Supportive care needs of patients who had a stroke: a scoping review protocol.

INTRODUCTION: Incidences of stroke are on the rise and approximately 80 million stroke survivors worldwide live with disabilities. Supportive care needs of stroke survivors are not adequately defined, and the assessment tools to help care service providers identify these needs are unclear. The overall aim of this scoping review will be to map the supportive care needs of stroke survivors against the Supportive Care Needs Framework. METHODS AND ANALYSIS: This scoping review will be conducted following Arksey and O'Malley's methodological framework and Joanna Briggs Institute (JBI) updated methodological guidance for scoping review. This review will mainly use Arksey and O'Malley's methodological framework as the basic framework. The review will also follow JBI's updated methodological guidance for scoping reviews to optimise the review. For the search strategy, the three-step method recommended by the JBI will be used in the study. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Six English databases, including PubMed, CINAHL, Web of Science, Embase, Cochrane Library and PsycInfo, and four Chinese databases, including CNKI, Wanfang, VIP and China Biomedical Literature Database will be systematically searched from inception to the present. Studies published in English and Chinese will be included. ETHICS AND DISSEMINATION: Ethical approval is not required as this scoping review does not involve human participants. The findings shall be disseminated at scientific conferences and published in a peer-reviewed journal.

Global disease burden attributed to unsafe sex in 204 countries and territories from 1990 to 2019: results from the Global Burden of Disease Study 2019.

Unsafe sex has become a public safety problem that endangers society, and research on deaths and disability-adjusted life years (DALYs) related to unsafe sex is valuable for global policy-making. We aimed to estimate the deaths and DALYs attributable to unsafe sex by country, gender, age group, and sociodemographic status from 1990 to 2019. We extracted data on disease burden from the Global Disease Burden 2019 (GBD 2019) database for unsafe sex, including deaths, DALYs and age-standardized rates (ASRs). Comparative analyses were performed on data about deaths, DALYs and the responding ASRs attributable to unsafe sex in different countries and regions using the Social Demographic Index (SDI). The global age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to unsafe sex were 11.98 (95% uncertainty intervals (UI): 10.97-13.52) per 100,000 people and 570.78 (95% UI: 510.24-658.10) per 100,000 people, respectively. Both the ASMRs and ASDRs were the highest in southern sub-Saharan Africa and lowest in Australasia and decreased with increasing SDI levels. About unsafe-sex-related disease, HIV/AIDS has the highest ASMR [8.48 (95% UI: 7.62-9.95)/100,000 people] and ASDR [447.44 (95% UI: 394.82-533.10)/100,000 people], followed by Cervical cancer [ASMR: 3.40 (95% UI: 2.90-3.81)/100,000 people and ASDR: 107.2 (95% UI: 90.52-119.43)/100,000 people] and sexually transmitted infections excluding HIV [ASMR: 0.10 (95% UI: 0.08-0.11)/100,000 people and ASDR: 16.14 (95% UI: 10.51-25.83)/100,000 people]. The death and DALY burden caused by these three diseases were more serious in the over 75 years old age group. The 40-44 age group for men and the 35-39 age group for women had the highest population of unsafe sex-related deaths and DALYs, respectively. In addition, the burden of unsafe sex in women was more serious than those in men. Unsafe sex is an important risk factor for global disease burden and a leading cause of substantial health loss. We found that the risk of ASMRs and ASDRs attributable to unsafe sex had negative correlation with SDI levels. These results demonstrate that the need for revised policies that focus on efforts to reduce overall unsafe sex worldwide.

Parental detection of neonatal jaundice using a low-cost colour card: a multicentre prospective study.

BACKGROUND: Since most infants are usually discharged before age 48-72 hours, peak bilirubin levels will almost always occur after discharge. Parents may be the first to observe the onset of jaundice after discharge, but visual assessment is unreliable. The jaundice colour card (JCard) is a low-cost icterometer designed for the assessment of neonatal jaundice. The objective of this study was to evaluate parental use of JCard to detect jaundice in neonates. METHODS: We conducted a multicentre, prospective, observational cohort study in nine sites across China. A total of 1161 newborns ≥35 weeks of gestation were enrolled in the study. Measurements of total serum bilirubin (TSB) levels were based on clinical indications. The JCard measurements by parents and paediatricians were compared with the TSB. RESULTS: JCard values of parents and paediatricians were correlated with TSB (r=0.754 and 0.788, respectively). The parents' and paediatricians' JCard values 9 had sensitivities of 95.2% vs 97.6% and specificities of 84.5% vs 71.7% for identifying neonates with TSB ≥153.9 µmol/L. The parents' and paediatricians' JCard values 15 had sensitivities of 79.9% vs 89.0% and specificities of 66.7% vs 64.9% for identifying neonates with TSB ≥256.5 µmol/L. Areas under the receiver operating characteristic curves of parents for identifying TSB ≥119.7, ≥153.9, ≥205.2, and ≥256.5 µmol/L were 0.967, 0.960, 0.915, and 0.813, respectively, and those of paediatricians were 0.966, 0.961, 0.926 and 0.840, respectively. The intraclass correlation coefficient was 0.933 between parents and paediatricians. CONCLUSION: The JCard can be used to classify different levels of bilirubin, but it is less accurate with high bilirubin levels. The JCard diagnostic performance of parents was slightly lower than that of paediatricians.

Orosomucoid: a promising biomarker for the assessment of exercise-induced fatigue triggered by basic combat training.

BACKGROUND: Orosomucoid (ORM) is a positive acute phase protein verified to be upregulated in various forms of exercise-induced fatigued (EIF) rodents. However, its association with EIF among human beings remained unknown. This study aimed to explore the association between serum ORM and EIF triggered by military basic combat training (BCT). METHODS: The degree of EIF were measured by Borg's Rating of Perceived Exertion Scale (Borg-RPE-Scale®) as RPE score after BCT. Fifty-three male recruits were classified into three groups according to the RPE score: (1) group 1 (slight fatigue group): RPE score after BCT < 13; (2) group 2 (moderate fatigue group): RPE score after BCT = 13 or 14; (3) group 3 (severe fatigue group): RPE score after BCT > 14. The levels of blood ORM, lactate (LAC), cortisol and C-reactive protein (CRP) were determined before and after BCT. The diagnostic value of ORM was evaluated by receiver operating characteristic (ROC) curve analysis and logistic regression. RESULTS: After BCT, the level of LAC, CRP, and cortisol increased among all groups, but the changes had no significant between-group difference (all p > 0.05). The level of ORM had a specific significant increase in group 3 (p = 0.039), and the changes of ORM (ΔORM) had significant difference among groups (p = 0.033). ROC curve analysis showed that the estimated area under ROC curve for ΔORM was 0.724 (p = 0.009) with the recommended optimal cut-off value as 0.2565 mg/mL. Logistic analysis showed that recruits with ΔORM ≥ 0.2565 mg/mL had higher odds for suffering from severe EIF, 5.625 times (95% CI 1.542-20.523, p = 0.009) as large as those with ΔORM < 0.2565 mg/mL. CONCLUSION: ORM might be a promising biomarker of severe EIF triggered by BCT among male recruits. Its potential optimal cut-off value regarding ΔORM was recommended to be 0.2565 mg/mL.

External Quality Assessment of Maternal Serum Levels of Alpha-Fetoprotein, Free Beta-Human Chorionic Gonadotropin, and Unconjugated Estriol in Detecting Down Syndrome and Neural Tube Defects in the Second Trimester of 87 Maternal Serum Samples, Based on 105-139 Days.

BACKGROUND We aimed to insure the accuracy and reproducibility of alpha-fetoprotein (AFP), free beta-human chorionic gonadotropin (free ß-hCG), and unconjugated estriol (uE3) concentrations for the screening for trisomy 21 (T21) and neural tube defects (NTD) in the second trimester. We conducted an external quality assessment of 6 laboratories, using maternal serum specimens. MATERIAL AND METHODS Serum specimens collected from 87 women of singleton pregnancies (4 with T21, 5 with NTD, and 78 with normal fetuses) were divided into 6 equivalent-volume fractions and transported to 6 laboratories (A, B, C, D, E, and F). All laboratories used the time-resolved fluorescence analyzer and supporting reagents to measure concentrations of AFP, free ß-hCG, and uE3. The screening efficacies of T21 and NTD were compared with the certified or accredited status of the participants' quality systems. RESULTS Concentrations of AFP measured by laboratory F were low compared with those determined by the other 5 laboratories, and the differences were significant (P<0.01). There was no statistically significant difference in the free ß-hCG and uE3 concentrations measured by the 6 laboratories (P>0.05). The correlation coefficients for the 3 multiples of the median values were all >0.900. The McNemar paired chi-squared test showed the differences in the positivity and detection rates were not statistically significant (P=1.000). CONCLUSIONS AFP, free ß-hCG, and uE3 values measured by the other 5 laboratories were comparable with those of laboratory A, with good linear correlation. When used in the maternal prenatal screening of T21 and NTD, the test results met the clinical requirements.

A cross-sectional study of implicit rationing of care in publicly funded nursing homes in Shanghai, China.

AIMS: To investigate the level of implicit care rationing and its association with training needs in nursing homes in Shanghai, China. BACKGROUND: Nursing homes in Shanghai are confronted with a lack of care resources. Implicit care rationing can emerge due to inadequate training of care workers. METHODS: A cross-sectional survey was conducted between 10 September and 17 November 2020. A total of 374 care workers from 16 randomly were selected nursing homes from each of the administrative districts participated the surveys. The Basel Extent of Rationing of Nursing Care-Nursing Home instrument and the training needs analysis were adopted to measure implicit care rationing and training needs, respectively. Multiple regression techniques were used to explore the factors associated with implicit care rationing. RESULTS: Activities related to social care, documentation and activation/rehabilitation (mean rating = 2.8, 1.89 and 1.93 respectively) were mostly likely to be rationed. Training needs of activities of daily living (ADL), activation/rehabilitation and documentation were significantly related to their implicit rationing (ß = 0.864, 0.21 and 0.166, respectively, p < .01). CONCLUSION: Training needs are crucial determinants of implicit care rationing. IMPLICATIONS FOR NURSING MANAGEMENT: Quality control systems are needed to ensure care comprehensiveness. The current training system should be re-designed according to results of training needs analysis.

A nomogram based on clinicopathological features and serological indicators predicting breast pathologic complete response of neoadjuvant chemotherapy in breast cancer.

A single tumor marker is not enough to predict the breast pathologic complete response (bpCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients. We aimed to establish a nomogram based on multiple clinicopathological features and routine serological indicators to predict bpCR after NAC in breast cancer patients. Data on clinical factors and laboratory indices of 130 breast cancer patients who underwent NAC and surgery in First Affiliated Hospital of Xi'an Jiaotong University from July 2017 to July 2019 were collected. Multivariable logistic regression analysis identified 11 independent indicators: body mass index, carbohydrate antigen 125, total protein, blood urea nitrogen, cystatin C, serum potassium, serum phosphorus, platelet distribution width, activated partial thromboplastin time, thrombin time, and hepatitis B surface antibodies. The nomogram was established based on these indicators. The 1000 bootstrap resampling internal verification calibration curve and the GiViTI calibration belt showed that the model was well calibrated. The Brier score of 0.095 indicated that the nomogram had a high accuracy. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.941 (95% confidence interval: 0.900-0.982) showed good discrimination of the model. In conclusion, this nomogram showed high accuracy and specificity and did not increase the economic burden of patients, thereby having a high clinical application value.

Exposure and health risk assessment of secondary contaminants closely related to brominated flame retardants (BFRs): Polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs) in human milk in shanghai.

Polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs), as the secondary environmental pollutants of the widely used brominated flame retardants (BFRs), possess the similar physicochemical and toxic properties as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). However, studies on human body exposure to them are extremely limited. In this study, forty human milk samples collected in Shanghai were measured for 13 PBDD/F congeners using gas chromatography-high resolution mass spectrometry (GC-HRMS), to investigate their exposure level and characteristics, potential source and corresponding health risks to breastfed infants. The results showed no PBDDs but three PBDF congeners including 2,3,7,8-TBDF, 1,2,3,4,6,7,8-HpBDF and OBDF (mean concentration (detection rates) are 3.2 pg/g (72.5%), 9.5 pg/g (100%) and 28 pg/g (67.5%), respectively) were detected. The average toxic equivalent quantity (TEQ, 0.42 pg/g lw) presented the highest concentration level compared to other regions reported. The contribution of PBDFs to the total TEQ of PBDD/Fs and PCDD/Fs is 6.8%. The correlation between PBDD/Fs and age or dietary habits was not observed, which normally existed in their chlorinated analogues-PCDD/Fs. Significant correlations were observed between PBDFs and highly brominated polybrominated diphenyl ethers (PBDEs) (especially for BDE 183 and BDE 209). The correlation between PCDD/Fs and PBDFs was not observed except 2,3,7,8-TBDF. The high PBDFs exposure in Shanghai may originate from the emission of PBDEs and/or non-PBDE BFRs in environment, according to the consistency of the environmental data previously reported. The average estimated dietary intakes (EDI) for breastfed infants is 2.0 pg TEQ/kg·bw/day (0.13-13 pg TEQ/kg·bw/day), within the range of the tolerable daily intake (TDI) for TCDD (1-4 pg TEQ/kg·bw/day) suggested by the World Health Organization (WHO). However, given the high toxicity of PBDD/Fs, the potential health risks of these pollutants for breastfed infants should be of concern.

Health risk and temporal trend of dietary potentially toxic elements exposure in the residents of the Shenzhen metropolis, China, between 2005 and 2017: a risk assessment based on probabilistic estimation.

Dietary potentially toxic elements (PTEs) exposure in developing countries is of great concern. Probabilistic estimation exhibits great superiority in risk assessment by dealing with the variability and uncertainty of the parameters. Here, a probabilistic estimation based on two dimensions, PTEs in foods and food intake, was conducted. A total of 13 foods were collected from Shenzhen markets during 2005-2017, and the concentrations of Pb, Cd, Hg, and As were detected. A total of 853 residents from 245 households participated in a total diet study. The mean concentrations of Pb, Cd, Hg and As were 0.046, 0.0196, 0.0038, and 0.029 mg kg-1 in cereals, 0.042, 0.0174, 0.0027, and 0.014 mg kg-1 in vegetables, 0.044, 0.0237, 0.0056, and 0.021 mg kg-1 in meat, and 0.081, 0.1035, 0.0257, and 0.680 mg kg-1 in aquatic products, respectively. The probability density function showed that the 95th percentiles of the Pb, Cd, Hg, As hazard quotients (HQ) and the hazard index (HI) were 0.68, 1.57, 0.38, 5.81 and 7.51, respectively. Cumulative probability and sensitivity analysis showed that cereals and vegetables contributed most to Pb and Cd exposure; aquatic products to Hg exposure; and cereals and aquatic products to As exposure. The results showed that Shenzhen residents were at risk of exposure to Cd, As, and four PTEs in combination, although a temporal decreasing trend was observed. The probabilistic estimation used here reveals a complete picture of multiple PTEs exposure risk and identifies major contributing food categories, providing a valuable means for risk assessment.

Ultralight, hydrophobic, sustainable, cost-effective and floating kapok/microfibrillated cellulose aerogels as speedy and recyclable oil superabsorbents.

Cellulose aerogels achieve excellent absorption of waste oil and organic pollutant, which has received lots of attention recently. It is still a big challenge to obtain aerogels with both high cost-effectiveness and advanced oil absorption performance, since it is a time-consuming, and environmentally unfriendly process to obtain cellulose, compared with direct usage of natural fibers. In this manuscript, we develop highly porous and hydrophobic kapok/microfibrillated cellulose (MFC) aerogels with a dual-scale hierarchically porous structure at micro-level as cost-effective, sustainable, and floating superabsorbents via simple vacuum freeze-drying and surface modification. Kapok, a natural hollow fiber, has been recently considered as a new sustainable resource for oil cleanup. By partially replacing MFC with chopped kapok fibers in MFC aerogels (MMAs), the resultant kapok/MFC aerogels (KCAs) exhibit ultralow density (5.1 mg/cm-3), ultrahigh porosity (99.58%) and hydrophobicity (140.1°) leading to advanced oil sorption (130.1 g/g) that is 25.3% higher than that of MMAs. In addition, these KCAs can rapidly and selectively absorb waste oil from oil-water mixture with ultrahigh absorption ability of 104-190.1 g/g, which is comparable to other environmentally unfriendly and high-cost aerogels. Furthermore, the KCAs own excellent reusability and sustainability. These benefits enable the KCAs a suitable alternative to clean oil spills.

Willingness-to-pay and willingness-to-accept of informal caregivers of dependent elderly people in Shanghai, China.

BACKGROUND: In order to make optimal long-term care-related decisions, it is important to take a societal perspective. Shanghai is one of the pilot cities of social long-term care insurance in China. However, little knowledge exists about the economic value of the informal care provided to dependent elderly people in China. This paper aims to evaluate the economic value of informal caregiving in Shanghai using the contingent valuation method by their least-preferred care tasks, and identify the associated factors of willingness-to-pay (WTP) and willingness-to-accept (WTA) of the informal caregivers. METHODS: This study employed the contingent valuation method to elicit 371 informal caregivers' WTP and WTA for 1 hour of reduction or increase of least-preferred caring tasks in Shanghai. Univariate and multivariate analyses were conducted to explore the associated factors with the WTP and WTA values. RESULTS: The average WTP and WTA were 25.31 CNY and 38.66 CNY, respectively. The associated factors with WTP include caregiver's income and caregiver's relationship to the recipient. Care recipient's age, income, least-preferred task by the caregiver, and subscales of Caregiver Reaction Assessment were found to be associated with WTA. The non-responsiveness rates were 26.1 and 33.2% for WTP and WTA questions, respectively. CONCLUSIONS: The findings of the current study demonstrated that decision-makers and researchers should take the economic valuation results of informal care into account to make more informed and effective long-term care-related policies and analyses.

Impact of Formal Care Use on Informal Care from Children after the Launch of Long-Term Care Insurance in Shanghai, China.

The impact of formal care (co-paid by long term care (LTC) insurance) on informal care is critical to the improvement and promotion of public policy. We conducted an interview-based survey to examine how the use of formal care impacts the use of informal care in Shanghai, which was one of China's first long-term insurance pilots in 2016. In addition to total informal care time, the following four types of informal care were considered: (1) household activities of daily living (HDL) tasks, (2) activities of daily living (ADL) tasks, (3) instrumental activities of daily living (IADL) tasks, and (4) supervision tasks. Of the 407 families, an average of 12.36 h (SD = 6.70) of informal care was crowded out each week. Among them, ADL tasks, HDL tasks, and supervision tasks were reduced an average of 4.60 (SD = 3.59), 5.50 (SD = 3.38), and 2.10 h (SD = 3.06) per week, respectively. Each additional hour of formal care reduced 0.473 h of informal care. Care recipients' gender and health status were also determined to be associated with crowding out hours of informal care. These findings can be utilized as empirical evidence for decision-makers to consider the scope of funding for formal care, and this study provides comparable results to developing countries and regions.

The response of soil Olsen-P to the P budgets of three typical cropland soil types under long-term fertilization.

The Olsen phosphorus (Olsen-P) concentration of soil is generally a good indicator for estimating the bioavailability of P and environmental risk in soils. To maintain soil Olsen-P at adequate levels for crop growth and environmental sustainability, the relationship between soil Olsen-P and the P budget (the P input minus the output) as well as the variations of soil Olsen-P and P budget were investigated from three long-term (22 years) experiments in China. Five treatments were selected: (1) unfertilized control (CK); (2) nitrogen and potassium (NK); (3) nitrogen, phosphorous, and potassium (NPK); (4) nitrogen, phosphorous, potassium and straw; (5) nitrogen, phosphorous, potassium and manure. The results showed that without P fertilizers (CK, NK), there was a soil P deficit of 75-640 kg ha-1, and the lowest P deficit (mean of CK and NK) was in Eutric Cambisol. Soil Olsen-P decreased by 0.11-0.39 mg kg-1 year-1 in the order of Luvic Phaeozems > Eutric Cambisol > Calcaric Cambisol. Soil Olsen-P and the P deficit had a significantly (P<0.01) positive linear relationship. For every 100 kg of P ha-1 of deficit, soil Olsen-P decreased by 0.44-9.19 mg kg-1 in the order of Eutric Cambisol > Luvic Phaeozems > Calcaric Cambisol. Under the P fertilizer treatments (NPK, NPKS, and NPKM), soil Olsen-P showed an obvious surplus (except the NPK and NPKS in Luvic Phaeozems) of 122-2190 kg ha-1, and the largest P surplus was found under the NPKM treatment at each site. The relation between soil Olsen-P and the experimental years could be simulated using quadratic equation of one unknown in Calcaric Cambisol for the lower P input after 14 years of fertilization. And soil Olsen-P increased by 1.30-7.69 mg kg-1 year-1 in the order of Luvic Phaeozems > Eutric Cambisol. The relation between soil Olsen-P and the P surplus could be simulated by a simple linear equation except under NPK and NPKS in Luvic Phaeozems. With 100 kg ha-1 P surplus, soil Olsen-P increased by 3.24-7.27 mg kg-1 in the order of Calcaric Cambisol (6.42 mg kg-1) > Eutric Cambisol (3.24 mg kg-1). In addition, the change in soil Olsen-P with a 100 kg P ha-1 surplus (soil Olsen-P efficiency) was affected by the soil organic matter (SOM), pH, and CaCO3 content, etc. In the practice of fertilization, it's not necessary to increase the amount of P fertilizers, farmers should take measure to solve the local problem, for adjust the soil pH of Eutric Cambisol and Calcaric Cambisol, and apply more nitrogen in Luvic Phaeozems. In the area of serious soil P surplus, it is encouraged to stop applying P fertilizers for a few years to take advantage of soil accumulated P and make the high Olsen-P content decrease to a reasonable level.

Are Bus Company Regulations Associated with Crash Risk? Findings from a Retrospective Survey in Four Chinese Cities.

Bus crashes are common in urban China, and bus company regulations are hypothesized to be related to bus crash risk. We conducted a retrospective survey to examine the association in four large Chinese cities (Changsha, Shenzhen, Fuzhou, and Wuhan). Four types of bus crashes were considered: (a) passengers injured while riding the bus; (b) bus colliding with or scraping other motor vehicles; (c) bus colliding with non-motorized vehicles or pedestrians; and (d) bus damaging public facilities. Based on regulations governing the drivers' work, complete round trips per day, and their paid salary, three categories of companies were studied: type A: ≥14 h worked/day, ≥6 round trips/day, and >70% of salary based on performance; type B: 8-13 h/day, 4 or 5 round trips/day, and 36-70% of salary; and type C: <36% of salary and no other specified requirements. Of the 926 respondents, 20.7% reported one or more crashes or related risk events in the past month. Drivers from the three types of companies reported crash incidence rates of 31.9%, 8.8%, and 6.0%, respectively, in the past month. Type A crash rates were significantly higher than type C after controlling for relevant covariates (adjusted odds ratio (OR) = 7.1, 95% confidence interval (CI): 3.74-13.47). We conclude that more stringent bus company regulations, which mandate drivers to work long hours and obtain salary based on job performance in meeting demanding metrics, are associated with elevated bus-related crash risks. Local governments in China should regulate bus companies to ensure drivers work reasonable hours and are paid based on the quality of their work (e.g., safety).

Assessment and Implications of Social Withdrawal Subtypes in Young Chinese Children: The Chinese Version of the Child Social Preference Scale.

The authors' goals were to evaluate the psychometric properties of the Chinese version of the Child Social Preference Scale (CSPS; R. J. Coplan, K. Prakash, K. O'Neil, & M. Armer, 2004) and examine the links between both shyness and unsociability and indices of socioemotional functioning in young Chinese children. Participants included of two samples recruited from kindergarten classes in two public schools in Shanghai, China. Both samples included children 3-5 years old (Sample 1: n = 350, Mage = 4.72 years, SD = 0.58 years; Sample 2: n = 129, Mage = 4.40 years, SD = 0.58 years). In both samples, mothers rated children's social withdrawal using the newly created Chinese version of the CSPS, and in Sample 2, teachers also provided ratings of socioemotional functioning. Consistent with previous findings from other cultures, results from factor analyses suggested a 2-factor model for the CSPS (shyness and unsociability) among young children in China. In contrast to findings from North America, child shyness and unsociability were associated with socioemotional difficulties in kindergarten. Some gender differences were also noted. Results are discussed in terms of the assessment and implications of social withdrawal in early childhood in China.

Concentrations and health risk assessment of trace elements in animal-derived food in southern China.

This study aimed to investigate the levels of trace elements in animal-derived food in Shenzhen, Southern China. The concentrations of 14 trace elements (Cd, Hg, Pb, As, Cr, Cu, Fe, Zn, Mn, Mo, Ni, Co, Se and Ti) in a total of 220 meat samples, collected from the local markets of Shenzhen were determined. Cu, Fe and Zn were the major elements, with concentrations approximately 2-3 orders of magnitude higher than those of other elements. However, the daily intakes of Cu, Fe and Zn merely via the consumption of the meat products were lower than the recommended nutrient intake values provided by the 2013 Chinese Dietary Guide. Among the non-essential trace elements, Cd was accumulated in animal viscera, and the concentration ratios of chicken gizzard/chicken, chicken liver/chicken, pig kidney/pork and pig liver/pork were 41.6, 55.2, 863 and 177, respectively. In addition, high concentrations of As were found in aquatic products, especially in marine fish. The concentration of As in marine fish was slightly higher than the limits recommended by China, USA and Croatia. The health risk assessment of trace elements through the consumption of meat products by adult residents in Shenzhen was evaluated by using the target hazard quotient (THQ) method. The total THQ was greater than 1, implying a potential health risk. Approximately 66% of total THQ values, mainly from As, were from the consumption of aquatic products.

Trace elements contamination and human health risk assessment in drinking water from Shenzhen, China.

The levels of seven essential trace elements (Mn, Co, Ni, Cu, Zn, Se, and Mo) and six non-essential trace elements (Cr, As, Cd, Sb, Hg, and Pb) in a total of 89 drinking water samples collected in Shenzhen, China were determined using inductively coupled plasma mass spectrometry (ICP-MS) in the present study. Both the essential and non-essential trace elements were frequently detectable in the different kinds of drinking waters assessed. Remarkable temporal and spatial variations were observed among most of the trace elements in the tap water collected from two tap water treatment plants. Meanwhile, potential human health risk from these non-essential trace elements in the drinking water for local residents was also assessed. The median values of cancer risks associated with exposure to carcinogenic metals via drinking water consumption were estimated to be 6.1 × 10(-7), 2.1 × 10(-8), and 2.5 × 10(-7) for As, Cd, and Cr, respectively; the median values of incremental lifetime for non-cancer risks were estimated to be 6.1 × 10(-6), 4.4 × 10(-5), and 2.2 × 10(-5) for Hg, Pb, and Sb, respectively. The median value of total incremental lifetime health risk induced by the six non-essential trace elements for the population was 3.5 × 10(-5), indicating that the potential health risks from non-carcinogenic trace elements in drinking water also require some attention. Sensitivity analysis indicates that the most important factor for health risk assessment should be the levels of heavy metal in drinking water.

[The influence of the economy in the fight to save TCM in Republic of China].

Influenced by national nihilism in modern times, many people do not recognize Traditional Chinese Medicine (TCM). Its economic value and social economic support played an important role in the victory of the fight for TCM in the period of the Republic of China. Meanwhile, the education, clinical practice and administration of TCM during the period of Republic of China were all under the constraint of economy. Analysis of the economy's impact on the development of TCM is of practical value. Related to the national economy and the people's livelihood, TCM could be considered both as an important component of national economy and as a state investment. Only when the relationship between TCM and social economy is emphasized and handled well, could the national health industry be rapidly developed.

Economy-wide material input/output and dematerialization analysis of Jilin Province (China).

In this paper, both direct material input (DMI) and domestic processed output (DPO) of Jilin Province in 1990-2006 were calculated and then based on these two indexes, a dematerialization model was established. The main results are summarized as follows: (1) both direct material input and domestic processed output increase at a steady rate during 1990-2006, with average annual growth rates of 4.19% and 2.77%, respectively. (2) The average contribution rate of material input to economic growth is 44%, indicating that the economic growth is visibly extensive. (3) During the studied period, accumulative quantity of material input dematerialization is 11,543 x 10(4) t and quantity of waste dematerialization is 5,987 x10(4) t. Moreover, dematerialization gaps are positive, suggesting that the potential of dematerialization has been well fulfilled. (4) In most years of the analyzed period, especially 2003-2006, the economic system of Jilin Province represents an unsustainable state. The accelerated economic growth relies mostly on excessive resources consumption after the Revitalization Strategy of Northeast China was launched.