Use of Primary Healthcare Among Chinese Older Adults With Functional Limitations.

The aim of this study was to assess the factors associated with primary healthcare (PHC) utilization among older adults with functional limitations, providing insights for improving the effectiveness of PHC for this population. We used the China Health and Retirement Longitudinal Study (CHARLS) dataset, which encompasses 28 provinces in China. Logistic regression was used to analyze the people-related, care context-related, and linkage-related factors associated with PHC utilization. Approximately 55.61% of older adults with functional limitations utilized PHC in the past month, regardless of visit frequency or extent. Participants with lower educational attainment, those reporting more pain, and those living in rural areas had a higher likelihood of PHC utilization. Participants who received inpatient care in the past year had a lower likelihood of PHC utilization. We recommend that policymakers complement existing PHC health programs with increased health and social welfare support for this population.

Association of living environmental and occupational factors with semen quality in chinese men: a cross-sectional study.

Sperm quality can be easily influenced by living environmental and occupational factors. This study aimed to discover potential semen quality related living environmental and occupational factors, expand knowledge of risk factors for semen quality, strengthen men's awareness of protecting their own fertility and assist the clinicians to judge the patient's fertility. 465 men without obese or underweight (18.5 < BMI < 28.5 kg/m2), long-term medical history and history of drug use, were recruited between June 2020 to July 2021, they are in reproductive age (25 < age < 45 years). We have collected their semen analysis results and clinical information. Logistic regression was applied to evaluate the association of semen quality with different factors. We found that living environment close to high voltage line (283.4 × 106/ml vs 219.8 × 106/ml, Cohen d = 0.116, P = 0.030) and substation (309.1 × 106/ml vs 222.4 × 106/ml, Cohen d = 0.085, P = 0.015) will influence sperm count. Experienced decoration in the past 6 months was a significant factor to sperm count (194.2 × 106/ml vs 261.0 × 106/ml, Cohen d = 0.120, P = 0.025). Living close to chemical plant will affect semen PH (7.5 vs 7.2, Cohen d = 0.181, P = 0.001). Domicile close to a power distribution room will affect progressive sperm motility (37.0% vs 34.0%, F = 4.773, Cohen d = 0.033, P = 0.030). Using computers will affect both progressive motility sperm (36.0% vs 28.1%, t = 2.762, Cohen d = 0.033, P = 0.006) and sperm total motility (57.0% vs 41.0%, Cohen d = 0.178, P = 0.009). After adjust for potential confounding factors (age and BMI), our regression model reveals that living close to high voltage line is a risk factor for sperm concentration (Adjusted OR 4.03, 95% CI 1.15-14.18, R2 = 0.048, P = 0.030), living close to Chemical plants is a protective factor for sperm concentration (Adjusted OR 0.15, 95% CI 0.05-0.46, R2 = 0.048, P = 0.001) and total sperm count (Adjusted OR 0.36, 95% CI 0.13-0.99, R2 = 0.026, P = 0.049). Time spends on computer will affect sperm total motility (Adjusted OR 2.29, 95% CI 1.11-4.73, R2 = 0.041, P = 0.025). Sum up, our results suggested that computer using, living and working surroundings (voltage line, substation and chemical plants, transformer room), and housing decoration may association with low semen quality. Suggesting that some easily ignored factors may affect male reproductive ability. Couples trying to become pregnant should try to avoid exposure to associated risk factors. The specific mechanism of risk factors affecting male reproductive ability remains to be elucidated.

A Leading Role of Water Resources and Animal Husbandry in Environmental Sustainability: A Case Study of China.

Animal husbandry is an important emission source of greenhouse gas. In order to discover the real situation of carbon emission in China's animal husbandry scientifically, the paper measured and calculated carbon emission in China's animal husbandry from 1997 to 2017 on the basis of soil and water resources. In addition, analyzing its time-order characters, structural characters, driving factors and decoupling relationships are all done in this treatise. Major findings are as follows: (1) The carbon emission of China's animal husbandry in 2017 was 374.3528 million tons, an increase of 17.8066 million tons over 1997, with the average annual growth rate of 0.24% and the average annual carbon emission of 398.7817 million tons; (2) There was a decreasing trend in carbon emission of intestinal fermentation in China's animal husbandry while there was an increasing trend in carbon emission of manure emission in China's animal husbandry; (3) The carbon emission of China's animal husbandry peaked in 2006 and went through three phases of up-down-steady between 1997 and 2017; (4) The contribution of cattle, pig, sheep, other large livestock, poultry and rabbits to China's animal husbandry carbon emissions decreased in turn, and the average contribution of cattle, pigs and sheep to China's animal husbandry carbon emissions was as high as 98.15%. (5) Five factors reducing carbon emission of China's animal husbandry were carbon intensity, agricultural industrial structure, agricultural population-water resources matching degree, agricultural water-soil resources and per capita cultivated land area. Two factors increasing carbon emission of China's animal husbandry were population and economic benefits of agriculture per unit agricultural population; (6) There was a generally weak decoupling between carbon emission in China's animal husbandry and animal husbandry's economic growth from 1997 to 2017.

Sustainable supply chain partner selection and order allocation: A hybrid fuzzy PL-TODIM based MCGDM approach.

Sustainability, as a trend of social development and the embodiment of corporate social responsibility, has begun to receive more attention. To achieve this goal, sustainable supplier selection (SSS) and order allocation (OA) are seen as the crucial activities in corporate management. In the process of SSS, the psychological behavior of decision-makers (DMs) could play a critical role in the evaluation results. Therefore, introducing it into the decision-making process may lead to decision in line with the actual situation. In the uncertain multi-criteria group decision-making (MCGDM) problem described by probability linguistic term sets (PLTS), the DMs can evaluate the criteria of each supplier based on his own preference and hesitation, which is useful to avoid the loss of information. For this reason, this study develops a novel multi-criteria group decision-making combined with fuzzy multi-objective optimization (MCGDM-FMOO) model for SSS/OA problems by considering the triple bottom line (TBL) in which includes economic, environmental and social factors. The proposed method includes four stages. (1) the best-worst method (BWM) and entropy weight method are utilized to assign the weights of criteria to obtain the comprehensive weight. According to the output weights, the an acronym for interactive and multi-criteria decision-making in Portugese (TODIM) approach is applied to rank the suppliers under PLTS environment; (2) a FMOO model that can effectively deal with uncertainties and dynamic nature of parameter is formulated for allocating optimal order quantities; (3) two novel approaches are utilized to solve the FMOO model in order to obtain the richer Pareto frontier; and (4) the final OA solution is achieved by technique for order preference by similarity to ideal solution (TOPSIS) method. Finally, the validity and practicability of proposed MCGDM-FMOO model are verified by an example and comparative analysis with other classical MCGDM methods.

Financial toxicity among older cancer survivors in China: a qualitative study of oncology providers' perceptions and practices.

OBJECTIVE: Despite oncology providers' significant roles in patient care, few studies have been conducted to investigate oncology providers' understanding of financial toxicity. This study aimed to explore oncology providers' perceptions and practices relating to the financial toxicity of older cancer survivors in China. METHODS: A qualitative study was conducted. Individual interviews were conducted with 14 oncology providers at four general hospitals and two cancer specialist hospitals in China. Qualitative data was analyzed using descriptive coding and thematic analysis methods. RESULTS: The perceptions of participants about the financial toxicity of older cancer survivors include (1) older adults with cancer are especially vulnerable to financial toxicity; (2) inadequate social support may lead to financial toxicity; and (3) cancer-related financial toxicity increased the risk of poor treatment outcomes. The interventions to mitigate its negative effects include (1) effective communication about the cancer-related costs; (2) improving the professional ability to care for the patient; (3) cancer education program as a way to reduce knowledge gaps; and (4) clinical empathy as an effective treatment strategy. CONCLUSION: Oncology providers perceive that older cancer patients' financial toxicity plays a key role in increasing the negative effects of diagnosis and treatment of cancer, as well as possibly worsening cancer outcomes. Some potential practices of providers to mitigate financial toxicity include utilizing effective cost communication, improving professional ability in geriatric oncology care, and promoting further cancer education and clinical empathy.

Carbon Sink Cost and Influence Factors Analysis in a National Afforestation Project under Different Investment Modes.

Afforestation projects are the main source of carbon sink. Measurement and impact analysis of carbon sink costs will help accelerate the marketization of forestry carbon sink. Considering the opportunity cost of land use and the carbon release cost of wood products, this study proposed a forestry carbon sink cost model under the Public-Private Partnership (PPP) and the direct (DI) investment mode based on the classic carbon sink model. Then, the proposed models were applied to a real-world afforestation project, the 20-year national afforestation project (NAP) in Laohekou City, Hubei Province, China. With the help of the input-output forestry carbon sink cost-benefit analysis framework, the dynamic analysis of factors such as rotation period, timber price, discount rate and yield rate for forestry is carried out. Results show that: (1) with the increasing of rotation period, wood market price, and wood yield rate, the carbon sink cost of Laohekou NAP gradually decreases, while the discount rate has the opposite trend; (2) the DI mode is more feasible than the PPP model at the present condition. The PPP mode is more feasible than the DI mode only when the wood price is lower than 73.18% of the current price, the yield rate is lower than 0.485, and the discount rate is higher than 6.77%. (3) When choosing tree species for NAP, the carbon sink capacity, wood market price, maturity time, and planting cost should be synthetically considered. The proposed model and the obtained results can not only support local governments and forestry carbon sink enterprises to make tradeoffs between PPP and DI mode, but also provide them with useful information for reducing carbon sink costs.

Distribution, sources, and ecological risk assessment of HCHs and DDTs in water from a typical coal mining subsidence area in Huainan, China.

Coal mining subsidence areas are a special and widespread ecosystem in China and many developing countries in the world. However, limited research has focused on HCHs and DDTs in coal mining subsidence areas. Investigating the concentration, distribution, and sources of HCHs and DDTs at the Yangzhuang coal mining subsidence area in Huainan, China, is the object of this study. Water samples from different depths were collected from this region to detect and analyze HCHs and DDTs using gas chromatography-mass spectrometry. The result showed that the concentrations of HCHs and DDTs increased with increasing water depth, and the average concentrations of HCHs and DDTs in the top (T-layer), middle (M-layer), and bottom (B-layer) layers were 152, 169, and 182 ng∙L-1, respectively. Spatial distribution of HCH and DDT concentrations in the study area revealed that the concentrations gradually decreased in the direction of water flow, and the highest concentration was observed at the entrance of the Nihe River. The T-layer was easily influenced by environmental and human activities, while the M-layer and B-layer were mainly influenced by sediment. Using principal component analysis and diagnostic ratios, we found that HCHs and DDTs in the study area mainly originated due to natural and human activities (such as pesticide use). Hexachlorocyclohexanes (HCHs) were mainly derived from lindane, and dichlorodiphenyltrichloroethanes (DDTs) mainly originated due to the recent agricultural use of dicofol; both of these are directly related to agricultural activities. Based on a comparison of reported concentrations of HCHs and DDTs in the rivers and lakes throughout China, we found that the overall ecological risk of HCHs and DDTs in the study area was elevated. The results are important for further understanding the transfer characteristics of HCHs and DDTs as well as the ecological health of the water in coal mining subsidence areas.

Assessment on the Impact on Human Health, Environment, Water and Soil by Disposing Household Expired Drugs: A Cross-Sectional Study in China.

BACKGROUND: The household expired drugs disposal has been a huge public issue in many countries, including China, which may affect various side and toxic effects on human health and environment, water resources, and soil too. This paper explores the knowledge, attitude, and practice of Guangzhou city residents regarding household expired drugs and their effect on human health and provided the scientific pieces of evidence to carry out the long-term recovery mechanism for expired medicines. METHODS: An observational, cross-sectional study was conducted using a self-structured questionnaire. Descriptive analysis, including univariate and unconditional logistic regression models, was carried out to analyze the data. RESULTS: A total of 613 community residents with a 99.4% response rate enrolled for the study. More than half 60.2% of residents stated that expired drugs pollute the environment, soil, and water resources, where 81.2% of respondents knew that it would produce side effects or toxic effects. However, still, 71.6% of respondents disposed of directly into the trash bin or sink, and, only 24.8% had good practice that they use a designed recycling bin. Likewise, only 8.3% of respondents placed expired drugs into collection points nearly 3-5 times in a year, while 65.1% of participants never disposed of in the collection point, which found a worse practice. CONCLUSION: Overall, the knowledge, attitude, and practice of Guangzhou residents regarding household expired drugs disposal were not ideal. To improve the resident's awareness about family expired drugs disposal, ensure the financial support for the recycling process, establish an accessible and acceptable recycling point, and introduce relevant laws and regulations for the long-term mechanism.

A novel approach to determine two optimal cut-points of a continuous predictor with a U-shaped relationship to hazard ratio in survival data: simulation and application.

BACKGROUND: In clinical and epidemiological researches, continuous predictors are often discretized into categorical variables for classification of patients. When the relationship between a continuous predictor and log relative hazards is U-shaped in survival data, there is a lack of a satisfying solution to find optimal cut-points to discretize the continuous predictor. In this study, we propose a novel approach named optimal equal-HR method to discretize a continuous variable that has a U-shaped relationship with log relative hazards in survival data. METHODS: The main idea of the optimal equal-HR method is to find two optimal cut-points that have equal log relative hazard values and result in Cox models with minimum AIC value. An R package 'CutpointsOEHR' has been developed for easy implementation of the optimal equal-HR method. A Monte Carlo simulation study was carried out to investigate the performance of the optimal equal-HR method. In the simulation process, different censoring proportions, baseline hazard functions and asymmetry levels of U-shaped relationships were chosen. To compare the optimal equal-HR method with other common approaches, the predictive performance of Cox models with variables discretized by different cut-points was assessed. RESULTS: Simulation results showed that in asymmetric U-shape scenarios the optimal equal-HR method had better performance than the median split method, the upper and lower quantiles method, and the minimum p-value method regarding discrimination ability and overall performance of Cox models. The optimal equal-HR method was applied to a real dataset of small cell lung cancer. The real data example demonstrated that the optimal equal-HR method could provide clinical meaningful cut-points and had good predictive performance in Cox models. CONCLUSIONS: In general, the optimal equal-HR method is recommended to discretize a continuous predictor with right-censored outcomes if the predictor has an asymmetric U-shaped relationship with log relative hazards based on Cox regression models.

Highly Compressible Integrated Supercapacitor-Piezoresistance-Sensor System with CNT-PDMS Sponge for Health Monitoring.

Rapid improvement of wearable electronics stimulates the demands for the matched functional devices and energy storage devices. Meanwhile, wearable microsystem requires every parts possessing high compressibility to accommodate large-scale mechanical deformations and complex conditions. In this work, a general carbon nanotube-polydimethylsiloxane (CNT-PDMS) sponge electrode is fabricated as the elementary component of the compressible system. CNT-PDMS sponge performs high sensitivity as a piezoresistance sensor, which is capable of detecting stress repeatedly and owns great electrochemical performance as a compressible supercapacitor which maintains stably under compressive strains, respectively. Assembled with the piezoresistance sensor and the compressible supercapacitor, such highly compressible integrated system can power and modulate the low-power electronic devices reliably. More importantly, attached to the epidermal skin or clothes, it can detect human motions, ranging from speech recognition to breathing record, thus showing feasibility in real-time health monitor and human-machine interfaces.

[Land use change dynamics and driving forces of the vulnerable ecological region in northwestern Shanxi Province, China].

By using remote sensing and GIS technology, this paper collected land use information of 1980, 1990, 2000 and 2010 and the relevant statistical data, and analyzed the characteristics of land use change and its driving forces in northwestern Shanxi Province, the typical ecological fragile area. The results showed that there were significant changes in land use patterns in the past 30 years. During 1980-1990, 1990-2000 and 2000-2010 periods, the area of farmland decreased continuously, while the areas of grassland and woodland experienced increase-decrease-increase and decrease-increase-decrease patterns of change, respectively. The areas of industrial and resident lands increased continuously, but the water body and unused land decreased. The farmland was mainly transformed to grassland and woodland, and the areas of industrial and resident lands increased from the farmland. The lost area of water body was transformed to grassland and farmland. The decrease of unused land was due to the implementation of ecological engineering and urban ex-panding. In general, the changes of land use types were significantly higher before 2000 than after 2000. The industrial and resident lands, unused land and grassland changed drastically. The relationships between land use types and driving forces indicated that population pressure and economic development led to the changes of industrial land and farmland; policy of forestry ecological engi- neering drove the changes of woodland and grassland; the drought-characterized climate was the major cause inducing the decrease of water area and hindering the restoration of forest.