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National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

SummaryThis large-scale prospective study showed that a significant association between longer duration of daily outdoor walking and reduced osteoporosis risk was found among older adults, particularly among those with a low genetic predisposition to osteoporosis, which highlighted the importance of outdoor walking as a simple, cost-effective adjunct for preventing osteoporosis.PurposeThe available cross-sectional data and small-scale studies indicate that outdoor walking benefits bone metabolism. Nevertheless, there is a scarcity of comprehensive prospective research investigating the enduring correlation between outdoor walking and osteoporosis. This study aims to conduct a prospective analysis of the correlation between outdoor walking and osteoporosis while also examining potential variations influenced by genetic susceptibility to osteoporosis.Methods24,700 older adults without osteoporosis at baseline were enrolled. These individuals were followed up until December 31, 2021, during which data on outdoor walking was gathered. The genetic risk score for osteoporosis was comprised of 14 single-nucleotide polymorphisms.Results4,586 cases of osteoporosis were identified throughout a median follow-up period of 37.3 months. Those who walked outside for > 30 but ≤ 60 min per day had a hazard ratio (HR) of 0.83 (95% confidence interval (CI): 0.72–0.95) for incident osteoporosis, whereas those who walked outside for > 60 min per day had an HR of 0.60 (95% CI: 0.39–0.92). We found that osteoporosis risk exhibited a declining trend in individuals with low genetic risk. Individuals walking outside for > 60 min per day tended to have the lowest overall osteoporosis risk among those with high genetic risk.ConclusionsA significant negative correlation exists between an extended period of daily outdoor walking and osteoporosis incidence risk. This correlation is particularly pronounced among individuals with low genetic risk. The results above underscore the significance of outdoor walking as a simple and economical adjunct to public health programs to prevent osteoporosis.

Background The Kunshan explosion in 2014 brought about massive casualties and injuries. Gastrointestinal (GI) insufficiency secondary to burn injuries was one of the most critical risk factors. However, the impact of GI insufficiency on burn patients’ survival from the Kunshan explosion remained unclear. Therefore, our study aimed at illustrating how GI insufficiency contributed to all-cause mortality and interacted with other clinical characteristics. The hypothesis was proposed that GI insufficiency functioned as a risk factor for severely burned patients. Methods A case-control study was conducted to include 185 burn victims. Kaplan-Meier (K-M) survival analysis was utilized to compare the overall survival (OS) between severely burned patients with and without GI insufficiency. Furthermore, multivariate Cox regression analysis was deployed to evaluate the impact of GI insufficiency on patients’ prognosis, followed by a predictive model constructed. Meanwhile, multiple subgroup analysis was performed to uncover the clinical interaction. Finally, the similar statistical methods were applied on an external validation cohort of Changhai Hospital for further investigation. Results K-M analysis showed a statistical significance of OS between severely burned patients with and without GI insufficiency ( p  < 0.001). Multivariate Cox regression analysis also demonstrated GI insufficiency functioned as a risk factor to burn patients’ survival (Hazard Rate HR = 1.7, p  = 0.046). Chi-square test in subgroup analysis indicated “GI bleeding”, “organ dysfunction”, “acute kidney injury (AKI)”, “disseminated intravascular coagulation (DIC)”, “deep vein catheterization” and “hemodialysis” were all statistically significant. The multivariate Cox regression analysis results of external validation (HR = 2.78, p  < 0.001) coordinated with Kunshan cohort. Conclusion GI insufficiency was a risk factor for severely burned patients. There was an urgent need for more effective strategies to prevent and manage GI insufficiency and relevant complications in severely burned population.

This study assessed the noncarcinogenic and carcinogenic health risks associated with formaldehyde exposure for employees working in 4 categories of public places in Kunshan City in China. A total of 564 different public places, which can be divided into 4 categories (hotel and social interaction places, bathing and beauty places, cultural and entertainment places, and shopping places), and 2716 indoor air samples in those places were measured from January 1, 2010, to December 31, 2015. The average concentration of formaldehyde was 0.57 mg/m³, which is 5.7 times the acceptable concentration level (0.1 mg/m³). The noncarcinogenic risk assessment index for the 4 categories of places tested was above 1. The carcinogenic risk of formaldehyde for employees of the 4 categories of public places was 4.70 × 10−5 to 1.57 × 10−4, which was greater than the acceptable carcinogenic risk probability (1 × 10−6) from the US Environmental Protection Agency. The highest carcinogenic risk occurred in bathing and beauty places, and male employee carcinogenic risk was greater than that of females. Occupational formaldehyde exposure has serious noncarcinogenic and carcinogenic health risks for employees, and further research is needed to improve indoor air quality in the workplace environment.

Village resettlement communities (VRCs) are a special type of urban community that the government has promoted considerably during China’s rapid urbanization. This study uses the theory of the production of space as a basis to explore the processes and mechanisms of the physical and social space evolution of VRCs through a case study of Qunyi Community, one of the largest VRCs in Kunshan. Questionnaires and semi-structured interviews were employed in this study. Results indicate that the coupling relationship between local government power and diversified capital is the fundamental reason that promotes the production of macrophysical space. Moreover, the economic and social relationships among residents promote the reproduction of microsocial space. Landless farmers are the most important spatial producers in the microsocial space. The individual needs and cultural differences of immigrant workers also have significant effects on microspatial production. Furthermore, the production and reproduction of the physical and social spaces, respectively, of VRCs deduce the adjustment relationship among the urbanization processes of land, population, and individuals. Results also indicate that the urbanization of individuals appears to lag behind the previous two processes. This study can provide a theoretical basis for the spatial renovation and management optimization of VRCs, as well as the promotion of a new type of “people-centered” urbanization.

This study aimed to evaluate the annual pollution characteristics of trichloromethane (TCM) in Kunshan City’s tap water from 2016 to 2022. This research analyzed 566 tap water samples from centralized water supply units, utilizing the GB 5749-2006 Sanitary Standard for Drinking Water as the evaluation benchmark. Data analysis employed non-parametric tests and Spearman’s correlation analysis using Excel 2017 and SPSS 26.0. The results indicated a 100% compliance rate with the TCM limit (0.06 mg/L), with median annual concentrations ranging from 0.1 to 6.4 μg/L. Significant inter-annual variations were observed (H = 222.5, p < 0.01), with the lowest levels in 2019 and the highest in 2020. Quarterly analysis revealed significant seasonal differences (H = 94.0, p < 0.01), peaking in the third quarter (8.0 μg/L) and bottoming in the first quarter (3.5 μg/L). TCM concentrations showed significant correlations with annual and quarterly trends, turbidity, and chlorides (|rs| > 0.3, p < 0.01) but not with pH (rs = −0.0025, p = 0.55). While Kunshan City’s drinking water demonstrates satisfactory TCM levels, an increasing annual trend and higher concentrations in the latter half of the year warrant continued monitoring and investigation. In this study, we assessed the health risks for households in Kunshan, China, due to trichloromethane (TCM) in drinking water. The overall carcinogenic risk from multiple exposure pathways was slightly above the ideal level, while the non-carcinogenic risk was within an acceptable range.

An energy pile undertakes the functions of supporting the superstructure and controlling the indoor temperature of the building, and the thermal-mechanical coupling response of an energy pile makes its load transfer mechanism different from that of conventional engineering piles. Moreover, the thermal-mechanical coupling responses of the energy piles in summer and winter conditions are also different and need to be explored separately. Based on a ground source heat pump pile foundation workshop project in Kunshan city, Jiangsu Province, a multiphysics simulation study was carried out. The simulation results of the outlet water temperature and pile settlement are consistent with the real-world measurements, which verifies the reliability of the numerical simulation. The responses of the temperature distribution, axial stress, lateral shear stress, and settlement of the energy pile in summer and winter were analyzed, and the response laws of the energy pile in different seasons were obtained. Compared with the pure conventional load state, under the effect of thermal-mechanical coupling in winter conditions, the maximum compressive stress of the pile body is reduced by about 11.5%, but the settlement of the pile top increases by about 47.66%. Therefore, the winter conditions should be used as the design energy for the normal use of the pile. The control condition of the limit state: compared with the pure conventional load state, the maximum compressive stress of the pile increases by about 12% and the settlement of the pile top decreases by about 7.23% under the thermal-mechanical coupling effect of the summer condition. Therefore, the summer condition is the pile control conditions for the limit state of the body’s carrying capacity.

Pollen and phytolith analyses were undertaken at the Jiangli site in Suzhou, Jiangsu Province, combined with studies on macrofossils by flotation. The concentration of pollen decreased while the percentage of Poaceae pollen in the profile increased from the late phase of the Majiabang Culture to the Songze Culture suggesting that human impact on the local environment intensified gradually. The discovery of rice paddy implies a relatively advanced rice cultivation in this area during the middle-late Holocene. Other than phytoliths, the high percentage of Oryza-type Poaceae pollen (larger than 40 µm) supplied robust evidence for the existence of rice paddy. Moreover, the fact that the farther from the rice paddy, the lower the concentration and percentage of Poaceae pollen also proves that the dispersal and deposition of pollen is inversely proportional to the distance.

At a stage of rapid economic development and urbanization in China, most cities are faced with serious problems caused by environment deterioration such as pollution, space press, afforestation degradation, and disordering. Kunshan City, one of the most economically vigorous regions in China, has suffered a more prominent conflict between urbanization and environmental safety. In this paper, urban land expansion in Kunshan City in the Yangtze River Delta was measured with reference to the Landsat data recorded in 1982, 1991, 1995, and 2003 and change in land-use pattern in 1981, 1991, 1995, and 2004 as well as that in nutrients in soils of different purposes between the periods were analyzed to study the effect of urban land-use expansion on soil characteristics. To get a better understanding of soil nutrients, heavy metal content, and pollution, on-the-spot investigation, sampling and laboratory analysis were all conducted, and the geo-accumulation factors and revised Nemerow comprehensive index method were adopted for evaluation of the findings. The results show that the content of organic matter, total nitrogen, rapidly available nitrogen, and available phosphorus in the soil (except available potassium) all increased, and the average content of As, Cd, Cr, Cu, Pb, Ni, Hg, Se, and Zn prove to be 8.61, 0.12, 83.53, 32.49, 29.93, 30.45, 0.27, 0.24, and 93.3 mg kg⁻¹, respectively, showing degradation in soil quality.

The effect of a tea plantation on soil basic properties, chemical and mineralogical compositions, and magnetic properties of Alfisols from eastern China was studied. Under the tea plantation, acidification took place within a soil depth of 70 cm, with the maximum difference in pH in the upper 17 cm (ΔpH = 2.80). Both the tea plantation and unused soil profiles were predominated by free Fe and Al oxides, i.e. citrate/bicarbonate/dithionite extractable Fe (Fe d ) and Al (Al d ). Tea plantation soil was characterized by higher Al d and Fe d and lower Fe oxalate, Fe 2 O 3 and Al 2 O 3 ; CaO was depleted, whereas SiO 2 accumulated. Acidification induced by the tea plantation led to destruction of vermiculite followed by dissolution of the hydroxy-Al interlayers within its structure. The data clearly demonstrated that significant soil weathering occurred with acidification caused by tea cultivation. This acidification also resulted in decreased content of ferrimagnetic minerals due to the dissolution of minerals and movement of Fe in the profile.