Measurement properties of the EQ-5D-5L in sub-health: evidence based on primary health care workers in China.

BACKGROUND: Sub-health which is the state between health and disease is a major global public health challenge. As a reversible stage, sub-health can work as a effective tool for the early detection or prevention of chronic disease. The EQ-5D-5L (5L) is a widely used, generic preference-based instrument while its validity in measuring sub-health is not clear. The aim of the study was thus to assess its measurement properties in individuals with sub-health in China. METHODS: The data used were from a nationwide cross-sectional survey conducted among primary health care workers who were selected on the basis of convenience and voluntariness. The questionnaire was composited of 5L, Sub-Health Measurement Scale V1.0 (SHMS V1.0), social-demographic characteristics and a question assessing the presence of disease. Missing values and ceiling effects of 5L were calculated. The convergent validity of 5L utility and VAS scores was tested by assessing their correlations with SHMS V1.0 using Spearman's correlation coefficient. The known-groups validity of 5L utility and VAS scores was assessed by comparing their values between subgroups defined by SHMS V1.0 scores using the Kruskal-Wallis test. We also did an analysis in subgroups according to different regions of China. RESULTS: A total of 2063 respondents were included in the analysis. No missing data were observed for the 5L dimensions and only one missing value was for the VAS score. 5L showed strong overall ceiling effects (71.1%). The ceiling effects were slightly weaker on the "pain/discomfort" (82.3%) and "anxiety/depression" (79.5%) dimensions compared with the other three dimensions (nearly 100%). The 5L weakly correlated with SHMS V1.0: the correlation coefficients were mainly between 0.2 and 0.3 for the two scores. 5L was yet not sensitive in distinguishing subgroups of respondents with different levels of sub-health, especially the subgroups with adjacent health status (p > 0.05). The results of subgroup analysis were generally consistent with those of the full sample. CONCLUSIONS: It appears that the measurement properties of EQ-5D-5L in individuals with sub-health are not satisfactory in China. We thus should be cautious to use it in the population.

Childhood trauma and psychological sub-health among Chinese adolescents: the mediating effect of Internet addiction.

BACKGROUND: The factors related to psychological sub-health (PSH) have been widely described, but the research on the mechanism behind the complex relationship between childhood trauma and PSH is limited. This study investigated the current situation and risk factors of PSH among Chinese adolescents. And further, explore whether Internet addiction (IA) plays a potential mediating effect in childhood trauma and PSH. METHODS: The study was conducted in October 2020 in Anhui Province, China. The PSH state of 866 adolescents was investigated, including demographic information such as gender, age, and grade. Childhood trauma, IA, and PSH were measured by the Childhood Trauma Questionnaire Short Form (CTQ-SF), Young's Internet Addiction Test (IAT), and the Multidimensional Sub-health Questionnaire of Adolescents (MSQA). The mediating effect is further verified by the structural equation model (SEM). RESULTS: In this study, 866 adolescents were selected as subjects, and the proportion of male and female is roughly equal. The prevalence of PSH in adolescents was 25.8%, and left-behind children, boarding, or adolescents who have had non-suicidal self-injury (NSSI) are more likely to have PSH. Through the mediation test, the direct effect of childhood trauma on PSH was 0.23 (95% CI [4.91,9.00],p <0.001), and the mediating effect of IA on childhood trauma and PSH was 0.07 (95% CI [1.42, 3.32],p <0.001). and the proportion of them is 75.14% and 24.86% respectively. CONCLUSIONS: Childhood trauma has direct and indirect effects on PSH, and IA plays a mediating effect in the indirect effect. Therefore, clarifying these relationships helps formulate and implement effective interventions to improve psychological health (PH) in Chinese adolescents.

Effect of self-employment on the sub-health status and chronic disease of rural migrants in China.

BACKGROUND: Rural migrants usually suffer from major disease risks, but little attention had been paid toward the relationship between self-employment behavior and health status of rural migrants in China. Present study aims to explore the causal effect of self-employment behavior on rural migrants' sub-health status and chronic disease. Two research questions are addressed: does self-employment status affect the sub-health status and chronic disease of rural migrants? What is potential mechanism that links self-employment behavior and health status among rural migrants in China? METHODS: The dataset from the 2017 National Migrants Population Dynamic Monitoring Survey (NMPDMS-2017) was used to explore the causal effect. Logit regression was performed for the baseline estimation, and linear probability model with instrument variable estimation (IV-LPM) was applied to correct the endogeneity of self-employment. Additionally, logit regression was conducted to explore the transmission channel. RESULTS: Self-employed migrants were more susceptible to sub-health status and chronic disease, even when correcting for endogeneity. Moreover, self-employed migrants were less likely to enroll in social health insurance than their wage-employed counterparts in urban destinations. CONCLUSION: Self-employed migrants were more likely to suffer from sub-health status and chronic disease; thus, their self-employment behavior exerted a harmful effect on rural migrants' health. Social health insurance may serve as a transmission channel linking self-employment and rural migrants' health status. That is, self-employed migrants were less prone to participate in an urban health insurance program, a situation which leaded to insufficient health service to maintain health.

[Level and influencing factors of occupational stress and sub-health of the pharmaceutical marketers in Northeast China].

OBJECTIVE: To understand the occupational stress and sub-health level of pharmaceutical marketers in Northeast China, and to analyze their influencing factors and the impact of occupational stress on sub-health. METHODS: From October to December in 2016, we conducted a questionnaire survey about occupational stress and sub-health status of 698 women and 454 men pharmaceutical marketers aged from 22 to 58 years old in northeast China. RESULTS: The rate of occupational stress was 86. 9%. The top 3 stressors with higher scores were the pressure brought about by the intensification of social competition(2. 90±1. 017), the higher standards of job assessment and the great efforts needed by individuals(2. 90±0. 959). The detection rate of sub-health was 82. 1%. There were statistically differences in the rate of sub-health detection among the groups of different genders(χ~2=4. 726, P=0. 030) and different business types(χ~2=7. 961, P=0. 047). There were statistically significant differences in the rate of different ages(χ~2=9. 534, P=0. 009), different marital status(χ~2=7. 010, P=0. 008), different working years(χ~2=18. 082, P<0. 001), and different stress groups(χ~2=152. 565, P<0. 001). Multivariate analysis showed that occupational stress is the key factor affecting sub-health. Mild stress(OR=0. 076, 95%CI 0. 040-0. 143)and moderate stress(OR=0. 348, 95%CI 0. 189-0. 641)are the protected factors of sub-health. CONCLUSION: The occupational stress rate and sub-health detection rate of medical marketers were both higher. Relieving the pressure of pharmaceutical marketers effectively can improve their sub-health status.

The development and evaluation of a sub-health self-rating scale for university students in China.

BACKGROUND: Sub-health status is defined as declines in vitality, physiological function and capacity for adaptation, but without the presence of clinical or sub-clinical disease. We have developed and evaluated a comprehensive questionnaire, the Sub-Health Self-Rating Scale (SSS), to assess sub-health status in university students. METHOD: The items for the draft questionnaire were discussed in focus groups. The WHOQOL-BREF was selected as the validity reference. From a professional perspective and large sample evaluation, the scale ultimately consisted of 58 items. The reliability and validity of the SSS was examined in undergraduate students and 1000 questionnaires were randomly selected from the samples for expert evaluation. RESULTS: Cronbach's α of the total scale was 0.942. The dimensions of physiological, psychological and social had high reliability: 0.915, 0.856 and 0.850, respectively. Based on scree plot and related theories, there were 10 factors to be extracted. The correlation coefficient between the total scale and sub-scale was high. The dimensions of physiological, psychological and social had high correlations with the total scale: 0.929, 0.803 and 0.774, respectively. The sub-health cut-off point of the total scale was 72; for the physiological field, it was 72; for the psychological field, it was 60; and the social field, it was 56. The fit between the expert evaluation method and the scale method was 0.758. The lower the score, the worse the health condition. CONCLUSION: We established and evaluated a valid instrument (SSS) that encompasses physiological, psychological and social factors to investigate sub-health status. It is short and easy to complete, and therefore suitable for use with undergraduate students.

[Association of health literacy and physical sub-health among Chinese middle school students].

OBJECTIVE: To examine the association between health literacy( HL) and physical sub-health in middle school students. METHODS: From November 2015 to January 2016, a multi-stage convenient cluster sampling method was adopted to conduct a questionnaire survey among 22 628 middle school students from grade 7 to grade12 in Shenyang, Bengbu, Xinxiang, Ulanqab, Chongqing and Yangjiang, among whom10 990( 48. 6%) were boys and 11 638( 51. 4%) were girls. The Chinese Adolescent Interactive Health Literacy Questionnaire( CAIHLQ), the Multidimensional Sub-health Questionnaire of Adolescents( MSQA) and demographic variables were used to measure the Chinese middle school students ' HL and physical sub-health. RESULTS: The detection rate of physical sub-health was 30. 1%( 6822/22628). High school students reported more physical sub-health than junior school students. The detection rate of physical sub-health in developed area, being only children, resident students, with low socio-economic status was significantly higher detection rate of sub-health than their peers( P< 0. 001). The scores of CAIHLQ was( 104. 06 ± 18. 68). Students who were boys, junior school students, urban residence, only children in family, non-resident students, higher parental education level and lower family income had significantly higher HL scores than the correspnding other students( χ~2= 44. 62, 455. 21, 133. 54, 35. 04, 326. 06, 272. 09, 366. 19 and 572. 35, P < 0. 001). Multiple Logistic regression analysis showed that moderate or low level of overall HL and six dimensions increase the risk of physical sub-health. CONCLUSION: School type, whether it is an economically developed area, whether it is an only child, whether it lives in the school on the study day, and selfassessment of family economic conditions affecting physical sub-health, lower HL may increase the risk of physical subhealth among middle school students.

Effectiveness of Mild Moxibustion for Sub-Health Conditions in Pre- and Post-Menopausal Women: A Randomized Controlled Clinical Trial.

BACKGROUND Mild moxibustion has been reported to effectively treat menopausal syndrome. This study investigated the efficacy and safety of using mild moxibustion at Shenshu for treating sub-health states in perimenopausal women. MATERIAL AND METHODS Sixty participants were randomly assigned to moxibustion and control groups. Participants in the moxibustion group received mild moxibustion at bilateral Shenshu (BL23) for 15 min daily. A course was 5 days, with 2 days between courses; treatment was conducted for 4 courses. Participants in the control group were given vitamin E soft capsules for 28 days. Physical condition, living conditions, emotional status, and energy status scores were assessed, and serum sex hormone levels measured. RESULTS Mild moxibustion significantly improved physical condition, living conditions, and emotional status compared to the control group after treatment ([i]P[/i]<0.05). Physical condition ([i]P[/i]<0.01) and living conditions ([i]P[/i]<0.05) improved significantly in post-menopausal women, while living conditions and emotional status were improved in pre-menopausal women ([i]P[/i]<0.05). Serum estradiol level was significantly higher after moxibustion, especially for pre-menopausal women ([i]P[/i]<0.01). CONCLUSIONS Mild moxibustion is safe and effective for treating sub-health state in pre-menopausal and post-menopausal women. A study with larger sample size and longer-term treatment is needed for further assessment of this topic.

Spa therapy (balneotherapy) relieves mental stress, sleep disorder, and general health problems in sub-healthy people.

To investigate the relieving effects of hot spring balneotherapy on mental stress, sleep disorder, general health problems, and women's health problems in sub-healthy people, we recruited 500 volunteers in sub-health in Chongqing, and 362 volunteers completed the project, including 223 in the intervention group and 139 in the control group. The intervention group underwent hot spring balneotherapy for 5 months, while the control group did not. The two groups took questionnaire investigation (general data, mental stress, emotional status, sleep quality, general health problems, as well as some women's health problems) and physical examination (height, weight, waist circumference, blood pressure, blood lipid, blood sugar) 5 months before and after the intervention, respectively. After intervention, sleep disorder (difficulty in falling asleep (P = 0.017); dreaminess, nightmare suffering, and restless sleep (P = 0.013); easy awakening (P = 0.003) and difficulty in falling into sleep again after awakening(P = 0.016); and mental stress (P = 0.031) and problems of general health (head pain (P = 0.026), joint pain(P = 0.009), leg or foot cramps (P = 0.001), blurred vision (P = 0.009)) were relieved significantly in the intervention group, as compared with the control group. While other indicators (fatigue, eye tiredness, limb numbness, constipation, skin allergy) and women's health problems (breast distending pain; dysmenorrhea, irregular menstruation) were relieved significantly in the self-comparison of the intervention group before and after intervention (P < 0.05), but showed no statistically significant difference between two groups (P > 0.05). All indications (except bad mood, low mood, and worry or irritability) in the intervention group significantly improved, with effect size from 0.096 to 1.302. Multiple logistic regression analysis showed that the frequency, length, and location of balneotherapy in the intervention group were the factors influencing emotion, sleep, and health condition (P < 0.05). Relief of insomnia, fatigue, and leg or foot cramps was greater in old-age group than in young-aged group (P < 0.05). Physical examination found that waist circumferences in women of various ages under 55 years were significantly reduced in the intervention group (P < 0.05), while that in men did not significantly change (P > 0.05). Spa therapy (balneotherapy) relieves mental stress, sleep disorder, general health, and reduces women's waist circumferences in sub-healthy people.

[Measurement invariance of sub-health questionnaire in doctor and nurse].

OBJECTIVE: To examine the measurement invariance of sub-health questionnaire in doctor and nurse, and compare their sub-health status. METHODS: Totally 1832 doctors and nurses were selected by multi-stage stratified cluster random sampling method and investigated with a sub-health questionnaire. Measurement invariance between two groups was tested by multiple group confirmatory factor analysis. RESULTS: The test of measurement invariance for the one-factor model showed that the subhealth questionnaire met the criteria for measurement invariance( ΔCFI < 0. 01). The level of strict invariance( equal factor loadings, intercepts, and residual variances between groups) was achieved. When the latent means were compared, differences between groups were not statistically significant( the latent means of the dimensions were0. 029, 0. 050, 0. 054 and 0. 010, respectively, and the P value were 0. 385, 0. 168, 0. 092 and 0. 753, respectively). CONCLUSION: The sub-health questionnaire has the universal applicability to the medical staff.

[Emotional stress-induced Shanghuo syndrome increases disease susceptibility].

Shanghuo(excessive internal heat) is a special organic state based on the concept of traditional Chinese medicine(TCM), commonly known as the abnormal heating syndrome of body in folks. With the acceleration of modern life rhythm and the increase of the social competition pressure, emotional stress has become an important cause for the spread of Shanghuo symptoms. What's more, Shanghuo can impact the body physiological functions to cause the onset, recurrence and progression of common diseases, harming the health of the body. According to the long-term research findings, the author found that Shanghuo referred to the imbalance of multiple physiological functions, such as nerve, immunity and metabolism, caused by emotional stress. "Shanghuo" is not a disease itself, but it can increase the susceptibility to a variety of diseases. This study reviewed the traditional medicine theory and the modern medical studies, and explored the relevance and correlation mechanisms between the Shanghuo symptoms and disease susceptibility, so as to provide a reference to improve the state of sub-health and prevent or treat modern diseases.

Diverse characteristics of the urinary excretion of amino acids in humans and the use of amino acid supplementation to reduce fatigue and sub-health in adults.

BACKGROUND: The excretion of amino acids in urine represents an important avenue for the loss of key nutrients. Some amino acids such as glycine and histidine are lost in higher abundance than others. These two amino acids perform important physiological functions and are required for the synthesis of key proteins such as haemoglobin and collagen. METHODS: Stage 1 of this study involved healthy subjects (n = 151) who provided first of the morning urine samples and completed symptom questionnaires. Urine was analysed for amino acid composition by gas chromatography. Stage 2 involved a subset of the initial cohort (n = 37) who completed a 30 day trial of an amino acid supplement and subsequent symptom profile evaluation. RESULTS: Analyses of urinary amino acid profiles revealed that three groups could be objectively defined from the 151 participants using k-means clustering. The amino acid profiles were significantly different between each of the clusters (Wilks' Lambda = 0.13, p < 0.0001). Cluster 1 had the highest loss of amino acids with histidine being the most abundant component. Cluster 2 had glycine present as the most abundant urinary amino acid and cluster 3 had equivalent abundances of glycine and histidine. Strong associations were observed between urinary proline concentrations and fatigue/pain scores (r = .56 to .83) for females in cluster 1, with several other differential sets of associations observed for the other clusters. CONCLUSIONS: Different phenotypic subsets exist in the population based on amino acid excretion characteristics found in urine. Provision of the supplement resulted in significant improvements in reported fatigue and sleep for 81% of the trial cohort with all females reporting improvements in fatigue. TRIAL REGISTRATION: The study was registered on the 18th April 2011 with the Australian New Zealand Clinical Trials Registry ( ACTRN12611000403932 ).

[Sub-health status of middle school teachers and its correlation analysis with occupational stress].

Objective: To study the distribution of sub-health and occupational stress as well as their correlation among middle school teachers in Tianjin, then provide evidences for prevention and control of the status of sub-health. Methods: A total of 3 522 middle school teachers from six districts of Tianjin were recruited with stratified cluster sampling strategy for the investigation of Sub-Health Measurement Scale version 1.0 (SHMS V1.0) and Occupational Stress Inventory-Revised Edition (OSI-R) . Results: Detection rate of sub-health status among Tianjin middle school teachers was 58.55%. Men had significantly lower sub-health detection rate (55.19%) than women (59.71%) . Sub-health detection rate increased with age (P<0.05) , the sub-health detection rate among middle school teachers more than 50 years old was the highest (66.84%) . The mean score of OSI-R was 403.18±41.80 with the scores of 176.00±21.05, 103.17±17.53, and 124.02±20.28 for ORQ, PSQ, PRQ, respectively, which showed significantly difference compared with the occupational stress norm of China (P<0.001) . The mean scores of OSI-R, ORQ, PSQ, PRQ in different health status were significantly different (P<0.001) . The partial correlation analysis between the scores of sub-health and occupational stress of middle school teachers showed that the scores of occupational role and personal strain were negatively correlated with the scores of sub-health state (P< 0.001) , while, there was significantly positive correlation between the scores of personal resource and the scores of sub-health state (P<0.001) . Conclusion: Sub-health detection rate of middle school teachers in Tianjin is higher. Effective measures should be taken to appropriately mitigate the occupational stress level of middle school teachers, increase personal resources, and scientific and effective health guidance and education should be strengthened.

[Methodological quality evaluation of randomized controlled trials for traditional Chinese medicines for treatment of sub-health].

To evaluate the methodological quality of the randomized controlled trials(RCTs) for traditional Chinese medicines for treatment of sub-health, in order to provide a scientific basis for the improvement of clinical trials and systematic review. Such databases as CNKI, CBM, VIP, Wanfang, EMbase, Medline, Clinical Trials, Web of Science and Cochrane Library were searched for RCTS for traditional Chinese medicines for treatment of sub-health between the time of establishment and February 29, 2016. Cochrane Handbook 5.1 was used to screen literatures and extract data, and CONSORT statement and CONSORT for traditional Chinese medicine statement were adopted as the basis for quality evaluation. Among the 72 RCTs included in this study, 67 (93.05%) trials described the inter-group baseline data comparability, 39(54.17%) trials described the unified diagnostic criteria, 28(38.89%) trials described the unified standards of efficacy, 4 (5.55%) trials mentioned the multi-center study, 19(26.38%) trials disclosed the random distribution method, 6(8.33%) trials used the random distribution concealment, 15(20.83%) trials adopted the method of blindness, 3(4.17%) study reported the sample size estimation in details, 5 (6.94%) trials showed a sample size of more than two hundred, 19(26.38%) trials reported the number of withdrawal, defluxion cases and those lost to follow-up, but only 2 trials adopted the ITT analysis,10(13.89%) trials reported the follow-up results, none of the trial reported the test registration and the test protocol, 48(66.7%) trials reported all of the indicators of expected outcomes, 26(36.11%) trials reported the adverse reactions and adverse events, and 4(5.56%) trials reported patient compliance. The overall quality of these randomized controlled trials for traditional Chinese medicines for treatment of sub-health is low, with methodological defects in different degrees. Therefore, it is still necessary to emphasize the correct application of principles such as blindness, randomization and control in RCTs, while requiring reporting in accordance with international standards.

The effects of big five personality traits on sub-health in a Chinese young adults: A moderated mediation model.

BACKGROUND: Sub-health can have an impact on the physical condition of the young adults, and this study aimed to investigate the influencing factors of sub-health related to the Big Five personality in Chinese young adults. METHODS: A multi-stage random sampling method was used to survey the Chinese young adults. A moderated mediation analysis was conducted to investigate how sleep quality and family health influenced the relationship between diverse personalities and sub-health in young adults. RESULTS: A total of 6165 young adults were included in this study. The results of the mediation analysis indicated that sleep quality partially mediated the relationship between neurotic, extraversion, agreeableness, and conscientiousness of young adults and sub-health. Family health played a moderating role between the sleep quality and agreeableness of young adults. LIMITATIONS: The cross-sectional study limits conclusions about causal relationships between factors. CONCLUSION: Family health and sleep quality can influence sub-health in Chinese young adults with different personality traits.

Prevalence and risk factors of sub-health and circadian rhythm disorder of cortisol, melatonin, and temperature among Chinese midwives.

Objective: This study aimed to explore the influencing factors of sub-health and circadian rhythm disorder among midwives and whether circadian rhythm disorder was associated with sub-health. Methods: A multi-center cross-sectional study was conducted among 91 Chinese midwives from six hospitals through cluster sampling. Data were collected by demographic questionnaire, Sub-Health Measurement Scale version 1.0, and circadian rhythm detection. Minnesota single and population mean cosine methods were used to analyze the rhythm of cortisol, melatonin, and temperature. Binary logistic regression, nomograph model, and forest plot were performed to identify variables associated with midwives' sub-health. Results: There were 65 midwives with sub-health and 61, 78, and 48 midwives with non-validation of circadian rhythms of cortisol, melatonin, and temperature among 91 midwives, respectively. Midwives' sub-health was significantly related to age, duration of exercise, weekly working hours, job satisfaction, cortisol rhythm, and melatonin rhythm. Based on these six factors, the nomogram was presented with significant predictive performance for sub-health. Furthermore, cortisol rhythm was significantly associated with physical, mental, and social sub-health, whereas melatonin rhythm was significantly correlated with physical sub-health. Conclusion: Sub-health and circadian rhythm disorder were generally common among midwives. Nurse administrators are supposed to pay attention and take measures to prevent sub-health and circadian rhythm disorder among midwives.

Mediating effect of physical sub-health in the association of sugar-sweetened beverages consumption with depressive symptoms in Chinese college students: A structural equation model.

BACKGROUND: Although previous findings with small samples indicated that sugar-sweetened beverages (SSB) consumption was associated with depressive symptoms in adolescents, the mediating effect of physical sub-health in the association is unknown. METHODS: A survey was conducted among freshmen from 11 provinces in China. A food frequency questionnaire was used to collect dietary behavior, and patient health questionnaire-9 items was used to assess depressive symptoms. A generalized linear model was used to analyze the association between SSB consumption, physical sub-health and depressive symptoms. The structural equation model was used to analyze the mediating effect of physical sub-health. RESULTS: Of the 31,856 participants, 36.5 % had positive depressive symptoms. After adjusting for variables, carbonate beverages (ß = 0.11; 95%CI: 0.07-0.15; P = 0.000) and milk tea (ß = 0.07; 95%CI: 0.01-0.13; P = 0.021) consumption was associated with depressive symptoms in boys. Carbonate beverages (ß = 0.09; 95%CI: 0.05-0.13; P = 0.000), tea beverages (ß = 0.09; 95%CI: 0.04-0.13; P = 0.000), and milk tea (ß = 0.08; 95%CI: 0.04-0.11; P = 0.000) consumption was associated with depressive symptoms in girls. The mediating effect of physical sub-health accounted for 81.3 % of the total effect in the mediating model of SSB associated with depressive symptoms. LIMITATIONS: Retrospective survey has certain information bias. Association observed in the cross-sectional study is uncertain. CONCLUSIONS: The present study suggests that the consumption of SSB associated with depressive symptoms in Chinese college students, and physical sub-health plays a complete mediating role in the association.

SPARSH electronic sub-health centers (e-SHCs) - A model of nurse-run SHCs supported by general practitioners through telemedicine.

Background: The primary health care services in India suffer from inconsistent availability of providers, lack of quality, poor availability of medicines and diagnostics, and a poorly functioning referral linkage. A multi-pronged approach is required to address these issues. Methods: We describe here a model of electronic sub-health centers (e-SHCs) managed by trained nurses supported by a general practitioner over telemedicine. The e-SHCs are expected to meet two objectives - 1) to create a point of comprehensive primary health care delivery at an affordable cost and 2) to create a referral support system backed by information technology and physical movement. Results: The model is described in nine sections - service delivery framework, human resources, diagnostics, infrastructure, quality improvement, health management information system, materials management, financing, and branding. It is a video-based real-time (synchronous) health worker to the registered medical practitioner telemedicine facility. The model has been compared with five other telemedicine and five other tele-rehabilitation models. Conclusion: Although there are inherent challenges to operationalize this model, it also presents a unique opportunity of testing an innovative approach of providing quality primary health care at an affordable cost. The process will generate learnings for addressing the primary care health care delivery gaps in the country.

Pharmaceutical Potential of High-Altitude Plants for Fatigue-Related Disorders: A Review.

Natural plants from plateaus have been the richest source of secondary metabolites extensively used in traditional and modern health care systems. They were submitted to years of natural selection, co-evolved within that habitat, and show significant anti-fatigue-related pharmacological effects. However, currently, no review on high-altitude plants with anti-fatigue related properties has been published yet. This study summarized several Chinese traditional high-altitude plants, including Rhodiola rosea L., Crocus sativus L., Lepidium meyenii W., Hippophaerhamnoides L., which are widely used in the Qinghai-Tibet Plateau and surrounding mountains, as well as herbal markets in the plains. Based on phytopharmacology studies, deeper questions can be further revealed regarding how these plants regulate fatigue and related mental or physical disease conditions. Many active derivatives in high-altitude medical plants show therapeutic potential for the management of fatigue and related disorders. Therefore, high-altitude plants significantly relieve central or peripheral fatigue by acting as neuroprotective agents, energy supplements, metabolism regulators, antioxidant, and inflammatory response inhibitors. Their applications on the highland or flatland and prospects in natural medicine are further forecast, which may open treatments to reduce or prevent fatigue-related disorders in populations with sub-optimal health.

Research on Ecological Landscape Design and Healing Effect Based on 3D Roaming Technology.

Impacted by the COVID-19 epidemic, the human sub-health in national high-tech zones (hereinafter referred to as high-tech zones) has become more prominent. It is critical for the mental sub-health group in the high-tech zone to relieve the anxiety and tension caused by the pressure of life and work. This paper uses SketchUp virtual engine (Unity 2019) software, and 3D roaming technology to carry out the ecological landscape transformation design of the Baotzixi ecological corridor in the East Lake High-tech Zone, to construct a 3D roaming landscape scene and measure its therapeutic effect by inviting subjects to participate in an interactive experience experiment on the ErgoLAB platform. The results illustrate that: (1) the thermogram trend shows that the more attractive the 3D roaming landscape scene is, the stronger the subjects' interest is; (2) the participants have a positive emotional arousal state in the immersive experience of the 3D roaming landscape scene after the modification design; and (3) the mean skin conductance (SC) fluctuation variance of the subjects is 5.819%, indicating that the healing effect is significant in the state of positive emotional arousal. The research results show that there is a connection between the subjects and the 3D roaming landscape scene after the transformation design of "high interest, emotional arousal and significant healing".

Childhood Trauma and Non-suicidal Self-Injury Among Chinese Adolescents: The Mediating Role of Psychological Sub-health.

The factors associated with non-suicidal self-injury (NSSI) of adolescents have been widely researched. However, the underlying mechanism of the relationship between childhood trauma and NSSI is limited. This study aimed to explore the risk factors for NSSI among Chinese adolescents. Our hypothesis was that psychological sub-health (PSH) played a mediating role between childhood trauma and NSSI. The Childhood Trauma Questionnaire, the Multidimensional Sub-health Questionnaire of Adolescent, and the self-report NSSI were used to measure childhood trauma, PSH, and NSSI. Structural equation model (SEM) was performed to verify our hypothesis. The results showed that 33.9% of the participants in our survey had engaged in NSSI in the past year. Adolescents who were left-behind children or in primary schools were more likely to engage in NSSI. Additionally, 56.2% of the participants had moderate to severe childhood trauma, and 26.1% of the participants had PSH. Furthermore, childhood trauma and PSH would increase the risk of NSSI by 2 times (B = 0.79, p < 0.01) and 5 times (B = 1.64, p < 0.01), respectively. SEM was established (p = 0.512) and the goodness-of-fit indices were examined (CMIN/DF = 0.892; GFI = 0.997; AGFI = 0.992; NFI = 0.991; RFI = 0.980; IFI = 1.00; TLI = 1.00; CFI = 1.00; RMSEA < 0.001). The SEM indicated that childhood trauma positively predicted NSSI both directly and indirectly through PSH. PSH has been confirmed to have partial mediating effects between childhood trauma and NSSI. The assessment of PSH may be an operable and effective method to screen and predict NSSI. Meanwhile, the intervention of childhood trauma and PSH may effectively prevent and reduce the occurrence of NSSI among adolescents.