Low-cost diatomite supported binary transition metal sulfates: an efficient reusable solid catalyst for biodiesel synthesis.

Using a simple method of impregnation and then calcination, diatomite supported binary transition metal sulfates (Fe and Zr, designated as Fe2(SO4)3&Zr(SO4)2@diatomite) were prepared and used as a catalyst in the preparation of renewable biofuels. The synthesised Fe2(SO4)3&Zr(SO4)2@diatomite catalyst (Fe2(SO4)3 : Zr(SO4)2 : diatomite = 1 : 2 : 6, mass ratio) was thoroughly characterised using transmission electron microscopy (TEM), X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, microbeam X-ray fluorescence (µ-XRF) spectroscopy and thermogravimetric analysis (TG). The results demonstrated that the sulfate was successfully loaded onto the diatomite with a uniform distribution. The N2 adsorption/desorption analysis indicated that the catalyst's specific surface area was 1.54 m2 g-1. The catalyst exhibited outstanding performance in the preparation of renewable biofuel (biodiesel) from waste fatty acids and the optimal parameters were methanol-to-oil 1.25 : 1, reaction temperature 70 °C, catalyst concentration 10 wt%, reaction time 4 h. The conversion was found to reach 98.90% under optimal parameters, which is better than that of Fe2(SO4)3·xH2O, Zr(SO4)2·4H2O, Fe2(SO4)3@diatomite and Zr(SO4)2@diatomite. Moreover, the catalyst can be recycled by simple filtration and reused for three cycles after regeneration without noticeable reduction in catalytic activity.

Association of childhood threat and deprivation with depressive symptoms and the moderating role of current economic status among middle-aged and older adults in China.

PURPOSE: To investigate the independent impact of threat-related and deprivation-related adverse childhood experiences (ACEs) on depressive symptoms among middle-aged and older adults, and to evaluate the moderating role of current economic status in these associations. METHODS: This cross-sectional study included 11,048 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We captured five threat-related ACEs and five deprivation-related ACEs by questionnaires. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Current economic status was reflected by annual per capita household consumption expenditure. We performed logistic regression analyses to evaluate the independent association of childhood threat and deprivation with depressive symptoms, and conducted stratified analyses and tests for interaction to explore the moderation effect of current economic status in such associations. RESULTS: Compared with the nonexposed group, the experience of both childhood threat and deprivation were independently associated with greater risks of depressive symptoms later in life (odds ratio [OR] 1.75, 95% CI 1.49-2.05 for ≥ 2 threat-related ACEs; OR 2.02, 95% CI 1.67-2.43 for ≥ 2 deprivation-related ACEs). High current economic status significantly ameliorated the impact of childhood deprivation, but not threat, on depressive symptoms (P value for interaction 0.038). CONCLUSIONS: Both threat-related and deprivation-related ACEs were associated with the risk of depressive symptoms among middle-aged and older adults, while current economic status was a significant moderator in such risks only for childhood deprivation. The findings implied that prioritising targeted interventions for individuals with ACEs, especially for childhood deprivation victims who were economically disadvantaged in adulthood, may help mitigate depressive symptoms in later life.

Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics.

Importance: Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored. Objectives: To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations. Design, Setting, and Participants: This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020. Exposures: Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more. Main Outcomes and Measures: Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. Results: Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity. Conclusions and Relevance: In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.

Analysis of the economic burden of diagnosis and treatment on patients with tuberculosis in Bao'an district of Shenzhen City, China.

BACKGROUND: Illness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Few studies have investigated the full costs, including direct and indirect costs, at the patient and household levels in south-east China. METHODS: A case follow-up study was conducted in the Bao'an district of Shenzhen City, China. Eligible new and previously treated individuals with pulmonary tuberculosis (TB) during January 1st 2013 to June 30th 2013 were enrolled. Medical and non-medical costs as well as income loss were calculated in diagnosis and treatment periods, respectively. Factors associated with costs due to TB diagnosis, treatment and TB care (diagnosis + treatment) were explored respectively with a linear regression model. RESULTS: Of the total 514 TB patients enrolled, 95% were from the migrant population, and 65% were males, with a mean age of 32.25 (±10.11). The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively. The median costs due to TB care (diagnosis and treatment) per patient was 1218USD, corresponding to 26% of patients' annual income pre-illness. Those who visited more times to health facilities, hospitalized, received higher education, or occupied in national civil servant/services/retired staff might expense more before diagnosis. Costs due to TB treatment was significantly higher among migrant patients, sputum smear positive patients, and widowed/divorced population. Factors associated with less total costs were native patients, fewer times of visiting to health-care facilities and those with no hospitalization history due to TB. CONCLUSIONS: Although a free TB control policy is in force, patients with TB are still facing a heavy economic burden. More available interventions to reduce the financial burden on tuberculosis patients are urgently needed.

Associations of CYP2A6 genotype with smoking behaviors in southern China.

AIMS: To investigate the association of CYP2A6 genetic polymorphisms with smoking-related phenotypes in Chinese smokers. DESIGN: Case-only genetic association study. SETTING: Southern China. PARTICIPANTS: A total of 1328 Han Chinese smokers who participated in a community-based chronic disease screening project in Guangzhou and Zhuhai from 2006 to 2007. MEASUREMENTS: All participants answered a structured questionnaire about socio-demographic status and smoking behaviors and informative alleles were genotyped for the cytochrome P450 2A6 (CYP2A6) gene (CYP2A6*4,*5,*7,*9 and *10). FINDINGS: The frequencies of CYP2A6*4, *5, *7, *9 and *10 alleles were 8.5, 1.2, 6.3, 13.5 and 2.4%, which corresponded to 48.9, 15.4, 24.2 and 11.5% of participants being classified as normal, intermediate, slow and poor metabolizers, respectively. Multivariate analyses in male smokers demonstrated that compared with normal metabolizers, poor metabolizers reported smoking fewer cigarettes per day [adjusted odds ratio (OR) = 0.49; 95% confidence interval (CI): 0.32-0.76], started smoking regularly later in life (adjusted OR = 1.55; 95% CI: 1.06-2.26) and, among former smokers, reported smoking for a shorter duration prior to quitting (adjusted OR = 0.33; 95% CI: 0.12-0.94). However, poor metabolizers were less likely to quit smoking and remain abstinent than normal metabolizers (adjusted OR = 0.54; 95% CI: 0.34-0.86). CONCLUSIONS: Reduced metabolism function of cytochrome P450 2A6 in smokers appears to be associated with fewer cigarettes smoked, later initiation of smoking regularly, shorter smoking duration and lower likelihood of smoking cessation.

How do type 2 diabetes mellitus-related chronic complications impact direct medical cost in four major cities of urban China?

OBJECTIVE: The purpose of this study was to evaluate the direct medical costs of type 2 diabetes mellitus with or without complications, and to determine the economic impact of complications on type 2 diabetic patients. METHODS: We performed a cross-sectional study of prevalent type 2 diabetes carried out in four major cities of China. The study populations were 1530 outpatients and 524 inpatients from clinics or wards of a total of 20 hospitals, using a two-phase subject enrollment process, by face-to-face interview with a unique questionnaire. RESULTS: The annual direct medical cost per patient was estimated to be 4800 Chinese Yuan (CNY) in median or 10,164 CNY in mean. There is a difference between annual direct medical costs for patients with or without complications (6056 vs. 3583 CNY; P < 0.001). It is also significantly different for the pay-out-of-pocket proportions (P = 0.015) between the patients with (44.6%) and without complications (40.4%). The direct medical cost varied significantly among the four cities (P < 0.001). Patients who simultaneously suffered microvascular and macrovascular diseases had higher direct medical cost (7600) than those with macrovascular (6000) (P = 0.012) and microvascular disease (5364) (P < 0.001), and those without both (3600) (P < 0.001). The correlation was statistically significant between the number of complications and direct medical costs (P < 0.001). CONCLUSIONS: The high economic burden raised by diabetes and its complications challenges the Chinese health-care system. It implicates an urgent need of intervention to prevent the development of long-term complications among the diabetic population, especially on the development of complications in high-cost body system.

Type 2 diabetes mellitus in China: a preventable economic burden.

OBJECTIVES: To estimate the direct and indirect costs of type 2 diabetes mellitus (T2DM) in China in 2007 and project these costs for the year 2030, and to examine and compare the benefits of selected interventions. STUDY DESIGN: Annual direct costs of medical and nonmedical care and indirect costs of income losses were estimated through case calculation of data from a cross-sectional survey carried out in 4 major Chinese cities from March 2007 to September 2007. METHODS: The subjects were consecutively recruited T2DM outpatients and inpatients from 20 secondary and tertiary hospitals using selection probability proportional to size sampling. We combined the existing data from cost-effectiveness studies into the case estimation to examine the benefits of the observed regime of interventions for preventing and treating diabetes. RESULTS: Annual direct medical and direct nonmedical costs per case averaged 1320.90 USD and 180.80 USD, respectively. The mean annual indirect costs of T2DM and its complications were estimated to be 206.10 USD. Based on case numbers in 2007 and projected case numbers in 2030, the direct medical costs of T2DM and its complications were estimated to be 26.0 billion USD in 2007 and were projected to be 47.2 billion USD in 2030. CONCLUSIONS: The results indicated that T2DM consumes a large portion of healthcare expenditures and will continue to place a heavy burden on health budgets in the future. Preventive intervention, screening, and treatment strategies may effectively decrease the incidence and complications of diabetes and therefore save costs.

Energy expenditure and energy intake in 10-12 years obese and non-obese Chinese children in a Guangzhou boarding school.

OBJECTIVE: The objective of this study was to observe the variation of energy intake and energy expenditure in the obese Chinese children. METHODS: Basic metabolic rate was measured by using open-circuit indirect calorimetry in 54 obese children and 60 non-obese children aged 10-12 years in a full- time boarding school in Guangzhou suburb, China. Total energy expenditure was estimated by using a factorial method. Dietary intake was surveyed by the weighed inventory method. Physical activity was determined using a 2-day activity diary. RESULTS: Univariate analysis showed that basic metabolic rate was significantly higher (p<0.05) in obese children than in non-obese ones, but the significant difference disappeared after controlling for fat free mass and fat mass. Energy intake and total energy expenditure were significantly higher (p<0.05) in obese than in non-obese children. Obese children spent more time in sleeping and light physical activity, but less time in moderate physical activity and vigorous physical activity than non-obese children (p<0.05). CONCLUSIONS: Compared to non-obese children, both energy intake and expenditure were higher in obese Chinese children. It appears that an area for preventive strategies may be to encourage increased physical activity expenditure in this age group.

Differences in students' smoking-related knowledge, attitudes, and behaviors among public, factory, and private secondary schools in Guangzhou, China.

BACKGROUND: The prevalence of smoking among Chinese adolescents has dramatically increased in recent years. The purpose of this study was to examine the differences in smoking-related knowledge, attitudes, and behaviors among Chinese students in 3 types of secondary schools. METHODS: This cross-sectional study was conducted among 3,957 students of seventh, eighth, and ninth grades and 2,870 student parents from 3 public, 1 factory, and 2 general-paid private secondary schools at Guangzhou in 2004. Participants were asked to complete self-administered questionnaires about sociodemographic characteristics, smoking-related family and school environments, smoking-related knowledge and attitudes, and smoking behaviors. RESULTS: The average scores of students' smoking-related knowledge and attitudes (higher score, more against smoking) were highest in the factory school, followed by public schools and private schools. The differences among them were statistically significantly (P < .05). The lifetime smoking prevalence was also significantly different (P < .001) among 3 types of schools: 35.4% in private schools, 17.4% in public schools, and 13.2% in the factory school. The prevalence of students' weekly smoking was also higher in private schools (6.2%) than in public schools (4.9%) or the factory school (4.0%). Similar disparity was observed in the prevalence of daily smoking (3.9% private, 3.5% public, and 2.7% factory). However, differences in weekly and daily smoking were not statistically significant (P > .05). CONCLUSIONS: Compared with students in public and factory schools, those in general-paid private schools had poorer smoking-related knowledge, more supportive attitudes toward smoking, and more popular smoking behaviors. Therefore, more intensive smoking prevention programs should be implemented among them.

[Evaluation on the application of the mouse nicotine toxicity experiment in tobacco control among adolescents].

OBJECTIVE: To explore the application of the mouse nicotine toxicity experiment in tobacco control among adolescents. METHODS: A cross-sectional survey was conducted among 1626 students of three secondary schools with self-administered questionnaires three months after the intervention. The measurements of the student' s evaluation included their response, confidence and support to the experiment. RESULTS: Among the respondents, 87.4% had interest in the experiment and 84.0% had perceived its impact. The mouse nicotine toxicity experiment was attracted by greater interest from the students and was strong perceived by impact on them, when compared with the multi-media and the textbook. There were statistically significant (P < 0.001) difference in students' response between the three interventions. And 85.5% of the students believed that nicotine could be similar effects on the human body and 83.7% thought that the experiment could educate middle school students refuse smoking. Among the students, 76.4% agreed to show this kind of animal experiments to middle school students but 9.4% objected. 843 (51.9%) students were willing to do the experiment by themselves. The grade 7 students had lower response and confidence to the experiment than grade 8 students (P < 0.05). The evaluation on the experiment were significant (P < 0.05) different among the students in three smoking stages: non-smokers more than irregular smokers more than regular smokers. CONCLUSION: The mouse nicotine toxicity experiment was believed by most students and could get great support from them. It could deserve wider application in school-based tobacco control programs.

[Analysis on the influence factors of parental participation in prevention and control of smoking among secondary school students].

OBJECTIVE: To identify the influence factors of parental participation in tobacco control among adolescents. METHODS: In a cross-sectional survey, self-administered questionnaires were used to collect data about smoking-related information from 2851 students and their parents in six secondary schools. The method of Ordinal Regression was applied to select significant influence factors. RESULTS: A total of 2617 pairs of valid questionnaires were included in final analysis. The portion of parents with V level participation was highest (46.4%), followed by IV level at 33.4%, III level at 13.4%, II level at 4.9% and I level at 1.9%. The mothers' participation was significant (P < 0.05) higher than fathers'. With Ordinal Regression, ten variables were selected as significant influence factors that could predict parental participation. Eight of them were associated with high parental participation and ranked as follows according to odds ratio: high education level, ever tried to quit smoking, correct attitudes to image and psychological effects of smoking, level of knowledge about respiratory diseases and cancers caused by cigarette smoking, correct attitudes to bans of smoking, having a male child, correct attitudes to smoking and personal interaction, and correct attitudes to health damage of smoking. On the contrary, two variables had significant association with low parental participation: current smoking and ages of parents. CONCLUSION: The parents with lower education level, older age, daughters and current smoking are comparatively inactive in tobacco control among adolescents. Health promotion family is proposed as an effective way to increase their participation. As a result, the prevalence of smoking among adolescents in China will be under control in some extent.