LiverRisk score: An accurate, cost-effective tool to predict fibrosis, liver-related, and diabetes-related mortality in the general population.

BACKGROUND: Noninvasive and early assessment of liver fibrosis is of great significance and is challenging. We aimed to evaluate the predictive performance and cost-effectiveness of the LiverRisk score for liver fibrosis and liver-related and diabetes-related mortality in the general population. METHODS: The general population from the NHANES 2017-March 2020, NHANES 1999-2018, and UK Biobank 2006-2010 were included in the cross-sectional cohort (n = 3,770), along with the NHANES follow-up cohort (n = 25,317) and the UK Biobank follow-up cohort (n = 17,259). The cost-effectiveness analysis was performed using TreeAge Pro software. Liver stiffness measurements ≥10 kPa were defined as compensated advanced chronic liver disease (cACLD). FINDINGS: Compared to conventional scores, the LiverRisk score had significantly better accuracy and calibration in predicting liver fibrosis, with an area under the receiver operating characteristic curve (AUC) of 0.76 (0.72-0.79) for cACLD. According to the updated thresholds of LiverRisk score (6 and 10), we reclassified the population into three groups: low, medium, and high risk. The AUCs of LiverRisk score for predicting liver-related and diabetes-related mortality at 5, 10, and 15 years were all above 0.8, with better performance than the Fibrosis-4 score. Furthermore, compared to the low-risk group, the medium-risk and high-risk groups in the two follow-up cohorts had a significantly higher risk of liver-related and diabetes-related mortality. Finally, the cost-effectiveness analysis showed that the incremental cost-effectiveness ratio for LiverRisk score compared to FIB-4 was USD $18,170 per additional quality-adjusted life-year (QALY) gained, below the willingness-to-pay threshold of $50,000/QALY. CONCLUSIONS: The LiverRisk score is an accurate, cost-effective tool to predict liver fibrosis and liver-related and diabetes-related mortality in the general population. FUNDING: The National Natural Science Foundation of China (nos. 82330060, 92059202, and 92359304); the Key Research and Development Program of Jiangsu Province (BE2023767a); the Fundamental Research Fund of Southeast University (3290002303A2); Changjiang Scholars Talent Cultivation Project of Zhongda Hospital of Southeast University (2023YJXYYRCPY03); and the Research Personnel Cultivation Program of Zhongda Hospital Southeast University (CZXM-GSP-RC125).

Microplastics in drinking water: A review on methods, occurrence, sources, and potential risks assessment.

Microplastics in drinking water captured widespread attention following reports of widespread detection around the world. Concerns have been raised about the potential adverse effects of microplastics in drinking water on human health. Given the widespread interest in this research topic, there is an urgent need to compile existing data and assess current knowledge. This paper provides a systematic review of studies on microplastics in drinking water, their evidence, key findings, knowledge gaps, and research needs. The data collected show that microplastics are widespread in drinking water, with large variations in reported concentrations. Standardized methodologies of sampling and analysis are urgently needed. There were more fibrous and fragmented microplastics, with the majority being <10 µm in size and composed of polyester, polyethylene, polypropylene, and polystyrene. Little attention has been paid to the color of microplastics. More research is needed to understand the occurrence and transfer of microplastics throughout the water supply chain and the treatment efficiency of drinking water treatment plants (DWTPs). Methods capable of analyzing microplastics <10 µm and nanoplastics are urgently needed. Potential ecological assessment models for microplastics currently in use need to be improved to take into account the complexity and specificity of microplastics.

Accelerating drug development at Bristol Myers Squibb through innovation.

This paper focuses on the use of novel technologies and innovative trial designs to accelerate evidence generation and increase pharmaceutical Research and Development (R&D) productivity, at Bristol Myers Squibb. We summarize learnings with case examples, on how we prepared and continuously evolved to address the increasing cost, complexities, and external pressures in drug development, to bring innovative medicines to patients much faster. These learnings were based on review of internal efforts toward accelerating R&D focusing on four key areas: adopting innovative trial designs, optimizing trial designs, leveraging external control data, and implementing novel methods using artificial intelligence and machine learning.

Device-measured movement behaviours in over 20,000 China Kadoorie Biobank participants.

BACKGROUND: Movement behaviours, including physical activity, sedentary behaviour, and sleep have been shown to be associated with several chronic diseases. However, they have not been objectively measured in large-scale prospective cohort studies in low-and middle-income countries. We aim to describe the patterns of device-measured movement behaviours collected in the China Kadoorie Biobank (CKB) study. METHODS: During 2020 and 2021, a random subset of 25,087 surviving CKB individuals participated in the 3rd resurvey of the CKB. Among them, 22,511 (89.7%) agreed to wear an Axivity AX3 wrist-worn triaxial accelerometer for seven consecutive days to assess their habitual movement behaviours. We developed a machine-learning model to infer time spent in four movement behaviours [i.e. sleep, sedentary behaviour, light intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA)]. Descriptive analyses were performed for wear-time compliance and patterns of movement behaviours by different participant characteristics. RESULTS: Data from 21,897 participants (aged 65.4 ± 9.1 years; 35.4% men) were received for demographic and wear-time analysis, with a median wear-time of 6.9 days (IQR: 6.1-7.0). Among them, 20,370 eligible participants were included in movement behavior analyses. On average, they had 31.1 mg/day (total acceleration) overall activity level, accumulated 7.7 h/day (32.3%) of sleep time, 8.8 h/day (36.6%) sedentary, 5.7 h/day (23.9%) in light physical activity, and 104.4 min/day (7.2%) in moderate-to-vigorous physical activity. There was an inverse relationship between age and overall acceleration with an observed decline of 5.4 mg/day (17.4%) per additional decade. Women showed a higher activity level than men (32.3 vs 28.8 mg/day) and there was a marked geographical disparity in the overall activity level and time allocation. CONCLUSIONS: This is the first large-scale accelerometer data collected among Chinese adults, which provides rich and comprehensive information about device-measured movement behaviour patterns. This resource will enhance our knowledge about the potential relevance of different movement behaviours for chronic disease in Chinese adults.

Low-cost UAV detection via WiFi traffic analysis and machine learning.

In recent years, unmanned aerial vehicles (UAVs) have undergoing experienced remarkable advancements. Nevertheless, the growing utilization of UAVs brings forth potential security threats to the public, particularly in private and sensitive locales. To address these emerging hazards, we introduce a low-cost, three-stage UAV detection framework for monitoring invading UAVs in vulnerable zones. This framework devised through an exhaustive investigation of the Chinese UAV market. Various scenarios were examined to evaluate the effectiveness of the framework, and it was subsequently implemented on a portable board. Experiments demonstrated that the proposed framework can detect invading UAVs at an early stage, even in stealthy mode. As such, the framework has the potential to be applied in the formulation of a portable surveillance system for a UAV-restricted region.

Neuronal AR Regulates Glucose Homeostasis and Energy Expenditure in Lean Female Mice With Androgen Excess.

Hyperandrogenemia and polycystic ovary syndrome are a result of the imbalance of androgen levels in females. Androgen receptor (Ar) mediates the effect of androgen, and this study examines how neuronal Ar in the central nervous system mediates metabolism under normal and increased androgen conditions in female mice. The neuron-specific ARKO mouse (SynARKO) was created from female (Ar fl/wt; synapsin promoter driven Cre) and male (Ar fl/y) mice. A glucose tolerance test revealed impaired glucose tolerance that was partially alleviated in the SynARKO-dihydrotestosterone (DHT) mice compared with Con-DHT mice after 4 months of DHT treatment. Heat production and food intake was higher in Con-DHT mice than in Con-veh mice; these effects were not altered between SynARKO-veh and SynARKO-DHT mice, indicating that excess androgens may partially alter calorie intake and energy expenditure in females via the neuronal Ar. The pAkt/Akt activity was higher in the hypothalamus in Con-DHT mice than in Con-veh mice, and this effect was attenuated in SynARKO-DHT mice. Western blot studies show that markers of inflammation and microglia activation, such as NF-kB p-65 and IBA1, increased in the hypothalamus of Con-DHT mice compared with Con-veh. These studies suggest that neuronal Ar mediates the metabolic impacts of androgen excess in females.

Spatial Distribution and Risk Assessment of Heavy Metal(oid)s Contamination in Topsoil around a Lead and Zinc Smelter in Henan Province, Central China.

A total of 137 farmland soil samples were collected around a lead/zinc smelter within 64 km2. The concentration, spatial distribution, and potential source of nine heavy metal(oid)s (As, Cd, Co, Cr, Cu, Ni, Pb, V, and Zn) in soils and their potential ecological risk were investigated in detail. The results showed that the average concentrations of Cd, Pb, Cr and Zn in these soils were higher than their background value in Henan Province, and the average content of Cd was 2.83 times of the risk screening values in the national standard of China (GB 15618-2018). According to the distribution of different heavy metal(oid)s in soils, Cd and Pb in soil decrease gradually with the increase of distance from the smelter to the surrounding area. This indicates that the Pb and Cd originate from smelters via airborne practices according to the typical air pollution diffusion model. The distribution of Zn, Cu, and As were similar to Cd and Pb. However, Ni, V, Cr, and Co were mainly affected by soil parent materials. The potential ecological risk of Cd was higher than those of other elements, and the risk grade of the other eight elements was mainly low. The polluted soils with significantly high and high potential ecological risk covered 93.84% of all the studied regions. This should be of serious concern to government. The results of a principal component analysis (PCA) and cluster analysis (CA) show that Pb, Cd, Zn, Cu, and As were the elements mainly stemmed from smelter and other types of plants, with a contribution rate of 60.08%, while Co, Cr, Ni, and V are mainly caused by nature, with a contribution rate of 26.26%.

Development, validation, and evaluation of a risk assessment tool for personalized screening of gastric cancer in Chinese populations.

BACKGROUND: Effective risk prediction models are lacking for personalized endoscopic screening of gastric cancer (GC). We aimed to develop, validate, and evaluate a questionnaire-based GC risk assessment tool for risk prediction and stratification in the Chinese population. METHODS: In this three-stage multicenter study, we first selected eligible variables by Cox regression models and constructed a GC risk score (GCRS) based on regression coefficients in 416,343 subjects (aged 40-75 years) from the China Kadoorie Biobank (CKB, development cohort). In the same age range, we validated the GCRS effectiveness in 13,982 subjects from another independent Changzhou cohort (validation cohort) as well as in 5348 subjects from an endoscopy screening program in Yangzhou. Finally, we categorized participants into low (bottom 20%), intermediate (20-80%), and high risk (top 20%) groups by the GCRS distribution in the development cohort. RESULTS: The GCRS using 11 questionnaire-based variables demonstrated a Harrell's C-index of 0.754 (95% CI, 0.745-0.762) and 0.736 (95% CI, 0.710-0.761) in the two cohorts, respectively. In the validation cohort, the 10-year risk was 0.34%, 1.05%, and 4.32% for individuals with a low (≤ 13.6), intermediate (13.7~30.6), and high (≥ 30.7) GCRS, respectively. In the endoscopic screening program, the detection rate of GC varied from 0.00% in low-GCRS individuals, 0.27% with intermediate GCRS, to 2.59% with high GCRS. A proportion of 81.6% of all GC cases was identified from the high-GCRS group, which represented 28.9% of all the screened participants. CONCLUSIONS: The GCRS can be an effective risk assessment tool for tailored endoscopic screening of GC in China. Risk Evaluation for Stomach Cancer by Yourself (RESCUE), an online tool was developed to aid the use of GCRS.

Scenario Simulation of the Relationship between Land-Use Changes and Ecosystem Carbon Storage: A Case Study in Dongting Lake Basin, China.

High-frequency land-use changes caused by rapid economic development have become a key factor in the imbalance of carbon sequestration within regions. How to balance economic development and ecological protection is a difficult issue for regional planning. Studying the relationship between future land-use changes and ecosystem carbon storage (CS) is of important significance for the optimization of regional land-use patterns. The research used the gray prediction model and coupled the patch-generating land-use simulation (PLUS) model and the integrated valuation of ecosystem services and trade-offs (InVEST) model. On this basis, the evolution characteristics and spatial coordination between land-use changes and CS in the Dongting Lake Basin (DLB) in different scenarios in 2030 were simulated. The results show that: (1) The spatial distribution of CS remains stable in different scenarios, while land-use types with high carbon density in the periphery of cities are constantly invaded by construction land, which results in the greatest carbon loss in the urban areas. (2) Compared with the natural evolution scenario (NES), only 195.19 km2 of land-use types with high carbon density are transformed into construction land in the ecological protection scenario (EPS), generating a carbon sink gain of 182.47 × 104 Mg. Conversely, in the economic development scenario (EDS), a total of over 1400 km2 of farmland and ecological land are transformed into construction land, which weakens the carbon sequestration capacity of ecosystems, and more than 147 × 104 Mg of carbon loss occurs in the urban areas. (3) The planned development scenario (PDS) takes ecological protection and economic development both into consideration, which not only generates a carbon sink gain of 121.33 × 104 Mg but also reduces the carbon loss in urban areas by more than 50%. The PDS performs well in both land use and CS growth and can better motivate the effect of land-use changes in increasing the carbon sink, which is also proved by analysis of the coordination between land-use intensity (LUI) and CS. Therefore, the PDS better satisfies the future development demand of DLB and can provide a reference for sustainable land use in the basin.

Impacts of solid fuel use versus smoking on life expectancy at age 30 years in the rural and urban Chinese population: a prospective cohort study.

Background: The impact of solid fuel use on life expectancy (LE) in less-developed countries remains unclear. We aimed to evaluate the potential impact of household solid fuel use on LE in the rural and urban Chinese population, with the effect of smoking as a reference. Methods: We used data from China Kadoorie Biobank (CKB) of 484,915 participants aged 30-79 free of coronary heart disease, stroke, or cancer at baseline. Analyses were performed separately for solid fuel use for cooking, solid fuel use for heating, and smoking, with participants exposed to the other two sources excluded. Solid fuels refer to coal and wood, and clean fuels refer to electricity, gas, and central heating. We used a flexible parametric Royston-Parmar model to estimate hazard ratios of all-cause mortality and predict LE at age 30. Findings: Totally, 185,077, 95,228, and 230,995 participants were included in cooking-, heating-, and smoking-related analyses, respectively. During a median follow-up of approximately 12.1 years, 12,725, 7,531, and 18,878 deaths were recorded in the respective analysis. Compared with clean fuel users who reported cooking with ventilation, participants who used solid fuels with ventilation and without ventilation had a difference in LE (95% confidence interval [CI]) at age 30 of -1.72 (-2.88, -0.57) and -2.62 (-4.16, -1.05) years for men and -1.33 (-1.85, -0.81) and -1.35 (-2.02, -0.67) years for women, respectively. The difference in LE (95% CI) for heating was -2.23 (-3.51, -0.95) years for men and -1.28 (-2.08, -0.48) years for women. In rural men, the LE reduction (95% CI) related to solid fuel use for cooking (-2.55; -4.51, -0.58) or heating (-3.26; -6.09, 0.44) was more than that related to smoking (-1.71; -2.54, -0.89). Conversely, in urban men, the LE reduction (95% CI) related to smoking (-3.06; -3.56, -2.56) was more than that related to solid fuel use for cooking (-1.28; -2.61, 0.05) and heating (-1.90; -3.16, -0.65). Similar results were observed in women but with a smaller magnitude. Interpretation: In this Chinese population, the harm to LE from household use of solid fuels was greater than that from smoking in rural residents. Conversely, the negative impact of smoking was greater than solid fuel use in urban residents. Our findings highlight the complexity and diversity of the factors affecting LE in less-developed populations. Funding: National Natural Science Foundation of China, National Key R&D Program of China, Kadoorie Charitable Foundation, UK Wellcome Trust.

Tobacco smoking and risks of more than 470 diseases in China: a prospective cohort study.

BACKGROUND: Tobacco smoking is estimated to account for more than 1 million annual deaths in China, and the epidemic continues to increase in men. Large nationwide prospective studies linked to different health records can help to periodically assess disease burden attributed to smoking. We aimed to examine associations of smoking with incidence of and mortality from an extensive range of diseases in China. METHODS: We analysed data from the prospective China Kadoorie Biobank, which recruited 512 726 adults aged 30-79 years, of whom 210 201 were men and 302 525 were women. Participants who had no major disabilities were identified through local residential records in 100-150 administrative units, which were randomly selected by use of multistage cluster sampling, from each of the ten diverse study areas of China. They were invited and recruited between June 25, 2004, and July 15, 2008. Upon study entry, trained health workers administered a questionnaire assessing detailed smoking behaviours and other key characteristics (eg, sociodemographics, lifestyle, and medical history). Participants were followed up via electronic record linkages to death and disease registries and health insurance databases, from baseline to Jan 1, 2018. During a median 11-year follow-up (IQR 10-12), 285 542 (55·7%) participants were ever hospitalised, 48 869 (9·5%) died, and 5252 (1·0%) were lost to follow-up during the age-at-risk of 35-84 years. Cox regression yielded hazard ratios (HRs) associating smoking with disease incidence and mortality, adjusting for multiple testing. FINDINGS: At baseline, 74·3% of men and 3·2% of women (overall 32·4%) ever smoked regularly. During follow-up, 1 137 603 International Classification of Diseases, 10th revision (ICD-10)-coded incident events occurred, involving 476 distinct conditions and 85 causes of death, each with at least 100 cases. Compared with never-regular smokers, ever-regular smokers had significantly higher risks for nine of 18 ICD-10 chapters examined at age-at-risk of 35-84 years. For individual conditions, smokers had significantly higher risks of 56 diseases (50 for men and 24 for women) and 22 causes of death (17 for men and nine for women). Among men, ever-regular smokers had an HR of 1·09 (95% CI 1·08-1·11) for any disease incidence when compared with never-regular smokers, and significantly more episodes and longer duration of hospitalisation, particularly those due to cancer and respiratory diseases. For overall mortality, the HRs were greater in men from urban areas than in men from rural areas (1·50 [1·42-1·58] vs 1·25 [1·20-1·30]). Among men from urban areas who began smoking at younger than 18 years, the HRs were 2·06 (1·89-2·24) for overall mortality and 1·32 (1·27-1·37) for any disease incidence. In this population, 19·6% of male (24·3% of men residing in urban settings and 16·2% of men residing in rural settings) and 2·8% of female deaths were attributed to ever-regular smoking. INTERPRETATION: Among Chinese adults, smoking was associated with higher risks of morbidity and mortality from a wide range of diseases. Among men, the future smoking-attributed disease burden will increase further, highlighting a pressing need for reducing consumption through widespread cessation and uptake prevention. FUNDING: British Heart Foundation, Cancer Research UK, Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, UK Medical Research Council, National Natural Science Foundation of China, Wellcome Trust.

Exploring the Nexus of Healthcare Employees' Professional Quality, Health Psychology and Service Value: A Qualitative Study.

While the implementation of the "graded diagnosis and treatment" system highlights the important role of general practitioners as "residents' health gatekeepers", it brings the problem of insufficient service capacity and difficulty in realizing the service value. At present, the service value of general practitioners is a relatively new topic in the field of general medicine. Therefore, few studies discuss the specific path that affects the realization of their service value. According to literature analysis, the professional quality of general practitioners plays a positive role in improving their service quality. So it can be inferred that the main reason for this phenomenon is that the professional quality level of general practitioners as the service subject is low and they have not been trusted and recognized by the residents of the service object. So far, it is difficult for most residents to change their willingness to go to large hospitals. Training is the most critical link to improving the professional quality of general practitioners. Therefore, how to enhance the professional quality of general practitioners through effective training so as to realize the service value is a problem worth discussing. Our study took 37 general practitioners from 12 Community Health Service hospitals as the interviewees and used grounded theory to mine the internal correlation between variables. The results show that: (1) the professional quality of general practitioners mainly includes three dimensions: professional ethics, theoretical knowledge, and professional skills; (2) through training, the professional quality of general practitioners has been effectively improved; (3) the improvement of general practitioners' professional quality directly affects the realization of their technical value, environmental value and information value; (4) the professional quality of general practitioners can be improved through training, which will affect the realization of their service value. Our research contribution is to break through the previous research paradigm of analyzing the relationship between variables based on the existing literature. This paper uses the procedural grounded theory method to analyze the concept of general practitioners' professional quality from scratch through continuous refinement and summary and constructs a theoretical model of the training path from general practitioners' professional quality to service value. On the one hand, the research results can realize their service value by improving the professional quality of general practitioners. On the other hand, the realization of the service value of general practitioners can provide effective support for patients to create a good medical environment.

Water-Quality Assessment and Pollution-Risk Early-Warning System Based on Web Crawler Technology and LSTM.

The openly released and measured data from automatic hydrological and water quality stations in China provide strong data support for water environmental protection management and scientific research. However, current public data on hydrology and water quality only provide real-time data through data tables in a shared page. To excavate the supporting effect of these data on water environmental protection, this paper designs a water-quality-prediction and pollution-risk early-warning system. In this system, crawler technology was used for data collection from public real-time data. Additionally, a modified long short-term memory (LSTM) was adopted to predict the water quality and provide an early warning for pollution risks. According to geographic information technology, this system can show the process of spatial and temporal variations of hydrology and water quality in China. At the same time, the current and future water quality of important monitoring sites can be quickly evaluated and predicted, together with the pollution-risk early warning. The data collected and the water-quality-prediction technique in the system can be shared and used for supporting hydrology and in water quality research and management.

Metal(loid)s Spatial Distribution, Accumulation, and Potential Health Risk Assessment in Soil-Wheat Systems near a Pb/Zn Smelter in Henan Province, Central China.

To understand the influence of Pb/Zn smelter on surrounding environment, 110 soil and 62 wheat grain samples (62 paired samples) were collected nearby a Pb/Zn smelter in Jiaozuo City, Henan Province, China. The content and spatial distribution of metal(loid)s in the soil-wheat system, and the potential health risk via consumption of wheat grains were determined. Results showed that the average content of Pb, Cd, As, Cu, Zn, and Ni in soil were 129.16, 4.28, 17.95, 20.43, 79.36, and 9.42 mg/kg, respectively. The content of Cd in almost all soil samples (99.1%) exceeded the national limitation of China (0.6 mg/kg). Spatial distribution analysis indicated that atmospheric deposition might be the main pollution source of Pb, Cd, As, and Zn in soil. In addition, the average content of Pb, Cd, As, Cu, Zn, and Ni in wheat grain were 0.62, 0.35, 0.10, 3.7, 35.77, and 0.15 mg/kg, respectively, with the average Pb and Cd content exceeding the national limitation of China. The average bioaccumulation factor of these metal(loid)s followed the following order: Zn (0.507) > Cu (0.239) > Cd (0.134) > Ni (0.024) > Pb (0.007) > As (0.006). Health risk assessment indicated that the average noncarcinogenic risk of children (6.78) was much higher than that of adults (2.83), and the carcinogenic risk of almost all wheat grain is higher than the acceptable range, with an average value of 2.43 × 10−2. These results indicated that humans who regularly consume these wheat grains might have a serious risk of noncarcinogenic and carcinogenic diseases.

Migration of heavy metals in the soil-grape system and potential health risk assessment.

The accumulation of heavy metals in soil may introduce them to the food chain and cause health risks for humans. In the present study, 43 pairs of soil and grape samples (leaf and fruit) were collected form vineyards in the suburbs of Kaifeng city (wastewater-irrigated area in Henan Province, China) to assess the heavy metal (Pb, Cd, Cu, Zn and Ni) pollution level in soil, heavy metal accumulation in different grape tissues and the potential health risk via consumption of grapes. The results showed that the average contents of Pb, Cd, Cu, Zn and Ni in vineyard soil were 42.27, 3.08, 62.33, 262.54 and 26.60 mg/kg, respectively. Some of these soil samples were severely contaminated with Cd and Zn, with an average pollution index (Pi) of 5.14 and 0.88, respectively. Most of these soil samples were severely polluted by heavy metals, with an average Nemerow integrated pollution index (PN) of 3.77. The bioavailable heavy metals were negatively correlated with soil pH and positively correlated with soil organic matter (OM). In addition, heavy metals were more likely to accumulate in grape leaves, and their contents in grape pulp were all within the maximum permissible limit set by China (GB 2762-2017). The average bioaccumulation factors (BFs) of Pb, Cd, Cu, Zn and Ni in grape pulp were 0.007, 0.096, 0.160, 0.078 and 0.023, respectively. Health risk assessment indicated that there was no noncarcinogenic risk for grape consumers (adults and children). However, the carcinogenic risk (CR) ranged from 4.95 × 10-7 to 2.17 × 10-4, and the CR value of three grape samples was higher than 10-4, indicating that a probability of carcinogenic disease existed for humans who regularly consumed the grapes from this region.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study.

Background: Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Methods: Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. Results: A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. Conclusion: We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

Socioeconomic Status in Relation to Risks of Major Gastrointestinal Cancers in Chinese Adults: A Prospective Study of 0.5 Million People.

BACKGROUND: Low socioeconomic status (SES) is associated with higher risk of certain gastrointestinal (e.g., colorectal, pancreatic, and liver) cancers in Western populations. Evidence is very limited in China, where correlates and determinants of SES differ from those in the West. METHODS: The prospective China Kadoorie Biobank recruited 512,715 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) regions. During 10 years of follow-up, 27,940 incident cancers (including 3,061 colorectal, 805 pancreatic, and 2,904 liver) were recorded among 510,131 participants without prior cancer at baseline. Cox regression was used to estimate adjusted HRs for specific cancers associated with area-level (e.g., per capita gross domestic product, disposable income) and individual-level (e.g., education, household income) SES. RESULTS: Area-level SES and household income showed positive associations with incident colorectal and pancreatic cancers and inverse associations with liver cancer (P trend < 0.05). Education showed no association with colorectal cancer but inverse associations with pancreatic and liver cancers, with adjusted HRs comparing university to no formal schooling being 1.05 [95% confidence interval (CI), 0.85-1.29], 0.49 (95% CI, 0.28-0.85), and 0.61 (95% CI, 0.47-0.81), respectively. Potential risk factors (e.g., smoking, alcohol) partly explained the inverse associations of education with pancreatic and liver cancers (17.6% and 60.4%), respectively. CONCLUSIONS: Among Chinese adults, the associations of SES with gastrointestinal cancers differed by cancer type and SES indicator. Potential risk factors partially explained the inverse associations of education with pancreatic and liver cancers. IMPACT: The different associations between SES with gastrointestinal cancers may inform cancer prevention strategies.

Exploring Determinants of Population Ageing in Northeast China: From a Socio-Economic Perspective.

The paper aims to examine the population ageing process in northeast China, typically perceived as a region experiencing dramatic demographic change and socio-economic slowdown that is much deeper and more significant compared to other regions. Using the 2000 and 2010 census data at the sub-regional level, the SEM (spatial error model) estimation suggests that at least seven socio-economic factors are associated with the evolution of the ageing pattern in northeast China, including birth rate, mortality, education, healthcare conditions, the level of economic development, urbanization, and population mobility. However, these associations vary according to time and space, which are further confirmed by the geographical weighted regression (GWR). These findings imply that there are complicated and diversified factors which may be associated with the deteriorating population ageing at the local level in northeast China. Therefore, the sustainable development of the northeast region may not be delivered by dichotomous policy interventions, such as the control of birth rate or mortality rate, as many of the previous studies have focused on; instead, the implementation of ageing policy shall be consistent and complementary with the principles of social benefits, for example, providing incentives for improving regional economic structures, or by policies aimed at building up an adequate "tolerant culture" for slowing down population outflows.

Sex differences in the association between socioeconomic status and diabetes prevalence and incidence in China: cross-sectional and prospective studies of 0.5 million adults.

AIMS/HYPOTHESIS: China has undergone rapid socioeconomic transition accompanied by lifestyle changes that are expected to have a profound impact on the health of its population. However, there is limited evidence from large nationwide studies about the relevance of socioeconomic status (SES) to risk of diabetes. We describe the associations of two key measures of SES with prevalent and incident diabetes in Chinese men and women. METHODS: The China Kadoorie Biobank study included 0.5 million adults aged 30-79 years recruited from ten diverse areas in China during 2004-2008. SES was assessed using the highest educational level attained and annual household income. Prevalent diabetes was identified from self-report and plasma glucose measurements. Incident diabetes was identified from linkage to disease and death registries and national health insurance claim databases. We estimated adjusted ORs and HRs for prevalent and incident diabetes associated with SES using logistic and Cox regression models, respectively. RESULTS: At baseline, 30,066 (5.9%) participants had previously diagnosed (3.1%) or screen-detected (2.8%) diabetes among 510,219 participants included for cross-sectional analyses. There were 480,153 people without prevalent diabetes at baseline, of whom 9544 (2.0%) had new-onset diabetes during follow-up (median 7 years). Adjusted ORs (95% CIs) for prevalent diabetes, comparing highest vs lowest educational level, were 1.21 (1.09, 1.35) in men and 0.69 (0.63, 0.76) in women; for incident diabetes, the corresponding HRs were 1.27 (1.07, 1.51) and 0.80 (0.67, 0.95), respectively. For household income, the adjusted ORs for prevalent diabetes, comparing highest vs lowest categories, were 1.45 (1.34, 1.56) in men and 1.26 (1.19, 1.34) in women; for incident diabetes, the HRs were 1.36 (1.19, 1.55) and 1.06 (0.95, 1.17), respectively. CONCLUSIONS/INTERPRETATION: Among Chinese adults, the associations between education and diabetes prevalence and incidence differed qualitatively between men and women, whereas higher household income was positively associated with diabetes prevalence and incidence in both sexes, with a stronger relationship in men than in women.

The distribution and correlates of self-rated health in elderly Chinese: the China Kadoorie Biobank study.

BACKGROUND: Self-rated health (SRH) have been widely used as a valid indicator of health status at the population and individual level. We aimed to investigate the distribution and correlates of global SRH and age-comparative SRH in elderly Chinese. METHODS: Survey of 57,693 men and 67,089 women aged 60 years and above was conducted in five rural (Gansu, Sichuan, Hunan, Henan, Zhejiang) and five urban areas (Heilongjiang, Shandong, Jiangsu, Guangxi, Hainan) in China between 2004 and 2008. Logistic regression models were used to calculate the relations of different factors with global SRH and age-comparative SRH. RESULTS: Among the participants, 38.33% reported their global SRH as good or excellent while 61.67% as fair or poor, and 17.70% reported better age-comparative SRH while 17.99% as worse. In the multivariate model, compared to women, men tended to report a good global SRH and better age-comparative SRH, urban residents tend to report good global SRH and better age-comparative SRH. The socioeconomic and health behavior factors that were associated with good global SRH and better age-comparative SRH (with varying strengths of association) included: high educational level, high household income, house ownership, quitting smoking by own choices, occasional and current alcohol drinking, overweight, and high physical activity level. The factors that were associated with poor global SRH and worse age-comparative SRH included: quitting smoking by illness, former drinking, underweight, and weight lost ≥2.5 kg in the previous year. CONCLUSIONS: We found a moderate level of good global SRH and a low level of better age-comparative SRH among elderly Chinese. We identified a number of demographic, socioeconomic and health behavior factors that were related to SRH measures. Our study emphasizes the importance of incorporating both global and age-comparative SRH measures in future studies, and considering gender inequalities and urban/rural disparity, as well as socioeconomic status and health behaviors as important modifiers of health.