Assessment of surgical management for locked fracture-dislocations of the proximal humerus in patients of different ages.

Background: Locked fracture-dislocation of the proximal humerus (LFDPH) is a very severe complex injury; neither arthroplasty nor internal plating are fully satisfactory. This study aimed to evaluate different surgical treatments for LFDPH to determine the optimal option for patients of different ages. Methods: From October 2012 to August 2020, patients who underwent open reduction and internal fixation (ORIF) or shoulder hemiarthroplasty (HSA) for LFDPH were retrospectively reviewed. At follow-up, radiologic evaluation was performed to evaluate bony union, joint congruence, screw cut-out, avascular necrosis of the humeral head, implant failure, impingement, heterotopic ossification, and tubercular displacement or resorption. Clinical evaluation comprised the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley and visual analog scale (VAS) scores. Additionally, intraoperative and postoperative complications were assessed. Results: Seventy patients (47 women and 23 men) with final evaluation results qualified for inclusion. Patients were divided into three groups: group A: patients aged under 60 years who underwent ORIF; group B: patients aged ≥60 years who underwent ORIF; and group C: patients who underwent HSA. At a mean follow-up of 42.6 ± 26.2 months, function indicators, namely shoulder flexion, and Constant-Murley and DASH scores, in group A were significantly better than those in groups B and C. Function indicators in group B were slightly but not significantly better compared with group C. Regarding operative time and VAS scores, there were no significant differences between the three groups. Complications occurred in 25%, 30.6%, and 10% of the patients in groups A, B, and C, respectively. Conclusions: ORIF and HSA for LFDPH provided acceptable but not excellent results. For patients aged <60 years, ORIF might be optimal, whereas, for patients aged ≥60 years, both ORIF and HSA provided similar results. However, ORIF was associated with a higher rate of complications.

Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local.

BACKGROUND: The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population characteristics, ignoring the differences in regional characteristics. Thus, our study aimed to explore the impact of various influencing factors on the ICHE from a spatiotemporal perspective. METHODS: We used data from the China Health and Retirement Longitudinal Study (waves 1 to 4), to conduct a retrospective cohort study across 28 provinces, from 2011 to 2018. We measured regional incidences of catastrophic health expenditure using methods recommended by the World Health Organization. Ordinary least squares (OLS) and geographical and temporal weighted regression (GTWR) were used as the global and local estimation models, respectively. The Fortheringham method was used to test the spatiotemporal non-stationarity. RESULTS: National ICHE showed a gradual increase from 2011 to 2015, but suddenly decreased from 2015 to 2018, also showing the spatial heterogeneity. And the southwest area and Hebei showed persistently high ICHE (Qinghai even reached the highest value of 27.5% in 2015). Out-of-pocket payment, gross domestic product, PM2.5, ageing, incidence of non-communicable diseases and disabilities, number of nurses, and health insurance coverage in the global estimation passed the significance test, and the GTWR model showed a better model fit (0.769) than the OLS model (0.388). Furthermore, except for health insurance coverage, all seven variables had spatiotemporal non-stationarity among their impacts on ICHE. CONCLUSION: In this longitudinal study, we found spatiotemporal non-stationarity among the variable relationships, supporting regional governments' adoption of regional-target policies. First, after the completion of universal health insurance coverage, the spatiotemporal non-stationarity of the prevalence of non-communicable diseases and disability and ageing should be the focus of the next phase of health insurance design, where improvements to compensation coverage and benefit packages are possible policy instruments. Second, the governance and causes of catastrophic health expenditure need to be laid out from a macro perspective rather than only from the individual/household perspective, especially for the potential impact of economic development, air pollution and nursing resources.

Dynamic evolution analysis of the factors driving the growth of energy-related CO2 emissions in China: An input-output analysis.

In recent years, the global greenhouse effect caused by excessive energy-related carbon emissions has attracted more and more attention. In this paper, we studied the dynamic evolution of factors driving China's energy-related CO2 emissions growth from 2007 to 2015 by using energy consumption method and input-output analysis and used the IO-SDA model to decompose the energy carbon emissions. Within the research interval, the results showed that (1) on the energy supply-side, the high carbon energy represented by raw coal was still the main factor to promote the growth of energy-related CO2 emissions. However, the optimization of energy consumption structure is conducive to reducing emissions. Specifically, the high carbon energy represented by raw coal exhibited a downward trend in promoting the increment of energy-related CO2 emissions, while the clean energy represented by natural gas showed an upward trend in promoting the increment of CO2 emissions. It is worth noting that there is still a lot of room for optimization of China's energy consumption structure to reduce emissions. (2) On the energy demand-side, the final demand effect is the main driving force of the growth of carbon emissions from fossil energy. Among them, the secondary industry plays a major role in the final demand effect. The "high carbonization" of the final product reflects the characteristics of China's high energy input in the process of industrialization. At the same time, since the carbon emission efficiency of the tertiary industry and the primary industry is better than that of the secondary industry, actively optimizing the industrial structure is conducive to slowing down the growth of carbon emission brought by the demand effect. (3) The input structure effect is the main restraining factor for the growth of energy carbon emissions, while the energy intensity effect has a slight driving effect on the growth of energy carbon emissions. The results show that China's "extensive" economic growth model has been effectively reversed, but the optimization of fossil energy utilization efficiency is still not obvious, and there is still a large space to curb carbon emissions by improving fossil energy utilization efficiency in the future.