A Comprehensive Review of the Global Epidemiology, Clinical Management, Socio-Economic Impacts, and National Responses to Long COVID with Future Research Directions.

Background: Long COVID, characterized by a persistent symptom spectrum following SARS-CoV-2 infection, poses significant health, social, and economic challenges. This review aims to consolidate knowledge on its epidemiology, clinical features, and underlying mechanisms to guide global responses; Methods: We conducted a literature review, analyzing peer-reviewed articles and reports to gather comprehensive data on long COVID's epidemiology, symptomatology, and management approaches; Results: Our analysis revealed a wide array of long COVID symptoms and risk factors, with notable demographic variability. The current understanding of its pathophysiology suggests a multifactorial origin yet remains partially understood. Emerging diagnostic criteria and potential therapeutic strategies were identified, highlighting advancements in long COVID management; Conclusions: This review highlights the multifaceted nature of long COVID, revealing a broad spectrum of symptoms, diverse risk factors, and the complex interplay of physiological mechanisms underpinning the condition. Long COVID symptoms and disorders will continue to weigh on healthcare systems in years to come. Addressing long COVID requires a holistic management strategy that integrates clinical care, social support, and policy initiatives. The findings underscore the need for increased international cooperation in research and health planning to address the complex challenges of long COVID. There is a call for continued refinement of diagnostic and treatment modalities, emphasizing a multidisciplinary approach to manage the ongoing and evolving impacts of the condition.

Optimization and Local Cost-Effectiveness of Nasopharyngeal Carcinoma Screening Strategies in Southern China: Secondary Analysis of the Guangdong Randomized Trial.

BACKGROUND: Screening with anti-Epstein-Barr virus (EBV) serology and endoscopy decreased nasopharyngeal carcinoma (NPC) mortality in Guangdong in a randomized trial. We conducted a secondary analysis of this trial using local incidence and cost data to optimize screening programs, hypothesizing that screening could be cost-effective in southern China. METHODS: Screening costs and life-years after NPC diagnosis were obtained from the Guangdong trial's intent-to-screen population (men and women aged 30-69). Seropositive subjects were rescreened annually for 5 years. Thereafter, we evaluated 12 screening strategies in Guangdong and Guangxi using a validated model. Strategies used combinations of serology, nasopharyngeal swab PCR (NP PCR), endoscopy, and MRI from trial subcohorts. Incidence data and costs were obtained from local cancer registries and the provincial healthcare system. RESULTS: In the intent-to-screen population, screening with serology and endoscopy was cost-effective (¥42,366/life-year, 0.52 GDP per capita). Screening for 5 to 15 years between ages 35 and 59 years met a willingness-to-pay threshold of 1.5 GDP/quality-adjusted life-years in all modeled populations. Despite doubling costs, adding MRI could be cost-effective via improved sensitivity. NP PCR triage reduced endoscopy/MRI referrals by 37%. One-lifetime screen could reduce NPC mortality by approximately 20%. CONCLUSIONS: EBV-based serologic screening for NPC is likely to be cost-effective in southern China. Among seropositive subjects, the preferred strategies use endoscopy alone or selective endoscopy triaged by MRI with or without NP PCR. These data may aid the design of screening programs in this region. IMPACT: These findings support population-based screening in southern China by defining the target population, cost-effectiveness, and optimized screening approach.

Spontaneous delayed migration or shortening after pipeline embolization device treatment of intracranial aneurysm: incidence, management, and risk factors.

BACKGROUND: Studies reporting spontaneous delayed migration or shortening (SDMS) after treatment with the Pipeline Embolization Device (PED) are limited. This study aimed to evaluate the incidence of SDMS after PED treatment, propose management strategies, and identify the risk factors contributing to its occurrence. METHODS: We retrospectively reviewed consecutive patients with an intracranial aneurysm (IA) treated with PEDs at three institutions. SDMS was classified as type I or II based on whether the PED covered the aneurysm neck. RESULTS: The total cohort comprised 790 patients. SDMS was identified in 24 (3.04%) patients. Eighteen of the 24 patients had type I SDMS and did not require retreatment, while the remaining six patients had type II SDMS and all received retreatment. Multivariate logistic regression showed that the difference between the proximal and distal parent artery diameters (DPAD) (adjusted OR 2.977; 95% CI 1.054 to 8.405; P=0.039) and device tortuosity index (DTI) (adjusted OR 8.059; 95% CI 2.867 to 23.428; P<0.001) were independent predictors of SDMS after PED treatment, while the difference in length (DL) (adjusted OR 0.841; 95% CI 0.738 to 0.958; P=0.009) and PED plus coiling (adjusted OR 0.288; 95% CI 0.106 to 0.785; P=0.015) were protective factors. CONCLUSION: The incidence of SDMS after PED treatment of IA was 3.04%. For patients with type I SDMS with incomplete aneurysm occlusion we recommend continuous imaging follow-up while, for patients with type II SDMS, we recommend aggressive retreatment. The DPAD and DTI were independent risk predictors of SDMS after PED treatment, while the DL and PED plus coiling were protective factors.

Evolutionary patterns and influencing factors of relationships among ecosystem services in the hilly red soil region of Southern China.

As a crucial ecological protection area in China, the Southern hilly red soil region is characterized by uneven spatial and temporal distribution of ecological landscape elements, unpredictable and changeable interrelationships between them, diversified driving factors, and lack of comprehensive consideration of ecosystem services. In order to better understand the interaction between ecosystem services, restore regional ecology, and promote sustainable development, the evolution law and influencing mechanism of ecosystem services and their driving factors are quantitatively analyzed in the study. Based on simulations of different ecosystem services from 2000 to 2020, their spatial and temporal changes and the contributions of main drivers are quantified, their trade-offs and synergies are analyzed, and the changing rules under the influence of natural factors and socioeconomic factors are explored. The results show that (1) the crop production significantly increases in the southwest and north regions, the habitat quality decreases in urban and coastal areas, and the soil retention and water yield show an increasing trend from west to east. (2) Land use/cover is the main driver of carbon storage and habitat quality variation, and precipitation is an important driver of water yield spatial variation. (3) The crop production and the other four ecosystem services show a trade-offs relationship, and the relationship between supporting services and regulating services is the synergetic. (4) The altitude weakens the synergistic relationship between soil retention and habitat quality/carbon storage, while it enhances the synergistic relationship between soil retention and water yield. Driven by precipitation factors, ecosystem services related to water yield have significant differences in the change. The population density enhances the trade-offs of crop production and soil retention, as well as the synergistic relationship between soil retention and habitat quality/carbon storage. In different land use/cover (LULC), the influence of urban land on ecosystem services relationship change is more obvious. Overall, this study can provide scientific bases and policy suggestions for ecosystem protection/restoration in the red soil region of Southern China, which has an important theoretical and practical significance.

Research on the sustainability of "greening" process in the Mu Us Sandy Land based on the spatiotemporal stability of ecological land.

In environmentally sensitive areas, especially the arid and semi-arid regions, the greening stability process and its influencing factors can directly affect the sustainable development of the ecological environment. In this study, multi-source remote sensing data such as land use/cover data, MODIS NDVI, and soil moisture, methods such as stability index, vegetation quantitative remote sensing, and Geodetector were employed to analyze the sustainability of the greening process in the Mu Us Sandy in 2000-2020, which were viewed from three aspects: changes in stability of land use types and function, soil moisture change and influencing factors on greening stability. The results showed that, (1) From the stability of land use types, continuous stable ecological land accounted for more than 50%, showing that decreased from northwest toward southeast. (2) From the functional stability, NDVI showed a fluctuated growth (0.035/a), with an increasing distribution pattern from northwest to southeast. Additionally, Vegetation changes were unstable and concentrated in the western part of the study area (OtogBanner and Otog Front Banner), while the eastern part was stable, in which vegetation improvement took the main position. Moreover, mobile dunes almost disappeared, and semi-fixed dunes decreased and gradually shrank to the west of the sandy area, while fixed dunes soared and were concentrated in the middle of the sandy land. (3) From the soil moisture change, soil moisture at different underground depths showed an overall increasing trend, but the deep soil moisture was higher than the shallow, and spatial distribution varied greatly. (4) From the influencing factors, natural factors significantly influence greening stability, among which precipitation had a particularly profound impact, and interactions with other natural and social factors were higher explanatory. The paper aims to explore whether the ecological environment is developing in a good and orderly direction in the Mu Us Sandy Land, and the potential factors that cause its changes, to provide a theoretical basis for scientific governance in the Mu Us Sandy Land and other arid and semi-arid areas in the future.

A Satellite Imagery Dataset for Long-Term Sustainable Development in United States Cities.

Cities play an important role in achieving sustainable development goals (SDGs) to promote economic growth and meet social needs. Especially satellite imagery is a potential data source for studying sustainable urban development. However, a comprehensive dataset in the United States (U.S.) covering multiple cities, multiple years, multiple scales, and multiple indicators for SDG monitoring is lacking. To support the research on SDGs in U.S. cities, we develop a satellite imagery dataset using deep learning models for five SDGs containing 25 sustainable development indicators. The proposed dataset covers the 100 most populated U.S. cities and corresponding Census Block Groups from 2014 to 2023. Specifically, we collect satellite imagery and identify objects with state-of-the-art object detection and semantic segmentation models to observe cities' bird's-eye view. We further gather population, nighttime light, survey, and built environment data to depict SDGs regarding poverty, health, education, inequality, and living environment. We anticipate the dataset to help urban policymakers and researchers to advance SDGs-related studies, especially applying satellite imagery to monitor long-term and multi-scale SDGs in cities.

Navigating the landscape of global sustainable livelihood research: past insights and future trajectory.

Sustainable livelihoods (SL) have emerged as a crucial area of focus in global environmental change research, aligning with the Sustainable Development Goals (SDGs). This field is rapidly gaining prominence in sustainability science and has become one of the primary research paradigms. In our study, we conducted scientometrics analysis using the ISI Web of Science core collection database to examine research patterns and frontier areas in SL research. We selected 6441 papers and 265,759 references related to SL published from 1991 to 2020. To achieve this, we employed advanced quantitative analysis tools such as CiteSpace and VOSviewer to quantitatively analyze and visualize the evolution of literature in the SL research field. Our overarching objectives were to understand historical research characteristics, identify the knowledge base, and determine future research trends. The results revealed an exponential increase in SL research documentation since 1991, with the Consortium of International Agricultural Research Center (CGIAR) contributing the highest volume of research documents and citations. Key journals in this field included World Development, Global Environmental Change, Ecological Economics, and Ecology and Society. Notably, Singh RK and Shackleton CM emerged as prolific authors in SL research. Through our analysis, we identified six primary clusters of research areas: livelihoods, conservation, food security, management, climate change, and ecosystem services. Additionally, we found that tags such as rural household, agricultural intensification, cultural intensification, and livelihoods vulnerability remained relevant and represented active research hotspots. By analyzing keyword score relevance, we identified frontier areas in SL research, including mass tourism, solar home systems, artisanal and small-scale mining, forest quality, marine-protected areas, agricultural sustainability, sustainable rangeland management, and indigenous knowledge. These findings provide valuable insights to stakeholders regarding the historical, current, and future trends in SL research, offering strategic opportunities to enhance the sustainability of livelihoods for farmers and rural communities in alignment with the SDGs.

Comparative study of electroplating sludge reutilization in China: environmental and economic performances.

Harmless disposal and reutilization of electroplating sludge (ES) attract growing interests due to the high content of heavy metals, which requires economical-affordable and environmentally friendly processing technologies. Main reutilization alternatives in China, i.e., acid leaching, bioleaching, smelting, ironmaking blast furnace co-processing (IBFC), and cement kiln co-processing (CKC), were evaluated and compared via life cycle assessment (LCA) and life cycle costing (LCC) methods. In addition, the heavy metal recovery potential of these scenarios was also evaluated to focus on the sustainable use of metal resources. LCA results show that acid leaching outperforms other scenarios due to the environmental benefits originating from recovering heavy metals, while smelting exhibits the worst due to high energy consumption. The environmental contribution analysis reveals that the product nickel sulfate has a significant positive impact on acid leaching and bioleaching scenarios, and energy consumption is the key factor for smelting, IBFC, and CKC. LCC results show that bioleaching outperforms others, while CKC performs the worst because only inorganic materials are utilized. Bioleaching has the lowest externality cost while CKC has the highest. The heavy metal recovery assessment indicates that bioleaching exhibits the greatest potential with recovery rates of 99%, 99%, 93%, 96%, and 95% for Cu, Cr, Ni, Zn, and Fe, respectively. In contrast, the target heavy metal recovery rate for both acid leaching and smelting is 93%. Acid leaching and bioleaching scenarios are more advantageous from a comprehensive comparison.

Micro- and nanoplastics in soil: Linking sources to damage on soil ecosystem services in life cycle assessment.

Soil ecosystems are crucial for providing vital ecosystem services (ES), and are increasingly pressured by the intensification and expansion of human activities, leading to potentially harmful consequences for their related ES provision. Micro- and nanoplastics (MNPs), associated with releases from various human activities, have become prevalent in various soil ecosystems and pose a global threat. Life Cycle Assessment (LCA), a tool for evaluating environmental performance of product and technology life cycles, has yet to adequately include MNPs-related damage to soil ES, owing to factors like uncertainties in MNPs environmental fate and ecotoxicological effects, and characterizing related damage on soil species loss, functional diversity, and ES. This study aims to address this gap by providing as a first step an overview of the current understanding of MNPs in soil ecosystems and proposing a conceptual approach to link MNPs impacts to soil ES damage. We find that MNPs pervade soil ecosystems worldwide, introduced through various pathways, including wastewater discharge, urban runoff, atmospheric deposition, and degradation of larger plastic debris. MNPs can inflict a range of ecotoxicity effects on soil species, including physical harm, chemical toxicity, and pollutants bioaccumulation. Methods to translate these impacts into damage on ES are under development and typically focus on discrete, yet not fully integrated aspects along the impact-to-damage pathway. We propose a conceptual framework for linking different MNPs effects on soil organisms to damage on soil species loss, functional diversity loss and loss of ES, and elaborate on each link. Proposed underlying approaches include the Threshold Indicator Taxa Analysis (TITAN) for translating ecotoxicological effects associated with MNPs into quantitative measures of soil species diversity damage; trait-based approaches for linking soil species loss to functional diversity loss; and ecological networks and Bayesian Belief Networks for linking functional diversity loss to soil ES damage. With the proposed conceptual framework, our study constitutes a starting point for including the characterization of MNPs-related damage on soil ES in LCA.

The incidence of asthma attributable to temperature variability: An ecological study based on 1990-2019 GBD data.

BACKGROUND: Asthma, the second leading cause of death from chronic respiratory diseases, is associated with climate change, especially temperature changes. It is currently unclear about the relationship between long-term temperature variability and the incidence of asthma on a global scale. METHODS: We used asthma incidence, demographic and socioeconomic data from the Global Burden of Disease (GBD) Results Database, and environmental and geographical statistics from TerraClimate between 1990 and 2019 to determine the association between maximum temperature variability and asthma incidence. We also predicted the incidence of heat-related asthma in the future (2020-2100) under four shared socioeconomic pathways (SSPs: 126, 245, 370, and 585). RESULTS: Between 1990 and 2019, the global median incidence of asthma was 402.0 per 100,000 with a higher incidence (median: 1380.3 per 100,000) in children under 10 years old. We found that every 1 °C increase in maximum temperature variability increased the risk of asthma globally by 5.0 %, and the effect was robust for individuals living in high-latitude areas or aged from 50 to 70 years. By 2100, the average incidence of asthma is estimated to be reduced by 95.55 %, 79.32 %, and 40.02 % under the SSP126, SSP245, and SSP370 scenarios, respectively, compared to the SSP585 at latitudes >60°. CONCLUSION: Our study provides evidence that maximum temperature variability is associated with asthma incidence. These findings suggest that implementing stricter mitigation and adaptation strategies may be importment in reducing asthma cases caused by climate change.

Policy evaluation during a pandemic.

National and local governments have implemented a large number of policies in response to the Covid-19 pandemic. Evaluating the effects of these policies, both on the number of Covid-19 cases as well as on other economic outcomes is a key ingredient for policymakers to be able to determine which policies are most effective as well as the relative costs and benefits of particular policies. In this paper, we consider the relative merits of common identification strategies that exploit variation in the timing of policies across different locations by checking whether the identification strategies are compatible with leading epidemic models in the epidemiology literature. We argue that unconfoundedness type approaches, that condition on the pre-treatment "state" of the pandemic, are likely to be more useful for evaluating policies than difference-in-differences type approaches due to the highly nonlinear spread of cases during a pandemic. For difference-in-differences, we further show that a version of this problem continues to exist even when one is interested in understanding the effect of a policy on other economic outcomes when those outcomes also depend on the number of Covid-19 cases. We propose alternative approaches that are able to circumvent these issues. We apply our proposed approach to study the effect of state level shelter-in-place orders early in the pandemic.

Association study between drug prescriptions and Alzheimer's disease claims in a commercial insurance database.

In the ongoing effort to discover treatments for Alzheimer's disease (AD), there has been considerable focus on investigating the use of repurposed drug candidates. Mining of electronic health record data has the potential to identify novel correlated effects between commonly used drugs and AD. In this study, claims from members with commercial health insurance coverage were analyzed to determine the correlation between the use of various drugs on AD incidence and claim frequency. We found that, within the insured population, several medications for psychotic and mental illnesses were associated with higher disease incidence and frequency, while, to a lesser extent, antibiotics and anti-inflammatory drugs were associated with lower AD incidence rates. The observations thus provide a general overview of the prescription and claim relationships between various drug types and Alzheimer's disease, with insights into which drugs have possible implications on resulting AD diagnosis.

Health risk assessment of dietary cadmium intake in children aged 2-17 years in East China.

Food is the main way for people to be exposed to heavy metal cadmium (Cd), and Cd pollution will affect human health. In this paper, exposure and health risk assessment of dietary Cd intake were conducted in children aged 2, 3, 4, 5, 6-8, 9-11, 12-14 and 15-17 years in East China. The results showed that the total exposure of dietary Cd intake in children exceeded the standard limits. The total exposure of all age groups were 1.11 × 10-3, 1.15 × 10-3, 9.67 × 10-4, 8.75 × 10-4, 9.18 × 10-4, 7.75 × 10-4, 8.24 × 10-4, 7.11 × 10-4 mg kg-1 d-1, respectively, and the highest was the children aged 3 years. The hazard quotients of children aged 2 and 3 years were 1.11 and 1.15, respectively, at an unacceptable health risk level. The hazard quotients of dietary Cd intake in children of other ages were less than 1, at an acceptable health risk level. Staple foods were the most significant contributor to the dietary Cd intake in children, and the contribution ratio of non-carcinogenic risk of dietary Cd intake in all age groups were more than 35%, the proportion of non-carcinogenic risk in children aged 6-8 and 9-11 years were as high as 50%. This study provides scientific basis for the health of children in East China.

Incidence, mortality, survival, and disease burden of breast cancer in China compared to other developed countries.

Breast cancer was the most diagnosed malignant neoplasm and the second leading cause of cancer mortality among Chinese females in 2020. Increased risk factors and widespread adoption of westernized lifestyles have resulted in an upward trend in the occurrence of breast cancer. Up to date knowledge on the incidence, mortality, survival, and burden of breast cancer is essential for optimized cancer prevention and control. To better understand the status of breast cancer in China, this narrative literature review collected data from multiple sources, including studies obtained from the PubMed database and text references, national annual cancer report, government cancer database, Global Cancer Statistics 2020, and Global Burden of Disease study (2019). This review provides an overview of the incidence, mortality, and survival rates of breast cancer, as well as a summary of disability-adjusted life years associated with breast cancer in China from 1990 to 2019, with comparisons to Japan, South Korea, Australia and the United States.

Global competence of medical students: An assessment scale and preliminary investigation in China.

INTRODUCTION: The importance of global competence has been acknowledged in medical care as well as medical education. This study aims to develop a scale assessing the global competence of medical students, determine the factor structure and internal consistency of the scale and explore the underlying factors influencing the global competence of Chinese medical students in 8-year programs. METHODS: A questionnaire (Global Competence Assessment Scale for Medical Students, MS-GCAS) was developed, and a cross-sectional multicenter survey was conducted in 1062 medical students from 10 medical schools in China. Questionnaire data were analyzed using exploratory factor analysis and multiple linear regression. RESULTS: The exploratory factor analysis revealed a three-factor scale. The MS-GCAS has good internal consistency (Cronbach's alpha = 0.79 to 0.87). In the multivariate regression analyses, medical education stage (p<0.05), the frequency of communicating with foreigners (p<0.001), multilingual ability (p<0.05) and grade level (p<0.05) are associated with the MS-GCAS scores. DISCUSSION: The MS-GCAS has the potential to serve as a tool to measure the global competence of medical students. This three-factor scale can be used by medical education researches to improve future versions. Medical schools should conduct further educational reforms to promote students' global competence.

Assessment of screen-recalled abnormalities for digital breast tomosynthesis versus digital mammography screening in the BreastScreen Maroondah trial.

INTRODUCTION: Australia's first population-based pilot trial comparing digital breast tomosynthesis (DBT) and digital mammography (DM) screening reported detection measures in 2019. This study describes the trial's secondary outcomes pertaining to the assessment process in women screened with DBT or DM, including the type of recalled abnormalities and the procedures performed. METHODS: Women with suspected abnormalities at screening were recalled for further investigation. Outcome measures were number of lesions assessed, types of imaging findings recalled to assessment, and data on testing and assessment outcomes; these were reported using descriptive analyses of lesion-specific data. RESULTS: A total of 274 lesions and 203 lesions were reported in the DBT-screened and DM-screened groups, respectively. There were a higher proportion of lesions depicted as calcifications (32.4% vs 21.3%), and a lower proportion of lesions depicted as asymmetrical densities (3.2% vs 15.7%) for DBT recalls than DM recalls. A lower proportion of DBT-recalled lesions was assessed with additional mammography than DM-recalled lesions (49.3% vs 93.1%). Higher proportions of DBT-recalled lesions than DM-recalled lesions were investigated with clinical breast examination (50.4% vs 39.9%), core needle biopsy (45.6% vs 28.6%) and open biopsy (4.0% vs 1.0%). Similar proportions of DBT- and DM-recalled lesions were assessed using ultrasound (76.3% vs 71.4%). CONCLUSION: Assessment of screen-recalled lesions showed that, compared with DM, DBT found more benign and more malignant lesions, and generally required more procedures except for less additional mammography workup. These findings show that a transition to DBT screening changes the assessment workload.

Caregiver burden for informal caregivers of patients after surgical treatment of early-stage lung cancer.

BACKGROUND: Caregivers of lung cancer patients frequently experience psychological distress and high caregiver burden. Previous studies have focused on caregiver burden for patients with advanced lung cancer, while few studies focused on the caregiver burden among informal caregivers of postoperative patients with early-stage non-small cell lung cancer (NSCLC). OBJECTIVES: This study aimed to (a) examine caregiver burden for caregivers of patients with early-stage NSCLC after surgical treatment and (b) identify predictive factors related to caregiver burden of patients with early-stage NSCLC. METHODS: A cross-sectional study was conducted in a university-affiliated hospital in Changsha, China. A total of 385 patients with early-stage NSCLC and postsurgical treatment and their caregivers were included in this study. Caregiver burden was evaluated using the Zarit caregiver burden interview (ZBI). A set of questionnaires was used to assess psychosocial characteristics of participants, including simplified coping style questionnaire, social support rate scale, and hospital anxiety and depression scale. Hierarchical regression analysis was applied to identify factors associated with caregiver burden. We followed STROBE checklist for reporting the study. RESULTS: The average ZBI score was 29.1 ± 11.4. Most caregivers (62.6%) demonstrated mild to moderate caregiving burden. The duration of caregiving (ß = 0.18, p < .001), passive coping of caregiver (ß = 0.17, p = .001) and anxiety (ß = 0.13, p = .007) were significant predictors of caregiving burden. A variance of 17.6% in caregiving burden was explained by these identified factors. CONCLUSIONS: Caregivers of early-stage NSCLC patients experience a mild to moderate level of caregiver burden. The duration of caregiving, passive coping and anxiety are factors associated with caregiver burden. RELEVANCE TO CLINICAL PRACTICE: Clinicians should provide early care to support new roles of family members as caregivers.

Environmental and economic assessment of rural domestic waste gasification models in China.

The dispersed sources and inconvenient transportation of rural domestic waste (RDW) lead to difficult centralized treatment. Gasification is suitable for decentralized waste treatment, which can effectively avoid RDW long-distance transportation and reduce dioxin emissions compared with small-scale incineration. Hence, economically-affordable and environmentally-friendly RDW treatment models with different gasification scales are required, and village, town and county models were compared via life cycle assessment (LCA) and life cycle cost (LCC) methods in this study. Furthermore, scenario analysis investigated waste sorting based on two food waste (FW) treatment technologies, different FW separate collection efficiency, and electricity recovery to explore the environmental and economic improvement potentials of three models. LCA results show that electricity consumption and direct emissions are significant contributors to environmental impacts, and the county model outperforms village and town models. Moreover, transportation accounts for 6% of the overall environmental impact in the county model. Scenario analysis reveals that waste sorting and electricity recovery can reduce the overall environmental impact by 29% to 146% for three models. LCC results demonstrate that the town model delivers the lowest economic cost, while the village model is the highest. In scenario analysis, resource utilization of FW and electricity recovery of other waste exhibit promising economic benefits. The findings provide comprehensive references for sustainable RDW treatment.

Caregiving burden and positive aspects of caregiving among family caregivers of people living with schizophrenia: Two sides of the same coin.

BACKGROUND: Caring for a family member with schizophrenia is associated with a significant burden, but may also bring about positive transformation among caregivers, which were rarely studied simultaneously. AIMS: The current study aims to investigate the association between caregiver burden and positive aspects of caregiving (PAC), as well as explore and compare the correlates of each. METHODS: A cross-sectional study was conducted on a representative urban sample of schizophrenia family caregivers in China (N = 406). Participants were interviewed individually to complete questionnaires regarding socio-demographics, caregiver burden, PAC, and psychosocial factors that included social support, coping, and family functioning. RESULTS: The caregivers reported moderate levels of both caregiver burden (mean:43.05 ± 18.26, range: 0-88) and PAC (mean: 25.88 ± 9.59, range: 0-36), which were not significantly associated with each other (r = -0.06, p = 0.25) and had different correlates. Parent caregivers, middle and high school education, additional dependents, lower level of social support, and frequent endorsement of active and passive coping were all associated with more caregiver burden. Higher levels of social support, active coping, and family functioning were associated with higher PAC. CONCLUSIONS: Caring for a family member with schizophrenia can be both burdensome and rewarding. Caregiver burden and PAC coexist yet are unrelated with different correlates. Future research and intervention programs should not only focus on mitigating caregiver burden but also enhancing PAC, which may be realized through the improvement of social support, active coping, and family functioning while paying special attention to various socio-demographics.

A systematic assessment of online international breast density information.

BACKGROUND: Breast density has become a topic of international discussion due to its associated risk of breast cancer. As online is often a primary source of women's health information it is therefore essential that breast density information it is understandable, accurate and reflects the best available evidence. This study aimed to systematically assess online international breast density information including recommendations to women. METHODS: Searches were conducted from five different English-speaking country-specific Google locations. Relevant breast density information was extracted from the identified websites. Readability was assessed using the SHeLL Editor, and understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). A content analysis of specific recommendations to women was also conducted. RESULTS: Forty-two eligible websites were identified and systematically assessed. The included informational content varied across websites. The average grade reading level across all websites was 12.4 (range 8.9-15.4). The mean understandability was 69.9% and the mean actionability was 40.1%, with 18/42 and 39/42 websites respectively scoring lower than adequate (70%). Thirty-six (85.7%) of the websites had breast density-related recommendation to women, with 'talk to your doctor' (n = 33, 78.6%) the most common. CONCLUSIONS: Online information about breast density varies widely and is not generally presented in a way that women can easily understand and act on, therefore greatly reducing the ability for informed decision-making. International organisations and groups disseminating breast density information need to ensure that women are presented with health literacy-sensitive and balanced information, and be aware of the impact that recommendations may have on practice.