Background Air pollutants, particularly fine particulate matters (PM2.5) have been associated with mental disorder such as depression. Clean air policy (CAP, i.e., a series of emission-control actions) has been shown to reduce the public health burden of air pollutions. There were few studies on the health effects of CAP on mental health, particularly, in low-income and middle-income countries (LMICs). We investigated the association between a stringent CAP and depressive symptoms among general adults in China. Methods We used three waves (2011, 2013 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS), a prospective nationwide cohort of the middle-aged and older population in China. We assessed exposure to PM2.5 through a satellite-retrieved dataset. We implemented a difference-in-differences (DID) approach, under the quasi-experimental framework of the temporal contrast between 2011 (before the CAP) and 2015 (after the CAP), to evaluate the effect of CAP on depressive symptoms. The association was further explored using a mixed-effects model of the three waves. To increase the interpretability, the estimated impact of PM2.5 was compared to that of aging, an established risk factor for depression. Findings Our analysis included 15,954 participants. In the DID model, we found a 10-µg/m3 reduction of PM2.5 concentration was associated with a 4.14% (95% CI: 0.41–8.00%) decrement in the depressive score. The estimate was similar to that from the mixed-effects model (3.63% [95% CI, 2.00–5.27%]). We also found improved air quality during 2011–2015 offset the negative impact from 5-years’ aging. Interpretation The findings suggest that implementing CAP may improve mental wellbeing of adults in China and other LMICs.
Having a risk analysis of harmful releases over mountainous terrains through wind tunnel experiment is a frontier problem in China. In this paper, a straight-flow wind tunnel is applied to simulate the atmospheric boundary layer and research the motion of high-sulfur gas released to atmosphere when accidental releases occur in a gathering station over the mountainous terrain. After an analysis of hourly concentration in the field accident for eight wind directions, experimental results reveal that nearby concentration fields are dominated by wind and far-field concentration distribution is dominated by topography, which leads to complete levels of consequence impact for the personnel risk inside and around the gathering station. Based on CFD techniques, a three-dimensional modelling was established in comparison with the wind tunnel experiment, which suggests that CFD prediction had underestimated the near-field gas concentration and the performance could not precisely match actual risks the gathering station causes to the mountainous terrain, which leads to a modified equation for numerical prediction. Instead of proposing a lower personnel risk evaluation obtained through the use of CFD techniques, the wind tunnel experiment offers a new choice for the consequence impact analysis for the petrochemical industry in China.
Background
Although the progress in global health initiatives has improved the availability of primary health care (PHC), unqualified healthcare remains a serious challenge in low- and middle-income countries, where PHC is often underutilized. This study examines factors associated with patients’ healthcare-seeking behaviors in rural Chin—seeking healthcare at village-level PHC providers, at higher-level health facilities, self-medicating, and refraining from seeking medical help. We focus on provider-side factors, including (1) the unobservable quality indicator, (2) the observable quality indicator, and (3) the observable signal indicator.
Methods
We analyzed 1578 episodes of healthcare-seeking behaviors of patients with diarrhea or cough/runny nose symptom from surveys conducted in July 2017 and January 2018 in 114 villages of the Yunnan province. We investigated the correlation between quality-related factors with patients’ healthcare-seeking behaviors by multinomial logit regression.
Results
We found that rural patients were insensitive to the unobservable quality of healthcare providers, as measured by standardized clinical vignettes, which might be attributable to the credence nature of PHC. The observable quality indicator, whether the clinician has received full-time junior college formal medical education, was associated with patients’ healthcare choices. Patients, however, were more likely to select healthcare based on the observable signal indicator, which was measured by the availability of medicines. Additionally, the observable signal indicator had no significant association with two quality indicators. Notably, socioeconomically-disadvantaged patients relied more on the village-level PHC, which emphasized the role of PHC in promoting the welfare of rural populations.
Conclusions
Our study found an inconsistency between objective quality of healthcare provided by providers and subjective quality perceived by patients. Patients could not identify the actual quality of PHC precisely, while they were more likely to make decisions based on the observable signal indicator. Therefore, the quality of PHC should be more observable to patients. This study not only supplements the literature on healthcare-seeking choices by examining four types of behaviors simultaneously but also clarifies rural patients’ perceptions of the quality of PHC for policy decision-making on increasing the utilization of PHC and improving the medical welfare of the vulnerable.
Chronic kidney disease is a major public health burden. Elevated urinary albumin-to-creatinine ratio is a measure of kidney damage, and used to diagnose and stage chronic kidney disease. To extend the knowledge on regulatory mechanisms related to kidney function and disease, we conducted a blood-based epigenome-wide association study for estimated glomerular filtration rate (n = 33,605) and urinary albumin-to-creatinine ratio (n = 15,068) and detected 69 and seven CpG sites where DNA methylation was associated with the respective trait. The majority of these findings showed directionally consistent associations with the respective clinical outcomes chronic kidney disease and moderately increased albuminuria. Associations of DNA methylation with kidney function, such as CpGs at JAZF1, PELI1 and CHD2 were validated in kidney tissue. Methylation at PHRF1, LDB2, CSRNP1 and IRF5 indicated causal effects on kidney function. Enrichment analyses revealed pathways related to hemostasis and blood cell migration for estimated glomerular filtration rate, and immune cell activation and response for urinary albumin-to-creatinineratio-associated CpGs.
The pilot-scale solid-phase denitrification systems supporting with poly(3-hydroxybutyrateco-3-hydroxyvalerate) (PHBV) and PHBV-sawdust were constructed for advanced nitrogen removal from wastewater treatment plants (WWTPs) effluent, and the impacts of biomass blended carbon source on microbial community structure, functions and metabolic pathways were analyzed by metagenomic sequencing. PHBV-sawdust system achieved the optimal denitrification performance with higher NO3- - N removal efficiency (96.58%), less DOC release (9.00 +/- 4.16 mg L–(1)) and NH4+-N accumulation (0.37 +/- 0.32 mg L (- 1)) than PHBV system. Metagenomic analyses verified the significant differences in the structure of microbial community between systems and the presence of four anaerobic anammox bacteria. Compared with PHBV, the utilization of PHBV-sawdust declined the relative abundance of genes encoding enzymes for NH4+-N generation and increased the relative abundance of genes encoding enzymes involved in anammox, which contributed to the reduction of NH4+-N in effluent. What's more, the encoding gene for electrons generation in glycolysis metabolism obtained higher relative abundance in PHBV-sawdust system. A variety of lignocellulase encoding genes were significantly enriched in PHBV-sawdust system, which guaranteed the stable carbon supply and continuous operation of system. The results of this study are expected to provide theoretical basis and data support for the promotion of solid-phase denitrification. (C) 2021 Elsevier Ltd. All rights reserved.