Author: Nevin Manimala

BMJ Open. 2023 Jul 20;13(7):e071407. doi: 10.1136/bmjopen-2022-071407.

ABSTRACT

OBJECTIVE: This study aims to comprehensively evaluate the resources for prevention and control of chronic and non-communicable diseases (NCDs) in China to provide a reference basis for optimising the resource allocation for prevention and control of NCDs.

METHODS: China Chronic Disease and Risk Factor Surveillance sites and National Demonstration Areas for Integrated Chronic and Non-communicable Disease Prevention and Control (NCDDA) were selected as investigation objects. In December 2021, the district (or county) resource allocation for NCD prevention and control was investigated through the NCDDA management information system. According to the index system of NCD prevention and control, 31 indicators of 6 dimensions were collected, and the weighted technique for order preference by similarity to an ideal solution, weighted rank-sum ratio and fuzzy comprehensive evaluation methods were used for comprehensive evaluation of resources for prevention and control of NCDs.

RESULTS: The 653 districts (or counties) in this study cover 22.96% of China’s districts (or counties). The top three weights were full-time staff for NCD prevention and control (0.1066), the amount of funds for NCD prevention and control (0.0967), and the coverage rate of districts (or counties) establishing chronic obstructive pulmonary disease surveillance information system (0.0886). The comprehensive evaluation results for the resources for prevention and control of NCDs by the three methods were basically the same. The results of fuzzy comprehensive evaluation showed that the resource allocation in urban areas (0.9268) was better than that in rural areas (0.3257), the one in eastern region (0.9016) was better than that in central (0.3844) and western regions (0.3868), and the one in NCDDA (0.9625) was better than that in non-NCDDA (0.2901).

CONCLUSION: The resources in China for NCD prevention and control differ among different regions, which should be taken into account in future policymaking and resource allocation.

PMID:37474175 | DOI:10.1136/bmjopen-2022-071407

BMJ Open. 2023 Jul 19;13(7):e065622. doi: 10.1136/bmjopen-2022-065622.

ABSTRACT

OBJECTIVE: To model the referral, diagnostic and treatment pathway for cardiovascular disease (CVD) in the English National Health Service (NHS) to provide commissioners and managers with a methodology to optimise patient flow and reduce waiting lists.

STUDY DESIGN: A systems dynamics approach modelling the CVD healthcare system in England. The model is designed to capture current and predict future states of waiting lists.

SETTING: Routinely collected, publicly available data streams of primary and secondary care, sourced from NHS Digital, NHS England, the Office of National Statistics and StatsWales.

DATA COLLECTION AND EXTRACTION METHODS: The data used to train and validate the model were routinely collected and publicly available data. It was extracted and implemented in the model using the PySD package in python.

RESULTS: NHS cardiovascular waiting lists in England have increased by over 40% compared with pre- COVID-19 levels. The rise in waiting lists was primarily due to restrictions in referrals from primary care, creating a bottleneck postpandemic. Predictive models show increasing point capacities within the system may paradoxically worsen downstream flow. While there is no simple rate-limiting step, the intervention that would most improve patient flow would be to increase consultant outpatient appointments.

CONCLUSIONS: The increase in NHS CVD waiting lists in England can be captured using a systems dynamics approach, as can the future state of waiting lists in the presence of further shocks/interventions. It is important for those planning services to use such a systems-oriented approach because the feed-forward and feedback nature of patient flow through referral, diagnostics and treatment leads to counterintuitive effects of interventions designed to reduce waiting lists.

PMID:37474168 | DOI:10.1136/bmjopen-2022-065622

BMJ Open. 2023 Jul 20;13(7):e074615. doi: 10.1136/bmjopen-2023-074615.

ABSTRACT

INTRODUCTION: Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients.

METHODS AND ANALYSIS: A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the ‘Evidence-Based Research’ framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation.

ETHICS AND DISSEMINATION: As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.

TRIAL REGISTRATION NUMBER: osf.io/kxwq9.

PMID:37474166 | DOI:10.1136/bmjopen-2023-074615

Am J Clin Nutr. 2023 Jul 18:S0002-9165(23)66055-1. doi: 10.1016/j.ajcnut.2023.07.011. Online ahead of print.

ABSTRACT

BACKGROUND: Adherence to the American Cancer Society (ACS) guidelines of avoiding obesity, maintaining physical activity, and consuming a diet rich in fruits, vegetables, and whole grains is associated with longer survival in colorectal cancer (CRC) survivors. Dietary components of the ACS guidelines may act in part by changing the microbiome, which is implicated in CRC outcomes.

OBJECTIVES: We conducted a pilot cross-sectional study to explore associations between ACS guidelines and the gut microbiome.

DESIGN: Stool samples and questionnaires were collected from 28 CRC survivors at the University of California, San Francisco (UCSF) from 2019-2020. ACS scores were calculated based on validated questionnaires. Gut microbial community structure from 16S amplicons and gene/pathway abundances from metagenomics were tested for associations with the ACS score and its components using analysis of variance (ANOVA) and general linear models.

RESULTS: The overall ACS score was not significantly associated with variations in the fecal microbiota. However, fruit and vegetable intake and alcohol intake accounted for 19% (p=0.005) and 13% (p=0.01) of variations in the microbiota, respectively. Fruit/vegetable consumption was associated with increased microbial diversity, increased Firmicutes, decreased Bacteroidota, and changes to multiple genes and metabolic pathways, including enriched pathways for amino acid and short-chain fatty acid biosynthesis and plant-associated sugar degradation. In contrast, alcohol consumption was positively associated with overall microbial diversity, negatively associated with Bacteroidota abundance, and associated with changes to multiple genes and metabolic pathways. The other components of the ACS score were not statistically significantly associated with the fecal microbiota in our sample.

CONCLUSION: These results guide future studies examining the impact of changes in intake of fruits, vegetables, and alcoholic drinks on the gut microbiome for CRC survivors.

PMID:37474105 | DOI:10.1016/j.ajcnut.2023.07.011

Prog Cardiovasc Dis. 2023 Jul 18:S0033-0620(23)00071-3. doi: 10.1016/j.pcad.2023.07.005. Online ahead of print.

NO ABSTRACT

PMID:37474084 | DOI:10.1016/j.pcad.2023.07.005

Sci Total Environ. 2023 Jul 18:165650. doi: 10.1016/j.scitotenv.2023.165650. Online ahead of print.

ABSTRACT

Earth observation satellites have facilitated the quantification of how vegetation phenology responds to climate warming on large scales. However, satellite image pixels may contain a mixture of multiple vegetation types or species with diverse phenological responses to climate variability. It is unclear how these mixed pixels affect the statistical relationships between satellite-derived vegetation phenology and climate factors. Here, we aim to investigate the impacts of percent tree cover (PTC), a measure of mixed pixel, on the statistical relationships between satellite-derived vegetation greenup date (GUD) and spring air temperature across Eurasian boreal forests at a 0.05° spatial resolution. We estimated GUD using Moderate Resolution Imaging Spectroradiometer (MODIS) time series data. The responses of GUD to interannual variation in spring temperature (April to May) during 2001-2020 were characterized by correlation coefficient (RT_AM) and sensitivity (ST_AM). We then evaluated the local impacts of PTC on spatial variations in RT_AM and ST_AM using partial correlation analysis through spatial moving windows. Our results indicate that, for most areas, forests with higher PTC were associated with stronger RT_AM and ST_AM. Moreover, PTC had stronger local impacts on RT_AM and ST_AM than mean annual temperature and temperature seasonality for 37.3 % and 27.4 % of the moving windows, respectively. These impacts were spatially varying and different among forest types. Specifically, deciduous broadleaf forests and deciduous needleleaf forests tend to have a higher proportion of these impacts compared to other forest types. Our findings demonstrate the nonnegligible effects of PTC on the statistical responses of GUD to temperature variability at coarse spatial resolution (0.05°) across Eurasian boreal forests.

PMID:37474076 | DOI:10.1016/j.scitotenv.2023.165650

Sci Total Environ. 2023 Jul 18:165561. doi: 10.1016/j.scitotenv.2023.165561. Online ahead of print.

ABSTRACT

Small-scale water sources serving villages and towns are the main source of drinking water in rural areas. Compared to centralized water sources, rural water sources are less frequently monitored for water quality and have poor post-treatment facilities, making them vulnerable to drinking health risks. To reveal the hydrochemical characteristics, contaminant sources, and health risks in rural water sources, 189 water samples were collected from lakes and reservoirs, rivers, and groundwater in North and East China for major ions, nutrient salts, microelements, and stable isotope analysis. Statistical analysis and isotopic tracing were performed, as well as human health risk assessment. The exceeding threshold rates for fluoride (F^–) and nitrate (NO₃^–) in surface water were 1.8 % and 9.1 %, respectively. For groundwater, the exceeding threshold rates were 20.9 % for F^–, 15.7 % for total iodine (TI), and 4.5 % for NO₃^–. F^– and TI were mainly derived from the leaching of fluoride- and iodine-containing minerals by cationic exchange, and NO₃^– is mainly derived from nitrogen in the soil (31.7-43.9 %), the use of ammonia fertilizers (24.3-36.1 %), and the discharge of manure and sewage (19.4-31.9 %). Nitrogen in the soil can be an important source of nitrate in the aquatic environment, and soils with higher clay content have a greater retention effect on the migration of nitrogen pollutants from the surface to the groundwater. F^– in water sources contributes most to human health risks for drinking, followed by NO₃^– and TI, and a higher proportion of groundwater (37 %) present health risks for drinking than surface water (14 %) for children. Authorities should give high priority to optimizing the choice of water sources and technology for water treatment, and rational measures should be taken to protect water sources from the threats of anthropogenic pollution.

PMID:37474072 | DOI:10.1016/j.scitotenv.2023.165561

Sci Total Environ. 2023 Jul 18:165609. doi: 10.1016/j.scitotenv.2023.165609. Online ahead of print.

ABSTRACT

Water replenishment can be a key factor of driving lake eutrophication status. In arid and semi-arid regions China, water replenishment for a lake has been widely carried out for not only improving water environmental quality, but also maintaining ecological system function. However, it is still unclear in terms of mechanism by which water replenishment drives lake eutrophication status. In this study, fluorescence excitation-emission matrix spectroscopy (EEMs) combined with multiple statistical analysis models (including parallel factor analysis, correlation analysis, redundancy analysis, and partial least squares structural equation modeling) was utilized to reveal potential driving mechanism and causality between water replenishment, dissolved organic matter (DOM) fractions and eutrophic status of Lake Shahu in China. Based on variations of DOM fractions, fulvic-like substance could be accumulated during the replenishment period, while nutrients carried along the replenishment might conduce to increase microbial activities during the non-replenishment period. This should contributed to an alteration of prominent component from fulvic-like substances to tyrosine-like substances during the replenishment period to non-replenishment period. According to partial least squares structural equation modeling, two potential indirect paths were finally revealed, i.e., water replenishment derived the eutrophic status of Lake Shahu: water replenishment → microbial activity → algae → eutrophication, and water replenishment → microbial activity → eutrophication. This supposed that the water replenishment should indirectly drive the algae and eutrophication of the lake by promoting the transformation of DOM fractions. In addition, natural conditions could indirectly contribute to the eutrophication of the lake through impacting the algae growth. These findings should be conducive to trace the alteration of DOM fractions in lakes by water replenishment and in recognizing potential driving mechanisms of water replenishment on eutrophication of lakes by changing DOM fractions. This could provide basic theoretical support for policymakers to regulate and treat the eutrophication of lakes.

PMID:37474068 | DOI:10.1016/j.scitotenv.2023.165609

Sci Total Environ. 2023 Jul 18:165653. doi: 10.1016/j.scitotenv.2023.165653. Online ahead of print.

ABSTRACT

Soil minor and trace elements are vital regulators of ecological processes that sustain alpine ecosystem functions. In this study, the vertical pattern and driving factors of element concentrations in alpine soils of the Tibetan Plateau were investigated. Three snow mountains (Meili, Baima, and Haba) part of the Hengduan Mountain range, were selected as the study area to determine the vertical distribution of 12 typical elements (Cr, Ni, Cu, Fe, Mn, Zn, Cd, Pb, Ca, Sr, As, and Se) in topsoil with increasing and decreasing elevation, as well as the dominant driving factors of their spatial heterogeneity. Results showed that all elements, except Se, showed strong vertical heterogeneity, among which Cr, Ni, Cu, and Fe showed peak concentrations at 2700-3000 m; the highest concentrations of Mn and Zn were at 3200 m and 2700 m, with Cd and Pb at 2500 m. Ca and Sr levels gradually decreased with increasing elevation. According to the structural equation model and random forest analysis, the vertical heterogeneity of soil elements is directly regulated by the variability of climate and soil properties due to changes in elevation. A three-way PERMANOVA further quantized the contributions of climate and soil properties on vertical heterogeneity of all soil elements, which were 35.2 % and 50.5 %, respectively. This study used various statistical tools to reveal the dominant factors affecting the vertical heterogeneity of soil elements. These findings provided a scientific overview of element distribution on the Tibetan Plateau and significant references for the vertical distribution of elements in the topsoil of other snow mountains worldwide.

PMID:37474062 | DOI:10.1016/j.scitotenv.2023.165653

Sci Total Environ. 2023 Jul 18:165588. doi: 10.1016/j.scitotenv.2023.165588. Online ahead of print.

ABSTRACT

BACKGROUND: Although emerging studies have illuminated the protective association between greenness and respiratory mortality, efforts to quantify the potentially complex role of air pollution in the causal pathway are still limited. We aimed to examine the potential roles of air pollution in the causal pathway between greenness and respiratory mortality in China.

METHODS: We used data from a community-based prospective cohort of 654,115 participants in southern China (Jan 2009-Dec 2020). We evaluated the greenness exposure as a three-year moving average Normalized Difference Vegetation Index (NDVI) within the 500 m buffer around the residence. Cox proportional hazards model was applied to estimate the association between greenness and respiratory mortality. Causal mediation analysis combined with a four-way dimensional decomposition method was utilized to simultaneously quantify the interaction and mediation role of air pollution including PM_2.5, PM₁₀, or NO₂ on the greenness-respiratory mortality relationship.

FINDINGS: We observed 6954 respiratory deaths during 12 years of follow-up. Increasing NDVI level from the lowest to the highest quartile is associated with a 19 % (95%CI: 13-25 %) reduction in the respiratory mortality risk. For the total protective effect, the proportion attributable to the overall negative interaction between greenness and air pollution (PM_2.5, PM_10, or NO₂) was 2.2 % (1.7-3.2 %), 3.5 % (0.4-3.7 %), or 25.0 % (22.8-27.1 %), respectively. Simultaneously, we estimated 25.5 % (20.1-32.0 %), 49.5 % (32.5-71.9 %), or 1.0 % (0.8-1.2 %) of the total protective association was mediated through a reduction in PM_2.5, PM₁₀, or NO₂, respectively.

INTERPRETATION: Increased greenness exposure mitigated respiratory mortality through both the antagonistic interaction and mediation pathway of air pollution (PM_2.5, PM₁₀, or NO₂).

PMID:37474059 | DOI:10.1016/j.scitotenv.2023.165588