A meta-analysis between robotic hepatectomy and conventional open hepatectomy.

Current meta-analysis was performed to compare robotic hepatectomy (RH) with conventional open hepatectomy (OH) in terms of peri-operative and postoperative outcomes. PubMed, EMBASE, and the Cochrane Library were all searched up for comparative studies between RH and OH. RevMan5.3 software and Stata 13.0 software were used for statistical analysis. Nineteen studies with 1747 patients who received RH and 23,633 patients who received OH were included. Pooled results indicated that patients who received RH were generally younger than those received OH (P < 0.00001). Moreover, RH was associated with longer operative time (P = 0.0002), less intraoperative hemorrhage (P < 0.0001), lower incidence of intraoperative transfusion (P = 0.003), lower incidence of postoperative any morbidity (P < 0.00001), postoperative major morbidity (P = 0.0001), mortalities with 90 days after surgery (P < 0.0001), and shorter length of postoperative hospital stay (P < 0.00001). Comparable total hospital costs were acquired between RH and OH groups (P = 0.46). However, even at the premise of comparable R0 rate (P = 0.86), RH was associated with smaller resected tumor size (P < 0.00001). Major hepatectomy (P = 0.02) and right posterior hepatectomy (P = 0.0003) were less frequently performed in RH group. Finally, we concluded that RH was superior to OH in terms of peri-operative and postoperative outcomes. RH could lead to less intraoperative hemorrhage, less postoperative complications and an enhanced postoperative recovery. However, major hepatectomy and right posterior hepatectomy were still less frequently performed via robotic approach. Future more powerful well-designed studies are required for further exploration.

Assessment and evaluation of online education and virtual simulation technology in dental education: a cross-sectional survey.

BACKGROUND: The global outbreak of coronavirus disease (COVID-19) has led medical universities in China to conduct online teaching. This study aimed to assess the effectiveness of a blended learning approach that combines online teaching and virtual reality technology in dental education and to evaluate the acceptance of the blended learning approach among dental teachers and students. METHODS: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed in this study. A total of 157 students' perspectives on online and virtual reality technology education and 54 teachers' opinions on online teaching were collected via questionnaires. Additionally, 101 students in the 2015-year group received the traditional teaching method (TT group), while 97 students in the 2017-year group received blended learning combining online teaching and virtual reality technology (BL group). The graduation examination results of students in the two groups were compared. RESULTS: The questionnaire results showed that most students were satisfied with the online course and the virtual simulation platform teaching, while teachers held conservative and neutral attitudes toward online teaching. Although the theoretical score of the BL group on the final exam was greater than that of the TT group, there was no significant difference between the two groups (P = 0.805). The skill operation score of the BL group on the final exam was significantly lower than that of the TT group (P = 0.004). The overall score of the BL group was lower than that of the TT group (P = 0.018), but the difference was not statistically significant (P = 0.112). CONCLUSIONS: The blended learning approach combining online teaching and virtual reality technology plays a positive role in students' learning and is useful and effective in dental education.

Fabrication of robust and cost-efficient Hoffmann-type MOF sensors for room temperature ammonia detection.

The development of fast-response sensors for detecting NH3 at room temperature remains a formidable challenge. Here, to address this challenge, two highly robust Hoffmann-type metal-organic frameworks are rationally applied as the NH3 sensing materials which possess ultra-high static adsorption capacity for NH3, only lower than the current benchmark material. The adsorption mechanism is in-depth unveiled by dynamic adsorption and simulation studies. The assembled interdigital electrode device exhibits low detection limit (25 ppb) and short response time (5 s) at room temperature, which set a record among all electrical signal sensors. Moreover, the sensor exhibits excellent selectivity towards NH3 in the presence of 13 other potential interfering gases. Prominently, the sensor can stably output signals for more than two months at room temperature and can be recovered by simply purging nitrogen at room temperature without heating. This study opens up a way for reasonably designing gas sensing materials for toxic gases.

Benefit-Risk Assessment of Chinese Medicine Injections for Primary Liver Cancer Based on Multi-criteria Decision Analysis.

OBJECTIVE: To evaluate the benefit-risk of 3 commonly used Chinese medicine injections, Aidi Injection (ADI), Cinobufagin Injection (CINI) and Compound Kushen Injection (CKI), in the treatment of primary liver cancer (PLC), so as to provide a reference for clinical decision-making. METHODS: Randomized controlled trials (RCTs) of ADI, CINI and CKI in the treatment of PLC published in the databases of China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, SinoMed, PubMed, Cochrane Library, and Web of Science were retrieved from January 2020 to October 2022. The data of benefit and risk indicators were combined to obtain the effect value. The multi-criteria decision analysis (MCDA) model was applied to build the decision tree. The benefit value, risk value and benefit risk value of the 3 injections in PLC treatment were calculated. Monte Carlo simulation was carried out to calculate the 95% confidence interval and probability of differences among the 3 injections, so as to optimize the evaluation results. RESULTS: A total of 71 RCTs were included. The benefit values of ADI, CINI and CKI combined with transcatheter arterial chemoembolization (TACE) were 42, 38 and 36, respectively. The risk values were 42, 25 and 37, respectively. The benefit risk values were 42, 31 and 37, respectively. The benefit risk differences of ADI vs. CINI, ADI vs. CKI, and CKI vs. CINI were 11 (-0.86, 17.75), 5 (-5.01, 11.09), and 6 (-1.87, 12.63), respectively. The probability that ADI superior to CINI, ADI superior to CKI, and CKI superior to CINI was 96.26%, 77.27%, and 92.62%, respectively. CONCLUSION: Based on the results of MCDA model, CINI combined with TACE has the greatest risk in the treatment of the PLC. Considering the efficacy and safety, the possible priority of the 3 Chinese medicine injections combined with TACE in the treatment of PLC is ADI, CKI and CINI.

Interventions to tackle health inequalities in cardiovascular risks for socioeconomically disadvantaged populations: a rapid review.

INTRODUCTION: Cardiovascular disease (CVD) has shown significant health inequalities for people with low socioeconomic status associated with more risk factors. This review was to synthesize interventions that targeted CVD risks and outcomes among socioeconomically disadvantaged populations and to understand the impact associated with these interventions. SOURCES OF DATA: Cochrane CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL were searched for records published in the last decade using a systematic search strategy, complemented by screening the reference lists and citation indexes. Nineteen studies were included and a narrative synthesis with the effect direction plot was undertaken in which studies, interventions, participants and outcomes were examined according to the intervention type focusing on behaviours, lifestyle, education, medication and monitoring. AREAS OF AGREEMENT: No universal definition of disadvantaged socioeconomic status was used with common factors relating to racial/ethnic minorities, low income and low or no health insurance. Mixed effects of interventions were reported on clinical outcomes including weight, body mass index, blood pressure, glycated haemoglobin and cholesterol. AREAS OF CONTROVERSY: Inconsistent effect was reported due to a large variety of settings, participants and intervention components although they are considered necessary to address the complex health needs of socioeconomically disadvantaged populations. GROWING POINTS: There is inadequate evidence to determine whether any of the intervention types are effective in optimising lipids management for socioeconomically disadvantaged populations. AREAS TIMELY FOR DEVELOPING RESEARCH: Research is needed with mixed evidence using real world evaluation and lived experience combined with health economic evaluation, on both mental and physical health outcomes.

Temporal trends in inequalities of the burden of cardiovascular disease across 186 countries and territories.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally. The extent to which CVD affects the population's health varies across countries. Moreover, quantitative estimates of the trend of inequalities in CVD burden remain unclear. The objective of our study was to assess the socioeconomic inequalities and temporal trends of CVD burden across 186 countries and territories from 2000 to 2019. METHODS: We extracted data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019, and conducted a cross-national time-series analysis. Age-standardized disability-adjusted life-year (DALY) rates were used to measure the burden of CVDs, and gross national income (GNI) per capita was used to approximate the socioeconomic development. Concentration curves and concentration indexes (CIs) were generated to evaluate the cross-national socioeconomic inequality of CVD burden. A joinpoint regression analysis was used to quantify the changes in trends in socioeconomic inequality of CVD burden from 2000 to 2019. RESULTS: The age-standardized DALY rates of CVDs decreased in 170 (91%) of 186 countries from 2000 to 2019. The concentration curves of the age-standardized DALY rates of CVDs were above the equality line from 2000 to 2019, indicating a disproportional distribution of CVD burden in low-income countries. The CIs declined from - 0.091 (95% CI: -0.128 to - 0.054) in 2000 to - 0.151 (95% CI: -0.190 to - 0.112) in 2019, indicating worsened pro-poor inequality distributions of CVD burden worldwide. A four-phase trend of changes in the CIs of age-standardized DALY rates for CVD was observed from 2000 to 2019, with an average annual percentage change (AAPC) of - 2.7% (95% CI: -3.0 to - 2.4). Decreasing trends in CIs were observed in all CVD subcategories but endocarditis, with AAPC ranging from - 6.6% (95% CI: -7.3 to - 5.9) for ischemic heart disease to - 0.2% (95% CI: -0.4 to - 0.1) for hypertensive heart disease. CONCLUSIONS: Globally, the burden of CVD has decreased in more than 90% of countries over the past two decades, accompanied by an increasing trend of cross-country inequalities. Moreover, the overall burden of CVD continues to fall primarily on low-income countries.

Digital screening method using social media advertising for the remote assessment of trigeminal neuralgia.

Objective: Global trends, such as improving accessibility to healthcare services through the Internet, and the COVID-19 pandemic are among the driving factors in the adoption of digital health. This study hypothesized that digital solutions can reach and gather data from a large number of patients with trigeminal neuralgia (TN), a commonly misdiagnosed neuropathic facial pain syndrome, and quickly and fast-track their diagnosis by suggesting them to consult a neurologist. We developed an accessible digital screening tool based on patient symptoms and history to test this hypothesis and used social media advertisement to screen a general population for TN. Methods: The standard diagnostic criteria, International Classification of Orofacial Pain, for facial pain is digitized as a web-based questionnaire that allows easy access to the evaluation for patients with suspected TN symptoms. Targeted search with relevant keywords and display campaigns on Google search engine and Facebook social media platform were used to reach large numbers of subjects. A report was autogenerated, which included a summary of a subject's symptoms, likely or likely not TN diagnosis, and information to seek appropriate medical assistance. Results: The website was live for seven weeks and generated 240 screening questionnaire submissions, with a total spending of $2482. Forty-four subjects (18.3%) that reported typical symptoms of TN experienced unilateral and episodic pain in one of the trigeminal nerve regions. Conclusions: We have demonstrated the feasibility of social media advertisement and digitally screening a general population for TN, gathering valuable clinical data, such as pain characteristics, through a web-based questionnaire. Based on these data, patients with similar symptoms of TN are suggested to consult a neurologist for diagnosis. This study provides a framework for using digital screening tools to improve the healthcare experience of patients who would spend several months before finding appropriate diagnosis for their specific conditions.

Exploring support, experiences and needs of older women and health professionals to inform a self-management package for urinary incontinence: a qualitative study.

OBJECTIVES: Many women attempt to manage urinary incontinence (UI) independently with variable success while health professionals may be unaware of their needs. This study aimed to (1) understand older women's experiences of UI, their self-management strategies and support needs; (2) explore health professionals' experiences of supporting women and providing relevant services and (3) combine their experiences contribute to development of a theory-based and evidence-based self-management package for UI. DESIGN: Qualitative semi-structured interviews were conducted with 11 older women with UI and 11 specialist health professionals. Data were analysed independently using the framework approach, then synthesised in a triangulation matrix to identify implications for content and delivery of the self-management package. SETTING: Community centres, community continence clinic and urogynaecology centre of a local teaching hospital in northern England. PARTICIPANTS: Women aged 55 years and over who self-reported symptoms of UI and health professionals delivering UI services. RESULTS: Three overarching themes emerged. Older women see UI as a 'fact of life' but many struggle with it: women typically considered UI as part of ageing yet expressed annoyance, distress, embarrassment and had made significant lifestyle changes. Access to information and limited high-quality professional support: health professionals provided specialist UI care and information. Yet less than half of women accessed specialist services, those who had, highly valued these services. 'Trial and error' with different self-management strategies: women had tried or were using different strategies (continence pads, pelvic floor exercises, bladder management and training, fluid management and medication), with mixed success. Health professionals provided evidence-based, personalised support and motivation. CONCLUSIONS: Findings informed the content of the self-management package that focused on providing facts, acknowledging challenges of living with/self-managing UI, sharing others' experiences, using motivational strategies and self-management tools. Delivery preferences were independent use by women or working through the package with a health professional.

Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND: The burden of asthma in terms of premature death or reduced quality of life remains a huge issue. It is of great importance to evaluate asthma burden geographically and time trends from 1990 to 2019 and to assess the contributions of age, period, and cohort effects at global level. METHODS: Asthma prevalence, deaths, and disability adjusted life years (DALYs) as well as risk-attributable burden were collected from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 database and were compared by age and sex. The Smoothing Splines models were used to estimate the relationship between asthma DALYs and the sociodemographic index (SDI). The Age-Period-Cohort model was used to determine effects of ages, periods, and birth cohorts on disease rates. RESULTS: Between 1990 and 2019, the declines were 24.05% (95% uncertainty interval [UI] - 27.24 to - 20.82) in age-standardized asthma prevalence, 51.3% (- 59.08 to - 43.71) in mortality, and 42.55% (- 48.48 to - 36.61) in DALYs rate. However, the burden of asthma continued to rise, with an estimated 262.41 million prevalent cases globally (95% UI 224.05 to 309.45). Asthma caused greater DALYs in females than in males among people aged 20 years and older. The lowest age-standardized DALYs rate was observed at a SDI of approximately 0.70. The Longitudinal age curves showed an approximate W-shaped pattern for asthma prevalence and a likely J-shaped pattern for asthma mortality. The period effect on prevalence and mortality of asthma decreased from 1990 to 2019. Compared with the 1955-1959 birth cohort, the prevalence relative risk (RR) of asthma was highest in the 1905-1909 birth cohort, whereas the mortality RR continued to decline. At the global level, the percentages of high body-mass index, occupational asthmagens, and smoking contributing to DALYs due to asthma were 16.94%, 8.82%, and 9.87%, respectively. CONCLUSIONS: Although the age-standardized rates of asthma burden declined in the past 30 years, the overall burden of asthma remains severe. High body mass index becomes the most important risk factor for DALYs due to asthma at the global level.

Do environmental target constraints of local government affect high-quality economic development? Evidence from China.

The purpose of this paper seeks to investigate the impact that environmental target constraints imposed by local governments have on the quality of economic development. In this paper, the city-level economic high-quality development index was measured, and data on environmental target constraints were compiled from the governmental work reports submitted by 230 cities between the years 2004 and 2013. Using the DID model and the instrumental variable method, it is found that (1) when environmental performance is factored into the performance evaluation of governmental officials, environmental target constraints contribute significantly to the high-quality growth of the local economy and (2) environmental target constraints are heterogeneous across regions and have a greater promoting effect on cities in eastern China than in central and western China. These conclusions are supported by a number of robustness tests. Resultantly, this paper provides a novel perspective for understanding the relationship between environmental protection and the quality of economic development. In addition, it offers the government theoretical and empirical support to strengthen the development of an environmental protection system and promote high-quality economic development. Moreover, this study delivers crucial empirical evidence for developing countries to simultaneously achieve environmental pollution control and economic growth.

Preoperative and intraoperative assessment of myometrial invasion in patients with FIGO stage I non-endometrioid endometrial carcinoma-a large-scale, multi-center, and retrospective study.

INTRODUCTION: Myometrial invasion is a prognostic factor for lymph node metastases and decreased survival in non-endometrioid endometrial carcinoma patients. Herein, we explored the mode of myometrial invasion diagnosis in FIGO stage I non-endometrioid carcinoma and evaluated the differences in diagnostic efficiency among intraoperative frozen section (IFS), intraoperative gross examination (IGE), magnetic resonance imaging (MRI), and computed tomography (CT) in clinical practice. Finally, we suggested which test should be routinely performed. METHOD: This was a historical cohort study nationwide with 30 centers in China between January 2000 and December 2019. Clinical data, including age, histology, method of myometrial invasion evaluation (MRI, CT, IGE, and IFS), and final diagnosis of postoperative paraffin sections, were collected from 490 non-endometrioid endometrial carcinoma (serous, clear cell, undifferentiated, mixed carcinoma, and carcinosarcoma) women in FIGO stage I. RESULTS: Among the 490 patients, 89.59% presented myometrial invasion. The methods reported for myometrial invasion assessment were IFS in 23.47%, IGE in 69.59%, MRI in 37.96%, and CT in 10.20% of cases. The highest concordance was detected between IFS and postoperative paraffin sections (Kappa = 0.631, accuracy = 93.04%), followed by IGE (Kappa = 0.303, accuracy = 82.40%), MRI (Kappa = 0.131, accuracy = 69.35%), and CT (Kappa = 0.118, accuracy = 50.00%). A stable diagnostic agreement between IFS and the final results was also found through the years (2000-2012: Kappa = 0.776; 2013-2014: Kappa = 0.625; 2015-2016: Kappa = 0.545; 2017-2019: Kappa = 0.652). CONCLUSION: In China, the assessment of myometrial invasion in non-endometrioid endometrial carcinoma is often performed via IGE, but the reliability is relatively low in contrast to IFS. In clinical practice, IFS is a reliable method that can help accurately assess myometrial invasion and intraoperative decision-making (lymph node dissection or not). Hence, it should be routinely performed in non-endometrioid endometrial carcinoma patients.

Assessment of cognitive impairment after acute cerebral infarction with T1 relaxation time measured by MP2RAGE sequence and cerebral hemodynamic by transcranial Doppler.

Objective: This study aimed to investigate early brain microstructural changes discovered using magnetization-prepared two rapid acquisition gradient echo (MP2RAGE) sequence and cerebral hemodynamic using TCD for cognitive impairment after acute cerebral infarction. Methods: We enrolled 43 patients with acute cerebral infarction and 21 healthy people in the study, who were subjected to cognitive assessments, the MP2RAGE sequence, and a cerebral hemodynamic examination. A total of 26 brain regions of interest were investigated. Furthermore, we used cerebral hemodynamics to explain brain microstructural changes, which helped us better understand the pathophysiology of cognitive impairment after acute cerebral infarction and guide treatment. Results: T1 relaxation times in the left frontal lobe, right frontal lobe, right temporal lobe, left precuneus, left thalamus, right hippocampus, right head of caudate nucleus, and splenium of corpus callosum were substantially different across the three groups, which were significantly correlated with neuropsychological test scores. CI group patients had significantly lower cerebral blood flow velocity than those in the N-CI and Normal groups. The receiver operating curve analysis revealed that most T1 relaxation times had high sensitivity and specificity, especially on the right temporal lobe and right frontal lobe. There was a potential correlation between T1 relaxation times and MMSE scores through TCD parameters. Conclusion: The MP2RAGE sequence can detect alterations in whole brain microstructure in patients with cognitive impairment after acute cerebral infarction. Brain microstructural changes could influence cognitive function through cerebral hemodynamics. T1 relaxation times on the right temporal lobe and the right frontal lobe are expected to be a prospective biomarker of cognitive impairment after acute cerebral infarction.

Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study.

Background: Cancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients. Methods: The 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients. Results: Contracting a family physician (incidence rate ratio IRR: 2.38, 1.18-4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91-8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46-6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56-13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20-0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10-1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32-0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14-0.72]. Conclusions: The socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.

[Ecological Risk Assessment of Quinolones Antibiotics and the Correlation Analysis Between QNs and Physical-Chemical Parameters in Groundwater, Shijiazhuang City].

Most studies on antibiotics in groundwater have focused on pollution characteristics, whereas less attention has been paid to the ecological risks of antibiotics and the correlation to environmental parameters. In this study, the groundwater in Shijiazhuang City was selected as the research area. Through high performance liquid chromatography-tandem mass spectrometry (HPLC-MS), the concentration of quinolones (QNs) in the groundwater was analyzed. Correlation analysis was conducted between QNs concentrations and physical-chemical parameters. The results showed that:① the detection frequency of flumequine (FLU) was the highest (100%), followed by enoxacin (ENO) (80.0%) and ciprofloxacin (CIP) (75.0%). ② The concentration of QNs ranged from 3.02 to 98.5 ng·L-1; in terms of spatial distribution, the highest concentration of QNs appeared at S4 (98.5 ng·L-1), whereas the lowest concentration was exhibited at S19 (3.02 ng·L-1). ③ Temperature (T), chemical oxygen demand (COD), total dissolved solids (TDS), total number of colonies (BCTC), and pH were significantly correlated with QNs (P<0.01 or P<0.05) based on correlation analysis. ④ For the spatial distribution of ecological risk, the results showed that the ecological risk at S4 was high, whereas the risks for other sites were low. For the type of QNs, ciprofloxacin (CIP) was at a medium-high risk level, whereas the other QNs were at a low-risk level. Thus, in order to guarantee the ecological safety of groundwater in Shijiazhuang City, more attention should be paid to the risk management and control of antibiotics in groundwater in the future.

The antibiotic resistance and risk heterogeneity between urban and rural rivers in a pharmaceutical industry dominated city in China: The importance of social-economic factors.

Rivers are important environmental sources of human exposure to antibiotic resistance. Many factors can change antibiotic resistance in rivers, including bacterial communities, human activities, and environmental factors. However, the systematic comparison of the differences in antibiotics resistance and risks between urban rivers (URs) and rural rivers (RRs) in a pharmaceutical industry dominated city is still rare. In this study, Shijiazhuang City (China) was selected as an example to compare the differences in antibiotics resistance and risks between URs and RRs. The results showed higher concentrations of total quinolones (QNs) antibiotics in both water and sediment samples collected from URs than those from RRs. The subtypes and abundances of antibiotic resistance genes (ARGs) in URs were significantly higher than those in RRs, and most emerging ARGs (including OXA-type, GES-type, MCR-type, and tet(X)) were only detected in URs. The ARGs were mainly influenced by QNs in URs and social-economic factors (SEs) in RRs. The composition of the bacterial community was significantly different between URs and RRs. The abundance of antibiotic-resistant pathogenic bacteria (ARPBs) and virulence factors (VFs) were higher in URs than those in RRs. Therein, 371 and 326 pathogen types were detected in URs and RRs, respectively. Most emerging ARGs showed a significantly positive correlation with priority ARPBs. Variance partitioning analysis revealed that SEs were the main driving factors of ARGs (80 %) and microbial communities (92 %) both in URs and RRs. Structural equation models indicated that antibiotics (QNs) and microbial communities were the most direct influence of ARGs in URs and RRs, respectively. The cumulative resistance risk of QNs was high in URs, but relatively low in RRs. Enrofloxacin and flumequine posed the highest risk in water and sediment, respectively. This study could help us to better manage and control the risk of antibiotic resistance in different rivers.

Tailoring lipid management interventions to reduce inequalities in cardiovascular disease risk management in primary care for deprived communities in Northern England: a mixed-methods intervention development protocol.

INTRODUCTION: Hyperlipidaemia contributes a significant proportion of modifiable cardiovascular disease (CVD) risk, which is a condition that disproportionally affects disadvantaged socioeconomic communities, with death rates in the most deprived areas being four times higher than those in the least deprived. With the national CVD Prevention programme being delivered to minimise risk factors, no evidence is available on what has been implemented in primary care for deprived populations. This study describes the protocol for the development of a tailored intervention aiming to optimise lipid management in primary care settings to help reduce inequalities in CVD risks and improve outcomes in deprived communities. METHODS AND ANALYSIS: A mixed-methods approach will be employed consisting of four work packages: (1) rapid review and logic model; (2) assessment and comparison of CVD risk management for deprived with non-deprived populations in Northern England to England overall; (3) interviews with health professionals; and (4) intervention development. A systematic search and narrative synthesis will be undertaken to identify evidence-based interventions and targeted outcomes in deprived areas. General practice-level data will be assessed to establish the profile of lipid management, compared with the regional and national levels. Health professionals involved in the organisation and delivery of routine lipid management to deprived populations will be interviewed to understand the implementation and delivery of current lipid management and associated challenges. The prototype intervention will be informed by the evidence generated from workpackages 1-3, which will be reviewed and assessed using the nominal group technique to reach consensus. Training and skills development materials will also be developed as needed. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Faculty of Medical Sciences Research Ethics Committee at Newcastle University, UK. Findings will be disseminated to the participating sites, participants, commissioners, and in peer-reviewed journals and academic conferences.

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals.

Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.

Multimorbidity and catastrophic health expenditure among patients with diabetes in China: a nationwide population-based study.

INTRODUCTION: Multimorbidity is common among patients with diabetes and can lead to catastrophic health expenditure (CHE) for their families. This study aims to investigate the prevalence of multimorbidity and CHE among people with diabetes in China, and the association between multimorbidity and CHE and whether this is influenced by socioeconomic status and health insurance type. METHODS: A national survey was conducted in China in 2013 that included 8471 people aged ≥18 years who were living with diabetes. The concentration curve and concentration index were used to measure socioeconomic-related inequalities. Factors influencing CHE and the impact of multimorbidity on CHE according to socioeconomic status and health insurance type were examined by logistic regression. RESULTS: There were 5524 (65.2%) diabetes patients with multimorbidity. The prevalence of CHE was 56.6%, with a concentration index of -0.030 (95% CI -0.035 to -0.026). For each additional chronic disease, the probability of CHE increased by 39% (OR=1.39, 95% CI 1.31 to 1.47). Factors that were positively associated (p<0.05) with CHE included older age; male sex; lower educational level; being retired, unemployed or jobless; being a non-smoker and non-drinker; having had no physical examination; lower socioeconomic status; being in an impoverished family; and residing in the central or western regions. Among participants with Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme, the probability of CHE increased by 32% (OR=1.32, 95% CI 1.23 to 1.43), 43% (OR=1.43, 95% CI 1.24 to 1.65) and 47% (OR=1.47, 95% CI 1.33 to 1.63), respectively, with each additional chronic disease. The association between multimorbidity and CHE was observed across all health insurance types irrespective of socioeconomic status. CONCLUSIONS: Multimorbidity affects about two-thirds of Chinese patients with diabetes. Current health insurance schemes offer limited protection against CHE to patients' families.

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis.

Background: A previous study has shown that 81% of the COVID-19 patients had mild or moderate symptoms. However, most studies on the sequelae in COVID-19 patients focused on severe cases and the long-term follow-up studies on the health consequences in non-severe cases are limited. The current study aimed to assess the sequelae of COVID-19 in patients nearly 1 year after diagnosis with a particular focus on the recovery of patients with non-severe COVID-19. Methods: We enrolled 120 patients infected with SARS-CoV-2 discharged from Wuhan Union hospital west district (designated hospital for COVID-19) and Fangcang shelter hospitals between January 29, 2020 and April 1, 2020. All participants were asked to complete a series of questionnaires to assess their symptoms and quality of life and for psychological evaluation. Also, pulmonary function test, chest CT, 6-min walking test (6MWT), routine blood test, liver and kidney function tests, fasting blood glucose test, lipid test, and immunoglobulin G antibody test were performed to evaluate their health. Results: The mean age of the study population was 51.6 ± 10.8 years. Of the 120 patients, 104 (86.7%) were cases of non-severe COVID-19. The follow-up study was performed between November 23, 2020 and January 11, 2021, and the median time between the diagnosis and the follow-up was 314.5 (IQR, 296-338) days. Sleep difficulties, shortness of breath, fatigue, and joint pain were common symptoms observed during follow-up and nearly one-third of the non-severe cases had these symptoms. A total of 50 (41.7%) and 45 (37.5%) patients reported anxiety and depression, respectively. And 18.3% of the patients showed negative results in the IgG test at the follow-up, which correlated with the severity of the infection (R = 0.203, p = 0.026), and the proportion of IgG negative cases in non-severe COVID-19 patients was higher than that in the severe cases (20.2 vs. 6.3%). Pulmonary diffusion impairment was reported in 30 (26.1%) out of 115 patients, and 24 (24.2%) out of the 99 non-severe cases. The values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, vital capacity (VC), total lung capacity (TLC), and residual volume (RV) were less than the normal range in 1.7, 8.6, 0.9, 11.2, 7.0, and 0.9% of the patients, respectively. A total of 55 (56.7%) out of the 97 patients showed abnormal CT findings, including ground-glass opacities (GGO), bronchiectasis, nodules, lines and bands, and fibrosis. Furthermore, there was a correlation between all the SF-36-domain scores and the duration of hospitalization, pulmonary function, and a 6MWT. Conclusions: At the nearly 1-year follow-up, COVID-19 survivors still had multi-system issues, including those in the respiratory functioning, radiography, quality of life, and anxiety and depression. Moreover, non-severe cases also showed some sequelae and the proportion of IgG negative cases in the non-severe patients was higher than that in severe cases. Therefore, conducting follow-ups and preventing the reinfection of SARS-CoV-2 in this group is necessary.