The short- and long-term effects of community-family-doctor-based type 2 diabetes self-management interventions.

OBJECTIVES: The popularity of contracted family doctor services in China has been growing in recent years, but community-family-doctor-based type 2 diabetes mellitus (T2DM) intervention programs have yet to be adequately studied. This study was to evaluate the short- and long-term effects of community-family-doctor-based self-management interventions for T2DM and to explore strategies for long-term glycemic control. STUDY DESIGN: This was a randomized controlled trial. METHODS: A total of 144 eligible participants were randomly assigned to intervention and control groups. The control group received only routine community diabetes care, and the intervention group received community-family-doctor-based interventions involving the same standard of care. The interventions lasted for 3 months, and the follow-up was continued for 15 months. Intention-to-treat analysis and generalized estimation equations were then used to determine the short- and long-term effects of the interventions on glycated hemoglobin (HbA1c), diabetes self-management, and medication adherence. RESULTS: There were statistically significantly greater improvements in all aspects of the intervention group after 3 months of intervention. Compared with baseline, changes in the attitude (ß = 0.384, 95% confidence interval [CI; 0.194, 0.574], P < 0.001), practice (ß = 1.751, 95% CI [0.762, 2.739], P = 0.001), and knowledge, attitudes, practice total scores (ß = 2.338, 95% CI [0.682, 3.995], P = 0.006) of patients in the intervention group were statistically significant after 15 months, and the HbA1c (8.19 ± 1.73%), knowledge (16.42 ± 3.21), and medication adherence (5.53 ± 1.76) scores were slightly better than those at baseline, although not statistically significant (P > 0.05). CONCLUSIONS: T2DM self-management interventions based on community family doctors improved patients' HbA1c, diabetes self-management, and medication adherence, did not do so significantly in the long term.

Volatile organic compounds (VOCs) emissions from internal floating-roof tank in oil depots in Beijing: Influencing factors and emission reduction strategies analysis.

The internal floating-roof tank is the main type of storage tank for refined oil products. The volatile organic compounds (VOCs) emission from the internal floating-roof tank plays a dominant role in the unorganized emission source of the oil depot. In this study, we selected six typical oil depots in Beijing to investigate VOC emission characteristics from the tank top vent hole using infrared imaging technology and flame ionization detector (FID). The results reveal that infrared thermal imager is efficient in quickly identifying the emission level of the tank discharge point. The ambient temperature and wind speed have a direct effect on sealing loss, the turnover can greatly influence the wall hanging loss, and the concentration of VOCs emitted from the tank top vent hole is negatively correlated with liquid height. Furthermore, the influence of accessories type of the internal floating-roof tank on the concentration of VOCs emission from the top vent hole is also studied when other parameters remain unchanged, and find the floating deck type and sealing mode have a significant influence on their VOCs emissions, of which the combination of pontoon type floating deck and secondary seal are effective in controlling the concentration of VOCs emitted from the tank top vent hole. Finally, based on our experimental results, several feasible emission reduction strategies are proposed in terms of source prevention and process control in order to achieve the fine management of the whole process. This paper provides important technical support and policy thoughts for VOCs emission control during oil storage.

Safety analysis of antineoplastic drugs for lung cancer: a retrospective analysis based on Shaanxi Province in Western China.

BACKGROUND: China has the highest proportion of lung cancer-related deaths. Drug therapy is the main tool of comprehensive anticancer treatment. However, most studies to date have focused on certain types of targets or immunotherapeutic modalities for drug safety; few studies have addressed the factors that influence ADRs for each type of drug in patients with lung cancer, and even fewer studies have explored the risk factors for certain types of ADRs. Based on it, we comprehensively evaluate the drug safety of patients and provide a clinical reference with a focus on lung cancer. RESEARCH DESIGN AND METHODS: We examined 767 reports of adverse drug reactions (ADRs) in patients with lung cancer and conducted a logistic regression analysis on the risk factors that may cause different types of organ system damage and serious ADRs. RESULTS: The logistic regression identified various independent risk factors for system organ damage, and ADRs involving erythrocyte abnormalities (P < 0.001), respiratory system damage (P < 0.001), and leukocyte and reticuloendothelial system abnormalities (P < 0.001) were more likely to be severe. CONCLUSIONS: Rare adverse reactions and different Clinical medication guidelines for molecular-targeted drugs were identified. These findings had certain practical significance in clinical safe drug use.

Safety analysis of therapeutic drugs for breast cancer patients and construction of a predictive model for serious adverse drug reactions.

OBJECTIVES: To explore the characteristics of the occurrence of antineoplastic drug adverse reactions (ADRs) in breast cancer and to utilize a computerized tool to identify early warning indicators of potentially serious ADRs. METHODS: We conducted descriptive statistical analyses of the demographic features, medication use characteristics, and clinical manifestations of suspected ADRs in ADR-exposed patients using data from the Shaanxi Provincial Adverse Drug Reaction Monitoring Center, China, from 2017 to 2021. Using disproportionality methods (reporting odds ratio, proportional reporting ratio, and comprehensive standard method), the relationship between drugs and ADRs was measured. Finally, a web-based clinical prediction model for serious ADRs based on binary logistic regression was developed to estimate individual event probabilities numerically. RESULTS: We developed a new computer-mineable breast cancer-ADR system. In total, 1119 ADR reports were received between 2017 and 2021, with an increasing trend in the number. Antineoplastic medications of natural sources made up the greatest portion of the drug category (530, 38.10%) while targeted drugs' part increased with time. The medicine with the greatest number of ADR cases was docetaxel. Bone marrow failure was the most reported ADR. The disproportionality methods produced 19 signals of disproportionate reporting, two signals of disproportionate reporting were unknown ADRs. The occurrence of serious ADRs was shown to be substantially correlated with gender, platinum drugs, and blood and lymphatic system disorders. The clinical prediction model for serious ADRs had above-moderate discriminatory power (C-index was 0.775). CONCLUSIONS: The number of ADRs to breast cancer antineoplastic drugs was constantly increasing, with docetaxel ranking first, with the majority of ADRs presenting as bone marrow suppression, nausea, and vomiting. Data mining identified 19 signals of disproportionate reporting.

Emission of VOCs from service stations in Beijing: Species characteristics and pollutants co-control based on SOA and O3.

Currently, air pollution is primarily characterized by PM2.5 and O3. Therefore, the co-control of PM2.5 and O3 has become an important task of atmosphere pollution prevention and control in China. However, few studies have been conducted on the emissions from vapor recovery and processes, which is an important source of VOCs. This paper analyzed the VOC emissions of three vapor process technologies in service stations and first proposed key pollutants for priority control based on the coordinated reactivity of O3 and SOA. The concentration of VOCs emitted from the vapor processor was 3.14-9.95 g m-3, compared to 631.2-717.8 g m-3 for uncontrolled vapor. Alkanes, alkenes, and halocarbons accounted for a high proportion of the vapor both before and after control. Among the emissions, i-pentane, n-butane, and i-butane were the most abundant species. Then, the species of OFP and SOAP were calculated through the maximum incremental reactivity (MIR) and fractional aerosol coefficient (FAC). The average source reactivity (SR) value of the VOC emissions from three service stations was 1.9 g g-1, while the OFP ranged from 8.2 to 13.9 g m-3 and SOAP ranged from 0.18 to 0.36 g m-3. By considering the coordinated chemical reactivity of O3 and SOA, a comprehensive control index (CCI) was proposed for the control of key pollutant species that have multiplier effects on environment. For adsorption, trans-2-butene and p-xylene were the key co-control pollutants, while toluene and trans-2-butene were the most important for membrane and condensation + membrane control. A 50% emission reduction of the top two key species that emission account for 4.3% averagely will reduce O3 by 18.4% and SOA by 17.9%.

[Chemical Composition of VOCs from Service Stations Vapor Processing Device and Associated Contributions to Secondary Pollution].

Vapor processing device is a device that can control the headspace pressure in the underground storage tanks and recover the vapor. By analyzing the chemical composition of volatile organic compounds (VOCs) at the inlet and outlet of the vapor processing device, the ozone formation potential (OFP) and secondary organic aerosol formation potential (SOAP) were estimated by maximum incremental reaction (MIR) and fractional aerosol coefficients (FAC), and the secondary pollution formation contribution of VOCs were quantitatively evaluated. The results showed that:① the ρ(total volatile organic compounds, TVOC) at the inlet and outlet of the vapor processing device were 436-706 g·m-3 and 4.98-10.04 g·m-3, respectively. Alkanes (72%±4%), oxygenated organics (14%±2%), and olefins (11%±5%) were the dominant components of VOCs emissions. There were little differences in VOCs emissions from the different vapor processing devices; the key species were i-pentane (approximately 25%), followed by n-butane, i-butane, and n-pentane. ② The ozone source reactivity (SR) of VOCs emissions from the outlet of the vapor processing device was 2.6-3.3 g·g-1, and the OFP was 3.5-25.6 g·m-3. Olefins contributed the most (43%-69%), followed by alkanes (20%-35%) and oxygenated organics (10%-22%). Butene, cis-2-butene, trans-2-butene, i-pentane, and propionaldehyde were the species that highly contributed to OFP. ③ Aromatics in VOCs emissions contributed the most to SOAP (80%-92%), and the main active species were toluene, 1, 2, 4-trimethylbenzene, 1, 3, 5-trimethylbenzene, and p-diethylbenzene. The research showed that different VOCs species emitted by the vapor processing device contributed obvious differences to the secondary atmospheric pollution, and butene species and aromatics such as toluene were the focus of VOCs emission control of vehicle gasoline and vapor processing device.

Use of Failure Mode and Effects Analysis (FMEA) for Risk Analysis of Drug Use in Patients with Lung Cancer.

It is crucial to investigate the risk factors inherent in the medication process for cancer patients since improper antineoplastic drug use frequently has serious consequences. As a result, the Severity, Occurrence, and Detection rate of each potential failure mode in the drug administration process for patients with lung cancer were scored using the Failure Mode and Effect Analysis (FMEA) model in this study. Then, the risk level of each failure mode and the direction of improvement were investigated using the Slacks-based measure data envelopment analysis (SBM-DEA) model. According to the findings, the medicine administration process for lung cancer patients could be classified into five links, with a total of 60 failure modes. The risk of failure modes for patient medication and post-medication monitoring ranked highly, with unauthorized use of traditional Chinese medicine and folk prescription and unauthorized drug addition (incorrect self-medication) ranking first (1/60); doctor prescription was also prone to errors. The study advises actively looking at ways to decrease the occurrence and difficulty of failure mode detection to continually enhance patient safety when using medications.

Effects of community family doctors-led intervention for self-management and medication adherence in type 2 diabetes mellitus patients: study protocol of a cluster randomised controlled trial.

INTRODUCTION: The management of diabetes has become a critical public health issue in China. The development of community-based type 2 diabetes management in China has not yet reached an ideal state, and the most suitable management methods for diabetic patients are still being explored. Few studies have used community-based family doctors to perform interventions of appropriate intensity. This protocol describes a planned randomised controlled trial to evaluate the effectiveness of a family doctor-led intervention model for diabetes self-management and medication adherence in type 2 diabetes mellitus patients. METHODS AND ANALYSIS: This is a Standard Protocol Items: Recommendations for Interventional Trials-compliant cluster randomised controlled trial. The study will be conducted at four CHCs (community health centers). The control group will receive conventional medical services and health education. The intervention group will receive an intervention led by community family doctors based on the conventional medical services and health education. It will include five parts: usual care, a medication reminder, a 4-week plan, a weekly phone interview and a monthly interview. The primary outcomes are changes in fasting blood glucose, glycosylated haemoglobin, self-management knowledge and behaviour, and medication adherence from baseline to the 3rd and 6th months. The secondary outcome is the proportion of people whose blood sugar and glycosylated haemoglobin are under control in the 3rd and 6th months. ETHICS AND DISSEMINATION: The study proposal was approved by the Biomedical Ethics Committee of the Medical Department of Xi'an Jiaotong University (no. 2021-1371). The findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry, ChiCTR2100051685.

A cross-sectional study: comparison of public perceptions of adverse drug reaction reporting and monitoring in eastern and western China.

BACKGROUND: Adverse drug reactions (ADRs) cause a substantial clinical and economic burden. Spontaneous reporting of ADRs by the public is crucial. In some developed countries like the United States, Canada, consumers have been allowed to directly report ADRs, however, convenient channels for direct ADR reporting by the public are lacking in China. OBJECTIVE: We aimed to compare the knowledge, attitudes, and practice(KAP) regarding monitoring and reporting of adverse drug reaction (ADR) among the general public in eastern and western China. METHODS: A questionnaire-guided cross-sectional study was administered to participants in Nanjing and Xi'an during April-July 2019. A descriptive statistical analysis was used to describe respondents' demographic information and other results. The t-test and analysis of variance were used to test the differences in knowledge and attitudes among respondents with different demographic characteristics. P < 0.05 was considered statistically significant. Binary logistic regression analysis was used to examine factors associated with knowledge and attitudes. RESULTS: A total of 1085 questionnaires were distributed in this survey, 869 valid questionnaires were returned, the recovery rate was 80.09%. Respondents showed poor knowledge of the definition of ADRs and reporting criteria, with a significant difference in average knowledge scores according to education level, gender, and age group. Most respondents had positive attitudes toward ADR monitoring and reporting, with no significant differences in knowledge and attitude scores between the two cities. In total, 68.93% of respondents said they would feedback information to health care professionals, most (84.35%) would take the initiative to report ADRs if there were a convenient method. More than half (58.57%) of respondents were more likely to report ADRs by telephone. CONCLUSION: The findings of our study indicated that health care professionals should encourage patients to actively report ADR. China should also explore ways to facilitate direct public reporting of ADRs by improving relevant laws and regulations.

Assessment of medication adherence, medication safety awareness and medication practice among patients with lung cancer: A multicentre cross-sectional study.

OBJECTIVES: We aimed to explore the current status of medication adherence, safety awareness and practice among patients with lung cancer. METHODS: We conducted a questionnaire-guided cross-sectional study in Xi'an, Yulin, Hanzhong and Weinan in Shaanxi Province, China, from April to June 2021 for a period of 3 months. The study questionnaire was developed according to previous related studies reported in the literature, and includes basic demographic information and patients' medication safety questions. The data were double-entered using EpiData 3.1 software; descriptive statistics, t-test, analysis of variance, the Kruskal-Wallis test and the Mann-Whitney U-test were performed to analyse the data. RESULTS: A total of 567 participants were included, and 409 valid questionnaires were finally completed, with an effective response rate of 72.13%. More than 80% of patients showed good medication adherence; the average adherence score was 22 ± 2.68 of 25. The average score for medication safety awareness was 16.40 ± 4.41, which was significantly lower than that of medication adherence (p < .001). Only 22.74% of patients always checked their medicines before a nurse administered them; 17.60% of patients never checked their medicines. Few patients actively consulted an health care professional to understand safety information before taking a medication. A significant difference existed in safety awareness scores among age groups (p = .039) and geographic regions (p < .001). Patients with three or more comorbidities had the lowest awareness scores (p = .027). CONCLUSION: We found that patients with lung cancer showed better medication adherence, but their awareness about medication safety was poor. Older patients, those with comorbidities and patients in regions with poor medical resources may have worse awareness about safety. Current medication education for patients should not only aim to improve adherence but should also encourage patients to take greater responsibility for their own safety and to actively participate in their medication safety. Greater systematic and individualized medication safety information is needed for older patients, those with more comorbidities and patients in areas with poor medical resources. PATIENT CONTRIBUTION: We conducted a questionnaire-guided cross-sectional study on hospitalized lung cancer patients in Shaanxi Province to explore the patients' practices related to safety medication, including medication adherence and medication safety awareness.

1,25-Dihydroxyvitamin D deficiency induces sarcopenia by inducing skeletal muscle cell senescence.

To determine if 1,25(OH)2D deficiency can induce age-related sarcopenia, the skeletal muscular phenotype of male wild-type (WT) and Cyp27b1 knockout (KO) mice were compared at 3 and 6 months of age. We found that muscle mass, grip strength and muscle fiber size were significantly decreased in aging Cyp27b1 KO male mice. The expression levels of genes related to mitochondrial metabolic activity, and antioxidant enzymes including SOD1, catalase, Nqo1 and Gcs were significantly down-regulated in skeletal muscle tissue of Cyp27b1 KO male mice; in contrast, the percentage of p16+ and p21+ myofibers, and the expression of p16, p19, p21, p53, TNFα, IL6 and MMP3 at mRNA and/or protein levels were significantly increased. We then injected tibialis anterior muscle of WT and Cyp27b1+/- male mice with BaCl2, and analyzed the regenerative ability of skeletal muscle cells 7 days later. The results revealed that the numbers of newly formed regenerating central nucleated fibers (CNF), the percentage of BrdU+ cells and the expression of MyoD, MyHC and Myf5 at mRNA levels were significantly down-regulated in the injured skeletal muscle tissue of Cyp27b1+/- mice. In summary, our studies indicate that 1,25(OH)2D deficiency can result in the development of age-related sarcopenia by inducing oxidative stress, skeletal muscular cell senescence and SASP, and by inhibiting skeletal muscle regeneration. Cyp27b1 KO mice can therefore be used as an animal model of age-related sarcopenia in order to investigate the pathogenesis of age-related sarcopenia and potentially to test intervention measures for treatment of sarcopenia.

Predictors of Glycemic Control among Patients with Type 2 Diabetes in Western China: A Multi-center Cross Sectional Study.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing rapidly in China. Glycemic control is vital in this patient population. We designed a cross-sectional questionnaire to investigate glycemic control and associated factors in T2DM patients in Western China. The survey included patients' medical history, blood glucose status, and therapeutic medications, as well as demographic data. The Chi-square test, Fisher's exact test, and logistic regression were performed to analyze the data. The STROBE checklist was used to check the procedure. Among 510 T2DM patients included in this study, 47.5% of them had blood glucose control within the normal range, defined as glycated hemoglobin A1c (HbA1c) ≤7% or fasting plasma glucose (FPG) <7.0 mmol/L. The mean age of participants was 60.58 ± 11.20 years, with a male to female ratio of 1.02 : 1. Glycemic control was significantly associated with region (p < 0.001), comorbidities (p < 0.001), monitoring frequency (p = 0.002), treatment with insulin (p = 0.003), and medication compliance (p < 0.001). Logistic regression analysis showed that unsuccessful glycemic control was significantly related to wealthier residence (p < 0.001), more comorbidities (p = 0.017), monitoring frequency (p = 0.003), and medication incompliance (p < 0.001). These results suggested that the level of glycemic control among T2DM patients in Western China was poor. It is necessary to carry out health management and nursing of diabetic patients from community, family and patients jointly.

[Emission Status and Standards of Volatile Organic Compounds from Chinese and Foreign Bulk Petroleum Terminals].

Chinese emission standard of air pollutants for bulk gasoline terminals (GB 20950-2007) stipulate standards for vapor emissions during gasoline storage and receiving in bulk gasoline terminals. However, the standards are not applicable to crude oil, aviation kerosene, naphtha, and other kinds of oil. We assess emission standards or directives for vapor processing equipment in terminals in the United States (US) and European Union (EU), and analyze the emission status of vapor processing equipment in three typical cities in China. We further propose revisions to GB 20950-2007. We made the following observations. ① US and EU standards include scope not only for gasoline, but also crude oil and other organic liquids. ② The emission limits of non-methane hydrocarbons defined in GB 20950-2007 are i) 0.5, 1.8, and 8.9 times those defined in Subpart XX, Subpart R, and Subpart Y in the US federal regulations, ii) 1.8 and 3.1 times those defined in Rule 462 and Rule 1142 in southern California law, and iii) 0.7 and 500 times those defined in EU and German directives, respectively. The vapor leakage limit for general areas of China is 0.5 times that defined in Subpart XX of the US standards, whereas the limits for some other specific areas of China, are 0.7 and 2.0 times those defined by Rule 462 and Rule 1142 in southern California law. ③ The numerical range of P5th-P95th of NMHC emissions from the inlet and outlet of vapor processing equipment in three typical cities of China were 115-811 g·m-3 and 0.1-20.0 g·m-3, respectively. The proportion of NMHC emission concentrations less than or equal to 10 g·m-3 at the outlet of vapor processing equipment was>85%. We suggest that the scope of application of GB 20950-2007 should be extended to crude oil, gasoline (including ethanol gasoline), aviation kerosene, and naphtha. The emission concentration limit of NMHC from vapor processing equipment should be tighten from 25 g·m-3 to 20 g·m-3, with a emission limit of 10 g·m-3 added for particular cases.

[VOCs Emission Inventory of Service Stations in a Subcenter (Tongzhou District) of the City of Beijing].

As a subcenter of the city of Beijing, Tongzhou District is faced with enormous pressure from the rapid growth of VOCs emissions from service stations. In this study, a set of bottom-up VOCs inventory estimation methods for service stations in Tongzhou District is established. Using local VOCs emission factors of service stations in Beijing, combined with gasoline and diesel sales from every service station, a high resolution VOCs emission inventory of service stations in Tongzhou District from 2015 to 2022 was established. The results showed the following. ①An online monitoring system (OMS) based on unloading, refueling, and tank pressure vapor emission control measures can reduce the VOCs emission factor from 190 mg·L-1 to 115 mg·L-1, and when the percent onboard refueling vapor recovery system (ORVR) Penetration reaches to about 50%, the emission factors can be reduced to 131 mg·L-1 and 96 mg·L-1, respectively. The VOCs emission factor (13 mg·L-1) of diesel from the service station is 0.8% of the uncontrolled emission factor (1552 mg·L-1) of gasoline. ②The amount of VOCs emissions from service stations in Tongzhou District was 97.8 t·a-1 in 2015, and the emissions of gasoline and diesel were 96.2 t·a-1 and 1.6 t·a-1, respectively, accounting for 98.4% and 1.6%. The emissions were mainly concentrated in the area surrounding the new Beijing Municipal Government site. ③After implementation of the vapor recovery requirements of "Beijing's Clean Air Action Plan from 2013-2017," considering the increase in oil sales from 2017 to 2022, VOCs emissions of gasoline and diesel from service stations will decrease by 9% and 6%, respectively, compared to those of 2015 in Tongzhou District. Assuming that the OMS will also be installed at 28 (2000-5000) t·a-1 service stations by the end of 2022, VOCs emissions of service stations will be reduce by 13% compared to those of 2015. ④The measure of restricting the number of vehicles in operation by 50% can reduce VOCs emissions of service stations by (22±12)% every day during 2014 Asia-Pacific Economic Cooperation conference (APEC). ⑤It is suggested to strengthen vapor recovery supervision on service stations in the area surrounding the new Beijing Municipal Government site, and in summer and refueling idle such as in noon.

[Study and Application of Test Method for VOCs Emission Factor of Refueling in Service Station].

VOCs emission of service station is one of the main sources of VOCs in Beijing. Uncontrolled emission factor (UEF) of refueling in China, US EPA, EEA respectively is 2.16, 1.31 and 1.00 times of CARB UEF (1008 mg·L-1). China's gasoline standards have changed in the last 20 years, and there is an urgent need to carry out the localization of gasoline refueling VOCs emission factor research. This paper compared test methods for refueling emission factors of European Union (EU) and California Air Resources Board (CARB) and found that the EU method was simpler and easier to operate than the CARB method, so we processed refueling VOCs emission factors test device in reference to EU test methods and chose a set of United States Stage Ⅱ vapor recovery system in Beijing service stations to carry out studies on VOCs emission factors. The results showed that: 1 For the fuel test tank, refueling vapor recovery efficiencies were 0.93 and 0.83 times of air to liquid volume ratio (A/L) of Stage Ⅱ respectively in winter and summer. Refueling emission factor in summer was greater than that in winter, and its recovery efficiency was lower than that in winter. 2 For the social vehicles, winter and summer refueling UEF respectively was (525±42) mg·L-1 and (963±174) mg·L-1, at the same time was 0.52 and 0.95 times of CARB refueling UEF (1008 mg·L-1) in A/L=0.The average value of emission factors respectively was (55±30) mg·L-1 and (112±108) mg·L-1 in A/L 1.05-1.07 in winter and summer. 3Refueling UEF without vapor recovery of social vehicles was chosen as the localized summer and winter refueling UEF in Beijing, we could calculate the emission factor of vapor recovery in different A/L combining with the linear equation of the fuel test tank.