A protocol of Chinese expert consensuses for the management of health risk in the general public.

Introduction: Non-communicable diseases (NCDs) represent the leading cause of mortality and disability worldwide. Robust evidence has demonstrated that modifiable lifestyle factors such as unhealthy diet, smoking, alcohol consumption and physical inactivity are the primary causes of NCDs. Although a series of guidelines for the management of NCDs have been published in China, these guidelines mainly focus on clinical practice targeting clinicians rather than the general population, and the evidence for NCD prevention based on modifiable lifestyle factors has been disorganized. Therefore, comprehensive and evidence-based guidance for the risk management of major NCDs for the general Chinese population is urgently needed. To achieve this overarching aim, we plan to develop a series of expert consensuses covering 15 major NCDs on health risk management for the general Chinese population. The objectives of these consensuses are (1) to identify and recommend suitable risk assessment methods for the Chinese population; and (2) to make recommendations for the prevention of major NCDs by integrating the current best evidence and experts' opinions. Methods and analysis: For each expert consensus, we will establish a consensus working group comprising 40-50 members. Consensus questions will be formulated by integrating literature reviews, expert opinions, and an online survey. Systematic reviews will be considered as the primary evidence sources. We will conduct new systematic reviews if there are no eligible systematic reviews, the methodological quality is low, or the existing systematic reviews have been published for more than 3 years. We will evaluate the quality of evidence and make recommendations according to the GRADE approach. The consensuses will be reported according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT).

Identifying the natural and anthropogenic factors influencing the spatial disparity of population hollowing in traditional villages within a prefecture-level city.

In developing countries, the phenomena of rural depopulation have been an intense continuing, which have become a major bottleneck for the sustainable revitalization of traditional villages. However, the factors influencing the spatial disparity of population hollowing (SDPH) in traditional villages within a prefecture-level city have not been fully quantitatively researched. Based on the factors that influence general villages, this study incorporated historical and cultural factors related to traditional village characteristics to construct a targeted influencing factor index system and then identified the key factors by applying the geo-detector method. With the percentage of resident population (PRP) used as a metric, this study examined Lishui, one of China's traditional village agglomeration regions, as an example to explore SDPH in traditional villages. The results of this study were revealed in the following. (1) The average PRP value in traditional villages in Lishui was 0.68, with clear spatial disparities between the northern region (0.73) and the southern region (0.57). (2) The factors driving the SDPH included both natural and anthropogenic factors; of these, altitude, the number of public facilities, and the number of communication base stations were the most significant influencing factors. In contrast, historical and cultural factors have relatively low impacts. (3) The interaction relationships of pair factors were often enhanced on a bivariate basis, with the highest enhanced impact occurring from the interaction of two variables: the degree of intangible cultural inheritance and altitude. (4) The intervals of the variables leading to the hollowing of the population above a moderate level can be detected. This method can effectively analyze the factors influencing SDPH in traditional villages; can help reveal the interaction impact of pair factors; and can help identify the factors' risk intervals.

Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review.

PURPOSE: Type B aortic dissection is a rare but life-threatening disease. Thoracic endovascular aortic repair (TEVAR) was widely used for Type B aortic dissection patients in the last decade due to the lower mortality and morbidity compared with open chest surgical repair (OCSR). AKI in type B aortic dissection is a well-recognized complication and indicates poor short-term and long-term outcome. The objective of this concise review was to identify the risk factors and the impact of AKI on type B aortic dissection patients. METHODS AND RESULTS: A literature search was performed using PubMed, Embase, MEDLINE, and Cochrane Library with the search terms 'type B aortic dissection' and 'acute kidney injury' (AKI), and all English-language literatures published in print or available online from inception through August 2020 were thoroughly reviewed. Studies that reported relative AKI risks and outcomes in type B aortic dissection patient were included. Major mechanisms of AKI in type B aortic dissection included renal hypoperfusion, inflammation response, and the use of contrast medium. Type B aortic dissection patients with AKI significantly had increased hospital stay duration, need of renal replacement therapy, and 30-d and 1-year mortality. CONCLUSIONS: AKI in type B aortic dissection is a well-recognized complication and associated with poor short-term and long-term outcome. Early identification of high-risk patients, early diagnosis of AKI, stabilization of the hemodynamic parameters, avoidance of nephrotoxic drugs, and optimization of the use of contrast agents are the major strategies for the reduction of AKI in type B aortic dissection patients.

Evidence of forest restoration success and the conservation value of community-owned forests in Southwest China using dung beetles as indicators.

Protection of the world's remaining forests and biodiversity is a matter of global concern. Yunnan, China is home to China's only mainland tropical rainforests, and 20% of China's total biodiversity. Despite restoration measures and establishment of new protected areas, this region is still experiencing biodiversity loss due to inadequate management and monitoring. We evaluate restoration success of China's tropical forests in Xishuangbanna National Nature Reserve (XSBN-NNR), Yunnan, China using dung beetles as an indicator taxon. We sampled across a land-use gradient of human alteration: protected forest, restored forest, community owned forest, and rubber plantation. We collected 3,748 dung beetles from 21 species over a 3 month period. Multivariate analyses revealed unique assemblages in each land-use category, but with restored forest most similar to protected areas, suggesting restoration success in this region. Community forests were more diverse than plantations, suggesting that community forests may be a valuable and practical conservation tool in this region. Most species were generalists, although some had dietary and habitat preferences. Furthermore, dietary niche breadths were, on average, higher in disturbed areas, suggesting that disturbance may result in dietary changes. We show that restoration of tropical forests appears to be successful for a key ecological and biological indicator group- dung beetles. Furthermore, community-owned forests appear to be valuable and practical method of maintaining ecosystem health and biodiversity in the region. Future management in this region would likely benefit from encouragement to maintain community-owned forests, economic incentives for restoring farmland to forest, and increased environmental monitoring across the land-use gradient.

Gender differences in positive life orientation among the nursing home elders in China: A cross-sectional study.

INTRODUCTION: Life orientation among the nursing home elders would differ from those of community-dwelling elders due to the different living environment, but may have greater differences in gender. OBJECTIVES: This study was designed to investigate the positive life orientation and explore the potential risk factors including gender disparities among nursing home elders in China. METHODS: This cross-sectional study was conducted in Northeast China. Two steps cluster sampling procedure were chosen. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) systems were used to estimate the functional status. Positive life orientation was measured using the six-question life orientation scale (LOS). RESULTS: 2512 nursing home elders were enrolled in the study. The mean age of the participants was 73.14±6.746years. Of the 1308 men and 1204 women, 14.9% had a positive life orientation in women and 16.1% in men. Higher level of education, independent in BADL and IADL were related to positive life orientation both in men and women. Age and BMI were also found to be significantly associated with positive life orientation in men (OR=0.587, 1.132, respectively). For women, the influence of income and vision on positive life orientation was also significant (OR=1.967, 1.926, respectively). CONCLUSION: The positive life orientation was higher in men than women. The gender-specific differences contribute to take more effective measures to improve the positive life orientation.

The burden of depressive symptoms and various chronic conditions and health concerns on the quality of life among those with Medicare Supplement Insurance.

OBJECTIVE: This study aims to estimate the burden of currently having depressive symptoms on quality of life independently and in combination with various chronic conditions/health concerns among adults with Medicare Supplement Insurance (i.e., Medigap) coverage. METHODS: Data were obtained from the Health Update Survey (HUS). The HUS contains questions on demographics, comorbid conditions, and all of the questions on the Veterans RAND 12-item (VR-12) health status/quality of life survey. The survey was mailed to a random sample of 30,000 insureds from 10 states between 2008 and 2009. On the basis of relevant questions from the survey, respondents were categorized into two groups: those currently suffering from current depressive symptoms (N = 2283) and those who never had depressive symptoms (N = 7058). Multiple regression modeling was used to test the impact on quality of life of depressive symptoms independently or as an interaction of depressive symptoms with various chronic conditions/health concerns. RESULTS: Depressive symptoms were common, with an estimated prevalence of 24.4%. The greatest impact of depressive symptoms in combination with various chronic conditions/health concerns on quality of life was on the ability to handle emotional roles, bodily pain, social functioning, and ability to handle physical roles. Most of the significant interactions between depressive symptoms and various chronic conditions/health concerns were demonstrated for those chronic conditions contributing to functional impairment (e.g., difficulty walking, falls, chronic pain, and diabetes). CONCLUSIONS: Although depressive symptoms independently reduced quality of life, having depressive symptoms in addition to other chronic conditions/health concerns had a greater impact on quality of life.

The prevalence of hearing impairment and its burden on the quality of life among adults with Medicare Supplement Insurance.

PURPOSE: To estimate the impact of hearing impairment on quality of life from a physical and mental standpoint. METHODS: Data were obtained from the Health Update Survey, which contains questions on demographics, comorbid conditions, and the Veterans RAND 12-item health status/quality of life survey. It was fielded on a random sample of 15,000 adults with an AARP(®) Medicare Supplement plan, insured by UnitedHealthcare. Respondents were divided into those with hearing impairments and others, based on their response to a survey question. Univariate and multivariate analyses were conducted to estimate the likelihood of hearing impairment and its impact on quality of life while controlling for respondent demographics and comorbid conditions. RESULTS: Of the 5,515 eligible respondents, 10.4% reported having hearing impairments. The strongest predictor of hearing impairment was older age, while those with 4 years of college or more were least likely to have hearing impairments. Those with hearing impairments averaged significantly lower physical component and mental component scores, exceeding those of numerous other chronic conditions. CONCLUSIONS: This is the first known study of hearing impairment among those with Medigap coverage. Hearing impairment was strongly associated with lower quality of life from both a physical and mental health standpoint.

The burden of falling on the quality of life of adults with Medicare supplement insurance.

To study the impact of falling or risk of falling on quality of life (QOL) outcomes, a survey was mailed to a random sample of 15,000 adults with an AARP® Medicare Supplement plan insured by UnitedHealthcare from 10 states in 2008. Approximately 21% had fallen in the past year; 17% did not fall but reported balance or walking problems (i.e., at high risk of falling); and 62% were in the low-risk, no-falls comparison group. Multiple regression analyses showed the strongest predictors of falling or being at high risk of falling were advancing age, female gender, heart conditions, stroke, digestive disorders, arthritis, sciatica, diabetes, and hearing problems. Average physical and mental component scores were significantly lower for both those who fell and those at risk of falling than the comparison group, indicating that falling or being at risk of falling had a stronger negative influence on QOL than most of the comorbidities measured. Clinicians, patients, and families should be aware of the potential negative impact of falling and fear of falling on the QOL of older adults.

The prevalence of urinary incontinence and its burden on the quality of life among older adults with medicare supplement insurance.

PURPOSE: Estimate the prevalence and burden of urinary incontinence (UI) on the quality of life (QOL) among adults (65 or older) with Medigap insurance. METHODS: Data were obtained from the health update survey (HUS), which contains questions on demographics, comorbid conditions, and the Veteran's RAND 12-item health status survey. The mail survey was fielded on a random sample of 15,000 insureds from 10 states in 2008. Respondents were divided into those with UI and others, based on their response to a question about leaking urine during the last six months. Univariate and multivariate analyses were conducted to estimate the likelihood of UI and its impact on QOL while controlling for respondent demographics and comorbid conditions. RESULTS: Of the 5,530 eligible respondents, 37.5% reported having UI. The strongest predictors of UI were female gender, advancing age, and obesity. All the QOL estimates were significantly lower for those with UI (P < 0.001). Further, UI had a stronger influence on QOL than did diabetes, cancer, and arthritis, particularly from a mental health standpoint. CONCLUSIONS: Consistent with other Medicare populations (e.g. Medicare managed care), UI was common in Medigap insureds, strongly associated with lower QOL affecting mental, physical, and social well-being, and is often untreated.

Bamboo saccharification through cellulose solvent-based biomass pretreatment followed by enzymatic hydrolysis at ultra-low cellulase loadings.

The modified cellulose solvent- (concentrated phosphoric acid) and organic solvent- (95% ethanol) based lignocellulose fractionation (COSLIF) was applied to a naturally-dry moso bamboo sample. The biomass dissolution conditions were 50 degrees C, 1 atm for 60 min. Glucan digestibility was 88.2% at an ultra-low cellulase loading of one filter paper unit per gram of glucan. The overall glucose and xylose yields were 86.0% and 82.6%, respectively. COSLIF efficiently destructed bamboo's fibril structure, resulting in a approximately 33-fold increase in cellulose accessibility to cellulase (CAC) from 0.27 to 9.14 m(2) per gram of biomass. Cost analysis indicated that a 15-fold decrease in use of costly cellulase would be of importance to decrease overall costs of biomass saccharification when cellulase costs are higher than $0.15 per gallon of cellulosic ethanol.