The impact of ambient air pollution on hospital admissions, length of stay and hospital costs for patients with diabetes mellitus and comorbid respiratory diseases in Panzhihua, Southwest China.

Background: There is limited evidence on association between air pollutants and hospital admissions, hospital cost and length of stay (LOS) among patients with diabetes mellitus (DM) and comorbid respiratory diseases (RD), especially in low- and middle-income countries (LMICs) with low levels of air pollution. Methods: Daily data on RD-DM patients were collected in Panzhihua from 2016 to 2020. A generalised additive model (GAM) was used to explore the effect of air pollutants on daily hospital admissions, LOS and hospital cost. Attributable risk was employed to estimate RD-DM's burden due to exceeding air pollution exposure, using both 0 microgrammes per cubic metre (µg/m3) and WHO's 2021 air quality guidelines as reference. Results: For each 10 ug/m3 increase of particles with an aerodynamic diameter <2.5 micron (µm) (PM2.5), particles with an aerodynamic diameter <10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3), the admissions of RD-DM patients increased by 7.25% (95% CI = 4.26 to 10.33), 5.59% (95% CI = 3.79 to 7.42), 10.10% (95% CI = 7.29 to 12.98), 12.33% (95% CI = 8.82 to 15.95) and -2.99% (95% CI = -4.08 to -1.90); per 1 milligramme per cubic metre (mg/m3) increase of carbon monoxide (CO) corresponded to a 25.77% (95% CI = 17.88 to 34.19) increment for admissions of RD-DM patients. For LOS and hospital cost, the six air pollutants showed similar effect. Given 0 µg/m3 as the reference, NO2 showed the maximum attributable fraction of 32.68% (95% CI = 25.12 to 39.42%), corresponding to an avoidable burden of 5661 (95% CI = 3611 to 5860) patients with RD-DM. Conclusions: There is an association between PM2.5, PM10, SO2, NO2, and CO with increased hospital admissions, LOS and hospital cost in patients with RD-DM. Disease burden of RD-DM may be improved by formulating policies related to air pollutants exposure reduction, especially in LMICs with low levels of air pollution.

Associations of socioeconomic status and obesity with hypertension in tibetan adults in a Chinese plateau area.

BACKGROUND: Previous studies have identified that socioeconomic status (SES) and obesity are associated with hypertension. However, their interaction on hypertension risk has not yet been assessed. METHODS: The study used data from 6,069 Tibetan residents in Chengguan District in Lhasa, the Chinese Tibetan autonomous region's capital, based on a cohort study conducted from May 2018 to September 2019 in five provinces in southwest China. We used logistic regression models to assess the complex relations of SES and obesity with hypertension. RESULTS: Compared with individuals of high SES, low and moderate SES were positively associated with high risk of hypertension. SES and obesity have significant additive interaction on hypertension (general obesity by BMI: RERI = 1.33, P < 0.001; abdominal obesity by WC: RERI = 0.76, P < 0.001; abdominal obesity by WHtR: RERI = 0.96, P < 0.001). In people from the low and moderate SES segments, obesity was linked to an increased risk of hypertension, but the correlations were stronger in people from the moderate SES category. Compared with people of high SES and non obese, those with moderate SES and obesity had a higher risk of hypertension, and ORs were 4.38 (2.80, 6.84) for general obesity by BMI, 3.38 (2.05, 5.57) for abdominal obesity by WC, and 3.18 (1.57, 6.42) for abdominal obesity by WHtR. CONCLUSION: There is an independent and additive interaction effect of obesity and SES on the risk of hypertension. People with obesity, especially those of moderate and low SES, should reduce weight and waist circumference, and pay more attention to blood pressure. Moreover, the government, health administration departments, and society should prioritize improving the socioeconomic status of the Tibetan population and addressing risk factors like obesity.

Investigation of Volatile Components and Assessment of Antioxidant Potential in Seven Lamiaceae Plant Hydrosols.

Aromatic plants of the family Lamiaceae, especially of the genus Thymus, have promising antioxidant applications in pharmacology, medicine, food, cosmetology, and aromatherapy. Hydrosols (HDs) were extracted by hydrodistillation from seven species of Lamiaceae, including Thymus vulgaris, Thymus mongolicus, Mentha × piperita, Melissa officinalis, Rosmarinus officinali, Salvia elegans, and Leonurus artemisia. In total, 369 volatile components were determined and analyzed by gas chromatography-mass spectrometry (GC-MS). Among them, alcohols (2.86-28.48%), ethers (2.46-10.69%), and phenols (0.11-21.78%) constituted a large proportion, mainly linalool (0.28-19.27%), eucalyptol (0.16-6.97%), thymol (0-19.54%), and carvacrol (0-26.82%). Multivariate statistical analyses were performed and 27 differential metabolites were screened. Three different methods (ABTS+•, DPPH•, and FRAP) were used to determine the in vitro antioxidant activity of seven HDs. Thymus vulgaris hydrosols (Tv HDs) and Thymus mongolicus hydrosols (Tm HDs) had the strongest antioxidant activity and their stronger antioxidant capacity was related to their high levels of phenolic constituents, mainly thymol. The antioxidant activity of the other five Lamiaceae HDs was associated with their high alcohol (mainly linalool and eucalyptol) content, and the alcohol constituents may synergistically affect their antioxidant capacity. Therefore, the present study suggests that Lamiaceae plants can be utilized as antioxidant products or antioxidants in different industrial sectors including pharmaceuticals, food, cosmetics, and agrochemicals.

Health and economic impacts of ambient air pollution on hospital admissions for overall and specific cardiovascular diseases in Panzhihua, Southwestern China.

Background: The associations of ambient air pollution with hospital admissions (HAs) for overall and specific causes of cardiovascular diseases (CVDs), as well as related morbidity and economic burdens remain understudied, especially in low-pollution areas of low- and middle-income countries (LMICs). We evaluated the short-term effects of exposure to PM2.5 (particles with an aerodynamic diameter ≤2.5 µm), PM10 (particles with an aerodynamic diameter ≤10 µm), and SO2 (sulfur dioxide) on HAs for CVDs in Panzhihua, China, during 2016-2020, and calculated corresponding attributable risks and economic burden. Methods: We used a generalized additive model (GAM) while controlling for time trends, meteorological conditions, holidays, and days of the week to estimate the associations. The cost of illness (COI) method was adopted to further assess corresponding hospitalization costs and productivity losses. Results: A total of 27 660 HAs for CVDs were included in this study. PM10 and SO2 were significantly associated with elevated risks of CVDs hospitalizations. Each 10 µg/m3 increase in PM10 and SO2 at lag06 corresponded to an increase of 2.48% (95% confidence interval (CI) = 0.92%-4.06%), and 5.50% (95% CI = 3.09%-7.97%) in risk of HAs for CVDs, respectively. The risk estimates of PM10 and SO2 on CVD hospitalizations were generally robust after adjustment for other pollutants in two-pollutant models. We found stronger associations between air pollution (PM10 and SO2) and CVDs in cool seasons than in warm seasons. For specific causes of CVDs, significant associations of PM10 and SO2 exposure with cerebrovascular disease and ischaemic heart disease were observed. Using 0 µg/m3 as the reference concentrations, 11.91% (95%CI = 4.64%-18.56%) and 15.71% (95%CI = 9.30%-21.60%) of HAs for CVDs could be attributable to PM10 and SO2, respectively. During the study period, PM10 and SO2 brought 144.34 million Yuan economic losses for overall CVDs, accounting for 0.028% of local GDP. Conclusions: Our results suggest that PM10 and SO2 exposure might be an important trigger of HAs for CVDs and accounted for substantial morbidity and economic burden.

Urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old: evidence from a cross-sectional study in Tibet.

OBJECTIVE: To assess urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old. DESIGN: A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination. SETTING: Tibet, China. PARTICIPANTS: Children under 5 years old in Tibet. RESULTS: Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (ß = -0·23, 95 % CI: -0·38, -0·08), Z-scores of weight-for-age (ß = -0·24, 95 % CI: -0·39, -0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05). CONCLUSIONS: High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children's nutrition is urgently needed in areas above 3500 m, especially in rural ones.

Between- and within-person associations of mobile gaming time and total screen time with sleep problems in young adults: Daily assessment study.

OBJECTIVES: To explore associations of screen time (total, mobile gaming) with sleep problems in Chinese young adults. METHODS: This was a 4-week daily morning (completion rate = 82.1%, 909/1107) and evening (completion rate = 92.4%, 1061/1148) assessment study in 41 university students (22 female, mean age = 22.3 [SD 4.2] years). Short sleep duration < 7 h, difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and any of these three insomnia symptoms were self-reported in the morning. Mobile gaming time was self-reported in the evening, whilst total screen time was objectively tracked. Bayesian multilevel mixed-effects modeling disaggregated between- and within-person associations. RESULTS: Between person, longer mobile gaming time predicted short sleep duration (adjusted odds ratio [AOR] = 1.90, 95% CI 1.39, 2.69), any insomnia symptoms (AOR = 1.59, 95% CI 1.20, 2.11), difficulty initiating sleep (AOR = 3.05, 95% CI 1.51, 6.24), and difficulty maintaining sleep (AOR = 2.19, 95% CI 1.18, 3.74). Short sleep duration (adjusted b = 0.99, 95% CI 0.05, 1.95), any insomnia symptoms (adjusted b = 1.19, 95% CI 0.24, 1.94), and difficulty initiating sleep (adjusted b = 1.72, 95% CI 0.11, 3.19) reversely increased mobile gaming time. Within person, any insomnia symptoms (adjusted b = 0.17, 95% CI 0.04, 0.31) and early morning awakening (adjusted b = 0.28, 95% CI 0.08, 0.48) increased next-day mobile gaming time. Total screen time was not associated with sleep problems both between and within person. CONCLUSIONS: Bidirectional between-person associations of mobile gaming time with short sleep duration and insomnia symptoms informed multiple-health-behavior-change interventions. Unidirectional within-person associations of insomnia symptoms with next-day mobile gaming time informed just-in-time adaptive interventions addressing daily variations in insomnia symptoms. [250/250 word limits].

Social capital and sleep disorders in Tibet, China.

OBJECTIVE: Sleep plays an important role in the health and well-being of middle aged and elderly people, and social capital may be one of the important factors for sleep disorders. This study aimed to understand the relationship between social capital and sleep disorders in a unique region of China -Tibet that generally has the disadvantaged economic status compared to other parts of China. METHODS: The study was based on Tibetan data from The China Multi-Ethnic Cohort (CMEC) and was conducted from May 2018 to September 2019. A total of 3194 Tibetans aged > 50 were selected from the community population by multi-stage stratified cluster sampling. Social capital was measured using two validated health-related social capital scales, family/community and society.. Sleep disorders were measured as the presence of disorders of initiating and maintaining sleep, early morning awakening, or daytime dysfunction. Logistic regression models were applied to examine the association between social capital and sleep disorders. RESULTS: 39.9% (1271/3194) of the participants had sleep disorders. In addition, after controlling for all potential variables, family social capital was significantly negatively associated with sleep disorders (OR = 0.95, P < 0.05), while community and society social capital was not associated with sleep disorders. Then, when we did all the sex-stratified analyses, the significant association between social capital and sleep disorders was found only in women (OR = 0.94, P < 0.05), while no association was found in males; neither males nor females showed any association with community and society social capital. CONCLUSION: Our study would help to better understand the extent of health inequality in China, and guide future interventions, strategies and policies to promote sleep quality in low-income areas, taking into account both the role of Tibetan specific cultural traditions, lifestyles and religious beliefs in social capital and the gender differences in social capital.

Determinants of self-rated health among an older Tibetan population in a Chinese plateau area: analysis based on the conceptual framework for determinants of health.

BACKGROUND: Self-rated health (SRH) has been frequently used in population health surveys. However, most of these studies only focus on specific factors that might directly affect SRH, so only partial or confounding information about the determinants of SRH is potentially obtained. Conducted in an older Tibetan population in a Chinese plateau area, the aim of our study is to assess interrelationships between various factors affecting SRH based on the conceptual framework for determinants of health. METHODS: Between May 2018 and September 2019, 2707 Tibetans aged 50 years or older were recruited as part of the China Multi-Ethnic Cohort Study (CMEC) from the Chengguan District of Lhasa city in Tibet. The information included SRH and variables based on the conceptual framework for determinants of health (i.e., socioeconomic status, health behaviors, physical health, mental health, and chronic diseases). Structural equation modeling (SEM) was used to estimate the direct and indirect effects of multiple factors in the conceptual framework. RESULTS: Among all participants, 5.54% rated their health excellent, 51.16% very good, 33.58% good, 9.12% fairly poor and 0.59% poor. Physical health (ß = - 0.23, P <  0.001), health behaviors (ß = - 0.44, P <  0.001), socioeconomic status (ß = - 0.29, P <  0.001), chronic diseases (ß = - 0.32, P <  0.001) and gender (ß = 0.19, P <  0.001) were directly associated with SRH. Socioeconomic status, physical health and gender affected SRH both directly and indirectly. In addition, there are potential complete mediator effects in which age and mental health affect SRH through mediators, such as physical health, health behaviors and chronic diseases. CONCLUSIONS: The findings suggested that interventions targeting behavioral changes, health and chronic disease management should be attached to improve SRH among older populations in plateau areas without ignoring gender and socioeconomic disparities.

[Effects of different tillage methods on photosynthetic characteristics, dry matter production and economic benefit of double cropping soybean].

In order to explore suitable mode of high yield cultivation of double cropping soybean after wheat under drip irrigation in northern Xinjiang, field trials were set in 2013-2014 to investigate physiological indices and agronomic traits of double cropping soybean under different tillage methods under drip irrigation. The results showed that leaf area index (LAI), chlorophyll content (SPAD), leaf net photosynthetic rate (Pn), transpiration rate (Tr) and stomatal conductance (g(s)) during the determination period under different tillage methods were in the order of tillage plus film covering (TP)> tillage (T)> rotary tillage (RT) > no-tillage (NT) , and the concentration of intercellular CO2(Ci) was the opposite. LAI, SPAD, Pn, Tr, and g(s) of TP were higher than that with NT by 55.0%, 9.1%, 41.8%, 37.5% and 56.4%, respectively, and Ci was decreased by 22.1%. TP enhanced the photosynthetic efficiency of soybean and improved the ability of CO2assimilation, consequently leading to the increase of soybean yield under TP compared to NT. The plant dry matter accumulation of TP treatment was improved greatly, with the pod number and seeds number per plant, 100-seed mass and yield of quadric sowing soybean being increased by 50.3%, 48.1%, 11.8% and 20.8% compared with that under NT, and the differences were significant. Therefore, the plastic film mulching combined with tillage under drip irrigation technology was suitable for double cropping soybean after wheat in northern Xinjiang under this experimental condition.

[Acute Toxicity and Safety Assessment of Three Typical Organic Pollutants to Two Aquatic Organisms].

Acute toxic effects of three typical organic pollutants 1 ,2,4-trichlorobenzene (1,2,4-TCB), nitrobenzene and chlorpyrifos were investigated using Tetrahymena thermophila and Limnodrilus hoffmeisteri as living test organisms under laboratory conditions. The results showed that with the increase of pollutants' concentration and the extension of time, toxicity of the three kinds of pollutants significantly enhanced, and the mortality of two kinds of aquatic organisms also had a rising trend, and an obvious dose-effect relationship. The 96 h-LC50. values of 1 ,2, 4-TCB, nitrobenzene and chlorpyrifos were 71.88, 285.76, and 5.50 mg x L(-1) for L. hoffmeisteri and 15.58, 140.22, and 14.69 mg x L(-1) for T. thermophila. These results showed that the toxicity among the three typical pollutants to T. thermophila was 1 , 2,4-TCB > chlorpyrifos > nitrobenzene. Findings were able to provide more information on water quality criteria and more data on their toxicity to indigenous aquatic organisms in China.

Reliability and validity of the Chinese version of the Short Musculoskeletal Function Assessment questionnaire in patients with skeletal muscle injury of the upper or lower extremities.

BACKGROUND: The Short Musculoskeletal Function Assessment (SMFA) questionnaire is one of the most commonly used scales to evaluate functional status and quality of life (QOL) of patients with a broad range of musculoskeletal disorders. However, a Chinese version of the SMFA questionnaire for the psychometric properties of skeletal muscle injury patients in China is still lacking. The current study translated the SMFA into Chinese and assessed its reliability and validity among Chinese patients with skeletal muscle injury of the upper or lower extremities. METHODS: The original SMFA was translated from English into Chinese and culturally adapted according to cross-cultural adaptation guidelines. A multicenter cross-sectional study was conducted, comprising 339 skeletal muscle injury patients (aged 20-75 years) from 4 hospitals. The SMFA, the health survey short form (SF-36) along with a region-specific questionnaire (including the disabilities of the arm, shoulder, and hand questionnaire (DASH), the hip disability and osteoarthritis outcome score (HOOS), the knee injury and osteoarthritis outcome score (KOOS), and the foot function index (FFI)) were completed according to the region of injury. Reliability was estimated from the internal consistency using Cronbach's α and validity was assessed via convergent validity, known-groups comparison, and construct validity. RESULTS: Cronbach's α coefficient was over 0.75 for two subscales and four categories of the SMFA, suggesting that the internal consistency reliability of the SMFA was satisfactory. Known-groups comparison showed that the dysfunction index and the bother index of the SMFA discriminated well between patients who differed in age, gender, injury location, and operation status rather than in subgroups based on the body mass index (BMI). The convergent validity of the SMFA was good, as moderate to excellent correlations were found between the subscales of the SMFA and the four subscales of SF-36 (physical function, role-physical, bodily pain, and social functioning) and the region-specific questionnaires. The construct validity was proved by the presence of a six-factor structure that accounted for 66.85 % of the variance. CONCLUSION: The Chinese version of the SMFA questionnaire is a reliable and valid instrument to measure patient-reported impact of musculoskeletal injuries in the upper or lower extremities.

Potential genotoxicity and risk assessment of a chlorinated flame retardant, Dechlorane Plus.

Dechlorane Plus (DP) is a chlorinated flame retardants that is globally ubiquitous. It is a potentially persistent organic pollutant (POPs) and an environmental toxin. However, the toxicity data is still limited and cannot provide a comprehensive environmental ecological risk assessment for DP. In this study, luminous bacteria, Vicia faba and Tetrahymena thermophila were chosen as testing organisms to investigate the acute toxicity and mutagenicity of DP. The concentration gradient of DP used in this study was chosen based on its environmental levels (experiments of luminous bacteria: 0.591, 2.95, 14.8, 73.8, 369 µg L(-1); micronucleus tests: 2.4, 12, 60, 300, 1500 µg L(-1); comet assay: 2.4, 12, 60, 300, 1500 µg L(-1)). For luminous bacteria, the relative luminosities were around 100% in treated groups, which suggested that there is no acute toxicity to luminous bacteria under the studied DP concentrations. The micronucleus test showed no significant difference between treatment and control groups, indicating no genotoxicity of DP. However the comet assay conducted with T. thermophila was relatively sensitive as there was a significant increase in DNA damage when the concentrations of DP increased from 300 to 1500 µg L(-1), while the lower concentrations failed to show any treatment-related differences. Therefore, DP may pose a potential risk at concentration⩾300 µg L(-1). The results provide scientific information on the ecological risk assessment of DP.

Marine phytoplankton motility sensor integrated into a microfluidic chip for high-throughput pollutant toxicity assessment.

A microfluidic chip was designed to assess the toxicity of pollutants in a high-throughput way by using marine phytoplankton motility as a sensor signal. In this chip, multiple gradient generators (CGGs) with diffusible chambers enable large scale of dose-response bioassays to be performed in a simple way. Two mobile marine phytoplankton cells were confined on-chip and stimulated by 8 concentrations (generated by CGG) of Hg, Pb, Cu and phenol singly, as well as Cu and phenol jointly. CASA system was used to characterize motility by motile percentage (%MOT), curvilinear velocity (VCL), average path velocity (VAP) and straight line velocity (VSL). In all cases, dose-dependent inhibitions of motility were observed. In the present system, only 2h was needed to predict EC50. Thus, the developed microfluidic chip device was proved to be useful as a rapid/simple and high-throughput test method in marine pollution toxicity assessment.

Stable aerobic granules in continuous-flow bioreactor with self-forming dynamic membrane.

A novel continuous-flow bioreactor with aerobic granular sludge and self-forming dynamic membrane (CGSFDMBR) was developed for efficient wastewater treatment. Under continuous-flow operation, aerobic granular sludge was successfully cultivated and characterized with small particle size of about 0.1-1.0mm, low settling velocity of about 15-25 m/h, loose structure and high water content of about 96-98%. To maintain the stability of aerobic granular sludge, strategies based on the differences of settling velocity and particle-size between granular and flocculent sludge were implemented. Moreover, in CGSFDMBR, membrane fouling was greatly relieved. Dynamic membrane was just cleaned once in more than 45 days' operation. CGSFDMBR presented good performance in treating septic tank wastewater, obtaining average COD, NH(4)(+)-N, TN and TP removal rates of 83.3%, 73.3%, 67.3% and 60%, respectively, which was more efficient than conventional bioreactors since that carbon, nitrogen and phosphorus were simultaneously removed in a single aerobic reactor.