Social innovation in health training to engage researchers in resource-limited settings: process description and evaluation.

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.

Solid rocket motor propellant health monitoring based on oxide-doped curved long-period fiber grating.

A kind of curved long-period fiber grating(CLPFG) engraved by CO2 laser based on oxide-doped fiber was designed to monitor the structural integrity of propellant. The mechanical damage characteristics of the propellant were analyzed. The sensor model is constructed and the refractive index modulation characteristics of the CLPFG are analyzed. The strain coupling characteristics and the strain transfer efficiency of the interface between the CLPFG and the propellant are clarified. Propellant modules with implanted CLPFG were fabricated. The novel grating sensor has been effectively coated and structurally packaged. Conducted experiments on strain and temperature of propellant modules. The large strain measurement of propellant from 0 µÎµ to 24000 µÎµ is realized. Solved the thorny problem of large strain measurement for propellants. In addition, the temperature discrimination measurement in the temperature range of 30 ℃ to 250 ℃ can be realized. Sensor exhibit extremely high stability characteristics and has good compatibility with propellants. The sensor implantation and extraction structure has been designed to improve the survival rate of the sensor inside the solid rocket motors (SRM). Sensors can accurately measure the mechanical and thermal state parameters of propellants, providing effective data support for the health management of SRM.

Ecological risk assessment under the PSR framework and its application to shallow urban lakes.

Shallow urban lakes are naturally vulnerable to ecosystem degradation. Rapid urbanization in recent decades has led to a variety of aquatic problems such as eutrophication, algal blooms, and biodiversity loss, increasing the risk to lake-wide ecological sustainability. Instead of a simple binary assessment of ecological risk, holistic evaluation frameworks that consider multiple stressors and receptors can provide a more comprehensive assessment of overall ecological risk. In this study, we analyzed a combined dataset of government statistics, remote sensing images, and 1 year of field measurements to develop an index system for urban lake ecological risk assessment based on the pressure-state-response (PSR) framework. We used the developed ecological safety index (ESI) system to evaluate the ecological risk for three urban lakes in Jiangsu Province, China: Lake Yangcheng-LYC, Lake Changdang-LCD, and Lake Tashan-LTS. LYC and LTS were classified as "mostly safe" and "generally recognized as safe," respectively, while LCD was assessed as having "potential ecological risk." Our data suggest that socioeconomic pressure and aquatic health are the two main factors affecting the ecological risk in both LYC and LCD. The ecological risk of LTS could be improved more effectively if regional management plans are well implemented. Our study highlights the pressure of external wastewater loading, low forest-grassland coverage, and lake shoreline damage on the three selected urban lakes. The findings of this study can inform watershed management for lake ecosystem restoration and environmental sustainability.

Job preferences of Chinese primary health care workers: A discrete choice experiment.

OBJECTIVE: Primary health workers (PHWs) are a critical pillar of health systems but primary health care centers often struggle to attract and retain talented staff. To better understand why this is, we investigated the job preference of PHWs in a Chinese urban setting. METHODS: In a discrete choice experiment, PHWs from 15 primary health care centers in Guangzhou, China, made trade-offs between several hypothetical job scenario combinations of salary, type of health institution, bianzhi (permanent post), work years required for promotion, career development and training opportunities, educational opportunities for children, and community respect. Based on the estimate of the mixed logit model, willingness to pay and policy simulations were applied to estimate the utility of each attribute. RESULTS: Data were collected from 446 PHWs. The PHWs were willing to forgo Chinese Renminbi 2806.1 (US$ 438.5) per month to obtain better education opportunities for their children, making it the most important non-monetary factor. Their preferences were also influenced relatively more by salary, bianzhi, and community respect, than with the other attributes we tested for, work years required for promotion, career development and training opportunities, and type of health institution. CONCLUSION: Salary is a robust predictive factor, while three non-monetary factors (opportunities for children's education, bianzhi, and community respect) are essential in retaining health workers in primary care.

Prosocial Interventions and Health Outcomes: A Systematic Review and Meta-Analysis.

Importance: Prosocial interventions encourage voluntary actions that benefit others. Community solidarity in response to the COVID-19 pandemic, expanding mutual aid programs, and health workforce issues have accelerated prosocial health interventions. Objective: To investigate the association of prosocial interventions with health outcomes in clinical trials and observational studies. Data Sources: In this systematic review and meta-analysis informed by the Cochrane Handbook for Systematic Reviews of Interventions, 5 databases (MEDLINE [via PubMed], Embase, CINAHL, PsycInfo, and Scopus) were searched from database inception through February 23, 2023. The search included terms for altruism and prosocial behaviors, health outcomes, and study type. Study Selection: Included studies, determined by multiple reviewers, compared health outcomes in a prosocial intervention group with a nonintervention group. Data Extraction and Synthesis: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, data extraction and synthesis captured quantitative and qualitative data. To pool data from quantitative studies, random-effects meta-analyses were used to estimate the impact of prosocial interventions. To combine data from quantitative and qualitive studies, data were transformed into qualitative narratives using meta-aggregation. Main Outcomes and Measures: The main outcome was whether prosocial interventions were associated with improved health outcomes. Barriers to and facilitators of implementation of these interventions were assessed. Results: The search identified 5229 citations; 30 studies were included in the synthesis. Studies indicated that prosocial interventions were associated with positive health outcomes for givers (17 studies [56.7]) and recipients (8 [26.7%]). Prosocial interventions included acts of kindness (12 studies [40.0%]), cash gifts (7 [23.3%]), pay-it-forward approaches (6 [20.0%]), and expressions of kindness (5 [16.7%]). Improvements were reported in depression, testing for sexually transmitted diseases, vaccine uptake, physical activity, and individual biomarkers. Data from 6 studies (20.0%) demonstrated that pay-it-forward approaches were associated with increased uptake of diagnostic tests or vaccines among vulnerable groups (moderate certainty of evidence). Data from 14 studies (46.7%) suggested that community connectedness facilitated prosocial interventions. Shared vulnerabilities among groups (eg, sexual minority individuals, older adults) may provide a context for collective mobilization to improve health in local communities. Conclusions and Relevance: This systematic review and meta-analysis found that prosocial interventions were associated with improved health outcomes among vulnerable groups and have been useful for addressing health disparities. Further research is needed to develop and evaluate prosocial interventions.

Automating General Movements Assessment with quantitative deep learning to facilitate early screening of cerebral palsy.

The Prechtl General Movements Assessment (GMA) is increasingly recognized for its role in evaluating the integrity of the developing nervous system and predicting motor dysfunctions, particularly in conditions such as cerebral palsy (CP). However, the necessity for highly trained professionals has hindered the adoption of GMA as an early screening tool in some countries. In this study, we propose a deep learning-based motor assessment model (MAM) that combines infant videos and basic characteristics, with the aim of automating GMA at the fidgety movements (FMs) stage. MAM demonstrates strong performance, achieving an Area Under the Curve (AUC) of 0.967 during external validation. Importantly, it adheres closely to the principles of GMA and exhibits robust interpretability, as it can accurately identify FMs within videos, showing substantial agreement with expert assessments. Leveraging the predicted FMs frequency, a quantitative GMA method is introduced, which achieves an AUC of 0.956 and enhances the diagnostic accuracy of GMA beginners by 11.0%. The development of MAM holds the potential to significantly streamline early CP screening and revolutionize the field of video-based quantitative medical diagnostics.

A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: a cross-sectional study.

BACKGROUND: Non-communicable diseases (NCDs) pose a major challenge to health economic cost and residents' health status. Community health workers (CHWs) are the gatekeeper of primary health care. OBJECTIVE: This study aimed to conduct a situational analysis of current human resource and requirements of NCDs-related training among CHWs in Chengdu with regard to address to understand the suggestions for improvement of challenges and barriers. METHODS: A descriptive online cross-sectional survey was conducted among CHWs (doctors and nurses) from 23 districts and counties in Chengdu. Sociodemographic and NCDs-related variables were collected. Univariate analysis and multiple response analysis were used to describe the characteristics of these variables. RESULTS: 711 doctors and 637 nurses completely responded. There were significant differences among gender, age, educational levels, professional title, working year, type of institution, urban circle and registration in general practice between doctors and nurses (P < 0.001). 60.6% of doctors were female, compared to 98.0% for nurses. 58.2% of doctors held a bachelor's degree compared with 45.4% of nurses, while 48.3% of nurses held a junior college degree compared with 25.7% of doctors. Higher levels of professional title and registration in general practice were found in doctors compared with nurses. The proportions of NCDs' category, NCDs-related roles and tasks, NCDs-related training contents and forms that CHWs have attend and hoped to gain more were significantly different between doctors and nurses (P < 0.001). In general, the proportions in nurses were much lower than those of doctors (P < 0.05). The top five diseases managed by CHWs were hypertension, diabetes, cerebrovascular disease, chronic respiratory diseases and mental diseases. The five most reported roles performed among doctors included the distribution of health education (91.4%), following up (85.9%), establishing archives (71.3%), medicine adjustment (64.7%) and treatment implementation (52.0%). The top three diseases managed by nurses were same with doctors. The top four and five tasks were contact with patients or health services (39.6%) and referral (16.6%) in nurses. Most CHWs had received primary and common diseases-related trainings, but they had few opportunities to study in a tertiary hospital (40.4% in doctors and 20.9% in nurses, respectively), attend domestic academic conferences (26.9% in doctors vs. 9.7% in nurses), and take part in training courses (44.9% in nurses). CHWs hoped that the above-discussed training contents and forms could be provided more in the future. Besides basic skills related trainings, some specific skills related trainings should be strengthened. CONCLUSION: The qualifications in doctors were much better than those of nurses. The roles performed by CHWs in NCDs management are varied form common and frequent disease management to subsequent follow up and supervision. CHWs hope to receive more desired and oriented trainings. There is a need for building capacity of CHWs, optimizing and defining CHWs' role, facilitating postgraduate medical education support and strengthening multidisciplinary collaboration would be effective in NCDs management.

Pay-it-forward influenza vaccination among older adults and children: A cost-effectiveness analysis in China.

A quasi-experimental study was conducted to evaluate the effectiveness of a pay-it-forward strategy for increasing influenza vaccination among children and older adults compared to a self-paid vaccination strategy in China. Pay-it-forward is an innovative community-engaged intervention in which participants receive a free influenza vaccination and are then asked if they would like to donate or create a message to support subsequent vaccinations. This economic evaluation used a decision-tree model to compare pay-it-forward to a standard of care arm in which patients had to pay for their own influenza vaccine. The analysis was performed from the healthcare provider perspective and costs were calculated with 2020 United States dollars. The time horizon was one year. In the base case analysis, pay-it-forward was more effective (111 vs 55 people vaccinated) but more costly than standard-of-care ($4477 vs $2725). Pay-it-forward spurred 96.4% (107/111) of individuals to voluntarily donate to support influenza vaccination for high-risk groups in China. Further costing and implementation research is needed to inform scale up.

A real-world cost-effectiveness study of vancomycin versus linezolid for the treatment of late-onset neonatal sepsis in the NICU in China.

BACKGROUND AND OBJECTIVE: Currently, the detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceed the national average drug resistance level, and vancomycin and linezolid are the primary antibacterial drugs used for these resistant bacteria according to the results of etiological examinations. However, a comprehensive evaluation of their costs and benefits in late-onset neonatal sepsis in a neonatal intensive care unit (NICU) has not been conducted. This study aimed to compare the cost and effectiveness of vancomycin and linezolid in treating neonatal sepsis in the NICU. METHODS: A cost-effectiveness analysis of real-world data was carried out by retrospective study in our hospital, and the cost and effectiveness of vancomycin and linezolid were compared by establishing a decision tree model. The drug doses in the model were 0.6 g for linezolid and 0.5 g for vancomycin. The cost break down included cost of medical ward, NICU stay, intravenous infusion of vancomycin or linezolid, all monitoring tests, culture tests and drugs. The unit costs were sourced from hospital information systems. The effectiveness rates were obtained by cumulative probability analysis. One-way sensitivity analysis was used to analyze uncertain influencing factors. RESULTS: The effectiveness rates of vancomycin and linezolid in treating neonatal sepsis in the NICU were 89.74% and 90.14%, respectively, with no significant difference. The average cost in the vancomycin group was ¥12261.43, and the average cost in the linezolid group was ¥17227.96. The incremental cost effectiveness was ¥12416.33 cost per additional neonate with treatment success in the linezolid group compared to vancomycin group at discharge. Factors that had the greatest influence on the sensitivity of the incremental cost-effectiveness ratio were the price of linezolid and the effectiveness rates. CONCLUSIONS: The cost for treatment success of one neonate in linezolid group was ¥5449.17 more than that in vancomycin group, indicating that vancomycin was more cost-effective. Therefore, these results can provide a reference for a cost effectiveness treatment scheme for neonatal sepsis in the NICU.

Preferences for accessing sexual health services among middle-aged and older adults in the UK: a study protocol for a discrete choice experiment using mixed methods.

INTRODUCTION: Sexual health is essential for general health and well-being. Sexual health services for middle-aged and older adults are not prioritised and optimising available services for this population is often overlooked. Not much is known about preferences for accessing sexual health services among middle-aged and older people or level of satisfaction with current services. The aim of this study is to explore preferences for seeking sexual health services among middle-aged and older adults in the UK. This study will use discrete choice experiments (DCEs) including initial qualitative interviews followed by the survey, which have been used as a tool to explore preferences in various health service delivery. METHODS AND ANALYSIS: The project will be carried out in two phases. First, we will conduct in-depth semi-structured interviews with 20-30 adults (aged 45+), including disabled people, and those from sexual minority groups resident in the UK. Interviews will explore indications, preferences and factors related to accessing sexual health services. Themes and subthemes emerging from the analysis of the interviews will then be used to design the choice sets and attribute level for the DCEs. For the second phase, for the DCEs, we will design choice sets composed of sexual health service delivery scenarios. The software Ngene will be used to develop the experimental design matrix for the DCE. We will use descriptive statistics to summarise the key sociodemographic characteristics of the study population. Multinomial logit, latent class and mixed logit models will be explored to assess sexual health service preferences and preference heterogeneity. ETHICS AND DISSEMINATION: Ethical approval for both parts of this study was granted by the Research and Ethics Committee at the London School of Hygiene & Tropical Medicine. Findings from this study will be disseminated widely to relevant stakeholders via scheduled meetings, webinars, presentations and journal publications.

HPLC-CAD as a supplementary method for the quantification of related structure impurities for the purity assessment of organic CRMs.

In organic purity assessment, chromatography separation with a suitable detector is required. Diode array detection (DAD) has been a widely used technique for high-performance liquid chromatography (HPLC) analyses, but its application is limited to compounds with sufficient UV chromophores. Charged aerosol detector (CAD), as a mass-dependent detector, is advantageous for providing a nearly uniform response for analytes, regardless of their structures. In this study, 11 non-volatile compounds with/without UV chromophores were analyzed by CAD using continuous direct injection mode. The RSDs of CAD responses were within 17%. For saccharides and bisphenols, especially, the RSDs were lower (2.12% and 8.14%, respectively). Since bisphenols exist in UV chromophores, their HPLC-DAD responses were studied and compared with CAD responses, with CAD showing a more uniform response. Besides, the key parameters of HPLC-CAD were optimized and the developed method was verified using a Certified Reference Material (CRM, dulcitol, GBW06144). The area normalization result of dulcitol measured by HPLC-CAD was 99.89% ± 0.02% (n = 6), consistent with the certified value of 99.8% ± 0.2% (k = 2). The result of this work indicated that the HPLC-CAD method could be a good complementary tool to traditional techniques for the purity assessment of organic compounds, especially for compounds lacking UV chromophores.

Interpreting regional ecological security from perspective of ecological networks: a case study in Ningxia Hui Autonomous Region, China.

The rapid economic development and intense human activities have seriously restricted the sustainable development of ecology and the maintenance of ecosystem services. Ecological network can effectively connect fragmented habitats and is an important way to couple landscape structure, ecological process, and function. This study proposes a multimodel coupling framework to explore the ecological security status of Ningxia Hui Autonomous Region (NHAR) under different development scenarios from the perspective of ecological networks. The conclusions are as follows: (1) From 2000 to 2030, grassland and arable land were the main land types of NHAR. Grassland is the main expansion land type under the ecological land protection (ELP) scenario, while construction land is the main expansion land type in two other scenarios. (2) The main gather and change of the ecological sources occurred in the central region, and the ecological expansion should develop from the middle to the south. (3) The average area of ecological sources under BAU and RED scenarios is smaller than that under ELP scenario, and more ecological corridors are needed to connect. (4) The centrality of the ecological sources under the BAU scenario is generally high, but the ecological sources under ELP and RED scenarios have undergone spatial migration. In addition, the urbanization trend of NHAR is different under different scenarios, and more attention should be paid to the maintenance and protection of ecological networks in typical areas. This study can provide important reference for NHAR's ecological space planning and ecological protection policy formulation.

A Pay-It-Forward Approach to Improve Chlamydia and Gonorrhea Testing Uptake Among Female Sex Workers in China: Venue-Based Superiority Cluster Randomized Controlled Trial.

BACKGROUND: Regular chlamydia and gonorrhea testing are essential for key populations, such as female sex workers (FSWs). However, testing cost, stigma, and lack of access prevent FSWs in low- and middle-income countries from receiving chlamydia and gonorrhea testing. A social innovation to address these problems is "pay it forward," where an individual receives a gift (free testing) and then asks whether they would like to give a gift to another person in the community. OBJECTIVE: This cluster randomized controlled trial examined the effectiveness and cost of the pay-it-forward strategy in increasing access to chlamydia and gonorrhea testing among FSWs in China. METHODS: This trial integrated a pay-it-forward approach into a community-based HIV outreach service. FSWs (aged 18 years or older) were invited by an outreach team from 4 Chinese cities (clusters) to receive free HIV testing. The 4 clusters were randomized into 2 study arms in a 1:1 ratio: a pay-it-forward arm (offered chlamydia and gonorrhea testing as a gift) and a standard-of-care arm (out-of-pocket cost for testing: US $11). The primary outcome was chlamydia and gonorrhea test uptake, as ascertained by administrative records. We conducted an economic evaluation using a microcosting approach from a health provider perspective, reporting our results in US dollars (at 2021 exchange rates). RESULTS: Overall, 480 FSWs were recruited from 4 cities (120 per city). Most FSWs were aged ≥30 years (313/480, 65.2%), were married (283/480, 59%), had an annual income

Barriers that prevent adults living with HBV infection from participating in clinical research: experience from South Africa.

High profile international goals have been set for the elimination of hepatitis B virus (HBV) infection as a public health threat by the year 2030. Developing and expanding equitable, accessible translational HBV research programmes that represent real-world populations are therefore an urgent priority for clinical and academic communities. We present experiences and insights by an expert interdisciplinary group focusing on barriers that impede adults living with HBV infection from participating in clinical studies. Our viewpoint describes barriers we have identified through working in a variety of settings across South Africa, including lack of education and awareness, experiences of stigma and discrimination, challenges for governance and data management, and a burden of complex morbidity. Through identifying these challenges, we propose solutions and interventions, highlight new approaches, and provide a framework for future research.

Estimating national, regional and provincial cost-effectiveness of introducing childhood 13-valent pneumococcal conjugate vaccination in China: a modelling analysis.

Background: Although 13-valent pneumococcal conjugate vaccine (PCV13) is available in China's private market, it has yet to be introduced into the National Immunization Programme (NIP) and is therefore not available to large parts of the population. This study aimed to estimate the cost-effectiveness of including PCV13 in China's NIP at national and provincial levels. Methods: We adopted a decision-tree Markov model to estimate the cost-effectiveness of adding 3-dose PCV13 in the NIP compared to the status quo in the private market from a societal perspective. The model hypothesized a birth cohort for five years after vaccine introduction. Treatment costs and vaccine program costs were calculated from Chinese Center for Disease Control and Prevention (CDC) and national insurance databases. Disease burden data, incidence rate ratios, and other parameters were derived from published and grey literature. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were estimated at the provincial, regional, and national levels. One-way, scenario and probabilistic sensitivity analyses were conducted to explore model uncertainty. Findings: At the national level, introducing PCV13 in the NIP was predicted to prevent approximately 4807 pneumococcal deaths (66% reduction) and 1,057,650 pneumococcal cases (17% reduction) in the first five years of the 2019 birth cohort. Under the assumed base case price of US$ 25 per dose in the NIP, PCV13 in the NIP was cost-effective nationally with ICER of US$ 5.222 per QALY gained, and was cost-effective in 17 and cost-saving in 4 of the 31 provinces compared to the status quo. One-way and scenario sensitivity analyses indicated robust results when varying all model parameters, and probabilistic sensitivity analysis showed a 98% probability of cost-effectiveness nationally. Interpretation: Our findings highlight the cost-effectiveness of introducing PCV13 in China's NIP. Provincial results supported subnational introduction of PCV13, and priority should be given to less socioeconomically developed provinces. Since vaccination cost is the most influential model parameter, efforts to improve PCV affordability after pooled procurement will benefit public health in a cost-effective manner. Funding: The Bill & Melinda Gates Foundation.

Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis.

OBJECTIVES: This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. METHODS: We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. RESULTS: Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. CONCLUSIONS: Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.

Short- and Long-Term Effects of Underemployment on Workers' Health: Empirical Analysis from the China Labor Force Dynamics Survey.

Underemployment is a global problem. This study aimed to assess the short- and long-term effects of underemployment (hidden unemployment) on workers' health, using data from the China Labor-force Dynamic Survey (CLDS) 2016 and 2014. Indicators reflecting workers' self-rated health, mental health, prevalence of illness over time, and employment status were analyzed using logit regression models, propensity score matching methods, and instrumental variable methods. Empirical analyses showed that: (1) In the short-term, the impact on health is multidimensional, with underemployment significantly associated with a decline in workers' self-rated health, an increase in the propensity for depression, and an increase in the prevalence of illness over a certain period of time. (2) In the long-term, the experience of underemployment two years in the past is associated with a current decline in workers' mental health. That is, the negative effects of underemployment on workers' mental health persist and do not disappear rapidly over time. The results demonstrated that underemployment is detrimental to workers' health in the short- and long-term. In the context of epidemic prevention and control, the government and society should focus on this expanding group, establish labor protection mechanisms, and reduce the multiple effects of underemployment on workers' health.

Value of texture analysis based on dynamic contrast-enhanced magnetic resonance imaging in preoperative assessment of extramural venous invasion in rectal cancer.

OBJECTIVE: Accurate preoperative assessment of extramural vascular invasion (EMVI) is critical for the treatment and prognosis of rectal cancer. The aim of our research was to develop an assessment model by texture analysis for preoperative prediction of EMVI. MATERIALS AND METHODS: This study enrolled 44 rectal patients as train cohort, 7 patients as validation cohort and 18 patients as test cohort. A total of 236 texture features from DCE MR imaging quantitative parameters were extracted for each patient (59 features of Ktrans, Kep, Ve and Vp), and key features were selected by least absolute shrinkage and selection operator regression (LASSO). Finally, clinical independent risk factors, conventional MRI assessment, and T-score were incorporated to construct an assessment model using multivariable logistic regression. RESULTS: The T-score calculated using the 4 selected key features were significantly correlated with EMVI (p < 0.010). The area under the receiver operating characteristic curve (AUC) was 0.797 for discriminating between EMVI-positive and EMVI-negative patients with a sensitivity of 88.2% and specificity of 70.4%. The conventional MRI assessment of EMVI had a sensitivity of 23.53% and a specificity of 96.30%. The assessment model showed a greatly improved performance with an AUC of 0.954 (sensitivity, 88.2%; specificity, 92.6%) in train cohort, 0.833 (sensitivity, 66.7%; specificity, 100%) in validation cohort and 0.877 in test cohort, respectively. CONCLUSIONS: The assessment model showed an excellent performance in preoperative assessment of EMVI. It demonstrates strong potential for improving the accuracy of EMVI assessment and provide a reliable basis for individualized treatment decisions.

Assessment of left ventricular myocardial work done by noninvasive pressure-strain loop technique in patients with essential hypertension.

OBJECTIVE: To investigate the value of the noninvasive pressure-strain loop (PSL) technique for assessing left ventricular myocardial work done in patients with essential hypertension. METHODS: Prospectively, 60 patients with hypertension visiting the hospital from August 2020 to July 2021 were collected and divided into the mild hypertension group (SBP 140-159 mmHg, 35 cases) and the moderate-to-severe hypertension group (SBP ≥160 mmHg, 25 cases). Another 40 cases of healthy adults were collected as the control group. The differences in the global long-axis strain (GLS) and peak strain dispersion (PSD) of the left ventricle, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were compared among the three groups. The receiver operating characteristic curve was used to evaluate the PSD, GWI, GCW, and GWW. The myocardial work index (MWI) and MWI percentages in the apical, middle, and basal segments of the heart were also compared among the groups. RESULTS: (1) The PSD, GWI, GCW, and GWW were significantly different among the groups (Χ2  = 57.605, 79.203, 76.973, and 17.429, respectively, p < .05), while the GLS and GWE were not (Χ2  = 1.559 and 5.849, respectively, p > .05). (2) The GWI had the highest specificity (97.5%) and the GCW the highest sensitivity (95%) in predicting hypertension. The percentage of apical MWI gradually increased (F = 11.230, p < .05) and the percentage of basal MWI gradually decreased (F = 10.665, p < .05) from the control group to the mild hypertension group to the moderate-to-severe hypertension group; there was no significant difference in the percentage of mid-MWI (F = 0.593, p > .05). CONCLUSIONS: The noninvasive PSL technique could be used to assess myocardial work done in patients with essential hypertension.

Education Level, Underemployment, and Health.

Under the dual background of underemployment and health inequality, this study empirically analyzes the impact of education level on underemployed workers' health based on data from the 2016 China Labor-force Dynamics Survey. The results show that underemployment is significantly related to the decline of self-rated health, increased depressive tendencies, and the prevalence of illness over a certain period. The results indicate that underemployment can significantly reduce the health level of workers in both low and high education level groups. However, underemployment appears to have no significant impact on workers' health in the middle education level group. This result holds even if the measurement method of the indicators is adjusted and endogeneity is considered; this indicates that the research conclusions are robust. Moreover, this kind of health inequality mainly comes from the economic and leisure effects of underemployment for workers with different educational levels. Although underemployment significantly reduces the economic level of workers in each education level group, it brings a positive leisure effect to workers with a middle education level and a negative leisure effect to workers with a low education level. This study provides empirical support for increasing labor protection mechanisms for underemployed people and reducing the health inequality caused by differences in education level.