receive any relevant medical information, and the communication about vaccines between caregivers and professional information sources, such as healthcare workers, is inadequate. Hence, caregivers have no scientific evidence to back up their perceptions. In terms of access to vaccination service, caregivers reported conflicts between time of vaccination service and their schedule, and the need for vaccine prices to be reduced., Discussion: Targeted interventions are needed to address caregivers' lack of risk perception on influenza during COVID-19 and promote communication between caregivers and professional information sources. Extending vaccination service hours and increasing the number of vaccine clinics close to residential areas and expansion of financing sources for self-paid vaccination could facilitate the access to influenza vaccination service., Competing Interests: The Vaccine Confidence Project, which HL leads, receives collaborative grants with Astra Zeneca, GlaxoSmithKline, J&J, and Merck in addition to public sector grants. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Han, Hou, Tu, Wang, Hu, Xing, Du, Zang, Chantler and Larson.)

Accurately tracking carbon flows is the first step toward reducing the climate impacts of the iron and steel industry (ISI), which is still lacking in China. In this study, we track carbon flows from coal/mineral mines to end steel users by coupling the cross-process material and energy flow model, point-based emission inventory, and interprovincial trade matrices. In 2020, ISI emitted 2288 Tg of CO 2 equivalent (CO 2 eq, including CH 4 and CO 2 ), 96% of which came from energy use and 4% from raw material decomposition. Often overlooked off-gas use and CH 4 leakage in coal mines account for 25% of life-cycle emissions. Due to limited scrap resources and a high proportion of pig iron feed, the life-cycle emission intensity of the electric arc furnace (EAF) (1.15 t CO 2 eq/t steel) is slightly lower than the basic oxygen furnace (BOF) (1.58 t CO 2 eq/t steel) in China. In addition, over 49% of producer-based emissions are driven by interprovincial coal/coke/steel trade. In particular, nearly all user-based emissions in Zhejiang and Beijing are transferred to steelmaking bases. Therefore, we highlight the need for life-cycle and spatial shifts in user-side carbon management.

Organic phosphite antioxidants (OPAs) are widely added in plastic products and can be oxidized to generate oxidized derivatives (OPAs = O), namely organic phosphate esters (OPEs), during production and use processing. Herein, the occurrence of OPEs and OPAs in five plastic food packages was detected by liquid chromatography-tandem mass spectrometry. Three OPEs (TPhP, TCEP, and AO168 = O) and three OPAs (TPhPi, TCEPi, and AO168) were found in the plastic packages, with concentrations of 3 OPAs) and 196-831 ng/g (∑ 3 OPEs), respectively. The migration potential of OPAs and OPEs to food was measured by simulation experiments. OPAs and OPEs in plastic can efficiently migrate to oily simulants, alkaline simulants, and acidic simulants. After 14 days, the total concentration of all OPAs and OPEs in the food simulants reached 3 OPAs + ∑ 3 OPEs: 18.3-28.9 ng/mL) and in oils (∑ 3 OPAs + ∑ 3 OPEs: 32.7-60.9 ng/mL). Accordingly, the estimated ingestion of OPAs and OPEs through plastic-packaged food can reach 2.6 and 32.7 ng/kg in children and 1.1 and 6.5 ng/kg in adults, indicating a non-negligible exposure risk of organic phosphorus pollutants.

Few longitudinal studies have examined the effect of weight status change on blood pressure change over time and incidence of hypertension among Chinese children. The longitudinal study enrolled 17,702 Chinese children aged 7 years in Yantai in 2014 as baseline, with a continuous 5 years of follow-up to 2019. Generalized estimating equation model was fitted to examine the main and interaction effects of weight status change and time with blood pressure and the incidence of hypertension. Compared with the participants who remained normal weight, the participants who remained overweight or obese had higher systolic blood pressure (SBP) (β = 2.89, p < 0.001) and diastolic blood pressure (DBP) (β = 1.79, p < 0.001). Significant interactions were identified between weight status change and time with SBP (χ 2 interaction  = 697.77, p < 0.001) and DBP (χ 2 interaction  = 270.49, p < 0.001). The odds ratio (OR) and 95% confidence interval (CI) of hypertension were 1.70 (1.59-1.82) for participants who appeared overweight or obese, 2.26 (2.14-2.40) for participants who remained overweight or obese, compared with the participants who remained normal weight. Those who switched from overweight or obesity to normal weight had almost the same risk of developing hypertension (OR = 1.13, 95% CI: 1.02 to 1.26) as children who remained normal weight. Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension, whereas losing weight could reduce blood pressure and the risk of hypertension. Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension, whereas losing weight could reduce blood pressure and the risk of hypertension., (© 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Aim: To explore the basic and core competencies of dental hygienists, construct a systematic and scientific competency framework for dental hygienists taking into account China's national conditions and provide a theoretical basis for the future training in China and other countries that have not yet established the competencies of dental hygienists., Background: The establishment of dental hygienists role is essential for the public to improve the dental health level. Currently, more than 50 countries around the world have established the role of dental hygienists and defined the core competencies needed by dental hygienists. However, studies on developing a standardized and unified consensus of competencies of dental hygienists are lacking in China., Methods: Based on the literature review and theoretical research, this study explored the theoretical basis and fundamental principle of constructing the competency framework for dental hygienists. Moreover, a correspondence questionnaire on dental hygienists' competency framework was initially constructed to clarify the specific content of each competency. Finally, the Delphi method was adopted to establish the indicators of the dental hygienists' competency framework according to the principle of expert selection and inclusion criteria., Results: The three rounds of Delphi consultation experts were from nursing, stomatology and management and other fields. Three rounds of Delphi results showed that the expert authority, enthusiasm and coordination coefficients were high. Thereafter, a competency framework of dental hygienists with 4 primary indicators, 15 secondary indicators and 50 tertiary indicators was constructed, which included theoretical knowledge, professional skills, professional abilities and occupational qualities., Conclusion: Literature and theoretical research methods along with Delphi expert consultation were used to construct the competency framework of dental hygienists based on the onion model. The competency framework of dental hygienists was scientific, reasonable and practical, which is consistent with the current health situation in China and has distinct Chinese characteristics. Some of our findings, offer ideas for other developing countries that have not yet set up the role of dental hygienists or are in an initial stage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)