Direct quantification of ion composition and mobility in organic mixed ionic-electronic conductors.

Ion transport in organic mixed ionic-electronic conductors (OMIECs) is crucial due to its direct impact on device response time and operating mechanisms but is often assessed indirectly or necessitates extra assumptions. Operando x-ray fluorescence (XRF) is a powerful, direct probe for elemental characterization of bulk OMIECs and was used to directly quantify ion composition and mobility in a model OMIEC, poly(3,4-ethylenedioxythiophene)-poly(styrene sulfonate) (PEDOT:PSS), during device operation. The first cycle revealed slow electrowetting and cation-proton exchange. Subsequent cycles showed rapid response with minor cation fluctuation (~5%). Comparison with optical-tracked electrochromic fronts revealed mesoscale structure-dependent proton transport. The calculated effective ion mobility demonstrated thickness-dependent behavior, emphasizing an interfacial ion transport pathway with a higher mobile ion density. The decoupling of interfacial effects on bulk ion mobility and the decoupling of cation and proton migration elucidate ion transport in conventional and emerging OMIEC-based devices and has broader implications for other ionic conductors writ large.

Bridging length scales in organic mixed ionic-electronic conductors through internal strain and mesoscale dynamics.

Understanding the structural and dynamic properties of disordered systems at the mesoscale is crucial. This is particularly important in organic mixed ionic-electronic conductors (OMIECs), which undergo significant and complex structural changes when operated in an electrolyte. In this study, we investigate the mesoscale strain, reversibility and dynamics of a model OMIEC material under external electrochemical potential using operando X-ray photon correlation spectroscopy. Our results reveal that strain and structural hysteresis depend on the sample's cycling history, establishing a comprehensive kinetic sequence bridging the macroscopic and microscopic behaviours of OMIECs. Furthermore, we uncover the equilibrium and non-equilibrium dynamics of charge carriers and material-doping states, highlighting the unexpected coupling between charge carrier dynamics and mesoscale order. These findings advance our understanding of the structure-dynamics-function relationships in OMIECs, opening pathways for designing and engineering materials with improved performance and functionality in non-equilibrium states during device operation.

Decoupling the Influence of Poly(3,4-Ethylenedioxythiophene)-Collagen Composite Characteristics on Cell Stemness.

Conductive polymers (CPs) are widely studied for their ability to influence a myriad of tissue systems. While their mixed ionic/electronic conductivity is commonly considered the primary driver of these benefits, the mechanisms by which CPs influence cell fate remain unclear. In this study, CP-biomaterial interactions are investigated using collagen, due to its widespread prevalence throughout the body and in tissue engineering constructs. Collagen is functionalized with both electrostatically and covalently bound derivatives of the CP poly(3,4-ethylenedioxythiophene) (PEDOT) doped via backbone-tethered sulfonate groups, which enable high solubility and loading to the collagen biomatrix. Intrinsically doped scaffolds are compared to those incorporated with a commercially available PEDOT formulation, which is complexed with polyanionic polystyrene sulfonate (PSS). Low loadings of intrinsically doped PEDOT do not increase substrate conductivity compared to collagen alone, enabling separate investigation into CP loading and conductivity. Interestingly, higher PEDOT loading bolsters human mesenchymal stromal (hMSC) cell gene expression of Oct-4 and NANOG, which are key transcription factors regulating cell stemness. Conductive collagen composites with commercial PEDOT:PSS do not significantly affect the expression of these transcription factors in hMSCs. Furthermore, it is demonstrated that PEDOT regulates cellular fate independently from physical changes to the material but directly to the loading of the polymer.

Quantitative Composition and Mesoscale Ion Distribution in p-Type Organic Mixed Ionic-Electronic Conductors.

Understanding the ionic composition and distribution in organic mixed ionic-electronic conductors (OMIECs) is crucial for understanding their structure-property relationships. Despite this, direct measurements of OMIEC ionic composition and distribution are not common. In this work, we investigated the ionic composition and mesoscopic structure of three typical p-type OMIEC materials: an ethylene glycol-treated crosslinked OMIEC with a large excess fixed anionic charge (EG/GOPS-PEDOT:PSS), an acid-treated OMIEC with a tunable fixed anionic charge (crys-PEDOT:PSS), and a single-component OMIEC without any fixed anionic charge (pg2T-TT). A combination of X-ray fluorescence (XRF) and X-ray photoelectron spectroscopies, gravimetry, coulometry, and grazing incidence small-angle X-ray scattering (GISAXS) techniques was employed to characterize these OMIECs following electrolyte exposure and electrochemical cycling. In particular, XRF provided quantitative ion-to-monomer compositions for these OMIECs from passive ion uptake following aqueous electrolyte exposure and potential-driven ion uptake/expulsion following electrochemical doping and dedoping. Single-ion (cation) transport in EG/GOPS-PEDOT:PSS due to Donnan exclusion was directly confirmed, while significant fixed anion concentrations in crys-PEDOT:PSS doping and dedoping were shown to occur through mixed anion and cation transport. Controlling the fixed anionic (PSS-) charge density in crys-PEDOT:PSS mapped the strength of Donnan exclusion in OMIEC systems following a Donnan-Gibbs model. Anion transport dominated pg2T-TT doping and dedoping, but a surprising degree of anionic charge trapping (∼1020 cm-3) was observed. GISAXS revealed minimal ion segregation both between PEDOT- and PSS-rich domains in EG/GOPS-PEDOT:PSS and between amorphous and semicrystalline domains in pg2T-TT but showed significant ion segregation in crys-PEDOT:PSS at length scales of tens of nm, ascribed to inter-nanofibril void space. These results bring new clarity to the ionic composition and distribution of OMIECs which are crucial for accurately connecting the structure and properties of these materials.

Aqueous processing of organic semiconductors enabled by stable nanoparticles with built-in surfactants.

The introduction of oligoether side chains onto a polymer backbone can help to stabilise polymeric dispersions in water without the necessity of surfactants or additives when conjugated polymer nanoparticles are prepared. A series of poly(3-hexylthiophene) (P3HT) derivatives with different content of a polar thiophene derivative 3-((2-methoxyethoxy)methyl)thiophene was interrogated to find the effect of the polar chains on the stability of the formed nanoparticles, as well as their structural, optical, electrochemical, and electrical properties. Findings indicated that incorporation of 10-20 percent of the polar side chain led to particles that are stable over a period of 42 days, with constant particle size and polydispersity, however the particles from the polymer with 30 percent polar side chain showed aggregation effects. The polymer dispersions showed a stronger solid-like behaviour in water with decreasing polar side chain content, while thin film deposition from water was found to afford globular morphologies and crystallites with more isotropic orientation compared to conventional solution-processed films. As a proof-of-principle, field-effect transistors were fabricated directly from the aqueous dispersions demonstrating that polymers with hydrophilic moieties can be processed in water without the requirement of surfactants.

Drinking water behavior and willingness to use filters by middle-aged and elderly residents in rural areas: A cross-sectional study in Tengchong, China.

Access to safe drinking water is critical to health and development issues, and residents' drinking behavior reflects their awareness of health and water hygiene. Random sampling and face-to-face questionnaires were used to investigate the drinking water behavior, sanitation and perceptions of drinking water among middle-aged and elderly residents in Tengchong, southwest Yunnan from July 1 to July 28, 2021. Differences between groups were assessed using the Chi-square test and t-test. Two binary logistic regression analyses were conducted to explore the influencing factors of drinking unboiled tap water and willingness to use filters. Results show that 35% of residents drink unboiled tap water, and 29.8% of respondents indicated a willingness to use filters. The model results showed a strong correlation between 60 and 79 years old (OR: 0.510, 95% CI: 0.303-0.858), 80 and above years old (OR: 0.118, 95% CI: 0.038-0.365), drinking water at a regular interval (OR: 0.397, 95% CI: 0.257-0.612), wanting to gain knowledge about drinking water (OR: 0.198, 95% CI: 0.099-0.395), Perceived health risks (PHR) (OR: 0.847, 95% CI: 0.771-0.929), having kidney stones (OR: 2.975, 95% CI: 1.708-5.253) and drinking unboiled tap water (p < 0.05). 60-79 years old (OR: 0.446, 95% CI: 0.244-0.815), 80 and above years old (OR: 0.228, 95% CI: 0.064-0.812), water storage (OR: 0.088, 95% CI: 0.026-0.300), middle school and above (OR: 2.238, 95% CI: 1.289-3.883), household water treatment (HWT) (OR: 33.704, 95% CI: 9.726-116.791), Perceived health risks (PHR) (OR:1.106, 95% CI: 1.009-1.213), water authority satisfaction (WAT) (OR:0.857, 95% CI: 0.769-0.956) and willingness to use filters were correlated (p < 0.05). Our findings suggested that a certain proportion of permanent middle-aged and elderly residents in rural areas still drink unboiled tap water, and residents are less willing to use filters. Residents' perception of drinking water can reflect residents' drinking water behavior and willingness to a certain extent. It is recommended that the government and Centers for Disease Control (CDC) should strengthen relevant measures such as knowledge popularization and health education, and regulate the water use behavior of middle-aged and elderly residents. Promote safe, economical and effective household water filtration facilities to ensure public health safety.

Influence of the molecular weight and size distribution of PSS on mixed ionic-electronic transport in PEDOT:PSS.

The commercially available polyelectrolyte complex poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) is ubiquitous in organic and hybrid electronics. As such, it has often been used as a benchmark material for fundamental studies and the development of new electronic devices. Yet, most studies on PEDOT:PSS have focused on its electronic conductivity in dry environments, with less consideration given to its ion transport, coupled ionic-electronic transport, and charge storage properties in aqueous environments. These properties are essential for applications in bioelectronics (sensors, actuators), charge storage devices, and electrochromic displays. Importantly, past studies on mixed ionic-electronic transport in PEDOT:PSS neglected to consider how the molecular structure of PSS affects mixed ionic-electronic transport. Herein, we therefore investigated the effect of the molecular weight and size distribution of PSS on the electronic properties and morphology of PEDOT:PSS both in dry and aqueous environments, and overall performance in organic electrochemical transistors (OECTs). Using reversible addition-fragmentation chain transfer (RAFT) polymerization with two different chain transfer agents, six PSS samples with monomodal, narrow (D = 1.1) and broad (D = 1.7) size distributions and varying molecular weights were synthesized and used as matrices for PEDOT. We found that using higher molecular weight of PSS (M n = 145 kg mol-1) and broad dispersity led to OECTs with the highest transconductance (up to 16 mS) and [µC * ] values (~140 F·cm-1V-1s-1) in PEDOT:PSS, despite having a lower volumetric capacitance (C * = 35 ± 4 F cm-3). The differences were best explained by studying the microstructure of the films by atomic force microscopy (AFM). We found that heterogeneities in the PEDOT:PSS films (interconnected and large PEDOT- and PSS-rich domains) obtained from high molecular weight and high dispersity PSS led to higher charge mobility (µ OECT ~ 4 cm2V-1s-1) and hence transconductance. These studies highlight the importance of considering molecular weight and size distribution in organic mixed ionic-electronic conductor, and could pave the way to designing high performance organic electronics for biological interfaces.

Indoor solid fuel use for cooking and the risk of incidental non-fatal cardiovascular disease among middle-aged and elderly Chinese adults: a prospective cohort study.

OBJECTIVES: The harm of indoor air pollution to health has gradually attracted attention, but the effect of indoor air pollution from burning solid fuels on incidental non-fatal cardiovascular disease (CVD) is not well understood. Under these circumstances, this study examined the association between solid fuel use and incidental non-fatal CVD. DESIGN: The prospective cohort study was conducted in 2011, 2013, 2015 and 2018. SETTING: The nationally representative survey was conducted in 28 provinces of China. PARTICIPANTS: This study included 13 544 middle-aged and elderly adults without CVD in the baseline survey, and they were followed for 7 years. OUTCOME MEASURES: First incidence of non-fatal CVD (heart disease or stroke). METHODS: Based on longitudinal data, Cox proportional hazards models were used to assess the effects of solid fuel use and persistent use on incidental CVD events. RESULTS: During the 7-year follow-up period, there were 1533 non-fatal CVD cases. A total of 7310 (54%) participants used solid fuel for cooking at the baseline survey, and 2998 (41%) users continued to use solid fuel. Solid fuel use was associated with incidental non-fatal CVD (HR: 1.18; 95% CI: 1.05 to 1.32) compared with clean fuel, and persistent solid fuel use might lead to a higher risk of incidental non-fatal CVD (HR: 1.38; 95% CI: 1.18 to 1.61) and heart disease (HR: 1.49; 95% CI: 1.24 to 1.81). In the subgroup analysis, the relationship remained significant in the female, elderly, rural and hypertensive groups. However, we found no significant interaction between these risk factors and fuel use (all p<0.05). CONCLUSIONS: This cohort study provides evidence for the effects of solid fuel use on incidental non-fatal CVD in middle-aged and elderly Chinese adults. Advocating for the use of clean energy and ventilation stoves is important to cardiovascular health.

The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study.

BACKGROUND: As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women. METHODS: From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women. RESULTS: In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000-15,000 yuan (OR:0.16, 95% CI:0.06-0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01-0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06-0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18-0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08-10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91-12.20) were more likely to have psychological distress. CONCLUSION: Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women.

Synthetic Nuances to Maximize n-Type Organic Electrochemical Transistor and Thermoelectric Performance in Fused Lactam Polymers.

A series of fully fused n-type mixed conduction lactam polymers p(g7NCnN), systematically increasing the alkyl side chain content, are synthesized via an inexpensive, nontoxic, precious-metal-free aldol polycondensation. Employing these polymers as channel materials in organic electrochemical transistors (OECTs) affords state-of-the-art n-type performance with p(g7NC10N) recording an OECT electron mobility of 1.20 × 10-2 cm2 V-1 s-1 and a µC* figure of merit of 1.83 F cm-1 V-1 s-1. In parallel to high OECT performance, upon solution doping with (4-(1,3-dimethyl-2,3-dihydro-1H-benzoimidazol-2-yl)phenyl)dimethylamine (N-DMBI), the highest thermoelectric performance is observed for p(g7NC4N), with a maximum electrical conductivity of 7.67 S cm-1 and a power factor of 10.4 µW m-1 K-2. These results are among the highest reported for n-type polymers. Importantly, while this series of fused polylactam organic mixed ionic-electronic conductors (OMIECs) highlights that synthetic molecular design strategies to bolster OECT performance can be translated to also achieve high organic thermoelectric (OTE) performance, a nuanced synthetic approach must be used to optimize performance. Herein, we outline the performance metrics and provide new insights into the molecular design guidelines for the next generation of high-performance n-type materials for mixed conduction applications, presenting for the first time the results of a single polymer series within both OECT and OTE applications.

Operando Characterization of Organic Mixed Ionic/Electronic Conducting Materials.

Operando characterization plays an important role in revealing the structure-property relationships of organic mixed ionic/electronic conductors (OMIECs), enabling the direct observation of dynamic changes during device operation and thus guiding the development of new materials. This review focuses on the application of different operando characterization techniques in the study of OMIECs, highlighting the time-dependent and bias-dependent structure, composition, and morphology information extracted from these techniques. We first illustrate the needs, requirements, and challenges of operando characterization then provide an overview of relevant experimental techniques, including spectroscopy, scattering, microbalance, microprobe, and electron microscopy. We also compare different in silico methods and discuss the interplay of these computational methods with experimental techniques. Finally, we provide an outlook on the future development of operando for OMIEC-based devices and look toward multimodal operando techniques for more comprehensive and accurate description of OMIECs.

The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China.

The complex relationships among social support, experienced stigma, psychological distress, and quality of life (QOL) among tuberculosis (TB) patients are insufficiently understood. The purpose of this study was to explore the interrelationships among social support, experienced stigma, psychological distress, and QOL and to examine whether experienced stigma and psychological distress play a mediating role. A cross-sectional survey was conducted between November 2020 and March 2021 in Dalian, Liaoning Province, Northeast China. Data were obtained from 473 TB patients using a structured questionnaire. Structural equation modelling was used to examine the hypothetical model. The research model provided a good fit to the measured data. All research hypotheses were supported: (1) social support, experienced stigma and psychological distress were associated with QOL; (2) experienced stigma fully mediated the effect of social support on psychological distress; (3) psychological distress fully mediated the effect of experienced stigma on QOL; and (4) experienced stigma and psychological distress were sequential mediators between social support and QOL. This study elucidated the pathways linking social support, experienced stigma, and psychological distress to QOL and provides an empirical basis for improving the QOL of TB patients.

Electrochemistry of Thin Films with In Situ/Operando Grazing Incidence X-Ray Scattering: Bypassing Electrolyte Scattering for High Fidelity Time Resolved Studies.

Electroactive polymer thin films undergo repeated reversible structural change during operation in electrochemical applications. While synchrotron X-ray scattering is powerful for the characterization of stand-alone and ex situ organic thin films, in situ/operando structural characterization has been underutilized-in large part due to complications arising from supporting electrolyte scattering. This has greatly hampered the development of application relevant structure property relationships. Therefore, a new methodology for in situ/operando X-ray characterization that separates the incident and scattered X-ray beam path from the electrolyte is developed. As a proof of concept, the operando structural characterization of weakly-scattering, organic mixed conducting thin films in an aqueous electrolyte environment is demonstrated, accessing previously unexplored changes in the π-π peak and diffuse scatter, while capturing the solvent swollen thin film structure which is inaccessible in previous ex situ studies. These in situ/operando measurements improve the sensitivity to structural changes, capturing minute changes not possible ex situ, and have multimodal potential such as combined Raman measurements that also serve to validate the true in situ/operando conditions of the cell. Finally, new directions enabled by this in situ/operando cell design are examined and state of the art measurements are compared.

Prevalence and associated factors of psychological distress in tuberculosis patients in Northeast China: a cross-sectional study.

BACKGROUND: Psychological distress, a major comorbidities of tuberculosis (TB) patients, has posed a serious threat to the progress being made in global TB programs by affecting treatment adherence and health outcomes. However, the magnitude and associated factors of psychological distress have not been fully studied in China. The aim of the current study was to assess the prevalence of psychological distress in TB patients and to further determine the effects of socio-demographic characteristics, health-related variables, substance use status, social support, and experienced stigma on psychological distress. METHODS: A cross-sectional survey was conducted among TB patients attending three medical institutions in Dalian, Liaoning Province, Northeast China from November 2020 to March 2021. A structured questionnaire was developed to collect data on patients' socio-demographic characteristics, health-related information, substance use status, psychological distress, family function, doctor-patient relationship, policy support, experienced stigma and so on. The binary logistics regression model was used to determine the associated factors of psychological distress. RESULTS: A total of 473 TB patients were enrolled in this study, and the prevalence of psychological distress was 64.1%. Binary logistic regression analysis revealed that patients with a middle school education level or above (OR: 0.521, 95%CI: 0.279-0.974), no adverse drug reactions (OR: 0.476, 95%CI: 0.268-0.846), and regular physical exercise (OR: 0.528, 95%CI: 0.281-0.993) were more likely to stay away from psychological distress. However, patients who had a high economic burden (OR: 1.697, 95%CI: 1.014-2.840), diabetes (OR: 2.165, 95%CI: 1.025-4.573), self-rated illness severe (OR: 3.169, 95%CI: 1.081-9.285), perceived poor resistance (OR: 2.065, 95%CI: 1.118-3.815), severe family dysfunction (OR: 4.001, 95%CI: 1.158-13.823), perceived need for strengthen psychological counseling (OR: 4.837, 95%CI: 2.833-8.258), and a high experienced stigma (OR: 3.253, 95%CI: 1.966-5.384) tended to have a psychological distress. CONCLUSIONS: The study found that the proportion of psychological distress among TB patients was high in Northeast China, and it was influenced by a variety of factors. Effective interventions to reduce psychological distress in TB patients urgently need to be developed, and greater attention should be given to patients with risk factors.

Mimicking associative learning using an ion-trapping non-volatile synaptic organic electrochemical transistor.

Associative learning, a critical learning principle to improve an individual's adaptability, has been emulated by few organic electrochemical devices. However, complicated bias schemes, high write voltages, as well as process irreversibility hinder the further development of associative learning circuits. Here, by adopting a poly(3,4-ethylenedioxythiophene):tosylate/Polytetrahydrofuran composite as the active channel, we present a non-volatile organic electrochemical transistor that shows a write bias less than 0.8 V and retention time longer than 200 min without decoupling the write and read operations. By incorporating a pressure sensor and a photoresistor, a neuromorphic circuit is demonstrated with the ability to associate two physical inputs (light and pressure) instead of normally demonstrated electrical inputs in other associative learning circuits. To unravel the non-volatility of this material, ultraviolet-visible-near-infrared spectroscopy, X-ray photoelectron spectroscopy and grazing-incidence wide-angle X-ray scattering are used to characterize the oxidation level variation, compositional change, and the structural modulation of the poly(3,4-ethylenedioxythiophene):tosylate/Polytetrahydrofuran films in various conductance states. The implementation of the associative learning circuit as well as the understanding of the non-volatile material represent critical advances for organic electrochemical devices in neuromorphic applications.

Prevalence of Multidrug-Resistant Tuberculosis in Dalian, China: A Retrospective Study.

PURPOSE: Multidrug-resistant tuberculosis (MDR-TB) is the cause of serious health and economic burdens worldwide. The present study aimed to explore the initial and acquired drug-resistance rates among TB patients from 2012 to 2019 in Dalian, China. The effectiveness of MDR-TB prevention and control strategies were then evaluated. PATIENTS AND METHODS: Drug susceptibility testing (DST) was performed for 6429 diagnosed, culture-positive, Mycobacterium tuberculosis (MTB) strains, including 4661 new cases and 1768 previously treated cases. Descriptive statistics were employed to calculate the frequencies and percentages of TB strains, and the average annual growth rates (AAGRs) for each strain were calculated. The Chi-square test was applied to examine the significance of linear drug-resistance trends over time during the study period. RESULTS: Over the eight-year study period, the percentages of both initial (from 9.01% to 4.82%) and acquired (from 40.85% to 9.09%) MDR-TB cases decreased significantly, AAGRs of 8.55% and 19.32%, respectively. Among new and previously treated TB patients, significant downtrends were observed for the rates of both initial and acquired MDR-TB among young and middle-aged individuals (P < 0.05). Additionally, among both new and previously treated TB patients, the percentages of individuals with drug resistance against isoniazid (INH), rifampicin (RFP), ofloxacin (OFX), and amikacin (AMK) decreased significantly (P < 0.05) from 2012 to 2019 in Dalian, China. CONCLUSION: The initial and acquired multidrug resistance rates exhibited significantly decreasing trends from 2012 to 2019, suggesting that MDR-TB prevalence has been controlled effectively in Dalian, China. The MDR-TB epidemic was reversed in the short term by establishing feasible strategies for detection, diagnosis, treatment, and infection control.

Association between solid fuel use and cognitive decline among middle-aged and elderly Chinese adults: a longitudinal study.

This study was conducted to investigate (1) the association between solid fuel use for cooking and cognitive function; (2) the moderating effects of gender and residential area on cognitive scores among solid fuel users; and (3) the effects of solid fuel use on cognitive decline among different gender and age subgroups in 2011-2018. A total of 5140 Chinese middle-aged and elderly participants were successfully followed for 7 years (2011-2018). Solid fuel use was self-reported as using solid fuel for cooking at home, and cognitive function was assessed by 4 parts: episodic memory, time orientation, numerical ability and picture drawing. After adjusting for covariates, solid fuel users had lower cognitive scores, and the moderation effects of gender and residence on cognitive function were significant among the solid fuel users. In addition, compared with the group of clean fuel users, solid fuel users had a faster decline rate of cognitive function among the subgroups of female and elderly people.

Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study.

BACKGROUND: The stigma of tuberculosis (TB) poses a significant challenge to TB control because it leads to delayed diagnosis and non-adherence. However, few studies on TB-related stigma have been completed in China. The aim of the current study was to explore the status of TB-related stigma and its associated predictive factors among TB patients in Dalian, Northeast China. METHODS: An institution-based, cross-sectional survey was conducted among outpatients at Dalian Tuberculosis Hospital in Liaoning Province, Northeast China. Data were collected by using a questionnaire that measured TB-related stigma, treatment status, anxiety, social support, doctor-patient communication and so on. A multiple linear regression model was used to determine the predictors of TB-related stigma. RESULTS: A total of 601 eligible participants were recruited. The mean score for TB-related stigma was 9.07, and the median score was 10. The average scores for anxiety, social support and doctor-patient communication were 4.03, 25.41 and 17.17, respectively. Multiple linear regression analysis revealed that patients who were female (ß = 1.19, 95% CI: 0.38-2.01, P < 0.05), had self-assessed moderate or severe disease (ß = 1.08, 95% CI: 0.12-2.03 and ß = 1.36, 95% CI: 0.03-2.70, respectively, P < 0.05), and had anxiety (ß = 0.38, 95% CI: 0.30-0.46, P < 0.001) were more likely to have a greater level of TB-related stigma than their counterparts. However, a significantly lower level of TB-related stigma was observed in patients with good social support (ß = - 0.25, 95% CI: - 0.33--0.17, P < 0.001) and doctor-patient communication (ß = - 0.14, 95% CI: - 0.29--0.00, P < 0.05). CONCLUSIONS: This study showed that stigma among TB patients was high. Targeted attention should be paid to female patients and patients with moderate or severe disease in TB stigma-related interventions. Moreover, the important role of social support and doctor-patient communication in reducing TB-related stigma should also be emphasized.

Cut-off Points of Treatment Delay to Predict Poor Outcomes Among New Pulmonary Tuberculosis Cases in Dalian, China: A Cohort Study.

PURPOSE: Despite increasing literature on the association between treatment delay and outcomes, cut-off point (1 month or median) selection in almost all studies for treatment delay is too subjective. This study explored more scientific cut-off points of treatment delay for poor treatment outcomes and death at the clinical level. PATIENTS AND METHODS: A total of 18,100 newly confirmed pulmonary tuberculosis (TB) cases in Dalian, China were used in the final analysis. A 3-knotted restricted cubic spline (RCS) fitted for Cox proportional hazard regression models is used to analyse the effects of cut-off points of treatment delay on incident poor treatment outcomes. To explore the moderating effects of age, gender and diabetes, we added the interaction terms of these moderating variables and treatment delay to Cox proportional hazard regression models. RESULTS: The median time of treatment initiation was 30 days (IQR: 14-59 days). The risk of incident poor treatment outcomes increased when the time was greater than cut-off point 1 (53 days; adjusted HR: 1.26; 95% CI: 1.00-1.60) of treatment delay, and the risk of incident death events increased when the time was greater than cut-off point 2 (103 days; adjusted HR: 1.56; 95% CI: 1.00-2.44) of delay. In addition, treatment delay was associated with an increased risk of incident poor treatment outcomes and death, and older age, male sex, and diabetes may increase the risk of treatment delay for poor outcomes. CONCLUSION: This study is the first to identify scientific cut-off points of treatment delay for poor treatment outcomes and death, and this method of exploration should be popularized. In addition, the knowledge of tuberculosis must be spread to every adult. Moreover, the tuberculosis diagnosis level of community level health workers should be enhanced.