Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019.

BACKGROUND: Tuberculosis(TB) remains a pressing public health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major threat. And healthcare authorities require reliable epidemiological evidence as a crucial reference to address this issue effectively. The aim was to offer a comprehensive epidemiological assessment of the global prevalence and burden of MDR-TB from 1990 to 2019. METHODS: Estimates and 95% uncertainty intervals (UIs) for the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASR of DALYs), and age-standardized death rate (ASDR) of MDR-TB were obtained from the Global Burden of Disease (GBD) 2019 database. The prevalence and burden of MDR-TB in 2019 were illustrated in the population and regional distribution. Temporal trends were analyzed by using Joinpoint regression analysis to calculate the annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval(CI). RESULTS: The estimates of the number of cases were 687,839(95% UIs: 365,512 to 1223,262), the ASPR were 8.26 per 100,000 (95%UIs: 4.61 to 15.20), the ASR of DALYs were 52.38 per 100,000 (95%UIs: 22.64 to 97.60) and the ASDR were 1.36 per 100,000 (95%UIs: 0.54 to 2.59) of MDR-TB at global in 2019. Substantial burden was observed in Africa and Southeast Asia. Males exhibited higher ASPR, ASR of DALYs, and ASDR than females across most age groups, with the burden of MDR-TB increasing with age. Additionally, significant increases were observed globally in the ASIR (AAPC = 5.8; 95%CI: 5.4 to 6.1; P < 0.001), ASPR (AAPC = 5.9; 95%CI: 5.4 to 6.4; P < 0.001), ASR of DALYs (AAPC = 4.6; 95%CI: 4.2 to 5.0; P < 0.001) and ASDR (AAPC = 4.4; 95%CI: 4.0 to 4.8; P < 0.001) of MDR-TB from 1990 to 2019. CONCLUSIONS: This study underscored the persistent threat of drug-resistant tuberculosis to public health. It is imperative that countries and organizations worldwide take immediate and concerted action to implement measures aimed at significantly reducing the burden of TB.

Global prevalence, burden and trend in HIV and drug-susceptible tuberculosis co-infection from 1990 to 2019 and prediction to 2040.

Objectives: The purpose of this study is to describe the current situation and forecast the trends of co-infection between the human immunodeficiency virus (HIV) and drug-susceptible tuberculosis (DS-TB) in different countries, across various age groups and genders. Methods: We obtained data on the number of cases, age-standardized incidence rate, age-standardized prevalence rate, age-standardized rate of disability-adjusted life years (DALYs), and age-standardized death rate from the Global Burden of Disease (GBD) 2019 database. These data were used to describe the distribution and burden of co-infection between the human immunodeficiency virus (HIV) and DS-TB in different regions, genders, and age groups. We employed joinpoint regression analysis to analyze the temporal trends from 1990 to 2019. Additionally, an age-period-cohort model was established to forecast the future trends of co-infection up to 2040. Results: The prevalence and burden of co-infection varied across different age groups and genders. The territories with the higher disease burden were distributed in some Asian and African countries. In terms of temporal trends, the age-standardized incidence rate and age-standardized prevalence rate of HIV and DS-TB co-infection exhibited an overall increasing trend from 1990 to 2019, and the prediction indicated a slow downward trend from 2019 to 2040. Conclusions: The co-infection of HIV and DS-TB posed a grave threat to public health and economic development. What's more, there existed a significant disparity between the actual state of co-infection and the desired goals for prevention and control.

The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data.

BACKGROUND: Healthy China is a nationwide health strategy aiming at improving health from diverse dimensions, and strengthening high-quality assessment is essential for its stimulation. However, there is limited evidence in the surveillance of the actual performance of the initiative at regional levels. This study innovatively proposes a two-step surveillance process which comprehensively monitors Healthy China Initiative based on regional realities, thus provides guidance for policymaking. METHODS: A flexible indicator system was firstly developed basing on Delphi survey and focus group discussions. And then the Analysis Hierarchical Process and the TOPSIS method were used to determine the weights of indicators and calculate comprehensive indexes as the surveillance outcomes. A pilot study was conducted in a typical area in China to verify the applicability of the process. RESULTS: Following the surveillance process and basing on the implementation of Healthy China Initiative in the target region, an indicator system comprised of 5 domains and 23 indicators with weights was first developed specifically for the pilot area. Then 1848 interagency data of the study area were collected from 8 provincial institutions/departments to calculate the indexes and ranks of the five domains which were health level, healthy living, disease prevention and control, health service, and healthy environment. The outcomes showed that Healthy China Initiative in the pilot area had been constantly improved since the strategy proposed, while there were still issues to be tackled such as the deficient monitoring mechanisms and unevenly development progress. CONCLUSIONS: This study proposed a pragmatic surveillance process with indicators which could be tailored for specific context of target regions and produce meaningful surveillance outcomes to inform decision-making for policymakers, and also provided a theoretical foundation as well as empirical evidence for further health strategies and plannings assessment studies.

Life cycle assessment and carbon reduction potential prediction of electric vehicles batteries.

Electric vehicles (EVs) battery is a crucial component of energy storage components for electric vehicles. However, the environmental impact of EVs battery is still not clear. Therefore, this paper establishes a cradle-to-cradle life cycle assessment (LCA) frame and clarifies the environmental impacts on the entire lifespan of EVs battery in China. Specifically, the environmental impact of battery production, battery use, and recycling & disposal stages are analyzed and measured. In addition, the carbon reduction potential of recycling and secondary use under a future electricity mix is estimated. Results show that: (1) The production stage of EVs battery with the carbon emission of 105 kgCO2-eq/kWh, which has the most significant impact on the environment. (2) In the recycling process, cascade utilization can reduce 1.536 kgCO2-eq/kWh carbon emission. In terms of recycling methods, hydrometallurgy can reduce the most carbon emission (13.3 kgCO2-eq/kWh), followed by the combined hydro-pyrometallurgical process (8.11 kgCO2-eq/kWh) and pyrometallurgy (0.57 kgCO2-eq/kWh). (3) Under the estimated electricity mix in 2030, 2040, and 2050, the carbon emission in battery production can be approximately reduced by 31.9 %, 45 %, and 48.1 %, respectively.

The impact of financial development on CO2 emissions of global iron and steel industry.

As carbon peaking and carbon neutrality have become a global consensus, more and more countries have introduced relevant policies to adapt to their own countries and formulated corresponding time roadmap. The industrial sector, especially the steel sector, which produces high levels of pollution and carbon emissions, is facing significant pressure to transform its operations to reduce CO2 emissions. Previous studies have shown the importance of financial development (FD) in environmental protection; however, the impact of FD on the CO2 emissions of the steel sector is ignored. This paper examines the impact of FD on the CO2 emissions of the iron and steel industry from a global perspective using comprehensive panel data from a total of 30 countries during the period from 1990 to 2018. Empirical results show that an improved level of FD in a given country reduces the CO2 emissions of the iron and steel industry. The mechanism analysis indicates that FD promotes the upgrading of the structure of the iron and steel industry and the reduction of the CO2 emissions by means of the three-stage least square method. Our results also show that the effect of FD on reducing the CO2 emissions of the iron and steel industry in developing countries is less than its effect in developed countries. Estimation results also show the existence of the environmental Kuznets curve hypothesis in the iron and steel industry. Finally, we discuss the policy implications of achieving carbon neutrality in the steel sector.

Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China.

Objective: The aim of this study was to investigate the prevalence of workplace violence against health care workers, to explore the combined association of work stress, psychological job demands, and social approval with workplace violence and their respective mechanisms among health care workers. Methods: Using data from the Chinese Sixth National Health Service Survey (NHSS) in 2018 conducted among 1,371 health care workers in Sichuan province of China. A self-administered structured questionnaire was used to collect data on health care workers' socio-demographic and work-related characteristics, work stress, psychological job demands, social approval, and workplace violence. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. Results: The results showed that a total of 77.0% health care workers were exposed to workplace violence. Work stress was directly related to workplace violence (ß = 2.167, 95%CI: 1.707, 2.627), while psychological job demands and social approval had indirect associations with workplace violence via work stress [ß = 0.427, 95%CI: 0.297, 0.557; ß = -0.787, 95%CI: (-0.941)-(-0.633)]. Both psychological job demands (ß = 0.197, 95%CI: 0.139, 0.255) and social approval [ß = -0.346, 95%CI: (-0.399)-(-0.294)] had direct associations with work stress, while social approval had direct association with psychological job demands [ß = -0.085, 95%CI: (-0.136)-(-0.034)]. Psychological job demands mediated the relationship between social approval and work stress. Conclusion: Overall, decreasing workplace violence among health care workers requires to promote interventions to reduce work stress and psychological job demands by improving social approval.

[Application of modified overt aggression scales on risk behavior assessment of patients with mental illness].

OBJECTIVE: To explore the value of Modified Overt Aggression Scales (MOAS) in assessing risk behavior of patients with mental illness. METHODS: Four hundred and ninety patients, who were from three mental health institutions (Refined Control Ward in Ankang Hospital, Mental Health Center of West China Hospital, Relief Ward in De Kang Hospital) belong to public security, health and civil system respectively, were evaluated with MOAS. RESULTS: Three hundred and thirteen patients did not have dangerous behavior, but 177 patients did (99 aggression, 78 violence). The descending order of risk behavior in patients with mental illness were Refined Control Ward in Ankang Hospital, Mental Health Center of West China Hospital, Relief Ward in De Kang Hospital. Physical and total aggression scores were higher in Refined Control Ward in Ankang Hospital than that in other two hospitals (P < 0.05). Autoaggression score in Mental Health Center of West China Hospital was higher than that in other two hospitals (P < 0.05). Physical and total aggression scores in male were higher than that in female (P < 0.05). Autoaggression score in female was higher than that in male (P < 0.05). Score of every single item and total score were higher in violent and aggressive group than that in non dangerous behavior group (P < 0.05). Physical and total aggression scores in violent group were higher than that in aggressive group (P < 0.05). CONCLUSION: The proportion, type and degree of risk behaviors in three mental health institutions are different and the type of risk behavior has gender difference.

Assessment of dietary intake among pregnant women in a rural area of western China.

BACKGROUND: Adequate maternal nutrient intake during pregnancy is important to ensure satisfactory birth outcomes. There are no data available on the usual dietary intake among pregnant women in rural China. The present study describes and evaluates the dietary intake in a cohort of pregnant women living in two counties of rural Shaanxi, western China. METHODS: 1420 pregnant women were recruited from a trial that examined the effects of micronutrient supplementation on birth outcomes. Dietary information was collected at the end of their trimester or after delivery with an interviewed-administrated semi-quantitative food frequency questionnaire (FFQ). Nutrients intake was calculated from the FFQ and compared to the Estimated Average Requirements (EAR). The EAR cut-offs based on the Chinese Nutrition Society Dietary Reference Intakes (DRIs) were used to assess the prevalence of inadequate dietary intakes of energy, protein, calcium, zinc, riboflavin, vitamin C and folate. Mann-Whitney U and Kruskal Wallis tests were used to compare nutrient intakes across subgroups. RESULTS: The mean nutrient intakes assessed by the FFQ was similar to those reported in the 2002 Chinese National Nutrition and Health Survey from women living in rural areas except for low intakes of protein, fat, iron and zinc. Of the participants, 54% were at risk of inadequate intake of energy. There were high proportions of pregnant women who did not have adequate intakes of folate (97%) and zinc (91%). Using the "probability approach", 64% of subjects had an inadequate consumption of iron. CONCLUSION: These results reveal that the majority of pregnant women in these two counties had low intakes of nutrients that are essential for pregnancy such as iron and folate. TRIAL REGISTRATION: ISRCTN08850194.

[The application of decision tree in the research of anemia among rural children under 3-year-old].

OBJECTIVE: To study the application of decision tree in the research of anemia among rural children. METHODS: In the Enterprise Miner module of software SAS 8.2, 3000 observations were sampled from database and the decision tree model was built. The model using decision tree of CART bases on Gini impurity index. RESULTS: The misclassification rate of decision tree model was, training set 21.2%, validation set 21.9%. The Root ASE of decision tree model was, training set 0.399, validation set 0.404. The area under the ROC curve was larger than the reference line. The diagnostic chart showed that the corresponding percentage was higher than the other. The decision tree model selected 9 important factors and ranked them by their power, among which mother of anemia (1.00) was the most important factor. Others were children's age (0.75), time of ablactation (0.53), mother's age (0.32), the time of egg supplementation (0.26), category of the project county (0.26), the time of milk supplementation (0.16), number of people in the family (0.13), the education status of the mother (0.12). Decision tree produced simple and easy rules that might be used to classify and predict in the same research. CONCLUSION: Decision tree could screen out the important factors of anemia and identify the cutting-points for factors. With the wide application of decision tree, it would exhibit important application values in the research of the rural children health care.