Global burden of neoplasms attributable to specific occupational carcinogens over 30 years: a population-based study.

OBJECTIVES: The study aimed to analyze the global burden of occupational neoplasms from various epidemiological perspectives. STUDY DESIGN: In this cross-sectional study, secondary analyses were conducted to assess the burden of neoplasms attributable to occupational carcinogens and their distribution characteristics using data from GBD 2019 and the World Bank database. METHODS: Based on the GBD 2019 and the World Bank database, we analyzed the global burden of occupational neoplasms including the age-period-cohort model, decomposition analysis, health inequality analysis, and panel model. All analyses were conducted in R (version 4.0.3) and Joinpoint (version 4.9.1). RESULTS: The absolute number of neoplasms burden attributable to occupational carcinogens has continued to rise over 30 years. In 2019, occupational neoplasms caused 333,867 [95% uncertainty interval (UI): 263,491 to 404,641] mortalities and 6,964,775 (95% UI: 5,467,884 to 8,580,431) disability-adjusted life years (DALYs) globally. Greenland, Monaco, the Netherlands, and Andorra suffered the highest burden. The burden was higher in countries with a higher sociodemographic index. The age effect was prominent in the elderly, and the 1925 birth cohort had the highest cohort effect. Population growth was the most significant driver of the mortalities (89%) and DALYs (111%) change. Moreover, the proportion of urban population was significantly positively associated with the disease burden, while GDP per capita was negatively correlated with the disease burden. CONCLUSIONS: The burden of occupational neoplasms was unevenly distributed across locations and populations. The need for rational allocation of healthcare resources was urgent.

[A survey of cervical and lumbar spine diseases of express delivery employees].

Objective: To understand the current situation and influencing factors of cervical and lumbar spine diseases of the express delivery employees, and provide scientific basis for carrying out their occupational health protection in a targeted manner. Methods: From February 2020 to January 2021, the current situation research method was used to obtain 527 express delivery employees by cluster sampling. Online questionnaires were used to investigate sociodemographic characteristics and emotional characteristics, and clinical data were obtained by digital X-ray (DR) examination of the neck and waist. Pearson χ(2) test and multivariate logistic regression were used to analyze the influencing factors of cervical and lumbar spine diseases in express delivery employees. Results: The prevalence rates of cervical spine and lumbar spine diseases among express delivery employees were 49.15% (259/527) and 67.74% (357/527) , respectively. Univariate analysis showed that there were statistically significant differences in the distribution of cervical and lumbar spine disease among express delivery employees with different ages, length of service, working hours per week, and different degrees of distress due to emotional factors (P<0.05) . Multivariate analysis showed that express delivery employees aged ≥25 years old had a higher risk of cervical spine disease (P<0.05) , the express delivery employees who worked 49-55 hours per week had a lower risk of cervical spine disease (P<0.05) . Express delivery employees aged≥35 years old had a lower risk of lumbar spine disease (P<0.05) , and the risk of lumbar spine disease was higher among express delivery workers who suffered moderate or more distress due to emotional factors (such as anxiety, depression, or irritability) in the past 4 weeks (P<0.05) . Conclusion: The prevalence of cervical and lumbar spine diseases is relatively high among express delivery employees. It is recommended to adjust the weekly working hours of express delivery employees, organize psychological counseling training, and effectively protect the occupational health rights of express delivery employees.

[Assessment of cognitive function of the elderly by serum metabolites of brain-gut axis].

Objective: To investigate the feasibility of assessing cognitive function of the elderly by serum metabolites of brain-gut axis. Methods: Convenience sampling was used to select 100 and 60 participants from the healthy population cohort and microecological balance cohort of the longevity population in Guangxi, to constitute subset of healthy population and longevity population, respectively. A questionnaire was used to investigate the demographic characteristics of the subjects, 2-5 ml of fasting venous blood was collected from the subjects, and the serum untargeted metabolomics was determined by liquid chromatography tandem mass spectrometry. The biomarkers related to the brain-gut axis were collected through literature retrieval, and the results were intersected with the untargeted metabolites and annotated. Spearman correlation analysis was used to screen serum metabolites of brain-gut axis associated with aging, and multiple linear regression method was used to construct biological age model. The mini mental status examination was used to evaluate the cognitive function of longevity population subsets. The differences of biological age and chronological age of longevity population subsets with different cognitive function were compared. Results: The M (Q1, Q3) of subset of healthy population and longevity population were 64 (38, 72) and 97 (95, 99) years old, respectively, and there were 50 (50.0%) and 44 (73.3%) females, respectively. Nine serum metabolites of brain-gut axis were obtained by initial screening, which were propionic acid, glutamic acid, γ-aminobutyric acid (GABA), lactic acid, 5-hydroxytryptamine (5-HT), tryptophan, trimethylamine oxide, dopamine and canine urea. Spearman correlation analysis showed that glutamic acid and dopamine were positively correlated with aging (r values were 0.208 and 0.524, respectively, all P values<0.05), and tryptophan, 5-HT and GABA were negatively correlated with aging (r values were -0.308, -0.533 and -0.213, respectively, all P values<0.05). The biological age model was constructed as: y=49.81-1.18×10-5× GABA-1.82×10-4×5-HT+1.99×10-3×dopamine+1.65×10-6×glutamic acid -2.04×10-6×tryptophan+2.36×gender, where y was the biological age (years), the items on the right were the intercept item, the relative concentration of each metabolite, and gender (male=1, female=2). The coefficient of determination of model was 0.50 (P<0.001). The M (Q1, Q3) of the chronological age of the subset of longevity population with poor, moderate and good cognitive function were 97 (94, 100), 97 (93, 101) and 96 (94, 101) years old, respectively, and there was no statistical significance in pairwise comparison (all P values>0.05). The M (Q1, Q3) of the biological age of the subjects with better cognitive function was 51 (38, 54) years old, which was lower than that of the subjects with poor cognitive function [57 (47, 61)] (P=0.040). Conclusion: The biological age model can be constructed based on serum metabolites of brain-gut axis and used to evaluate the cognitive function of the elderly.

Secular trends of incidence and hospitalization cost of hip fracture in Tangshan, China.

We investigated the secular trends of the incidence and hospitalization cost of hip fracture in Tangshan, China. The incidence of hip fracture and the hospitalization cost were both increasing during the observation period. INTRODUCTION: The present study aimed to determine sex-, age-, and fracture type-specific incidence and annual changes in hip fractures in Tangshan, China, between 2007 and 2018. METHODS: We analyzed annual hip fracture incidence using urban hospital data during 2007-2018 and calculated incidence rate/100,000 person years in each age group and sex. We assessed annual changes in incidence among people aged >60 years using linear-by-linear association tests and evaluated hospitalization costs with the Kruskal-Wallis test. RESULTS: During the study period, we observed an increasing proportion of hip fractures in people >60 years old from 14.2 to 22.79%. Crude hip fracture incidence increased markedly from 140.87 to 306.56/100,000 in women (p < 0.01) and from 124.83 to 167.19/100,000 in men (p < 0.01) in the age group >60 years. Type-specific analysis indicated significantly increased trends in incidence of cervical and trochanteric fractures among women and cervical fracture among men (p < 0.01). In people aged 36-60 years, the trend of hip fracture increased significantly in both sexes. The total and cervical-to-trochanteric ratio in men increased, with significant upward trends (p < 0.01). The proportion of cervical fracture was higher than that for trochanteric fracture in women, with stable levels from 2007 to 2018. Hospitalization costs for cervical and trochanteric fractures increased by 51.91% and 53.20%, respectively, during 2011-2018. CONCLUSION: Tangshan will have an increasing burden on health care resources attributable to a considerable rise in hip fracture incidence and the older population. Further investigation of risk factors and subsequent implementation of effective measures to prevent hip fracture are needed.

[Development and validation of three-dimensional body image stimuli for Chinese middle-aged adults].

Objective: To develop a three-dimensional body image stimuli suitable for middle-aged people in China, and verify the validity and reliability of the body image stimuli. Method: According to China and World Health Organization body mass index classification standards of adults, a set of three-dimensional body image stimuli of Chinese middle-aged males and females with different body size was developed by using 3D Studio Max and Adobe Photoshop CC based on the literature and expert consultation method. Forty-two 45- and 59-year-old middle-aged people in Zhengzhou City, Henan Province were recruited to verify the three-dimensional body image stimuli. Through questionnaire survey and physical examination, the coincidence between the selected body type and the actual body type was tested; the body composition was measured by dual-energy absorptiometry (DXA), and the structure validity of the image was tested; the body size satisfaction was investigated by the body image stimuli and the standard questionnaire, and the empirical validity of the image was tested. The repeated survey was conducted 14 days after the initial survey, and three experts were invited to score the current somatotype of the subjects to test the test-retest reliability and inter-rater reliability of the body image stimuli. Pearson, Spearman, Kendall correlation and Kappa consistency analysis were used to evaluate the validity and reliability of the body image stimuli. Results: The average age of 42 subjects was 52.7 years old, including 13 males and 29 females. A group of three-dimensional body image stimuli of middle-aged men and women were developed, and each group included 8 images. 73.8% of the subjects chose the body size consistent with the actual body type, and the weighted Kappa coefficient was 0.755 (P<0.01). The selected somatotype was positively correlated with body weight and body composition indexes such as fat content, and the Pearson correlation coefficient of construct validity was 0.623-0.717 (P<0.05). The results of the two surveys were positively correlated, and the Spearman correlation coefficient of test-retest reliability was 0.784-0.821 (P<0.05). The scores of the three experts on the current somatotype of the subjects were positively correlated, and the Kendall correlation coefficient of inter-rater reliability was 0.818-0.878 (P<0.05). Conclusion: The development of principle and reference basis of three-dimensional body image stimuli of middle-aged people is reliable, and the validity and reliability of the body image stimuli are good.

Patterns and correlates of major depression in Chinese adults: a cross-sectional study of 0.5 million men and women.

BACKGROUND: Worldwide 350 million people suffer from major depression, with the majority of cases occurring in low- and middle-income countries. We examined the patterns, correlates and care-seeking behaviour of adults suffering from major depressive episode (MDE) in China. METHOD: A nationwide study recruited 512 891 adults aged 30-79 years from 10 provinces across China during 2004-2008. The 12-month prevalence of MDE was assessed by the Modified Composite International Diagnostic Interview-short form. Logistic regression yielded adjusted odds ratios (ORs) of MDE associated with socio-economic, lifestyle and health-related factors and major stressful life events. RESULTS: Overall, 0.7% of participants had MDE and a further 2.4% had major depressive symptoms. Stressful life events were strongly associated with MDE [adjusted OR 14.7, 95% confidence interval (CI) 13.7-15.7], with a dose-response relationship with the number of such events experienced. Family conflict had the highest OR for MDE (18.9, 95% CI 16.8-21.2) among the 10 stressful life events. The risk of MDE was also positively associated with rural residency (OR 1.5, 95% CI 1.4-1.7), low income (OR 2.3, 95% CI 2.1-2.4), living alone (OR 2.6, 95% CI 2.3-3.0), smoking (OR 1.4, 95% CI 1.3-1.6) and certain other mental disorders (e.g. anxiety, phobia). Similar, albeit weaker, associations were observed with depressive symptoms. Among those with MDE, about 15% sought medical help or took psychiatric medication, 15% reported having suicidal ideation and 6% reported attempting suicide. CONCLUSIONS: Among Chinese adults, the patterns and correlates of MDE were generally consistent with those observed in the West. The low rates of seeking professional help and treatment highlight the great gap in mental health services in China.

The assessment of the cardiac compensatory function of elderly people with coronary artery disease by quantitive dobutamine stress echocardiography.

OBJECTIVE: The aim of the study is to investigate the cardiac compensatory function change in senior people with Coronary Artery Disease (CAD) by Quantitive Dobutamine Stress Echocardiography (DSE) and Tissue Doppler Imaging (TDI). PATIENTS AND METHODS: All of the 98 senior people (age >60) who were suspected to have CAD received the examination of DSE and TDI. The mean systolic peak velocity (Sa), early diastolic peak velocity (Ea) and late diastolic peak velocity (Aa) of mitral annulus were measured in a different dose of dobutamine stress. Besides, the coronary angiography (CAG) was done within 2 weeks for the 98 senior people. RESULTS: In the basic status, the mean Sa, Ea and Aa were not significantly different between the patients from the normal group and CAD group. However, under a 20 µg/kg·min dose of dobutamine stress, significant differences of mean Sa and Ea between two groups were observed. For the mean Aa, a significant difference could be observed with the dose of 40 µg/kg·min. CONCLUSIONS: Both the cardiac systolic and diastolic compensatory function were lower in the CAD group than the normal group, which is detectable in the 20 µg/kg·min dose of dobutamine stress status. In other words, Quantitive Dobutamine Stress Echocardiography is a safe, efficient, non-invasive diagnostic method. It can reflect the compensatory cardiac function of the patients with CAD.

Greening academia: developing sustainable waste management at Higher Education Institutions.

Higher Education Institutions (HEIs) are often the size of small municipalities. Worldwide, the higher education (HE) sector has expanded phenomenally; for example, since the 1960s, the United Kingdom (UK) HE system has expanded sixfold to >2.4 million students. As a consequence, the overall production of waste at HEIs throughout the world is very large and presents significant challenges as the associated legislative, economic and environmental pressures can be difficult to control and manage. This paper critically reviews why sustainable waste management has become a key issue for the worldwide HE sector to address and describes some of the benefits, barriers, practical and logistical problems. As a practical illustration of some of the issues and problems, the four-phase waste management strategy developed over 15 years by one of the largest universities in Southern England--the University of Southampton (UoS)--is outlined as a case study. The UoS is committed to protecting the environment by developing practices that are safe, sustainable and environmentally friendly and has developed a practical, staged approach to manage waste in an increasingly sustainable fashion. At each stage, the approach taken to the development of infrastructure (I), service provision (S) and behavior change (B) is explained, taking into account the Political, Economic, Social, Technological, Legal and Environmental (PESTLE) factors. Signposts to lessons learned, good practice and useful resources that other institutions--both nationally and internationally--can access are provided. As a result of the strategy developed at the UoS, from 2004 to 2008 waste costs fell by around £125k and a recycling rate of 72% was achieved. The holistic approach taken--recognizing the PESTLE factors and the importance of a concerted ISB approach--provides a realistic, successful and practical example for other institutions wishing to effectively and sustainably manage their waste.

Assessment of sleep impairment in persistent allergic rhinitis patients using polysomnography.

BACKGROUND: Although questionnaires have demonstrated an association between impairment of quality of sleep and symptoms in allergic rhinitis (AR) patients, to date there is no report of an objective assessment of sleep in patients with persistent allergic rhinitis (PER) as defined by ARIA guidelines. The aim of the present study was therefore to assess sleep disturbance in PER patients by polysomnography (PSG). METHODS: Ninety-eight PER patients with moderate-to-severe nasal obstruction and 30 healthy volunteers were included in the study. All patients underwent PSG during nocturnal sleep to assess the presence and severity of sleep disorders. Peak nasal inspiratory flow (PNIF) was also measured to assess nasal resistance. RESULTS: There were statistically significant, though clinically modest, differences between PER patients and healthy controls in most PSG parameters including sleep efficiency, arousal index, average SaO(2), lowest SaO(2), time spent with a saturation below 90%, and snoring time. Although the apnea-hypopnea index (AHI) was not significantly different between the 2 groups, 17 subjects (17.3%) in the PER group but none of the control subjects had an AHI >5. Patients with higher T5SS scores (12 ≤ T5SS ≤ 15) had a greater tendency to snore than did patients with lower scores (8 ≤ T5SS ≤ 11). Finally, PNIF in the PER group was significantly lower than in the control group. Weak correlations between the arousal index and PNIF, average SaO(2), and PNIF were found. CONCLUSION: PSG showed modest changes in PER patients versus control subjects.

The effect of HMOs on hospital capacity, 1982-1996.

Hospital capacity has declined in recent years and is forecast to decline further. The objective of this study is to determine if hospital capacity has declined more rapidly in metropolitan statistical areas (MSAs) with high HMO market penetration compared with MSAs with low HMO market penetration in the period from 1982 to 1996. The findings presented in this study are that greater reductions in beds per capita occur in MSAs with greater HMO penetration, but the magnitude of the differences is small. Reductions in other measures of hospital capacity--hospital closures, beds per hospital, and occupancy--are not consistently associated with HMO market penetration. Bed capacity occurs at roughly similar rates in all MSAs.

Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care.

OBJECTIVE: Intensive care units (ICUs) account for an increasing percentage of hospital admissions and resource consumption. Adverse events are common in ICU patients and contribute to high mortality rates and costs. Although evidence demonstrates reduced complications and mortality when intensivists manage ICU patients, a dramatic national shortage of these specialists precludes most hospitals from implementing an around-the-clock, on-site intensivist care model. Alternate strategies are needed to bring expertise and proactive, continuous care to the critically ill. We evaluated the feasibility of using telemedicine as a means of achieving 24-hr intensivist oversight and improved clinical outcomes. DESIGN: Observational time series triple cohort study. SETTING: A ten-bed surgical ICU in an academic-affiliated community hospital. PATIENTS: All patients whose entire ICU stay occurred within the study periods. INTERVENTIONS: A 16-wk program of continuous intensivist oversight was instituted in a surgical ICU, where before the intervention, intensivist consultation was available but there were no on-site intensivists. Intensivists provided management during the intervention using remote monitoring methodologies (video conferencing and computer-based data transmission) to obtain clinical information and to communicate with on-site personnel. To assess the benefit of the remote management program, clinical and economic performance during the intervention were compared with two 16-wk periods within the year before the intervention. MEASUREMENTS AND MAIN RESULTS: ICU and hospital mortality (observed and Acute Physiology and Chronic Health Evaluation III, severity-adjusted), ICU complications, ICU and hospital length-of-stay, and ICU and hospital costs were measured during the 3 study periods. Severity-adjusted ICU mortality decreased during the intervention period by 68% and 46%, compared with baseline periods one and two, respectively. Severity-adjusted hospital mortality decreased by 33% and 30%, and the incidence of ICU complications was decreased by 44% and 50%. ICU length of stay decreased by 34% and 30%, and ICU costs decreased by 33% and 36%, respectively. The cost savings were associated with a lower incidence of complications. CONCLUSIONS: Technology-enabled remote care can be used to provide continuous ICU patient management and to achieve improved clinical and economic outcomes. This intervention's success suggests that remote care programs may provide a means of improving quality of care and reducing costs when on-site intensivist coverage is not available.

Hospital expenditures and utilization: the impact of HMOs.

OBJECTIVE: To determine whether hospital utilization and expenditures have declined more rapidly in metropolitan statistical areas (MSAs) with high health maintenance organization (HMO) penetration compared with MSAs with low HMO penetration. STUDY DESIGN: Levels and rates of change in hospital expenditures and hospital utilization in MSAs with varying levels of HMO penetration (1982 to 1996) were compared in a natural experiment. METHODS: MSAs were grouped into 4 categories based on HMO penetration rates in 1996. Levels and rates of change in hospital admission rates, hospital inpatient days, emergency room visits, total expenditures per capita, and expenditures per adjusted inpatient day from 1982 to 1996 were compared. A first-difference multivariate model was evaluated for 1993 to 1996. RESULTS: At the MSA level, the rates of change in hospital utilization and hospital expenditures varied only modestly with the level of HMO penetration. Changes in hospital admission rates did not vary systematically with HMO penetration rates except in the 1993 to 1996 period, when MSAs with the highest HMO penetration had the largest decline. Reductions in hospital days per capita and expenditures per day did not vary systematically by level of HMO penetration. Emergency room days declined most rapidly in the MSAs with the highest HMO penetration in the 1982 to 1993 period and were similar in the 1993 to 1996 period. Hospital expenditures per capita showed the greatest association with managed care penetration. They averaged 1.6% slower annual growth in MSAs with high versus low HMO penetration in the 1982 to 1996 period. CONCLUSIONS: This national study using data from 1982 to 1996 suggests that the effects of HMO penetration on hospital expenditures and hospital utilization at the MSA level are small (generally less than 1% per year).

Reliability and validity of the Chinese versions of the Scales for Assessment of Positive and Negative Symptoms.

This 4-center study assesses the reliability and validity of the Chinese versions of the Scale for Assessment of Positive Symptoms and the Scale for Assessment of Negative Symptoms. Interrater reliability, short-term test-retest reliability, and internal consistency were excellent; intraclass correlation coefficients and Cronbach alphas for the overall scores were all over 0.8. The strong correlation of the scales with an independently assessed parallel measure (the Chinese version of the Brief Psychiatric Rating Scale) and the separate positive and negative factors found with principal components analysis confirm the construct validity of the instruments. These findings demonstrate the importance of culturally sensitive revision and rigorous psychometric evaluation of Western instruments prior to their use in non-Western cultures.