Research on the improvement path of grassroots social governance innovation performance in China--Qualitative comparative analysis based on 35 cases.

With the rapid development of China's economy and society, the innovation of grassroots social governance has become increasingly important. This paper constructs 35 grassroots social governance innovation samples. Using the TOE theoretical framework and a fuzzy set qualitative comparative analysis (fsQCA), this paper analyzes the joint effects and interactive relationships of multiple factors on grassroots social governance innovation performance from three dimensions: technology, organization, and environment. The research reveals that internal environmental openness is a necessary condition for achieving high innovation performance in grassroots social governance, and proposes four grouping models that affect the performance of grassroots social governance innovation. This paper explores the inner logic of grassroots social governance innovation from a histological perspective, and on this basis proposes an adaptive path to enhance the performance of grassroots social governance innovation.

Resilience assessment and obstacle factor analysis of urban areas facing waterlogging disasters: a case study of Shanghai, China.

In recent years, accelerated global warming, rainstorms, typhoons, and other natural disasters have been frequently observed, bringing immeasurable direct and indirect economic losses to urban areas. Determining how to further enhance the resilience of urban areas has become an important topic in economic and social development. Therefore, based on waterlogging scenarios, this study uses a more accurate research method combining the subjective evaluation AHP (analytic hierarchy process) method and objective evaluation TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) method to evaluate the urban resilience of 16 districts of the Shanghai megacity as the research objects and divides the resilience grade results using the ArcGIS natural breakpoint method. The results show that (1) the overall resilience of all districts in Shanghai needs to be further improved. Among the 16 districts in Shanghai, Pudong New Area has the highest urban resilience level. There are more areas with moderate and above-moderate resilience levels, while some areas with low and moderate resilience levels are distributed mainly in the downtown area of Shanghai. (2) Through the analysis of obstacles to the development of urban resilience in the districts of Shanghai, such obstacles tend to be the same under the waterlogging disaster scenarios. Compared to ecological and social policy resilience indices, economic resilience indices and infrastructure resilience indices significantly impact the resilience of urban districts under waterlogging scenarios. The above conclusions can not only help improve the direction of urban resilience governance in various districts of Shanghai but also provide empirical theoretical experience for the resilient construction of urban areas in the future.

A spatiotemporal analysis of urban resilience to the COVID-19 pandemic in the Yangtze River Delta.

The COVID-19 pandemic has severely affected the normal socioeconomic operation of countries worldwide, causing major economic losses and deaths and posing great challenges to the sustainable development of cities that play a leading role in national socioeconomic development. The strength of urban resilience determines the speed of urban social and economic recovery. This paper constructed a comprehensive evaluation index system for urban resilience under the COVID-19 pandemic scenario considering four dimensions-economy, ecology, infrastructure, and social systems-conducted a quantitative evaluation of urban resilience in the Yangtze River Delta of China, revealed its spatiotemporal differences and change trends, and proposed targeted strategies for improving urban resilience. The results show that (1) the Yangtze River Delta urban resilience system is growing stronger every year, but there are significant differences in the level of urban resilience, its spatial distribution and regional urban resilience. (2) In the Yangtze River Delta urban agglomeration, there is less distribution of areas with a higher resilience index, while those with high and medium resilience levels are more distributed. However, the resilience of most cities is low. (3) The resilience index of eastern coastal cities is significantly higher, and the resilience of cities under the COVID-19 scenario presents obvious east-west differentiation. (4) When constructing urban resilience, the individual situation of cities should be taken into account, measures adjusted according to local conditions, reasonable lessons drawn from effective international urban resilience construction, and reasonable planning policies formulated; it is important to give play to the relationship between the whole and the parts of resilience to achieve unified and coordinated development.

Establishment of a 5-gene risk model related to regulatory T cells for predicting gastric cancer prognosis.

BACKGROUND: Gastric cancer (GC) is one of the high-risk cancers that lacks effective methods for prognosis prediction. Therefore, we searched for immune cells related to the prognosis of GC and studied the role of related genes in GC prognosis. METHODS: In this study, we collected the mRNA data of GC from The Cancer Genome Atlas (TCGA) database and studied the immune cells that were closely related to the prognosis of GC. Spearman correlation analysis was performed to show the association between immune cell-related genes and the differentially expressed genes (DEGs) of GC. Univariate and multivariate Cox regression analyses were conducted on the immune cell-related genes with a high correlation with GC. A prognostic risk score model was constructed and the most significant feature genes were identified. Kaplan-Meier method was then used to compare the overall survival (OS) of patients with high-risk and low-risk, and receiver operating characteristic (ROC) analysis was used to assess the accuracy of the risk model. In addition, GC patients were grouped according to the median expression of the features genes, and survival analysis was further carried out. RESULTS: It was noted that regulatory T cells (Tregs) were significantly correlated with the prognosis of GC, and 172 genes related to Tregs were found to be closely associated with GC. An optimal prognostic risk model was constructed, and a 5-gene (including LRFN4, ADAMTS12, MCEMP1, HP and MUC15) signature-based risk score was established. Survival analysis showed significant difference in OS between low-risk and high-risk samples. ROC analysis results indicated that the risk model had a high accuracy for the prognosis prediction of samples (AUC = 0.717). The results of survival analysis on each feature gene based on expression levels were consistent with the results of multivariate Cox analysis for predicting the risk rate of the 5 genes. CONCLUSION: These results proved that the 5-gene signature-based risk score could be used to predict the survival of GC patients, and these 5 genes were closely related to Tregs. These findings are of great significance for studying the role of immune cells and related immune factors in regulating the prognosis of GC.

Association of ERCC1 Polymorphisms with the Risk of Colorectal Cancer: A Meta-Analysis.

The ERCC1 enzyme in the nucleotide excision repair (NER) pathway plays a vital role in DNA repair. Numerous epidemiological studies have evaluated the association between ERCC1 polymorphisms and the risk of colorectal cancer (CRC), with conflicting results. To evaluate the potential associations, we conducted a meta-analysis. Eligible studies were identified by searching electronic databases. The odds ratio (OR) and 95% confidence interval (CI) were applied to assess the associations between ERCC1 polymorphisms and CRC risk. The meta-analysis results revealed significant associations between ERCC1 rs3212986 and rs2298881 polymorphisms and CRC risk (rs3212986 GG vs CC: OR = 1.66, 95% CI = 1.13-2.44; CG vs CC: OR = 1.12, 95% CI = 0.82-1.55; the dominant model: OR = 1.21, 95% CI = 0.86-1.71; the recessive model: OR = 1.59, 95% CI = 1.09-2.31; rs2298881 CC vs. AA: OR = 2.04, 95% CI = 1.29-3.23; AC vs. AA: OR = 1.19, 95% CI = 0.91-1.56; the dominant model: OR = 1.33, 95% CI = 1.04-1.72; the recessive model: OR = 1.91, 95% CI = 1.22-3.00). However, no association with CRC risk was identified for ERCC1 polymorphisms rs11615 and rs2276466. In conclusion, these findings identified no association between rs11615 and rs2276466 polymorphisms and CRC susceptibility, but the data indicate that ERCC1 rs3212986 and rs2298881 polymorphisms may increase susceptibility to CRC. Large and well-designed studies are needed to further validate our findings.

Association between the Epithelial Cadherin - 160C/A Polymorphism and Colorectal Cancer Risk: Evidence from a Meta-Analysis.

The aim of the present study was to assess the association between the epithelial cadherin (CDH1) -160C/A polymorphism and colorectal cancer (CRC) using a meta-analysis. A literature search of PubMed, Embase, and Web of Science databases was performed for relevant studies. Statistical analyses were carried out using Stata 12.0 to combine all of the relevant studies. Odds ratio (OR) with 95% confidence interval (CI) values were applied to evaluate the strength of the association. Eight studies with 7231 cases and 7080 controls were included. The meta-analysis results showed that the CDH1 -160C/A polymorphism was significantly associated with CRC risk (AA vs. CC: OR = 0.98, 95% CI = 0.71-1.36; CA vs. CC: OR = 0.92, 95% CI = 0.86-0.99; dominant model: OR = 1.01, 95% CI = 0.81-1.26; recessive model: OR = 0.91, 95% CI = 0.81-1.02). In the subgroup analysis based on ethnicity, significant association was found between the CDH1 -160C > A polymorphism and CRC risk in Caucasians. In conclusion, the CDH1 -160C/A polymorphism may be a susceptible predictor for the risk of CRC in Caucasians.

Adjunctive antidepressant use in schizophrenia in China: A national survey (2002-2012).

OBJECTIVE: This study examined the pattern of adjunctive antidepressant use in schizophrenia patients and its demographic and clinical correlates in a nationwide survey in China. METHODS: Fourteen thousand and thirteen patients in 45 Chinese psychiatric hospitals or centers were interviewed (4,486 in 2002, 5,288 in 2006, and 4,239 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Chi-square test, independent-samples t test, Mann-Whitney U test, and multiple logistic regression analysis were used in data analyses. RESULTS: Antidepressant use was found in 5.2% of the study population with 4.6% in 2002, 4.3% in 2006, and 6.9% in 2012, respectively. A significant increase in use from 2006 to 2012 was found (p < .001). Multiple logistic regression analyses in the whole population revealed that patients receiving adjunctive antidepressants were more likely to be outpatients in tertiary referral centers (level-III hospitals) and who had an earlier age of onset, less severe global illness, but more depressive symptoms. They were less likely to receive first-generation antipsychotics but more likely to receive benzodiazepines (R2  = 0.255, p < .001). CONCLUSIONS: Despite an increasing trend, the frequency of antidepressant use in schizophrenia in China was considerably lower than in Western countries. The benefits and risks associated with concomitant use of antidepressants in schizophrenia need to be studied further.

Electroconvulsive Therapy in Schizophrenia in China: A National Survey.

OBJECTIVE: Little is known about electroconvulsive therapy (ECT) use in the treatment of schizophrenia in China. This study examined the frequency of ECT use, its trend between 2006 and 2012, and its independent demographic and clinical correlates in a nationwide survey in China. METHODS: A total of 5162 inpatients in 45 Chinese psychiatric hospitals/centers were interviewed (2696 in 2006 and 2466 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. RESULTS: Electroconvulsive therapy was used in 6.1% of the whole sample; 4.7% in 2006 and 7.7% in 2012 (P < 0.001) with wide interprovince variations. Multiple logistic regression analyses of the whole sample revealed that patients receiving ECT were more likely to be women, receive second-generation antipsychotics, treated in tertiary referral centers (level III hospitals), had a shorter illness duration, and more positive and depressive symptoms (R = 0.181; P < 0.001). CONCLUSIONS: Electroconvulsive therapy for schizophrenia has increased between 2006 and 2012 in China. Its percentage was higher than the figures reported in most other countries. Reasons for the substantial variations in the frequency of ECT across different provinces in China require further investigations.

Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002-2012).

OBJECTIVE: We examined the time trends and correlates of clozapine use in schizophrenia patients in China. METHOD: A total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were interviewed in 2002, 2006 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and quality of life (QOL) were recorded in a standardized fashion. RESULTS: Clozapine was used in 32.9% of the whole sample; with corresponding figures of 39.7%, 32.5% and 26.4% in 2002, 2006 and 2012 (p<0.001). Families of clozapine users had lower satisfaction with treatment than those of the non-clozapine group, without significant differences with respect to patients' treatment satisfaction and mental or physical QOL. In multiple logistic regression analyses, compared to the non-clozapine group, patients on clozapine had an earlier age of onset, longer illness duration, more global illness severity and drug-induced central nervous system, gastrointestinal and other side effects, lower antipsychotic doses, less delusions and hallucinations, more negative symptoms, were more likely male, inpatients, to have a family history of psychiatric disorders, receive treatments in regional centers and receive antipsychotic polypharmacy, but less likely to have health insurance and receive first-generation antipsychotics and benzodiazepines (R(2)=0.498, p<0.001). CONCLUSIONS: Clozapine was used in one-third of schizophrenia patients in China, with decreasing frequency since 2002. Patients prescribed clozapine had multiple markers of greater global illness severity/chronicity and decreased satisfaction with treatment by the families, but similar QOL and less delusions and hallucinations than patients not prescribed clozapine.

Antipsychotic Medications in Major Depression and the Association with Treatment Satisfaction and Quality of Life: Findings of Three National Surveys on Use of Psychotropics in China Between 2002 and 2012.

BACKGROUND: Optimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns of antipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life (QOL). METHODS: A total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and QOL were recorded using a standardized protocol and data collection. RESULTS: The frequency of antipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively (χ2 = 90.3, df = 2, P < 0.001). Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals (i.e., Level-III hospital). Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups. CONCLUSIONS: Concurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients' and relatives' satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.

Antipsychotic polypharmacy in schizophrenia patients in China and its association with treatment satisfaction and quality of life: findings of the third national survey on use of psychotropic medications in China.

OBJECTIVE: This study examined the use, demographic and clinical correlates of antipsychotic polypharmacy (APP) and its associations with treatment satisfaction and quality of life (QOL) in schizophrenia patients in China. METHOD: A total of 4239 patients in 45 nationwide Chinese psychiatric hospitals/centers were interviewed in 2012 in the third cross-sectional study, with the first two having been conducted in 2002 and 2006. Patients' socio-demographic and clinical characteristics, including psychopathology, side effects, satisfaction with treatment and QOL, were recorded using a standardized protocol and data collection procedure. RESULTS: The proportion of APP prescriptions in 2012 was 34.2%, which was significantly higher than the frequency of APP in 2002 (26.1%) and 2006 (26.4%) (p<0.001). Of patients on APP, 91.1% received two antipsychotics, 8.6% received three and 0.3% received four or more antipsychotics. Multiple logistic regression analyses revealed that compared to those on antipsychotic monotherapy, patients on APP and their families had lower satisfaction with treatment, had higher QOL in the mental domain, younger age of onset, more side effects, higher doses of antipsychotics and were more likely to receive first-generation antipsychotics and less likely to receive benzodiazepines (total R (2)=0.31, p<0.001). CONCLUSIONS: APP was found in about one in three schizophrenia patients. The prevalence of APP seems to have been increasing since 2002. Considering the increased frequency of drug-induced side effects and the patients' and their relatives' dissatisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of APP and its alternatives is warranted.

Long-term benzodiazepine use in patients with major depressive disorder in China.

PURPOSE: There have been no data about long-term benzodiazepine (BZD) use and its correlates in patients with major depressive disorder (MDD) in China. This study aimed to examine the prevalence of long-term BZD use (more than three months) and its demographic and clinical correlates in Chinese patients with MDD. DESIGN AND METHODS: A total of 1,192 patients with MDD were examined in 10 mental health centers in China. Patients' socio-demographic and clinical characteristics and prescriptions for psychotropic drugs were recorded using a standardized form. FINDINGS: A large portion of patients (36.2%) received long-term BZD treatment. Univariate analyses revealed that long-term BZD users were older, poorer, and had more impaired occupational functioning than patients not taking BZDs. Long-term BZD users had fewer psychotic symptoms and took less antipsychotic drugs. In multivariate analyses, long-term BZD use was independently associated with older age and more severe impaired occupational functioning; long-term BZD users were less likely to receive antipsychotic medications and traditional antidepressants (tricyclic antidepressants, tetracyclic antidepressant, and monoamine oxidase inhibitors). PRACTICE IMPLICATIONS: Long-term BZD use was common in patients with MDD in China. A host of demographic and clinical factors were independently associated with long-term BZD use.

Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women.

BACKGROUND: In European and US studies, patients with major depressive disorder (MDD) report more stressful life events (SLEs) than controls, but this relationship has rarely been studied in Chinese populations. METHODS: Sixteen lifetime SLEs were assessed at interview in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MDD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression. RESULTS: 60% of controls and 72% of cases reported at least one lifetime SLE. Fourteen of the sixteen SLEs occurred significantly more frequently in those with MDD (median odds ratio of 1.6). The three SLEs most strongly associated with risk for MDD (OR>3.0) preceded the onset of MDD the majority of the time: rape (82%), physical abuse (100%) and serious neglect (99%). LIMITATIONS: Our results may apply to females only. SLEs were rated retrospectively and are subject to biases in recollection. We did not assess contextual information for each life event. CONCLUSIONS: More severe SLEs are more strongly associated with MDD. These results support the involvement of psychosocial adversity in the etiology of MDD in China.

Factors that influence the prescription of antipsychotics for patients with schizophrenia in china.

OBJECTIVE: To investigate the patterns of antipsychotic use in China and to analyze the factors that influence antipsychotic prescriptions. METHODS: A standardized survey was conducted from May 20 to 24 2002 in five different regions of China with varying economic levels. The patterns of antipsychotic medication use were analyzed in a sample of 4,779 patients with schizophrenia. The survey gathered information on demographic characteristics, clinical profiles, and antipsychotic medications prescribed. Multiple logistic regression was used to analyze factors related to patterns of antipsychotic medication use. RESULTS: A plurality of patients with schizophrenia was treated with clozapine (39%); this was followed by risperidone, sulpride, chlorpromazine, perphenazine, and haloperidol. More than 56.3% of patients were treated with only one atypical antipsychotic. The mean daily dose of chlorpromazine was 365±253 mg (mean±standard deviation), and 6.5% of patients were treated with depot injections of typical antipsychotic medications. A total of 73.7% (n=3,523) of patients with schizophrenia received monotherapy, 24.8% (n=1,183) received two antipsychotics, 1.1% (n=52) received three antipsychotics, and one received four different antipsychotics. Patients often simultaneously received other classes of medications including anticholinergic agents, benzodiazepines, ß-blockers, antidepressants, and mood stabilizers. Economic status and clinical symptoms were the main factors that contributed to the patterns of antipsychotic prescription. CONCLUSION: The present study suggests that atypical antipsychotic medications, especially clozapine, are the primary psychiatric treatments of choice in the management of schizophrenia in China. Moreover, the economic status and clinical profile of the patient are the major factors affecting the prescription of antipsychotic medication.

Respiratory complaints in Chinese: cultural and diagnostic specificities.

STUDY OBJECTIVES: We investigated the qualitative components of a wide range of Chinese descriptors of dyspnea and associated symptoms, and their relevance for clinical diagnosis. MEASUREMENTS: Sixty-one spontaneously reported descriptors were elicited in Chinese patients to make a symptom checklist, which was administered to new groups of patients with different cardiopulmonary diseases, to patients with medically unexplained dyspnea and to healthy subjects. RESULTS: Test-retest reliability was satisfactory for most of the descriptors. A principal component analysis on 61 descriptors yielded the following eight factors: dyspnea-effort of breathing; dyspnea-affective aspect; wheezing; anxiety; tingling; palpitation; coughing and sputum; and dying experience. Although the descriptors of dyspnea-effort of breathing resembled Western wordings and were shared by patients with a variety of diseases, the descriptors of dyspnea-affective aspect appeared to be more culturally specific and were primarily linked to the diagnosis of medically unexplained dyspnea, whereas wheezing was specifically linked to asthma. CONCLUSIONS: Three factors of breathlessness were found in Chinese. The descriptors of dyspnea-effort of breathing and wheezing appear to be similar to Western descriptors, whereas the dyspnea-affective aspect seems to bear cultural specificity.