The digital economy and job quality: Facilitator or inhibitor? --Evidence from micro-individuals.

The improvement of workers' employment quality is an important manifestation of high-quality economic development. Based on 13,969 valid samples from the China Family Panel Studies (CFPS) data, the paper examines the impact of urban digital economy development level on individual employment quality from a micro perspective using a multilevel regression model. The study finds that the level of urban digital economy development significantly promotes individual employment quality. For every 1 unit increase in the level of urban digital economy development, the quality of individual employment will increase by 1.033 units. And air quality positively moderates the relationship between urban digital economy development level and individual employment quality, i.e., in cities with good air quality, the urban digital economy development level has a more important role in promoting the quality of individual employment. Further heterogeneity analysis reveals that the level of digital economy development in cities has a more pronounced effect on the employment quality of males, younger workers (40 years old and below), and party members. To be more specific, every increase of one unit in the development level of urban digital economy will increase the employment quality by 1.649, 0.787, and 0.897 units, respectively. The above findings are useful for the formulation of policies to achieve high quality of employment and the implementation of environmental management plans.

Analysis of factors associated with family disease burden and correlation with social support among family caregivers of patients with severe mental illnesses.

BACKGROUND: Caregivers are responsible for the home care of family members with severe mental illnesses (SMIs) and their lives are often subject to changes that can create stress and burden. The purpose of this study was to explore the current state of family disease burden and its correlation with social support among family caregivers of SMIs patients. METHODS: Using a random sampling method, a total of 1,108 family caregivers of SMIs patients in community health service centers were selected. A general information questionnaire of family caregivers and patients, the Family Disease Burden Scale, and the Social Support Rating Scale were used. RESULTS: The score of the Family Disease Burden Scale of 1108 family caregivers was 16.57 ± 10.65. Family disease burden was negatively correlated with social support (p < .05). The main influencing factors of family disease burden were average annual family income, duration of illness, distance to medical care, risk of unpredictable behavior, social support, caregiver-patient relationship, gender, and comorbid chronic conditions (p < .05). CONCLUSION: Family caregivers of SMIs patients have a relatively low level of caregiver-perceived social support. Interventions to enhance perceived social support could help maintain the health of family caregivers and improve the quality of family care.

Optimized carbonization of coffee shell via response surface methodology: A circular economy approach for environmental remediation.

The disposal of coffee shell waste on farmland, is a common practice that can causing the environmental and waste valuable resources. Carbonization has been identified as an effective method for transforming coffee shells into useful products that mitigate environmental pollution. Through the response surface methodology, the carbonization conditions of the coffee shells were optimized and its potential as a biochar-based slow-release urea fertilizer was explored. Experiments were conducted on coffee shell performance under varying carbonization conditions such as temperature (600-1000 °C), time (1-5 h), and heating rate (5-20 °C/min). The results indicated that the ideal urea adsorption was 56.3 mg/g, achieved under carbonization conditions of 2.83 h, 809 °C, and 15.3 °C/min. The optimal nutrient release rate within seven days was 45.4% under carbonization conditions of 3.19 h, 813 °C, and 15.0 °C/min. The infrared spectroscopy analysis indicates that carbonization conditions influenced the absorption peak intensity of coffee shell biochar, while the functional group types remain unchanged. The biochar exhibits diverse functional groups and abundant pores, making it a promising candidate for use as a biochar-based fertilizer material. Overall, the findings demonstrate an effective waste management approach that significantly reduces environmental pollutants while remediating pollution.

Characteristics, sources and health risk assessment of trace metals and polycyclic aromatic hydrocarbons in PM2.5 from Hefei, China.

Trace metals (TRs) and polycyclic aromatic hydrocarbons (PAHs) are major toxic components of fine particulate matter (PM2.5) and related to various health adverse outcomes. The study aims to get a better understanding of the contents, sources and risks of PM2.5-bounded TRs and PAHs in Hefei, China, during the period of 2019-2021. We collected 504 samples and measured twelve TRs and sixteen priority PAHs by inductively coupled plasma mass spectrometry and high-performance liquid chromatography. The annual mass concentrations of PM2.5 was fluctuated in the year of 2019-2021 at 50.95, 47.48 and 59.38 µg/m3, with seasonal variations in rank order of winter > spring > autumn > summer. The median concentrations of PM2.5-bounded Æ©TRs and Æ©PAHs were also fluctuated, 132.85, 80.93 and 120.27 ng/m3 for Æ©TRs, 2.57, 5.85 and 2.97 ng/m3 for Æ©PAHs, in the year of 2019, 2020 and 2021, respectively. Seasonal variations of Æ©TRs and Æ©PAHs show the highest concentration in winter. Positive matrix factorization was used for identified pollution emission sources, and TRs mainly originated from coal combustion, traffic emission and fugitive dust, while PAHs stemmed from biomass, diesel, gasoline and coal combustion. Health risk assessment indicated that adults were more vulnerable than children, the carcinogenic risk assessment of As and Cr manifested a certain degree of cancer risk (1.0 × 10-6 < CR < 1.0 × 10-4) in adults group, and health risks of TRs were higher than PAHs in Hefei. These findings suggest that PM2.5-bounded TRs and PAHs should be considered when making emission control strategies for air pollution, and winter, combustion sources and adults should achieve more policy attention to decrease exposure risks in Hefei.

Validation of a Disability Assessment Tool Based on the International Classification of Functioning, Disability, and Health in the Chinese Context.

Background: The common standards of disability assessment for long-term care (LTC) insurance are currently absent. The International Classification of Functioning, Disability and Health (ICF) was designed for a better description of health and functioning, which could fill the demand gap for the standards of disability assessment and be a promising tool for the development of LTC insurance system. Objectives: To validate a disability assessment scale for disabled elderly individuals based on the ICF for LTC in the Chinese context. Methods: The present study is a cross-sectional study. A disability assessment tool based on the ICF was developed by referring to other assessment tools and an expert consensus meeting in the initial phase of the study. The developed tool was used to evaluate 1,610 elderly individuals in the LTC institutions. The Cronbach's α coefficient and split-half reliability were applied to test the internal consistency of the tool, while the Interclass correlation coefficients (ICCs) were used to evaluate the interrater reliability (IRR). Factor analysis was performed to verify the construct validity of the tool. The scores from the Medical Outcomes Short Form-12 (SF-12) were correlated with that from the disability assessment tool, to assess the criterion-related validity. Results: The Cronbach's α coefficient and split-half reliability of the disability assessment tool were 0.969 and 0.877, respectively. The ICCs of the sum scale was 0.85, and the ICCs of each of the 20 items in the scale ranged from 0.78 to 0.94. The items were divided into three factors through analysis, which is consistent with the structure expectation. The scores of each item and the sum score of the disability assessment scale were negatively correlated with the scores of the physical and psychological fields in SF-12 (p < 0.001). Overall, the data indicated that the tool was characterized by good internal consistency, IRR, construct validity, and criterion-related validity. Conclusions: The disability assessment tool based on the ICF is a reliable and valid tool for the collection of information on functioning across various LTC settings. The information of disability provided evidence for the distribution of LTC service and guided the development of LTC insurance standards.

The impact of national centralized drug procurement on health expenditures for lung cancer inpatients: A difference-in-differences analysis in a large tertiary hospital in China.

The availability and affordability of medicines remain major health challenges around the world. In March 2019, the Chinese government introduced a pilot National Centralized Drug Procurement (NCDP) program in order to reduce drug prices and improve the affordability of effective and safe medicines. This study aimed to assess the impact of NCDP policy on health expenditures of cancer patients. Using inpatient discharge records from a large hospital in the pilot city, we performed a difference-in-differences design to estimate the change in health expenditures before and after the policy. We found that the implementation of NCDP was associated with a significant decrease in total expenditures (14.13%) and drug expenditures (20.75%) per inpatient admission. There were also significant reductions in non-drug-related expenditures, including a 7.65% decrease in health service expenditures, a 38.28% decrease in diagnosis expenditures, and a 25.31% decrease in consumable material expenditures per inpatient admission. However, the NCDP implementation was associated with a 107.97% increase in the traditional Chinese medicine expenditures. Overall, the study provided evidence that the NCDP policy has achieved its goals of high-quality and affordable healthcare. The drug expenditures of lung cancer patients revealed a continuous decline, and the policy may have spillover effects on other healthcare expenditures. Further studies are needed to evaluate the long-term effects of NCDP on policy-related expenditures and health outcomes.

Clinical assessment of cardiac impairment favored by two-dimensional speckle tracking echocardiology in patients with systemic sclerosis.

BACKGROUND: Cardiac involvement is a major cause of death in SSc, while early detection remains a challenge. OBJECTIVES: The purpose of this study was to investigate the prevalence and clinical implications of cardiac impairment in SSc. METHODS: Ninety-five consecutive SSc patients [55.6 (13.8) years old, 5.3 (8.1) years from diagnosis] were included in the study. Patients with heart diseases onset prior to SSc were excluded. All patients underwent two-dimensional speckle-tracking echocardiology (2D-STE) with measuring left and right ventricular global longitudinal strain (GLS/RGLS). Clinical manifestation, laboratory evaluation (CRP, cTnI, antibodies, etc.) and ECG were collected at the same time. Comparisons between the SSc subgroups (lcSSc and dcSSc) were performed using Student's t-test, Mann-Whitney U or Fisher's exact test. Binary logistic regression was applied to determine the independent effects of variables in cardiac impairment. RESULTS: Early left and right ventricular impairment measured by GLS and RGLS were detected in 22.1% and 24.2% of the SSc patients, respectively. In comparison, only 2.1% showed reduced left ventricular ejection fraction (LVEF). Impaired GLS was mainly observed in the basal and medial segments of anterior, lateral and posterior left ventricle walls, and more profound in dcSSc. Elevated CRP (OR 3.561 95% CI: 1.071, 11.839, P <0.05) was associated with reduced GLS/RGLS. The adoption of GLS/RGLS enhanced the efficacy of routine screening for cardiac impairment that 52.6% of patients showed potential cardiac impairment. CONCLUSIONS: Cardiac impairment is a common manifestation in SSc. Increasing awareness of early cardiac impairment is warranted with elevated CRP and dcSSc.

A cognitive evaluation and equity-based perspective of pay for performance on job performance: A meta-analysis and path model.

Pay for performance, as one of the most important means of motivating employees, has attracted the attention of many scholars and managers. However, controversy has continued regarding whether it promotes or undermines job performance. Drawing on a meta-analysis of 108 independent samples (N = 71,438) from 100 articles, we found that pay for performance was positively related to job performance. That pay for performance had a more substantial positive effect on task performance than contextual performance in workplace settings. From the cognitive evaluation perspective, we found that pay for performance enhanced employees' task performance and contextual performance by enhancing intrinsic motivation and weakened task performance and contextual performance by increasing employee pressure. From the equity perspective, our results indicated that the relationship between pay for performance and task performance was partially mediated by employee perceptions of distributive justice and procedural justice, with distributive justice having a more substantial mediating effect than procedural justice. However, the relationship between pay for performance and contextual performance was only partially mediated by procedural justice. Further tests of moderating effects indicated that the varying impacts of pay for performance are contingent on measures of pay for performance and national culture. The findings contributed to understanding the complex mechanisms and boundary conditions of pay-for-performance's effects on job performance, which provided insights for organizations to maximize its positive effects.

Assessment of type 2 diabetes mellitus patients' behavioral characteristics associated with integrated treatment and prevention services in community health centers in China.

Objective: The purpose of this study was to describe behavioral characteristics of type 2 diabetes mellitus (T2DM) patients, identify homogeneous clusters, and explore factors affecting behaviors associated with integrated treatment and prevention (ITP) services for T2DM in community health centers in China. Methods: A convenient sampling method was employed at a community health center between January and July 2022 in Nanjing. A total of 354 patients completed the self-reported questionnaires. After performing a Cluster Analysis to create a profile of participants' behaviors, a multiple linear regression analysis was conducted to explore the correlations between T2DM patients' characteristics and their behaviors associated with ITP services. Results: 316 T2DM patients with a mean age of 72.09 years (SD = 5.96) were included. The behavior profiles of patients associated with ITP services were clustered into "Lower" (n = 198) and "Higher" (n = 118) groups, with average scores of 54.41 and 71.46, respectively. Of all the behaviors, complication examination and public health utilization scored the lowest. Health insurance, duration of disease, and treatment modality were independent predictors on the patients' behaviors associated with ITP services for T2DM. Conclusion: Patients' behaviors associated with ITP services for T2DM were moderately good (the score rate was 63.98%). Of all the behaviors, complication examination and public health service utilization scored the lowest and, as such, may warrant further research. The clustering of patients' behaviors tends to be polarization, distributed at the upper and lower ends of the behavior spectrum. It is necessary to develop and implement targeted interventions for different groups to improve T2DM patients' behaviors associated with ITP services.

Elemental Impurities in Pediatric Calcium Carbonate Preparations-High Throughput Quantification and Risk Assessment.

Calcium carbonate which is extracted from the Earth in combination with other mineral impurities, is largely used in preparations for pediatric supplements. Elemental impurities in drug products pose toxicological concerns without therapeutic benefits. Thus, it is very urgent to assess the safety of chronic exposure to elements that may be present in trace amounts. In the present study, we developed high throughput ICP-MS method for the quantitative determination of 62 elemental impurities in high matric calcium carbonate samples and validated according to USP 233. Calcium carbonate preparations which state clearly used for child (including neonates, infants, toddlers and children) from 9 manufactures and two types of raw materials (light calcium carbonate and ground calcium carbonate) were investigated in terms of the content and variability of 62 elemental impurities. According to the results, ground calcium carbonate was more suitable to be used in pediatric preparations concerning elemental impurities. Parts of elemental impurities in CaCO3 preparations which are derived from the raw materials and the preparation process, may cause potential risks for children. These results indicate that it is necessary to establish a modern instrumental analysis method to evaluate and control elemental impurities in CaCO3 raw materials and preparations.

A Guideline-Based Decision Tree Achieves Better Glucose Control with Less Hypoglycemia at 3 Months in Chinese Diabetic Patients.

INTRODUCTION: China has the world's largest diabetes epidemic and has been facing a serious shortage of primary care providers for chronic diseases including diabetes. To help primary care physicians follow guidelines and mitigate the workload in primary care communities in China, we developed a guideline-based decision tree. This study aimed to validate it at 3 months with real-world data. METHODS: The decision tree was developed based on the 2017 Chinese Type 2 Diabetes (T2DM) guideline and 2018 guideline for primary care. It was validated with the data from two registry studies: the NEW2D and ORBIT studies. Patients' data were divided into two groups: the compliance and non-compliance group, depending on whether the physician's prescription was consistent with the decision tree or not. The primary outcome was the difference of change in HbA1c from baseline to 3 months between the two groups. The secondary outcomes included the difference in the proportion of patients achieving HbA1c < 7% at 3 months between the two groups, the incidence of self-reported hypoglycemia at 3 months, and the proportion of patients (baseline HbA1c ≥ 7%) with a HbA1c reduction ≥ 0.3%. The statistical analysis was performed using linear or logistic regression with inverse probability of treatment weighting with adjustments of confounding factors. RESULTS: There was a 0.9% reduction of HbA1c in the compliance group and a 0.8% reduction in the non-compliance group (P < 0.001); 61.1% of the participants in the compliance group and 44.3% of the participants in the non-compliance group achieved a HbA1c level < 7% at 3 months (P < 0.001). The hypoglycemic events occurred in 7.1% of patients in the compliance group vs. 9.4% in the non-compliance group (P < 0.001). CONCLUSION: The decision tree can help physicians to treat their patients so that they achieve their glycemic targets with fewer hypoglycemic risks. ( http://www.clinicaltrials.gov NCT01525693 & NCT01859598).

Cost-effectiveness analysis of the integrated control strategy for schistosomiasis japonica in a lake region of China: a case study.

BACKGROUND: Schistosomiasis japonica remains an important public health concern due to its potential to cause severe outcomes and long-term sequelae. An integrated control strategy implemented in the Peoples' Republic of China has been shown to be effective to control or interrupt the transmission of schistosomiasis. The objective of this study is to estimate the disease burden of schistosomiasis and assess the cost-effectiveness of the integrated control strategy focused on different major interventions at three stages for schistosomiasis control in a lake setting, to provide reference for policy making or planning. METHODS: Annual cost data of schistosomiasis control during 2009-2019 were obtained from the control program implementers in Jiangling County, Hubei Province, China. Economic costs are provided in constant 2009 Chinese Yuan (CNY). Epidemiological data of schistosomiasis were collected from the Jiangling county station for schistosomiasis control. Disease burden of schistosomiasis was assessed by calculating years of life lost (YLLs) owing to premature death, years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs were calculated as the sum of YLLs and YLDs. We then conducted a rudimentary cost-effectiveness analysis by determining the ratio by dividing the difference between the average cost of integrated control strategy at transmission control (2013-2016) or transmission interruption (2017-2019) and the average cost at stage of infection control (2009-2012) with the difference between the DALYs of schistosomiasis at different control stages. Descriptive statistics on the costs and DALYs were used in the analysis. RESULTS: The total economic costs for schistosomiasis control in Jiangling County from 2009 to 2019 were approximately CNY 606.88 million. The average annual economic costs for schistosomiasis prevention and control at stages of infection control (2009-2012), transmission control (2013-2016), and transmission interruption (2017-2019) were approximately CNY 41.98 million, CNY 90.19 million and CNY 26.06 million respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to 1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the infection control stage as the control, the incremental cost-effectiveness ratio of integrated control strategy was CNY 8505.5 per case averted, CNY 60 131.6 per DALY decreased at transmission control stage and CNY -2217.6 per case averted, CNY -18 116.0 per DALY decreased at transmission interruption stage. CONCLUSIONS: The disease burden of schistosomiasis decreased significantly with the implementation of the integrated prevention and control strategy. Surveillance and management on elder population should be strengthened to decrease diseases burden. There remains a need for well-conducted studies that examine the long-term cost-effectiveness of the integrated control strategy for schistosomiasis. GRAPHIC ABSTARCT.

Contrast-enhanced ultrasound: a valuable modality for extracapsular extension assessment in papillary thyroid cancer.

OBJECTIVES: To evaluate the diagnostic accuracy of preoperative contrast-enhanced ultrasound (CEUS) to detect extracapsular extension (ECE) and identify the relationship between ECE and nodule enhancement patterns in patients with papillary thyroid cancer (PTC). METHODS: Patients with suspected thyroid cancer underwent ultrasound (US) and CEUS examinations. The US and CEUS features of the PTC nodules and thyroid capsule were recorded and classified individually. The accuracy of US and CEUS in detecting ECE was compared individually, and its relationship with various tumour enhancement patterns was analysed. The presence or absence of ECE and cervical lymph node metastasis (LNM) was confirmed pathologically. RESULTS: The final dataset included 119 patients with 124 PTC nodules. Seventy-two (60.5%) of these patients with PTC had no ECE (including 38 patients with single capsule invasion), while the remaining 52 had ECE. A significant difference was found in nodules with non-capsule invasion, single capsule invasion, and ECE between the cervical LNM and non-LNM groups (p < 0.01). Receiver operating characteristic curve analysis demonstrated that area under the curve (AUC) of ECE for cervical LNM was higher than that of capsule invasion (71.9% vs. 49.6%). Moreover, the CEUS images acquired to detect ECE showed higher AUC values than those of US images (79.4% vs. 65.8%) (p = 0.02). Among the PTC nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%). CONCLUSIONS: Compared with conventional US, CEUS is a more valuable and non-invasive imaging modality to detect ECE. KEY POINTS: • Single capsular invasion was a poor predictor of cervical lymph node metastasis, while extracapsular extension assessments were clinically significant for predicting cervical lymph node metastasis. • CEUS is better than conventional US in detecting extracapsular extension in papillary thyroid carcinoma (AUC: 79.4% vs. 65.8%) (p = 0.02). • Among the thyroid papillary carcinoma nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of single capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%).

[Pollution Characteristics and Assessment of Heavy Metals in Atmospheric Deposition in Core Urban Areas,Chongqing].

Pollution characteristics and risk of heavy metals in atmospheric deposition in core urban areas of Chongqing were investigated for one year from December 2017 to November 2018.Six functional zones:suburb, education area, residential area, commercial area, transportation hub, and industrial-residential area in Chongqing were selected for monthly atmospheric deposition collection. Concentrations of Cd, Cr, Ni, and Pb were analyzed using AAS. The potential ecological risk index and geoaccumulation index were used to evaluate the heavy metals pollution. Results show that the concentrations of Cd, Cr, Ni, and Pb in the atmospheric deposition were 1.59, 72.68, 20.99, and 101.17 mg·kg-1, respectively, and their annual deposition fluxes were 0.39, 8.04, 2.41, and 10.41 mg·(m2·a)-1, respectively. Concentrations of heavy metals in autumn were significantly higher than those in the other three seasons, especially for Cd, and their deposition fluxes in winter were lowest. The potential ecological risk index of Cd was biggest, achieving a very high ecological hazard level, while the ecological risk of Cd and Pb in industrial-residential area was highest, and that of Cr and Ni, respectively, were highest in transportation hub and residential area. The geoaccumulation index indicated that the pollution of Cd was the highest, and that of Cr, Ni, and Pb was very low. The pollution in industrial-residential area and transportation hub was high, while that in the suburb was relatively low.

Rapid Assessment of Exercise State through Athlete's Urine Using Temperature-Dependent NIRS Technology.

Athletes usually take nutritional supplements and perform the specialized training to improve the performance of sport. A quick assessment of their athletic status will help to understand the current physical function of athletes' status and the effect of nutritional supplementation. Human urine, as one of the most important body indicators, is composed of many metabolites, which can provide effective monitoring information for physical conditions. In this study, temperature-dependent near-infrared spectroscopy (NIRS) technology was used to collect the spectra of athlete's urine for evaluating the feasibility of rapidly detecting the exercise state of the basketball player. To obtain the detection results accurately, several chemometrics methods including principal component analysis (PCA), variables selection method of variable importance in projection (VIP), continuous 1D wavelet transform (CWT), and partial least square-discriminant analysis (PLS-DA) were employed to develop a classifier to distinguish the physical status of athletes. The optimal classifying results were obtained by wavelet-PLS-DA classifier, whose average precision, sensitivity, and specificity are all above 0.95, and the overall accuracy of all samples is 0.97. These results demonstrate that temperature-dependent NIRS can be used to rapidly assess the physical function of athlete's status and the effect of nutritional supplementation is feasible. It can be believed that temperature-dependent NIR spectroscopy will obtain applications more widely in the future.

Differentiating Westlake Longjing tea from the first- and second-grade producing regions using ultra high performance liquid chromatography with quadrupole time-of-flight mass spectrometry-based untargeted metabolomics in combination with chemometrics.

There are numerous articles published for geographical discrimination of tea. However, few research works focused on the authentication and traceability of Westlake Longjing green tea from the first- and second-grade producing regions because the tea trees are planted in a limited growing zone with identical cultivate condition. In this work, a comprehensive analytical strategy was proposed by ultrahigh performance liquid chromatography-quadrupole time-of-flight mass spectrometry-based untargeted metabolomics coupled with chemometrics. The automatic untargeted data analysis strategy was introduced to screen metabolites that expressed significantly among different regions. Chromatographic features of metabolites can be automatically and efficiently extracted and registered. Meanwhile, those that were valuable for geographical origin discrimination were screened based on statistical analysis and contents in samples. Metabolite identification was performed based on high-resolution mass values and tandem mass spectra of screened peaks. Twenty metabolites were identified, based on which the two-way encoding partial least squares discrimination analysis was built for geographical origin prediction. Monte Caro simulation results indicated that prediction accuracy was up to 99%. Our strategy can be applicable for practical applications in the quality control of Westlake Longjing green tea.

Prediction of Prolonged Length of Stay for Stroke Patients on Admission for Inpatient Rehabilitation Based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set: A Study from 50 Centers in China.

BACKGROUND This study aimed to develop a risk prediction model for prolonged length of stay (LOS) in stroke patients in 50 inpatient rehabilitation centers in 20 provinces across mainland China based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set case mix on admission. MATERIAL AND METHODS In this cohort study, 383 stroke patients were included from inpatient rehabilitation settings of 50 hospitals across mainland China. Independent predictors of prolonged LOS were identified using multivariate logistic regression analysis. A prediction model was established and then evaluated by receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test. RESULTS Multivariate logistic regression analysis showed that the type of medical insurance and the performance of daily activities (ICF, d230) were associated with prolonged LOS (P<0.05). Age and mobility level measured by the ICF Generic Set demonstrated no significant predictive value. The prediction model showed acceptable discrimination shown by an area under the curve (AUC) of 0.699 (95% CI, 0.646-0.752) and calibration (χ²=11.66; P=0.308). CONCLUSIONS The risk prediction model for prolonged LOS in stroke patients in 50 rehabilitation centers in China, based on the ICF Generic Set, showed that the scores for the type of medical insurance and the performance of daily activities (ICF, d230) on admission were independent predictors of prolonged LOS. This prediction model may allow stakeholders to estimate the risk of prolonged LOS on admission quantitatively, facilitate the financial planning, treatment regimens during hospitalization, referral after discharge, and reimbursement.

Sex disparities in clinical characteristics and prognosis of immunoglobulin G4-related disease: a prospective study of 403 patients.

OBJECTIVES: To study the impact of sex on the clinical presentation of IgG4-related disease (IgG4-RD). METHODS: We prospectively enrolled 403 newly diagnosed IgG4-RD patients. We compared the demographic features, clinical manifestations, organ involvement, laboratory tests and treatment outcomes between female and male patients. The organs involved were divided into superficial organs (salivary glands, lacrimal glands, orbit, sinus and skin) and internal organs (all the other organs). The patients treated with glucocorticoids with or without additional immunosuppressants were included in the assessment of treatment outcomes, and potential confounding factors were corrected by propensity score matching or multivariate Cox regression analysis. RESULTS: Female patients showed younger age at both symptom onset and diagnosis, and a longer interval between symptom onset and diagnosis. Allergy history, Mikulicz's disease and thyroiditis were more common in female patients, while autoimmune pancreatitis, sclerosing cholangitis and retroperitoneal fibrosis were more common in male patients. In accordance, female patients more frequently presented with superficial organ involvement, while male patients more frequently had internal organ involvement, and the discrepancy was more prominent in the patients with older age. Male sex was associated with higher peripheral eosinophils, CRP and IgG4 levels at baseline. In response to glucocorticoid-based therapies, male sex was associated with a higher IgG4-RD responder index during follow-up as well as a greater risk of relapse (hazard ratio 3.14, P = 0.003). CONCLUSION: Our study revealed the sex disparities in clinical characteristics of IgG4-RD, and indicated that male sex was independently associated with worse prognosis in response to glucocorticoid-based therapies.

System-wide Clinical Assessment of Functioning Based on the International Classification of Functioning, Disability and Health in China: Interrater Reliability, Convergent, Known Group, and Predictive Validity of the ICF Generic-6.

OBJECTIVE: To validate the International Classification of Functioning, Disability and Health (ICF) Generic-6 in daily routine clinical practice in Mainland China. Specific objectives were to analyze (1) interrater reliability, (2) convergent validity, (3) known group validity, and (4) predictive validity of the ICF Generic-6. DESIGN: Multicenter prospective cohort study. SETTING: Fifty hospitals from 20 provinces of Mainland China. PARTICIPANTS: A total of 4510 patients from departments of rehabilitation, orthopedics, neurology, cardiology, pneumology, and cerebral surgery of the participating hospitals with different health conditions were included in this study. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The assessment was undertaken by nurses with ICF Generic-6 in combination with a numeric rating scale. Interrater reliability was evaluated with intraclass correlation coefficients (ICC). Convergent validity was evaluated with Spearman correlation coefficients between ICF Generic-6 and Medical Outcomes Short Form (SF)-12 items. Known group validity was examined by comparing discharge scores between different discharge destinations. Predictive validity was determined by using ICF Generic-6 baseline scores for estimating length of hospital stay with a loglogistic survival model with gamma shared frailty and cost of in-hospital treatment with a mixed effects generalized linear regression model of the gamma family. RESULTS: The interrater reliability of items and score of ICF Generic-6 was good with ICCs ranging from 0.67-0.87. ICF Generic-6 items were further correlated with respective SF-12 items. Discharge scores of patients differed significantly by discharge destination. The ICF Generic-6 admission score was a significant predictor of length of stay and treatment cost. CONCLUSIONS: The ICF Generic-6 administered in combination with a 0-10 numeric rating scale is a reliable and valid tool for the collection of minimal information on functioning across various clinical settings.

ICF Generic Set as new standard for the system wide assessment of functioning in China: a multicentre prospective study on metric properties and responsiveness applying item response theory.

OBJECTIVES: To examine metric properties and responsiveness of the International Classification of Functioning, Disability and Health (ICF) Generic Set when used in routine clinical practice to assess functioning. DESIGN: Prospective multicentre study. SETTING: 50 hospitals from 20 provinces of Mainland China. PARTICIPANTS: 4510 adult inpatients admitted to the departments of Pulmonology, Cardiology, Neurology, Orthopaedics, Cerebral Surgery or Rehabilitation Medicine. MAIN OUTCOME MEASURES: The ICF Generic Set (ICF Generic 6 Set) applied with an 11-point numeric rating scale (0-no problem to 10-complete problem) was fit to the Partial Credit Model (PCM) to create an interval score of functioning. RESULTS: PCM assumptions were found to be fulfilled after accounting for Differential Item Functioning. With an average improvement by 7.86 points of the metric ICF Generic 6 score (95% CI 7.53 to 8.19), the ICF Generic 6 Set proved sensitive to change (Cohen's f2=0.41). Ceiling and floor effects on detecting change in functioning were cancelled or reduced by using the metric score. CONCLUSION: The ICF Generic 6 Set can be used for the assessment of functioning in routine clinical practice and an interval score can be derived which is sensitive to change.