Design and impact assessment of policies to overcome oversupply in China's national carbon market.

China has adopted a national carbon emissions trading market to promote emission reductions, but until now, overallocation of allowances suffer low carbon prices and thus to unfulfilled emission reduction goals. We report a general equilibrium modeling that indicates the flexible compliance and price adjustment mechanism of the carbon market, along with explores the solution to the oversupply of allowances in the China's national carbon market. We find that, under the current policy, the initial loose allowance allocation decreases the overall carbon price, and simultaneously the total amount of banked carbon allowances reaches 4.880 billion tons in 2030, resulting in the level of carbon price cannot achieve NDC (Nationally Determined Contribution) targets. However, by introducing carbon market price adjustment schemes, we observe that the cumulative amount of allowances can effectively reduce, enabling the carbon price rising. Importantly, the amount of the supply of allowances decreases most under the benchmark decrease scenario, which increases the emission reduction pressure of the enterprises from the beginning, leading to the largest economic losses, the price-based adjustment mechanism raises the carbon price to expected level at the minimize economic losses, and the quantity-based adjustment mechanism is more sensitive to policy parameters compared to the price -based adjustment mechanism. These findings offer a promising avenue for selecting cost-effective price adjustment mechanism to improve price mechanism design for national carbon markets.

Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review.

Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.

Degradation dynamics, residues, processing factors, and dietary risk assessment of bisultap in citrus by LC-MS/MS.

BACKGROUND: Citrus leaf miners are a common pest harming citrus production and quality during citrus planting. During the citrus plant's growth phase, bisultap formulation was frequently used to boost yield and produce fruit of high quality. However, research on citrus's dietary risk assessment for bisultap residues, dissipation and residues is lacking. RESULTS: Liquid chromatography-tandem mass spectrometry was used to develop an accurate and sensitive analytical method for derivatizing bisultap into nereistoxin in whole fruit, pulp and peel. At various levels of addition, the mean recovery of bisultap ranged from 84.64% to 111.09% with a reasonable relative RSD (< 20%). The half-lives in Guangxi and Guizhou were 3.96 and 6.03 days, respectively. After 14-21 days of bisultap application, total residues (bisultap and its metabolite nereistoxin) in the whole fruit were from < 0.02 to 0.228 mg kg-1 in the four experiment sites. Total residue (bisultap and nereistoxin, expressed by bisultap) in whole fruit was approximately 1.05-7.23 times that of pulp. The washing process with tap water removed 85.71% to 98.78% of the bisultap residue in the whole fruit. Bisultap's risk assessment value in citrus was in the range 0.16-1.28%. CONCLUSION: In the whole citrus fruit, bisultap degrades rapidly. Bisultap residues primarily accumulate on citrus peels, and so washing and peeling citrus may effectively remove bisultap residues. For various age groups, the chronic dietary risk of bisultap was acceptable. © 2023 Society of Chemical Industry.

In vitro inhalation bioaccessibility and health risk assessment of difenoconazole in the atmosphere.

BACKGROUND: Assessment of the risk of pesticide inhalation in populations around farmland is necessary because inhalation is one of the ways in which pesticides can risk human health. This study aimed to identify the inhalation risk of difenoconazole on humans by using dose-response and exposure assessments. RESULTS: In the field simulation application, respiratory exposure in populations around farmland ranged from 71 to 430 ng/m3 . Using response surface methodology, the maximum bioaccessibility of difenoconazole in three simulated lung fluids was 35.33% in Gamble's solution (GS), 34.12% in artificial lysosomal fluid (ALF), and 42.06% in simulated interstitial lung fluid (SLF). Taking the proliferation activity of the A549 cell model as the endpoint, the benchmark dose limit and benchmark dose of difenoconazole on A549 cells were 16.36 and 5.60 mg/kg, respectively. The margin of exposure to difenoconazole in GS, ALF and SLF were, respectively, 8.66 × 105 to 5.28 × 106 , 8.97 × 105 to 5.47 × 106 and 7.28 × 105 to 4.44 × 106 . CONCLUSION: The risk assessment results indicate that under all circumstances, applying difenoconazole is safe for populations around farmland. However, a fan-shaped nozzle, suspension concentrate and greater inhalation height increase the risk of inhalation. © 2023 Society of Chemical Industry.

Holistic Assessment Based On Hepatocyte Mitochondria: Lycopene Repairs Oxidized mtDNA to Alleviate Mitochondrial Stress Induced by Atrazine.

Atrazine (ATZ) is a highly persistent herbicide that harms organism health. Lycopene (LYC) is an antioxidant found in plants and fruits. The aim of this study is to investigate the mechanisms of atrazine-induced mitochondrial damage and lycopene antagonism in the liver. The mice were divided into seven groups by randomization: blank control (Con group), vehicle control (Vcon group), 5 mg/kg lycopene (LYC group), 50 mg/kg atrazine (ATZ1 group), ATZ1+LYC group, 200 mg/kg atrazine (ATZ2 group), and ATZ2+LYC group. The present study performed a holistic assessment based on mitochondria to show that ATZ causes the excessive fission of mitochondria and disrupts mitochondrial biogenesis. However, the LYC supplementation reverses these changes. ATZ causes increased mitophagy and exacerbates the production of oxidized mitochondrial DNA (Ox-mtDNA) and mitochondrial stress. This study reveals that LYC could act as an antioxidant to repair Ox-mtDNA and restore the disordered mitochondrial function caused by ATZ.

Cognitive reserve in patients with mood disorders: Validation study of the Chinese version of the cognitive reserve assessment scale in health.

BACKGROUND: Cognitive reserve (CR) is closely associated with cognitive and functional outcome, disease severity, progression and prognosis in psychiatric patients; however, it has not been extensively tested in mood disorders. This study examined the psychometric properties of the Cognitive Reserve Assessment Scale in Health (CRASH) in mood disorder patients. METHODS: Altogether 166 subjects were recruited, 44 with major depressive disorder (MDD), 64 with bipolar disorder (BD), and 58 healthy controls. CR was assessed using the CRASH and the Cognitive Reserve Questionnaire (CRQ). RESULTS: Internal consistency (Cronbach's alpha) was 0.779 for the CRASH. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.73 (95 % CI: 0.647-0.809). The optimal cut-off score of 51 generated the best combination of sensitivity (0.78) and specificity (0.43) for discriminating between patients with mood disorders and healthy controls. The CRASH score was highly correlated with the CRQ score in both mood disorder patients (rs = 0.586, P < 0.001) and healthy controls (rs = 0.627, P < 0.001), indicating acceptable convergent validity for the CRASH. Within the mood disorder sample, the CRASH score was associated with functional outcomes (FAST: rs = -0.243, P = 0.011). CONCLUSIONS: The CRASH is a useful tool to measure CR in mood disorder with acceptable psychometric properties and could be used in both research and clinical practice.

[Risk Assessment and Sources of Heavy Metals in Farmland Soils of Yellow River Irrigation Area of Ningxia].

The farmland environment is directly related to the quality and safety of agricultural products. In order to understand the characteristics and main influencing factors of heavy metals in farmland soil in the Yellow River irrigation area of Ningxia, sampling and monitoring were conducted for five consecutive years from 2017 to 2021, and the distribution characteristics and correlation of heavy metals were analyzed. The pollution status and potential ecological risks of heavy metals were evaluated, and the main sources of heavy metals in farmland were analyzed. The results showed that the average values of Pb, As, Zn, Ni, Cu, Hg, Cr, and Cd in the soil of the Ningxia Yellow River irrigation area were 19.74, 11.67, 66.88, 29.09, 22.55, 0.03, 62.27, and 0.19 mg·kg-1, respectively, which were enriched to some extent compared with the background values of the soil environment in Ningxia. Among them, Hg and Cd had middle- and high-grade ecological risk points; however, none of them exceeded the control value of agricultural land soil pollution risk, and all sampling sites had no high-risk or extremely high-risk levels. The results of source analysis based on positive matrix factorization (PMF) and correlation analysis showed that there were five main sources of heavy metals in farmland soil in the study area: natural sources, mixed sources of industrial and mining activities and the production and life of residents, transportation sources, agricultural production activities sources, and industrial sources, with contribution rates of 26.54%, 25.59%, 22.52%, 15.63%, and 9.72%, respectively. On the whole, the heavy metals in farmland soil in the Ningxia Yellow River irrigation area did not exceed the standard, and there was no high-level ecological risk. The production environment of the farmland soil was good, but the contribution rate of human activities to soil heavy metals was large.

Role of Up-Regulated Transmembrane Channel-Like Protein 5 in Pancreatic Adenocarcinoma.

BACKGROUND: Pancreatic adenocarcinoma (PAAD) is a malignant tumor responsible for a heavy disease burden. Previously, only one pan-cancer study of Transmembrane channel-like protein 5 (TMC5) showed that TMC5 was highly expressed in PAAD, but the results lacked comprehensive verification, and the mechanism of TMC5 in PAAD was still unclear. METHODS: For exploring the expression and clinical value of TMC5 in PAAD better, we adopted a comprehensive evaluation method, using internal immunohistochemistry (IHC) data combined with microarray and RNA-sequencing data collected from public databases. The single cell RNA-sequencing (scRNA-seq) data were exploited to explore the TMC5 expression in cell populations and intercellular communication. The potential mechanism of TMC5 in PAAD was analyzed from the aspects of immune infiltration, transcriptional regulation, function and pathway enrichment. RESULTS: Our IHC data includes 148 PAAD samples and 19 non-PAAD samples, along with the available microarray and RNA-sequencing data (1166 PAAD samples, 704 non-PAAD samples). The comprehensive evaluation results showed that TMC5 was evidently up-regulated in PAAD (SMD = 1.17). Further analysis showed that TMC5 was over-expressed in cancerous epithelial cells. Furthermore, TMC5 was up-regulated in more advanced tumor T and N stages. Interestingly, we found that STAT3 as an immune marker of Th17 cells was not only positively correlated with TMC5 and up-regulated in PAAD tissues, but also the major predicted TMC5 transcription regulator. Moreover, STAT3 was involved in cancer pathway of PAAD. CONCLUSION: Up-regulated TMC5 indicates advanced tumor stage in PAAD patients, and its role in promoting PAAD development may be regulated by STAT3.

The Impact of Intermediate Goods Imports on Energy Efficiency: Empirical Evidence from Chinese Cities.

Improving energy efficiency is a critical way to solve energy shortage and environmental problems and achieve the goal of "double carbon". As China expands imports and integrates into global value chains, can import trade improve energy efficiency? This topic is extremely important for solving current energy problems and promoting sustainable economic development. Based on panel data of prefecture-level cities in China, this paper uses the Super-SBM model to measure the total factor energy efficiency of cities and investigates the impact of intermediate goods imports on energy efficiency with fixed effects models and instrumental variable method (IV). The study finds that: (1) intermediate goods imports contribute to the increase of urban energy efficiency, and the mechanism test indicates that intermediate goods imports affect energy efficiency through the technology spillover effect and intermediate goods type diversification effect. (2) According to the heterogeneity analysis, the effect of intermediate goods imports on energy efficiency is more evident in eastern China and cities with low topographic relief, medium population scale, and high absorption capability. (3) Analysis of the spatial spillover effect with the SDM model shows that importing intermediate goods promotes energy efficiency in local cities and radiates energy efficiency improvement in neighboring cities.

Development and validation of the Chinese Geriatric Depression Risk calculator (CGD-risk): A screening tool to identify elderly Chinese with depression.

BACKGROUND: The prevalence of depression among China's elderly is high, but stigma surrounding mental illness and a shortage of psychiatrists limit widespread screening and diagnosis of geriatric depression. We sought to develop a screening tool using easy-to-obtain and minimally sensitive predictors to identify elderly Chinese with depressive symptoms (depression hereafter) for referral to mental health services and determine the most important factors for effective screening. METHODS: Using nationally representative survey data, we developed and externally validated the Chinese Geriatric Depression Risk calculator (CGD-Risk). CGD-Risk, a gradient boosting machine learning model, was evaluated based on discrimination (Concordance (C) statistic), calibration, and through a decision curve analysis. We conducted a sensitivity analysis on a cohort of middle-aged Chinese, a sub-group analysis using three data sets, and created predictor importance and partial dependence plots to enhance interpretability. RESULTS: A total of 5681 elderly Chinese were included in the development data and 12,373 in the external validation data. CGD-Risk showed good discrimination during internal validation (C: 0.81, 95 % CI 0.79 to 0.84) and external validation (C: 0.77, 95 % CI: 0.76, 0.78). Compared to an alternative screening strategy CGD-Risk would correctly identify 17.8 more elderly with depression per 100 people screened. LIMITATIONS: We were only able to externally validate a partial version of CGD-Risk due to differences between the internal and external validation data. CONCLUSIONS: CGD-Risk is a clinically viable, minimally sensitive screening tool that could identify elderly Chinese at high risk of depression while circumventing issues of response bias from stigma surrounding emotional openness.

Validation of the 33-Item Hypomania Checklist-External Assessment in Screening Adolescents for Bipolar Disorder.

Background: Bipolar disorder (BD) is often misdiagnosed, leading to poor treatment outcomes. Thus, accurate assessment of BD is of great importance, including in BD adolescents. The aim of the study was to explore the psychometric properties of the 33-item Hypomania Checklist-External Assessment (HCL-33-EA) in depressed adolescents. Methods: The study was conducted between March and November 2020 in Beijing, China. Depressed adolescents aged between 13 and 17 years (N = 260) with BD (N = 147) or major depressive disorder (MDD) (N = 113) diagnosed according to the International Classification of Diseases, Tenth Revision (ICD-10) were recruited. Patients' hypomanic symptoms were assessed by their carers using the HCL-33-EA. Results: The HCL-33-EA showed high internal consistency (Cronbach's alpha = 0.82) with two factorial dimensions. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.61 (95% confidence interval (CI): 0.54-0.67). The optimal cut-off score of 7 generated the best combination of sensitivity (0.81) and specificity (0.37) for discriminating between adolescents with BD and MDD. Conclusion: The HCL-33-EA, with a two-factor structure, seems to be a useful tool for screening for BD in depressed adolescents. However, the high sensitivity and low specificity of the HCL-33-EA at the optimal cut-off value of 7 indicate that the HCL-33-EA needs to be further refined for young patients.

Giant pyroelectricity in nanomembranes.

Pyroelectricity describes the generation of electricity by temporal temperature change in polar materials1-3. When free-standing pyroelectric materials approach the 2D crystalline limit, how pyroelectricity behaves remained largely unknown. Here, using three model pyroelectric materials whose bonding characters along the out-of-plane direction vary from van der Waals (In2Se3), quasi-van der Waals (CsBiNb2O7) to ionic/covalent (ZnO), we experimentally show the dimensionality effect on pyroelectricity and the relation between lattice dynamics and pyroelectricity. We find that, for all three materials, when the thickness of free-standing sheets becomes small, their pyroelectric coefficients increase rapidly. We show that the material with chemical bonds along the out-of-plane direction exhibits the greatest dimensionality effect. Experimental observations evidence the possible influence of changed phonon dynamics in crystals with reduced thickness on their pyroelectricity. Our findings should stimulate fundamental study on pyroelectricity in ultra-thin materials and inspire technological development for potential pyroelectric applications in thermal imaging and energy harvesting.

[Non-carcinogenic Risk Assessment of Cadmium Exposure Through Drinking Water in Chinese Residents Based on Age-stratification Weight].

Drinking water is an important cadmium (Cd) exposure pathway for residents in China. In order to quantitatively characterize the risk of cadmium exposure through drinking water, the Cd concentrations of three main drinking water types in China were collected via systematic literature review. The probability distribution of the exposure parameters was estimated using regression models. The non-carcinogenic risk of cadmium exposure to residents through drinking water was evaluated by Monte Carlo simulation. The results showed that significant differences were found among Cd contents in the three water types. The geometric mean of ρ(Cd) in tap water, untreated underground water, and surface water were (0.48±0.78), (1.07±1.82), and (1.04±1.38) µg·L-1, respectively. The non-carcinogenic risk assessment showed that the median of hazard quotients in all age groups and in the three water types were found to be less than 1. Compared with the exposure dose threshold recommended by the US EPA, the probabilities exceeding the threshold of underground water, surface source water, and tap water were 2.4%, 1.3%, and 1.0%, respectively. Children aged 6-8 had the greatest daily average dose of Cd, and the least exposure dose was found in the 15-17 age group. The result of Monte Carlo simulation based on age-stratification weight showed that people 18-44 years old accounted for 50.8% of the total number of people who exceeded the exposure threshold. In summary, the probability of noncarcinogenic risk caused by Cd exposure through drinking water of Chinese residents was relatively low. However, people in some sub-groups still had a relatively high probability of exceeding the exposure dose threshold. It is necessary to further strengthen the control of cadmium pollution in drinking water in order to reduce the health risk caused by cadmium exposure and ensure drinking water safety.

Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China.

OBJECTIVES: This study aimed to explore the association of visual, hearing, or dual sensory impairment with healthcare use and costs. STUDY DESIGN: This is a cohort study. METHODS: These research data were from the China Health and Retirement Longitudinal Study spanning 2011-2018 and included 8982 community-dwelling middle-aged and older adults (aged ≥45 years at baseline). Sensory impairment was measured according to self-reported assessment of visual and hearing functions, and healthcare use and costs were ascertained via self-report. The associations of sensory impairment with healthcare use and costs were estimated using the mixed-effects regression models. RESULTS: Of the 8982 respondents, 4346 (48.39%) were females and their mean (standard deviation) age at baseline was 57.03 (8.26) years. Individuals with hearing impairment (HI) only, visual impairment (VI) only, and dual sensory impairment (DSI) were all at significantly higher risks of healthcare use and catastrophic health expenditure than those without sensory impairment (all P < 0.05), except that VI only non-significantly prolonged inpatient days. Compared with no impairment, DSI was associated with increases in outpatient (ß = 50.67, 95% confidence interval [CI] = 17.47-83.86) and inpatient out-of-pocket costs (ß = 40.35, 95% CI = 5.94-74.76), while VI only or HI only did not show significant effects. Further stratification analyses indicated that the associations between sensory impairment and outpatient use were more pronounced among males than among females but that age group did not moderate the associations with any healthcare outcomes. CONCLUSIONS: HI and VI were independently and together associated with higher risks of healthcare use and catastrophic health expenditure. Dual sensory impairment was the only category consistently associated with increased outpatient and inpatient costs.

[Characteristics and Health Risk Assessment of Cadmium, Lead, and Arsenic Accumulation in Leafy Vegetables Planted in a Greenhouse].

In recent years, dust pollution has occurred frequently in spring and haze or fog in autumn and winter. The inhalable particulate matters in the atmosphere, especially PM2.5, loaded in heavy metals such as cadmium, lead, and arsenic, are easily taken up by leafy vegetables and accumulate in the edible parts. It is not clear whether the accumulation of heavy metals in the edible parts of leafy vegetables in greenhouses is also affected by atmospheric deposition. Therefore, a field experiment was conducted to explore characteristics and health risk assessment of cadmium, lead, and arsenic accumulation in leafy vegetables planted in a greenhouse using six types of common leafy vegetables (spinach, leaf lettuce, lettuce, pakchoi, Chrysanthemum coronarium, and fennel) in the Beijing-Tianjin-Hebei region. The results showed that C. coronarium, pakchoi, and spinach are the leafy vegetables with a low accumulation of Cd, Pb, and As, respectively. Fennel is the leafy vegetable with a low accumulation of Cd and Pb. In the greenhouse, Pb concentrations in PM2.5 were 42.6 and 8.4 times of Cd and As, respectively. Moreover, PM2.5-Pb contributed on average 36.5% to the edible parts of six kinds of leafy vegetables, which indicated that the Cd, Pb, and As accumulated in leafy vegetables were mainly derived from the soil. Meanwhile, the concentrations of Cd, Pb, and As in the edible parts of vegetables did not exceed the safety limitations of three heavy metals (GB 2762-2017), and Pb accumulation in leafy vegetables does not pose a health risk to humans. However, Cd in the leafy vegetables could threaten the health of adults and children, except for the intake of fennel. Conversely, As in the C. coronarium could threaten the health of adults and children.

Cost-effectiveness analysis of first-line treatment for chronic hepatitis B in China.

OBJECTIVES: Hepatitis B virus infection is an important public health problem. We analysed the cost-effectiveness of the first-line therapies, including nucleotide analogues (namely tenofovir alafenamide fumarate (TAF), tenofovir disoproxil fumarate (TDF) and entecavir) and pegylated interferon (Peg-IFN) for patients with chronic hepatitis B (CHB) in China. METHODS: A Markov model describing CHB disease progression was constructed to compare the cost-effectiveness of the first-line therapies, considering both satisfactory (HBeAg seroconversion) and optimal (HBsAg seroclearance) treatment goals. We examined the main outcomes, including cumulative lifetime cost per patient, incremental quality-adjusted life years (QALYs), incremental cost-effectiveness ratio and net monetary benefit. Uncertainty analysis was conducted to identify key influential parameters. RESULTS: Compared with the baseline strategy, Peg-IFN had the highest QALY gain for HBeAg-positive (HBeAg+) CHB patients achieving a satisfactory goal and an optimal goal (3.19 and 6.32 respectively), and TDF was the most cost-effective therapy for HBeAg-negative CHB patients ($1418/QALY) achieving a satisfactory goal. Among nucleotide analogues, TAF was the most-effective strategy and had higher acceptability to achieve an optimal goal in the Eastern region of China (under 1 x GDP per capita threshold). CONCLUSIONS: Among nucleotide analogues, TDF was the most cost-effective treatment in China for CHB patients to achieve satisfactory and optimal treatment goals, whereas TAF was cost-effective and more effective in the wealthier region. Peg-IFN was most cost-effective among HBeAg+ CHB patients to achieve both goals, with better clinical outcomes. Our findings also indicate the importance of regular monitoring during and after CHB treatment, and could inform treatment strategies in China and other countries.

A comparison of the 33-item Hypomania Checklist with the 33-item Hypomania Checklist-external assessment for the detection of bipolar disorder in adolescents.

BACKGROUND: Adolescents with bipolar disorder (BD) are often misdiagnosed as having major depressive disorder (MDD), which delays appropriate treatment and leads to adverse outcomes. The aim of this study was to compare the performance of the 33-item Hypomania Checklist (HCL-33) with the 33-item Hypomania Checklist- external assessment (HCL-33-EA) in adolescents with BD or MDD. METHODS: 147 adolescents with BD and 113 adolescents with MDD were consecutively recruited. The HCL-33 and HCL-33-EA were completed by patients and their carers, respectively. The sensitivity, positive predictive value (PPV), specificity, negative predictive value (NPV), and area under the curve (AUC) were calculated and compared between the two instruments, using cut-off values based on the Youden's index. RESULTS: The total scores of the HCL-33 and HCL-33-EA were positively and significantly correlated (rs = 0.309, P < 0.001). Compared to the HCL-33, the HCL-33-EA had higher sensitivity and NPV (HCL-33: sensitivity = 0.58, NPV = 0.53; HCL-33-EA: sensitivity = 0.81, NPV = 0.60), while the HCL-33 had higher specificity and PPV (HCL-33: specificity = 0.61, PPV = 0.66; HCL-33-EA: specificity = 0.37, PPV = 0.63). CONCLUSION: Both the HCL-33 and HCL-33-EA seem to be useful for screening depressed adolescents for BD. The HCL-33-EA would be more appropriate for distinguishing BD from MDD in adolescents due to its high sensitivity in Chinese clinical settings.

Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients.

Objectives: The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) is common in depressed older adults. The self-rated HCL-33 and its external assessment version (HCL-33-EA) have been developed to screen for hypomanic symptoms. This study compared the screening ability of these two instruments to discriminate BD from MDD. Methods: A total of 215 patients (107 with BD and 108 with MDD) and their carers were recruited. Patients and their carers completed the HCL-33 and HCL-33-EA, respectively. The consistency of the total score and the positive response to each item between the two scales was calculated with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient separately. Receiver operating characteristics (ROC) curves were drawn for both instruments. The optimal cut-off points were determined according to the maximum Youden's Index. The areas under the ROC curve (AUC) of the HCL-33 and HCL-33-EA were calculated separately and compared. The sensitivity and specificity at the optimal cut-off values were also calculated separately for the HCL-33 and HCL-33-EA. Results: The intraclass correlation coefficient (ICC) between the total scores of the HCL-33 and HCL-33-EA was 0.823 (95% CI = 0.774-0.862). The positive response rate on all items showed high agreement between the two instruments. ROC curve analysis demonstrated that the total scores of both HCL-33 and HCL-33-EA differentiated well between MDD and BD, while there was no significant difference in the AUCs between the two scales (Z = 0.422, P = 0.673). The optimal cutoff values for the HCL-33 and HCL-33-EA were 14 and 12, respectively. With the optimal cutoff value, the sensitivities of the HCL-33 and HCL-33-EA were 88.8% and 93.5%, and their specificities were 82.4% and 79.6%. Conclusion: Both the HCL-33 and HCL-33-EA had good screening ability for discriminating BD from MDD in depressed older adults.

Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis.

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors. Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect. Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14-1.52; frail: OR = 1.67, 95%CI = 1.13-2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance. Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

COVID-19 Vaccine Donations-Vaccine Empathy or Vaccine Diplomacy? A Narrative Literature Review.

Introduction: Vaccine inequality inflames the COVID-19 pandemic. Ensuring equitable immunization, vaccine empathy is needed to boost vaccine donations among capable countries. However, damaging narratives built around vaccine donations such as "vaccine diplomacy" could undermine nations' willingness to donate their vaccines, which, in turn, further exacerbate global vaccine inequality. However, while discussions on vaccine diplomacy are on the rise, there is limited research related to vaccine diplomacy, especially in terms of its characteristics and effects on vaccine distribution vis-à-vis vaccine empathy. Thus, to bridge the research gap, this study aims to examine the defining attributes of vaccine diplomacy and its potential effects on COVID-19 immunization, particularly in light of vaccine empathy. Methods: A narrative review was conducted to shed light on vaccine diplomacy's defining attributes and effects in the context of COVID-19 vaccine distribution and dissemination. Databases such as PubMed and Medline were utilized for literature search. Additionally, to ensure up-to-date insights are included in the review, validated reports and reverse tracing of eligible articles' reference lists in Google Scholar have also been conducted to locate relevant records. Results: Vaccine empathy is an individual or a nation's capability to sympathize with other individuals or nations' vaccine wants and needs, whereas vaccine diplomacy is a nation's vaccine efforts that aim to build mutually beneficial relationships with other nations ultimately. Our findings show that while both vaccine empathy and vaccine diplomacy have their strengths and weaknesses, they all have great potential to improve vaccine equality, particularly amid fast-developing and ever-evolving global health crises such as COVID-19. Furthermore, analyses show that, compared to vaccine empathy, vaccine diplomacy might be a more sustainable solution to improve vaccine donations mainly because of its deeper and stronger roots in multilateral collaboration and cooperation. Conclusion: Similar to penicillin, automated external defibrillators, or safety belts amid a roaring global health disaster, COVID-19 vaccines are, essentially, life-saving consumer health products that should be available to those who need them. Though man-made and complicated, vaccine inequality is nonetheless a solvable issue-gaps in vaccine distribution and dissemination can be effectively addressed by timely vaccine donations. Overall, our study underscores the instrumental and indispensable role of vaccine diplomacy in addressing the vaccine inequality issue amid the COVID-19 pandemic and its potentials for making even greater contributions in forging global solidarity amid international health emergencies. Future research could investigate approaches that could further inspire and improve vaccine donations among capable nations at a global scale to advance vaccine equity further.