Comprehensive assessment of occurrence, temporal-spatial variations, and ecological risks of heavy metals in Jiaozhou Bay, China: A comprehensive study.

Heavy metals play a significant role in marine ecosystems, exerting notable impacts on the environment and human health. In this study, water, sediment, and aquatic organism samples from Jiaozhou Bay were investigated to comprehensively assess the distribution, temporal-spatial variations, and ecological risks of heavy metals. The results indicate that pollution from industrial wastewater discharge contributes to regional differences in the distribution of heavy metals, possibly being a major source of Zn, Cr, Cd, and Hg (r > 0.7, p < 0.05). Biological and physicochemical processes influence the distribution of Zn, Cr, and Pb in the water and sediment. Hg exhibits a polluted state in both the water and sediment, with As and Hg being the two highest-risk heavy metals in water and sediment, respectively. Among the organisms, crustaceans show significantly higher levels of heavy metal content and accumulation compared to mollusks and fish (p < 0.05), and the bioamplification of heavy metals occurs in the sediment-Rapana venosa-Portunus trituberculatus biological pathway. Portunus trituberculatus, Charybdis japonica, Oratosquilla oratoria, and Octopus ocellatus could pose risks to human health, especially for children and vulnerable populations. This study aims to enhance our understanding of the current status of heavy metal pollution in Jiaozhou Bay and to provide a scientific basis and favorable support for the ecological environmental protection and prevention of ecological risks associated with heavy metal pollution in Jiaozhou Bay and other bays in China.

Sources and spatiotemporal variations of nitrogen and phosphorus in Liaodong Bay, China.

Excessive discharge of N and P pollutants results in deterioration of marine environment quality and reduction of sustainability and safety of marine ecology. Spatiotemporal variations characteristics and sources of N and P pollutants were determined based on the long-term monitoring data in Liaodong Bay. Results indicated that an evident spatiotemporal variation was investigated for nutrients. The highest concentrations of NH3-N, NO2-N, NO3-N and PO4-P were in spring (25.32 µg/L), summer (20.67 µg/L) and autumn (222.07 µg/L, 11.08 µg/L), respectively. The hot-spots of pollutants were mainly concentrated in estuarine and aquaculture areas. The hot spot of PO4-P gradually extended to the middle of Liaodong Bay in autumn. In addition, pollution sources in each marine functional zone were different, the main pollution source was aquaculture wastewater, river input, domestic sewage. This study provided reasonable suggestions for effectively reducing N and P pollution in Liaodong Bay, and elsewhere.

Characteristics of Harmful Algal Species in the Coastal Waters of China from 1990 to 2017.

Harmful algal blooms (HABs) have occurred frequently in coastal waters of China, imposing negative effects on the marine ecological environment. A dataset of HABs and terrestrial runoff was collected and analyzed in this study, and factors responsible for HABs were further explored. Frequency and expansion of HABs peaked between 2001 and 2007, and although they have declined slightly since then, they have remained quite high. Frequency and accumulative area of HABs peaked in 2004-2005, and most occurred from April to August during these years. HABs occurred frequently in the Changjiang (Yangtze River) estuary, and Prorocentrum donghaiense, Noctiluca scientillans, Karenia mikimotoi, and Skeletonema costatum were the main algal species. The increases of eutrophication, the abnormal sea surface temperature caused by climate and ocean currents, and the species invasion caused by the discharge of ballast water may be important factors for the long-term outbreak of HABs in the Chinese coastal waters. These findings provide a better understanding of HABs in China, which will be helpful to further prevention and control.

A multimodal intervention to improve hand hygiene compliance via social cognitive influences among kindergarten teachers in China.

Children attending kindergarten are at high risk for contracting infections, for which hand hygiene (HH) has been recognized as the most cost-effective prevention measure globally. Kindergarten teachers' HH behavior plays a vital role in encouraging favorable hygiene techniques and environment. This study aims to evaluate the effectiveness of a multimodal intervention at changing kindergarten teachers' HH behavior and social cognitive factors that influences HH behavior in China. The intervention named "Clean Hands, Happy Life" includes HH products with refills, reminders and cues for action, a kick-off event with awards, and training programs. We evaluated the intervention using a self-administrative questionnaire with a stratified random sample of 12 kindergartens. Two surveys was completed by 176 teachers at baseline and 185 after the 6-month intervention. Compared with the baseline scores, there was a significant improvement in the overall self-reported HH compliance of teachers (9.38 vs. 9.68 out of 10, p = 0.006), as well as teachers' perceived disease susceptibility, disease severity and behavioral control after the intervention (p<0.05). We found that teachers' HH compliance was likely to be higher among those who have better HH guideline awareness (ß = 0.48, p<0.01) and perceived behavioral control (ß = 0.26, p = 0.01), which explained 24.2% of the variance of self-reported compliance of teachers at baseline. The assessed intervention may provide Chinese kindergarten teachers with behavioral skills and cognitions that associated with the compliance of HH behavior. We thus recommend future intervention studies consider our HH behavior change techniques, address multiple social cognitive determinants of HH behavior and include the change of targeted influences in the impact evaluation.

A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial.

OBJECTIVES: To evaluate the effect of the "Clean Hands, Happy Life" intervention on the incidence of hand, food and mouth disease (HFMD) and on school absences due to sickness in kindergarten students. METHODS: The intervention consisted of four hand hygiene (HH) promotion components and was evaluated in a cluster-randomized controlled trial among 8275 children and 18 kindergartens from May to October, 2015 in Shenzhen, China. We compared two intervention arms - received the intervention in kindergartens only and in both kindergartens and families, respectively - to the control arm in multilevel analyses. RESULTS: During the follow-up, the incidence of HFMD in both intervention arms was significantly lower than in the control arm (IRR1: 0.39, 95%CI: 0.26-0.59; IRR2: 0.30, 95%CI: 0.19-0.49); the duration of absence due to sickness (in days) in both intervention arms was significantly shorter than in the control arm (ß1 = 0.58, 95%CI: 0.41-0.74; ß2 = 0.34, 95%CI: 0.17-0.50), controlling for the area type of kindergarten and grade level of children. Furthermore, during the follow-up we found that there were fewer episodes of absence due to respiratory, skin and eye infections (P < 0.05). CONCLUSIONS: Our intervention is effective at reducing HFMD infections and absence due to sickness in children attending kindergartens in China.

Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids.

In appropriate prescribing is a global problem. It is especially salient in China, where drug sales constitute a major portion of health care providers' incomes, price distortions are rampant, and oversight is lax. However, few data exist on the prevalence of inappropriate prescribing in China. This study, the first of its kind in China, examined 230,800 prescriptions written between 2007 and 2009 by 784 community health institutions in 28 cities across China. The data show substantial overprescribing, including twice as many prescriptions for antibiotics as recommended by the World Health Organization and rates of injection that are three times higher than in similar countries. These findings point to the need to integrate rational prescribing into China's ongoing health care reform.

Service functions of private community health stations in China: A comparison analysis with government-sponsored community health stations.

In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available concerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based recommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.

Mapping the knowledge structure of research on patient adherence: knowledge domain visualization based co-word analysis and social network analysis.

BACKGROUND: Patient adherence is an important issue for health service providers and health researchers. However, the knowledge structure of diverse research on treatment adherence is unclear. This study used co-word analysis and social network analysis techniques to analyze research literature on adherence, and to show their knowledge structure and evolution over time. METHODS: Published scientific papers about treatment adherence were retrieved from Web of Science (2000 to May 2011). A total of 2308 relevant articles were included: 788 articles published in 2000-2005 and 1520 articles published in 2006-2011. The keywords of each article were extracted by using the software Biblexcel, and the synonym and isogenous words were merged manually. The frequency of keywords and their co-occurrence frequency were counted. High frequency keywords were selected to yield the co-words matrix. Finally the decomposition maps were used to comb the complex knowledge structures. RESULTS: Research themes were more general in the first period (2000 to 2005), and more extensive with many more new terms in the second period (2006 to 2011). Research on adherence has covered more and more diseases, populations and methods, but other diseases/conditions are not as hot as HIV/AIDS and have not become specialty themes/sub-directions. Most studies originated from the United States. CONCLUSION: The dynamic of this field is mainly divergent, with increasing number of new sub-directions of research. Future research is required to investigate specific directions and converge as well to construct a general paradigm in this field.

The role of functional polymorphisms of the TNF-alpha gene promoter in the risk of ischemic stroke in Chinese Han and Uyghur populations: Two case-control studies.

BACKGROUND: Increasing evidences for the role of tumor necrosis factor-alpha (TNF-alpha) in the occurrence of ischemic stroke (IS) have shown that it belongs to pro-inflammatory cytokines and carries functional polymorphisms (TNF-alpha -238G/A and TNF-alpha -308G/A) in its promoter region, which affect their transcription rate and plasma cytokine level. We determined the association between these polymorphisms and the occurrence of IS in the Chinese Han and Uyghur populations. METHODS: The TNF-alpha -238G/A and TNF-alpha -308G/A polymorphisms were determined by TaqMan SNP Genotyping assays in cases (n=748) and controls (n=748). Multivariate logistic regression analysis was used to show the association between the TNF-alpha genotypes and the IS events. RESULTS: No significant difference was found in the association between TNF-alpha -238G/A and IS in both ethnic populations. The result showed that carriage of the TNF-alpha -308GA was a decreased risk of IS in both Han and Uyghur populations (OR:0.453, 0.213). In addition, the significant difference in GA frequency in TNF-alpha was found between the two ethnic controls (P=0.000). CONCLUSIONS: TNF-alpha -308 GA heterozygous may be an independent protective factor for IS in the Chinese Han and Uyghur populations.