Nutritional Status in Patients Undergoing Phase II Cardiac Rehabilitation by Mini Nutritional Assessment.

Background: Malnutrition impairs quality of life and prognosis of patients with cardiovascular disease. The Mini Nutritional Assessment (MNA) is a screening tool developed for the nutritional assessment of older adults. However, usefulness of MNA for patients undergoing cardiac rehabilitation (CR) has not been fully investigated. Methods: From March 2017 to September 2019, the MNA-short form (MNA-SF) and the MNA total score in patients undergoing phase II CR at the Juntendo University Hospital were evaluated. Results: A total of 336 patients (mean age 70.1 ± 11.4 years; males: 209) were analyzed. In the MNA-SF, 157 patients (47%) were found to be malnourished or at risk of malnutrition. In MNA total score, 168 patients (50%) were found to be malnourished or at risk of malnutrition. The MNA-SF < 12 group had significantly lower body mass index (BMI), hemoglobin level, low MNA scores for protein/water intake, self-evaluation of nutrition and health, and upper arm and calf circumferences compared to the MNA-SF ≥ 12 group. Assuming BMI < 18.5 as malnutrition, the sensitivity and specificity for malnutrition were 100% and 58.9% for MNA-SF, and 96.9% and 54.9% for MNA total score, respectively. Conclusions: MNA is useful in screening for malnutrition in patients undergoing CR. Approximately 50% of them were determined to be malnourished or at risk of malnutrition, suggesting the need for detailed evaluation regarding their food intake and dietary intervention.

Prevalence, risk factors, and management of asthma in China: a national cross-sectional study.

BACKGROUND: Asthma is a common chronic airway disease worldwide. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of asthma. We therefore aimed to estimate the national prevalence of asthma in a representative sample of the Chinese population. METHODS: A representative sample of 57 779 adults aged 20 years or older was recruited for the national cross-sectional China Pulmonary Health (CPH) study using a multi-stage stratified sampling method with parameters derived from the 2010 census. Ten Chinese provinces, representative of all socioeconomic settings, from six geographical regions were selected, and all assessments were done in local health centres. Exclusion criteria were temporary residence, inability to take a spirometry test, hospital treatment of cardiovascular conditions or tuberculosis, and pregnancy and breastfeeding. Asthma was determined on the basis of a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. All participants were assessed with a standard asthma questionnaire and were classed as having or not having airflow limitation through pulmonary function tests before and after the use of a bronchodilator (400 µg of salbutamol). Risk factors for asthma were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was assessed by the self-reported history of physician diagnosis, treatments, and hospital visits in people with asthma. FINDINGS: Between June 22, 2012, and May 25, 2015, 57 779 participants were recruited into the CPH study. 50 991 (21 446 men and 29 545 women) completed the questionnaire survey and had reliable post-bronchodilator pulmonary function test results and were thus included in the final analysis. The overall prevalence of asthma in our sample was 4·2% (95% CI 3·1-5·6), representing 45·7 million Chinese adults. The prevalence of asthma with airflow limitation was 1·1% (0·9-1·4), representing 13·1 million adults. Cigarette smoking (odds ratio [OR] 1·89, 95% CI 1·26-2·84; p=0·004), allergic rhinitis (3·06, 2·26-4·15; p<0·0001), childhood pneumonia or bronchitis (2·43, 1·44-4·10; p=0·002), parental history of respiratory disease (1·44, 1·02-2·04; p=0·040), and low education attainment (p=0·045) were associated with prevalent asthma. In 2032 people with asthma, only 28·8% (95% CI 19·7-40·0) reported ever being diagnosed by a physician, 23·4% (13·9-36·6) had a previous pulmonary function test, and 5·6% (3·1-9·9) had been treated with inhaled corticosteroids. Furthermore, 15·5% (11·4-20·8) people with asthma reported at least one emergency room visit and 7·2% (4·9-10·5) at least one hospital admission due to exacerbation of respiratory symptoms within the preceding year. INTERPRETATION: Asthma is prevalent but largely undiagnosed and undertreated in China. It is crucial to increase the awareness of asthma and disseminate standardised treatment in clinical settings to reduce the disease burden. FUNDING: National Key R&D Program of China, Ministry of Science and Technology of China; the Special Research Foundation for Public Welfare of Health, Ministry of Health of China; the Chinese National Research Program for Key Issues in Air Pollution Control; and the National Natural Science Foundation of China.

Livelihood changes matter for the sustainability of ecological restoration: A case analysis of the Grain for Green Program in China's largest Giant Panda Reserve.

Payments for ecosystem services (PES) are expected to promote ecological restoration while simultaneously improving human livelihoods. As an adaptive management tool, PES programs should be dynamic and adjusted according to changing natural and socio-economic contexts. Taking the implementation of China's famous ecological restoration policy known as the Grain for Green Program (GGP) in the Wolong National Nature Reserve as an example, we analyzed changes in the livelihood capitals and strategies of local households that had participated in the GGP over a 10-year period and discussed the implications of these changes for the next stage of the program's implementation. Data were collected from a locally implemented questionnaire in both 2004 and 2015. We found that local livelihood capitals and strategies had experienced dramatic change over the 10-year period. Natural capital decreased and was unequally distributed among local respondents. In terms of financial capital, despite that agricultural and nonagricultural income increased, compensation from the GGP decreased and did not keep pace with increasing cost of cropland, household income and more broadly national economic development and inflation. Regarding human capital, the local labor force is facing huge transformational pressures. In particular, there is a increase in the supply of local labor force aged between 21 and 40 and the implications of this for the future of the GGP should be given more attention. The findings have demonstrated that: Some changes in participants' livelihood were expected by the GGP but were not evenly distributed among the participants; and PES programs are embedded in changing and multi-dimensional socio-economic contexts, and so their design and implementation must be coordinated with other related policies if they are to achieve long-term success.

Farmers' Willingness to Participate in the Next-Stage Grain-for-Green Project in the Three Gorges Reservoir Area, China.

The policy implications for success in the next-stage Grain-for-Green Project (GFGP) in China are analyzed from the perspectives of farmers' willingness. The ecological protection belt of the Three Gorges Reservoir Area was chosen as the case study area, where 1207 valid questionnaire surveys based on participatory rural appraisal were collected in 2012. Our study found that farmers with lower levels of education, older age, and higher livelihood dependency on farmland were more prone to reclamation if the compensation ended. Females and non-migrants were more reluctant to participate in the next GFGP than others. Nevertheless, traditional farming was no longer a preferred livelihood by all respondents. The majority of respondents (74.4%) wished to be liberated from the low-income farmland work through the next GFGP, and half of them (50.6%) hoped to get non-cash compensation. The Willingness to Accept (WTA) values of the next GFGP showed significant social heterogeneity and regional difference, with an average of annual RMB¥16,665 ha(-1), about 4.5 times the local compensation standard in 2000. By revealing some limitations of the uniform nationwide compensation standard system and the single payment form in adapting to evolving socioeconomic conditions, our study highlighted the importance of developing a region-based compensation standard system, integrating the next GFGP into regional sustainable development organically by more comprehensive alternative policy, and bonding a vertical partnership between the local community and the nation. Our study revealed some key elements for success in the future design of restoration projects in China.

[Toxicity tests and their application in safety assessment of water quality].

The safety of water quality has important impacts not only on the health of ecological system, but also on the survival and development of human beings. The conventional assessment methods for water quality based on the concentration limits are not reliable. The toxicity tests can vividly reflect the whole adverse biological effects of multiple chemicals in water body, which has been regarded as a necessary supplement for conventional water quality assessment methods based on physicochemical parameters. Considering the chemical pollutants usually have various adverse biological effects, the ecotoxicity testing methods, including lethality, genotoxicity, endocrine disrupting effects, were classified according to the different toxicity types. Then, the potential applications of toxicity testing methods and corresponding evaluation indices in evaluating the toxicity characteristics of ambient water samples were discussed. Particularly, the safety assessment methods for water quality based on the toxicity tests, including potential toxicology, toxicity unit classification system, potential ecotoxic effect probe, and safety assessment of water quality based on toxicity test battery, were summarized. This paper not only systematically reviewed the progress of toxicity tests and their application in safety assessment of water quality, but also provided the scientific basis for the further development in the future.

[The role of 4-hydroxynonenal in assessment of chronic obstructive pulmonary disease severity].

OBJECTIVE: To measure the levels of 4-hydroxynonenal (4-HNE), TNF-α and IL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and stable COPD, and therefore to explore the role of 4-HNE in the assessment of COPD severity. METHODS: A total of 242 patients with AECOPD, 182 males and 60 females, age 54 - 89 (mean 72 ± 8) years, 57 outpatients with stable COPD, 55 males and 2 females, age 38 - 76 (mean 60 ± 8) years, and 67 healthy controls, 49 males and 18 females, age 42 - 86 (mean 66 ± 10) years, were included in the study. Based on whether there were respiratory failure, chronic pulmonary heart disease or a history of smoking, the patients with AECOPD were divided into different subgroups. Patients with stable COPD were divided into different subgroups based on lung function or whether there was a history of smoking. The serum 4-HNE, TNF-α and IL-6 concentrations were measured by using enzyme-linked immune sorbent assay (ELISA). RESULTS: The serum 4-HNE levels in patients with AECOPD or stable COPD (16 ± 4) mg/L, (15 ± 5) mg/L were higher than those in healthy controls (12 ± 4) mg/L (both P < 0.01). After control for age, the serum 4-HNE levels in patients with AECOPD were significantly higher than those in stable COPD (F = 7.93, P < 0.01). There were no differences in the serum 4-HNE among AECOPD patients of current smokers, non-smokers and ex-smokers (16 ± 4) mg/L, (17 ± 3) mg/L, (17 ± 4) mg/L. The serum 4-HNE in AECOPD patients with chronic pulmonary heart disease were particularly higher (17 ± 4) mg/L vs (15 ± 4) mg/L (F = 1.23, P < 0.01). There were no differences in the serum 4-HNE between stable COPD patients of current smokers and ex-smokers (14 ± 5) mg/L, (16 ± 4) mg/L (t = -1.44, P > 0.05). In patients with stable COPD, the serum 4-HNE levels were significantly correlated with FEV(1)% (r = -0.345, P < 0.01) and IL-6 (r = 0.363, P < 0.01). CONCLUSIONS: The serum levels of 4-HNE in COPD patients with different smoking status were all significantly elevated, particular in patients with acute exacerbation and with pulmonary heart disease. In patients with stable COPD, the 4-HNE levels were negatively correlated with FEV(1)% and positively with serum IL-6 levels. It may be a valuable biomarkers for the assessment of COPD severity.