Extending the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in Traditional Chinese Medicine (TCM): The GRADE-TCM.

AIM: To extend and form the "Grading of Recommendations Assessment, Development and Evaluation in Traditional Chinese Medicine" (GRADE-TCM). METHODS: Methodologies were systematically reviewed and analyzed concerning evidence-based TCM guidelines worldwide. A survey questionnaire was developed based on the literature review and open-end expert interviews. Then, we performed expert consensus, discussion meeting, opinion collection, external examination, and the GRADE-TCM was formed eventually. RESULTS: 265 Chinese and English TCM guidelines were included and analyzed. Five experts completed the open-end interviews. Ten methodological entries were summarized, screened and selected. One round of consensus was conducted, including a total of 22 experts and 220 valid questionnaire entries, concerning 1) selection of the GRADE, 2) GRADE-TCM upgrading criteria, 3) GRADE-TCM evaluation standard, 4) principles of consensus and recommendation, and 5) presentation of the GRADE-TCM and recommendation. Finally, consensus was reached on the above 10 entries, and the results were of high importance (with voting percentages ranging from 50 % to 81.82 % for "very important" rating) and strong reliability (with the Cr ranging from 0.93 to 0.99). Expert discussion meeting (with 40 experts), opinion collection (in two online platforms) and external examination (with 14 third-party experts) were conducted, and the GRADE-TCM was established eventually. CONCLUSION: GRADE-TCM provides a new extended evidence-based evaluation standard for TCM guidelines. In GRADE-TCM, international evidence-based norms, characteristics of TCM intervention, and inheritance of TCM culture were combined organically and followed. This is helpful for localization of the GRADE in TCM and internationalization of TCM guidelines.

Understanding the educational inequalities in suicide attempts and their mediators: a Mendelian randomisation study.

Background: Educational inequalities in suicide have become increasingly prominent over the past decade. Elucidating modifiable risk factors that serve as intermediaries in the impact of low educational attainment on suicide has the potential to reduce health disparities. Aims: To examine the risk factors that mediate the relationship between educational attainment and suicide attempts and quantify their contributions to the mediation effect. Methods: We conducted a two-sample Mendelian randomisation (MR) analysis to estimate the causal effect of educational attainment on suicide attempts, utilising genome-wide association study summary statistics from the Integrative Psychiatric Research (iPSYCH; 6024 cases and 44 240 controls) and FinnGen (8978 cases and 368 299 controls). We systematically evaluated 42 putative mediators within the causal pathway connecting reduced educational attainment to suicide attempts and employed two-step and multivariable MR to quantify the proportion of the mediated effect. Results: In the combined analysis of iPSYCH and FinnGen, each standard deviation (SD) decrease in genetically predicted educational attainment (equating to 3.4 years of education) was associated with a 105% higher risk of suicide attempts (odds ratio (OR): 2.05; 95% confidence interval (CI): 1.81 to 2.31). Of the 42 risk factors analysed, the two-step MR identified five factors that mediated the association between educational attainment and suicide attempts. The respective proportions of mediation were 47% (95% CI: 29% to 66%) for smoking behaviour, 36% (95% CI: 0% to 84%) for chronic pain, 49% (95% CI: 36% to 61%) for depression, 35% (95% CI: 12% to 59%) for anxiety and 26% (95% CI: 18% to 34%) for insomnia. Multivariable MR implicated these five mediators collectively, accounting for 68% (95% CI: 40% to 96%) of the total effect. Conclusions: This study identified smoking, chronic pain and mental disorders as primary intervention targets for attenuating suicide risk attributable to lower educational levels in the European population.

Assessment of the bidirectional causal association between frailty and depression: A Mendelian randomization study.

BACKGROUND: Observational studies have demonstrated a strong bidirectional association between frailty and depression, but it remains unclear whether this association reflects causality. This study aimed to examine the bidirectional causal relationship between frailty and depression. METHODS: Using genome-wide association study summary data, two-sample Mendelian randomization was performed to test for the potential bidirectional causality between frailty, as defined by both the frailty index and the frailty phenotype, and depression. Several frailty-related traits were additionally investigated, including weaker hand grip strength, slower walking pace and physical inactivity. Findings were replicated using an independent depression data source and verified using multiple sensitivity analyses. RESULTS: Genetically predicted higher frailty index (odds ratio [OR], 1.86; P < 0.001), higher frailty phenotype score (OR, 2.79; P < 0.001), lower grip strength (OR, 1.23; P = 0.003), slower walking pace (OR, 1.55; P = 0.027) and physical inactivity (OR, 1.44; P = 0.003) all were associated with a higher risk of depression. As for the reverse direction, genetic liability to depression showed consistent associations with a higher frailty index (beta, 0.167; P < 0.001) and a higher frailty phenotype score (beta, 0.067; P = 0.001), but not with other frailty-related traits that were investigated. The results were stable across sensitivity analyses and across depression datasets. CONCLUSIONS: Our findings add novel evidence supporting the bidirectional causal association between frailty and depression. Improving balance and muscle strength and increasing physical activity may be beneficial in both depression and frailty.

Prevalence, risk factors, impact and management of pneumonia among preschool children in Chinese seven cities: a cross-sectional study with interrupted time series analysis.

BACKGROUND: Pneumonia is a common disease worldwide in preschool children. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of pneumonia among preschool children. We therefore investigated the prevalence of pneumonia among preschool children in Chinese seven representative cities, and explore the possible risk factors of pneumonia on children, with a view to calling the world's attention to childhood pneumonia to reduce the prevalence of childhood pneumonia. METHODS: Two group samples of 63,663 and 52,812 preschool children were recruited from 2011 and 2019 surveys, respectively. Which were derived from the cross-sectional China, Children, Homes, Health (CCHH) study using a multi-stage stratified sampling method. This survey was conducted in kindergartens in seven representative cities. Exclusion criteria were younger than 2 years old or older than 8 years old, non-permanent population, basic information such as gender, date of birth and breast feeding is incomplete. Pneumonia was determined on the basis of parents reported history of clearly diagnosed by the physician. All participants were assessed with a standard questionnaire. Risk factors for pneumonia, and association between pneumonia and other respiratory diseases were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was evaluated by the parents' reported history of physician diagnosis, longitudinal comparison of risk factors in 2011 and 2019. RESULTS: In 2011 and 2019, 31,277 (16,152 boys and 15,125 girls) and 32,016 (16,621 boys and 15,395 girls) preschool children aged at 2-8 of permanent population completed the questionnaire, respectively, and were thus included in the final analysis. The findings showed that the age-adjusted prevalence of pneumonia in children was 32.7% in 2011 and 26.4% in 2019. In 2011, girls (odds ratio [OR] 0.91, 95%CI [confidence interval]0.87-0.96; p = 0.0002), rural (0.85, 0.73-0.99; p = 0.0387), duration of breastfeeding ≥ 6 months(0.83, 0.79-0.88; p < 0.0001), birth weight (g) ≥ 4000 (0.88, 0.80-0.97; p = 0.0125), frequency of putting bedding to sunshine (Often) (0.82, 0.71-0.94; p = 0.0049), cooking fuel type (electricity) (0.87, 0.80-0.94; p = 0.0005), indoor use air-conditioning (0.85, 0.80-0.90; p < 0.0001) were associated with a reduced risk of childhood pneumonia. Age (4-6) (1.11, 1.03-1.20; p = 0.0052), parental smoking (one) (1.12, 1.07-1.18; p < 0.0001), used antibiotics (2.71, 2.52-2.90; p < 0.0001), history of parental allergy (one and two) (1.21, 1.12-1.32; p < 0.0001 and 1.33, 1.04-1.69; p = 0.0203), indoor dampness (1.24, 1.15-1.33; p < 0.0001), home interior decoration (1.11, 1.04-1.19; p = 0.0013), Wall painting materials (Paint) (1.16, 1.04-1.29; p = 0.0084), flooring materials (Laminate / Composite wood) (1.08, 1.02-1.16; p = 0.0126), indoor heating mode(Central heating)(1.18, 1.07-1.30, p = 0.0090), asthma (2.38, 2.17-2.61; p < 0.0001), allergic rhinitis (1.36, 1.25-1.47; p < 0.0001), wheezing (1.64, 1.55-1.74; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (2.53, 2.31-2.78; p < 0.0001), allergic rhinitis (1.41, 1.29-1.53; p < 0.0001) and wheezing (1.64, 1.55-1.74; p < 0.0001). In 2019, girls (0.92, 0.87-0.97; p = 0.0019), duration of breastfeeding ≥ 6 months (0.92, 0.87-0.97; p = 0.0031), used antibiotics (0.22, 0.21-0.24; p < 0.0001), cooking fuel type (Other) (0.40, 0.23-0.63; p = 0.0003), indoor use air-conditioning (0.89, 0.83-0.95; p = 0.0009) were associated with a reduced risk of childhood pneumonia. Urbanisation (Suburb) (1.10, 1.02-1.18; p = 0.0093), premature birth (1.29, 1.08-1.55; p = 0.0051), birth weight (g) < 2500 (1.17, 1.02-1.35; p = 0.0284), parental smoking (1.30, 1.23-1.38; p < 0.0001), history of parental asthma (One) (1.23, 1.03-1.46; p = 0.0202), history of parental allergy (one and two) (1.20, 1.13-1.27; p < 0.0001 and 1.22, 1.08-1.37; p = 0.0014), cooking fuel type (Coal) (1.58, 1.02-2.52; p = 0.0356), indoor dampness (1.16, 1.08-1.24; p < 0.0001), asthma (1.88, 1.64-2.15; p < 0.0001), allergic rhinitis (1.57, 1.45-1.69; p < 0.0001), wheezing (2.43, 2.20-2.68; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (1.96, 1.72-2.25; p < 0.0001), allergic rhinitis (1.60, 1.48-1.73; p < 0.0001) and wheezing (2.49, 2.25-2.75; p < 0.0001). CONCLUSIONS: Pneumonia is prevalent among preschool children in China, and it affects other childhood respiratory diseases. Although the prevalence of pneumonia in Chinese children shows a decreasing trend in 2019 compared to 2011, a well-established management system is still needed to further reduce the prevalence of pneumonia and reduce the burden of disease in children.

[Effects of propiconazole on physiological and biochemical properties of Panax notoginseng and dietary risk assessment].

To study the residue and dietary risk of propiconazole in Panax notoginseng and the effects on physiological and bioche-mical properties of P. notoginseng, we conducted foliar spraying of propiconazole on P. notoginseng in pot experiments. The physiolo-gical and biochemical properties studied included leaf damage, osmoregulatory substance content, antioxidant enzyme system, non-enzymatic system, and saponin content in the main root. The results showed that at the same application concentration, the residual amount of propiconazole in each part of P. notoginseng increased with the increase in the times of application and decreased with the extension of harvest interval. After one-time application of propiconazole according to the recommended dose(132 g·hm~(-2)) for P. ginseng, the half-life was 11.37-13.67 days. After 1-2 times of application in P. notoginseng, propiconazole had a low risk of dietary intake and safety threat to the population. The propiconazole treatment at the recommended concentration and above significantly increased the malondialdehyde(MDA) content, relative conductivity, and osmoregulatory substances and caused the accumulation of reactive oxygen species in P. notoginseng leaves. The propiconazole treatment at half(66 g·hm~(-2)) of the recommended dose for P. ginseng significantly increased the activities of superoxide dismutase(SOD), peroxidase(POD), and catalase(CAT) in P. notoginseng leaves. The propiconazole treatment at 132 g·hm~(-2) above inhibited the activities of glutathione reductase(GR) and glutathione S-transferase(GST), thereby reducing glutathione(GSH) content. Proconazole treatment changed the proportion of 5 main saponins in the main root of P. notoginseng. The treatment with 66 g·hm~(-2) propiconazole promoted the accumulation of saponins, while that with 132 g·hm~(-2) and above propiconazole significantly inhibited the accumulation of saponins. In summary, using propiconazole at 132 g·hm~(-2) to prevent and treat P. notoginseng diseases will cause stress on P. notoginseng, while propiconazole treatment at 66 g·hm~(-2) will not cause stress on P. notoginseng but promote the accumulation of saponins. The effect of propiconazole on P. notoginseng diseases remains to be studied.

Environmental regulation, digital finance, and technological innovation: evidence from listed firms in China.

Environmental regulation becomes essential to corporate technological innovation amid increasing concern with environmental issues. However, a clear understanding of the specific role of environmental regulation's ex-post effectiveness is lacking. Using the panel data of Chinese A-share listed firms during 2011-2018, we examine the effects of environmental regulation on corporate technological innovation. The results indicate that environmental regulation negatively affects corporate technological innovation. With regard to digital finance, it benefits for corporate technological innovation and positively moderates the relationship between environmental regulation and corporate technological innovation. The heterogeneity analysis suggests that the negative impact of environmental regulation over technological innovation is much significant for small-scale firms, western-region firms, and firms with strong financing constraints. Furthermore, the moderating role of digital finance is more significant for firms with strong financing constraints and heavy polluting firms. We also verify the robustness of the regression results. The current study provides both theoretical support and reference to improve corporate technological innovation and promote high-quality economic development through adopting reasonable policy measures.

Cost-effectiveness analysis of the prevention of mother-to-child transmission of HIV.

BACKGROUND: The number of HIV-positive pregnant women accounted for about 10% of China's total over the past few years in Liangshan Prefecture, Sichuan province in China. Although cost-effectiveness of the PMTCT of HIV have been evaluated in other previous studies, no specific study has been conducted in Liangshan prefecture, nor has the expenses paid individually by HIV-positive pregnant women been included. The purpose of this study was to evaluate both the short-term and long-term cost-effectiveness of PMTCT of HIV in Liangshan Prefecture from the social perspective. METHODS: From December 2018 to January 2019, individual expenses and the other costs were collected: individual expenses of 133 recruited HIV-positive pregnant women registered in the National Information System of Prevention of Mother-to-Child Transmission of HIV, Syphilis, and HBV, and the other costs from local maternal and child healthcare hospitals, Centers for Disease Control and Prevention, and general hospitals. The costs, the number of pediatric infections averted from being HIV infected were analyzed. And, Life years gained by pediatric infections averted were calculated by using a life table. Besides, Direct benefit was calculated through a Markov mode. Furthermore, One-way sensitivity analysis was conducted for key variables affecting the benefit-cost ratio. RESULTS: The estimated number of pediatric infections averted was 164.The total cost was USD 114.1 million, including direct medical costs, direct non-medical costs, and indirect costs, which were USD 54.2 million, USD 53.4 million, and USD 6.5 million, respectively. 630.6 person-years discounted to 2017 were gained at a 3% annual rate, and cost per life year gained was USD 1809.50. Direct benefits were USD 198.4 million, indirect benefits USD 82.5 million, and the benefit-cost ratio was 1.5. The sensitivity analysis showed that if PMTCT costs hypothetically ranged from USD 85.6 million to USD 142.6 million, benefit-cost ratio would vary from 1.0 to 2.3. CONCLUSIONS: PMTCT of HIV in Liangshan Prefecture was very cost-effective. It was a great economic burden of PMTCT on HIV-positive pregnant women and their families to take individual expenses. Therefore, it could be suggested that individual expenses should be covered as much as possible by different types of financing.

Obesity Fact Sheet in Korea, 2021: Trends in Obesity Prevalence and Obesity-Related Comorbidity Incidence Stratified by Age from 2009 to 2019.

Background: The global public health burden of obesity has increased with socio-economic development. The Korean Society for the Study of Obesity released the 2021 Obesity Fact Sheet to address trends in obesity prevalence and comorbid conditions by different age groups. Methods: Individuals ≥20 years old who underwent a health checkup provided by the Korean National Health Insurance Service between 2009 and 2019 were included. The prevalence of obesity and abdominal obesity was standardized by age and sex based on the 2010 population and housing census. The incidence of obesity-related comorbidities was tracked from 2009 to 2019, and the incidence per 1,000 person-years was calculated using Poisson regression adjusted for age and sex. Results: Obesity and abdominal obesity prevalence has increased for the entire population over the past 11 years. Obesity prevalence has risen rapidly in individuals in their 20s and 80s compared with other age groups. Additionally, class III obesity prevalence in both men and women has significantly increased by nearly threefold. The relative risk of developing type 2 diabetes, myocardial infarction, ischemic stroke, and cancers in people with obesity or abdominal obesity is greater than in people without obesity or abdominal obesity. The relative risk was higher in young and middle-aged individuals than in the older population. Conclusion: The findings based on the 2021 Obesity Fact Sheet suggest the need to better understand obesity characteristics according to age and sex and to establish individualized treatment strategies.

Rapid determination and dietary intake risk assessment of 249 pesticide residues in Panax notoginseng.

UPLC-MS/MS and GC-MS/MS were used to establish a method to simultaneously determine various pesticide residues in Panax notoginseng. Results showed that the limits of detection of 249 pesticides were all 5-10 µg/kg. The detection rate of pesticides in 121 P. notoginseng samples was 93.39%, and 19 pesticides were detected. According to the US Code of Federal Regulations, the Chinese Pharmacopoeia recommended algorithm, and the Japanese "positive list system", the pass rates of pesticide residues were 100%, 99.17%, and 89.26%, respectively. The chronic risk quotient (ADI%) and acute risk quotient (ARfD%) of P. notoginseng were 0.00-0.12% and 0.00-0.15%, respectively. In summary, the detection method established in this study can be used for routine analysis of various P. notoginseng pesticide residues. The pesticide residues in the main root samples of P. notoginseng were at a safe level and unlikely pose health risks to consumers.

The Enigma of Gender Differences in an Environment-Behavior-Health Model of Elderly People: The Choice Between Individually and Sociality.

Gender difference in the health of elderly people has become an important perspective to consider when studying their health. However, the gender differences in terms of "environment-behavior-health" from the social ecology perspective remain unknown. On the basis of survey data from Shanghai, China, including 2839 samples, this study explored the gender differences of outdoor environment-behavior-activity ability in elderly people from two aspects of the mean value of variables and the path relationship, utilizing the structural equation model analysis method combined with social ecology theory. The results showed that, at the level of the mean of variables, the elderly males had significantly higher mean values than the females in terms of individual behaviors, but had significantly lower values in terms of social behaviors. At the level of path relationships, there were similarities in that the health of elderly males was more likely to be affected by individual factors, whereas that of the females was more effected by social factors. Through the great positive effect of the high-level social behaviors, the health of the elderly females was progressively promoted. The study provided some useful insights for future research, aiming at promoting gender-sensitive urban design.

Spatial Econometric Analysis of the Impact of Socioeconomic Factors on PM2.5 Concentration in China's Inland Cities: A Case Study from Chengdu Plain Economic Zone.

Particulate matter with a diameter less than 2.5 µm (PM2.5), one of the main sources of air pollution, has increasingly become a concern of the people and governments in China. Examining the socioeconomic factors influencing on PM2.5 concentration is important for regional prevention and control. Previous studies mainly concentrated on the economically developed eastern coastal cities, but few studies focused on inland cities. This study selected Chengdu Plain Economic Zone (CPEZ), an inland region with heavy smog, and used spatial econometrics methods to identify the spatiotemporal distribution characteristics of PM2.5 concentration and the socioeconomic factors underlying it from 2006 to 2016. Moran's index indicates that PM2.5 concentration in CPEZ does have spatial aggregation characteristics. In general, the spatial clustering from the fluctuation state to the stable low state decreased by 1% annually on average, from 0.190 (p < 0.05) in 2006 to 0.083 (p < 0.1) in 2016. According to the results of the spatial Durbin model (SDM), socioeconomic factors including population density, energy consumption per unit of output, gross domestic product (GDP), and per capita GDP have a positive effect on PM2.5 concentration, while greening rate and per capita park space have a negative effect. Additionally, those factors have identified spatial spillover effects on PM2.5 concentration. This study could be a reference and support for the formulation of more efficient air pollution control policies in inland cities.

Modeling the temporal dynamics of intertidal benthic infauna biomass with environmental factors: Impact assessment of land reclamation.

Anthropogenic activities such as land reclamation are threatening tidal marshes worldwide. This study's hypothesis is that land reclamation in a semi-enclosed bay alters the seasonal dynamics of intertidal benthic infauna, which is a key component in the tidal marsh ecosystem. Mai Po Tidal Marsh, Deep Bay, Pearl River Estuary, China was used as a case study to evaluate the hypothesis. Ecological models that simulate benthic biomass dynamics with governing environmental factors were developed, and various scenario experiments were conducted to evaluate the impact of reclamations. Environmental variables, selected from the areas of hydrodynamics, meteorology, and water quality based on correlation analysis, were used to generate Bayesian regression models for biomass prediction. The best-performing model, which considered average water age (i.e., a hydrodynamic indicator of estuarine circulation) in the previous month, salinity variation (i.e., standard deviation of salinity), and the total sunny period in the current month, captured well both seasonal and yearly trends in the benthic infauna observations from 2002 to 2008. This model was then used to simulate biomass dynamics with varying inputs of water age and salinity variation from coastal numerical models of different reclamation scenarios. The simulation results suggest that the reclamation in 2007 decreased the spatial and annual average benthic infauna biomass in the tidal marsh by 20%, which agreed with the 28% biomass decrease recorded by field survey. The range of biomass seasonal variation also decreased significantly from 2.1 to 230.5g/m2 (without any reclamation) to 1.2 to 131.1g/m2 (after the 2007 reclamation), which further demonstrates the substantial ecological impact of reclamation. The ecological model developed in this study could simulate seasonal biomass dynamics and evaluate the ecological impact of reclamation projects. It can therefore be applied to evaluate the ecological impact of coastal engineering projects for tidal marsh management, conservation, and restoration.

Soil-Plant Metal Relations in Panax notoginseng: An Ecosystem Health Risk Assessment.

This study features a survey of the content of heavy metals (Pb, Cd, Cr, As, Hg and Cu) in root and cultivation soils of Panax notoginseng (P. notoginseng), carried out in China's Yunnan Province. The average contents of Pb, Cd, Cr, As, Hg, and Cu in the soil were 61.6, 0.4, 102.4, 57.1, 0.3, and 35.1 mg·kg-1, respectively. The heavy metals' pollution indexes can be ranked as follows: As > Cd > Hg > Cu > Cr > Pb. The proportion of soil samples at slight, middle, strong, very strong, and extremely strong levels of potential environmental risk had values of 5.41%, 21.62%, 35.14%, 10.81%, and 27.03%, respectively. The potential environment risk index (RI) showed that 29.73% out of the total sample sites were above the level of strong and extremely strong. The ranges of Pb, Cd, Cr, As, Hg, and Cu content in tuber were 0.04-3.26, 0.04-0.33, 0.22-5.4, 0.10-1.8, 0.00-0.02, and 5.0-20.9 mg·kg-1, respectively. In combination with P. notoginseng consumption data, the estimated heavy metal daily intakes (EDIs) were 0.08-0.23, 0.006-0.019, 0.17-0.52, 0.04-0.12, 0.001-0.002, and 0.59-1.77 µg·kg-1·bw/day. All target hazard quotients (THQs) of individual elements and hazard indexes (HI) were less than one. The present study indicates that most of the P. notoginseng cultivation soil in the province of Yunnan presented slight and moderate ecological risk. Thus, more attention should be given to the heavy metals As, Cd, and Hg when selecting planting areas for the cultivation of P. notoginseng. Health risks associated with the intake of a single element or consumption of the combined metals through P. notoginseng are absent.

[Qualitative characteristics and classification study on commodity specification and grade standard of Panax notoginseng].

Through the markets investigations and literature surveying, this paper investigates and analyzes the qualitative characteristics and commodity condition of Panax notoginseng. And the samples collected from market and origin were analyzed in order to revise the commodity specification and grade standard of P. notoginseng combined with production practice. In this paper, the authors divide the P. notoginseng into 4 commodity specification which are root (including Cunqi and Dongqi ), Rhizome and rootlet according to different parts and harvest time. And the root were divided into 8 grade which are 20, 30, 40, 60, 80, 120, countless and substandard. The density and internal components between the different commodity specification and grade of P. notoginseng were also compared. As well as the effect of different producing area, cultivation years and harvesting time on the commodity specification and grade of P. notoginseng were researched. On this basis, we revise and improve the commodity specification and grade standard of P. notoginseng. Moreover, we suggest the quality control indexes of P. notoginseng should be developed according to the different medicinal part and commodity specification in CHP. In order to guide the standardized production of traditional Chinese medicine and ensure the quality of medicinal materials, the cultivation years and density of each medicinal materials should also be indicated in CHP.

Online sex-seeking behaviors among men who have sex with men: implications for investigation and intervention.

To investigate factors associated with online sex-seeking behaviors among men who have sex with men (MSM) in Beijing, China. MSM participants were recruited from two cohort studies with multiple enrollment methods from November 2006 to February 2007 and from March to June 2008, respectively. Data collected included demographics and sexual behaviors. Of the 901 participants, 68.1% were single; 69.3% were non-Beijing residents; 94.4% considered themselves to be homosexual; 65.2% received college or higher levels of education; the median age was 26 years; 73.0% sought male sex partners via the Internet in the past 3 months; 66.2% had ≥2 sex partners. Younger age, higher levels of education and having had ≥2 male sex partners in the past 3 months were independently associated with seeking sex partners on the Internet. These findings indicate that Internet-based intervention programs could encourage younger high-risk MSM to use condoms and reduce their numbers of sexual partners.

[Nitrate contents in autumn vegetables and assessment of nitrate intake in Shanghai].

To analyze and assess the nitrate contents in Autumn vegetables and nitrate intake in Shanghai resident 25 groups and 439 various vegetables were collected and analyzed from the green houses and outdoors in Songjiang, Fengxian, Jinshan and Pudong of Shanghai during Sep.-Nov., 2009. Nitrate contents were analyzed by UV-spectrophotometer. The results showed that the prevalence of severe contamination was 41.46%, the prevalence of heavy and medium contamination was 30.53%, the prevalence of mild contamination was 28.02%; the content of nitrate in vegetables was in the following descent order: leafy vegetables, root and stem vegetables, melons, egg plants, beans, the nitrate contents in different species differed greatly; the nitrate contents in leafy, root and stem vegetables with green-house planting were less than that of outdoor planting in Fengxian and Songjiang except Pudong and Jinshan. According to the assessment of nitrate intake, the average daily intake of local resident is 445.22 mg which exceeds ADI 38.42%, so limited standard and control are urgently needed.

Use of genomic models to study genetic control of environmental variance.

Vast amount of genetic marker information is being used to obtain insight into the genetic architecture of complex traits, for locating genomic regions (quantitative trait loci (QTL)) affecting disease and for enhancing the accuracy of prediction of genetic values in selection programmes. The genomic model commonly found in the literature, with marker effects affecting mean only, is extended to investigate putative effects at the level of the environmental variance. Two classes of models are proposed and their behaviour, studied using simulated data, indicates that they are capable of detecting genetic variation at the level of mean and variance. Implementation is via Markov chain Monte Carlo (McMC) algorithms. The models are compared in terms of a measure of global fit, in their ability to detect QTL effects and in terms of their predictive power. The models are subsequently fitted to back fat thickness data in pigs. The analysis of back fat thickness shows that the data support genomic models with effects on the mean but not on the variance. The relative sizes of experiment necessary to detect effects on mean and variance is discussed and an extension of the McMC algorithm is proposed.

Variation of cataract surgery costs in four different graded providers of China.

BACKGROUND: China has the largest population of cataract patients in the world. However, the cataract surgery rate per million remains low in China. We carried out a survey on costs of cataract surgery from four different graded providers in China and analyzed differences in cost among these clinics. METHODS: 1,189 patients were recruited for the study in four eye clinics, located in two provinces, Guangdong province in southern China and Hubei province in central China. The average cost of each cataract surgery episode was calculated including cost of intraocular lens, cost of drugs and facility cost. We also collected information on reimbursement and disposable annual income of local residents. RESULTS: Mean total cost per cataract intervention of four different providers varied considerably, ranging from US$ 1,293 in Union Hospital to US$ 536 in Jingshan County Hospital. In all providers, except for Jingshan County Hospital, the cost exceeded annual disposable income of local rural residents. As to the proportion of patients with reimbursement, the figure for Union Hospital was only 36%, while for other three clinics it was more than 60%. There was a significant difference between mean reimbursement ratios, with the highest ratio in Zhongshan Ophthalmic Center being 71%. CONCLUSIONS: Significant differences in costs of cataract surgery were found among the 4 different graded providers. A part of the cost was borne by patients. Proportion of patients with reimbursement and mean reimbursement ratios were higher in economically developed regions than in economically developing regions. Much more financial support should be directed into the rural New Cooperative Medical Scheme to raise the reimbursement ratio in rural China.

Assessment of motivation to change substance use in dually-diagnosed schizophrenia patients.

Assessment of motivation to change substance use can be helpful in evaluating treatment readiness and outcome. However, the utility of self-report measures of motivation with schizophrenia patients is questionable. In the current study patients with schizophrenia and either concurrent cocaine dependence or remitted dependence completed the University of Rhode Island Change Assessment-Maryland (URICA-M), a self-report inventory that assesses motivation, and an analogous cartoon instrument at baseline and 6-months follow-up. Results demonstrate that the cartoon readiness to change score was related to increased treatment utilization and decreased substance use; results were not as favorable for the URICA-M. Findings suggest that the cartoon measure may be a suitable alternative to assess motivation to change substance use with cognitively impaired patients.