GA signaling protein LsRGL1 interacts with the abscisic acid signaling-related gene LsWRKY70 to affect the bolting of leaf lettuce.

A variety of endogenous hormone signals, developmental cues, and environmental stressors can trigger and promote leaf lettuce bolting. One such factor is gibberellin (GA), which has been linked to bolting. However, the signaling pathways and the mechanisms that regulate the process have not been discussed in full detail. To clarify the potential role of GAs in leaf lettuce, significant enrichment of GA pathway genes was found by RNA-seq, among which the LsRGL1 gene was considered significant. Upon overexpression of LsRGL1, a noticeable inhibition of leaf lettuce bolting was observed, whereas its knockdown by RNA interference led to an increase in bolting. In situ hybridization analysis indicated a significant accumulation of LsRGL1 in the stem tip cells of overexpressing plants. Leaf lettuce plants stably expressing LsRGL1 were examined concerning differentially expressed genes through RNA-seq analysis, and the data indicated enhanced enrichment of these genes in the 'plant hormone signal transduction' and 'phenylpropanoid biosynthesis' pathways. Additionally, significant changes in LsWRKY70 gene expression were identified in COG (Clusters of Orthologous Groups) functional classification. The results of yeast one-hybrid, ß-glucuronidase (GUS), and biolayer interferometry (BLI) experiments showed that LsRGL1 proteins directly bind to the LsWRKY70 promoter. Silencing LsWRKY70 by virus-induced gene silencing (VIGS) can delay bolting, regulate the expression of endogenous hormones, abscisic acid (ABA)-linked genes, and flowering genes, and improve the nutritional quality of leaf lettuce. These results strongly associate the positive regulation of bolting with LsWRKY70 by identifying its vital functions in the GA-mediated signaling pathway. The data obtained in this research are invaluable for further experiments concerning the development and growth of leaf lettuce.

The Role of Subjective Wellbeing in Mediating Social Trust to the Mental Health of Health Workers.

Mental health problems of health workers are attracting increasing concerns in China and the world. A trustful relationship between health workers and patients is the foundation of quality patient care, which is currently under serious threat. This study aimed to determine the associations of social trust on subjective wellbeing and mental health of health workers. Using the survey data of 262 health workers extracted from the 2018 Chinese Family Panel Studies, a structural equation model with partial least square approach was established. The results showed that social trust was linked to both subjective wellbeing (ß = 0.251, p < 0.01) and mental health (ß = -0.210, p < 0.01). The effect of social trust on mental health was partially mediated by subjective wellbeing (51.87%). The association between social trust and subjective wellbeing was moderated by socioeconomic status: social trust has a stronger effect on subjective wellbeing in those with higher socioeconomic status. Erosion of social trust may present a serious risk to mental health and subjective wellbeing of health workers. High socioeconomic status can amplify the effect of social trust.

Estimating the effect of increasing ambient temperature on antimicrobial resistance in China: A nationwide ecological study with the difference-in-differences approach.

Antimicrobial resistance (AMR) and the possible consequences of rising ambient temperatures brought on by global warming have been extensively discussed. However, the epidemiological evidence on the effects of temperature on AMR is rare and little is known about the role of socioeconomic inequities. This ecological study obtained 31 provinces AMR data of Escherichia Coli (E. coli) from the China Antimicrobial Resistance Surveillance System (CARSS) over the period from 2014 to 2020, which were linked to the meteorological and socioeconomic data published in the China Statistical Yearbook. Modified difference-in-differences (DID) analyses were performed to estimate the effect of ambient temperature on AMR of E. coli to third-generation cephalosporins (ceftriaxone and cefotaxime), carbapenems, and quinolones, adjusting for variations in meteorological and socioeconomic factors. We estimated that every 1 °C increase in average ambient temperature was associated with 2.71 % (95 % confidence interval [CI]: 1.20-4.24), 32.92 % (95 % CI: 15.62-52.81), and 1.81 % (95 % CI: 0.47-3.16) increase in the prevalence of E. coli resistance to third-generation cephalosporins (ceftriaxone and cefotaxime), carbapenems and quinolones, respectively. The link was more profound in the regions with lower temperature and a median level of average humidity, and the regions with lower income, lower expenditure (in economics), lower health resources, and lower hospital admissions. Neither the replacement of the temperature variable nor the alternative approaches for confounding adjustment changed the positive association between ambient temperature and AMR. In general, there exists a positive association between ambient temperature and AMR, although the strength of such an association varies by socioeconomic and health services factors. The association is possibly nonlinear, especially for E. coli resistance to third-generation cephalosporins. The findings suggest that AMR control programs should explicitly incorporate weather patterns to increase their effectiveness.

Examining clinical capability of township healthcare centres for rural health service planning in Sichuan, China: an administrative data analysis.

OBJECTIVE: This study aimed to examine the clinical capability of township healthcare centres (THCs), the main primary care providers in rural China, as a basis for rural health service planning. DESIGN: Observational study of quantitative analysis using administrative data. SETTING: Three counties with low, middle and high social economic development level, respectively, in Sichuan province western China. PARTICIPANTS: 9 THCs and 6 county hospitals (CHs) were purposively selected in the three counties. Summary of electronic medical records of 31 633 admissions from 1 January 2015 to 30 December 2015 of these selected health institutions was obtained from the Health Information Centre of Sichuan province. MAIN OUTCOME MEASURES: Six indicators in scope of inpatient services related to diseases and surgeries in the THCs as proxy of clinical capability, were compared against national standard of capability building of THCs, among counties, and between THCs and CHs of each county. RESULTS: The clinical capability of THCs was suboptimal against the national standard, though that of the middle-developed county was better than that in the rich and the poor counties. THCs mainly provided services of infectious or inflammatory diseases, of respiratory and digestive systems, but lacked clinical services related to injuries, poisoning, pregnancy, childbirth and surgeries. A large proportion of the top 20 diseases of inpatients were potentially avoidable hospitalisations (PAHs) and were overlapped between THCs and CHs. CONCLUSIONS: The clinical capability of THCs was generally suboptimal against national standard. It may be affected by the economics, population size, facilities, workforce and the share of services of THCs in local health systems. Identification of absent services and PAHs may help to identify development priorities of local THCs. Clarification of the roles of THCs and CHs in the tiered rural health system in China is warranted to develop a better integrated health system.

Factors influencing the timeliness of care for patients with lung cancer in Bangladesh.

BACKGROUND: This study explored the factors associated with timeliness of care in the healthcare seeking pathway among patients with lung cancer in Bangladesh. METHODS: A structured questionnaire was used for data collection from 418 patients with lung cancer through face-to-face interviews in three tertiary care hospitals. Log-rank tests were performed to test differences in the length of intervals between points in healthcare by socioeconomic characteristics and care seeking behaviours of the patients. Cox Proportional Hazard (PH) regression analysis was performed to identify the predictors of the intervals after adjustment for variations in other variables. RESULTS: A higher education level was associated significantly (p < 0.05) with a shorter interval between first contact with a healthcare provider (HCP) and diagnosis (median 81 days) and initiation of treatment (median 101 days). Higher monthly household income was associated significantly with a shorter time from first contact and diagnosis (median 91 days), onset of symptom and diagnosis (median 99 days), onset of symptom and treatment (median 122 days), and first contact with any HCP to treatment (median 111 days). Consulting with additional HCPs prior to diagnosis was associated significantly with longer intervals from first contact with any HCP and diagnosis (median 127 days), onset of symptom and diagnosis (median 154 days), onset of symptom and treatment (median 205 days), and first contact with any HCP to treatment (median 174 days). Consulting with informal HCPs was associated significantly with a longer time interval from symptom to treatment (median 171 days). Having more than one triggering symptom was associated significantly with a shorter interval between onset of symptoms and first contact with any HCP. CONCLUSION: The predictors for timeliness of lung cancer care used in this study affected different intervals in the care seeking pathway. Higher education and income predicted shorter intervals whereas consulting informal healthcare providers and multiple providers were associated with longer intervals.

Delay in seeking health care from community residents during a time with low prevalence of COVID-19: A cross-sectional national survey in China.

Background: The pandemic of COVID-19 has significant implications on health resources allocation and health care delivery. Patients with non-COVID illness may have to change their care seeking behaviors to mitigate the risk of infections. The research aimed to investigate potential delay of community residents in seeking health care at a time with an overall low prevalence of COVID-19 in China. Methods: An online survey was conducted in March 2021 on a random sample drawn from the registered survey participants of the survey platform Wenjuanxing. The respondents who reported a need for health care over the past month (n = 1,317) were asked to report their health care experiences and concerns. Logistic regression models were established to identify predictors of the delay in seeking health care. The selection of independent variables was guided by the Andersen's service utilization model. All data analyses were performed using SPSS 23.0. A two-sided p value of <0.05 was considered as statistically significant. Key results: About 31.4% of respondents reported delay in seeking health care, with fear of infection (53.5%) as a top reason. Middle (31-59 years) age (AOR = 1.535; 95% CI, 1.132 to 2.246), lower levels of perceived controllability of COVID-19 (AOR = 1.591; 95% CI 1.187 to 2.131), living with chronic conditions (AOR = 2.008; 95% CI 1.544 to 2.611), pregnancy or co-habiting with a pregnant woman (AOR = 2.115; 95% CI 1.154 to 3.874), access to Internet-based medical care (AOR = 2.529; 95% CI 1.960 to 3.265), and higher risk level of the region (AOR = 1.736; 95% CI 1.307 to 2.334) were significant predictors of the delay in seeking health care after adjustment for variations of other variables. Medical consultations (38.7%), emergency treatment (18.2%), and obtainment of medicines (16.5%) were the top three types of delayed care, while eye, nose, and throat diseases (23.2%) and cardiovascular and cerebrovascular diseases (20.8%) were the top two conditions relating to the delayed care. Self-treatment at home was the most likely coping strategy (34.9%), followed by Internet-based medical care (29.2%) and family/friend help (24.0%). Conclusions: Delay in seeking health care remained at a relatively high level when the number of new COVID-19 cases was low, which may present a serious health risk to the patients, in particular those living with chronic conditions who need continuous medical care. Fear of infection is the top reason for the delay. The delay is also associated with access to Internet-based medical care, living in a high risk region, and perceived low controllability of COVID-19.

Healthcare practitioner use of real-time prescription monitoring tools: an online survey.

Objective The aim of this study is to investigate how healthcare practitioners use real-time prescription monitoring tools in clinical practice. Methods An online survey was distributed to Australian prescribers and pharmacists who use a real-time prescription monitoring tool. Data were analysed and descriptive statistics summarised participant characteristics and responses. A Chi-squared test was conducted to test the difference between prescribers and pharmacists. Results The majority of participants agreed that real-time prescription monitoring (RTPM) information is useful (92.2%) and the tool is valuable for informing clinical decisions (90.2%); however, just over half reported that they had changed their prescribing or dispensing practices as a result of RTPM information (51.0%), and they employed evidence-based clinical interventions to varying degrees. No statistically significant differences were detected between pharmacists and prescribers and perceptions on tool use. Conclusions This is the first known study to investigate practitioner use of RTPM tools in Australia, and is a starting point for further research. What constitutes 'success' in the clinical application of RTPM tools is yet to be realised.

Effects of social norm feedback on antibiotic prescribing and its characteristics in behaviour change techniques: a mixed-methods systematic review.

Low-cost and low-barrier antibiotic stewardship strategies are urgently needed to deal with the widespread problem of antibiotic resistance. Social norm feedback could be a promising strategy. In this mixed-methods systematic review (PROSPERO: CRD42022361039), we aimed to identify the key behaviour change techniques used in social norm feedback for antibiotic stewardship and assess their effectiveness in reducing antibiotic prescribing. We searched PubMed, Embase, Web of Science, and Scopus for peer-reviewed studies published between Jan 1, 2000, and Jan 20, 2022. 3547 studies were screened, of which 23 studies reporting the effects of social norm feedback interventions on antibiotic prescribing met the inclusion criteria. 19 behaviour change techniques were tested in the included studies. The meta-analyses showed that social norm feedback is an effective strategy for reducing antibiotic prescribing, with an overall rate difference of 4% (p<0·0001). The behaviour change technique with the highest effective ratio (ER=13) was information about health consequences, followed by instruction on how to perform the behaviour (ER=9) and adding objects to the environment (ER=9). Social norm feedback is a promising strategy to reduce antibiotic prescribing, and can be incorporated into the clinical decision-making support system.

Transcriptome and Metabolome Analysis Revealed That Exogenous Spermidine-Modulated Flavone Enhances the Heat Tolerance of Lettuce.

Lettuce is sensitive to high temperature, and exogenous spermidine can improve heat tolerance in lettuce, but its intrinsic mechanism is still unclear. We analyzed the effects of exogenous spermidine on the leaf physiological metabolism, transcriptome and metabolome of lettuce seedlings under high-temperature stress using the heat-sensitive lettuce variety 'Beisansheng No. 3' as the material. The results showed that exogenous spermidine increased the total fresh weight, total dry weight, root length, chlorophyll content and total flavonoid content, increased the activities of antioxidant enzymes such as superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT), and decreased malondialdehyde (MDA) content in lettuce under high temperature stress. Transcriptome and metabolome analyses revealed 818 differentially expressed genes (DEGs) and 393 metabolites between water spray and spermidine spray treatments under high temperature stress, and 75 genes from 13 transcription factors (TF) families were included in the DEGs. The Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis of DEG contains pathways for plant-pathogen interactions, photosynthesis-antennal proteins, mitogen-activated protein kinase (MAPK) signaling pathway and flavonoid biosynthesis. A total of 19 genes related to flavonoid synthesis were detected. Most of these 19 DEGs were down-regulated under high temperature stress and up-regulated after spermidine application, which may be responsible for the increase in total flavonoid content. We provide a possible source and conjecture for exploring the mechanism of exogenous spermidine-mediated heat tolerance in lettuce.

Use of social health insurance for hospital care by internal migrants in China-Evidence from the 2018 China migrants dynamic survey.

Background: China's welfare system including social health insurance has been closely linked to its unique household registration system, despite high population mobility over the past few decades. This study aimed to determine the pattern of health insurance usage from internal migrants in mainland China for hospital care. Methods: Data were extracted from the 2018 China Migrants Dynamic Survey. The respondents who enrolled in a social health insurance program and reported illness or injury over the past year were eligible for this study (n = 15,302). Two groups of outcome indicators were calculated assessing the use (incidence and settlement location) of insurance funds for hospital care and the burden of hospital expenditure (total hospital expenditure, out-of-pocket payments, and share of insurance reimbursement), respectively. Logit regression and Heckman's sample selection models were established to determine the predictors of insurance fund usage and the burden of hospital expenditure, respectively. Results: Most respondents enrolled in a social health insurance program outside of their residential location (70.72%). About 28.90% were admitted to a hospital over the past year. Of those hospitalized, 72.98% were admitted to a hospital at their migration destination, and 69.96% obtained reimbursement from health insurance, covering on average 47% of total hospital expenditure. Those who had a local insurance fund aligned with residency (AOR = 2.642, 95% CI = 2.108-3.310, p < 0.001) and enrolled in employment-based insurance (AOR = 1.761, 95% CI = 1.348-2.301, p < 0.001) were more likely to use insurance funds for hospital care, and paid less out-of-pocket (ß = -0.183 for local funds, p = 0.017; ß = -0.171 for employment-based insurance, p = 0.005) than others. A higher share of insurance reimbursement as a proportion of hospital expenditure was found in the employment-based insurance enrollees (ß = 0.147, p < 0.001). Insurance claim settlement at the residential location was associated with lower total hospital expenditure (ß = -0.126, p = 0.012) and out-of-pocket payments (ß = -0.262, p < 0.001), and higher share of insurance reimbursement (ß = 0.066, p < 0.001) for hospital expenditure. Conclusion: Low levels of health insurance benefits for hospital care are evident for internal migrants in mainland China, which are associated with the funding arrangements linked to household registration and inequality across different funds.

The vicious cycle of the public's irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review.

Background: The public's irrational use of antibiotics for upper respiratory tract infections (URTIs) is prevalent worldwide. This study aims to synthesize evidence on how people use antibiotics to treat URTIs, its prevalence and determinants. Methods: A mixed methods systematic review was conducted using a convergent segregated approach. Relevant studies were searched from PubMed, Cochrane Library, Embase, and Web of Science. A qualitative analysis was initiated, exploring the public's antibiotic use experience for URTIS based on the Consumer Behavior Model (CBM). This was followed by a quantitative synthesis, tapping into the prevalence and predictors of public behavior in antibiotic usage for URTIs. The segregated syntheses complemented each other and were further integrated. Results: A total of 86 studies were included: 48 quantitative, 30 qualitative, eight mixed methods studies. The included studies were conducted in Europe (n = 29), Asia (n = 27) and North America (n = 21), assessing the behaviors of patients (n = 46), their parents or caregivers (n = 31), or both (n = 9). Eleven themes emerged covering the six CBM stages: need recognition, information searching, alternative evaluation, antibiotic obtaining, antibiotic consumption, and post-consumption evaluation. The six stages reinforce each other, forming a vicious cycle. The high prevalence of the public's irrational use of antibiotics for URTIs is evident despite the high heterogeneity of the studies (ranging from 0.0 to 92.7%). The perceived seriousness of illness and misbelief in antibiotics were identified consistently across the studies as the major motivation driving the public's irrational use of antibiotics for URTIs. However, individual capacity (e.g., knowledge) and opportunity (e.g., contextual restriction) in reducing antibiotic use have mixed effect. Conclusion: Systemic interventions concerning both supply and demand sides are warranted. The public needs to be educated about the appropriate management of URTIs and health care providers need to re-shape public attitudes toward antibiotic use for URTIs through communication and prescribing practices. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier: CRD42021266407.

Health-related quality of life of young academics: A cross-sectional survey of universities in Wuhan, China.

Objective: This study aimed to assess the health-related quality of life (HRQoL) of young academics in Wuhan, China, and its determinants. Methods: A multistage stratified cluster sampling strategy was employed to recruit study participants (young academics <40 years old) from 12 universities in Wuhan. A total of 301 respondents returned a self-complete questionnaire that contained the EQ-5D-5L. Multivariate linear and Tobit regression models were established to determine the sociodemographic and job predictors of the visual analogue scale (VAS) score and the EQ-5D utility index, respectively. Results: The study participants reported a mean VAS value of 79.42 (SD = 10.51) and a mean EQ-5D utility index of 0.915 (SD = 0.090). Anxiety/depression was the most frequently reported problem (65.12%), followed by pain/discomfort (43.52%). Transitioning towards a full professorship in national key universities (p < 0.001), lower income (p < 0.05) and too much pressure for academic promotion (p < 0.001) were significant predictors of lower HRQoL; whereas, maintaining routines in physical activities (p < 0.001), sleep (p < 0.001) and meals (p < 0.001), a good relationship with colleagues and family members (p < 0.001), and social activities (p < 0.01) were significant predictors of higher HRQoL. Conclusion: Low HRQoL of young academics in China is evident, as indicated by the 7.08 and 0.049 gap in VAS and utility index, respectively, compared to the general population at the same age. Work and career pressures are associated with the low HRQoL of young academics. The findings of this study highlight the importance of work-life balance in promoting HRQoL of young academics in universities in China.

Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study.

Background: Population aging accompanied by multimorbidity imposes a great burden on households and the healthcare system. This study aimed to determine the incidence and determinants of catastrophic health expenditure (CHE) in the households of old people with multimorbidity in China. Methods: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, with 3,511 old people (≥60 years) with multimorbidity responding to the survey on behalf of their households. CHE was identified using two thresholds: ≥10% of out-of-pocket (OOP) health spending in total household expenditure (THE) and ≥40% of OOP health spending in household capacity to pay (CTP) measured by non-food household expenditure. Logistic regression models were established to identify the individual and household characteristics associated with CHE incidence. Results: The median values of THE, OOP health spending, and CTP reached 19,900, 1,500, and 10,520 Yuan, respectively. The CHE incidence reached 31.5% using the ≥40% CTP threshold and 45.6% using the ≥10% THE threshold. It increased by the number of chronic conditions reported by the respondents (aOR = 1.293-1.855, p < 0.05) and decreased with increasing household economic status (aOR = 1.622-4.595 relative the highest quartile, p < 0.001). Hospital admissions over the past year (aOR = 6.707, 95% CI: 5.186 to 8.674) and outpatient visits over the past month (aOR = 4.891, 95% CI: 3.822 to 6.259) of the respondents were the strongest predictors of CHE incidence. The respondents who were male (aOR = 1.266, 95% CI: 1.054 to 1.521), married (OR = 1.502, 95% CI: 1.211 to 1.862), older than 70 years (aOR = 1.288-1.458 relative to 60-69 years, p < 0.05), completed primary (aOR = 1.328 relative to illiterate, 95% CI: 1.079 to 1.635) or secondary school education (aOR = 1.305 relative to illiterate, 95% CI: 1.002 to 1.701), lived in a small (≤2 members) household (aOR = 2.207, 95% CI: 1.825 to 2.669), and resided in the northeast region (aOR = 1.935 relative to eastern, 95% CI: 1.396 to 2.682) were more likely to incur CHE. Conclusion: Multimorbidity is a significant risk of CHE. Household CHE incidence increases with the number of reported chronic conditions. Socioeconomic and regional disparities in CHE incidence persist in China.

Quality of working life of medical doctors and associated risk factors: a cross-sectional survey in public hospitals in China.

OBJECTIVES: To assess the quality of working life (QWL) of medical doctors and associated risk factors. SETTING AND PARTICIPANTS: A cross-sectional questionnaire survey of 2915 medical doctors from 48 hospitals was conducted in China. METHODS: The QWL-7-32 scale was adopted to assess seven domains of QWL: physical health, mental health, job and career satisfaction, work passion and initiative, professional pride, professional competence, and balance between work and family. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were analysed using SPSS V.19.0. Analysis of variance tests and multivariate linear regression analyses were performed to identify the sociodemographic characteristics and job factors associated with overall QWL and its seven subdomain scores. RESULTS: On average, the respondents reported an overall QWL score of 92.51 (SD=17.74) of a possible 160. Over 35% of respondents reported more than 60 hours of weekly working time; 59.9% experienced night sleep deprivation frequently; 16.6% encountered workplace violence frequently. The multivariate regression models revealed that the eastern region (ß≤-2.887 for non-eastern regions, p<0.001), shorter working hours (ß≤-2.638 for over 40 hours a week, p<0.01), less frequent night sleep deprivation (ß≤-5.366 for sometimes or frequent, p<0.001), higher income (ß≥2.795 for lower income, p<0.001) and less frequent encounters of workplace violence (ß≤-9.267 for sometimes or frequent, p<0.001) were significant predictors of higher QWL. Night sleep deprivation and workplace violence were common predictors (p<0.05) for all seven domains of QWL. CONCLUSION: The low QWL of medical doctors working in public hospitals in China is evident, which is associated with high workloads, low rewards and workplace violence. There are also significant regional differences in the QWL of medical doctors, with the eastern developed region featuring better QWL. Public hospitals in China are facing serious challenges in occupational health and safety, which needs to be addressed through a systems approach.

Air pollution and refraining from visiting health facilities: a cross-sectional study of domestic migrants in China.

BACKGROUND: Local environmental factors are associated with health and healthcare-seeking behaviors. However, there is a paucity in the literature documenting the link between air pollution and healthcare-seeking behaviors. This study aimed to address the gap in the literature through a cross-sectional study of domestic migrants in China. METHODS: Data were extracted from the 2017 China Migrants Dynamic Survey (n = 10,051) and linked to the official air pollution indicators measured by particulate matter (PM2.5 and PM10) and air quality index (AQI) in the residential municipalities (n = 310) of the study participants over the survey period. Probit regression models were established to determine the association between air pollution and refraining from visiting health facilities after adjustment for variations in the predisposing, enabling and needs factors. Thermal inversion intensity was adopted as an instrumental variable to overcome potential endogeneity. RESULTS: One unit (µg/m3) increase in monthly average PM2.5 was associated with 1.8% increase in the probability of refraining from visiting health facilities. The direction and significance of the link remained unchanged when PM2.5 was replaced by AQI or PM10. Higher probability of refraining from visiting health facilities was also associated with overwork (ß = 0.066, p = 0.041) and good self-related health (ß = 0.171, p = 0.006); whereas, lower probability of refraining from visiting health facilities was associated with short-distance (inter-county) migration (ß=-0.085, p = 0.048), exposure to health education (ß=-0.142, p < 0.001), a high sense of local belonging (ß=-0.082, p = 0.018), and having hypertension/diabetes (ß=-0.169, p = 0.005). CONCLUSION: Air pollution is a significant predictor of refraining from visiting health facilities in domestic migrants in China.

Self-reported work-related accumulative fatigue of nurses: A cross-sectional study in public hospitals in China.

Objectives: Work-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors. Methods: A questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The "Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue" was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue. Results: About one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5-10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue. Conclusion: High levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.

Conditions required to ensure successful detection and management of mild cognitive impairment in primary care: A Delphi consultation study in China.

Objective: Detection and management of mild cognitive impairment (MCI) in primary care has been recognized internationally as one of the strategies that can be employed to delay the development of dementia. However, little is known about what role primary care should play. This study aimed to develop a checklist of conditions necessary for successfully detecting and managing mild cognitive impairment in primary care in China. Methods: This study employed the Delphi method to establish expert consensus on the conditions required for successfully detecting and managing MCI in primary care in China. Twenty-four experts who specialized in general practice, public health, neuropsychology, or community health service management rated the importance of pre-defined conditions (44 items measuring providers' preparedness, patient engagement, and system support in line with the Chronic Care Model). The degree of consensus among the experts was measured using four indicators: median ≥ 4, mean ≥3.5, Co-efficient of Variance < 0.25, and retention in the checklist required ≥ 80% agreement with a rating of important or essential. The checklist and descriptions of the conditions were revised according to the experts' feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. Consensus was achieved after the second round of consultations, which was completed by 22 of the experts. Results: The experts endorsed a checklist of 47 conditions required for successful detection and management of MCI in primary care in China. These conditions were categorized into four domains: prepared general practitioners (17 items), engaged patients (15 items), organizational efforts (11 items), and environmental support (4 items). Conclusions: Successful detection and management of MCI in primary care in China requires a dedicated and competent workforce of general practitioners, as well as the engagement of patients and family caregivers. Adequate support from healthcare organizations, health system arrangements, and the broader society is needed to enable effective interactions between general practitioners and patients and efficient delivery of the services required to detect and manage MCI.

Effects of selenate and selenite on selenium accumulation and speciation in lettuce.

Lettuce is a common vegetable in hydroponic production. In this paper, a selenium (Se)-biofortification method was provided. The Se content, speciation, and the effects of different concentrations of selenate and selenite on lettuce growth and amino acids were investigated. The results showed that lettuce had strong ability to accumulate exogenous selenium, and inorganic Se could be effectively converted into organic Se. The proportion of organic Se in the shoots under treatment with 4 µmol L-1 selenite was 100%. Selenomethionine was the main organic Se, accounting for 51% (selenate) and 90% (selenite) of the total Se. Adding Se improves photosynthesis of lettuce and promotes growth. The growth with 2 µmol L-1 selenate and 4 µmol L-1 selenite was better than CK, and the shoot fresh weight was increased by 143.22% and 166.98%, respectively. Furthermore, the optimum Se application is 2 µmol L-1, and some areas can apply 4 µmol L-1 selenite. But Se-excessive areas are not recommended to grow selenium-rich foods. Therefore, lettuce has strong biofortification potential.

Genome-Wide Identification and Expression Analysis of MAPK Gene Family in Lettuce (Lactuca sativa L.) and Functional Analysis of LsMAPK4 in High- Temperature-Induced Bolting.

The mitogen-activated protein kinase (MAPK) pathway is a widely distributed signaling cascade in eukaryotes and is involved in regulating plant growth, development, and stress responses. High temperature, a frequently occurring environmental stressor, causes premature bolting in lettuce with quality decline and yield loss. However, whether MAPKs play roles in thermally induced bolting remains poorly understood. In this study, 17 LsMAPK family members were identified from the lettuce genome. The physical and chemical properties, subcellular localization, chromosome localization, phylogeny, gene structure, family evolution, cis-acting elements, and phosphorylation sites of the LsMAPK gene family were evaluated via in silico analysis. According to phylogenetic relationships, LsMAPKs can be divided into four groups, A, B, C, and D, which is supported by analyses of gene structure and conserved domains. The collinearity analysis showed that there were 5 collinearity pairs among LsMAPKs, 8 with AtMAPKs, and 13 with SlMAPKs. The predicted cis-acting elements and potential phosphorylation sites were closely associated with hormones, stress resistance, growth, and development. Expression analysis showed that most LsMAPKs respond to high temperatures, among which LsMAPK4 is significantly and continuously upregulated upon heat treatments. Under heat stress, the stem length of the LsMAPK4-knockdown lines was significantly shorter than that of the control plants, and the microscope observations demonstrated that the differentiation time of flower buds at the stem apex was delayed accordingly. Therefore, silencing of LsMAPK4 significantly inhibited the high- temperature-accelerated bolting in lettuce, indicating that LsMPAK4 might be a potential regulator of lettuce bolting. This study provides a theoretical basis for a better understanding of the molecular mechanisms underlying the MAPK genes in high-temperature-induced bolting.

General wellbeing and work impacts among community pharmacists during crisis management.

BACKGROUND: Community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed. Community pharmacists, as essential community health workers, play a critical role in the fight against coronavirus disease 2019 (COVID-19). This study aimed to determine the general wellbeing and work impacts of pharmacists and the factors important for adaptability and resilience during the COVID-19 pandemic. METHODS: This study adopted a cross-sectional design. Community pharmacists from various professional networks in Australia were invited through emails and social media posts to complete an anonymous online survey during the second wave of the COVID-19 pandemic in Victoria, Australia. RESULTS: Sixty-five community pharmacists completed the online survey. The respondents reported fair levels of general wellbeing during the COVID-19 pandemic, with a mean self-related health score of 33.57 (s.d.=13.19) out of a maximal of 96, despite relatively high levels of job stress and emotional labour. Lower levels of general wellbeing were correlated with higher levels of job stress (r=0.645, P<0.01) and emotional labour (r=0.513, P<0.01), and lower levels of occupational self-efficacy (r=-0.566, P<0.01). Leader member exchange was negatively correlated with job stress (r=-0.419, P<0.01) and positively correlated with psychological safety (r=0.693, P<0.01). The linear regression models showed that female pharmacists had lower occupational self-efficacy (ß=-0.286, P=0.024), but higher psychological safety (ß=0.234, P=0.042). Higher work ability was associated with lower job stress (ß=-0.529, P<0.001), higher occupational self-efficacy (ß=0.511, P=0.001), and poorer self-related health (ß=-0.659, P<0.001). CONCLUSIONS: The findings highlight the importance of a supportive work environment in helping community pharmacists to feel psychologically safe and reduce stress during a crisis.