Prevalence and associated risk factors for chronic kidney disease in the elderly physically disabled population in Shanghai, China: a cross-sectional study.

BACKGROUND: The global prevalence of chronic kidney disease (CKD) in the general population is relatively clear. Our previous study showed that elderly individuals who are physically disabled are more likely to experience kidney function impairment, and the main purpose of this study was to determine the prevalence and risk factors associated with CKD in elderly patients with physical disabilities. METHODS: A total of 2679 elderly individuals with physical disabilities from the 2018 Shanghai Disability Health Survey were screened to calculate the prevalence of CKD. Multiple logistic regression was performed to identify the factors associated with CKD. Detailed subgroup analyses of disability level were also conducted. RESULTS: We confirmed CKD in 287 of 2679 (10.7%) participants. Female sex, age, history of hypertension, red blood cell count, albumin, urea, and uric acid (UA) were independently correlated with CKD. Age and UA abnormalities were common risk factors for different levels of disabilities. CONCLUSION: The prevalence of CKD is higher in the mild level of older physically handicapped individuals. Age and the level of UA should also be considered in this population. The preventive strategies for patients with two levels of elderly disability should have different focuses.

Moderating effects of regional disparities on the relationship between individual determinants and public health service utilization among internal migrants: evidence from the China migrant dynamic survey in 2017.

BACKGROUND: Regional disparities and individual determinants have a significant impact on the accessibility of national essential public health services (NEPHS) for internal migrants (IMs) Nevertheless, few studies have explored the interaction between these two factors. METHOD: A cross-sectional sample of 102,632 IMs from the 2017 China Migrant Dynamic Survey was selected. The 28 provinces were divided into high-income provinces (HIPs) and low and middle-income provinces (LMIPs) according to their per capita disposable income (PCDI). Logistic regression was conducted using sex, residence duration, education, community type, migration range, social participation and relative personal income as independent variables, NEPHS awareness and health records registration (HRR) as dependent variables, and regional economic development level (REDL) as a moderating variable. RESULTS: The rate of NEPHS awareness and HRR in HIPs (60.7, 30.6%) were lower (x2 = 42.486, p < 0.001; x2 = 25.573, p < 0.001) than those in LMIPs (62.9, 32.2%). After controlling for other variables, NEPHS awareness (OR = 1.379, p < 0.001) and HRR (OR = 1.661, p < 0.001) of IMs in HIPs were higher. Sub-group proportion of education Ms. in HIPs were higher. Sub-group = 1.379, p < 0.001) and HRR dependent mong internal migrants:, 61.0, 42.2%) were higher than those in LMIPs (60.4, 19.7, 35.8, 25.5%). Among urban communities, intra-provincial migration, social participation, education > 9 years, and middle-income, the protective effect of the first three factors on NEPHS awareness was greater in HIPs (OR = 1.386, p < 0.001; OR = 1.383, p < 0.001; OR = 2.008, p < 0.001) than in LMIPs (OR = 1.053, p < 0.001; OR = 1.109, p < 0.001; OR = 1.861, p < 0.001), while the effect of all five factors on HRR was greater in HIPs (OR = 1.440, p < 0.001; OR = 1.380, p < 0.001; OR = 1.895, p < 0.001; OR = 1.148, p < 0.001; OR = 1.146, p < 0.001) than in LMIPs (OR = 1.045, p < 0.05; OR = 1.169, p < 0.001; OR = 1.677, p < 0.001; OR = 1.027, p > 0.05; OR = 1.028, p > 0.05). CONCLUSIONS: REDL directly affected the NEPHS utilization of IMs, and the negative effects of vulnerable characteristics on the NEPHS utilization of IMs were amplified in HIPs. The government is urged to regard IMs with vulnerable characteristics in HIPs as the key population in future NEPHS equalization and take targeted measures to stimulate their enthusiasm to participate in NEPHS.

Impact of social capital, sex and education on the utilization of public health services: a cross sectional study based on the China migrant dynamic survey.

BACKGROUND: China is making efforts to promote the equalization of National Essential Public Health Services (NEPHS) for internal migrants. Studies have demonstrated that the impacts of social capital on health services are different among subgroups of people. Clarifying these differences will help China accurately promote the equalization of NEPHS for the internal migrants and provide reference for other countries. METHODS: Data from the China Migrant Dynamic Survey of 2017, involving 130,642 migrants in 31 provinces were used to clarify the complex relationship between social capital and the utilization of NEPHS. Social capital was divided into regional cognitive social capital (RCSC), regional structural social capital (RSSC), individual cognitive social capital (ICSC), and individual structural social capital (ISSC). Then, multi-level logistic regression was conducted to analyze their impacts on the utilization of NEPHS of the migrants, and whether such impacts are moderated by sex and education. RESULTS: (1) There are significant differences in the levels of CSC, SSC, and NEPHS utilization between different sexs and educational subgroups of the migrants, among which the educational difference is more prominent. (2) An interaction exists between the levels and dimensions of social capital and NEPHS projects. Also, the impact of SSC on NEPHS is always greater than that of CSC at the same level. (3) The effects of RCSC, RSSC, ICSC, and ISSC on NEPHS utilization by migrants are not moderated by sex. However, a high education could weaken the relationship between RCSC and health education, ISSC and health education, and RSSC and health records but strengthen the correlation between RSSC and health education. CONCLUSION: Social capital plays an important role in the access of migrants to NEPHS. Governments should vigorously promote the construction of regional social capital, encourage migrants to actively participate in community activities, especially pay attention to the enhancement of the migrants with low SES to the destination identity.

Analysis of the reduction in injury mortality disparity between urban and rural areas in developing China from 2010 to 2016.

BACKGROUND: Injuries are of growing public health concern in China, and the trends of urban-rural injury mortality disparity for the last decade are still being explored. This study aims to analyze trends in injury mortality disparity between urban and rural areas of China by region, sex, and age from 2010 to 2016. METHODS: Using data from the Disease Surveillance Points system (DSPs) collected by the Chinese Center for Disease Control and Prevention (CDC) from 2010 to 2016, injury age-standardized mortality rates (ASMRs) and rate ratios (RRs) were calculated for different groups. Chi-square tests were used to compare differences in rates between urban and rural residents. The time trends of injury ASMRs were assessed via the annual percentage change (APC), and RRs were used to analyze urban-rural mortality disparity. RESULTS: The crude injury mortality rate of rural areas was 1.5 times higher than that of urban areas. The urban-rural RR of injury ASMR decreased from 1.8 to 1.5 (APC = 5.0%) over time, from 2.0 to 1.7 (APC = 4.7%) for eastern regions, from 1.9 to 1.5 (APC = 5.4%) and from 1.6 to 1.3 (APC = 4.5%) among males and females, respectively. Further decreases were from 2.0 to 1.4 (APC = 7.8%), from 1.9 to 1.6 (APC = 6.4%), and from 1.8 to 1.2 (APC = 5.7%) in the 5-14, 45-64, and 65+ year age groups, respectively. The urban-rural RRs of ASMRs for fall, drowning and suicide decreased from 1.3 to 1.2 (APC = - 3.0%), from 2.3 to 1.6 (APC = - 13.8%) and from 2.1 to 1.6 (APC = - 9.9%,), respectively. CONCLUSIONS: The urban-rural injury mortality disparity was large, but showed a significant decreasing trend in China. Residents of eastern regions, males/females, 5-14/45+ year age groups in the urban-rural injury mortality disparity all decreased gradually during the investigated period.

Associations between Work Experience and Betel Nut, Alcohol, or Tobacco Use among Low-Income Taiwanese Students from Middle School to University.

Background: Research suggests that young working students are at higher risk for substance use. However, most studies have focused on students from middle-class families, with few investigations conducted on substance use by students from low-income families. Objective: To examine the associations between work experience and betel nut, alcohol, or tobacco (BAT) use among Taiwanese students from low-income families. Methods: The data for this cross-sectional study were derived from the fourth wave of the Taiwan Panel Study of Children and Youth survey which provides primary data on low-income families. A total of 3,350 low-income students aged 12-25 years old from middle school to university participated. The χ2 test was performed to examine differences in sociodemographic characteristics and BAT use between employed and unemployed students. Multivariate logistic regression was used to examine the associations between work status, work intensity, monthly income, occupation, and BAT use. Results: Employed students displayed higher BAT use than those who were unemployed. Increased BAT use was also associated with higher work intensity (except for betel nut use), higher monthly income, and specific occupations (such as service or manual work). Conclusions: Employment is independently associated with a higher risk of BAT use among low-income Taiwanese students. Work intensity and specific occupational fields may offer insights into formulating relevant preventive measures for these students.

Effects of Prophylactic Ankle Supports on Vertical Ground Reaction Force During Landing: A Meta-Analysis.

There has been much debate on how prophylactic ankle supports (PASs) may influence the vertical ground reaction force (vGRF) during landing. Therefore, the primary aims of this meta-analysis were to systematically review and synthesize the effect of PASs on vGRF, and to understand how PASs affect vGRF peaks (F1, F2) and the time from initial contact to peak loading (T1, T2) during landing. Several key databases, including Scopus, Cochrane, Embase, PubMed, ProQuest, Medline, Ovid, Web of Science, and the Physical Activity Index, were used for identifying relevant studies published in English since inception to April 1, 2015. The computerized literature search and cross-referencing the citation list of the articles yielded 3,993 articles. Criteria for inclusion required that 1) the study was conducted on healthy adults; 2) the subject number and trial number were known; 3) the subjects performed landing with and without PAS; 4) the landing movement was in the sagittal plane; 5) the comparable vGRF parameters were reported; and 6) the F1 and F2 must be normalized to the subject's body weight. After the removal of duplicates and irrelevant articles, 6, 6, 15 and 11 studies were respectively pooled for outcomes of F1, T1, F2 and T2. This study found a significantly increased F2 (.03 BW, 95% CI: .001, .05) and decreased T1 (-1.24 ms, 95% CI: -1.77, -.71) and T2 (-3.74 ms, 95% CI: -4.83, -2.65) with the use of a PAS. F1 was not significantly influenced by the PAS. Heterogeneity was present in some results, but there was no evidence of publication bias for any outcome. These changes represented deterioration in the buffering characteristics of the joint. An ideal PAS design should limit the excessive joint motion of ankle inversion, while allowing a normal range of motion, especially in the sagittal plane. Key pointsPAS can effectively protect the ligamentous structure from spraining by providing mechanical support and cutaneous proprioceptive benefits.Using of PAS can significantly elevate F2 and reduce T1 and T2 during landing. These changes represented deterioration in the buffering characteristics of the joint.An ideal PAS design should limit the excessive joint motion of the ankle inversion, while allow normal range of motion, especially in the sagittal plane.

[Relationship between environmental tobacco smoke and lung cancer risk among nonsmokers in China: A meta-analysis].

OBJECTIVE: To investigate the relationship between the environmental tobacco smoke (ETS) and lung cancer by Meta-analysis. METHODS: We used "lung cancer/lung neoplasm", "non-smoking/non-smoker", "China/Chinese", "case-control/case control", "risk factor", "environmental tobacco smoke/passive smoking" as key words, to search papers in databases including Chinese BioMedical Literature (CBM), China National Knowledge Internet (CNKI), Wanfang, Vip Citation Databases (VIP), PubMed and Web of Science databases, and collected the case-control studies on ETS and lung cancer among Chinese non-smokers from January 1999 to December 2013. A total of 129 research papers were collected. RevMan 5.2 software was used to calculate combined odds radio (OR) and 95% CI. RESULTS: Qualified 18 literatures were included, total cases 6 145 and controls 8 132. Consolidated results showed that ETS exposure could increase the risk of lung cancer, combined OR (95% CI) = 1.52 (1.42-1.64). Stratified analysis showed that ETS exposure was found to be significantly associated with an increasing risk of the lung cancer on non-smoking women and men, and combined OR (95% CI) were 1.58 (1.42-1.75) and 1.34 (1.08-1.65), respectively; the ETS exposure from family or the working environment could increase the risk of lung cancer, and combined OR (95% CI) were 1.48 (1.20-1.82) and 1.38 (1.13-1.69) respectively; childhood exposure and adult exposure were no significant statistical significance, and combined OR (95% CI) were 1.37 (0.98-1.91), and 1.34 (0.97-1.85) respectively. CONCLUSION: Environmental tobacco smoke exposure was a significant risk factor of lung cancer among non-smokers in China.

Exploring the transition to DRGs in Developing Countries: A case study in Shanghai, China.

OBJECTIVE: With the success of DRGs (Diagnosis Related Groups) in developing countries, this prospective payment system has been imported into China from the early 21(st) century. However, DRGs has been struggling and has made little progress since (its adoption in) 2004. This study contributes to the debate on how to bridge the pay-for-service (system/scheme) and DRGs (Diagnosis Related Groups) during the transitional period of payment reform in China. METHODS: From 2008 to 2012, sixty regional general hospitals in Shanghai were divided into three groups according to their economic level, and one hospital was picked from each group randomly. After ranking of morbidity, 22130 patients with hypertension or coronary heart disease were chosen as sample. Using multiple linear regression analysis, the inter relationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay, region and economic level of the hospitals were examined. RESULTS: The main findings were (1) Age, LOS and the economic level of treatment location had a statistically significant impact on patients with hypertension or coronary heart disease. However, gender is only a significant factor to patients with coronary heart disease. The results suggested that age, LOS and the economic level of treatment location should be considered in formulating pricing standards for the hypertension patient group. Besides the above mentioned factors, gender should also be considered in formulating pricing standards for the coronary heart disease patient group. (2) Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases. CONCLUSION: Simplification of the DRGs standard- setting process based on standardized clinical pathways and accurate costing will greatly increase the efficiency of implementing DRGs in the developing world.

Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review.

BACKGROUND: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. OBJECTIVE: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. METHODS: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. RESULTS: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. CONCLUSIONS: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.

Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

BACKGROUND: Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. METHODS: Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. RESULTS: Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). CONCLUSION: The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

Association of blood pressure trajectories with coronary heart disease among the disabled population in Shanghai, China: a cohort study of 7 years following up.

BACKGROUND: Much less is known about the importance of blood pressure (BP) trajectories concerning the incidence of coronary heart disease (CHD) in people with disabilities. Our aim was to evaluate this association. METHODS: This cohort study surveyed 5711 adults from the Shanghai Disability Health Survey from June 2012 to June 2019. The latent class growth mixture model was used to examine distinct BP trajectories. We evaluated the association of BP trajectories with the risk of CHD by Cox proportional hazard models. The model for CHD risk fitted to BP trajectories was compared with models fitted to other BP-related indicators by goodness-of-fit, discrimination, and calibration. RESULTS: During a median follow-up of 71.74 months, 686 cases (median age was 49.03 (54.49, 58.55) years, 51.90% female) with CHD were identified, with a cumulative incidence of 12.01%. Systolic BP (SBP) and diastolic BP (DBP) were categorized into three classes, respectively. A statistically significant association was only observed between SBP trajectories and CHD. Compared with the normotensive stable SBP group (n = 1956), the prehypertension-stable group (n = 3268) had a higher risk (adjust hazards ratio (aHR) = 1.266, 95% confidence interval (CI) 1.014-1.581), and the stage 1 hypertension-decreasing group (n = 487) had the highest risk (aHR = 1.609, 95%CI 1.157-2.238). Among the BP-related indicators, the SBP trajectory was the strongest predictor of new-onset CHD. Findings were similar when sensitivity analyses were conducted. CONCLUSIONS: SBP trajectory was a more important risk factor for CHD than other BP-related indicators and stringent BP control strategies may be effective for primary CHD prevention in the disabled population.

The Role of Multifidus in the Biomechanics of Lumbar Spine: A Musculoskeletal Modeling Study.

BACKGROUND: The role of multifidus in the biomechanics of lumbar spine remained unclear. PURPOSE: This study aimed to investigate the role of multifidus in the modeling of lumbar spine and the influence of asymmetric multifidus atrophy on the biomechanics of lumbar spine. METHODS: This study considered five different multifidus conditions in the trunk musculoskeletal models: group 1 (with entire multifidus), group 2 (without multifidus), group 3 (multifidus with half of maximum isometric force), group 4 (asymmetric multifidus atrophy on L5/S1 level), and group 5 (asymmetric multifidus atrophy on L4/L5 level). In order to test how different multifidus situations would affect the lumbar spine, four trunk flexional angles (0°, 30°, 60°, and 90°) were simulated. The calculation of muscle activation and muscle force was done using static optimization function in OpenSim. Then, joint reaction forces of L5/S1 and L4/L5 levels were calculated and compared among the groups. RESULTS: The models without multifidus had the highest normalized compressive forces on the L4/L5 level in trunk flexion tasks. In extreme cases produced by group 2 models, the normalized compressive forces on L4/L5 level were 444% (30° flexion), 568% (60° flexion), and 576% (90° flexion) of upper body weight, which were 1.82 times, 1.63 times, and 1.13 times as large as the values computed by the corresponding models in group 1. In 90° flexion, the success rate of simulation in group 2 was 49.6%, followed by group 3 (84.4%), group 4 (89.6%), group 5 (92.8%), and group 1 (92.8%). CONCLUSIONS: The results demonstrate that incorporating multifidus in the musculoskeletal model is important for increasing the success rate of simulation and decreasing the incidence of overestimation of compressive load on the lumbar spine. Asymmetric multifidus atrophy has negligible effect on the lower lumbar spine in the trunk flexion posture. The results highlighted the fine-tuning ability of multifidus in equilibrating the loads on the lower back and the necessity of incorporating multifidus in trunk musculoskeletal modeling.

Risk factors and characteristics of new-onset coronary heart disease in adults with physical disabilities: A retrospective cohort study.

Objectives: There is limited information about coronary heart disease (CHD) in adults with physical disabilities. This study was performed to assess the incidence and predictors of the new development of CHD in adults with physical disabilities. Methods: A retrospective cohort study was performed on 3902 physically disabled people in Shanghai, China. Baseline information was collected in January 2012, and participants were followed-up with for 7.5 years for CHD events. Risk factors for demographic characteristics, disease history, electrocardiography, and blood biochemical indicators were evaluated using a Cox proportional hazard model. Subgroup analyzes were performed according to gender and level of physical disability. Results: Out of the total 3902 adults with physical disabilities (average age 55.9 ± 8.5 years), 468 (12.0%) developed CHD, during a median follow-up period of 7 years. Independent predictors of CHD included the following: age (HR = 1.411, 95% CI = 1.255-1.587, p＜0.001), gender (HR = 0.773, 95% CI = 0.637-0.940, p = 0.010), abnormal electrocardiogram(HR = 1.396, 95% CI = 1.088-1.792, p = 0.009), hypertension (HR = 1.657, 95% CI = 1.369-2.006, p＜0.001), diabetes (HR = 1.649, 95% CI = 1.307-2.081, p＜0.001), serum uric acid (HR = 1.001, 95% CI = 1.000-1.002, p = 0.046), and total cholesterol (HR = 1.416, 95% CI = 1.054-1.902, p = 0.021). In addition to the risk factors of the total population with physical disability, triglyceride was also a significant risk factor for CHD in the subgroup with women and mild disability. Conclusions: During a 7.5 years period, the CHD incidence rate among physically disabled people was 12.0%. We identified the role of CHD risk factors such as age, gender, hypertension, diabetes, serum uric acid, total cholesterol, and abnormal electrocardiogram.

Pilot Influenza Syndromic Surveillance System Based on Absenteeism and Temperature in China: Development and Usability Study.

BACKGROUND: Shortcomings of the current school-based infectious disease syndromic surveillance system (SSS) in China include relying on school physicians to collect data manually and ignoring the health information of students in attendance. OBJECTIVE: This study aimed to design and implement an influenza SSS based on the absenteeism (collected by face recognition) and temperature of attending students (measured by thermal imaging). METHODS: An SSS was implemented by extending the functionality of an existing application. The system was implemented in 2 primary schools and 1 junior high school in the Yangtze River Delta, with a total of 3535 students. The examination period was from March 1, 2021, to January 14, 2022, with 174 effective days. The daily and weekly absenteeism and fever rates reported by the system (DAR1 and DFR; WAR1 and WFR) were calculated. The daily and weekly absenteeism rates reported by school physicians (DAR2 and WAR2) and the weekly positive rate of influenza virus (WPRIV, released by the Chinese National Influenza Center) were used as standards to evaluate the quality of the data reported by the system. RESULTS: Absenteeism reported by school physicians (completeness 86.7%) was 36.5% of that reported by this system (completeness 100%), and a significant positive correlation between them was detected (r=0.372, P=.002). When the influenza activity level was moderate, DAR1s were significantly positively correlated among schools (rab=0.508, P=.004; rbc=0.427, P=.02; rac=0.447, P=.01). During the influenza breakout, the gap of DAR1s widened. WAR1 peaked 2 weeks earlier in schools A and B than in school C. Variables significantly positively correlated with the WPRIV were the WAR1 and WAR2 of school A, WAR1 of school C, and WFR of school B. The correlation between the WAR1 and WPRIV was greater than that between the WAR2 and WPRIV in school A. Addition of the WFR to the WAR1 of school B increased the correlation between the WAR1 and WPRIV. CONCLUSIONS: Data demonstrated that absenteeism calculation based on face recognition was reliable, but the accuracy of the temperature recorded by the infrared thermometer should be enhanced. Compared with similar SSSs, this system has superior simplicity, cost-effectiveness, data quality, sensitivity, and timeliness.

Simplified regimen for the management of hypertension with telemedicine and blood pressure self-monitoring (SIMPLE): study protocol for a randomised controlled trial.

INTRODUCTION: Telemedicine and blood pressure (BP) self-monitoring conduces to management of hypertension. Recent hypertension guidelines highly recommended single pill combination (SPC) for the initial treatment of essential hypertension. Based on this fact, an SPC-based telemedicine titration regimen with BP self-monitoring could be a better way in managing hypertension. This trial aims to elucidate whether telemedicine combined with BP self-monitoring is superior to self-monitoring alone during hypertension management. METHODS AND ANALYSIS: This study will be a multicentred, open-labelled, randomised controlled trial. A minimum sample of 358 hypertensive patients with uncontrolled BP from four centres will be included. The intervention group will include BP self-monitoring and tele-monitoring plus a free SPC-based telemedicine titration therapy for 6 months, they will be recommended to take BP measurements at least once every 7 days, in the meantime, researchers will call to give a consultation on lifestyle or titration advice once a fortnight. The control group will be required to self-monitor BP at the same time interval as intervention group, without any therapy change. Primary outcome of the trial will be the difference in systolic blood pressure at 6-month follow-up between intervention and control group, adjusted for baseline variables. Secondary outcomes such as BP control rate, major adverse cardiovascular events, medication adherence, quality of life will be investigated. ETHICS AND DISSEMINATION: Ethics approval was granted by Ethical Committee of Shanghai Tenth People's Hospital (SHSY-IEC-4.1/20-194/01). The results will be disseminated in peer-reviewed literature, and to policy-makers and healthcare partners. TRIAL REGISTRATION NUMBER: ChiCTR2000037217.

Penguin Suit and Fetal Position Finite Element Model to Prevent Low Back Pain in Spaceflight.

BACKGROUND: This study aimed to investigate the biomechanical effects of different interventions on astronauts lumbar intervertebral discs in a microgravity environment during spaceflight and in a gravity environment when the astronaut returns.METHODS: A finite element model of the L4L5 lumbar segment was developed with eight loading schemes representing different interventions. The loading schemes included no intervention, wearing a penguin suit, sleeping in a fetal position, wearing a penguin suit combined with sleeping in the fetal position, reclining for 4 or 16 h/d, and maintaining upright posture for 4 or 16 h/d.RESULTS: Without intervention, the microgravity environment led to increased central pore pressure, radial displacement, and water content in the lumbar intervertebral disc. Wearing a penguin suit combined with sleeping in the fetal position can reduce disc pore pressure, axial stress, radial displacement, and water content to 0.156 MPa, 11.50 kPa, 0.538 mm, and 1.390%, respectively. When astronauts return to the gravity environment, staying upright for 4 h can reduce the pore pressure, axial stress, radial displacement, and water content of the intervertebral disc to 0.222 MPa, 10.72 kPa, 0.373 mm, and 0.219%, respectively.CONCLUSION: This study showed that wearing a penguin suit and sleeping in the fetal position both have the potential to protect the lumbar intervertebral disc from the negative effects caused by microgravity. Remaining in the upright posture for 4 h per day may help squeeze out the water in the intervertebral disc safely when astronauts return to the gravity environment.Zhang S, Wang K, Zhu R, Jiang C, Niu W. Penguin suit and fetal position finite element model to prevent low back pain in spaceflight. Aerosp Med Hum Perform. 2021; 92(5):312318.

Influence of passive elements on prediction of intradiscal pressure and muscle activation in lumbar musculoskeletal models.

BACKGROUND AND OBJECTIVE: The objective of this study was to investigate the effect of incorporating various passive elements, which could represent combined or individual effects of intervertebral disc, facet articulation and ligaments, on the prediction of lumbar muscle activation and L4-L5 intradiscal pressure. METHODS: The passive elements representing the intervertebral disc, facet articulations, and ligaments were added to the existed lumbar musculoskeletal model with nonlinear rotational stiffness or force-strain relationships. The model was fed with kinematics of trunk flexion, extension, axial rotation and lateral bending to calculate muscle activation and L4-L5 intradiscal pressure. RESULTS: In the trunk axial rotation, the intradiscal pressure values predicted by the models with elements representing facet articulation were much higher than that predicated by models removing these elements. In the trunk flexion, the models with passive elements showed lower muscle activation of extensors than model with no passive elements. At the end of trunk flexion, extension, axial rotation and lateral bending, the intradiscal pressure values predicted by model with intact passive elements were 120.6%, 92.5%, 334.8% and 74.9% of the values predicted by model with no passive elements, respectively. CONCLUSIONS: Caution must be taken while modeling facet articulation as elements with rotational stiffness, as they may lead to overestimation of intradiscal pressure in trunk axial rotation. The inclusion of ligaments as spring-like elements may improve the simulation of flexion-relaxation phenomenon in trunk flexion. Future models considering detailed properties of passive elements are needed to allow more access to understanding the mechanics of the lumbar spine.

Effect of Dropping Height on the Forces of Lower Extremity Joints and Muscles during Landing: A Musculoskeletal Modeling.

The objective of this study was to investigate the effect of dropping height on the forces of joints and muscles in lower extremities during landing. A total of 10 adult subjects were required to landing from three different heights (32 cm, 52 cm, and 72 cm), and the ground reaction force and kinematics of lower extremities were measured. Then, the experimental data were input into the AnyBody Modeling System, in which software the musculoskeletal system of each subject was modeled. The reverse dynamic analysis was done to calculate the joint and muscle forces for each landing trial, and the effect of dropping-landing on the results was evaluated. The computational simulation showed that, with increasing of dropping height, the vertical forces of all the hip, knee, and ankle joints, and the forces of rectus femoris, gluteus maximus, gluteus medius, vastii, biceps femoris and adductor magnus were all significantly increased. The increased dropping height also resulted in earlier activation of the iliopsoas, rectus femoris, gluteus medius, gluteus minimus, and soleus, but latter activation of the tibialis anterior. The quantitative joint and muscle forces can be used as loading conditions in finite element analysis to calculate stress and strain and energy absorption processes in various tissues of the lower limbs.

Advancing Implementation of Evidence-Based Public Health in China: An Assessment of the Current Situation and Suggestions for Developing Regions.

Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively. Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR). Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system. Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.