The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report.

BACKGROUND: Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear. CASE PRESENTATION: A 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis. CONCLUSION: Standardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Preparation, structural characterization, biological activity, and nutritional applications of oligosaccharides.

Oligosaccharides are low-molecular-weight carbohydrates between monosaccharides and polysaccharides. They can be extracted directly from natural products by physicochemical methods or obtained by chemical synthesis or enzymatic reaction. Oligosaccharides have important physicochemical and physiological properties. Their research and production involve many disciplines such as medicine, chemical industry, and biology. Functional oligosaccharides, as an excellent functional food base, can be used as dietary fibrer and prebiotics to enrich the diet; improve the microecology of the gut; exert antitumour, anti-inflammatory, antioxidant, and lipid-lowering properties. Therefore, the industrial applications of oligosaccharides have increased rapidly in the past few years. It has great prospects in the field of food and medicinal chemistry. This review summarized the preparation, structural features and biological activities of oligosaccharides, with particular emphasis on the application of functional oligosaccharides in the food industry and human nutritional health. It aims to inform further research and development of oligosaccharides and food chemistry.

Sustainable remediation of Cr(VI)-contaminated soil by soil washing and subsequent recovery of washing agents using biochar supported nanoscale zero-valent iron.

Soil contamination by Cr(VI) has attracted widespread attention globally in recent years, but it remains a significant challenge in developing an environmentally friendly and eco-sustainable technique for the disposal of Cr(VI)-contaminated soil. Herein, a sustainable cyclic soil washing system for Cr(VI)-polluted soil remediation and the recovery of washing agents using biochar supported nanoscale zero-valent iron (nZVI-BC) was established. Citric acid (CA) was initially screened to desorb Cr(VI) from contaminated soil, mobilizing Cr from the highly bioaccessible fractions. The nZVI-BC exhibited superior properties for Cr(VI) and Cr(total) removal from spent effluent, allowing effective recovery of the washing agents. The elimination mechanism of Cr(total) by nZVI-BC involved the coordinated actions of electrostatic adsorption, reduction, and co-precipitation. The contributions to Cr(VI) reduction by Fe0, surface-bound Fe(II), and soluble Fe(II) were 0.6 %, 39.8 %, and 59.6 %, respectively. Meanwhile, CA favored the activity of surface-bound Fe(II) and Fe0 in nZVI-BC, enhancing the production of soluble Fe(II) to strengthen Cr(VI) removal. Finally, the recovered washing agent was proven to be reused three times. This study showcases that the combined soil washing using biodegradable chelant CA and effluent treatment by nZVI-BC could be a sustainable and promising strategy for Cr(VI)-contaminated soil remediation.

The Phenomenon and Determinants of Healthcare Service Utilization for Older Adults With Multimorbidity in China: An Explanatory, Mixed-Method Study.

OBJECTIVES: The objective of this study was to explore the phenomenon and determinants of healthcare service utilization in Chinese older adults with multimorbidity. METHODS: We adopted a mixed-methods explanatory design from July 2022 to May 2023. The quantitative research was a social network analysis to explore the phenomenon of healthcare service utilization in target participants. The quantitative results were further interpreted as the participant's propensity for healthcare services and the potential for information sharing between healthcare providers through shared patients. Logistic regression was conducted to identify individual determinants for healthcare service utilization. The quantitative research was followed by qualitative interviews with stakeholders to deeply understand the phenomenon of interest from the individual, healthcare system, and societal perspectives. RESULTS: We recruited 321 participants for the quantitative study. They preferred using medication services from primary healthcare providers, pharmacists at private pharmacies, and hospital specialists, and preferred using other services from hospital specialists. Dense relationships arose from shared patients among healthcare providers across various professions and settings, making it possible to share patient information. Primary healthcare providers were particularly important in the process, as they were closely related to others through patient sharing. Health status was identified through logistic regression and qualitative interviews as an individual determinant for healthcare service utilization. More determinants were explored in qualitative interviews with 30 stakeholders, including trust, resource allocation, healthcare accessibility, medical treatment process, and healthcare awareness. DISCUSSION: Strategies should be proposed to intervene with patients' nonoptimal propensity toward healthcare services and promote information sharing among healthcare providers.

Facilitators and Barriers of Integrated Care for Older Adults with Multimorbidity: A Descriptive Qualitative Study.

Purpose: A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China. Patients and Methods: From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings. Results: Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission. Conclusion: Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers.

Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study.

BACKGROUND: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. OBJECTIVE: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. METHODS: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). RESULTS: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. CONCLUSIONS: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.

Healthcare for Older Adults with Multimorbidity: A Scoping Review of Reviews.

Purpose: To summarize adverse healthcare outcomes experienced by older adults with multimorbidity and barriers perceived by stakeholders regarding the healthcare systems primarily designed to address individual health conditions. Healthcare elements that aim to provide coordinated, continuous, and comprehensive services for this population were also identified. Patients and Methods: We applied the methodology framework developed by Arksey and O'Malley to guide the review. The three-step search strategy was used to identify relevant English reviews that focused on adverse healthcare outcomes and barriers encountered by older adults with multimorbidity and other stakeholders regarding the single-disease-focused healthcare systems, as well as those concentrated on healthcare elements that aim to provide coordinated, continuous, and comprehensive services for older adults with multimorbidity. Five electronic databases, including PubMed/Medline, CINAHL, Web of Science Core Collection, Cochrane Library, and Embase, were systematically searched from database inception to February 2022. A standardized table was used to extract data. Thematic analysis was then conducted under the guidance of the Rainbow Model of Integrated Care and the Chronic Care Model. Results: Twenty reviews were included in this study. Therapeutic competitions, high healthcare service utilization, and high healthcare costs were three adverse healthcare outcomes experienced by patients. Both patients and healthcare professionals faced various barriers. Other stakeholders, including informal caregivers, healthcare managers, and policymakers, also perceived several barriers. Numerous healthcare elements were identified that may contribute to optimized services. The elements most frequently mentioned included the implementation of shared decision-making, comprehensive geriatric assessments, and individual care plans. Conclusion: This study conducted a comprehensive overview of the current knowledge related to healthcare for older adults with multimorbidity. In the future, it is necessary to develop more coordinated, continuous, and comprehensive healthcare service delivery models based on the healthcare needs of older adults with multimorbidity and the specific characteristics of different countries.

Development of an individualized WeChat mini program-based intervention to increase adherence to dietary recommendations applying the behaviour change wheel among individuals with metabolic syndrome.

BACKGROUND: Metabolic Syndrome (MetS) is a serious public health issue. Dietary changes form the core of MetS treatment. The adherence to dietary recommendations is critical for reducing the severity of MetS components and preventing complications. However, the adherence to dietary recommendations was not adequate among adults with MetS. This study utilizes the Behaviour Change Wheel (BCW) to develop an individualized WeChat mini program-based behavioural change intervention aimed at strengthening adherence to dietary recommendations in people with MetS. METHODS: The BCW theory was used to design an individualized WeChat mini program-based behavioural change intervention. A descriptive qualitative study was conducted to identify the determinants of adherence to dietary recommendations in individuals with MetS. The study was conducted at the health promotion centre of a prominent general university hospital in Zhejiang, China. Subsequently, the intervention functions (IFs) and policy categories were selected following the identified determinants. Afterwards, behaviour change techniques (BCTs) were chosen to translate into potential intervention strategies, and the delivery mode was determined. RESULTS: Our study identified fifteen barriers to improve the adherence to dietary recommendations in this population. These were linked with six IFs: education, training, persuasion, enablement, modelling, and environmental restructuring. Then, twelve BCTs were linked with the IFs and fifteen barriers. The delivery mode was a WeChat mini program. After these actions, an individualized WeChat mini program-based behavioural change intervention was developed to enhance adherence to dietary recommendations for individuals with MetS. CONCLUSIONS: The BCW theory helped scientifically and systematically develop an individualized WeChat mini program-based behavioural change intervention for individuals with MetS. In the future, our research team will refine and upgrade the WeChat mini program and then test the usability and effectiveness of the individualized WeChat mini program-based behavioural change intervention program.

This is the first paper to specify the content and active ingredients of an individualized WeChat mini program-based behavioural change intervention using a systematic evidence- and theory-based method for individuals with MetS.The findings can be used to provide guidance to improve dietary adherence, and ultimately improve the lives of people with MetS.This methodology can serve as a reference for other researchers who are developing behavioural change interventions.

Influencing factors of self-management behavior in cancer patients based on a theoretical domain framework. / åŸºäºŽç†è®ºåŸŸæ¡†æž¶çš„ç™Œç—‡æ‚£è€ è‡ªæˆ‘ç®¡ç†è¡Œä¸ºå½±å“å› ç´ åˆ†æž.

OBJECTIVES: To explore the factors that influence self-management behavior in cancer patients based on the theoretical domain framework. METHODS: Studies in Chinese and English about factors influencing self-management behavior in cancer patients were searched from Wanfang database, CNKI, VIP, SinoMed, PubMed, Embase, CINAHL, Web of Science Core Collection, Cochrane library and Medline from inception to June 2022. Two investigators independently identified, extracted data, and collected characteristics and methodology of the studies. Factors were analyzed with Nvivo12, and the theoretical domain framework was mapped to the theoretical domain. Then the secondary node was generalized by theme analysis. Finally, the specific influencing factors were summarized and analyzed. RESULTS: Thirty-four studies were included for analysis. A total of 194 factors were mapped to 13 theoretical domains, and 31 secondary nodes were summarized. Theoretical domains environmental context and resources, social/professional role and identity, and beliefs about consequences were the most common factors. Knowledge, age, self-efficacy, disease stage, social support, gender, economic status and physical status were the most influential factors for self-management in cancer patients. CONCLUSIONS: The influencing factors of self-management of cancer patients involve most of the theoretical domains, are intersectional, multi-source and complex.

Heterogenous subtypes of health literacy among individuals with Metabolic syndrome: a latent class analysis.

Objective To explore the heterogenous subtypes and the associated factors of health literacy among patients with metabolic syndrome.Methods A cross-sectional study was conducted, and 337 patients with metabolic syndrome were recruited from Sir Run Run Shaw Hospital in Zhejiang Province from December 2021 to February 2022. The Social Support Questionnaire, Short version of the Health Literacy Scale European Questionnaire (HLS-EU-Q16), and MacArthur Scale of Subjective Social Status were used for investigation. Latent class analysis (LCA) was performed to explore the heterogenous subtypes of health literacy among Metabolic syndrome patients. Univariate analysis and logistic regression were used to identify the predictors of the latent classes.Results The findings of LCA suggested that three heterogeneous subtypes of health literacy among individuals with metabolic syndrome were identified: high levels of health literacy, moderate levels of health literacy, and low levels of health literacy. The multinomial logistic regression results indicated that compared with low levels of health literacy class, the high levels of health literacy class were predicted by age (OR 0.932, 95%CI[0.900-0.966]), socio-economic status (OR 1.185, 95%CI[1.058-1.328]), and social support (OR 1.065, 95%CI[1.012-1.120]). Compared with low levels of health literacy class, the moderate levels of health literacy class were predicted by age (OR 0.964, 95%CI[0.934-0.995]), socio-economic status (OR 1.118, 95%CI[1.006-1.242]), male (OR 0.229, 95%CI[0.092-0.576]).Conclusion The levels of health literacy among patients with metabolic syndrome can be divided into three heterogenous subtypes. The results can inform policy-makers and care professionals to design targeted interventions for different subgroups among patients with metabolic syndrome who are male, at older age, have less social support, and with disadvantaged socio-economic status to improve health literacy.

Acid-modified red mud biochar for the degradation of tetracycline: Synergistic effect of adsorption and nonradical activation.

In this study, a novel acid-modified red mud biochar catalyst (MMBC) was synthesized by industrial waste red mud (RM) and peanut shell (PSL) to activate peroxodisulfate (PDS) for the degradation of TC. Meanwhile, MMBC exhibited remarkable adsorption capacity, reaching a 60% removal ratio of TC within 60 min (equilibrium adsorption capacity = 12 mg/g). After adding PDS, MMBC/PDS system achieved a 93.8% removal ratio of TC within 60 min. Quenching experiments and electron paramagnetic resonance (EPR) results showed that 1O2 played a dominant role in the degradation of TC and O2•- was the mainly precursor for the production of 1O2 in the MMBC/PDS system. X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared spectroscopy (FTIR) analysis showed that the surface Fe(II), -OH and -COOH provided the active sites for the activation of PDS by MMBC. In addition, acid modification optimised the surface structure of the catalyst and enhanced the conversion of Fe (mainly Fe(III) to Fe(II)), thereby improving the adsorption and catalytic efficiency of MMBC. This study confirmed that modified red mud biochar is an efficient composite with both adsorption and catalysis, providing new ideas for the practical treatment of antibiotic wastewater and the resource utilization of red mud.

The integrated common-sense model of illness self-regulation: predicting healthy eating, exercise behaviors, and health among individuals at risk of metabolic syndrome.

BACKGROUND: Little is known about the potential mechanisms of healthy eating and exercise change, and design interventions which aim to promote healthy eating and exercise change among individuals at risk of metabolic syndrome. This study aimed to identify key determinants of healthy eating, exercise behaviors, and health among individuals at risk of metabolic syndrome using the integrated common-sense model of illness self-regulation. METHOD: A cross-sectional study with a multi-wave data collection strategy. A total of 275 participants at risk of metabolic syndrome based on the clinical prediction model were included in the final analysis. Path analysis was employed to explore the pattern of relationships between key variables using AMOS. RESULTS: The mediation analysis suggested that personal and treatment control, and coherence can positively affect self-reported health via intentions and health behaviors (exercise and healthy eating). Additionally, relationships between self-efficacy (exercise and healthy eating) and health outcomes can be mediated by health behaviors, and both intentions and health behaviors. CONCLUSIONS: This current research used the integrated common-sense model of illness self-regulation to predict healthy eating, exercise behaviors, and self-reported health among individuals at risk of metabolic syndrome. The results suggested that self-efficacy, intention, consequences, personal control, treatment control, and coherence were the key determinants of behavior and health, which can help design interventions to encourage healthy eating and exercise changes among individuals with a high risk of MetS.

Sedentary behavior patterns and the risk of non-communicable diseases and all-cause mortality: A systematic review and meta-analysis.

BACKGROUND: The association between sedentary behavior and health-related outcomes has been well established, whereas it is inconclusive whether a sedentary behavior pattern is an additional risk factor for health-related outcomes independent of total sedentary time and physical activity. OBJECTIVES: To determine sedentary behavior patterns and their association with risks of noncommunicable diseases and all-cause mortality and to assess whether this association is independent of total sedentary time and physical activity. DESIGN: This was a systematic review and meta-analysis. METHODS: Studies were obtained by searching the Web of Science Core Collection, PubMed/Medline, the Cochrane Library, Embase, CINAHL, and SPORTDiscus up to April 2023. All observational studies published in English or Chinese were included if they explored sedentary behavior patterns and their association with risks of abdominal obesity, metabolic syndrome, diabetes, cardiovascular disease, cancer, and all-cause mortality among individuals who had never experienced the outcome event before the baseline assessment. Data extraction using a standardized form and quality appraisal using two authoritative tools were then performed. All these steps were completed by two independent reviewers from December 2022 to May 2023. If data were sufficiently homogenous, meta-analyses were performed; otherwise, narrative syntheses were employed. Harvest plots were also used to visually represent the distribution of evidence. RESULTS: Eighteen studies comprising 11 prospective cohort studies and seven cross-sectional studies were included. The findings suggested that prolonged sedentary time and usual sedentary bout duration were two metrics that reflected the nonlinear dose-response effect of prolonged sedentary behavior patterns. Only extremely high levels of prolonged sedentary behavior patterns significantly increased the risk of adverse health outcomes, independent of physical activity. Whether prolonged sitting was an additional risk factor for adverse health outcomes, independent of total sedentary time, was inconclusive due to an insufficient number of primary studies that included total sedentary time as one of the potential covariates. There was some evidence that supported a sedentary bout that significantly increased the risk of adverse health outcomes was 30-60 min. The threshold of prolonged sedentary time differed with outcomes, and future studies are needed to make this threshold more precise. CONCLUSION: A prolonged sedentary behavior pattern was associated with increased risks of several major noncommunicable diseases and all-cause mortality. People, especially those who do not reach the recommended level of moderate-to-vigorous physical activity, are encouraged to interrupt sedentary bouts every 30 to 60 min and limit prolonged sedentary time per day as much as possible. TWEETABLE ABSTRACT: Breaking up consecutive sedentary bouts >30 to 60 min and substituting them with brief bouts of physical activity.

Development and testing of the reliability and validity of a Chinese version of the Long-Term Conditions Questionnaire. / æ ¢æ€§ç— é•¿æœŸçŠ¶æ€é—®å·çš„æ±‰åŒ–åŠä¿¡æ•ˆåº¦æ£€éªŒ.

OBJECTIVES: To develop a Chinese version of the Long-Term Conditions Questionnaire (LTCQ) and to test its reliability and validity in Chinese patients with chronic diseases. METHODS: With the consent of the original authors, a Chinese version of LTCQ was developed according to the cultural adjustment guidelines. A questionnaire survey was conducted on 319 patients with chronic diseases in Sir Run Run Shaw Hospital, Wuyi County First People's Hospital and Hangzhou Gongchen Bridge Street Health Service Center. The questionnaire was evaluated by item analysis (including frequency analysis, total question correlation method and critical ratio method), reliability analysis (Cronbach's alpha coefficient) and validity analysis [including content validity (expert scoring method) and structural validity (exploratory factor analysis)]. RESULTS: The Chinese version of the LTCQ included 20 entries, with a Cronbach's alpha coefficient of 0.926, a retest reliability of 0.829, a split-half reliability of 0.878, an entry content validity index of 1, and a content validity index at the questionnaire level of 1. Four common factors were extracted by exploratory factor analysis, namely physical state and daily life, psychological state, support and coping, and safe environment, with a cumulative variance contribution rate of 67.244%. Discussion: The Chinese version of the LTCQ developed in this study has good reliability and validity and it may be used to assess the long-term conditions of patients with chronic diseases in China.

Effects of cultivar, water condition and their interactions on Cd accumulation in rice grains.

Using low Cd accumulation cultivars and managing field water regimes are effective measures to mitigate Cd accumulations in rice grains. However, the effect of the cultivar-water condition interaction (CWI) on grain Cd accumulations has largely been ignored. To solve this problem, pot and hydroponic experiments were conducted using 14 rice cultivars and two contrasting water conditions. The results showed that CWI significantly affected Cd concentrations in rice grains and roots, explaining 8.8% and 22.8% of the total variance, respectively. These CWI effects were derived from cultivar-dependent variations in rhizosphere soil properties [Eh, pH and available Cd associated with root radial oxygen loss (ROL)] and root Cd uptake. In this context, cultivar HH61 exhibited low, stable Cd accumulations, owing to its stably lower translocation rate, root Cd uptake ability and available Cd in its rhizosphere than the other cultivars, which was induced by its lower ROL. Root-to-grain Cd translocation rates were vital in determining Cd accumulations in grain of different cultivars but were independent from CWI. These results indicated that CWI could play an important role in Cd accumulation in rice while stable low-Cd cultivar should possess low ROL under flooding and low root-to-grain Cd translocation rate. The results will provide novel theoretical basis for cultivar selection and hence benefit the extensive use of low-accumulation cultivars and public health.

New insights into the mechanism of Fered-Fenton treatment of industrial wastewater with high chloride content: Role of multiple reactive species.

Hydroxyl radical (OH) is considered the dominant reactive species in the electro-Fenton (EF) and Fered-Fenton (EF-Fere) processes for wastewater treatment. However, in chloride-rich media, this is arguable due to the obscure mechanisms for the oxidant speciation and pollutant degradation. Herein, the role of active chlorine and Fe(IV)-oxo species (FeIVO2+) as primary oxidizing agents in HClO-mediated Fered-Fenton (EF-Fere-HClO) process is discussed, along with the dependence of their contribution on the pollutant structure. HClO generated from anodic oxidation of Cl- can be consumed by added H2O2 to form singlet oxygen (1O2), which is detrimental because this species is quickly deactivated by water. The reaction between HClO and Fe2+ was proved to generate FeIVO2+, rather than OH or Cl suggested in the literature. The yield of FeIVO2+ species was proportional to the Cl- concentration and barely affected by solution pH. The long-lived HClO and FeIVO2+ can selectively react with electron-rich compounds, which occurs simultaneously to the non-selective attack of OH formed from Fenton's reaction. The FeIVO2+ and OH concentration profiles were successfully modelled. Although the accumulation of toxic chlorinated by-products from HClO-mediated oxidation might cause new environmental concerns, the toxicity of pesticide wastewater with 508 mM Cl- was halved upon EF-Fere-HClO treatment.

Arsenic Elevated Groundwater Irrigation: Farmers' Perception of Rice and Vegetable Contamination in a Naturally Arsenic Endemic Area.

Arsenic (As) in groundwater and its accumulation in agricultural produces has caused serious threats to human health. The majority of current research on As mainly focuses on the technical aspects while bypassing the social perspectives. Farmers are the prime stakeholders as well as executors of agricultural strategies, and their adaptation largely depends on how they perceive the risk for which a mitigation strategy is proposed. This study aims to explore how rice and vegetable farmers perceive As accumulation in their rice and vegetables as well as explore current crop- and body-loading status, the subsequent health consequences of As, and alleviation possibilities with mitigation strategies and to investigate if there is an association between their socioeconomic status and their level of perception. Results reveal that one-fourth of the farmers gave a positive message regarding the As-contamination scenario in rice and vegetables. Although 10 farmers' socioeconomic characteristics were positively significant, distinctive emphasis should be given to five predictor variables explaining 88% variances: knowledge, direct participation in farming, information sources used, participant education, and organizational participation. Path analysis depicts that direct participation in farming presents the highest positive total effect (0.855) and direct effect (0.503), whereas information sources show the highest positive indirect effect (0.624). The mean As content in all five locations was statistically significant at the 5%, 5%, 0.1%, 1%, and 1% probability levels in scalp hairs, rice, vegetables, soils, and irrigation water, respectively. The first principal component (PC1) explains 92.5% of the variation. Significant variations were primarily explained by As levels in irrigation water, rice grain, and soil. Farmers' perception is far behind the actual field status of As level and its transfer. Therefore, intensified priorities should be administered on the farmers' characteristics contributing to variances in perception. The findings can be utilized for policy formulation in all As-endemic nations. More multidisciplinary research can be undertaken on farmers' attitude towards adopting As-mitigation techniques, with a focus on the socioeconomic position found to influence farmers' perceptions.

Determinants of adherence to diet and exercise behaviours among individuals with metabolic syndrome based on the Capability, Opportunity, Motivation, and Behaviour model: a cross-sectional study.

AIMS: Adherence to diet and exercise recommendations is crucial among metabolic syndrome (MetS) individuals. However, no studies have focused on comprehensive behavioural changes of diet and exercise among individuals with MetS. The present study aimed to explore determinants of adherence to diet and exercise behaviours among people with MetS based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model. METHODS AND RESULTS: A cross-sectional study was conducted in a health promotion centre of a large and general university hospital in Zhejiang Province, China, in 2021. A total of 241 individuals with MetS completed all scales. The mediation model was tested using structural equation modelling with bootstrapped samples. In the regression-based path analysis, MetS knowledge (ß = 0.140), socioeconomic status (ß = 0.162), and social support (ß = 0.143) directly positively influenced diet behaviour. In addition, social support indirectly positively influenced exercise behaviour through coping and adaptation (ß = 0.090). The final theoretical model showed a good fit (root mean square error of approximation = 0.057, comparative fit index = 0.946). CONCLUSION: Factors associated with diet behaviour were knowledge of MetS, socioeconomic status, and social support. Adaptation may be a mediator between social support and exercise behaviour. Intervention programmes targeting increased adherence to diet and exercise could include these factors for individuals with MetS.

Sedentary time and the risk of metabolic syndrome: A systematic review and dose-response meta-analysis.

The dose-response association between sedentary time and the risk of metabolic syndrome is unclear, which indicates an important knowledge gap in public health. The objective of this study was to determine the categorical and continuous dose-response associations between sedentary time and the risk of metabolic syndrome. A systematic literature search of English articles published in PubMed, CINHAL, Embase, and Web of Science Core Collection prior to June 2022 was conducted. All cohort and cross-sectional studies that examined the association between sedentary time and the risk of metabolic syndrome were considered, and duplicate and non-related studies were excluded. Data extraction using a standardized chart and quality assessment using two appraisal tools were also performed. Two independent reviewers were involved in these processes. In categorical meta-analyses, the pooled effect sizes for metabolic syndrome associated with different categories of sedentary time were calculated by comparing the highest and intermediate with the lowest categories. In continuous meta-analyses, the linear and nonlinear dose-response associations were estimated using generalized least squares and restricted cubic spline models, respectively. Data were collected and analyzed from March to June 2022. Four prospective cohort studies and 22 cross-sectional studies with 105,239 participants and 16,185 MetS cases were included in this study. In categorical analyses, both intermediate (median duration: 4.11 h/day; pooled OR: 1.17, 95% CI: 1.08-1.26, P < 0.001) and high levels (median duration: 7.26 h/day; pooled OR: 1.71, 95% CI: 1.43-2.04, P < 0.001) of total sedentary time were significantly associated with an increased risk of metabolic syndrome. Similarly, a significant association between screen time and the risk of metabolic syndrome was also found in intermediate (median duration: 2.22 h/day; pooled OR: 1.20, 95% CI: 1.10-1.32, P < 0.001) and high levels (median duration: 3.40 h/day; pooled OR: 1.63, 95% CI: 1.44-1.86, P < 0.001) of exposure. Of note, these associations were significantly stronger in women. Different patterns of the behavior-disease association were not observed in children, adolescents, and adults. The findings of continuous meta-analyses could not provide solid evidence for the linearity and nonlinearity of the behavior-disease association. This study demonstrated that long-time sedentary behavior was associated with a higher risk of MetS independent of physical activity and the patterns of association varied by gender instead of age. These findings have implications for future guideline recommendations on physical activity, sedentary behavior, and prevention of metabolic syndrome.

Development of a behavior change intervention to improve physical activity adherence in individuals with metabolic syndrome using the behavior change wheel.

BACKGROUND: Adherence to physical activity is inadequate in adults with metabolic syndrome. Adherence to physical activity recommendations is crucial and can result in improved health outcomes and reduced medical burdens. A comprehensive behavior change intervention, including identifying determinants of adherence to physical activity recommendations, intervention options, intervention content and implementation options, was imperative for enhancing physical activity adherence. The aim of the study is to develop an intervention to increase physical activity adherence among individuals with metabolic syndrome. METHODS: The study followed the eight steps of the Behavior Change Wheel guide, including defining the problem in behavioral terms (Step 1), selecting target behavior (Step 2), specifying target behavior (Step 3), identifying what needs to change (Step 4), identifying intervention functions (Step 5), identifying policy categories (Step 6), identifying behavior change techniques (Step 7), and determining model of delivery (Step 8). The semi-structured, in-depth interviews were employed to identify the determinants of adherence to physical activity among twenty-eight individuals with metabolic syndrome based on capability, opportunity, motivation and behavior model. Next, the intervention functions and policy categories were chosen to address these determinants. Finally, behavior change techniques were selected to assist in the delivery of the intervention functions and be translated into intervention content. RESULTS: Our study identified eighteen facilitators and fifteen barriers to physical activity adherence. It resulted in the selection of seven intervention functions and nineteen behavior change techniques for the intervention program. Then, the current study identified an app as the delivery mode. Finally, a behavioral change intervention was generated for individuals with metabolic syndrome to increase physical activity recommendation adherence. CONCLUSIONS: The Behavior Change Wheel provided a systematic approach to designing a behavior change intervention, which helped improve the health outcomes and reduce medical burdens and economic burdens among individuals with metabolic syndrome. The findings suggested that potential intervention should pay special attention to increasing knowledge in metabolic syndrome, imparting skills of physical activity, offering a supportive environment, and providing suggestions on regular physical activity using the appropriate behavior change techniques. A feasibility study will be undertaken to assess the acceptability and effectiveness of the intervention program in the future.