Essential role of composting industry in achieving China's dual-carbon goals: Case studies from Chinese composting companies.

Composting is one of the primary methods for organic waste recycling in China. This study aims to analyze the product quality of organic fertilizer enterprises from the perspective of actual production and the relationship between production process variations and organic matter content in organic fertilizers based on 348 samples from 229 organic fertilizer companies across 22 provinces. Results showed that fertilizers produced through composting processes contain higher organic matter, averaging 45.42 %, compared to commercial organic fertilizers and bio-organic fertilizers. Raw materials, equipment, methods, operational scale, and personnel structure are key factors affecting the content of organic matter in products. Optimizing equipment and processes in Chinese organic fertilizer companies could increase organic matter content to 49.3 %, potentially reducing annual carbon emissions by an estimated 3.07 to 6.97 billion kg of CO2 equivalent, thereby supporting the realization of dual carbon goals.

Translating lessons to reinforce national stillbirth response; multi-stakeholder perspectives regarding priorities and opportunities to deliver quality evidence-based interventions within a limited-resource context in Uganda.

BACKGROUND: There is noted increase in attention towards implementation of evidence-based interventions in response to the stillbirth burden in low- and middle-income countries including Uganda. Recent results reporting some of the strategies adopted have tended to focus much attention towards their overall effect on the stillbirth burden. More is needed regarding stakeholder reflections on priorities and opportunities for delivering quality services within a limited resource setting like Uganda. This paper bridges this knowledge gap. METHODS: Data collection occurred between March and June 2019 at the national level. Qualitative interviews were analysed using a thematic analysis technique. RESULTS: Identified priorities included; a focus on supportive functions such as the referral system, attention to the demand side component of maternal health services, and improvements in the support supervision particularly focusing on empowering subnational level actors. The need to strengthen the learning for better implementation of strategies which are compatible with context was also reported. A comprehensive and favourable policy environment with the potential to direct implementation of strategies, harnessing the private sector contribution as well as the role of national level champions and patient advocates to amplify national stillbirth reduction efforts for continued visibility and impact were recommended. CONCLUSION: Great potential exists within the current strategies to address the national stillbirth burden. However, priorities such as improving the supportive functions of MCH service delivery and attention to the demand side need to be pursued more for better service delivery with opportunities including a favourable policy environment primed to better serve the current strategies. This calls for dedicated efforts targeted at addressing gaps within the existing priorities and opportunities for better delivery of national strategies to address the stillbirth burden in Uganda.

Position specific physical demands in different phases of competitive matches in national level women's football.

The purpose of the present study was twofold: to investigate position-specific physical match demands of national level women's football; and to examine if demands change during a match (comparison between first and second half and in 15-minute intervals). Seven teams from the Finnish National League participated in the study. Eighty-five players met the inclusion criteria, and a total of 340 individual match observations from 68 individual matches were included for analysis. The Polar Team Pro -player tracking system (with 10 Hz GPS units, including 200 Hz tri-axial accelerometer, gyroscope, magnetometer and HR monitor) was used to assess positional data and HR response of the players. This study demonstrated that women's national level football matches place a range of physical demands on players, which in general were highest for wide midfielders, and lowest for central defenders. Wide midfielders and forwards performed significantly more 'very high-speed' running, sprinting, accelerations, and decelerations than other outfield positions (p < 0.05). HRmean varied from 84-87% of HRmax and was significantly lower for central defenders than central midfielders (p < 0.001). External load variables varied during a match and generally decreased especially after 60 minutes of play compared to first 15-min period of the match. Present study showed that national level women football players' positional differences in match demands are similar to those reported with elite players in previous studies. On national level, players' physical performance tended to decrease towards the end of the match, especially in terms of total distance (~10%), high-speed running (~20%), and decelerations (~20%).

Global tracking of access and quality in early childhood care and education.

Investments in early childhood care and education (ECCE) have contributed to a growing demand for internationally comparable data. Yet data on access to quality ECCE are not routinely collected in many countries, leading to limited information on equitable access to ECCE, quality of provision, and the impact on learning and wellbeing outcomes. This paper outlines the current status of global measurement of access to quality ECCE and identifies issues with definitions, availability, and accuracy of ECCE data across countries and outlines paths forward. We argue that estimates of access to ECCE should be based on children's participation in quality ECCE across multiple program types, rather than enrollment or attendance alone, given the critical importance of dosage and participation for ensuring positive benefits from ECCE. Governments, international organizations, and researchers all have roles to play in setting standards to define and monitor ECCE, generating workable tools for measuring nationally, and globally investing in national monitoring systems and routine household surveys to obtain accurate estimates of access to quality ECCE.

A qualitative evaluation of priority-setting by the Health Benefits Package Advisory Panel in Kenya.

Kenya's Ministry of Health established the Health Benefits Package Advisory Panel (HBPAP) in 2018 to develop a benefits package for universal health coverage. This study evaluated HBPAP's process for developing the benefits package against the normative procedural (acceptable way of doing things) and outcome (acceptable consequences) conditions of an ideal healthcare priority-setting process as outlined in the study's conceptual framework. We conducted a qualitative case study using in-depth interviews with national-level respondents (n = 20) and document reviews. Data were analysed using a thematic approach. HBPAP's process partially fulfilled the procedural and outcome conditions of the study's evaluative framework. Concerning the procedural conditions, transparency and publicity were partially met and were limited by the lack of publication of HBPAP's report. While HBPAP used explicit and evidence-based priority-setting criteria, challenges included lack of primary data and local cost-effectiveness threshold, weak health information systems, short timelines and political interference. While a wide range of stakeholders were engaged, this was limited by short timelines and inadequate financial resources. Empowerment of non-HBPAP members was limited by their inadequate technical knowledge and experience in priority-setting. Finally, appeals and revisions were limited by short timelines and lack of implementation of the proposed benefits package. Concerning the outcome conditions, stakeholder understanding was limited by the technical nature of the process and short timelines, while stakeholder acceptance and satisfaction were limited by lack of transparency. HBPAP's benefits package was not implemented due to stakeholder interests and opposition. Priority-setting processes for benefits package development in Kenya could be improved by publicizing the outcome of the process, allocating adequate time and financial resources, strengthening health information systems, generating local evidence and enhancing stakeholder awareness and engagement to increase their empowerment, understanding and acceptance of the process. Managing politics and stakeholder interests is key in enhancing the success of priority-setting processes.

Green complexity, economic fitness, and environmental degradation: evidence from US state-level data.

Green production is one of the major debates as environmental degradation poses threats globally. The paper attempts to explore the relationship between green production and environmental quality by using Economic Fitness approach. We develop a Green Complexity Index (GCI) dataset consisting of 290 traded green-labeled products and Economic Fitness Index (EFI) for the US states between 2002 and 2018. We analyze the environmental performance of green production using the GCI and EFI data at the sub-national level. Findings indicate that exporting more complex green products has insignificant effects on local (i.e., sulfur dioxide, particulate Matter 10) and global polluters such as carbon dioxide, even accounting for per capita income. Yet, economic fitness has a significant negative impact on the emission levels implying that sophisticated production significantly improves environmental quality in the USA. The insignificant impact of GCI on environmental degradation suggests that green product classifications should incorporate the production and end-use stages of goods to limit the adverse environmental effects of green-labeled products.

Farmland nutrient pollution and its evolutionary relationship with plantation economic development in China.

Contradiction between growing plantation economic demand and agro-ecological degradation has always restricted sustainable development of agricultural countries. This study applied the unit inventory analysis to evaluate the productions and discharges of farmland non-point source (FNPS) nitrogen (TN) and phosphorus (TP) among China's nine national-level agricultural districts over 1999-2019. On this basis, we quantified the evolutionary relationship between plantation economic output and FNPS pollution based on optimal regression fitting. The results showed that over 1999-2019, farmland cumulative TN and TP discharges for the whole China were approximately 15807 × 104 t and 1312 × 104 t, with prominent district heterogeneity. According to FNPS discharge magnitudes, China's agricultural districts can be classified into three categories: high, moderate and slight discharge zones. Huang-Huai-Hai Plain and Middle-lower Yangtze Plain were identified as the main severely-polluted districts. Mineral fertilizer is the primary contributor to FNPS pollution. Annual FNPS load showed a trend of increasing followed by decreasing, and the peak interval was recorded in 2014-2016. Spatiotemporal dynamics in FNPS discharge intensities were disparate from that in discharge magnitudes. SC has the highest TN discharge intensity, with an annual average intensity of 0.068 t/ha, followed by MLYP (0.044 t/ha) and HHHP (0.041 t/ha). HHHP has the highest TP discharge intensity, with an annual average intensity of 0.0051 t/ha, followed by SC (0.0038 t/ha) and MLYP (0.0031 t/ha). District-based agro-ecological restoration strategies were accordingly proposed considering FNPS discharge magnitude and intensity concurrently. In most agricultural districts, with the growing economic output in plantation, the FNPS load showed an increase followed by a decrease or to leveling off. Furthermore, with the increasing TN/TP economic partial productivity, the FNPS TN/TP discharge intensities reached the climax, then declined or tended to be flattening out.

Measurement of airborne nicotine, as a marker of secondhand smoke exposure, in homes with residents who smoke in 9 European countries.

OBJECTIVE: Smoke-free policies are effective in preventing secondhand smoke (SHS) exposure, but their adoption at home remains largely voluntary. This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households' characteristics, tobacco consumption habits, and national contextual factors. METHODS: Cross-sectional study (March 2017-September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nine European countries. We installed passive samplers for seven consecutive days to monitor nicotine concentrations. Through self-administered questionnaires, we collected sociodemographic information and the number of individuals who smoke, smoking rules, frequency, location, and quantity of tobacco use in households. Country-level factors included the overall score in the Tobacco Control Scale 2016, the smoking prevalence, and self-reported SHS exposure prevalence. Nicotine concentrations were analyzed as continuous and dichotomous variables, categorized based on the limit of quantification of 0.02 µg/m3. RESULTS: Overall, median nicotine concentration was 0.85 µg/m3 (interquartile range (IQR):0.15-4.42), and there was nicotine presence in 93% of homes. Participants reported that smoking was not permitted in approximately 20% of households, 40% had two or more residents who smoked, and in 79% residents had smoked inside during the week of sampling. We found higher nicotine concentrations in homes: with smell of tobacco smoke inside (1.45 µg/m3 IQR: 0.32-6.34), where smoking was allowed (1.60 µg/m3 IQR: 0.68-7.63), with two or more residents who smoked (2.42 µg/m3 IQR: 0.58-11.0), with more than 40 cigarettes smoked (2.92 µg/m3 IQR: 0.97-10.61), and where two or more residents smoked inside (4.02 µg/m3 IQR: 1.58-11.74). Household nicotine concentrations were significantly higher in countries with higher national smoking prevalence and self-reported SHS exposure prevalence (p < 0.05). CONCLUSIONS: SHS concentrations in homes with individuals who smoke were approximately twenty times higher in homes that allowed smoking compared to those reporting smoke-free household rules. Evidence-based interventions promoting smoke-free homes should be implemented in combination with strengthening other MPOWER measures.

Identifying areas of animal welfare concern in different production stages in Danish pig herds using the Danish Animal Welfare Index (DAWIN).

Animal welfare is of increasing public interest, and the pig industry in particular is subject to much attention. The aim of this study was to identify and compare areas of animal welfare concern for commercial pigs in four different production stages: (1) gestating sows and gilts; (2) lactating sows; (3) piglets; and (4) weaner-to-finisher pigs. One welfare assessment protocol was developed for each stage, comprising of between 20 and 29 animal welfare measures including resource-, management- and animal-based ones. Twenty-one Danish farms were visited once between January 2015 and February 2016 in a cross-sectional design. Experts (n = 26; advisors, scientists and animal welfare controllers) assessed the severity of the outcome measures. This was combined with the on-farm prevalence of each measure and the outcome was used to calculate areas of concern, defined as measures where the median of all farms fell below the value defined as 'acceptable welfare.' Between five and seven areas of concern were identified for each production stage. With the exception of carpal lesions in piglets, all areas of concern were resource- and management-based and mainly related to housing, with inadequate available space and the floor type in the resting area being overall concerns across all production stages. This means that animal-based measures were largely unaffected by perceived deficits in resource-based measures. Great variation existed for the majority of measures identified as areas of concern, demonstrating that achieving a high welfare score is possible in the Danish system.

Palliative care in the Eastern Mediterranean: comparative analysis using specific indicators.

BACKGROUND: Monitoring the development of palliative care (PC) illustrates the capacity of health systems to respond to the needs of people experiencing serious health-related suffering. AIM: To analyse comparatively the situation of PC in the countries of the Easter Mediterranean region using context-specific indicators. METHOD: An online questionnaire with 15 context-specific PC indicators investigating service provision, use of medicines, policy, education, and vitality was designed. Authors Institution 1 nominated in-country experts to complete the survey. Data were analysed using a comparative description of indicators per domain and a multivariate analysis. RESULTS: In-country experts were identified in 17/22 countries. 12/17 contributed to the survey. In total, 117 specialized PC services were identified. Specialized services per population ranges from 0.09 per 100,000 inhabitants in Lebanon and Saudi Arabia, Qatar and Kuwait; to zero services in the Occupied Palestinian Territories. On average, opioid consumption was 2.40 mg/capita/year. National PC strategies were reported in nine countries. In six countries, PC is officially accredited either as a specialty or sub-specialty, and PC mandatory courses are implemented in 36% of medical schools and 46% of nursing schools. National PC associations were documented in six countries. A higher pattern of development was identified in Jordan, Kuwait, Saudi Arabia, Oman, Lebanon, Qatar. CONCLUSIONS: Despite a higher development in the Arabian Peninsula, the region is characterised by a very low provision of specialized PC services and opioid consumption. Policy improvements represent an opportunity to improve access to PC.

Urban expansion dynamic and its potential effects on dry-wet circumstances in China's national-level agricultural districts.

Although urbanization has been widely examined in individual city and urban agglomeration scales, urban expansion patterns and dynamics in large-scale agricultural districts remain absent. In this study, multifaceted characteristics in urban expansion were quantified in China's nine national-level agricultural districts, and responses of dry-wet circumstances to urban sprawl were evaluated. From 1980 to 2018, China has undergone an extensive urban sprawl. Huang-Huai-Hai Plain (HHHP) has the maximum urban coverage extent, followed by Middle-lower Yangtze Plain (MLYP) and Southern China (SC). The largest annual increase was recorded in MLYP, reaching 816.12 km2; followed by HHHP, with an annual increase of 725.22 km2. There are prominent heterogeneities in expansion rate and direction among various districts. The dominating growth patterns were edge- and leapfrogging-expansion, accompanying by a less percentage of infilling-expansion. Accompanying by urbanization, connectedness in urban landscapes gradually improved, while separation degree decreased. Upon many occasions, holistic average dry-wet circumstances in non-urbanized areas are superior to those in urban areas, although this is not absolute for all the districts or periods. In urbanization progress, the development of leapfrogging-expansion has a potential to ameliorate dry-wet circumstances in both urban and non-urban zones, while infilling- and edge-expansion would constitute an inverse effect. In comparison to urban zones, leapfrogging-expansion would cause a more prominent effect on dry-wet environment in non-urbanized zones. Increased connectivity in urbanized landscapes would improve dry-wet environments, especially for urbanized zones. Inversely, increased spatial separated extent among urban landscapes would perform an opposite effect. This study provides a potential for understanding the dynamic features of urban expansion in large-scale agricultural districts. Moreover, the results can also provide a potential opportunity for optimizing dry-wet environments by regulating urbanization pattern and landscape configuration.

Gathering policymakers' perspectives as an essential step in planning and implementing palliative care services at a national level: an example from a resource-limited country.

BACKGROUND: Despite increasing recognition of the role played by palliative care (PC) services, the priorities of policymakers in supporting PC remain unclear and have sometimes engendered controversy. There are few studies exploring policymakers' perspectives towards PC services, with most shedding light on obstacles to PC development. Furthermore, no study has explored policymakers' perspectives towards providing PC at the national level in resource-limited countries. This study provides a platform for providing PC as part of the Palestinian healthcare system (HCS) by exploring policymakers' perspectives on PC, an essential step to developing a PC programme. METHODS: A descriptive qualitative study design was employed using semi-structured interviews. Participants were those identified as responsible for making executive and legislative decisions about health services (including PC) in the HCS. Data were analysed using qualitative content analysis. RESULTS: Twelve decision and policymakers participated in the study. Four categories were generated from the content analysis: (1) the nature of current PC healthcare services, (2) the potential benefits of PC, (3) challenges to providing PC, and (4) considerations in providing PC. The current PC services provided to Palestinian patients with life-limiting illnesses and their families are not comprehensive, and are limited to symptom management. There is a Palestinian national strategic plan for developing PC; however, the development goals are not clearly defined, and the plan's capabilities are inadequate. Several challenges to the provision of PC were found to relate to issues of education and training, the allocation of funding, and the availability of medications. CONCLUSIONS: Integrating PC into the Palestinian university curricula as a compulsory course and establishing higher degree programmes in PC to overcome the shortage of PC specialists is required. Developing policies aligned with national laws could help enhance health services to patients and their families and resolve several challenges. Cooperating with national and international institutions in seeking funding could boost PC development and medication availability.

Can ecological landscape pattern influence dry-wet dynamics? A national scale assessment in China from 1980 to 2018.

Land cover has been demonstrated to have substantial impacts on climate and dry-wet environment, but potential influence of landscape pattern dynamics accompanying land cover change on drought remains unclear. In this study, response of dry-wet dynamics to landscape pattern in China was examined. Results suggest that landscape pattern in China's nine agricultural districts had transformed to varying extents and showed spatiotemporal heterogeneity from 1980 to 2018. For forest landscape, the highest annual average Percentage of Landscape (PLAND) was recorded in SC, reaching 62.26%; and the highest Largest Patch Index (LPI) was presented in YGP, followed by SC, with annual values of 53.79% and 46.26% respectively. The QTP has the most prominent forest connectivity in spite of its lower abundance. For grass landscape, the highest abundance and dominance were recorded in QTP, with annual PLAND fluctuation range of 49.66%-63.52% and annual LPI variation range of 34.10%-58.46%, which is associated with its climate and altitude. The most prominent crop landscape abundance and dominance were recorded in HHHP, with annual PLAND fluctuating interval of 56.53%-60.64%, indicating the highest agricultural development level in this district. At landscape level, dry-wet circumstance could be improved with enhancements in the largest patch percentage, patch density and spatial connectivity, while worsen with increases of landscape fragmentation and separated degree. At class level, increases in abundance and dominance of forest and crop landscapes would reduce drought risk, while it was opposite for grass landscape. Improved forest connectedness would optimize dry-wet environment and reduce drought risk. The PLAND of forest and crop landscapes contributed the most prominent effect to alleviate drought intensity. Compared with forestland and grassland, determining suitable crop landscape configuration to reduce drought risk is more complex because the balance between agricultural economic benefits and ecological landscape effects should be taken into account.

Digital Entrepreneurial Nest: Supporting Digitization of Healthcare at National Level in Montenegro.

Health and health systems are not excluded from the influence of digitalization. In Montenegro, regarding the digitization process, when compared to other sectors, the health sector is lagging. In this poster presentation, we present an ambitious Erasmus+ DigN€ST project aimed on modernization of digitalization of healthcare system in Montenegro, as one of priority fields at national level.

Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator.

BACKGROUND: The coverage of palliative care (PC) may be understood as a country's capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries´ coverage capacities. METHOD: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. RESULTS: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. CONCLUSION: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs.

Perceived Social Support from Different Sources and Adolescent Life Satisfaction Across 42 Countries/Regions: The Moderating Role of National-Level Generalized Trust.

Although previous research established a positive association between perceived social support and adolescent life satisfaction, little is known about the relative importance of different sources of support for adolescent life satisfaction and cross-country variations in this respect. Using large-scale representative samples from the 2017/18 Health Behaviour in School-aged Children (HBSC) study, this study examined to what extent the association between social support and life satisfaction in early adolescence varied across different social sources and countries. Also, it examined whether cross-country variations are explained by national-level generalized trust, a sociocultural factor that shapes adolescent socialization. National-level data were linked to data from 183,918 early adolescents (Mage = 13.56, SD = 1.63, 52% girls) from 42 European and North American countries/regions obtained from HBSC. Multilevel regression analyses yielded a positive association between support from different sources and life satisfaction. The strongest associations were found for support from families, followed by teachers and classmates, and weakest for support from friends. Associations varied across different countries/regions. National-level trust amplified the association between perceived classmate support and adolescent life satisfaction. The revealed cross-country differences open avenues for future cross-cultural research on explanations for cross-cultural differences in the association between social support from different sources and life satisfaction in early adolescence.

Economic burden of work injuries and diseases: a framework and application in five European Union countries.

BACKGROUND: Estimates of the economic burden of work injuries and diseases can help policymakers prioritize occupational health and safety policies and interventions in order to best allocate scarce resources. Several attempts have been made to estimate these economic burdens at the national level, but most have not included a comprehensive list of cost components, and none have attempted to implement a standard approach across several countries. The aim of our study is to develop a framework for estimating the economic burden of work injuries and diseases and implement it for selected European Union countries. METHODS: We develop an incidence cost framework using a bottom-up approach to estimate the societal burden of work injuries and diseases and implement it for five European Union countries. Three broad categories of costs are considered-direct healthcare, indirect productivity and intangible health-related quality of life costs. We begin with data on newly diagnosed work injuries and diseases from calendar year 2015. We consider lifetime costs for cases across all categories and incurred by all stakeholders. Sensitivity analysis is undertaken for key parameters. RESULTS: Indirect costs are the largest part of the economic burden, then direct costs and intangible costs. As a percentage of GDP, the highest overall costs are for Poland (10.4%), then Italy (6.7%), The Netherlands (3.6%), Germany (3.3%) and Finland (2.7%). The Netherlands has the highest per case costs (€75,342), then Italy (€58,411), Germany (€44,919), Finland (€43,069) and Poland (€38,918). Costs per working-age population are highest for Italy (€4956), then The Netherlands (€2930), Poland (€2793), Germany (€2527) and Finland (€2331). CONCLUSIONS: Our framework serves as a template for estimating the economic burden of work injuries and diseases across countries in the European Union and elsewhere. Results can assist policymakers with identifying health and safety priority areas based on the magnitude of components, particularly when stratified by key characteristics such as industry, injury/disease, age and sex. Case costing can serve as an input into the economic evaluation of prevention initiatives. Comparisons across countries provide insights into the relevant performance of health and safety systems.

Air pollution and cause-specific mortality: A comparative study of urban and rural areas in China.

Air pollution increases the risks of all-cause mortality, cardiovascular mortality and respiratory mortality across China. However, the urban-rural differences in the associations between air pollution and mortality have not been clearly identified. In this study, a distributed lag nonlinear model was used to examine whether the air pollutants-mortality associations vary between urban and rural areas. Then, we used logistic regression analyses to evaluate the air pollutants-mortality relations. Also, generalized additive models were simulated to evaluate the nonlinear curves. Our results showed that the relative risks of air pollution-related mortality were generally higher in rural areas, where PM2.5 pollution was the dominant factor (p-value < 0.05). Mortality risks for all-cause, cardiovascular and respiratory will increase when average annual PM2.5 concentrations exceed approximately 38 µg/m3, 41 µg/m3 and 41 µg/m3, respectively, all of which exceed the annual Grade II standards. In urban areas, PM10-2.5 and NO2 were associated with mortality (p-value < 0.05). We proposed some area-specific strategies for controlling the NO2 pollution and PM10-2.5 pollution in urban areas and the PM2.5 pollution in rural areas to eliminate the gaps. Our findings identify that rural residents are more sensitive to air pollution than urban residents in China, and this result challenges previous assumptions about the more adverse effects of urbanization on residents' health in developing countries.

Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study.

OBJECTIVE: To determine the profile of Chinese medical professionals with burnout symptoms at the national level and identify the association between capability well-being and burnout. DESIGN AND SETTING: A cross-sectional study in a nonrandom national sample of medical staff from 6 provinces across western, central and eastern China. PARTICIPANTS: Physicians, medical laboratory scientists, nurses, and general practitioners aged 18 years or above who submitted a completed online questionnaire from June 2019 to January 2020 successfully (N = 25,120). MAIN OUTCOME MEASURES: The prevalence of burnout symptoms was assessed by the 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which consists of three domains: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). The overall high burnout was defined as EE score ≥27 or DP score ≥10. The capability well-being was measured by the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A) and the overall ICECAP-A score was calculated using the UK value set, ranging from a score of 0-1. Multivariable logistic regression analysis was used to identify the association between well-being and the overall high burnout. RESULTS: Among the 25,120 participants, 60.8% of the participants reported at least one symptom of burnout, whereas 11.2% reported all three symptoms of burnout. In the adjusted model, ICECAP-A score was independently associated with high burnout (AOR = 0.018, 95% CI = 0.015-0.022). Medical staff who were males, with shorter working years, working in tertiary hospitals, and those with the specialties of psychiatry, intensive care, emergency medicine, internal medicine, oncology, and pediatrics were at higher risk of reporting burnout symptoms. CONCLUSION: The burnout symptoms were relatively common among Chinese medical staff and they were found to be independently associated with capability well-being in health professionals. Interventions should be enhanced on vulnerable groups to reduce burnout and promote well-being in future studies.

Assessing NO2-related health effects by non-linear and linear methods on a national level.

Exposure to NO2 pollution has a significant adverse effect on residents' health. However, few studies have assessed the health effects associated with NO2 pollution. Compared with PM2.5 pollution, the harmfulness of NO2 pollution has not been quantitatively studied or clearly identified. In this study, we assessed the NO2 exposure-related health effects by non-linear and linear methods, taking advantage of online monitoring and survey data. We also assessed the economic cost of NO2 pollution in 338 cities in China. Our results showed that the average annual concentration of NO2 in the top fifteen cities with more than ten million permanent residents (except for Shenzhen, in the Guangdong province) exceeded the annual Grade II standards (40 µg/m3). The estimated national NO2-related all-cause mortality for non-linear and linear methods were 388.5 × 103 (95% CI: 198.1 × 103-748.2 × 103) and 374.1 × 103 (95% CI: 194.3 × 103-695.9 × 103), respectively. The total calculated national economic cost was about 28.8 billion US$ (95% CI: 14.7-55.4) in 2016. In addition, the comparison results showed that the harm caused by PM2.5 pollution was about four times that of NO2 pollution. Our statistics contribute to the limited research on NO2 pollution's effects on health and the economy in China.