Efficacy and Cost-Effectiveness Analysis of Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Randomized Controlled Trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a common and chronic mental illness with a high rate of disability. Internet-based cognitive behavioral therapy (ICBT) makes online treatment available to patients and has been shown to be effective. However, 3-arm trials on ICBT, face-to-face cognitive behavioral group therapy (CBGT), and only medication are still lacking. OBJECTIVE: This study is a randomized, controlled, assessor-blinded trial of 3 groups for OCD: ICBT combined with medication, CBGT combined with medication, and conventional medical treatment (ie, treatment as usual [TAU]). The study aims to investigate the efficacy and cost-effectiveness of ICBT related to CBGT and TAU for adults with OCD in China. METHODS: In total, 99 patients with OCD were selected and randomly assigned to the ICBT, CBGT, and TAU groups for treatment for 6 weeks. The primary outcomes were the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the self-rating Florida Obsessive-Compulsive Inventory (FOCI), compared at baseline, during treatment (3 weeks), and after treatment (6 weeks), to analyze efficacy. The secondary outcome was the EuroQol Visual Analogue Scale (EQ-VAS) scores of the EuroQol 5D Questionnaire (EQ-5D). The cost questionnaires were recorded to analyze cost-effectiveness. RESULTS: Repeated-measures ANOVA was used for data analysis, and the final effective sample size was 93 (ICBT: n=32, 34.4%; CBGT: n=28, 30.1%; TAU: n=33, 35.5%). After 6-week treatment, the YBOCS scores of the 3 groups significantly decreased (P<.001), and there were no significant differences among groups. The FOCI score of the ICBT (P=.001) and CBGT (P=.035) groups was significantly lower than that of the TAU group after treatment. The total cost of the CBGT group (renminbi [RMB] 6678.45, 95% CI 4460.88-8896.01 [US $1010.36, 95% CI 678.87-1345.84]) was significantly higher than that of the ICBT group (RMB 3308.81, 95% CI 2476.89-4140.73[US $500.58, 95% CI 374.72-626.43], P<.001) and the TAU group (RMB 2259.61, 95% CI 2074.16-2445.05 [US $341.85, 95% CI 313.79-369.90], P<.001) after treatment. The ICBT group spent RMB 303.19 (US $45.97) less than the CBGT group and RMB 11.57 (US $1.75) less than the TAU group for each unit reduction in the YBOCS score. CONCLUSIONS: Therapist-guided ICBT combined with medication is as effective as face-to-face CBGT combined with medication for OCD. ICBT combined with medication is more cost-effective than CBGT combined with medication and conventional medical treatment. It is expected to become an efficacious and economic alternative for adults with OCD when face-to-face CBGT is not available. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900023840; https://www.chictr.org.cn/showproj.html?proj=39294.

Comparative assessment of the Willems dental age estimation methods: a Chinese population-based radiographic study.

BACKGROUND: The comparison of the two Willems dental age estimation methods (gender-specific (Willems I) and non-gender-specific (Willems II)) has not been fully investigated. Here we aimed to explore the applicability of the Willems dental age estimation in an Eastern Chinese population, which may cast light on the field of dental age estimation. METHODS: A total of 1211 oral panoramic radiographs (582 boys and 629 girls) of the Chinese Han population aged 11-16 years old were collected. Dental ages (DAs) were calculated using the Willems method. Statistical significance was set at a p-value < 0.05. Age differences between chronological age (CA) and dental age were analyzed by paired t-tests and mean absolute error (MAE). RESULTS: The differences between CA and DA determined by the Willems I method were + 0.44 and + 0.09 years for boys and girls, respectively. When using the Willems II method, these differences were + 0.57 and - 0.09. The MAEs of the Willems I method between DA and CA were 0.95 and 1.00 years in boys and girls, respectively. For Willems II, MAEs were 1.02 and 1.00 years in boys and girls. CONCLUSIONS: This study showed that the Willems I method was more accurate than the Willems II method in the boys' group for predicting age from a whole scale. In comparison, Willems II is more competitive in the girls' group. Neither method may be satisfactory for 11-to-16-year-old teenagers in Eastern China.

Impacts of regional development on emissions in China's transport sector.

The CO2 emissions in China's transport sector increased from 349.00 Mt in 2005 to 723.87 Mt in 2017. Thus, a number of climate change policies are being implemented to adjust regional structure and to decrease the emissions in China's transport sector at the regional level. However, few studies explored the impact of changes in regional structure (that is, measured regional share of the added value of transport sector) on emissions in China's transport sector. Therefore, based on the Kaya identity and LMDI analysis, we decompose 8 factors (including carbon intensity, energy structure, energy intensity, turnover intensity, transport intensity, regional structure, per-capita traffic activity, and population size) to analyze the driving factors of emissions in China's transport sector. The period 1997-2017 is divided into four phases according to the growth rate of emissions. The results show that regional structure increased CO2 emissions in China's transport sector between 2013 and 2017. The fast transport development in the Southwest region, reflected by the increase in the share of total transport value added, resulted in emissions growth during 2013-2017. Moreover, the change in the growth rate of the regional transport sector's value added is positively correlated with the change in the regional share of value added, which is positively correlated with the change in regional emissions.

Global burden of non-communicable diseases attributable to dietary risks in 1990-2019.

BACKGROUND: Dietary risks have raised attention worldwide during recent decades. The present burden-of-disease study aimed to evaluate the global dietary risks for non-communicable diseases (NCDs) from 1990 to 2019 and quantify their impact on mortality and disability-adjusted life-years (DALYs). Data from the 2019 Global Burden of Disease Study on deaths and DALYs from NCDs attributable to worldwide dietary risks were obtained and underwent deep analysis by year, age, gender, location, leading risks and leading causes, and their associations were examined. The socio-demographic index (SDI) was used as an indicator of national socio-economic status, as well as the relationships between age-standardised rates of deaths or DALYs and socio-economic status. RESULTS: In 2019, 7.9 million deaths and 187.7 million DALYs were attributable to dietary risk factors. High intake of sodium and low intake of whole grains and fruits were leading dietary risks for deaths and DALYs worldwide. However, both indices showed a decreasing trend by year, an increase by age and a higher disease burden in males. The main distribution of dietary-related NCDs was located in highly populated countries. A negative association between the SDI and disease burden and a positive association between the SDI and male preponderance were found. CONCLUSIONS: Dietary risk factors for NCDs increased significantly and varied across regions during 1990-2019. Therefore, greater efforts are needed to raise public awareness of interventions and improve dietary practices aiming to reduce the disease burden caused by suboptimal dietary intake, especially in developing countries and among males.

Assessment of the intramolecular magnetic interactions in the highly saddled iron(iii) porphyrin π-radical cations: the change from planar to saddle conformations.

The intramolecular magnetic interactions in one-electron oxidized iron(iii) porphyrin π-radical cations, [Fe(OETPP˙)Cl][SbCl6] (1), [Fe(OMTPP˙)Cl][SbCl6] (2) and [Fe(TPP˙)Cl][SbCl6] (3), have been compared by means of X-ray crystallography, SQUID magnetometry, cyclic voltammetry, UV-Vis spectroelectrochemical analysis, NMR spectroscopy analysis and unrestricted DFT calculations. Unlike a generally recognized antiferromagnetic coupling dxy↑dxz↑dyz↑dz2↑dx2-y2↑P˙+(a2u)↓ (S = 2) state via a weak bonding interaction as in (3), we have disclosed that a strong bonding interaction among iron dx2-y2 and porphyrin a2u orbitals forms in (1) into a highly delocalized Ψπ = [P˙+(a2u) + FeIII(dx2-y2, dz2)] orbital that is able to accommodate two spin-paired electrons to form the Ψπ2dxy1dxz1dyz1, dz21 (S = 2) ground state. Concurrently, the spin polarization effect is exerted on the paired spins in the Ψπ orbital by magnetic induction from the remaining unpaired electrons in the iron d orbitals. The interpretation mentioned above is further verified by the diamagnetic nature of the saddled copper(ii) porphyrin π-cation radical, CuII(OETPP˙)(ClO4) (S = 0), where the strong bonding interaction leads to the Ψπ2dxy2dxz2dyz2dz22 (S = 0) ground state but no spin polarization exists. Thus, the magnetic nature of the iron(iii) porphyrin π-radical cation is tuneable by saddling the ring planarity.

[GIS Spatial Distribution and Ecological Risk Assessment of Heavy Metals in Surface Sediments of Shallow Lakes in Jiangsu Province].

To understand pollution of heavy metals in surface sediments of shallow lakes, surface sediments samples of 11 lakes in Jiangsu province were collected to determine the content of six heavy metals including As, Cr, Cu, Pb, Zn and Ni. GIS was used to analyze the spatial distribution of heavy metals, and geological accumulation index (Igeo), modified contamination index (mCd) pollution load index (PLI) and potential ecological risk index (RI) were used to evaluate heavy metal contamination in the sediments. The results showed that: in the lakes' surface sediments, the average content of As, Cu, Zn, Cr, Pb, Ni in multiples of soil background of Jiangsu province were 1.74-3.85, 0.65-2.66, 0.48-3.56, 0.43-1.52, 0.02-1.49 and 0.12-1.42. According to the evaluation results of Igeo and RI, As, which had high degree of enrichment and great potential ecological risk, was the main pollutant, followed by Cu, and pollution of the rest of heavy metals was relatively light. Combining the results of several evaluation methods, in surface sediments of Sanjiu Lake, Gaoyou Lake and Shaobo Lake, these heavy metals had the most serious pollution, the maximum pollution loading and moderate potential ecological risk; in surface sediments of Gehu Lake, Baima Lake and Hongze Lake, some regions were polluted by certain metals, the overall trend of pollution was aggravating, the pollution loading was large, and the potential ecological risk reached moderate; in the other 5 lakes, the risk of sediments polluted by heavy metals, as well as the pollution loading, was small, and the overall was not polluted.