Identifying the coupling coordination relationship between urbanization and forest ecological security and its impact mechanism: Case study of the Yangtze River Economic Belt, China.

Boosting the coordination and symbiosis of urbanization and forest ecological security is notably critical for promoting regional green and sustainable development and achieving emission peak and carbon neutrality goals. However, there was still a lack of in-depth analysis of the coupling coordination relationship between urbanization and forest ecological security and its impact mechanism. On the basis of the data from 844 counties in the Yangtze River Economic Belt, this paper explored the spatial differences and influencing factors of the coupling coordination degree of urbanization and forest ecological security. The results manifested that: i) There were apparent spatial disparities in the urbanization index, forest ecological security index, comprehensive index, coupling degree and coupling coordination degree of the Yangtze River Economic Belt. Among them, the spatial pattern of coupling coordination degree had a strong consistency with urbanization index, that is, areas with higher urbanization index also had higher coupling coordination degree. ii) Based on coupling feature identification, it was found that 249 'problem areas' were mainly located in Yunnan Province, southeastern Guizhou Province, central Anhui Province, and central and eastern Jiangsu Province. The main factor for the formation was due to the lag of urbanization in coordinated development. iii) Among the socioeconomic indicators, population structure (0.136), per capita year-end financial institutions loan balance (0.409) and per capita fixed asset investment (0.202) all had a positive impact on coupling coordination degree, while location conditions (-0.126) had a negative impact. Among the natural indicators, soil organic matter (-0.212) and temperature (-0.094) had a negative impact on coupling coordination degree. iv) During the process of coordinated development, it was necessary to increase financial investment and financial support, actively formulate policies to attract talents, enhance the education and publicity of ecological civilization, and develop a green circular economy. The above measures can promote the harmonious development of urbanization and forest ecological security in the Yangtze River Economic Belt.

Influencing factors of sarcopenia in older adults based on the Newman system model: a case-control study.

PURPOSE: Research on sarcopenia has primarily focused on single fields such as physiology or psychology. However, there is a lack of clear evidence to determine the influence of social factors on sarcopenia. Therefore, our aim was to explore the multidimensional factors that contribute to sarcopenia in older adults within the community. METHODS: In this retrospective case-control study, we applied the diagnostic criteria from The Asian Working Group on Sarcopenia (AWGS) 2019 to categorize study subjects into control and case groups. Our aim was to examine the impact of physical, psychological, and social factors on community-dwelling older adults with sarcopenia across multiple dimensions. We utilized descriptive statistics, as well as simple and multivariate logistic regression analyses, to analyze the data. We compared the odds ratios (OR) of the factors between the two groups and ranked the importance of the influencing factors using the XGBoost algorithm in Python software. RESULTS: Combined with multivariate analysis and XGBoost algorithm results, it can be seen that physical activity is the strongest predictor of sarcopenia [OR] = 0.922(95% CI 0.906-0.948), followed diabetes mellitus [OR] = 3.454(95% CI 1.007-11.854), older age [OR] = 1.112(95% CI 1.023-1.210), divorced or widowed [OR] = 19.148 (95% CI 4.233-86.607), malnutrition [OR] = 18.332(95% CI 5.500-61.099), and depressed [OR] = 7.037(95% CI 2.391-20.710). CONCLUSIONS: Factors associated with the development of sarcopenia in community-dwelling older adults cover a multiplicity of physical, psychological, and social factors, physical activity, diabetes mellitus, age, marital status, nutrition, and depression were important factors that have an impact on sarcopenia. REGISTRATION NUMBER: ChiCTR2200056297.

Loss of behavioral stress response in blind cavefish reduces energy expenditure.

The stress response is essential for animal self-defense and survival. However, species may exhibit stress response variation depending on their specific environmental and selection pressures. Blind cavefish dwell in cave environments, which differ markedly in stressors and resource availability compared to surface aquatic environments. However, whether blind cavefish exhibit differences in stress response as an adaptation to their cave environments remains unclear. Here, we investigated differences in stress response in six closely related Triplophysa species, including three blind cavefish (T. longibarbata, T. jiarongensis, and T. rosa) and three normal-sighted river fish (T. nasobarbatula, T. dongsaiensis, and T. bleekeri). Results showed that blind cavefish exhibited a range of distinct behavioral responses compared to sighted river fish, including greater levels of activity, shorter duration of freezing, absence of erratic movements or thrashing behavior, and opposite behavioral trends over time. Furthermore, the cavefish species demonstrated attenuated increases in metabolic rate in response to stressors related to novel environments. Cave-dwelling T. rosa also exhibited lower basal hypothalamic-pituitary-inter-renal (HPI) axis-related gene expression levels and stress hormone concentrations compared to river-dwelling T. bleekeri. These results suggest that blind cavefish may have lost their behavioral stress response, potentially mediated by a reduction in basal activity of the HPI axis, thus enabling the conservation of energy by reducing unnecessary expenditure in energy-limited caves.

Study on Spatiotemporal Evolution Features and Affecting Factors of Collaborative Governance of Pollution Reduction and Carbon Abatement in Urban Agglomerations of the Yellow River Basin.

Exploring spatiotemporal evolution features and factors affecting pollution reduction and carbon abatement on the urban agglomeration scale is helpful to better understand the interaction between ecological environment and economic development in urban agglomerations. In this study, we constructed an evaluation index system for collaborative governance of pollution reduction and carbon abatement in urban agglomerations. In addition, we employed the correlation coefficient matrix, the composite system synergy model, the Gini coefficient, and the Theil index to evaluate the level of and regional differences in collaborative governance of pollution reduction and carbon abatement in seven urban agglomerations in the Yellow River Basin from 2006 to 2020. Moreover, we explored the factors affecting collaborative governance of pollution reduction and carbon abatement in urban agglomerations in the basin. The following findings were obtained: (1) the order degree of collaborative governance of pollution reduction and carbon abatement in the seven urban agglomerations exhibited a significant growing trend, representing a spatial evolution feature of "high in the west and low in the east"; (2) the internal differences in collaborative governance synergy of pollution reduction and carbon abatement decreased in Lanzhou-Xining Urban Agglomeration, Hohhot-Baotou-Ordos-Yulin Urban Agglomeration, Central Shanxi Urban Agglomeration, Zhongyuan Urban Agglomeration, and Shandong Peninsula Urban Agglomeration, while the internal differences basically remained stable in Guanzhong Urban Agglomeration and the Urban Agglomeration along the Yellow River in Ningxia; (3) the variances in environmental regulation and industrial structure among urban agglomerations had a significant positive effect on collaborative governance of pollution reduction and carbon abatement in urban agglomerations in the basin, and the variances in economic growth had a significant inhibitory effect. In addition, the variances in energy consumption, greening construction, and opening-up had an inhibitory impact on collaborative governance of pollution reduction, but the impact was not significant. Finally, this study proposes various recommendations to improve collaborative governance for pollution reduction and carbon abatement in urban agglomerations in the basin in terms of promoting industrial structure upgrading, strengthening regional cooperation, and reducing regional differences. This paper represents an empirical reference for formulating differentiated collaborative governance strategies for pollution reduction and carbon abatement, comprehensive green and low-carbon economic and social transformation programs, and high-quality green development paths in urban agglomerations, which is of certain theoretical and practical significance.

Development and assessment of the Quality of Life Instruments for Chronic Diseases-Gout (QLICD-GO) (V2.0).

OBJECTIVE: To develop and assess the Quality of Life Instruments for Chronic Diseases-Gout QLICD-GO (V2.0). METHODS: The instrument was developed using a programmatic decision-making method to combine the general module of the Quality of Life Instruments for Chronic Diseases and a new specific module. The instrument was assessed by measuring the quality of life of 116 patients with gout. RESULTS: The QLICD-GO (V2.0) included 28 items from the general module of chronic diseases and 12 items in three facets from the specific module. In addition to the field of physiological function, the internal consistency reliability of other fields and dimensions of the instrument was > 0.7, and the split-half reliability was > 0.5. Three common factors were extracted from the specific module, with a cumulative variance contribution rate of 57.54%. The standardized response means of the specific module and the whole instrument were 0.94 and 1.20, respectively. CONCLUSIONS: The QLICD-GO (V2.0) has good reliability, validity, and responsiveness. The instrument comprehensively and objectively reflects the quality of life of patients with gout, and it can be used to assess treatment regimens developed by medical staff. Key Points • The QLICD-GO (V2.0) has been developed for patients with gout based upon the foundation of the QLICD-GM. • The QLICD-GO reflects the clinical signs and symptoms, drug-related side effects, and psychological changes specific to patients with gout. • Based on the assessment results, the QLICD-GO (V2.0) has good reliability, validity, and responsiveness. • QLICD-GO (V2.0) can objectively and comprehensively reflect the QOL of patients with gout and can be used by clinical staff to assess treatment regimens.

Intestine-specific removal of DAF-2 nearly doubles lifespan in Caenorhabditis elegans with little fitness cost.

Twenty-nine years following the breakthrough discovery that a single-gene mutation of daf-2 doubles Caenorhabditis elegans lifespan, it remains unclear where this insulin/IGF-1 receptor gene is expressed and where it acts to regulate ageing. Using knock-in fluorescent reporters, we determined that daf-2 and its downstream transcription factor daf-16 are expressed ubiquitously. Using tissue-specific targeted protein degradation, we determined that intracellular DAF-2-to-DAF-16 signaling in the intestine plays a major role in lifespan regulation, while that in the hypodermis, neurons, and germline plays a minor role. Notably, intestine-specific loss of DAF-2 activates DAF-16 in and outside the intestine, causes almost no adverse effects on development and reproduction, and extends lifespan by 94% in a way that partly requires non-intestinal DAF-16. Consistent with intestine supplying nutrients to the entire body, evidence from this and other studies suggests that altered metabolism, particularly down-regulation of protein and RNA synthesis, mediates longevity by reduction of insulin/IGF-1 signaling.

Financial Measures to Reduce Carbon Emissions in Britain, Japan and the United States: A SWOT Analysis.

To mitigate global warming, China, the world's largest greenhouse gas emitter, has set the goals of achieving carbon peak by 2030 and carbon neutrality by 2060, and financial measures could play an important role. To avoid unnecessary costs, China could learn from the experience of other countries to better understand the potential role of financial measures in achieving carbon emission reduction goals. Hence, this article adopts a SWOT analysis to compare the financial measures taken by Britain, Japan and the United States in the process of carbon emission reduction in the last twenty years. This article finds that government funds and financial innovation have contributed markedly to carbon emission reduction in those three countries. With the help of the SWOT analysis, we recommend that China take financial measures to help achieve carbon peaking and carbon neutrality goals from four aspects: formulating proper policy, regulating carbon trading market, strengthening international cooperation, and promoting innovation.

Happiness inequality has a Kuznets-style relation with economic growth in China.

Happiness studies generally investigate average levels of happiness rather than happiness inequality between regions, and studies of social inequality usually measure it based on the distribution of life opportunities (e.g., income) rather than life results (e.g., happiness). Inspired by the Kuznets curve, which illustrates the inverted U-shaped correlation between income inequality and economic growth, this study investigates whether there is a subjective wellbeing Kuznets curve. It uses data from ten waves of the Chinese General Social Survey to construct a panel data set and runs panel data models to investigate the hypothesized curvilinear relationship between happiness inequality and economic growth. The results show that happiness inequality, measured as the standard deviations of respondents' self-reported happiness, first increases and then decreases as per-capita GDP increases in Chinese provinces. These findings strongly support the subjective wellbeing Kuznets curve hypothesis and suggest that strategies for reducing happiness inequality must consider stages of economic development.

An optimization model for water resources allocation in Dongjiang River Basin of Guangdong-Hong Kong-Macao Greater Bay Area under multiple complexities.

In this research, an interval two-stage stochastic fuzzy-interval credibility constraint programming (ISFICP) method was developed for water resources allocation among multiple water users under complexities and uncertainties. The method could reflect the multiple complexities of water resources management, also trade-offs between the system benefits and violation risks. Dongjiang River (DJR) Basin, which supplies water to several core cities in south China such as Guangzhou, Shenzhen, and Hong Kong, was applied as the real demonstrative case. The water resources system of DJR Basin is particularly complex due to it is the primary source water for Guangdong-Hong Kong-Macao Greater Bay Area (GBA). Through considering multiple complexities and uncertainties of the water resources system, such as natural, economic, and social conditions, ISFICP was developed to obtain potential water-allocation schemes. Probabilistic distribution, fuzzy-interval sets (FIS), and discrete intervals were introduced to represent the multiple uncertainties associated with the multiple complexities. The results indicated that the model could provide practical schemes for local decision-makers under multiple scenarios such as flow levels, credibility levels, and recycling rates.

Considering economic-environmental joint benefits of water-land resources allocation for supporting sustainable agricultural system development in northeastern China.

Water and land are crucial natural resources for agricultural development. It is necessary to allocate water and land resources effectively in order to achieve the maximum economic profits and the minimum environmental costs. In this research, an inexact two-stage fractional programming model was developed for the allocation of water and land resources, which is integrated interval-parameters (IPP), two-stage stochastic programming (TSP), fractional programming (FP). This model could optimally allocate water and land resources at the same time under the scenario of the maximum economic profit and the minimum environmental cost; it was proved to be beneficial in (1) dealing with the conflicts between economic development and environmental protection and give insights in trade-off among the agricultural system; (2) allocating water and land resources for five crops under multiple flow level simultaneously; and (3) describing the uncertain inputs as interval-parameters to reduce model uncertainties. The developed model was applied to the northeast region of China. The optimal allocation schemes of water and land resources, the maximum economic profits, and the minimum environmental costs were obtained. The results showed that economic profits in the agricultural system in the northeast region of China would not definitely be connected with the allocation of water and land resources, and solid waste pollution would bear the largest environmental cost. The developed model could help decision-makers to get a deeper understanding of the agricultural system and manage water and land resources in an efficient and environment-friendly way.

Assessment of the water-energy-food nexus under spatial and social complexities: A case study of Guangdong-Hong Kong-Macao.

Water, energy, and food resources are indispensable and irreplaceable resources for the survival and development of human society. This study systematically assessed the three resources system in Guangdong, Hong Kong, and Macao based on constructed direct and nexus-oriented, multi-regional input-output, and ecological network analysis models. Various network analysis (e.g., control, utility, hierarchy, and robustness) was adopted to identify the critical factors of inter-regional resources trade from a perspective of supply-demand. The results indicated that Guangdong, Hong Kong, and Macao have complex control linkages in the three resources trade network, and Guangdong is the key to improving the three resources network structure. The three resources network existed highly competition and exploitation in the three regions. Industrial development is unbalanced and competitive for the three resources. The wholeness water-energy-food trade network of the three regions stayed in a positive environment, but the positive effect level was relatively weak. The three resources network robustness in the three regions is at a medium level. Hong Kong and Macao's water-energy-food network systems have a high vulnerability, and the lowest system robustness was food-related energy in Hong Kong. Finally, we provide some measures to help the sustainable development of the water-energy-food resource system in the three regions, such as cross-regional coordinated management, integration industries development, seawater toilets-flushing, sea rice, and renewable energy.

Social Exclusion and Green Consumption: A Costly Signaling Approach.

This article is dedicated to examine the impact of social exclusion (i.e., being rejected, isolated, excluded or ignored by other individuals or groups in society) on consumers' intention of green consumption. Based on Costly Signaling Theory, three experiments have been conducted to explore one main effect and the corresponding mechanism together with two boundary conditions. Specifically, the first study tests the main effect and internal mechanism by manipulating the state of social exclusion. The results show that social exclusion enhances consumers' intention to buy green products and consumers' desire for self-sacrifice mediates that relationship. Study 2 manipulates audience state to examine the first boundary condition. The findings show that the effect of social exclusion on green consumption exists only in public purchasing scenarios. Study 3 tests the second boundary condition by manipulating the stability of exclusion causes. The results indicate that the main effect is significant only when causes of exclusion are not stable. The final part discusses theoretical contributions and practical implications of this study in the field of both social exclusion and green consumption.

Preliminary Study to Evaluate Three Different Treatments on Stable Chronic Obstructive Pulmonary Disease Patients Based on Markov Model.

This study evaluates the costs and utilities of different treatment strategies for stable chronic obstructive pulmonary disease (COPD) patients based on Markov model and provides guidance for clinical decision and health policy making. Patients with stable COPD from four subcenters had been investigated. A Markov model with three states, namely, GOLD 1-2, GOLD 3-4, and death, was built using TreeAge Pro 2011 software. Cost-utility ratio (CUR) and incremental cost-utility ratio (ICUR) from forty Markov circles were applied to measuring the economics evaluation of three different treatments. A total of 236 stable COPD patients were randomly assigned into three groups, Western medicine group (79 cases), traditional Chinese medicine (TCM) group (79 cases), and combined group (78 cases). The results of Markov cohort simulation showed that the accumulative quality-adjusted life years (QALYs) of the three above groups per 100 000 people in 40 years were 1 702 773, 1 616 797, and 1 709 668 years, respectively, and the accumulative costs were 13 582 138 466, 1 207 904 113, and 14 656 607 371 Yuan, respectively. The CURs of the three groups were 87 235, 74 602, and 87 223 Yuan/QALY, respectively. ICURs of combined group were 8 707 and 41 705 Yuan as against Western medicine group and TCM group, respectively. Therefore, combined treatment has a lower cost, higher health output, and more socioeconomic benefits in the long run. Markov model is recommended to conduct health economics evaluation of different treatments for COPD.

Preexisting chronic conditions for fatal outcome among SFTS patients: An observational Cohort Study.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that is caused by a novel bunyavirus SFTSV. Currently our knowledge of the host-related factors that influence the pathogenesis of disease is inadequate to allow prediction of fatal outcome. Here we conducted a prospective study of the largest database on the SFTS patients, to identify the presence of comorbidities in SFTS, and estimate their effect on the fatal outcome. Among 2096 patients eligible for inclusion, we identified nine kinds of comorbidities, from which hyperlipidemia (12.2%; 95% CI: 10.8%-13.6%), hypertension (11.0%; 95% CI: 9.6%-12.3%), chronic viral hepatitis (CVH) (9.3%; 95% CI: 8.1%-10.5%), and diabetes mellitus (DM) (6.8%; 95% CI: 5.7%-7.9%) were prevalent. Higher risk of death was found in patients with DM (adjusted OR = 2.304; 95% CI: 1.520-3.492; P<0.001), CVH (adjusted OR = 1.551; 95% CI: 1.053-2.285; P = 0.026) and chronic obstructive pulmonary diseases (COPD) (adjusted OR = 2.170; 95% CI: 1.215-3.872; P = 0.009) after adjusting for age, sex, delay from disease onset to admission and treatment regimens. When analyzing the comorbidities separately, we found that the high serum glucose could augment diseases severity. Compared to the group with max glucose < 7.0 mmol/L, patients with glucose between 7.0-11.1 mmol/L and glucose ≥11.1 mmol/L conferred higher death risk, with the adjusted OR to be 1.467 (95% CI: 1.081-1.989; P = 0.014) and 3.443 (95% CI: 2.427-4.884; P<0.001). Insulin therapy could effectively reduce the risk of severe outcome in DM patients with the adjusted OR 0.146 (95% CI: 0.058-0.365; P<0.001). For CVH patients, severe damage of liver and prolongation of blood coagulation time, as well as high prevalence of bleeding phenotype were observed. These data supported the provocative hypothesis that treating SFTS related complications can attain potentially beneficial effects on SFTS.

Development and effectiveness of a mobile phone application conducting health behavioral intervention among men who have sex with men, a randomized controlled trial: study protocol.

BACKGROUND: Behavioral intervention is a key approach to HIV prevention among men who have sex with men (MSM). Widespread use of mobile phones provide us with novel opportunities to decrease HIV infection and transmission of MSM. The objective of the study was to design and develop a mobile phone application (app) aims to conduct behavioral intervention to MSM and to evaluate the efficacy of the app-based intervention compared to usual care, to analyze cost-effectiveness and mechanism of the intervention. METHODS: This study involves 2 phases, phase 1 use qualitative method and phase 2 is a randomized controlled trial lasting for 18 months, they will be conducted in Chagnsha, Hunan Province, China. Phase 1 is to design and develop the app, procedures including retrieval of domestic apps related to prevention and treatment about HIV and sexually transmitted diseases (HIV/STDs), personal interviews with MSM about preferences and functional needs of the HIV prevention app, multidisciplinary experts focused group discussions of the app, software engineers' development and users test of the app will be performed. In phase 2, we will recruit 800 MSM by cooperating with the local center of disease control and prevention and nongovernmental organizations, and divide them into intervention and control group evenly. Intervention group participants will receive app-based HIV prevention. Control group participants will be provided with usual care including HIV/STDs knowledge brochure and free voluntary counseling services. Data will be collected at baseline, 6, 12 and 18 months since subject's participation. Effectiveness of the intervention includes HIV/STDs infection rates, adherence to regularly HIV testing, sexual risk behavior, consistent condom use and relative risk of HIV infection. Cost-effectiveness will be analyzed by decision-analytic modeling, and mechanism analysis of this app-based intervention will be performed by path analysis. DISCUSSION: This will be the first study of its kind in China to develop an app and implement app-based HIV prevention intervention among MSM. It is of great potential to determine whether app-based intervention is a cost-effective way to decrease HIV infection among MSM and explore intervention mechanism with an accurate method. TRIAL REGISTRATION: Chinese Clinical Trial Register ( ChiCTR-IOR-15006724 ). Registered 10 July 2015.

Distributions and contamination assessment of heavy metals in the surface sediments of western Laizhou Bay: Implications for the sources and influencing factors.

Heavy metals (Cu, Pb, Cr, Cd and As) contents in surface sediments from western Laizhou Bay were analysed to evaluate the spatial distribution pattern and their contamination level. As was mainly concentrated in the coastal area near the estuaries and the other metals were mainly concentrated in the central part of the study area. The heavy metals were present at unpolluted levels overall evaluated by the sediment quality guidelines and geoaccumulation index. Principal component analysis suggest that Cu, Pb and Cd were mainly sourced from natural processes and As was mainly derived from anthropogenic inputs. Meanwhile, Cr originated from both natural processes and anthropogenic contributions. Tidal currents, sediments and human activities were important factors affecting the distribution of heavy metals. The heavy metal environment was divided into four subareas to provide a reference for understanding the distribution and pollution of heavy metals in the estuary-bay system.

Emergy-based comparative analysis on industrial clusters: economic and technological development zone of Shenyang area, China.

In China, local governments of many areas prefer to give priority to the development of heavy industrial clusters in pursuit of high value of gross domestic production (GDP) growth to get political achievements, which usually results in higher costs from ecological degradation and environmental pollution. Therefore, effective methods and reasonable evaluation system are urgently needed to evaluate the overall efficiency of industrial clusters. Emergy methods links economic and ecological systems together, which can evaluate the contribution of ecological products and services as well as the load placed on environmental systems. This method has been successfully applied in many case studies of ecosystem but seldom in industrial clusters. This study applied the methodology of emergy analysis to perform the efficiency of industrial clusters through a series of emergy-based indices as well as the proposed indicators. A case study of Shenyang Economic Technological Development Area (SETDA) was investigated to show the emergy method's practical potential to evaluate industrial clusters to inform environmental policy making. The results of our study showed that the industrial cluster of electric equipment and electronic manufacturing produced the most economic value and had the highest efficiency of energy utilization among the four industrial clusters. However, the sustainability index of the industrial cluster of food and beverage processing was better than the other industrial clusters.

Supporting smoking cessation in chronic obstructive pulmonary disease with behavioral intervention: a randomized controlled trial.

BACKGROUND: Cigarette smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). But a fewer smoking cessation measures were conducted in communities for smokers with COPD in China. The aim of our study was to assess the preventive effects of behavioral interventions for smoking cessation and potential impact factors in smokers with COPD in China. METHODS: In a randomised controlled smoking cessation trial 3562 patients with COPD who were current smoker were allocated to intervention group received behavioral intervention and control group received the usual care for two years. The primary efficacy endpoint was the complete and continuous abstinence from smoking from the beginning of month 24 to the end of month 30. Participants were followed up at month 48. RESULTS: Continuous smoking abstinence rates from month 24 to 30 were significantly higher in participants receiving behavioral intervention than in those receiving usual care (46.4% vs 3.4%, p < 0.001). Continuous abstinence rates from months 24 to 36 (45.8% vs 4.0%) and months 24 to 48 (44.3% vs 5.1%) were also higher in participants receiving behavioral intervention than in those control group. Family members or family physicians/nurses smoking were first identified to influence smoking cessation. CONCLUSIONS: Behavioral intervention doubled the smoking cessation rate in patients with COPD and was complied well by the general practitioners. The family members and family physicians/nurses smoking were the main risk factors for smoking cessation. TRIAL REGISTRATION: Chinese Clinical Trials Registration (ChiCTR-TRC-12001958).

Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study.

BACKGROUND: The incidence of chronic obstructive pulmonary disease (COPD) in China is very high. This study aimed to assess the vulnerability of COPD patients in rural areas outside Xuzhou City, Jiangsu province, in order to provide helpful guidance for future research and public policies. METHODS: The vulnerability of 8,217 COPD patients was evaluated using a face-to-face questionnaire to obtain information on general characteristics, awareness, beliefs, medication usage, acute exacerbation of the disease, and economic burdens. Direct economic burdens were calculated based on the questionnaire, and indirect economic burdens were estimated using local per capita income and life expectancy in 2008. The years of potential life lost were calculated using loss of life years for each age group and multiplying by the number of deaths in a given age group. RESULTS: Of the 8,217 patients, 7,921 (96.4%) had not heard of COPD, and 2,638 (32.1%) did not understand that smoking was a risk factor for COPD. No patients had used inhalers, nebulizer drugs or oxygen therapy, either regularly or sporadically. No patients had undergone pulmonary rehabilitation or surgical treatment, while 4,215 (51.3%) took theophylline to relieve dyspnea, and 3,418 (41.6%) used antibiotics to treat exacerbations. A total of 2,925 (35.6%) patients had been admitted to hospital during the past year because of respiratory symptoms. The average direct and indirect economic burdens on COPD patients were 1,090 and 20,605 yuan, respectively. CONCLUSIONS: The vulnerability of patients in rural Xuzhou to COPD was high. Their awareness of COPD was poor, their treatment during both the stable and acute exacerbation stages did not meet standards, and the economic burdens were large. Interventions are therefore needed to improve the prevention and management of COPD in this population. Further studies are required to verify these findings.