Health care-seeking behaviours and health expenditures in adults aged 45 years and older in China, 2011-2013.

OBJECTIVES: To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. METHODS: We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. RESULTS: We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self-medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self-medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. CONCLUSIONS: The monitoring of global progress to UHC should incorporate self-medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed.

A dynamic nomogram for predicting pathologic complete response to neoadjuvant chemotherapy in locally advanced rectal cancer.

AIM: To explore the clinical factors associated with pathologic complete response (pCR) for locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT) and develop a web-based dynamic nomogram. METHODS: Retrospective analysis of patients with examination confirmed LARC from 2011 to 2022. Patients from the Union Hospital of Fujian Medical University were included as the training cohort (n = 1579) and Zhangzhou Hospital of Fujian Medical University as the external validation cohort (n = 246). RESULTS: In the training cohort, after nCRT, 350 (22.2%) patients achieved pCR. More stomas were avoided in pCR patients (73.9% vs. 69.7%, p = 0.043). After a median follow-up time of 47.7 months (IQR 2-145) shown OS (5-year: 93.7% vs. 81.0%, HR = 0.310, 95%CI: 0.189-0.510, p < 0.001) and DFS (5-year: 91.2% vs. 75.0%, HR = 0.204, 95%CI: 0.216-0.484, p < 0.001) were significantly better among patients with pCR than non-pCR. Multivariable Logistic analysis shown pCR was significantly associated with Pre-CRT CEA (HR = 0.944, 95%CI: 0.921-0.968; p < 0.001), histopathology (HR = 4.608, 95%CI: 2.625-8.089; p < 0.001), Pre-CRT T stage (HR = 0.793, 95%CI: 0.634-0.993; p = 0.043), Pre-CRT N stage (HR = 0.727, 95%CI: 0.606-0.873; p = 0.001), Pre-CRT MRI EMVI (HR = 0.352, 95%CI: 0.262-0.473; p < 0.001), total neoadjuvant therapy (HR = 2.264, 95%CI: 1.280-4.004; p = 0.005). Meanwhile, the online version of the nomogram established in this study was publicized on an open-access website (URL: https://pcrpredict.shinyapps.io/LARC2/). The model predicted accuracy with a C-index of 0.73 (95% CI: 0.70-0.75), with an average C-index of 0.73 for the internal cross validation and 0.78 (95% CI: 0.72-0.83) for the external validation cohort, showing excellent model accuracy. Delong test results showed the model has an important gain value for clinical characteristics to predict pCR in rectal cancer. CONCLUSIONS: Patients with pCR had a better prognosis, including OS and DFS, and were independently associated with Pre-CRT CEA, histopathology, Pre-CRT T/N stage, Pre-CRT MRI EMVI, and TNT. A web-based dynamic nomogram was successfully established for clinical use at any time.

Human Health Risk Assessment of Elevated Fe and Mn Intake in Groundwater in Yangtze Catchment.

Globally, it has been reported that groundwater contains elevated levels of Fe and Mn. However, the risk of prolonged exposure to groundwater with elevated Fe and Mn was often ignored due to their much lower carcinogenic risk. To assess the human health risk of elevated Fe and Mn intake in groundwater, 1863 groundwater samples from the Yangtze catchment, a densely populated and economically prosperous area of China, were collected in this study. The spatial distributions of Fe and Mn in groundwater were investigated by the geographic information system (GIS) and their health risk assessment was done. The results indicated that 38.6% and 50.3% of the groundwater samples were defined as "elevated/high" levels for Fe and Mn, respectively, exceeding 0.3 and 0.1 mg/L (World Health Organization guidelines). Moreover, in the groundwater of Yangtze Catchment, the order of Fe and Mn contents is followed by upper< middle< lower. Based on the calculated hazard index (HI), HIadult and HIchild were in a range of 0-4.91 and 0-11.07, respectively. There was an area of 3,483 and 35,523 km2 with a non-carcinogenic risk from Fe and Mn, correspondingly. The numbers of affected adults and children were about 3,018,066 and 2,775,007, respectively. It means that 0.20% and 2.00% of the study area or 0.64% and 0.59% of the total population will suffer health risks from Fe and Mn intake in groundwater, respectively. Therefore, a significant basis for groundwater safety in the Yangtze catchment and similar areas was provided in this study.

Comparing the abiotic removal of glyphosate by ß-MnO2 and δ-MnO2 colloids: Insights into kinetics and mechanisms.

Glyphosate as an effective broad-spectrum herbicide is frequently detected in various water and soil resources. Given the ubiquity of ß-MnO2 and δ-MnO2 colloids in groundwater and soil, the abiotic removal of glyphosate by MnO2 colloids was investigated. ß-MnO2 colloids exhibited superior glyphosate removal efficiency, up to 37%, compared to 21% for δ-MnO2 colloids at a pH of 4.0. Glyphosate removal involved simultaneous adsorption and oxidation process, identified by HRTEM, NH3-TPD, XPS, LC-MS, FTIR analyses and the occurrence of aminomethylphosphonic acid (AMPA) and Mn2+. Moreover, adsorption dominated the removal of glyphosate by two MnO2 colloids. The solution pH had a substantial effect on glyphosate removal. Co-existing ions in the solution, such as carbonate (CO32-), phosphate (Na2HPO4, NaH2PO4) and humic acid (HA), were also found to impede glyphosate removal. Phosphate, in particular, exhibited a strong competitive effect for adsorption sites on both MnO2 colloids. Of them, the removal of glyphosate by ß-MnO2 colloids was more prone to occur due to its higher specific surface area, abundant oxygen vacancies, and moderate acid sites. However, δ-MnO2 colloids presented a stronger oxidation capacity than that of ß-MnO2 colloids due to the quicker generation rate of Mn2+. Finally, AMPA was the same products by two MnO2 colloids in the oxidation process, revealing the degradation pathway based on the cleavage of C-N bond. Therefore, by comparing kinetics and mechanisms of glyphosate removal by ß- and δ-MnO2 colloids, this study improves us better understanding for the behavior of glyphosate in the environment.

Vertical transfer of microplastics in nearshore water by cultured filter-feeding oysters.

Microplastics (MPs) are widely distributed in the sea, but the vertical transfer of MPs by marine organisms in coastal area is still poorly understood. In this study, we used laser direct infrared (LDIR) spectroscopy to determine the number and characteristics of MPs deposited by cultured oyster Crassostrea gigas and further compared the differences between MPs of natural deposit and biodeposit in field environments. The amounts of MPs found in the biodeposit of cultured oysters were 3.54 times greater than that in the natural deposition. The polymer types of biodeposit MPs also differed from those of natural deposition. It was estimated that a single oyster can deposit 15.88 MPs per day, which is a figure much higher than the initial results, and hotspots of MPs deposition may be formed within the oyster aquaculture area. We used generalized linear mixed model (GLMM) to further infer the sources of MPs in sediments and found that distance to shore, cultured zone and urban center were important predictors of MPs abundance in sediments of aquaculture area. The above results suggest that cultured bivalves have an important capacity for MPs biodeposition and will further change the vertical distribution pattern of MPs in coastal environments.

The factors influencing the vertical transport of microplastics in marine environment: A review.

There have been numerous studies that have identified the presence of low-density microplastics (MPs) in the water column and sediments. The focus of current MPs research has shifted towards the interaction of MPs with marine organisms and their potential hazards, including the uptake characteristics, biological transport and toxicological effects of MPs, but the processes involved in the deposition behavior of MPs are still poorly understood. In this review, we summarize the current state of knowledge on the vertical transport of MPs influenced by their physicochemical properties and marine organisms, and discuss their potential impact on MPs deposition. The physicochemical properties of MPs determine their initial distribution. The density, shape, and size of MPs influence their settling state in the marine environment. Marine biota play a key role in the transport of MPs to deep marine environment, mainly by changing the density and adsorption of MPs. Biofouling can alter the surface properties of MPs and increase the overall density, thus affecting the vertical flux of the plastic. Macroalgae may trap MPs particles by producing chemicals or by using electrostatic interactions. Marine swimming organisms ingest MPs and excrete them encapsulated in fecal particles, while the activity of marine benthic organisms may contribute to the transfer of MPs from surface sediments to deeper layers. In addition, MPs may be incorporated into organic particles produced by marine organisms such as marine snow or marine aggregates, increasing the vertical flux of MPs. However, due to the complexity of different sea areas and MPs properties, the deposition behavior of MPs may be the result of the interaction of multiple factors. Thus, the effects of MPs properties, marine organisms and the natural environment on MPs deposition in marine environment needs further research to fill this gap.

The effects of colloidal Fe and Mn on P distribution in groundwater system of Jianghan Plain, China.

Many studies have confirmed groundwater phosphorus (P) enrichment by anthropogenic and geogenic sources. However, the effects of colloidal iron (Fe) and manganese (Mn) on the groundwater P distribution remain poorly-understood. This study investigated the spatial distribution of three forms of Fe, Mn, and P (particulate, colloidal, and truly soluble) in aquifers based on groundwater monitoring data and sediment core samples for the Jianghan Plain. High proportions of colloidal Fe, Mn, and P of up to 52%, 58%, and 76%, respectively were found in the phreatic and confined aquifers. Particulate and truly soluble P dominated the phreatic aquifer and the confined aquifer, respectively. However, the truly soluble Fe and Mn were dominant among the three forms in both the phreatic and confined aquifers. The distributions of Fe, Mn, and P in colloids and sediments were also studied by X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDS). A comparison of the distributions of Fe, Mn, and P between site SD01 (riparian zones) and site SD02 (farmland) showed that both external inputs and the reduced release of Fe/Mn oxides/minerals from sediments contributed to the distributions of colloidal Fe, Mn, and P. Correlation analysis showed a strong relationship between colloidal Fe/Mn and P in both groundwater and sediment, implying that colloidal Fe/Mn play a role in regulating the distribution of P in the study area. This study provides a new understanding of the effects of colloidal Fe and Mn on the P distribution among the phreatic and confined aquifers.

Alteration of microbial mediated carbon cycle and antibiotic resistance genes during plastisphere formation in coastal area.

Microorganisms can attach on the surface of microplastics (MPs) through biological fouling process to form a diverse community called the "plastisphere", which has attracted extensive attention. Although the microbial structure and composition of biofilm have been studied, the knowledge of its microbial function and ecological risk is still limited. In this study, we investigated how the surface properties of MPs affect the biofilm communities and metabolic features under different environmental conditions, and explored the biofilm enrichment of antibiotic resistance genes (ARGs). The results showed that the incubation time, habitat and MPs aging state significantly influenced the structure and composition of biofilm microbial communities, and a small amount of pathogens have been found in the MPs-attached biofilm. The microbial carbon utilization capacity of the biofilm in different incubation habitats varies greatly with highest metabolism capacity appear in the river. The utilization efficiency of different carbon sources is polymer > carbohydrate > amino acid > carboxylic acids > amine/amide, which indicates that the biofilm communities have selectivity between different types of carbon sources. More importantly, ARGs were detected in all the MPs samples and showed a trend of estuary > river > marine. The aged MPs can accumulate more ARGs than the virgin items. In general, MPs in the aquatic environment may become a carrier for pathogens and ARGs to spread to other environment, which may enhance their potential risks to the ecosystem and human health.

Second-order asymmetric convolution network for breast cancer histopathology image classification.

Recently, convolutional neural networks (CNNs) have been widely utilized for breast cancer histopathology image classification. Besides, research works have also convinced that deep high-order statistic models obviously outperform corresponding first-order counterparts in vision tasks. Inspired by this, we attempt to explore global deep high-order statistics to distinguish breast cancer histopathology images. To further boost the classification performance, we also integrate asymmetric convolution into the second-order network and propose a novel second-order asymmetric convolution network (SoACNet). SoACNet adopts a series of asymmetric convolution blocks to replace each stand square-kernel convolutional layer of the backbone architecture, followed by a global covariance pooling to compute second-order statistics of deep features, leading to a more robust representation of histopathology images. Extensive experiments on the public BreakHis dataset demonstrate the effectiveness of SoACNet for breast cancer histopathology image classification, which achieves competitive performance with the state-of-the-arts.

Incubation habitats and aging treatments affect the formation of biofilms on polypropylene microplastics.

Microbial colonization and biofilm formation associated with microplastics (MPs) have recently attracted wide attention. However, little is known about the effect of MP aging and different exposed habitats on biofilm formation and associated microbial community characteristics. To obtain a comprehensive understanding, virgin and aged polypropylene MPs were selected as attachment substrates and exposed to different aquatic habitats (marine, estuary, and river). The results showed that the aging process could destroy surface structure and increase oxygen-containing groups of MPs. The total biomass of the biofilms, attached-bacterial OTU numbers, and α diversities increased with exposure time. The biofilms biomass and α diversity of MPs in the river were significantly higher than those in the marine and estuary habitats, and temperature and salinity were primary factors affecting microbial colonization. Bacterial communities in MP-attached biofilms were significantly different from those in surrounding water. Microorganisms tend to adhere to aged MPs, and especially, genes related to human pathogens were significantly expressed on aged MPs, suggesting a potential ecological and health risk of aged MPs in aquatic ecosystems. Our results showed that aged MPs and different habitats have an important influence on microbial colonization, and the weathering process can accelerate biofilm formation on MPs.

Socio-economic inequalities in the chronic diseases management among Chinese adults aged 45 years and above: a cross sectional study.

BACKGROUNDS: Non-communicable diseases (NCDs) have become a priority public health issue. The aim of this study was to examine whether socio-economic inequalities exist in chronic disease management among Chinese adults, and whether the relationship between SES and chronic disease management mediated by social capital. METHODS: We used combined data from China Health and Retirement Longitudinal Study (CHARLS). A total of 19,291 subjects, including 14,905 subjects from 2011 survey, 2036 subjects from 2013, and 2350 subjects from 2015 was included in this study. RESULTS: Subjects living in urban setting, with higher education attainment and economic status were more likely to have annual health checks, and to be diagnosed for those with hypertension, diabetes and dyslipidemia (all P < 0.05). Social participation could mediate the association between social economic status (SES) and annual health checks, diagnosis of hypertension and dyslipidemia, and health education of hypertension. Health checks could mediate the association between social participation and the diagnosis of hypertension, diabetes and dyslipidemia. The proportions of mediation were 17.5, 23.9 and 8.9%, respectively. There were no mediating effects observed from cognitive social capital variable-perceived helpfulness. CONCLUSION: It is necessary to deeply reform our social security system and enhance the social capital construction to promote those low SES people's physical health.