The association between patterns of weight change, diabetes status and glycaemia among adults with overweight and obesity.

AIMS: To investigate the associations between weight change patterns and 5-year incident non-diabetic hyperglycaemia (NDH), and glycated haemoglobin (HbA1c) levels among individuals who had overweight or obesity. METHODS: This longitudinal cohort study (N = 435) pooled data from a weight management trial. Participants were adults with a body mass index of ≥28 kg/m2. They were categorised as "no weight loss", "maintainers", and "regainers" based on their weight at 3 months and 12 months after baseline. Multivariable logistic regression models and linear regressions were conducted to examine the associations. RESULTS: Between 1-year and 5-year follow-ups, 77 participants developed NDH. We found no statistically significant association between weight change patterns and incident NDH at 5 years. Among weight loss maintainers, mean HbA1c was -0.15% (95% confidence intervals (CI): -0.22, -0.10) lower after 1 year and -0.15% (95% CI: -0.23, -0.06) lower after 5 years compared to the no weight loss group. There was no difference between weight loss regainers and no weight loss group in HbA1c levels. CONCLUSIONS: Compared to those who did not lose weight, participants who maintained their weight loss had lower HbA1c levels after 1 year and 5 years, which highlights the importance of providing long-term support to prevent weight regain.

Comparative investigations on the incorporation of biogenic Fe products into anaerobic granular sludge of different sources: Fe loading capacity, physicochemical properties, microbial community and long-term methanogenesis performance.

Anaerobic granular sludge (AGS) has been regarded as the core of lots of advanced anaerobic reactors. Formation of biogenic Fe products and their incorporation into AGS could influence interspecies electron transfer and methanogenesis performance. In this study, with anaerobic granular sludge (AGS) from different sources (brewery, chemical plant, paper mill, citric acid factory, and food factory) as the research targets, the formation of biogenic iron products in AGS through the biologically induced mineralization process was studied. Furthermore, the influences of physicochemical properties and microbial community on methanogenesis were investigated. Results showed that all the AGS of different sources possessed the capacity to form biogenic Fe products through dissimilatory iron-reduction process, and diverse Fe minerals including magnetite (Fe3O4), hematite (Fe2O3), goethite (FeOOH), siderite (FeCO3) and wustite (FeO) were incorporated into AGS. The AGS loaded with Fe minerals (Fe-AGS) showed increased conductivity, magnetism and zeta-potential comparing to the control. Those Fe-AGS of different sources demonstrated different methanogenesis performance during the long-term operation (50 days). Methane production was increased for the Fe-AGS of citric acid (6.99-32.50%), food (8.33-37.46%), chemical (2.81-7.22%) and brewery plants (2.27-2.81%), but decreased for the Fe-AGS of paper mill (54.81-72.2%). The changes of microbial community and microbial correlations in AGS as a response to Fe minerals incorporation were investigated. For the Fe-AGS samples with enhanced methane production capability, it was widely to find the enriched populations of fermentative and dissimilatory iron reducing bacteria Clostridium_sensu_stricto_6, Bacteroidetes_vadinHA17 and acetoclastic methanogens Methanosaeta, and positive correlations between them. This study provides comprehensive understanding on the effects of incorporation biogenic Fe products on AGS from different sources.

Enhancing methane production and interspecies electron transfer of anaerobic granular sludge by the immobilization of magnetic biochar.

Supplementation of conductive materials has been proved to be a promising approach for enhancing microbial interspecies electron transfer (IET) in anaerobic digestion systems. In this study, magnetic bamboo-based biochar was prepared at temperatures of 400-800 °C via a ball milling/carbonization method, and it immobilized in mature anaerobic granular sludge (AGS) aimed to enhance methane production by improving the IET process between syntrophic microbial communities in the AGS. Results showed that the AGS with magnetic biochar immobilization demonstrated increased glucotrophic and acetotrophic methane production by 69.54-77.56 % and 39.96-54.92 %, respectively. Magnetic biochar prepared at 800 °C with a relatively higher Fe content (0.37 g/g magnetic biochar) displayed a stronger electron charge/discharge capacity (36.66 F/g), and its immobilization into AGS promoted methane production most. The conductivity of AGS increased by 52.13-87.32 % after incorporating magnetic biochar. Furthermore, the extracellular polymeric substance (EPS) of AGS showed an increased capacitance and decreased electron transfer resistance possibly due to the binding of magnetic biochar and more riboflavin secretion in EPS, which could contribute to the accelerated IET process in the inner AGS. In addition, the immobilization of magnetic biochar could promote the production of volatile fatty acids by 15.36-22.50 %. All these improvements may jointly lead to the enhanced methane production capacity of AGS. This study provided a fundamental understanding of the role of incorporated magnetic biochar in AGS in promoting anaerobic digestion performance.

Mediating the performance of anaerobic granular sludge by exogenous flavin supplementation: Flavin binding capacity and behavior, interspecies electron transfer, and methane production.

Although flavins are known as effective electron mediators, the binding capacity of exogenous flavins by anaerobic granular sludge (AGS) and their role in interspecies electron transfer (IET) remains unknown. In this study, AGS was mediated by using three exogenous flavins of riboflavin (RF), flavin mononucleotide (FMN), and flavin adenine dinucleotide (FAD). Results showed that the total amounts of flavins associated with extracellular polymeric substance (EPS) of AGS increased by 2.03-2.42 and 3.83-4.94 folds, after exposure to 50 and 200 µM of exogenous flavins, respectively. A large portion of FMN and FAD was transformed into RF by AGS. Exogenous flavin mediation also stimulated the production of EPS and cytochrome c (c-Cyts) as well as cytochrome-bound flavins. The increased abundance of these electron mediators led to a reduced electrochemical impedance of EPS and improved extracellular electron transfer capacity. The methane production of AGS after mediation with exogenous RF, FMN, and FAD increased by 19.03-31.71%, 22.86-26.04%, and 28.51-33.44%, respectively. This study sheds new light on the role of exogenous flavins in promoting the IET process of a complex microbial aggregate of AGS.

Changes in physical activity and all-cause mortality in the oldest old population: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

BACKGROUND: Insufficient or decreasing physical activity is common in older adults. Most studies on physical activity changes and mortality were conducted in adults younger than 80 years old in developed countries. We aimed to investigate the relationship between changes in physical activity and longevity in the oldest old (80 years or older) population using the Chinese Longitudinal Healthy Longevity Survey. METHODS: Participants aged 80 or older at baseline were categorized into four groups: 1) remaining physically inactive (n = 14,287), 2) remaining physically active (n = 5411), 3) shifting from being inactive to active (n = 1364), and 4) shifting from being active to inactive (n = 1401). We fitted accelerated failure time Weibull survival regression models, adjusting for baseline sociodemographics, lifestyle factors and disease status. We further examined whether the associations differed by subgroups. RESULTS: A total of 15,707 participants died during follow-up (median duration of follow-up = 3.0 years). Compared with participants who remained physically inactive, those who remained active (fully adjusted event time ratio (ETR): 1.14, 95%CI: 1.11-1.17) or shifted from being inactive to active (fully adjusted ETR: 1.14, 95%CI: 1.08-1.20) had statistically significant longer survival time. No significant association was observed between remaining physically inactive and shifting from being active to inactive. Subgroup analyses showed consistent associations in nearly all strata. CONCLUSION: Maintaining frequent physical activity or shifting from being physically inactive to active was consistently associated with longer survival time in the oldest old population. Our findings provide evidence for encouraging older adults to regularly engage in physical activity to gain longevity benefits.

Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries.

Current evidence on digital health interventions is disproportionately concerned with high-income countries and hospital settings. This scoping review evaluates the extent of use and effectiveness of digital health interventions for non-communicable disease (NCD) management in primary healthcare settings of low- and middle-income countries (LMICs) and identifies factors influencing digital health interventions' uptake. We use PubMed, Embase, and Web of Science search results from January 2010 to 2021. Of 8866 results, 52 met eligibility criteria (31 reviews, 21 trials). Benchmarked against World Health Organization's digital health classifications, only 14 out of 28 digital health intervention categories are found, suggesting critical under-use and lagging innovation. Digital health interventions' effectiveness vary across outcomes: clinical (mixed), behavioral (positively inclined), and service implementation outcomes (clear effectiveness). We further identify multiple factors influencing digital health intervention uptake, including political commitment, interactivity, user-centered design, and integration with existing systems, which points to future research and practices to invigorate digital health interventions for NCD management in primary health care of LMICs.

Assessing parental marital quality and divorce related to youth sexual experiences and adverse reproductive health outcomes among 50,000 Chinese college students.

BACKGROUND: This study aimed to investigate the associations between parental marital quality, divorce, and sexual and reproductive health outcomes among Chinese young people. METHODS: The study included 51,124 students from a large-scale cross-sectional study in China from 2019 to 2020. The exposures were parental marital quality and legal marital status reported by students. The dichotomous outcomes included sexual experiences, high-risk sexual behaviors, unintended health outcomes, and sexual abuse. Multivariate logistic regression models adjusting for socio-demographic factors were used to assess the relationship between parental marital quality, divorce, and sexual and reproductive health outcomes, stratified by sex. RESULTS: A total of 10.72% of the surveyed students' parents had divorced. Participants from divorced family rated perceived parental marital quality less than half of the ratings on a 10-point scale of those from intact family (3.22 vs. 7.44). Parental divorce was associated with a higher likelihood of sexual abuse, high-risk sexual behaviors, and unintended health outcomes. A higher perceived parental marital quality was associated with a lower probability of adverse sexual and reproductive health experiences and outcomes, such as forced penetrative vaginal or anal intercourse (male: OR: 0.73, 95% CI: 0.64-0.83; female: OR:0.71, 95% CI: 0.65-0.77), casual sexual intercourse (male: OR: 0.78, 95% CI: 0.73-0.83; female: OR: 0.77, 95% CI: 0.72-0.83), and sexually transmitted infections (male: OR: 0.79, 95% CI: 0.70-0.89; female: OR: 0.82, 95% CI: 0.73-0.91). CONCLUSIONS: Parental marital quality and status are associated with poorer sexual and reproductive health outcomes among young adults, suggesting that specific intervention programs should be implemented for children from unharmonious families or divorced families to prevent adverse sexual and reproductive health outcomes.

Marital relationships in China have undergone significant transformations with the rapid industrialization and modernization of the society. The prevalence of divorce in China and worldwide has shown an upward trend in recent years. Divorce and parental marital quality often affect youth health, but its association with youth sexual and reproductive health requires more discussion. This study aimed to investigate the associations between parental marital quality and parental divorce status (marriage or divorce) and a range of youth sexual and reproductive health indicators. Participants included 51,124 students from universities or vocational colleges across all 31 provinces in mainland China. A total of 10.72% of the surveyed students' parents had divorced. Participants from divorced family rated perceived parental marital quality less than half of the ratings on a 10-point scale of those from intact family (3.22 vs. 7.44). Divorce and lower parental marital quality were separately associated with a higher likelihood of experiencing sexual abuse, high-risk sexual behaviors, and unintended health outcomes among youth. These findings highlight the importance of implementing specific intervention programs to protect children from unharmonious families or divorced families.

Active Antioxidant Packaging from Essential Oils Incorporated Polylactic Acid/Poly(butylene adipate-co-terephthalate)/Thermoplastic Starch for Preserving Straw Mushroom.

The short-term shelf life of straw mushrooms (Volvariella volvacea) is a major challenge, hampering their wide distribution. Thus, the aim of this work was to develop a novel active packaging composed of essential oils (EOs), particularly clove oil (CO) and peppermint oil (PO), to reduce autolysis of straw mushrooms. The morphological characterizations, mechanical properties, barrier properties, and antioxidant activities of the films were characterized. The suppressive effects of the EOs on straw mushroom autolysis were estimated during storage at 16 ± 1 °C for 96 h. The results indicated that the addition of EOs weakened the mechanical and barrier properties of the films. The radical-scavenging activities of polylactic acid/poly(butylene adipate-co-terephthalate)/thermoplastic starch-peppermint oil (PLA/PBAT/TPS-PO) and polylactic acid/poly(butylene adipate-co-terephthalate)/thermoplastic starch-clove oil (PLA/PBAT/TPS-CO) films for 2,2-diphenyl-1-picrylhydrazyl were 56.0% and 91.3%, respectively. However, the PLA/PBAT/TPS-PO film was more effective in reducing polyphenol oxidase activity and maintaining the total phenol content of straw mushrooms, demonstrating better antioxidative activity. Mushrooms packaged with the PLA/PBAT/TPS-PO film exhibited the lowest autolysis rate (42.29%, p < 0.05) after 96 h of storage. Thus, PO is a good preservative agent for straw mushroom.

Strengthening urban primary healthcare service delivery using electronic health technologies: A qualitative study in urban Nepal.

Background: Nepal is a South Asian country with a high burden of non-communicable diseases. Electronic health technologies are a promising strategy to mitigate the rising burden of non-communicable diseases by strengthening primary healthcare center service delivery. However, electronic health implementation in Nepal is limited. Furthermore, electronic health use at the primary healthcare center level is chronically understudied. This qualitative study seeks to understand the perceived awareness, benefits, and determinants of electronic health uptake in Nepal, focusing on primary healthcare center-level non-communicable disease management. Methods: We conducted in-depth interviews with 27 participants including policymakers, health experts, facility administrators, providers, and non-communicable diseases patients in 2019. We selected six urban primary healthcare center facilities via cluster convenience sampling for recruiting facility administrators, providers, and patients, and used convenience sampling to recruit policymakers and experts. We conducted thematic data analysis inductively and deductively using the electronic health readiness assessment framework to understand perceived barriers and facilitators of electronic health implementation. Results: While there was general awareness and acceptance of electronic health, multiple barriers impede readiness for implementation. These include policy making gaps, language barriers, low user technical literacy, concerns of overreliance on technology, and inadequate training for administrators and providers. Stakeholder suggestions include creating electronic health interfaces that meet the needs of end users (providers and patients), providing training to enable end users to effectively use electronic health technologies, and strong policy support at the national level. Conclusion: We identify several determinants for effectively promoting the use of electronic health for non-communicable diseases service delivery at the primary healthcare center level in Nepal.

Hypertension in China: burdens, guidelines and policy responses: a state-of-the-art review.

Hypertension is a leading risk factor of cardiovascular disease and it is becoming increasingly prevalent globally. Correspondingly, the Chinese government and public health institutions have issued a series of policy documents and guidelines for hypertension. However, no comprehensive review of such documents has been conducted. Hence, this review aims to provide an up-to-date and comprehensive assessment of not only the disease burden, but also hypertension management policies and guidelines in China. A total of 15 epidemiological studies based on national population surveys, 15 Chinese Hypertension Guidelines, and seven policy documents were identified. We found a larger burden of hypertension in men, while the awareness, treatment, and control rates have remained low in both sexes. The ranges of hypertension prevalence, awareness, treatment, and control rate among hypertensive patients were 18.0-44.7%, 23.6-56.2%, 14.2-48.5%, and 4.2-30.1% respectively. Chinese hypertension guidelines provide evidence-based instructions to healthcare practitioners over hypertension management in which primary healthcare is increasingly emphasized. Finally, the policy documents set national goals for hypertension management and standardized the services provided in primary healthcare. The findings highlight the importance of integrating new guidelines into hypertension management provided by primary healthcare practitioners and the need to evaluate the implementation of guidelines and policies.

Bridge Employment and Longevity: Evidence From a 10-Year Follow-Up Cohort Study in 0.16 Million Chinese.

OBJECTIVES: Bridge employment has been encouraged by many countries worldwide as societies age rapidly. However, the health impact on bridge employment is not consistent in previous studies. This study aims to explore the association between bridge employment and long-term health outcome among the Chinese population. METHODS: In this prospective cohort study, we used a subset of the China Kadoorie Biobank study, in which 163,619 participants who reached the statutory age of retirement at baseline (2004-2008) were included in this study. Mortality statistics were obtained from death registries in the Death Surveillance Points system annually. We used a Cox proportional hazard model to analyze the association between bridge employment and all-cause mortality. RESULTS: Overall, we found that compared to retired/nonemployed men and women, hazards of all-cause mortality were lower in older people with bridge employment (men: 0.82, 95% confidence interval [CI]: 0.77-0.88; women: 0.79, 95% CI: 0.74-0.94) in healthy populations. The protective effect of bridge employment was stronger among older adults living in rural areas and among those from a relatively low socioeconomic status. DISCUSSION: The lower risk of all-cause mortality associated with bridge employment was consistently observed among older men and women. Our findings may provide important insights from the health dimension on the retirement policy-making in China as a hyper-aging society.

Research capacity of global health institutions in China: a gap analysis focusing on their collaboration with other low-income and middle-income countries.

INTRODUCTION: This paper presented qualitative and quantitative data collected on the research capacity of global health institutions in China and aimed to provide a landscaping review of the development of global health as a new discipline in the largest emerging economy of the world. METHODS: Mixed methods were used and they included a bibliometric analysis, a standardised survey and indepth interviews with top officials of 11 selected global health research and educational institutions in mainland China. RESULTS: The bibliometric analysis revealed that each institution had its own focus areas, some with a balanced focus among chronic illness, infectious disease and health systems, while others only focused on one of these areas. Interviews of key staff from each institution showed common themes: recognition that the current research capacity in global health is relatively weak, optimism towards the future, as well as an emphasis on mutual beneficial networking with other countries. Specific obstacles raised and the solutions applied by each institution were listed and discussed. CONCLUSION: Global health institutions in China are going through a transition from learning and following established protocols to taking a more leading role in setting up China's own footprint in this area. Gaps still remain, both in comparison with international institutions, as well as between the leading Chinese institutions and those that have just started. More investment needs to be made, from both public and private domains, to improve the overall capacity as well as the mutual learning and communication within the academic community in China.

The role of reagent adding sequence in the NH4+-N recovery by MAP method.

Ammonium-nitrogen (NH4+-N) recovery from high concentration of NH4+-N-containing wastewater by struvite (MgNH4PO4·6H2O, MAP) precipitation method has been realized, but whether NH4+-N recovery under different reagent adding sequence of NaOH, solid Mg salt and P salt can generate different effects, remains ambiguous. In view of the problem, four modes to add reagents were investigated in detail on the formation of struvite. The results show that the Mode IV (M-IV, i.e. using 50% NH4+-N wastewater to dissolve completely the Mg salt and the P salt, respectively and then simultaneously poured into a beaker to mix the solution evenly and adjust the pH to 9.5.) has the highest NH4+-N recovery efficiency (90.80%) and the maximum mass of precipitates (896 mg) because of the more amount of alkali and initial seed formation. From the morphology of the obtained precipitates, it can be seen that sample M-IV is more loose and porous than the others. XRD patterns show that the four products under the different modes basically agree with the standard MAP.

Ultrasound-Enhanced Catalytic Ozonation Oxidation of Ammonia in Aqueous Solution.

Excessive ammonia is a common pollutant in the wastewater, which can cause eutrophication, poison aquatic life, reduce water quality and even threaten human health. Ammonia in aqueous solution was converted using various systems, i.e., ozonation (O3), ultrasound (US), catalyst (SrO-Al2O3), ultrasonic ozonation (US/O3), ultrasound-enhanced SrO-Al2O3 (SrO-Al2O3/US), SrO-Al2O3 ozonation (SrO-Al2O3/O3) and ultrasound-enhanced SrO-Al2O3 ozonation (SrO-Al2O3/US/O3) under the same experimental conditions. The results indicated that the combined SrO-Al2O3/US/O3 process achieved the highest NH4+ conversion rate due to the synergistic effect between US, SrO-Al2O3 and O3. Additionally, the effect of different operational parameters on ammonia oxidation in SrO-Al2O3/O3 and SrO-Al2O3/US/O3 systems was evaluated. It was found that the ammonia conversion increased with the increase of pH value in both systems. The NH3(aq) is oxidized by both O3 and ·OH at high pH, whereas the NH4+ oxidation is only carried out through ·OH at low pH. Compared with the SrO-Al2O3/O3 system, the ammonia conversion was significantly increased, the reaction time was shortened, and the consumption of catalyst dosage and ozone were reduced in the SrO-Al2O3/US/O3 system. Moreover, reasonable control of ultrasonic power and duty cycle can further improve the ammonia conversion rate. Under the optimal conditions, the ammonia conversion and gaseous nitrogen yield reached 83.2% and 51.8%, respectively. The presence of tert-butanol, CO32-, HCO3-, and SO42- inhibited the ammonia oxidation in the SrO-Al2O3/US/O3 system. During ammonia conversion, SrO-Al2O3 catalyst not only has a certain adsorption effect on NH4+ but accelerates the O3 decomposition to ·OH.

Visualized nutrition education and dietary behavioral change: A systematic review and meta-analysis.

Effectiveness of using visual approaches in health education and its influential factors were still in debate. This study aimed to asess the effects of visualized nutrition education on dietary knowledge and behavioral changes, and factors influencing them. A comprehensive search of PubMed, EMBASE, Scopus, and Cochrane Library was conducted. Eligible studies were trials assessed effects of visualized nutrition education on dietary knowledge or behavior changes, compared with non-visualized or no education group. Fourteen studies (n = 7,259) were qualitatively analyzed and 7 of them were included in the meta-analysis. We found a higher fiber intake in both short term (1.59 g/1000 kcals, 95% CI 0.90-2.27) and long term (1.36 g/1000 kcals, 95% CI 0.64-2.09). A marginal advantage was shown in short-term fruits and vegetables consumption (F&V consumption) (standardized mean difference [SMD] = 0.08, 95% CI -0.00 to 0.16). The education effects were more pronounced when education was delivered in series (SMDF&V consumption = 0.09, 95% CI 0.00-0.17), avoiding loss-framing (SMDFat intake = 0.31, 95% CI 0.10-0.51) and video modeling (SMDF&V consumption = 0.23, 95% CI 0.03-0.43), with short length plus cultural adaptation. Visualized nutrition education was overall promising in improving dietary behaviors. Delivering in series, short in length, with cultural adaptation were features tended to enlarge the benefits of visualized education while loss-framing and video modeling might be avoided.

Spicy food and self-reported fractures.

BACKGROUND & AIMS: Population-based evidence that suggests health effects of spicy consumptions on fracture was scant. The study aimed to explore the association of spicy food intake with self-reported history of fractures in the Chinese populations. METHODS: Data was drawn from the baseline survey of a large cohort study conducted in China between 2004 and 2008. A total of 512,891 adults (including 302,632 females) were included. Frequency, strength and duration of spicy food consumption were assessed using a survey questionnaire. Fracture history was self-reported based on physician's diagnoses. Multivariate logistic regression models stratified by socio-economic factors, body mass index and other lifestyle factors were performed adjusting for potential confounders. RESULTS: The prevalence of daily spicy food intake was 30.32% in males and 29.90% in females. The adjusted odds ratios for fractures were 1.04 (95% CI: 1.01-1.07) for those who ate spicy food occasionally, 1.10 (95% CI: 1.05-1.16) for those who ate one or two days a week, 1.15 (95% CI: 1.09-1.20) for three to five days a week, and 1.12 (95% CI: 1.07-1.17) for daily consumers, compared to participants who never ate spicy food. Participants who ate weak spicy food (OR: 1.10, 95% CI: 1.14-1.23), moderate spicy food (OR: 1.11, 95% CI: 1.06-1.15) and strong spicy food (OR: 1.18, 95% CI: 1.12-1.25) were more strongly associated with self-reported history of fracture. In addition, the strengths of associations were consistently stronger with the duration of spicy food exposure. In stratified analyses, the strength of such an association appeared stronger in rural areas (OR: 1.14, 95% CI: 1.09-1.20) than urban (OR: 1.09, 95% CI: 1.05-1.12). The correlation was consistently stronger in males than in females. CONCLUSIONS: Among Chinese adults, a positive cross-sectional association between the level of spicy food intake and history of fractures was found in both sexes.

Two Simple Formulas for Evaluating the Lower Bound of the Impact Velocity in Vehicle-pedestrian Accidents.

Formulas for evaluating the lower bound of the impact velocity are valuable in vehicle-pedestrian accident reconstruction. The theory of classical mechanics and four hypotheses were employed to derive formulas; the research results and simulation/accident tests were employed to validate their feasibility. Then, two simple formulas were developed according to the distance between the rest positions of the vehicle and the pedestrian and the flight-phase distance. The results showed that the evaluated results by the two proposed formulas are inferior to the existing results. The influence of a roadside step on the impact velocity, which decreased with an increase in the flight-phase distance and a reduction in the road slope, was evaluated. Based on a real accident, the study concludes that the lower bound can be easily obtained with the proposed formulas, which can be used to determine the evaluated impact velocity during simulations.