Identifying the causal effects of driver distraction on hazardous actions at intersections based on propensity score weighting.

Distracted driving is a threat to traffic safety that can result in more traffic crashes. Although previous studies have been conducted to explore the relationship between driver distraction and hazardous driving actions, few studies are available to identify the causation between them. Thus, the study intended to evaluate the causal effects of distraction on hazardous driving actions at intersections based on the crash data extracted from the Crash Report Sampling System (2021-2022). The multinomial logit model was employed to reveal the factors contributing to driver distraction. Then, propensity score weighting was adopted to balance the factor distributions between distraction and non-distraction cases to identify the causal effects on hazardous actions. Results indicated that 1) the propensity of distraction is relevant to factors such as the driver's age, gender, vehicle type, speed limit, area, weather, and light condition, 2) driver distraction can significantly increase the probability of risky actions including speeding, running red lights, failing to obey stop signs, failing to yield, following too closely, and 3) the causal effects show great diversity for different distraction types. The findings serve to understand the influence mechanism of distraction on specific crash risks and develop countermeasures to reduce distraction and hazardous driving actions.

Case report: Ofatumumab treatment in anti-DPPX autoimmune encephalitis.

Dipeptidyl peptidase-like protein 6 (DPPX) antibody encephalitis is a rare autoimmune encephalitis. Diagnosis and treatment of DPPX remain challenging, particularly in patients with refractory disease. Herein, we report the first case of anti-DPPX encephalitis treated with ofatumumab. The patient had a chronic insidious onset and predominantly presented with severe neuropsychiatric symptoms and the typical triad of symptoms (weight loss, central nervous system hyperexcitability, and cognitive dysfunction). Positive anti-DPPX antibodies in the serum (1:1,000) and cerebrospinal fluid (CSF) (1:100) were detected at the disease peak. The patient was unresponsive to four types of standard immunotherapies (intravenous globulin, plasma exchange, steroids, and tacrolimus), resulting in a treatment switch to ofatumumab. After five doses of injection and 12 months of follow-up, the patient improved well, with only a mild cognitive deficit.

The Synergy Reinforcement Effect of Sm0.85Zn0.15MnO3 and ZrMgMo3O12 on Sm0.85Zn0.15MnO3-ZrMgMo3O12/Al-20Si Composites.

Negative thermal expansion (NTE) ceramics Sm0.85Zn0.15MnO3 (SZMO) and ZrMgMo3O12 (ZMMO) were selected to prepare Sm0.85Zn0.15MnO3-ZrMgMo3O12/Al-20Si (SZMO-ZMMO/Al-20Si) composites using ball milling and vacuum heating-press sintering processes in this study. The synergistic effect of the SZMO and ZMMO NTE ceramic reinforcements on the microstructure, mechanical properties, and coefficient of thermal expansion (CTE) of the composites was investigated. The results show that the processes of ball milling and sintering did not induce the decomposition of SZMO or ZMMO NTE ceramic reinforcements, nor did they promote a reaction between the Al-20Si matrix and SZMO or ZMMO NTE ceramic reinforcements. However, the excessive addition of SZMO and ZMMO NTE ceramics led to their aggregation within the composite. Adding a small amount of SZMO in combination with ZMMO effectively increased hardness and yield strength while reducing CTE in the Al-20Si alloy. The improvement in strength was primarily provided by SZMO, while the inhibition effect on CTE was primarily provided by ZMMO. An evaluation parameter denoted as α was proposed to evaluate the synergy effects of SZMO and ZMMO NTE ceramic reinforcements on the mechanical properties and CTE of the composites. Based on this parameter, among all composites fabricated, adding 2.5 vol% SZMO NTE ceramic and 10 vol% ZMMO NTE ceramic resulted in an optimal balance between CTE and strength for these composites with a compressive yield strength of 349.72 MPa and a CTE of 12.55 × 10-6/K, representing a significant increase in yield strength by 79.20% compared to that of Al-20Si alloy along with a notable reduction in CTE by 26.44%.

Analyzing the factors influencing speeding behavior based on quasi-induced exposure and random parameter logit model with heterogeneity in means.

INTRODUCTION: Speeding behavior is a major threat to road traffic safety, which can increase crash risks and result in severe injury outcomes. Although several studies have been conducted to analyze speeding crashes and relevant influential factors, the heterogeneity of variables has not been fully explored. Based on the traffic crash data extracted from the Crash Report Sampling System, the study aims to identify the factors that influence speeding driving with the consideration of variable heterogeneity. METHOD: Quasi-induced exposure technique is adopted to identify the disparities in the propensities of speeding for various driving cohorts. The random parameter logit model with heterogeneity in means is employed to examine the factors impacting speeding behavior. RESULTS: Results indicate that: (a) driving cohorts such as young drivers, male drivers, passenger cars, and pickups appear to have higher propensities of engaging in speeding driving; (b) the propensity of speeding is higher when the driver is drinking, distracted, changing lanes, negotiating a curve, driving in lighted condition, and on curved roads; and (c) the random parameter logit model with heterogeneity in means has better performance as opposed to that without heterogeneity in means. CONCLUSIONS: Speeding behavior can be influenced by various factors in terms of driver-vehicle characteristics, physical condition, driving actions, and environmental conditions. PRACTICAL APPLICATIONS: The findings could serve to develop effective countermeasures to reduce speeding behavior and improve traffic safety.

Evaluating the traffic safety performance of left-turn waiting areas at signalized intersections.

Left-turn waiting area (LWA) is an innovative traffic design that is popularly applied to improve the traffic capacity of signalized intersections in China. The traffic safety impacts of the LWA, however, have not been fully discussed in previous studies. Thus, the study aims to evaluate the safety performance of the LWA by means of the traffic conflict technique. A field investigation was conducted to collect the post-encroachment time (PET) of conflicts and relevant variables at the signalized intersections in Jinhua, China. The Chi-square and two sample t-tests were adopted to examine the difference in conflict distribution between the intersections with and without LWA. The random parameter ordered logit model was employed to identify the factors contributing to the risks of vehicular collisions. Results indicate that (1) intersections with LWA are generally associated with more merging conflicts; (2) there are no significant discrepancies in the PET values between intersections with and without LWA; and (3) factors such as the number of left-turn lanes, number of receiving lanes, conflict type, vehicle type, driving direction, stopping outside LWA and overtaking behavior are identified to significantly impact the traffic conflicts. The findings serve to develop the countermeasures to ensure the safe operation of LWA.

PA suppresses antitumor immunity of T cells by disturbing mitochondrial activity through Akt/mTOR-mediated Ca2+ flux.

Deciphering the mechanisms behind how T cells become exhausted and regulatory T cells (Tregs) differentiate in a tumor microenvironment (TME) will significantly benefit cancer immunotherapy. A common metabolic alteration feature in TME is lipid accumulation, associated with T cell exhaustion and Treg differentiation. However, the regulatory role of free fatty acids (FFA) on T cell antitumor immunity has yet to be clearly illustrated. Our study observed that palmitic acid (PA), the most abundant saturated FFA in mouse plasma, enhanced T cell exhaustion and Tregs population in TME and increased tumor growth. In contrast, oleic acid (OA), a monounsaturated FFA, rescued PA-induced T cell exhaustion, decreased Treg population, and ameliorated T cell antitumor immunity in an obese mouse model. Mechanistically, mitochondrial metabolic activity is critical in maintaining T cell function, which PA attenuated. PA-induced T cell exhaustion and Treg formation depended on CD36 and Akt/mTOR-mediated calcium signaling. The study described a new mechanism of PA-induced downregulation of antitumor immunity of T cells and the therapeutic potential behind its restoration by targeting PA.

The difference in quasi-induced exposure to crashes involving various hazardous driving actions.

In quasi-induced exposure (QIE) theory, the presence of hazardous driving action is the typical determinant of the driver's responsibility for a crash. However, there is a lack of effort available to analyze the impacts of hazardous actions on the QIE estimate, which may result in estimation bias. Thus, the study aims to explore the difference in QIE to crashes involving various hazardous driving actions. Chi-square test is conducted to examine the consistency of non-responsible party distributions among the crashes involving various hazardous actions. Multinomial logit model and nested logit model are employed to identify the disparities of contributing factors to the actions. Results indicate that: 1) the estimated exposures appear to be inconsistent among the crashes with different hazardous actions, 2) driving cohorts have differential propensities of performing various hazardous actions, and 3) factors such as driver-vehicle characteristics, time, area, and environmental condition significantly affect the occurrence of hazardous actions while the directions and magnitude of the effects show great disparities for various actions. It can be concluded that the QIE estimates are significantly different for crashes involving various hazardous actions, which serves to highlight the importance of clarifying the specific hazardous actions for responsibility assignment in QIE theory.

Rates of perceived medical errors and its correlation with work-related factors and personal distress among emergency physicians in China: a national cross-sectional study.

PURPOSE: Medical errors are a global concern, and specifically, EDs are at considerable risk for medical errors. Few studies focus on the healthcare provider's self-perceived medical errors in hospitals, let alone the ED. Hence, this study explored perceived medical errors and their correlation with work-related factors and personal distress among physicians in EDs in China. METHODS: From July 2018 to August 2018, a national web-based cross-sectional study was conducted. The link to the web-based questionnaire was posted on the emergency physicians' working platform, inviting Chinese licensed emergency physicians to participate anonymously in this survey. Our outcome of interest, medical errors, was investigated using self-reporting methods. Occupational stress was assessed using the Chinese version of the Effort-Reward Imbalance scale. The Patient Health Questionnaire, the subscale of the 10-item Positive and Negative Affect Schedule, the subscale of the validated Leiden Quality of Work Questionnaire and the 10-item Generalised Self-efficacy Scale were used to assess personal distress. Logistic regression analysis was used to determine factors significantly associated with perceived medical errors. RESULTS: A sample of 10 457 emergency physicians completed the survey. Almost half (43.63%) of physicians reported self-perceived medical errors during the previous 3 months. The rate of workplace verbal aggression, effort-reward imbalance and depressive symptoms were 81.81%, 78.39% and 35.71%, respectively. Medical errors were more likely to be reported among chief physicians, and those who reported the department was short-staffed for physicians, and who experienced workplace verbal aggression and intense work stress. Medical errors were significantly associated with negative affect and lower self-efficacy. CONCLUSION: Self-perceived medical errors are prevalent among physicians working in EDs and are associated with their workplace environment and personal distress. Targeted interventions are required to reduce physicians' workload and improve their working environment. Accounting for healthcare providers' distress is imperative for reducing the incidence of medical errors and improving their health.

Occurrence of self-perceived medical errors and its related influencing factors among emergency department nurses.

AIMS AND OBJECTIVES: To determine the prevalence and the associated factors of self-perceived medical errors among Chinese emergency department nurses. BACKGROUND: The emergency department is a place with a high incidence of medical errors. Studies about the occurrence and related influencing factors of medical errors among emergency nurses in China are very insufficient. DESIGN: A nationwide cross-sectional study. METHODS: A nationwide cross-sectional study was conducted from July 2018-August 2018. A total of 17,582 emergency department nurses from 31 provinces across China were eventually included in the analysis. Logistic regression is applied to examine the association of the independent variables with the perceived medical errors. The reporting of this study was compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. RESULTS: Of 17,582 participating nurses, 4445 (25.28%) reported self-perceived medical errors in the past 3 months. Nurses who were serving as nurses-in-charge; who reported fair or bad physical health; who reported staff shortage; who were exposed to more verbal abuse at work; who experienced effort-reward imbalance; who reported more over-commitment; or who had depressive symptoms were more likely to report medical errors. Older age and female gender were protective factors. CONCLUSIONS: In this study, a quarter of the emergency nurses reported that they had made medical errors in the past 3 months. Self-perceived medical errors are associated with multiple domains of work-related factors and personal distress. Feasible measures should be taken to reduce nurses' workload, improve their working environment, monitor and minimise the occurrence of medical errors among emergency department nurses. RELEVANCE TO CLINICAL PRACTICE: Emergency nurses, who are the most frequently in contact with patients, play an important role in identifying risk factors and preventing medical errors. Identifying risk factors that may lead to medical errors in the medical environment from both internal and external aspects will help nursing practitioners, hospital administrators and policy makers to take timely preventive measures to reduce the occurrence of medical errors and reduce harm to patients.

Case report and literature review: thyroid carcinoma showing intrathyroid thymic carcinoma.

Background: Intrathyroid thymic carcinoma (ITTC) is a rare malignancy of the thyroid gland with histological and immunophenotypic resemblance to thymic carcinoma. Surgery combined with adjuvant radiotherapy improves the survival of patients with ITTC. However, for patients with extensive metastases, there is currently no effective treatment. Chemotherapy is an option but has not demonstrated improved patient survival. Methods and results: A female patient presented with metastases to the pleura, lung, and bone 16 years after surgery for ITTC. As radiotherapy and chemotherapy failed to control the recurrent disease, lenvatinib treatment was initiated. After 3 months, positron emission tomography/computed tomography showed a substantial reduction of all metastatic lesions and decreased tumor metabolism. The patient continues to receive lenvatinib and remains well and symptom-free. Conclusion: For patients with ITTC who have progressive, life-threatening metastases, lenvatinib represents a valuable salvage therapy that may offer a sustained reduction in tumor burden and maintenance of quality of life.

Influence of Pre-Pressing Ring on the Weld Quality of Ultrasonically Welded Short Carbon Fiber Reinforced Nylon 6 Composite.

The ultrasonic welding (UW) technique is a fast-joining process; it is very suitable for the carbon fiber reinforced thermoplastic (CFRTP) composite. For improving the consistency of the welded joint quality, a new pre-pressing ring clamp (PPRC) was designed for ultrasonic welding carbon fiber reinforced nylon composites in this paper. The effects of the PPRC on the weld quality of the ultrasonic welding welded 4.0 mm thick 30% mass short carbon fiber reinforced Nylon 6 composite was investigated and compared with that of normal clamp weld joint. The weld strength, microstructure, and temperature evolution of the joint were analyzed by tensile test, scanning electron microscope, and temperature measurement. The results showed that the PPCR UW joints had larger central weld nugget size (478 mm2 vs. 300 mm2), thicker stable fusion region thickness (1.10 mm vs. 0.96 mm), resulting in a higher joint strength (6.86 kN vs. 6.21 kN) compared with the normal clamp UW joints under the same welding parameters. The real-time monitor curve of the horn displacement and temperature at the faying interface showed that the PPRC increased the heat rating at the faying interface during instable melting stage. The PPRC could improve the contact condition between workpieces and the utilization efficiency of ultrasonic energy, which boosted the melting rate of materials at faying interface and consequently the formation of a sound joint with enough weld size (i.e., 433 mm2) in a shorter welding time (i.e., 1.3 s). Therefore, the flexibility of component assembly would be increased by the use of this sort of clamps.

Effect of Preload on the Weld Quality of Ultrasonic Welded Carbon-Fiber-Reinforced Nylon 6 Composite.

Ultrasonic welding (UW) of polymeric composites is significant in automobile industry; however, maintaining the perfect contact condition between workpieces is a great concern. In this study, effect of preloading and welding pressure on strengths of UWed 2.3-mm-thick short carbon fiber reinforced nylon6 (Cf/PA6) joints with poor contact between workpieces was investigated through stress simulation and energy dissipation at the faying interface. Results showed the application of preloading can increase the strength of normal joint by 18.7% under optimal welding parameters. Gaps between upper and lower workpieces decreased the joint strength significantly, especially for gaps greater than 1.5 mm. Preloading improved the strengths of the joints with gaps remarkably, where the strength of joints with 1.5 mm gap recovered to 95.5% of that the normal joint. When combining the weld nugget evolution, stress-deformation simulation during UW, and ultrasonic vibration transmission analysis, the improvement mechanism of the joint under preloading was mainly because the preloading compacted the contact between workpieces, which favored the energy transmission at faying interface.

Bayesian spatial correlation, heterogeneity and spillover effect modeling for speed mean and variance on urban road networks.

Analyzing speed mean and variance is vital to safety management in urban roadway networks. However, modeling speed mean and variance on structured roads could be influenced by the spatial effects, which are rarely addressed in the existing studies. The inadequacy may lead to biased conclusions when considering vehicle speed as a surrogate safety measure. The current study focuses on developing a Bayesian modeling approach with three types of spatial effects, i.e., spatial correlation, spatial heterogeneity, and spillover effect. To capture the spatial correlation, the study employs the intrinsic conditional autoregressive (ICAR) models, spatial lag models (SLM), and spatial error models (SEM). Spatial heterogeneity and spillover effect are considered by the random parameters approach and spatially lagged covariates (SLCs). Speed data are collected from the float cars running on 134 urban arterials in Chengdu, China. The results indicate that the random parameters ICAR model with SLCs (RPICAR-SLC) outperforms others in terms of goodness-of-fit, accuracy, and efficiency for modeling speed mean, while the random parameters ICAR model (RPICAR) is the best for modeling speed variance. Moreover, RPICAR-SLC and RPICAR models are beneficial to address spatial correlation of residuals, explaining the unobserved influence among the observations, and are less likely to cause biased or overestimated parameters. The study also discusses how traffic conditions, road characteristics, traffic management strategies, and facilities on roadway networks influence speed mean and variance. The findings highlight the importance of multi-type spatial effects on modeling speed mean and variance along the structured roadways.

Development trend of primary healthcare after health reform in China: a longitudinal observational study.

OBJECTIVES: Reconstructing the primary healthcare system is the focus of the new round of Chinese health reform. Nevertheless, there have been few studies focusing on the strengthening of primary healthcare in Chinese health system. DESIGN: This study was a longitudinal observational study. PRIMARY AND SECONDARY OUTCOME MEASURES: The data of this study came from China Health Statistical Yearbook (2009-2018). We evaluated the development of primary healthcare based on the absolute values of health resources allocation and health service provision and evaluated the status of primary healthcare throughout the health system based on the composition ratios of the indicators across the health system. The Cochran-Armitage trend test and linear trend test were used to identify the indicators' trends over time. RESULTS: From 2009 to 2018, the amounts of health resources allocation and health service provision of Chinese primary healthcare institutions showed a significant upward trend (p<0.001). However, compared with the indicators in 2009, excepting that the proportion of grants from the government in the whole health system has an upward trend, the proportions of other indicators had an escalating trend in 2018 by 3.66% for practicing (assistant) physicians, by 2.69% for nurses, by 3.99% for total revenues, by 5.87% for beds, by 8.39% for outpatient visits. CONCLUSION: The primary healthcare system has developed rapidly, but its development speed lagged behind the entire health system, resulting in the weakening of its actual functions, which is not in line with the goal of health reform. The government should be more aware of the importance of primary healthcare at all levels of local governments and ensure adequate financial input.

Causal mediation analysis of the impacts of distracted driving on crash injury risks.

Distracted driving can pose great risks to road traffic safety. Although there is a rich body of literature devoted to identifying the statistical association between distracted driving and crash risks, few are available to examine the causal effect mechanism of distracted driving. Thus, the study attempts to conduct the causal mediation analysis to reveal the impact mechanism of distracted driving on crash injury risks, in which various hazardous driving actions are used as the mediators between driver distraction and crash injuries. Sensitivity analysis is also carried out to validate the underlying assumption of causal mediation analysis. The analytic results indicate that 1) distracted driving can lead to a higher likelihood of hazardous driving actions such as failing to yield, disobeying traffic control devices, driving left of lane center, and failing to stop in assured clear distance, 2) both the driver distraction and hazardous actions are the contributory factors to the severe crash injuries, and 3) distracted driving is identified to have significant mediation effects on crash injury risks. The study confirms the causal mediation effects of distracted driving on crash injury risks, which can serve to propose specific safety countermeasures to mitigate the crash injury risks.

Influence of ball milling process on microstructure, mechanical and thermal expansion properties of ZrMgMo3O12/Al-40Si composites.

In this study, ZrMgMo3O12/Al-40Si (ZMMO/Al-40Si) composites with 15 wt% ZrMgMo3O12 were fabricated by ball milling-vacuum hot pressing (VHP) processes. The effect of ball milling processes on the microstructure, compressive properties and coefficient of thermal expansion (CTE) of the composites were investigated. It is found that ball milling treatments of mixed ZMMO/Al-40Si powders refine the particles of ZMMO reinforcements and primary Si in ZMMO/Al-40Si composites and improve the distribution of ZMMO reinforcements in α-Al matrix, resulting in the increase of the compressive strength and the decrease of the CTE of ZMMO/Al-40Si composites. The highest compressive yield strength of 430.82 MPa and the lowest CTEs of 5.8 × 10-6/°C (RT - 400 °C) are obtained after ball milling for 8 h at 250 rpm, increasing by 145.9% and decreasing by 61.3% respectively compared with the compressive yield strength and CTE of Al-40Si alloy. Among the reinforcements commonly used in aluminum matrix composites, ZMMO reinforcement has the highest reduction efficiency for CTE of ZMMO/Al-40Si composite. The application of high-energy ball milling to refine the microstructure is a promising method that can simultaneously increase the strength and reduce the CTEs of ZMMO/Al-40Si composites.

Geometric features of middle cerebral artery are associated with spontaneous basal ganglia intracerebral haemorrhage.

BACKGROUND AND PURPOSE: Haemodynamics around the middle cerebral artery (MCA) and lenticulostriate arteries is believed to play important roles in the vascular rupture and local haemodynamics is subject to vascular geometry. Nonetheless, the relationship between the geometric features of MCA and spontaneous basal ganglia intracerebral haemorrhage (ICH) has not been investigated. To examine the relationship between the MCA geometric features and spontaneous basal ganglia ICH. METHODS: This study was of retrospective and observational nature. The study recruited 158 consecutive hospitalised patients with consecutive CT-confirmed unilateral spontaneous basal ganglia ICH. Clinical data were extracted from electronic medical records, and imaging data were evaluated by two trained radiologists. The MCA-related geometric features were examined and their relationship with spontaneous basal ganglia ICH was analysed. Haemodynamic analyses under different MCA structural features were conducted. RESULTS: Compared with the contralateral MCA, the ipsilateral MCA had greater M1 diameter ratio (proximal/distal) and a smaller M1/M2 angle and MCA bifurcation angle (p＜0.01). Imaging study showed differences in the MCA shape in both sides on coronal plane (p＜0.05). These MCA features were significantly correlated with the spontaneous ICH in basal ganglia. The greater M1 diameter ratio (proximal/distal), the inferior-oriented M1, the smaller M1/M2 angle and the superior-oriented M1 conditions increased the pressure, from high to low. The greater M1 diameter ratio (proximal/distal) and the inferior-oriented M1 increased the shear stress at the distal end of M1 segment. CONCLUSIONS: The geometric features of MCA were significantly related to the spontaneous ICH in basal ganglia. The risk of haemorrhage, from high to low, included the greater M1 diameter ratio (proximal/distal), the inferior-oriented M1 (distal end), the smaller M1/M2 angle and the superior-oriented M1. Mechanistically, these vascular structural features contribute to increased vascular wall pressure and shear stress, which eventually lead to haemorrhage.

Estrogen receptor α mediated M1/M2 macrophages polarization plays a critical role in NASH of female mice.

Owing to lacking protective effect of estrogen, OVX mice have higher risk of non-alcoholic fatty liver disease compared with normal female mice, when fed with high fat diet. Our study was to explore how estrogen protect against nonalcoholic steatohepatitis in female mice. We found that, lacking estrogen, M1 macrphages was activated and promoted steatohepatitis in obese OVX mice. And, ERα was responsible for estrogen to inhibit M1 macrphages activation and steatohepatitis. ERα knockdown aggravated M1 macrophages infiltration by transcriptionally upregulated its CCR2 expression. CCR2 antagonist effectively improved nonalcoholic steatohepatitis, ER stress and insulin resistance in ERα knockdown obese female mice. These results demonstrated ERα mediated M1 macrophages activation played a key role in nonalcoholic steatohepatitis.

Activatable molecular probes for fluorescence-guided surgery, endoscopy and tissue biopsy.

The real-time, dynamic optical visualization of lesions and margins ensures not only complete resection of the malignant tissues but also better preservation of the vital organs/tissues during surgical procedures. Most imaging probes with an "always-on" signal encounter high background noise due to their non-specific accumulation in normal tissues. By contrast, activatable molecular probes only "turn on" their signals upon reaction with the targeted biomolecules that are overexpressed in malignant cells, offering high target-to-background ratios with high specificity and sensitivity. This review summarizes the recent progress of activatable molecular probes in surgical imaging and diagnosis. The design principle and mechanism of activatable molecular probes are discussed, followed by specific emphasis on applications ranging from fluorescence-guided surgery to endoscopy and tissue biopsy. Finally, potential challenges and perspectives in the field of activatable molecular probe-enabled surgical imaging are discussed.

Prevalence of Antibiotic Purchase Online and Associated Factors Among Chinese Residents: A Nationwide Community Survey of 2019.

Introduction: Online sales of antibiotics have increased public access to these medicines. This study aimed to analyze the online antibiotic purchase behavior of the Chinese residents and identify its associated factors. Methods: We conducted a nationwide cross-sectional online survey among Chinese community residents from January 20 to February 28, 2019. A structured questionnaire was used to collect data on their sociodemographic characteristics, health-related variables, and the online antibiotic purchase behavior in the past 3 months. Descriptive statistics and logistic regression analyses were used. The statistical analyses were performed using SAS version 9.4 (SAS Institute Inc.). Results: A total of 101,120 respondents were included in the analysis. The weighted prevalence of antibiotic purchase online was 3.71% (95% CI, 3.53-3.88%). Residents who purchased antibiotics online were more likely to be older (age≥65 years), be a male, live in rural areas, have a higher education level, report an excellent economic status, suffer from chronic diseases, and search for health information on the internet. Conclusion: Numerous residents had purchased antibiotics online in the past 3 months throughout China. We should pay more attention to this behavior. There is a need to strengthen regulation of antibiotic sales online and improve public education on antibiotic purchase online. More comprehensive information on antibiotic purchase online as well as the advantages and disadvantages of online sales of antibiotics should be investigated in the future studies.