Effect of Consultation Number on the Assessment and Treatment of Polycystic Ovary Syndrome.

Background: The basic medical education stage is not enough to support physicians to fully diagnose and evaluate polycystic ovary syndrome (PCOS). The study aims to discover the difference in treatment choice between participants with different annual consultation number of PCOS, to promote lifelong learning, and drive balanced development within healthcare. Methods: This is a multicenter cross-sectional survey. Participants' basic information, knowledge of PCOS and treatment options were collected online. According to the annual consultation number of patients with PCOS, physicians were divided into three groups: 0-50 people/yr, 50-200 people/yr, and >200 people/yr, and the results were derived from χ2 test, Fisher exact test, and multivariate logistic regression analysis. Results: The study analyzed 1689 questionnaires, and 1206 physicians (71.4%) received less than 50 women per year, 388 physicians (30.0%) with an annual number of 50-200 women, and 95 physicians (5.6%) with patient turnover for more than 200 people. Reproductive endocrinologists generally have higher access to the clinic. As the number of visits increases, more and more physicians would perceive patients as more likely to have abnormal blood glucose and heavy weight. Physicians with large numbers of consultations are more likely to use Asian or Chinese standards to assess obesity. The multivariate analysis involved variables such as age, hospital level, specialty, and patient turnover annually, and more young doctors actively assessed lipid profile (odds ratio (OR) 1.56, 95% confidence interval (CI) (1.16, 2.16)), and primary hospitals (OR 0.65 CI (0.44, 0.89)) chose OGTT for blood glucose assessment less than tertiary hospitals. Physicians in secondary hospitals are more aggressive in evaluating androgens. Conclusion: Our survey found differences in endocrine assessment, metabolic screening, and treatment in PCOS women in terms of the number of obstetrician-gynecologists who received different patient consultation numbers. The importance of continuing education for physicians is emphasized, to promote lifelong learning.

The effectiveness and safety of centralized early rehabilitation care for critically ill children with severe acquired brain injury: A retrospective cohort and implementation study.

BACKGROUND: Most children with neurocritical illness are at risk of physical, neurocognitive, and psychosocial sequelae and need centralized early rehabilitation care. OBJECTIVE: To identify the effectiveness and safety of centralized early rehabilitation care for children with severe acquired brain injury. METHODS: This is a mixed methods study-an implementation study and single-center retrospective cohort study with historical control. All children with severe acquired brain injury hospitalized in a specialized rehabilitation center in a comprehensive tertiary pediatric hospital between September 2016 and August 2020 were included. Patients treated in the centralized early rehabilitation unit were compared to historical controls dispersed in the normal inpatient rehabilitation ward. The effectiveness outcomes were measured by the Pediatric Cerebral Performance Category (PCPC) scale and the incidence of newly onset comorbidities. The safety outcomes were indicated by the mortality rate and the incidence of unexpected referrals. RESULTS: One hundred seventy-five patients were included. The delta PCPC scores of the first 4 weeks of inpatient rehabilitation in the intervention group were significantly lower than the control group (Z = -2.395, p = 0.017). The PCPC scores at 1 year in the intervention group were significantly reduced as compared to the control group (Z = -3.337, p = 0.001). The incidence of newly onset pneumonia/bronchitis was also decreased in the intervention group (χ2 = 4.517, p = 0.034). No death of patients was recorded, and there was no significant difference in unexpected referral rate between the two groups (χ2 = 0.374, p = 0.541). CONCLUSIONS: The centralized pediatrics early rehabilitation unit is effective and safe for children with severe acquired brain injury. Further multicenter prospective implementation studies on effectiveness, safety, and economic evaluation are needed.

Nickel uptake in leafy greens from contaminated soil: an investigation into phytoavailability and health risk assessment using in vitro digestion model.

Nickel (Ni) is a toxic metal that not only pollutes the environment but also causes harmful impacts on plant growth and human health. Therefore, it is crucial to assess the relationship between the phytoavailability of Ni in soil and its accumulation in edible and non-edible parts of vegetables. A pot experiment was conducted to investigate Ni uptake in three different leafy vegetables, spinach (Spinacia oleracea L.), lettuce (Lactuca sativa L.), and fenugreek (Trigonella foenum-graecum L.), grown in soil artificially contaminated with Ni at three different treatment levels (100 mg kg-1, 200 mg kg-1, and 300 mg kg-1). The potential dietary toxicity of these vegetables in humans was examined by using an in vitro digestion model. The lowest and highest chlorophyll contents were detected in lettuce at 300 mg kg-1 of Ni concentration and in control plants of spinach. Their values were 34.16 ± 3.01 (SPAD unit) and 53 ± 3.7673 (SPAD unit), respectively. Among the three vegetables, lettuce and spinach at 300 mg kg-1 exhibited the highest accumulation of Ni, with 43 mg kg-1 in edible parts and 182 mg kg-1 in non-edible parts. Furthermore, health risk index (HRI) values were found to be > 1 for lettuce and fenugreek at Ni concentrations of 200 and 300 mg kg-1 for both children and adults. The average bioaccessibility of Ni in lettuce, fenugreek, and spinach during the gastrointestinal phase was 32-23%, 24-10%, and 45-37%, respectively, at a Ni concentration of 300 mg kg-1. All three vegetables grown on Ni-contaminated soil may potentially contribute to food chain toxicity. The HRI values being > 1 suggest that these vegetables are unsafe for consumption. Monitoring of Ni concentration in leafy vegetables is essential to minimize human health risks associated with food chain contamination.

Validation of the mild cognitive impairment health literacy assessment scale (MCI-HLA scale) in middle-aged and older adults.

OBJECTIVES: Health literacy (HL) is associated with early prevention of mild cognitive impairment (MCI), but a targeted comprehensive assessment tool is lacking. This study aims to psychometrically evaluate the MCI-HLA scale. METHODS: This observational study was conducted in a tertiary-level hospital's physical examination center from October to December 2020. The middle-aged and older adults (N = 550, aged 41-80 years) completed the MCI-HLA questionnaire online. The validity of the MCI-HLA scale was assessed through content validity, exploratory factor analysis, confirmatory factor analysis (CFA), convergent validity, and discriminant validity. The internal reliability was measured using Cronbach's alpha, McDonald's Omega coefficient, and split-half reliability. RESULTS: 5 factors emerged, naming: Function (7 items), Knowledge (8 items), Practice (8 items), Attitude (4 items), and Motivation (3 items), explaining 72.42% of variance. The CFA revealed that five factors of the MCI-HLA scale fit well (χ2/df=4.076, RMSEA=0.078, SRMR=0.057, CFI=0.904, TLI=0.894). Good convergent validity was suggested by the Average Variance Extracted (AVE) values exceeding 0.50. Discriminant validity was demonstrated for all the square root AVE were higher than the correlation between the two factors. Internal consistency was high (Cronbach's alpha=0.875, McDonald's Omega coefficient=0.910, split-half reliability=0.949). CONCLUSIONS: The MCI-HLA scale takes on high reliability and validity, suitable for assessing MCI-related health literacy in middle-aged and older adults. The MCI-HLA scale could enhance MCI health literacy assessment and supports tailored interventions for improved outcomes.

Low-cost model for pancreatojejunostomy simulation in minimally invasive pancreatoduodenectomy.

Minimally invasive pancreatoduodenectomy (MIS PD) is a well reported technique with several advantages over conventional open pancreatoduodenectomy. In comparison to distal pancreatectomy, the adoption of MIS PD has been slow due to the technical challenges involved, particularly in the reconstruction phase of the pancreatojejunostomy (PJ) anastomosis. Hence, we introduce a low-cost model for PJ anastomosis simulation in MIS PD. We fashioned a model of a cut pancreas and limb of jejunum using economical and easily accessible materials comprising felt fabric and the modelling compound, Play-Doh. Surgeons can practice MIS PJ suturing using this model to help mount their individual learning curve for PJ creation. Our video demonstrates that this model can be utilized in simulation practice mimicking steps during live surgery. Our model is a cost-effective and easily replicable tool for surgeons looking to simulate MIS PJ creation in preparation for MIS PD.

Occurrence, source identification and ecological risk assessment of heavy metals in water and sediments of Uchalli lake - Ramsar site, Pakistan.

Uchalli Lake is an internationally significant Ramsar site that needs protection for supporting migratory birds. The current study aimed to assess wetland health by examining water and sediments utilizing total and labile heavy metals concentration, pollution indices, ecological risk assessment, water recharge and pollution induction sources through isotope tracer techniques. Al concentration in water was of serious concern as it was 440 times higher than the maximum acceptable concentration of Environmental Quality Standard of the UK for aquatic life in saline waters. Labile concentration predicted very severe enrichment of Cd, Pb, and moderate enrichment of Cu. Modified ecological risk index predicted very high ecological risk in sediments. The δ 18O, δ2H and D-excess values indicate that the lake was mainly recharged by local meteoric water. Enriched values of δ 18O and δ2H suggest a high evaporation of lake water, making lake sediments more enriched with metals. Isotopic and D-excess values of groundwater suggest a quick rainwater recharge to groundwater around the Uchalli Lake. Nitrates isotopes indicate that the rainwater runoff is main source of induction of fertilizers, pesticides and soil bonded metals in the lake system. The lake is recharged by rainwater runoff, from catchment areas, that erode the soil particles and agricultural residual waste dumped in the lake.

Cadmium mobility and health risk assessment in the soil-rice-human system using in vitro biaccessibility and in vivo bioavailability assay: Two year field experiment.

Humans are mainly exposed to cadmium (Cd) due to the rice consumption, however there exist considerable differences across rice cultivars in terms of Cd absorption and accumulation in the grains, and subsequent release after digestion (bioaccessibility), as well as uptake by Caco-2 cells of humans (bioavailability). This study comprised of field and lab simulation trials where in the field, firstly 39 mid-rice cultivars were screened for their phytoremediation potential coupled with safe production in relation to uptake and translocation of Cd. Lower Cd concentrations (˂0.2 mg kg-1) in polished rice of 74 % cultivars were ascribed to the increased root to straw translocation indicating that straw may acquire higher accumulation of Cd. Furthermore, the ionomic profile demonstrated that the spatial distribution of metals in different rice organs corresponds to the plant growth morphology. In the second year, in vitro-in vivo assay model was employed to assess the bioaccessibility and bioavailability of Cd in polished rice and to further estimate the daily Cd intake by humans through rice grains. The results of bioaccessibility and bioavailability assays and daily estimated Cd intake presented the corresponding values of 39.02-59.76 %, 8.69-24.26 %, and 0.0185-0.9713 µg kg-1 body weight day-1, respectively. There exists a strong connection between total Cd and bioaccessible Cd to humans (R2 = 0.94, P < 0.01). Polynomial fitting (R2 = 0.91, P < 0.01) showed a better statistically significant correlation between total Cd contents and bioavailable levels, suggesting that in vitro-in vivo assays should be considered in future studies. The results of field experiments and in vitro-in vivo assays recommended the Tianyouhuazhan (MR-29), Heliangyou1hao (MR-17), and Yongyou15 (MR-1) as suitable mid-rice cultivars for the phytoremediation of slightly Cd contaminated soils coupled with rice agro-production due to their high nutritional value and low total and bioavailable Cd for human.

Benefit-Risk Assessment of Dietary Patterns by Bioavailable Metals, Gut Microbes, and Their Interaction for Human Health.

The high-carbohydrate, low-fat, low-protein (HC-LFP) and low-carbohydrate, high-fat, high-protein (LC-HFP) diets are the main dietary patterns worldwide. The influence of dietary patterns on bioavailable metals, gut microbes, and their interaction is still unknown. A biomimetic digestive tract with full functions is constructed to transform the diets into chyme, and the gut microbes are cultured with the corresponding chyme. The diet species-specificity in bioavailable metal content and the positive and negative correlations between bioavailable metals and microbial reproductions are disclosed. The safe dosage and maximum consumption are 369.5 and 858.6 g/d and 268.6 and 3119.0 g/d for LC-HFP and HC-LFP, respectively. When replacing HC-LFP with LC-HFP for 21 days, the bioavailability of Fe and Cr is increased 83.2% and 268.4%, respectively; the reproductions of harmful and benefical microbes are significantly increased and decreased. The prevalences of obesity, inflammation, septicemia, and cancer are increased, and then the risk of dietary pattern shift is disclosed.

Cardiopulmonary exercise test-based assessment of the effects of sacubitril/valsartan on the blood pressure response to exercise in patients with acute myocardial infarction during hospitalization.

OBJECTIVE: To investigate the effects of sacubitril/valsartan (S/V) on cardiopulmonary function and blood pressure response to exercise during hospitalization in patients with acute myocardial infarction (AMI) based on the cardiopulmonary exercise test (CPET). METHODS: A total of 265 AMI patients were treated with either perindopril or S/V within 24 hours of admission. CPET was completed for all patients before discharge. There were 182 cases in the perindopril group and 83 cases in the S/V group. RESULTS: The proportion of exercise oscillatory ventilation (EOV) was higher in the S/V group than in the perindopril group (10.8% vs 1.6%, X2 = 11.148, P = .001). The resting heart rate (HR), resting diastolic blood pressure (DBP), and warm-up DBP were lower in the S/V group than in the perindopril group (P < .05). The resting systolic blood pressure (SBP) was 9.0 mmHg lower (115.7 ± 17.5 vs 106.7 ± 15.0, P < .001), the SBP during warm-up was 9.5 mmHg lower (124.8 ± 23.7 vs 115.3 ± 22.5,P = .002), the SBP at the anaerobic threshold (AT) was 10.5 mmHg lower (135.3 ± 24.8 vs 127.1 ± 25.1,P = .021),the SBP at max watts was 11.5 mmHg lower (148.9 ± 26.4 vs 137.4 ± 26.4,P = .001), and the SBP during one-minute recovery was 12.3 mmHg lower (146.5 ± 27.1 vs 134.2 ± 24.4, P = .001)in the S/V group than in the perindopril group. The S/V group had a higher oxygen ventilation equivalent and carbon dioxide ventilation equivalent (VE/VCO2) at AT and a lower oxygen uptake-work rate relationship during max watts (P < .05). The differences in the oxygen pulse, stroke volume, peak oxygen uptake (VO2 peak), and VE/VCO2 slope were not statistically significant between the two groups. CONCLUSION: Treatment with S/V was able to reduce the exercise blood pressure in patients with AMI during hospitalization, but did not significantly improve the VO2 peak, VE/VCO2 slope, or exercise tolerance.

Kirkpatrick's evaluation of the effect of a nursing innovation team training for clinical nurses.

AIM: This study aims to design a 100-h training programme for nursing innovation teams and to evaluate the effect of this training programme using Kirkpatrick's model. BACKGROUND: The innovative capability of nurses is a powerful driver for the development of the nursing discipline, and it is currently at a low to medium level in China. Innovation competency development has become a research trend in nurses' in-service education, but only changes in nursing innovation behaviours before and after training have been evaluated. The cascading, continuous assessment tools are rarely used. METHODS: This is a quasi-experimental research design: pretest and posttest design. Totally, 61 clinical nurses from Hangzhou Hospital of Traditional Chinese Medicine were enrolled for innovation training. This innovation team training programme consisted of a 36-h theoretical training phase and a 64-h collaborative training phase. The four levels of Kirkpatrick's model, that is, reaction, learning, behaviour, and result, were applied for the evaluation together with questionnaires. RESULTS: At reaction level, the nurses' attendance was over 85% in two phases. The differences between nurse organizational innovation climate scores of tested nurses before and after training were statistically significant (t = -22.559, P < .001). At learning level, there were statistically significant differences between nurses' innovation self-efficacy scale scores of tested nurses before and after training (t = -16.832, P < .001). At behaviour level, the nursing innovation behaviour scale scores of tested nurses were significantly higher after training (t = -18.950, P < .001) than before the training. At result level, the clinical nurse innovation ability of tested nurses after the training were higher than before the training (t = -26.275, P < .001). The numbers of patent applications, granted patents, application for scientific research projects, sponsored scientific research projects, and papers published by team members after the training were larger than those before training (Z = -2.032, P = .042). CONCLUSION: Kirkpatrick's model can evaluate the effectiveness of nursing innovation training for clinical nurses. The nursing innovation training is beneficial to improve nurses' innovation capacity, organizational innovation climate and innovation self-efficacy, and nursing innovation behaviour and promote the output of research and innovation projects. IMPLICATIONS FOR NURSING MANAGEMENT: Managers can flexibly develop training modules with regional characteristics based on this programme to effectively improve the innovation ability of clinical nurses, thus meeting the urgent demand for innovative nursing talents and the rapid development of nursing disciplines.

Chromium Contamination and Health Risk Assessment of Soil and Agricultural Products in a Rural Area in Southern China.

With the rapid development of industry, chromium (Cr) pollutants accumulate constantly in the soil, causing severe soil Cr pollution problems. Farmland Cr pollution hurts the safety of agricultural production and indirectly affects human health and safety. However, the current situation of Cr pollution in farmland soil and crops has not been detailed enough. In this study, the evaluation of Cr potential risk in soil-crop systems was conducted in a rural area that was affected by industry and historic sewage irrigation. Ten different crops and rhizosphere soils were sampled from four fields. The results showed that Cr contents in farmland soil exceeded the national standard threshold in China (>21.85%), and the Cr content in edible parts of some agricultural products exceeded that too. According to the PCA and relation analysis, the Cr accumulation in edible parts showed a significant correlation with soil Cr contents and available potassium contents. Except for water spinach, the target hazard quotient (THQ) of the other crops was lower than 1.0 but the carcinogenic health risks all exceeded the limits. The carcinogenic risks (CR) of different types of crops are food crops > legume crops > leafy vegetable crops and root-tuber crops. A comprehensive assessment revealed that planting water spinach in this area had the highest potential risk of Cr pollution. This study provided a scientific and reliable approach by integrating soil environmental quality and agricultural product security, which helps evaluate the potential risk of Cr in arable land more efficiently and lays technical guidelines for local agricultural production safety.

Life Cycle Assessment and Impact Correlation Analysis of Fly Ash Geopolymer Concrete.

Geopolymer concrete (GPC) has drawn widespread attention as a universally accepted ideal green material to improve environmental conditions in recent years. The present study systematically quantifies and compares the environmental impact of fly ash GPC and ordinary Portland cement (OPC) concrete under different strength grades by conducting life cycle assessment (LCA). The alkali activator solution to fly ash ratio (S/F), sodium hydroxide concentration (CNaOH), and sodium silicate to sodium hydroxide ratio (SS/SH) were further used as three key parameters to consider their sensitivity to strength and CO2 emissions. The correlation and influence rules were analyzed by Multivariate Analysis of Variance (MANOVA) and Gray Relational Analysis (GRA). The results indicated that the CO2 emission of GPC can be reduced by 62.73%, and the correlation between CO2 emission and compressive strength is not significant for GPC. The degree of influence of the three factors on the compressive strength is CNaOH (66.5%) > SS/SH (20.7%) > S/F (9%) and on CO2 emissions is S/F (87.2%) > SS/SH (10.3%) > CNaOH (2.4%). Fly ash GPC effectively controls the environmental deterioration without compromising its compressive strength; in fact, it even in favor.

Benefit-risk assessment of metal bioavailability in edible fungi by biomimetic whole digestive tracts with digestion, metabolism, and absorption functions.

As worldwide edible fungi, Lentinula edodes and Agaricus bisporus accumulate both essential and harmful metals. Metal bioavailability is important for metal benefit-risk assessment. A full functional model of digestive tracts (including digestion, metabolism, and absorption) is established. Under the digestive tract functions, the bioaccessible and bioavailable metals are released from edible fungi and absorbed by intestinal tract, respectively. Based on bioavailable metal contents in the intestine, safe dosage and maximum consumption are 43.52 g/d and 248.7 g/d for Agaricus bisporu, 20.59/328.9 g/d (for males/ female) and 132.9 g/d for Lentinus edodes; V, Co, Ni, Cu, Zn, Se, Cr, Cd and Pb in Agaricus bisporus and Lentinula edodes are absorbed mainly in the large intestine; Fe is mainly absorbed in small intestine; edible fungi species-specificity in metal bioavailability is observed for As and Mn, which are mainly absorbed by small and large intestine for Agaricus bisporus and Lentinus edodes, respectively; and then metal toxicity on small and large intestine is disclosed. Metal benefit-risk is assessed by the content of monolayer liposome-extracted metal in the chyme from small and large intestine, which is controlled by the gastrointestinal functions, metal and edible fungi species.

The effects and health risk assessment of cauliflower co-cropping with Sedum alfredii in cadmium contaminated vegetable field.

Phytoremediation coupled with co-cropping is assumed to be good for safety utilization and remediation of heavy metal contaminated farmland, which can ensure farmers' income without increasing health risks for human. In this study, the effects on plant cadmium (Cd) accumulation and health risk of consuming the vegetable plant were compared between monoculture and co-cropping of cauliflower (Brassica oleracea) with two ecotypes of Sedum alfredii in a moderately (0.82 mg kg-1) Cd contaminated greenhouse vegetable field. The results showed that co-cropping with S. alfredii raised Cd concentration in edible part of cauliflower with slightly growth promotion. The health risk of consuming cauliflower to different groups of people have been evaluated by calculating Hazard Quotient (HQ) and all HQ value were less than 1.0, which indicated that eating co-cropped cauliflower would not cause health risks to adults and children. Besides, the Cd concentration of hyperaccumulating ecotype (HE) of S. alfredii was 27.3 mg kg-1 in monoculture and it increased to 51.2 mg kg-1 after co-cropping with cauliflower, suggesting that the co-cropping system promoted HE Cd absorption capacity. Therefore, the "Phytoextraction Coupled with Agro-safe-production" (PCA) model of cauliflower and HE can serve as an alternative sustainable strategy in the Cd moderate polluted greenhouse.

Comparative assessment of Brassica pekinensis L. genotypes for phytoavoidation of nitrate, cadmium and lead in multi-pollutant field.

Information is needed for comparative assessment and agronomic practices for phytoavoidation in multi-pollutant field. A field study was conducted to explore 97 Brassica pekinensis L. genotypes with permissible limit of contaminants growing in a severely Cd, moderately nitrate and slightly Pb multi-polluted field. Thirteen genotypes, i.e. KGZY, CXQW, CAIB, JINL, JQIN, JFEN, WMQF, XLSH, TAIK, BJXS, JUKA, XYJQ and GQBW, were identified with permissible limit for nitrate, Cd and Pb based on their resistance to heavy metal and nitrate accumulation in leaves when grown in co-contaminated soils. Furthermore, the correlation between essential and toxic elements concentrations in plant of B. pekinensis were inconsistent. Generally speaking, application of increasing Ca, K and S fertilizers in appropriate forms and dosages tended to increase the yield and quality of B. pekinensis cultivated in multi-pollutant field.

Assessment of dermal safety of oil extracted from Periplaneta americana: acute dermal toxicity, irritation, and sensitization.

INTRODUCTION: The American cockroach (Periplaneta americana) is used in traditional Chinese medicine. Periplaneta americana (P. americana) is rich in oil that has shown potential antioxidant and antibacterial activities in vitro. OBJECTIVE: To evaluate the safety of oil extracted from P. americana by conducting acute dermal toxicity, irritation, and sensitization tests. MATERIALS AND METHODS: In an acute dermal toxicity study, adult Sprague-Dawley rats were exposed to P. americana oil (2000 mg/kg body weight) for 24 h. Clinical observations were conducted to evaluate the toxicity, behaviour, and health of the animals every day after dermal exposure for 14 days. For the dermal irritation test, the oil was applied to rabbits in single and multiple doses. Multi-dose treatment was administered once per day for 14 days. Each rabbit served as its own left- and right-side control and the rabbits' irritation reactions in local intact and damaged skin were recorded and scored. The skin sensitization study of guinea pigs with the oil was conducted for a period of 28 days. RESULTS: The acute dermal median lethal dose (LD50) of P. americana oil was > 2000 mg/kg body weight in adult rats. There was no significant difference in mean irritation scores between the negative control and oil groups. The oil caused very little or no irritation in the intact and damaged skin rabbits treated with either single or multiple doses and it was non-sensitizing to the skin of guinea pigs. CONCLUSIONS: These results suggest that P. americana oil does not produce any significant acute toxic effects and is safe for use in animal models with almost no dermal irritation or sensitization. Therefore, it presents a low risk of provoking skin reactions in humans.

Assessment of tea garden soils at An'xi County in southeast China reveals a mild threat from contamination of potentially harmful elements.

An extensive study of the spatial distribution characteristics of potentially harmful elements (PHEs) in tea (Camellia sinensis (L.) O. Kuntze) garden soils and ecological risk assessment at An'xi County, the birthplace of oolong tea in China, was implemented. A total of 78 soil samples were examined to determine the concentration of five PHEs (As, Cd, Cr, Hg and Pb), soil organic matter and pH by using geostatistical approaches combined with geographical information system analysis. All PHEs presented in the study area were slightly higher than their background values for provincial and national standards except Cr. Moreover, ecological risk assessment of PHEs in the tea garden soils at An'xi County was performed by means of the Håkanson method. The average ecological potential risk index (Er) of the five PHEs followed a descending order of Cd > Hg > Pb > As > Cr, and suggested a moderate ecological risk in the study area.

Use of portable X-ray fluorescence spectroscopy and geostatistics for health risk assessment.

Laboratory analysis of trace metals using inductively coupled plasma (ICP) spectroscopy is not cost effective, and the complex spatial distribution of soil trace metals makes their spatial analysis and prediction problematic. Thus, for the health risk assessment of exposure to trace metals in soils, portable X-ray fluorescence (PXRF) spectroscopy was used to replace ICP spectroscopy for metal analysis, and robust geostatistical methods were used to identify spatial outliers in trace metal concentrations and to map trace metal distributions. A case study was carried out around an industrial area in Nanjing, China. The results showed that PXRF spectroscopy provided results for trace metal (Cu, Ni, Pb and Zn) levels comparable to ICP spectroscopy. The results of the health risk assessment showed that Ni posed a higher non-carcinogenic risk than Cu, Pb and Zn, indicating a higher priority of concern than the other elements. Sampling locations associated with adverse health effects were identified as 'hotspots', and high-risk areas were delineated from risk maps. These 'hotspots' and high-risk areas were in close proximity to and downwind from petrochemical plants, indicating the dominant role of industrial activities as the major sources of trace metals in soils. The approach used in this study could be adopted as a cost-effective methodology for screening 'hotspots' and priority areas of concern for cost-efficient health risk management.

Socioeconomic status is associated with reduced lung function in China: an analysis from a large cross-sectional study in Shanghai.

BACKGROUND: An inverse association between socioeconomic status and pulmonary function has emerged in many studies. However, the mediating factors in this relationship are poorly understood, and might be expected to differ between countries. We sought to investigate the relationship between socioeconomic status and lung function in China, a rapidly industrializing nation with unique environmental challenges, and to identify potentially-modifiable environmental mediators. METHODS: We used data from the Shanghai Putuo Study, a cross-sectional study performed in Shanghai, China. Participants completed a questionnaire and spirometry. The primary exposure was socioeconomic status, determined by education level. The primary outcomes were FEV1 and FVC percent predicted. Multiple linear regressions were used to test this association, and the percent explained by behavioral, environmental, occupational, and dietary variables was determined by adding these variables to a base model. RESULTS: The study population consisted of a total of 22,878 study subjects that were 53.3 % female and had a mean age of 48. In the final multivariate analysis, the effect estimates for FEV1 and FVC percent predicted for low socioeconomic status (compared to high) were statistically significant at a p-value of <0.01. Smoking, biomass exposure, mode of transportation to work, a diet low in fruits or vegetables, and occupational category partially attenuated the relationship between SES and lung function. In a fully-adjusted age-stratified analysis, the socioeconomic disparity in lung function widened with increasing age. CONCLUSIONS: We found cross-sectional evidence of socioeconomic disparities in pulmonary function in Shanghai. These differences increased with age and were partially explained by potentially modifiable exposures.

[Evaluation on effect of treatment and assistance to advanced schistosomiasis patients in Hunan Province from 2004 to 2013].

OBJECTIVE: To comprehensively evaluate the effect of the program of treatment and assistance to advanced schistosomiasis patients in Hunan Province from 2004 to 2013. METHODS: The fund investment of the program, the profits of hospitals and the improvement of the patients' health were investigated by data collection and questionnaire survey. The evaluation index system of treatment and assistance to advanced schistosomiasis in Hunan Province was constructed by the Delphi method and analytic hierarchy process, and the program was assessed comprehensively. RESULTS: The evaluation index system including 6 primary indices and 33 secondary indices was established. Among all the primary indices, the score of the treatment and assistance (22.25) was the highest, and that of the satisfaction assessment (8.15) was the lowest, and the score of the comprehensive assessment was 87.06. The average cure rate of the patients was 13.08% from 2004 to 2013. More than 60% of the patients' disease condition got better, and nearly 70% of the patients' psychological condition improved, and more than 70% of patients' self-help ability and social contact improved, as well as family happiness increased. In addition, the annual average cost for caretakers decreased by 2000 Yuan, and the profits of all the fixed-point hospitals for treatment and assistance increased. CONCLUSION: The effectiveness and efficiency of the treatment and assistance to advanced schistosomiasis patients in Hunan Province is obvious, and the government should continuously invest in the program.