Advancing nuanced pollution control: Local improvements and spatial spillovers of policies on key enterprises.

This paper examines the impact of air pollution control policies targeting key polluting enterprises, highlighting a strategic shift towards precision pollution control that concentrates on high-emission, high-risk businesses. The paper explores the efficacy of these policies and their potential spatial spillover effects, utilizing panel data from 259 Chinese cities from 2013 to 2021. Employing the difference-in-differences (DID) model and spatial Durbin model, the study analyzes both the direct local effects and the broader spatial consequences of these regulatory measures on air quality. The findings indicate a significant reduction in air pollutant concentrations in urban areas, attributing this improvement to factors such as industrial restructuring, increased investment in science and technology, and economic growth. Spatial econometric analysis further reveals a substantial positive correlation in air quality among Chinese cities. However, estimates of the spillover effect indicate that while such policies successfully reduce pollution locally, they could unintentionally degrade air quality in adjacent areas. The study highlights the need for nuanced policy strategies to mitigate unintended spatial spillovers and enhance overall effectiveness. It recommends tailored policies that integrate environmental and socioeconomic objectives, national and regional coordination for consistent enforcement, technology-driven compliance strategies, and incentives for sustainable enterprise practices.

Evaluation of the Community-Based Hypertension Management Programs in China.

Purpose: The National Essential Public Health Services Package (NEPHSP), a set of community-based hypertension management programs, was launched by the Chinese government in 2009. However, the data are limited for the comprehensive evaluation of NEPHSP on hypertension management. This study was to estimate the effect of NEPHSP on hypertension control nationwide in China. Methods: Data were from China Hypertension Survey (CHS). The participants (n = 119,412) aged ≥35 years with hypertension were included in the analysis. Further, a subset of 64,188 diagnosed hypertensive patients were analyzed to evaluate the effect of NEPHSP by comparing the ones covered and not covered by NEPHSP. Blood pressure (BP) was measured by trained staff using a validated digital portable monitor in local communities or clinics. Results: Among adults aged ≥35 years with hypertension, the coverage of NEPHSP was 25.6% and increased with age. The coverage was significantly higher in women than in men (P < 0.001). Among the 64, 188 diagnosed hypertensive patients, compared to the control group (not covered by NEPHSP), the mean systolic and diastolic BPs were 2 mmHg and 1.6 mmHg lower in NEPHSP group, respectively. The rate of treatment for hypertension was significantly higher in NEPHSP group than the control group (93.0% vs. 81.4%, P < 0.001), and the rate of BP control was also significantly higher in NEPHSP group than the control group (35.9% vs. 29.6%, P < 0.001). Furthermore, similar trends were found in rural and urban, as well as in men and women. Conclusions: Our results showed that NEPHSP is effective in improving hypertension treatment and control in hypertensive patients in China. However, the coverage of NEPHSP was still low.

Effect of a Multicomponent Intervention Delivered on a Web-Based Platform on Hypertension Control: A Cluster Randomized Clinical Trial.

Importance: The prevalence of hypertension is high and still increasing across the world, while the control rate remains low in many countries. Emerging technology, such as telemedicine, may offer additional support to change the unsatisfactory situation. Objective: To establish a multicomponent intervention delivered on a web-based telemedicine platform and oriented with the Chinese hypertension management guidelines and to evaluate the effect of the intervention on blood pressure (BP) control for patients with hypertension. Design, Setting, and Participants: This cluster randomized clinical trial of a hypertension management program was conducted at 66 community health centers in China from October 1, 2018, to May 31, 2020, with a 12-month follow-up. Patients with hypertension were blinded to randomization and were randomized to either the intervention group or control group. Hypertension was diagnosed at mean systolic BP (SBP) and diastolic BP (DBP) readings higher than 140 and 90 mm Hg or with use of antihypertensive medication. Evaluation of the intervention effect was based on the principle of modified intention to treat. Interventions: Multicomponent intervention was delivered on a web-based platform and consisted of a primary prevention program for cardiovascular disease and standardized management for hypertension. Main Outcomes and Measures: The primary outcome was the change in BP control rate (SBP and DBP levels <140 and 90 mm Hg, or <130 and 80 mm Hg for patients with diabetes) from baseline to the 12-month follow-up among patients with hypertension in the intervention and control groups. Results: A total of 4118 patients (mean [SD] age, 61.6 [9.4] years; 2265 women [55.0%]) were included in the analysis, with 2985 in the intervention group and 1133 in the control group. The BP control rate at baseline was 22.8% in the intervention group and 22.5% in the control group. After 12 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (47.4% vs 30.2%; odds ratio, 1.18; 95% CI, 1.13-1.24; P < .001). The intervention effect on SBP level was -10.1 mm Hg (95% CI, -11.7 to -8.5 mm Hg; P < .001) and on DBP level was -1.8 mm Hg (95% CI, -2.8 to -0.8 mm Hg; P < .001). Conclusions and Relevance: Results of this trial showed that a multicomponent intervention delivered on a web-based platform improved BP control rate and lowered BP level more than usual care alone. Such a telemedicine program may provide a new, effective way to treat patients with hypertension in the community and may generate public health benefits across diverse populations. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR1800017791.

Gaseous elemental mercury concentration in atmosphere at urban and remote sites in China.

An investigation of gaseous elemental mercury concentration in atmosphere was conducted at Beijing and Guangzhou urban, Yangtze Delta regional sites and China Global Atmosphere Watch Baseline Observatory (CGAWBO) in Mt. Waliguan of remote continental area of China. High temporal resolved data were obtained using automated mercury analyzer RA-915+. Results showed that the overall hourly mean Hg0 concentrations in Mt. Waliguan were 1.7+/-1.1 ng/m3 in summer and 0.6+/-0.08 ng/m3 in winter. The concentration in Yangtze Delta regional site was 5.4+/-4.1 ng/m3, which was much higher than those in Waliguan continental background area and also higher than that found in North America and Europe rural areas. In Beijing urban area the overall hourly mean Hg0 concentrations were 8.3+/-3.6 ng/m3 in winter, 6.5+/-5.2 ng/m3 in spring, 4.9+/-3.3 ng/m3 in summer, and 6.7+/-3.5 ng/m3 in autumn, respectively, and the concentration was 13.5+/-7.1 ng/m3 in Guangzhou site. The mean concentration reached the lowest value at 14:00 and the highest at 02:00 or 20:00 in all monitoring campaigns in Beijing and Guangzhou urban areas, which contrasted with the results measured in Yangtze Delta regional site and Mt. Waliguan. The features of concentration and diurnal variation of Hg0 in Beijing and Guangzhou implied the importance of local anthropogenic sources in contributing to the high Hg0 concentration in urban areas of China. Contrary seasonal variation patterns of Hg0 concentration were found between urban and remote sites. In Beijing the highest Hg0 concentration was in winter and the lowest in summer, while in Mt. Waliguan the Hg0 concentration in summer was higher than that in winter. These indicated that different processes and factors controlled Hg0 concentration in urban, regional and remote areas.

[Dietary treatment and success rate of control in hypercholesterolemia patients treated with lipid lowering drugs: a multi-center study of current status on clinical control of hypercholesterolemia in China].

OBJECTIVE: To assess the current status in dietary treatment of hypercholesterolemia and its effects on control of this disease in China. METHODS: Twenty five Tertiary-A hospitals from 12 provinces in China were selected, in which 2136 patients were recruited who had had hypercholesterolemia and had been receiving lipid lowering treatment for at least 2 months. Serum lipids level was determined for each patient at the time of enrollment, and using a simplified food frequency method carried out dietary intake survey. Patients who take meat of less than 75 g per day and eggs of less than 5 per week, and fried foods of less than 5 times per week, and butter cakes and pastry of less than 5 times per week were considered as having their diet controlled. RESULTS: Among 1746 responded patients, 68.3% reported having controlled diet. Among those reported "controlled", 75% had a diet meeting the requirements suggested by the Chinese Recommendations on Prevention and Treatment of Hypercholesterolemia (CRPTH). The percentage of patients having their serum total cholesterol under control in diet controlled group, according to the CRPTH, was significantly higher than that in diet uncontrolled group (28.8% vs 13.6%, P < 0.01). After adjustment for drug treatment and other covariates, the diet controlled group showed a significantly higher rate in control of hypercholesterolemia than the diet uncontrolled group (OR = 2.7, 95% CI: 1.4 approximately 5.2). CONCLUSION: Diet control significantly improves the status in control of hypercholesterolemia and thus should be reinforced in routine clinical practice.

Hypertension control in community health centers across China: analysis of antihypertensive drug treatment patterns.

BACKGROUND: Blood pressure (BP) control in China is generally poor. It is assumed that an important cause of this unsatisfactory situation is the present standard of care provided by primary care physicians. METHODS: One thousand community health centers (CHCs) were selected across China based on geographical location, previous cooperative experience, and acceptance of an invitation to implement a standardized protocol of community-based BP management. Baseline information for each hypertensive patient under the care of these CHCs was collected, and the present pattern of hypertensive drug treatment was analyzed. RESULTS: Of all identified hypertensive patients (n = 249,830), 37% were treated with drugs. Characteristics linked with hypertension treatment included systolic BP, age, sex, region, smoking and alcohol consumption status, body mass index, comorbidities, and family history. The most frequently prescribed classes of antihypertensive drugs were diuretics (56.0%), followed by centrally active drugs (CADs) (38.3%), calcium channel blockers (CCBs) (36.8%), vasodilators (26.5%), and angiotensin-converting enzyme inhibitors (ACEIs) (23.3%). In regards to drug combination patterns, diuretics plus CADs was the most frequently used 2-drug combination (61.4%) and vasodilators plus CADs plus diuretics was the most frequently used 3-drug therapy (69.2%). Seventy-seven percent of patients on combination therapy were prescribed single pill combinations, 87.2% of which were composed of CADs and vasodilators and 12.8% of which were composed of ACEIs and diuretics. The control rates of patients on monotherapy and combination therapy were 27.7% and 24.1% (P < 0.05), respectively. CONCLUSIONS: Our study identified major shortcomings in the present status of antihypertensive pharmacotherapy in routine medical practice in China. It is essential to implement a program of professional education regarding the appropriate use of antihypertensive drugs.

Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were managed in the intensive care unit (ICU) and required an organ-failure support. The surgical intervention of the peri-pancreatic debridement with lumber-abdominal compound incisions and postoperative washing and drainage was performed, and the two patients recovered well. The therapeutic effect of the peri-pancreatic debridement with lumber-abdominal compound incisions combined with postoperative washing and drainage in the patients of severe post-ERCP-pancreatitis (PEP) and duodenum perforation is satisfactory.