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This paper investigates the interaction effects of income inequality and democracy on CO 2 emissions. The spatial panel model, which accounts for the spatial spillover effects across countries, is used. Using the panel data covering 41 Belt and Road initiative countries, the results indicate significant positive spatial spillovers effect to country-level CO 2 emission activity. The Kuznets Curve hypothesis, which assumes that reverse U relation presents between income and CO 2 emissions, is identified. Empirical results provide evidence that democracy levels promote the nonlinear nexus between income inequality and CO 2 emissions. High levels of inequality, ceteris paribus, in conjunction with poor democratic institutions are likely to result in higher pollution. The findings are robust to various robustness tests.

This research explores the effects of income inequality and country risk on CO 2 emissions and examines whether the effects change across countries with different development stages or income levels. A new panel quantile regression approach is used to conduct a comprehensive analysis of the impacts of affecting factors on CO 2 emissions at various quantiles, while addressing econometric challenges such as endogeneity and heterogeneity. From a global perspective, we can conclude that the marginal impact of inequality on emissions drops constantly with decreasing country risk at 10th to 50th quantiles, which even performs negative, whereas at the other quantiles, the marginal impact of inequality always remains negative. When we focus on the different income groups, the nexus of inequality emissions is negative first and then positive with decrease of country risk in low-income countries but shows no significant in low-middle- and upper-middle-income countries. Additionally, we validate the detrimental impact of income inequality in upper-income countries. Besides, country risk adversely moderates the nexus of inequality and emissions in low- and upper-income countries. Empirical results confirm that the nexus of inequality emissions lies in country risk, income level, and existing emission degree. These findings provide some important recommendations for policy-makers.

Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored. To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations. This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020. Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more. Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity. In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.

The essential roles of microglia in maintaining homeostasis in the healthy brain and contributing to neuropathology are well documented. Emerging evidence suggests that epigenetic modulation regulates microglial behavior in both physiological and pathological conditions. MicroRNAs (miRNAs) are short, non-coding epigenetic regulators that repress target gene expression mostly binding to 3'-untranslated region (3'-UTR) of mRNA in a Dicer-dependent manner. Dysregulation of certain miRNAs can contribute to microglial hyper-activation, persistent neuroinflammation, and abnormal macrophage polarization in the brain. These abnormal conditions can support the pathogenesis of neurological disorders such as glioma, Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), stroke, ischemia, and spinal cord injury (SCI). However, the roles of miRNAs in microglia in health and neurological disease have not been systematically summarized. This review will first report the role of Dicer, a key endoribonulease that is responsible for most miRNA biogenesis in microglia. Second, we will focus on recent research about the function of miRNAs in activation, inflammation and polarization of microglia, respectively. In addition, potential crosstalk between microglia and glioma cells miRNAs will be discussed in this part. Finally, the role of two essential miRNAs, miR-124, and miR-155, in microglia will be highlighted.

Background/Objectives: Elderly patients represent a growing proportion of ICU admissions, raising concerns about outcomes and healthcare costs. Evidence from China remains limited, yet understanding cost and mortality patterns is critical for optimizing care in aging populations. Methods: We retrospectively analyzed 31,535 ICU patients admitted from 2014 to 2021. After 1:1:1 matching on severity, comorbidities, sex, and admission type, three groups were formed: elderly (≥80 years), older (65–79 years), and younger (16–64 years), with 3398 patients each. Costs were inflation-adjusted, and outcomes compared across groups with appropriate statistical models. Results: Elderly patients accounted for 11.5% of admissions, had the longest ICU stay (4.5 vs. 3.8 vs. 3.1 days, p < 0.001), and the highest ICU (11.5%) and hospital (13.5%) mortality. Among non-surgical patients, elderly incurred the lowest costs; however, surgery reversed this pattern, producing a 124% increase. Expenditures were mainly driven by drugs and consumables. From 2014 to 2021, consumables rose from 32.0% to 42.0% of total costs, whereas drug costs declined. Inflation-adjusted hospital costs remained stable over time, while mortality among elderly patients decreased significantly (19.5% in 2014 vs. 8.8% in 2021; OR 0.86 per year, p < 0.001). Conclusions: Elderly ICU patients demonstrate unique cost and outcome profiles. While non-surgical elderly patients are less costly, surgery substantially increases expenses. Mortality declined over time without a rise in real costs, suggesting improved efficiency of critical care. These findings support tailored resource allocation and policy planning for aging ICU populations.

Studies investigating the association of threat-related and deprivation-related adverse childhood experiences (ACEs) with later-life cognitive decline are lacking. To evaluate the independent association of threat-related and deprivation-related ACEs with cognitive decline over time among middle-aged and older Chinese adults and to examine the modifying role of social isolation in such associations. This prospective cohort study used cognitive data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey that was administered between June 1, 2011, and March 31, 2012, and the CHARLS follow-up survey administered between July 1 and September 30, 2015. The life history survey with information of ACEs was additionally administered between June 1 and December 31, 2014. Statistical analysis was performed from March 1 to July 31, 2022. The study population consisted of middle-aged and older adults (age range, 45-97 years) with complete data on ACEs and 2 cognitive assessments and without cognitive impairment at baseline. Five threat-related ACEs (ie, physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and 5 deprivation-related ACEs (ie, emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death) before 17 years of age were queried by questionnaires. The cumulative scores of the 2 ACE dimensions were calculated and grouped into 3 categories as 0, 1, and 2 or more in main analyses. Cognitive function was measured by episodic memory and executive function. Global cognition was further calculated as the total score of these 2 dimensions. The raw scores of each cognitive test were standardized to z scores using baseline means and SDs. Linear mixed-effects models were constructed to examine the association between 2 dimensions of ACEs and the rate of annual cognitive decline. The modifying role of baseline social isolation in such associations was assessed with 3-way interaction tests. Of the 6466 participants included in main analyses, 3301 (51.1%) were men and the mean (SD) age was 57.2 (8.3) years. Compared with no exposures, experience of 1 deprivation-related ACE was associated with faster cognitive decline in global cognition (β = -0.012 [95% CI, -0.022 to -0.002] SD/y) and executive function (β = -0.010 [95% CI, -0.020 to -0.00002] SD/y), whereas individuals with at least 2 childhood deprivations had faster cognitive declines in all cognitive tests (β = -0.035 [95% CI, -0.050 to -0.019] SD/y for global cognition; β = -0.047 [95% CI, -0.068 to -0.025] SD/y for episodic memory; β = -0.019 [95% CI, -0.034 to -0.004] SD/y for executive function). However, such an association was not observed for threat-related ACEs. In addition, baseline social isolation was a significant modifier in the associations between deprivation-related ACEs and cognitive declines in global cognition (β = -0.033 [95% CI, -0.061 to -0.005] SD/y; P = .02 for 3-way interaction) and executive function (β = -0.032 [95% CI, -0.059 to -0.005] SD/y; P = .02 for 3-way interaction). Deprivation-related ACEs, but not threat-related ACEs, were associated with faster decline in later-life cognitive function, whereas social isolation could modify such detrimental impact. These findings highlight the potential benefits of promoting social integration in maintaining later-life cognitive function among individuals who have experienced childhood deprivation.

Background The global population of adults aged 60 and above surpassed 1 billion in 2020, constituting 13.5% of the global populace. Projections indicate a rise to 2.1 billion by 2050. While Hospital-at-Home (HaH) programs have emerged as a promising alternative to traditional routine hospital care, showing initial benefits in metrics such as lower mortality rates, reduced readmission rates, shorter treatment durations, and improved mental and functional status among older individuals, the robustness and magnitude of these effects relative to conventional hospital settings call for further validation through a comprehensive meta-analysis. Methods A comprehensive literature search was executed during April–June 2023, across PubMed, MEDLINE, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) to include both RCT and non-RCT HaH studies. Statistical analyses were conducted using Review Manager (version 5.4), with Forest plots and I 2 statistics employed to detect inter-study heterogeneity. For I 2  > 50%, indicative of substantial heterogeneity among the included studies, we employed the random-effects model to account for the variability. For I 2  ≤ 50%, we used the fixed effects model. Subgroup analyses were conducted in patients with different health conditions, including cancer, acute medical conditions, chronic medical conditions, orthopedic issues, and medically complex conditions. Results Fifteen trials were included in this systematic review, including 7 RCTs and 8 non-RCTs. Outcome measures include mortality, readmission rates, treatment duration, functional status (measured by the Barthel index), and mental status (measured by MMSE). Results suggest that early discharge HaH is linked to decreased mortality, albeit supported by low-certainty evidence across 13 studies. It also shortens the length of treatment, corroborated by seven trials. However, its impact on readmission rates and mental status remains inconclusive, supported by nine and two trials respectively. Functional status, gauged by the Barthel index, indicated potential decline with early discharge HaH, according to four trials. Subgroup analyses reveal similar trends. Conclusions While early discharge HaH shows promise in specific metrics like mortality and treatment duration, its utility is ambiguous in the contexts of readmission, mental status, and functional status, necessitating cautious interpretation of findings.

The plant extract \"total glucosides of peony\" (TGP) constitutes a mixture of glycosides that is isolated from the roots of the well-known traditional Chinese herb . Paeoniflorin (Pae) is the most abundant component and the main biologically active ingredient of TGP. Pharmacologically, Pae exhibits powerful anti-inflammatory and immune regulatory effects in some animal models of autoimmune diseases including Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). Recently, we modified Pae with an addition of benzene sulfonate to achieve better bioavailability and higher anti-inflammatory immune regulatory effects. This review summarizes the pharmacological activities of Pae and the novel anti-inflammatory and immunomodulatory agent Paeoniflorin-6'-O-benzenesulfonate (CP-25) in various chronic inflammatory and autoimmune disorders. The regulatory effects of Pae and CP-25 make them promising agents for other related diseases, which require extensive investigation in the future.

[This corrects the article DOI: 10.1371/journal.pone.0312654.].

This study investigates the relationship between screen time, screen content, and the risk of Attention Deficit Hyperactivity Disorder (ADHD) using data from a large sample. Specifically, it examines how different types of screen content (such as educational videos, cartoon videos, and interactive videos) are associated with the risk of ADHD. The aim is to offer a scientific foundation for the rational management of children's screen time and screen content. We collected data through a questionnaire survey involving a study population of 41,494 children from Longhua District, Shenzhen City, China. The questionnaire recorded the daily screen time and the type of content viewed by the children at ages 1-3 years and assessed their risk of ADHD using the Strengths and Difficulties Questionnaire (SDQ) at ages 4-6 years. Hierarchical logistic regression analysis, controlling for confounding factors, was employed to explore the associations between screen time, screen content, and ADHD risk. In the total sample, 6.7% of the participants had screen time exceeding 60 minutes per day, with educational videos predominant type (63.4%). 16.5% of the participants were identified as being at risk for ADHD. Statistically significant positive associations with ADHD were observed across all categories of screen time (P<0.001). Moreover, as screen time increased, the risk of ADHD also rose (OR1~60 mins/d=1.627, 95%CI=1.460~1.813; OR61~120 mins/d=2.838, 95%CI=2.469~3.261; OR>120 mins/d=3.687, 95%CI=2.835~4.796). Significant positive associations with ADHD were observed across all categories of screen time in the educational videos and cartoon videos. For the educational videos group, the odds ratios were as follows: OR1-60 mins/day=1.683 (95% CI=1.481-1.913), OR61-120 mins/day=3.193 (95% CI=2.658-3.835), and OR>120 mins/day=3.070 (95% CI=2.017-4.673). For the cartoon videos group, the odds ratios were: OR1-60 mins/day=1.603 (95% CI=1.290-1.991), OR61-120 mins/day=2.758 (95% CI=2.156-3.529), and OR>120 mins/day=4.097 (95% CI=2.760-6.081). However, no significant associations with ADHD risk were found for any category of screen time in the interactive videos group (OR1~60 mins/d=0.744, 95%CI=0.361~1.534; OR61~120 mins/d=0.680, 95%CI=0.296~1.560; OR>120 mins/d=1.678, 95%CI=0.593~4.748). Increased screen time is associated with a higher risk of ADHD, particularly for educational and cartoon videos, while interactive videos show no significant link. To mitigate this risk, parents and educators should implement strategies such as setting time limits, encouraging breaks, and promoting alternative activities. Future research should focus on longitudinal studies and intervention trials to further explore and address this relationship.