What fragile factors hinder the pace of China's alleviation efforts of the poverty-stricken population? A study from the perspective of impoverishment caused by medical expenses.

OBJECTIVE: China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3 and 14.4% of the total poverty-stricken population, respectively. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. In this study, we analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty. METHOD: Data were extracted from the Fifth National Health Service Survey in China in 2013 through a multi-stage, stratified, and random sampling method, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants. RESULTS: The poverty and impoverishment rate in China were 16.2 and 6.3% respectively. The poverty rate in western region was much higher than that of central and eastern regions. The rate of impoverishment by medical expense (IME) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. The New Cooperative Medical Scheme (NCMS) was associated with the highest rate (9.1%) of IME cases. The top three diseases associated with IME were malignant tumor, congenital heart disease, and mental disease. Households with non-communicable disease members or hospitalized members had a higher risk on IME. NCMS-enrolled, poorer households were more likely to suffer from IME. CONCLUSION: The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of IME. A combined strategy to precise target multiple vulnerabilities of poor population would be more effective.

Self-management behavior and fasting plasma glucose control in patients with type 2 diabetes mellitus over 60 years old: multiple effects of social support on quality of life.

OBJECTIVE: Elderly patients with type 2 diabetes mellitus are highly vulnerable due to severe complications. However, there is a contradiction in the relationship between social support and quality of life, which warrants further exploration of the internal mechanism. This study assessed the quality of life and its interfering factors in this patient population. METHODS: In total, 571 patients with type 2 diabetes mellitus over 60 years old were recruited from two community clinics in Heilongjiang Province, China. We collected data on health status, quality of life, self-management behavior, fasting plasma glucose (FPG) level, and social support. Structural equation modeling and the bootstrap method were used to analyze the data. RESULTS: The average quality of life score was - 29.25 ± 24.41. Poorly scored domains of quality of life were "Psychological feeling" (- 8.67), "Activity" (- 6.36), and "Emotion" (- 6.12). Of the 571 patients, 65.32% had normal FPG, 9.8% had high-risk FPG, 15.94% had good self-management behavior, and 22.07% had poor social support. Significant correlations among social support, self-management behavior, FPG level, and quality of life were noted. A multiple mediator model revealed that social support influenced quality of life in three ways: (1) directly (c' = 0.6831); (2) indirectly through self-management behavior (a1*b1 = 0.1773); and (3) indirectly through FPG control (a2*b2 = 0.1929). Self-management behavior influenced the quality of life directly and indirectly through FPG control. CONCLUSION: Improving self-management behavior and monitoring hypoglycemia should become priority targets for future intervention. Scheduled social support to self-management projects should be put into the standardized management procedure. Physicians should provide substantial and individualized support to the elderly patients with type 2 diabetes mellitus regarding medication, blood glucose monitoring, and physical exercise.

Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China.

BACKGROUND: China's fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. METHODS: Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. RESULTS: The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents' better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (- 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. CONCLUSION: The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.

Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system.

BACKGROUND: By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. METHODS: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. RESULTS: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is - 0.071 and - 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders' educational attainment both in integrated areas and non-integrated areas. CONCLUSIONS: The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

Identifying factors associated with depression among men living with HIV/AIDS and undergoing antiretroviral therapy: a cross-sectional study in Heilongjiang, China.

BACKGROUND: Depression is common among people living with HIV/AIDS; however, studies focusing on the depression of men living with HIV/AIDS are limited. Therefore, we examined the prevalence of depression and its associated factors among men living with HIV/AIDS in China. METHODS: A cross-sectional questionnaire survey was conducted in Harbin, China between March and August in 2013. Two-hundred twenty participants completed the Burns Depression Checklist, the Berger HIV Stigma, and the SPIEGEL questionnaire. We also investigated demographics, family support, hostility, and the antiretroviral therapy side effects of men living with HIV/AIDS. RESULTS: More than 40% of respondents had depressive symptoms and worry about the health was the major symptom of depression (40.9%). The logistic regression model indicated that bad sleep quality (OR = 3.452), hostility (OR = 1.120), perceived discrimination (OR = 1.110), and antiretroviral therapy side effects (OR = 1.083) were positively associated with depression. Family support (OR = 0.860) was negatively associated with depression for men living with HIV/AIDS. Demographic variables, HIV infection route, disease duration, and CD4+ cell count had no significant associations with depression. CONCLUSION: Although China's work of national HIV prevention and treatment has made much progress during the past several years, the prevalence of depression among men living with patients with HIV/AIDS is still prominent. The strongest factor associated with depression among men living with HIV/AIDS was sleep quality. Future studies should explore the effects of interventions for depression among PLWHA.

Evaluation of emergency drills effectiveness by center of disease prevention and control staff in Heilongjiang Province, China: an empirical study using the logistic-ISM model.

Introduction: Emergency drills are critical practices that can improve the preparedness for crisis situations. This study aims to comprehend the evaluation of emergency drill effectiveness by the staff at the Centers for Disease Control and Prevention (CDC) in Heilongjiang Province, China. It identifies potential factors that could influence the personnel's appraisal of outcomes throughout the emergency drill procedure. Methods: A cross-sectional survey was conducted among public health professionals from various CDCs in Heilongjiang, a northeastern Chinese province. The binary logistic regression analysis identified the factors associated with the CDC staff's assessment of emergency drill efficacy, while the Interpretative Structural Modeling (ISM) elucidated the hierarchical structure among the influencing factors. Results: 53.3% (95% CI = 50.6-55.4) of participants perceived the emergency drills' effectiveness as low. Binary logistic regression analysis revealed that the following adverse factors associated with the emergency drills increased the risk of a lower evaluation: lack of equipment and poor facilities (OR = 2.324, 95% CI = 1.884-2.867), poor training quality (OR = 1.765, 95% CI = 1.445-2.115), low leadership focus (OR = 1.585, 95% CI = 1.275-1.971), insufficient training frequency (OR = 1.539, 95% CI = 1.258-1.882), low skill in designing emergency drill plans (OR = 1.494, 95% CI = 1.180-1.890), lack of funding (OR = 1.407, 95% CI = 1.111-1.781), and poor coordination between departments (OR = 1.335, 95% CI = 1.085-1.641). The ISM revealed the hierarchical relationship of the influential factors, which were classified into three levels: Surface, Middle and Bottom. The Surface Level factors were training frequency, training quality, leaders' focus, and inter-departmental coordination. The Middle Level factors were equipment availability and skill in designing emergency drill plans. The Bottom Level factor was funding guarantee. Discussion: This survey revealed that over half of the CDC staff rated the effectiveness of public health emergency drills as low. The Logistic-ISM Model results indicated that the evaluation of drill effectiveness was negatively influenced by insufficient facility and equipment support, financial constraints, lack of departmental coordination, and inadequate leadership attention. Among these factors, funding guarantee was the most fundamental one. Therefore, this calls for strategic decisions to increase funding for equipment, leadership training support, and effective emergency coordination.

The bricolage mode of emergency medical teams in China: deficient and in urgent need of transformation-A qualitative study.

Introduction: Emergency medical rescue plays a vital role in alleviating the harm of all kinds of emergencies to people's physical and mental health and life safety. The current emergency medical teams (EMTs) formation model is not unified. We focused on the disadvantages of the bricolage mode of China EMTs and put forward empirical-based countermeasures to improve the emergency management ability of EMTs. Methods: From March to September 2022, 23 leaders of EMTs in North China (Tianjin) were selected by objective sampling method to conduct one-to-half structured in-depth interviews. Nvivo12.0 software was used for three-level coding. The disadvantages of the bricolage model of EMT were analyzed. Results: Based on the three-level coding, 150 initial concepts, 36 sub-coding, 17 main coding, six categories, and two core categories were sorted out. Management structure, internal stability, and support are recognized as the crucial elements armed with the EMTs. Discussion: The bricolage EMTs have disadvantages such as a chaotic management structure, weak internal stability, and inadequate support. It is necessary to construct full-time EMTs that incorporate a standardized personnel admission mechanism, full-time training and exercise mechanism, diversified incentive mechanism, and multi-agent cooperation mechanism, etc.

Human resource allocation status and equity research of Centers for Disease Control and Prevention in China from 2016 to 2020.

Background: In recent years, the development of global public health has become a matter of great concern and importance for governments worldwide. China, as the largest developing country, plays a crucial role in shaping the development of the public health and its ability to respond to sudden public health emergencies through the fairness of its human resource allocation in center for disease control and prevention (CDC). Objective: This study aims to analyze the situation of health human resource allocation in the China Centers for Disease Control and Prevention (China CDCs), assess the fairness of the allocation, and provide reference for the rational allocation of human resources. Methods: We selected data from the China Health Statistics Yearbook on healthcare technical personnel, other technical personnel, managerial personnel, and workforce technical personnel of China CDCs for the period of 2016-2020. We utilized the Health Resource Density Index to evaluate the level of human resource allocation in China CDCs. Additionally, we used the Gini coefficient and Theil index to assess the fairness of human resource allocation in China CDCs from both a population and geographical perspective. Results: Firstly, the educational qualifications and professional titles of CDC staff have improved, but the workforce is aging. Secondly, HRDI development trends vary among different personnel types and regions with varying levels of economic development. Finally, the results of the Gini coefficient and Theil index indicate that population distribution fairness is better than geographical distribution fairness. Overall, the unfair population distribution is primarily due to regional disparities. Conclusion: The China CDCs should tailor different standards for the allocation of health human resources based on regional characteristics, aiming to enhance the accessibility of health human resources in various regions and achieve equitable allocation.

Global attributed burden of death for air pollution: Demographic decomposition and birth cohort effect.

BACKGROUND: To identify the high-risk pollutants and evolving patterns of attributed mortality burden, more detailed evidence is needed to examine the contribution of different air pollutants to death across the disease spectrum, particularly considering population change as well as the context of the era. METHODS: We explored the evolving patterns of all-cause and disease-specific deaths attributed to overall air pollution and its main subcategories by using the estimated annual percentage change and additionally assessing the contribution of population growth and ageing to death burden using the decomposition method. Age-period-cohort model and Joinpoint analysis were used to evaluate birth cohort effects specific-disease death burden owing to high-risk air pollution subcategories. FINDINGS: The number of deaths caused by air pollution increased by 2.62 %, which was driven by ambient particulate matter pollution and ambient ozone pollution, whereas household air pollution decreased. Population ageing contributed 28.88 % of the deaths increase change for air pollution. Compared with other subcategories, the age-standardized mortality rate (ASMR) attributed to ambient particulate matter pollution remained the heaviest attributed death burden, comprehensively considering of bivariate burden. In 2019, ischemic heart disease attributed to ambient particulate matter pollution exhibited the highest ASMR, which may be impacted by a rapid increase era from 1950 to 1980 birth cohort in woman and 1970 to 1990 birth cohort in man. Diabetes mellitus attributed to ambient particulate matter pollution showed the largest increase for ASMR, which was driven primarily by men born 1910-1975 and women born 1950-1975.Uzbekistan showed the highest ASMR for ischemic heart disease, with Equatorial Guinea showing the fastest increase for diabetes mellitus. CONCLUSION: Priority intervention targets for air pollution and health should emphasize the susceptibility of the elderly population as well as the structural factors of the era, in particular sensitive diseases to the ambient particulate matter pollution.

Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials.

BACKGROUND: Sugar-sweetened beverages (SSBs) providing excess energy increase adiposity. The effect of other food sources of sugars at different energy control levels is unclear. OBJECTIVES: To determine the effect of food sources of fructose-containing sugars by energy control on adiposity. METHODS: In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library were searched through April 2022 for controlled trials ≥2 wk. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars), addition (energy from sugars added), subtraction (energy from sugars subtracted), and ad libitum (energy from sugars freely replaced). Independent authors extracted data. The primary outcome was body weight. Secondary outcomes included other adiposity measures. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. RESULTS: We included 169 trials (255 trial comparisons, n = 10,357) assessing 14 food sources at 4 energy control levels over a median 12 wk. Total fructose-containing sugars increased body weight (MD: 0.28 kg; 95% CI: 0.06, 0.50 kg; PMD = 0.011) in addition trials and decreased body weight (MD: -0.96 kg; 95% CI: -1.78, -0.14 kg; PMD = 0.022) in subtraction trials with no effect in substitution or ad libitum trials. There was interaction/influence by food sources on body weight: substitution trials [fruits decreased; added nutritive sweeteners and mixed sources (with SSBs) increased]; addition trials [dried fruits, honey, fruits (≤10%E), and 100% fruit juice (≤10%E) decreased; SSBs, fruit drink, and mixed sources (with SSBs) increased]; subtraction trials [removal of mixed sources (with SSBs) decreased]; and ad libitum trials [mixed sources (with/without SSBs) increased]. GRADE scores were generally moderate. Results were similar across secondary outcomes. CONCLUSIONS: Energy control and food sources mediate the effect of fructose-containing sugars on adiposity. The evidence provides a good indication that excess energy from sugars (particularly SSBs at high doses ≥20%E or 100 g/d) increase adiposity, whereas their removal decrease adiposity. Most other food sources had no effect, with some showing decreases (particularly fruits at lower doses ≤10%E or 50 g/d). This trial was registered at clinicaltrials.gov as NCT02558920 (https://clinicaltrials.gov/ct2/show/NCT02558920).

Can leisure and entertainment lifestyle promote health among older people living alone in China?-A simultaneous equation approach.

Objectives: With the surging number of older people living alone, their lifestyles and health status have aroused increasing concern. This study aims to investigate whether a leisure and entertainment lifestyle (LEL) can improve the multidimensional health among older people living alone and try to identify the latent mechanisms among them. Method: For this purpose, we extracted data from the Chinese General Social Survey (CGSS) and established a simultaneous equations model, comprising ordinary least square regression (OLS), two-stage least squares (2SLS), and the mediating effect model. Results: Older people living alone in China reported relatively better mental health status (3.64 ± 1.07), followed by physical health (3.41 ± 1.26) and social health (2.75 ± 1.18). In the OLS model, LEL significantly improved the social health of older people living alone (ß = 0.054, P < 0.01), followed by physical health (ß = 0.042, P < 0.01) and mental health (ß = 0.027, P < 0.01). After endogenous tests from 2SLS model and robustness tests, we found that more active LEL was associated with higher levels of physical health and mental health. However, LEL had no significant effect on the improvement of the social health of the older people living alone. Using the mediation analysis, exercise efficacy partially mediated the relationship of LEL with physical health and mental health, and the ratios were 19.75 and 24.85%, respectively. Similarly, positive life attitudes partially mediated the relationship between LEL and physical health, and LEL and mental health, with ratios of 10.65 and 26.83%, respectively. Conclusion: Our findings suggested that LEL is significantly associated with better physical and mental health for older people living alone in China, and the association is mediated by exercise efficacy and positive attitudes toward life. Promoting more leisure and recreational activities, upgrading exercise efficacy, and encouraging positive life attitudes are necessary health promotion measures in active aging policies for the wellbeing of older people living alone.

A Review of the Relationship between Lentil Serving and Acute Postprandial Blood Glucose Response: Effects of Dietary Fibre, Protein and Carbohydrates.

Pulse consumption has been shown to confer beneficial effects on blood glucose and insulin levels. Lentil consumption, in particular, consistently lowers acute blood glucose and insulin response when compared to starchy control foods. The mechanism by which lentils lower postprandial blood glucose response (PBGR) and insulin levels is unclear; however, evidence suggests that this effect may be linked to macronutrients and/or the amount of lentils consumed. This review attempts to consolidate existing studies that examined lentil consumption and glycemic and/or insulinemic responses and declared information on macronutrient composition and dietary fibre content of the foods tested. Collectively, these studies suggest that consumption of lentils reduces PBGR, with the minimum effective serving being ~110g cooked to reduce PBGR by 20%. Reductions in PBGR show modest-to-strong correlations with protein (45-57 g) and dietary fibre (22-30 g) content, but has weaker correlations with available carbohydrates. Increased lentil serving sizes were found to moderately influence relative reductions in peak blood glucose concentrations and lower the area under the blood glucose curve (BG AUC). However, no clear relationship was identified between serving and relative reductions in the BG AUC, making it challenging to characterize consistent serving-response effects.

Factors associated with peritraumatic stress symptoms among the frontline healthcare workers during the outbreak of COVID-19 in China.

OBJECTIVES: This study aimed to examine the prevalence of peritraumatic stress symptoms (PTSSs), perceived threat, social support and factors contributing to clinically significant PTSS among frontline COVID-19 healthcare workers (HCWs) in China. DESIGN AND SETTING: An online survey through self-administered questionnaires was conducted from 18 February to 4 March 2020, during the outbreak of COVID-19. OUTCOMES MEASURES: PTSS was assessed using the post-traumatic stress disorder (PTSD) self-rating scale. Demographic and socioeconomic characteristics, self-reported health, physical/psychological symptoms, perceived threat from frontline work and perceived social support were investigated. Multivariable line regression analysis distinguished factors associated with HCWs' PTSS scores. RESULTS: A total of 676 (58.1%) HCWs have shown clinically significant high levels of PTSS. Only 441 (37.9%) self-reported good health. Most had physical symptom(s) (915 (78.7%)), psychological symptom(s) (906 (77.9%)), inability to vent emotions (284 (24.4%)), emotional exhaustion (666 (57.3%)) and 1037 (89.2%) needed professional respect. Moreover, social support received was less than expected, and the receipt of psychological services/help scored the lowest (3.11±1.73). Combined psychological and physical symptoms, difficulty in releasing tension and venting emotions timely, fear of infection, emotional exhaustion and depersonalisation are significantly associated with PTSS scores among frontline HCWs. Working ≥8 hours, having the senior professional title, self-reported health, enjoying perfect protection and control measures, economic subsidy and control policy on reducing discriminatory practices are negatively correlated with PTSS scores. CONCLUSIONS: During the outbreak of COVID-19, frontline HCWs experienced clinically significant high levels of PTSS and heavy workload, and the emergency resulted in their inadequate psychosocial support. If this is left unchecked, HCWs have a higher risk of developing PTSD. Early detection, identification and person-directed, targeted multidisciplinary interventions should be undertaken to address various influencing factors. Comprehensive measures, including setting up emotional release channels, as well as providing psychological and social support intervention for HCWs globally, are highly recommended.

Evolving Patterns of Nutritional Deficiencies Burden in Low- and Middle-Income Countries: Findings from the 2019 Global Burden of Disease Study.

Low- and middle-income countries (LMICs) suffered the most from nutritional deficiencies (NDs). Although decades of efforts have reduced it, little is known about the changing trajectory of ND burden in LMICs. By extracting data of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we calculated indicators of incidence and disability-adjusted life years (DALYs) to measure the burden of NDs and its main subcategories in LMICs, including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, dietary iron deficiency, and other nutritional deficiencies by sex, age and spatial patterns. In LMICs, ND incidence still increased in the age group 15+ born before 2005, especially in males. The effort of reducing the DALYs of NDs has generated a strong decline in per age group. In the main subcategories of NDs, protein-energy malnutrition incidence in males age 45+ born before 1970 still increased. Despite vitamin A deficiency incidence and dietary iron deficiency, DALYs strongly experienced decreases over three decades while still remaining at the heaviest level in 2019, especially in females and children under 5 years. The top largest tendency estimates occurred in Mali' females and Bhutan' males. Zimbabwe was the only country with increased DALYs rate tendency in both sexes.

Global, Regional, and National Estimates of Nutritional Deficiency Burden among Reproductive Women from 2010 to 2019.

Women of reproductive age (15-49 years) are often considered a vulnerable population affected by nutritional deficiencies, impairing their health and that of their offspring. We briefly introduced (a) the incidence and disability-adjusted life years (DALYs) trends from 2010 to 2019 and (b) the correlation between sex differences and income levels and nutritional deficiencies of reproductive women firstly. Notably, the burden of overall nutritional deficiencies among reproductive women remained generally stable from 2010 to 2019, whereas the iodine and vitamin A deficiencies as a subcategory were associated with increased incidence rates and DALYs, respectively. A significant increasing trend occurred in South Asia, Southeast Asia, and Turkey for incidence, and Western Sub-Saharan Africa and Zimbabwe had a strong increase for DALYs. Further analysis of the correlation between nutritional deficiency incidence and economic capacity showed that they were not correlated with the income of women themselves, as was the result of income difference with men. The results of this study will help to identify gaps in nutritional deficiency burden among reproductive women and facilitate the development of regional or national responses. Compared with economic capital, macroscopic political guarantees and social and cultural capital are important measures to remedy the nutritional deficiencies of reproductive women.

Effect of Important Food Sources of Fructose-Containing Sugars on Inflammatory Biomarkers: A Systematic Review and Meta-Analysis of Controlled Feeding Trials.

BACKGROUND: Fructose-containing sugars as sugar-sweetened beverages (SSBs) may increase inflammatory biomarkers. Whether this effect is mediated by the food matrix at different levels of energy is unknown. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials on the effect of different food sources of fructose-containing sugars on inflammatory markers at different levels of energy control. METHODS: MEDLINE, Embase, and the Cochrane Library were searched through March 2022 for controlled feeding trials ≥ 7 days. Four trial designs were prespecified by energy control: substitution (energy matched replacement of sugars); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced). The primary outcome was C-reactive protein (CRP). Secondary outcomes were tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Independent reviewers extracted data and assessed risk of bias. GRADE assessed certainty of evidence. RESULTS: We identified 64 controlled trials (91 trial comparisons, n = 4094) assessing 12 food sources (SSB; sweetened dairy; sweetened dairy alternative [soy]; 100% fruit juice; fruit; dried fruit; mixed fruit forms; sweetened cereal grains and bars; sweets and desserts; added nutritive [caloric] sweetener; mixed sources [with SSBs]; and mixed sources [without SSBs]) at 4 levels of energy control over a median 6-weeks in predominantly healthy mixed weight or overweight/obese adults. Total fructose-containing sugars decreased CRP in addition trials and had no effect in substitution, subtraction or ad libitum trials. No effect was observed on other outcomes at any level of energy control. There was evidence of interaction/influence by food source: substitution trials (sweetened dairy alternative (soy) and 100% fruit juice decreased, and mixed sources (with SSBs) increased CRP); and addition trials (fruit decreased CRP and TNF-α; sweets and desserts (dark chocolate) decreased IL-6). The certainty of evidence was moderate-to-low for the majority of analyses. CONCLUSIONS: Food source appears to mediate the effect of fructose-containing sugars on inflammatory markers over the short-to-medium term. The evidence provides good indication that mixed sources that contain SSBs increase CRP, while most other food sources have no effect with some sources (fruit, 100% fruit juice, sweetened soy beverage or dark chocolate) showing decreases, which may be dependent on energy control. CLINICALTRIALS: gov: (NCT02716870).

Important Food Sources of Fructose-Containing Sugars and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials.

Background: Fructose providing excess calories in the form of sugar sweetened beverages (SSBs) increases markers of non-alcoholic fatty liver disease (NAFLD). Whether this effect holds for other important food sources of fructose-containing sugars is unclear. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials of the effect of fructose-containing sugars by food source at different levels of energy control on non-alcoholic fatty liver disease (NAFLD) markers. Methods and Findings: MEDLINE, Embase, and the Cochrane Library were searched through 7 January 2022 for controlled trials ≥7-days. Four trial designs were prespecified: substitution (energy-matched substitution of sugars for other macronutrients); addition (excess energy from sugars added to diets); subtraction (excess energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE. We included 51 trials (75 trial comparisons, n = 2059) of 10 food sources (sugar-sweetened beverages (SSBs); sweetened dairy alternative; 100% fruit juice; fruit; dried fruit; mixed fruit sources; sweets and desserts; added nutritive sweetener; honey; and mixed sources (with SSBs)) in predominantly healthy mixed weight or overweight/obese younger adults. Total fructose-containing sugars increased IHCL (standardized mean difference = 1.72 [95% CI, 1.08 to 2.36], p < 0.001) in addition trials and decreased AST in subtraction trials with no effect on any outcome in substitution or ad libitum trials. There was evidence of influence by food source with SSBs increasing IHCL and ALT in addition trials and mixed sources (with SSBs) decreasing AST in subtraction trials. The certainty of evidence was high for the effect on IHCL and moderate for the effect on ALT for SSBs in addition trials, low for the effect on AST for the removal of energy from mixed sources (with SSBs) in subtraction trials, and generally low to moderate for all other comparisons. Conclusions: Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. The evidence provides a good indication that the addition of excess energy from SSBs leads to large increases in liver fat and small important increases in ALT while there is less of an indication that the removal of energy from mixed sources (with SSBs) leads to moderate reductions in AST. Varying uncertainty remains for the lack of effect of other important food sources of fructose-containing sugars at different levels of energy control.

Family caregivers of rare disease: A survey on health-related quality of life in family caregivers for Gaucher disease patients in China.

BACKGROUND: Rare diseases affect the health-related quality of life (HRQoL) of patients and their family caregivers (FCs). However, limited evidence is available on the HRQoL of FCs of patients with Gaucher disease (GD). This study aimed to assess HRQoL and related factors among FCs of patients with GD in China. METHODS: A cross-sectional online survey was conducted with 49 FCs recruited by convenience sampling. Participants completed the Medical Outcome Study Short Form-36 (SF-36), Zung's Self-Rating Anxiety Scale, Zung's Self-Rating Depression Scale, the Multi-dimensional Scale of Perceived Social Support, the Herth Hope Index, and a questionnaire about FCs' and patients' sociodemographic characteristics. Single-sample t tests, one-way analysis of variance, and multivariate linear regression analysis were used to analyze the data analysis. RESULTS: Participating FCs had significantly lower scores in all eight SF-36 domains compared with the general population in China (p < 0.01). FCs' gender, education, daily care time, anxiety, and the perceived disease severity of patients were significant predictors of SF-36 physical component summary scores. Caregiving help from others, anxiety, perceived disease severity, and medical insurance type were significant predictors of SF-36 mental component summary scores. CONCLUSION: The findings showed FCs of patients with GD had lower HRQoL. There is an urgent need to address the health concerns of FCs of people with rare diseases including their HRQoL.

Economic burden and health related quality of life of ultra-rare Gaucher disease in China.

BACKGROUND: The diagnosis and health care of patients with rare diseases present a tremendous challenge worldwide. This study described the health care service utilization through participants' perspective and estimated the cost of illness (COI), and patients with Gaucher disease (GD)'s/caregivers' health-related quality of life in China. METHOD: An online retrospective survey of patients with GD and their caregivers was conducted during May-June 2018. Socio-demographic, health service utilization, disease-related expenses, social support, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the Short Form Health Survey (SF-36) were investigated. Using self-reported information, we estimated the annual COI, including direct healthcare, direct non-healthcare, and indirect costs. RESULTS: Forty patients and their 49 caregivers were surveyed. The patients' onset age of GD was 9.3 ± 10.9; their disease course was 3.5 ± 3.1 years. 21 (42.9%) patients had ≥ 2 caregivers, but 35 (71.4%) caregivers reported have no experience as a caregiver. 79.6% caregivers have stopped working, and 87.8% changed weekly working schedule. Before final diagnosis, patients visited 3.9 ± 3.1 (max = 20) hospitals and took 1.2 ± 1.7 (max = 6.6) years for confirmed diagnosis. On average, 5.0 ± 9.6 misdiagnoses occurred, and the per-patient diagnoses cost was USD ($) 7576. After GD confirmation, 8 (16.3%) patients received no treatment, 40 (81.6%) received pharmacotherapy, 10 (20.4%) received surgery, 38 (77.6%) received outpatient service (8.8 ± 9.1 times/annually), and 37 (77.5%) received inpatient service (4.0 ± 3.5 times/annually). Annual per-patient COI was USD ($) 49,925 (95% confidence interval: 29,178, 70,672). Average direct healthcare cost was $41,816, including pharmaceutical ($29,908), inpatient ($7,451), and outpatient ($1,838). Productivity loss per-caregiver was $1,980, and their Zarit Burden Inventory score was moderate-severe (48.6 ± 19.6). Both patients/caregivers reported lower social support (32.4 ± 7.4, 34.9 ± 7.6), two times higher PSQI (7.9 ± 2.9, 8.7 ± 3.6), and half lower SF-36 (41.3 ± 18.6, 46.5 ± 19.3) than those reported for healthy Chinese individuals. CONCLUSIONS: The high misdiagnosis rate, together with delayed diagnosis, substantial costs, and deteriorated health-related quality of life of GD patients as well as their heavy care burden, calls for extreme attention from policymakers in China. Further efforts of government and society are urgently demanded, including pharmaceutical reimbursement, screening newborns, developing precise diagnostic tools, and training doctors.

Comparative and quantitative analysis of COVID-19 epidemic interventions in Chinese provinces.

A mathematical model was developed to evaluate and compare the effects and intensity of the coronavirus disease 2019 prevention and control measures in Chinese provinces. The time course of the disease with government intervention was described using a dynamic model. The estimated government intervention parameters and area difference between with and without intervention were considered as the intervention intensity and effect, respectively. The model of the disease time course without government intervention predicted that by April 30, 2020, about 3.08% of the population would have been diagnosed with coronavirus disease 2019 in China. Guangdong Province averted the most cases. Comprehensive intervention measures, in which social distancing measures may have played a greater role than isolation measures, resulted in reduced infection cases. Shanghai had the highest intervention intensity. In the context of the global coronavirus disease 2019 pandemic, the prevention and control experience of some key areas in China (such as Shanghai and Guangdong) can provide references for outbreak control in many countries.