Smartphone access, digital economy, and pesticide use intensity: Evidence from China.

Pesticide overuse has been an increasing concern in China. Digital technology, such as smartphone access, is considered an effective way to promote proper use of pesticides. Using the Chinese Extended Family Database (2015, 2017, and 2019), this study empirically examines the impact of smartphone access on pesticide use intensity among Chinese farmers. The results show a "double-edged sword" effect of smartphone access on pesticide use intensity. In rural areas with a low level of digital economy, greater smartphone access led to higher pesticide use intensity. In rural areas with a high digital economy level, smartphone access reduced pesticide use intensity. The study results show that reducing pesticide use intensity through digital technology is not a linear process but a complicated one that involves social and engineering integration, including an increase in access to smartphones, development of a regional digital economy, reconstruction of agricultural extension systems, and enhancement of the capacity of digital technology.

Research on the impact of ESG performance on carbon emissions from the perspective of green credit.

Utilizing panel data from 30 Chinese provinces, this research examines the non-linear relationship between regional environmental, social, and governance (ESG) performance and carbon emissions (CE) from the viewpoint of green credit. The study reveals a single threshold effect between ESG performance and CE, with green credit acting as the threshold variable. When the amount of green credit in a region exceeds the threshold, the growth rate of CE in that region begins to decline with higher ESG scores. Furthermore, green credit acts as a catalyst, playing a negative moderating role between ESG performance and CE, validated by both threshold regression and fixed effects models on panel data. Green credit indirectly influences carbon emissions by supporting green innovation, thus facilitating the transition to a greener economic development framework. Lastly, regional disparities are found in the moderating influence of green credit between ESG performance and CE. In regions with high ESG performance, the moderating impact of green credit is smaller, while in regions with low ESG performance, the effect is more significant. The research findings offer theoretical backing for policymakers regarding the efficacy of ESG in achieving carbon neutrality objectives, and offer valuable strategic recommendations for the diversified formulation of green credit strategies on both national and provincial scales. Regional heterogeneity test results provide valuable support for formulating policies that encourage green credit in provinces with low ESG performance.

The role of physical activity on healthcare utilization in China.

BACKGROUND: Evidence on the role of physical activity (PA) on healthcare utilization and expenditure is limited in China. We aimed to examine the association between the total physical activity (TPA) per week, healthcare service use and expenditure. METHODS: We extracted the data from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015. Participants more than 50 years old who completed the follow-up for the three waves were enrolled. We converted the volume of vigorous physical activity (VPA) into an equivalent volume of moderate physical activity (MPA) and calculated the TPA per week for each participant. 12,927 of the 17,708 participants in CHARLS were included in our analysis. More than one-third of participants over 50 years old never participate in any moderate or intensity activity, and the median of self-reported moderate or intensity PA was about 525 (IQR 0-1680) MET-minutes per week in 2015. RESULTS: Compared to inactive subjects, the highest level of TPA was significantly related to the decreased risk number of inpatient visits (IRR: 0.58; 95% CI:0.50-0.67, p < 0.001), inpatient hospital days (IRR: 0.60; 95% CI: 0.42-0.84, p < 0.01), healthcare expenditure (IRR: 0.71; 95% CI: 0.65-0.79, p < 0.001) and catastrophic health expenditures (OR: 0.57; 95% CI: 0.45-0.72, p < 0.001) after adjusting for covariates. CONCLUSIONS: Engaging in moderate-to-vigorous PA may drive a potential decrease in healthcare utilization, healthcare expenditure and household financial risk with a dose-response relationship in China, and some possible policy implications in public health may be considered to promote exercise in the middle-aged and elderly to reduce the medical burden on individuals and healthcare systems.

[Pollution Characteristics and Risk Assessment of Heavy Metals in the Bioretention Systems of Sponge Cities].

As an important water purification and seepage measure for sponge cities, biofiltration systems have been widely used in their construction in China. In order to identify the heavy metal accumulation, pollution, and its potential environmental risk in the biofiltration systems, this study examined the heavy metal contents and spatial distribution characteristics by taking the biofiltration systems of Yuelai new town, Chongqing, the first demonstration area of sponge city construction in China, as the research object, and conducted a risk evaluation of the pollution level and ecological environment in this new town using the contamination factor (CF), geo-accumulation Index (Igeo), and potential ecological risk coefficient (PERC). The results showed that, except for Mn, the average contents of Cu, Zn, Pb, Ni, and Cd in the biofiltration systems of Yuelai new town were 4.14, 1.77, 4.98, 1.23, and 6.51 times higher than the soil background values of Chongqing. In terms of spatial distribution, the contents of heavy metals in biofiltration systems along the roads in different functional areas showed great differences. The contents of Cu, Zn, Mn, Pb, Ni, and Cd in the industrial area were significantly higher than those of the same types of heavy metals in the biofiltration systems in other areas (P<0.05). The CF and Igeo showed that the pollution level of heavy metals was ranked as follows:Mn

Sex Disparities in the Association of Serum Uric Acid With Kidney Stone: A Cross-Sectional Study in China.

BACKGROUND AND AIMS: Urolithiasis is characterized by high rates of prevalence and recurrence. Hyperuricemia is related to various diseases. We hope to determine the association between serum uric acid (UA) level and kidney stone (KS). METHODS: In this population-based cross-sectional study, a total of 82,017 Chinese individuals who underwent a comprehensive examination in 2017 were included. The KS was diagnosed based on ultrasonography examination outcomes. Fully adjusted odds ratio (OR) for KS, and mean difference between the two groups were applied to determine the association of UA level with KS. RESULTS: Among the 82,017 participants included in this study (aged 18~99 years), 9,435 participants (11.5%) are diagnosed with KS. A proportion of 56.3% of individuals is male. The mean UA level of overall participants is 341.77 µmol/L. The participants with KS report higher UA level than the participants without KS [mean UA level 369.91 vs. 338.11 µmol/L; mean difference (MD), 31.96 (95% CI, 29.61~34.28) µmol/L]. In men, the OR for KS significantly increases from 330 µmol/L UA level. Every 50 µmol/L elevation of UA level increases the risk of KS formation by about 10.7% above the UA level of 330 µmol/L in men. The subgroup analysis for male is consistent with the overall result except for the participants presenting underweight [adjusted OR, 1.035 (0.875~1.217); MD, -5.57 (-16.45~11.37)], low cholesterol [adjusted OR, 1.088 (0.938~1.261); MD, 8.18 (-7.93~24.68)] or high estimated glomerular filtration rate (eGFR) [adjusted OR, 1.044 (0.983~1.108); MD, 5.61 (-1.84~13.36)]. However, no significant association is observed in women between UA and KS either in all female participants or in female subgroups. CONCLUSION: Among Chinese adults, UA level is associated with KS in a dose-response manner in men but not in women. However, the association becomes considerably weak in male participants with malnutrition status.

Cost-effectiveness analysis of a community-based colorectal cancer screening program in Shanghai, China.

OBJECTIVE: This study investigated the cost-effectiveness of a community-based colorectal cancer-screening program (C-CRCSP) in Shanghai, China, among the residents in the urban, suburban and rural areas. METHODS: A Markov model was constructed to evaluate the cost-effectiveness of a 25-year annual C-CRCSP including 100 000 populations. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER); referring to either life-years gained, or quality-adjusted life-years (QALYs) gained. The threshold was gross domestic product per capita. Univariate and multivariate sensitivity analyses were performed to investigate the influence of compliance, prevalence, technological performance, medical cost and annual cost discount rate (3.5%) on ICER. A probabilistic sensitivity analysis evaluated the probability of the cost-effectiveness of C-CRCSP at different maximum acceptable ceiling ratios. RESULTS: Compared with no screening, the C-CRCSP resulted in total gains of 7840 QALYs and 2210 life-years (LY), at a total cost of CNY 58.54 million; that is, the ICER were CNY 7460/QALYs and CNY 26650/LY. Stratifying by residency, the cumulative gains in QALYs and LY were estimated to be the lowest in the urban populations compared with the rural and suburban populations. The cost for the urban population was 3-fold and 6-fold that of the suburban and rural populations. The ICER for QALYs ranged from 2180 (rural) to 16 840 (urban). CONCLUSION: The cost-effectiveness of a C-CRCSP in Shanghai was most favorable for the rural population, while the urban population benefits less in terms of QALYs. ICER could be enhanced by measures that increase compliance.

[Pathogen distribution, risk factors, and outcomes of nosocomial infection in very premature infants].

OBJECTIVE: To study the pathogen distribution and risk factors of nosocomial infection in very preterm infants, as well as the risk of adverse outcomes. METHODS: A retrospective analysis was performed for the clinical data of 111 very preterm infants who were born between January and December, 2016 and had a gestational age of <32 weeks and a birth weight of <1 500 g. According to the presence or absence of nosocomial infection after 72 hours of hospitalization, the infants were divided into infection group and non-infection group. The infection group was analyzed in terms of pathogenic bacteria which caused infection and their drug sensitivity. A multivariate logistic regression analysis was used to investigate the potential risk factors and risk of adverse outcomes of nosocomial infection in very preterm infants. RESULTS: Gram-negative bacteria were the main pathogens for nosocomial infection in very preterm infants and accounted for 54%, among which Pseudomonas aeruginosa was the most common one; the following pathogens were fungi (41%), among which Candida albicans was the most common one. The drug sensitivity test showed that Gram-negative bacteria were highly resistant to ß-lactam and carbapenems and highly sensitive to quinolones, while fungi had low sensitivity to itraconazole and high sensitivity to 5-fluorocytosine and amphotericin B. Early-onset sepsis, duration of peripherally inserted central catheter, steroid exposure, and duration of parenteral nutrition were risk factors for nosocomial infection in very preterm infants (P<0.05). Compared with the non-infection group, the infection group had significantly higher risks of pulmonary complications (P<0.05), as well as a significantly longer length of hospital stay and a significantly higher hospital cost (P<0.001). CONCLUSIONS: Nosocomial infection in very preterm infants is affected by various factors and may increase the risk of adverse outcomes. In clinical practice, reasonable preventive and treatment measures should be taken with reference to drug sensitivity, in order to improve the prognosis of very premature infants.

Incidence and psychological-behavioral characteristics of refractory functional dyspepsia: a large, multi-center, prospective investigation from China.

AIM: To explore the incidence and psychological and behavioral characteristics of refractory functional dyspepsia (RFD) in China. METHODS: The subjects of this study were 1341 new outpatients with functional dyspepsia (FD) who were diagnosed according to the Rome III criteria at four hospitals in Guangdong Province between June and September 2012, and 100 healthy volunteers. All subjects completed questionnaires and scales administered. RESULTS: Three-hundred and twenty-seven of the 1341 patients with FD had RFD (24.4%). Patients with RFD had a longer disease duration and a more severe form of the disease than patients with non-refractory FD (NRFD). The prevalence of depression and anxiety symptoms was higher in patients with RFD than in patients with NRFD. The prevalence of unhealthy eating behaviors, lack of physical activity, and sleeping disorders was higher in patients with RFD than in patients with NRFD. Patients with RFD sought medical advice on more occasions and spent more money on treatment than patients with NRFD. Finally, patients with RFD had poorer quality of life than patients with NRFD. CONCLUSION: RFD is not rare in clinical practice and should get attention by patients and doctors because of its long duration, severe symptoms, and associations with abnormal psychology and poor quality of life.