Preferences for healthcare services among hypertension patients in China: a discrete choice experiment.

OBJECTIVES: Our study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients. DESIGN: We identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients' preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients. SETTING: The DCE was conducted in Jiangsu province and Shanghai municipality in China. PARTICIPANTS: Patients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited. RESULTS: Patients highly valued healthcare services that produced good treatment effects (ß=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (ß=1.285, p<0.001), and the effective physician-patient communication (ß=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients' choice (ß=-0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial. CONCLUSIONS: Our findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients' preferences.

Zinc supplement ameliorates phthalates-induced reproductive toxicity in male rats.

People are inevitably exposed to phthalates (PEs) ubiquitously existing in environment. Our previous studies, simulating the actual situations of people exposure to PEs, have shown that the sub-chronic exposure to low-doses PEs mixture (MIXPs) impaired reproductive function in male rats. Zinc is an important element in maintaining male reproductive functions. However, it is still unknown whether zinc supplement could mitigate PEs-induced male reproductive toxicity or not with sub-chronic low-dose mixture exposure. This study aimed to explore the effect of zinc supplement on the reproductive toxicity caused by sub-chronic MIXPs exposure (160 mg/(kg•body weight)/d, for 90 days) in male rats, and further to reveal the underlying mechanisms. Testosterone (T), FSH and LH in serum, early toxicity indicators in urine, PIWI proteins (PIWIL1 and PIWIL2) expression in testes and pathological examination were performed for toxicity evaluation. Steroidogenic proteins (17ß-HSD, StAR, CYP17A1, P450scc and SRD5A) were measured for mechanisms of exploration. The results indicated that zinc supplement could inhibit the T, LH, FSH level decreases in serum, abolish the effect of 5 early toxicity indicators' levels in urine, restrain the alteration of PIWI proteins expression and improve the constructional injury of testes. These effects might be relevant with the suppressed alteration of the expression of steroidogenic proteins induced by MIXPs in rat testicular cells. This work may offer further insights into reducing health risks of MIXPs exposure.

Novel nanofibers mat as an efficient, fast and reusable adsorbent for solid phase extraction of non-steroidal anti-inflammatory drugs in environmental water.

Core-shell polyaniline/polyacrylonitrile nanofibers mat (PANI/Pan NFsM) was prepared for extraction of hydrophilic non-steroidal anti-inflammatory drugs (NSAIDs) in environmental water. Superior adsorption and desorption performance of PANI/Pan NFsM was confirmed by both static and dynamic adsorption/desorption experiments. These properties proved PANI/Pan NFsM was a potentially efficient and fast solid phase extraction (SPE) adsorbent for NSAIDs. Under the optimized conditions, only 3 mg of PANI/Pan NFsM could easily extract eight target analytes in 10 mL of water sample without any pre-treatment, and the analytes retained on NFsM could be easily eluted by 500 µL of 1% acetic acid methanol for direct UPLC-MS/MS analysis. In addition, each piece of PANI/Pan NFsM could be reused for at least 20 times without performance decline. Possible adsorption mechanisms were also proposed. Practical feasibility was validated through the actual sample analysis.

Determination of Five Sex Hormones in Urine Samples for Early Evaluation of Male Reproductive Toxicity Induced by Phthalate Esters in Rats.

In this work, male rats were exposed to multiple phthalate esters (MIXPs) in a long-term low-dose model for the early evaluation of reproductive toxicity. An ananlysis method with better sensitivity, accuracy and precision was established to determine the five sex hormones (androstenedione, testosterone, dehydroepiandrosterone, dihydrotestosterone, and estrone) in collected urine samples. The results showed that all the analytes in the MIXPs treated group changed in a time-dependent manner. Specifically, estrone significantly decreased from the 30th day and the other four changed from the 30th day and then significantly increased on the 60th day, while no obvious changes were found in the control group. Therefore, a possible way was provided for the early evaluation of male reproductive toxicity induced by Phthalate esters (PEs) . The reliability of judgment was improved by observing the changes of five target hormones simultaneously. Furthermore, good compliance was predicted for the practical application due to the noninvasive and convenient urine sample collection.

Nanofibers mat-based solid-phase extraction method for the pretreatment of urine samples and its application in the primary study on the disposition of nonylphenol after long-term low-level exposure in rats.

A method was established for the analysis of nonylphenol (NP) in rat urine samples based on a solid-phase extraction (SPE) procedure with an amino functionalized polyacrylonitrile nanofibers mat (NH2-PAN NFSM) as sorbent coupled with high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The calibration curves prepared in three different days showed good linearity over a wide range of NP concentrations from 0.1 to 100.0ng/mL. It was remarkable that the proposed NH2-PAN NFsM based SPE method showed superior extraction efficiency with the consumption of only 4mg of sorbent and 500µL of eluent. The eluent without any further concentration was directly analyzed by HPLC-MS/MS. As a result, a simple and effective sample preparation was achieved. In addition, the notable lower detection limit (LOD) of 0.03ng/mL revealed the excellent sensitivity of the proposed method in comparison with that in literatures. The recoveries ranged from 85.0% to 114.8% with the relative standard deviations (RSDs) ranging from 7.5% to 13.7%, which were better than or comparable to those from the published methods, suggesting high accuracy of the proposed method. The proposed method was applied in primary study on the disposition of nonylphenol after long-term low-level exposure in rats, providing information for health risk assessment on the real scenarios of NP exposure. NH2-PAN NFsM shows great potential as a novel SPE sorbent for the analysis of biological samples.

Development and optimization of a novel sample preparation method cored on functionalized nanofibers mat-solid-phase extraction for the simultaneous efficient extraction of illegal anionic and cationic dyes in foods.

A simple and efficient three-step sample preparation method was developed and optimized for the simultaneous analysis of illegal anionic and cationic dyes (acid orange 7, metanil yellow, auramine-O, and chrysoidine) in food samples. A novel solid-phase extraction (SPE) procedure based on nanofibers mat (NFsM) was proposed after solvent extraction and freeze-salting out purification. The preferred SPE sorbent was selected from five functionalized NFsMs by orthogonal experimental design, and the optimization of SPE parameters was achieved through response surface methodology (RSM) based on the Box-Behnken design (BBD). Under the optimal conditions, the target analytes could be completely adsorbed by polypyrrole-functionalized polyacrylonitrile NFsM (PPy/PAN NFsM), and the eluent was directly analyzed by high-performance liquid chromatography-diode array detection (HPLC-DAD). The limits of detection (LODs) were between 0.002 and 0.01 mg kg-1, and satisfactory linearity with correlation coefficients (R > 0.99) for each dye in all samples was achieved. Compared with the Chinese standard method and the published methods, the proposed method was simplified greatly with much lower requirement of sorbent (5.0 mg) and organic solvent (2.8 mL) and higher sample preparation speed (10 min/sample), while higher recovery (83.6-116.5%) and precision (RSDs < 7.1%) were obtained. With this developed method, we have successfully detected illegal ionic dyes in three common representative foods: yellow croaker, soybean products, and chili seasonings. Graphical abstract Schematic representation of the process of the three-step sample preparation.

Simple and sensitive determination of atrazine and its toxic metabolites in environmental water by carboxyl modified polyacrylonitrile nanofibers mat-based solid-phase extraction coupled with liquid chromatography-diode array detection.

Carboxyl modified polyacrylonitrile nanofibers mat (COOH-PAN NFsM) was prepared as a novel solid-phase extraction (SPE) adsorbent for the rapid and effective extraction of atrazine (ATZ) and its toxic metabolites deisopropylatrazine (DIA) and deethylatrazine (DEA) from environmental water samples. Without any pre-treatment but only with the simple filter, water samples passed through pre-conditioned COOH-PAN NFsM, which integrated extraction, purification and concentration into one single step, and the eluent was directly analyzed by high performance liquid chromatography-diode array detection (HPLC-DAD). Under the optimized conditions, the target analytes in 10mL of water sample could be completely extracted by only 4mg of COOH-PAN NFsM, and easily eluted using 400µL of methanol, indicating a high efficiency in both adsorption and desorption. Satisfactory linearity was achieved in the range of 0.4-40.0ngmL-1 for DIA, and 0.3-40.0ngmL-1 for DEA and ATZ. The limit of detection (LODs) were 0.12, 0.09 and 0.09ngmL-1 for DIA, DEA and ATZ, respectively. The recoveries ranged from 81.35 to 120.32%, with the intra-day and inter-day relative standard deviations of 4.03-9.81% even after the 6-cycle usage of NFsM. And, using just 10mL loading sample, the LOD had already satisfied the demand of surface water quality monitoring levels, revealing the good sensitivity of the proposed method.

Effects of six priority controlled phthalate esters with long-term low-dose integrated exposure on male reproductive toxicity in rats.

Human beings are inevitably exposed to ubiquitous phthalate esters (PEs) surroundings. The purposes of this study were to investigate the effects of long-term low-dose exposure to the mixture of six priority controlled phthalate esters (MIXPs): dimethyl phthalate (DMP), diethyl phthalate (DEP), di(n-butyl) phthalate (DBP), butyl benzyl phthalate (BBP), di(2-ethyhexyl) phthalate (DEHP) and di-n-octyl phthalate (DNOP), on male rat reproductive system and further to explore the underlying mechanisms of the reproductive toxicity. The male rats were orally exposed to either sodium carboxymethyl cellulose as controls or MIXPs at three different low-doses by gavage for 15 weeks. Testosterone and luteinizing hormone (LH) in serum were analyzed, and pathological examinations were performed for toxicity evaluation. Steroidogenic proteins (StAR, P450scc, CYP17A1 and 17ß-HSD), cell cycle and apoptosis-related proteins (p53, Chk1, Cdc2, CDK6, Bcl-2 and Bax) were measured for mechanisms exploration. MIXPs with long-term low-dose exposure could cause male reproductive toxicity to the rats, including the decrease of both serum and testicular testosterone, and the constructional damage of testis. These effects were related to down-regulated steroidogenic proteins, arresting cell cycle progression and promoting apoptosis in rat testicular cells. The results indicate that MIXPs with long-term low-dose exposure may pose male reproductive toxicity in human.

A high-throughput nanofibers mat-based micro-solid phase extraction for the determination of cationic dyes in wastewater.

This study used nanofibers mat (NFsM)-based micro-SPE (µ-SPE) in 96-well plate format as a novel high-throughput sample preparation technique prior to the determination of cationic dyes in wastewater using HPLC-DAD. P-Toluene sulfonate (PTS(-)) doped polypyrrole (PPy) functionalized NFsM (PTS-PPy NFsM) was optimized as SPE sorbent in aspects of PPy form (particles and NFsM) and its doped anions (Cl(-) and PTS(-)), which showed good extraction efficiency and adsorption capacity for cationic dyes (Auramine-O, Chrysoidine and Rhodamine-B). Under the optimal conditions, the limits of detection (LODs) were between 0.3 and 0.5µg/L, and the linearity was achieved in the concentration ranging from 1.0 to 150.0µg/L with correlation coefficients (R) between 0.992 and 0.999. Compared with the published SPE methods, this approach demonstrated its advantages such as shorter extraction time (0.3min per sample), lower requirement sorbent (2.0mg), lower volume of organic solvent (0.7mL), higher recovery (90.1-99.1%) and precision (RSDs<6.9%). With this developed method, we have successfully analyzed the dyeing industry wastewater, which meets the Discharge Standards of Water Pollutants for Dyeing and Finishing of Textile Industry in China. The concentrations of three analyzed cationic dyes were from 2.9 to 13.9µg/L. The NFsM-based µ-SPE technique is practically a high-throughput sample preparation procedure that can accurately assess the pollutants in the wastewater from dyeing industry.