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Background Improper settings of outdoor smoking points in public places may increase the risk of secondhand smoke exposure among the population. Conducting research on air pollution in and around smoking spots and related influencing factors can provide valuable insights for optimizing the setting of outdoor smoking points. Objective To investigate the influence of the number of smokers at outdoor smoking points and the distance on the diffusion characteristics of surrounding air pollutants, in order to optimize the setting of outdoor smoking points. Methods Surrounding the exhibition halls in the China International Import Expo (CIIE), two outdoor smoking points were randomly selected, one on the first floor (ground level) and the other on the second floor (16 m above ground), respectively. At 0, 3, 6, and 9 m from the smoking points in the same direction, validated portable air pollutant monitors were used to measure the real-time fine particulate matter (PM2.5) and carbon dioxide (CO2) concentrations for consecutive 5 d during the exhibition, as well as the environmental meteorological factors at 0 m with weather meters including wind speed, wind direction, and air pressure. An open outdoor atmospheric background sampling point was selected on each of the two floors to carry out parallel sampling. Simultaneously, the number of smokers at each smoking point were double recorded per minute. The relationships between the number of smokers, distance from the smoking points, and ambient PM2.5 and CO2 concentrations were evaluated by generalized additive regression models for time-series data after adjustment of confounders such as temperature, relative humidity, and wind speed. Results The median numbers of smokers at smoking points on the first and second floors were 6 [interquartile range (IQR): 3, 9] and 9 (IQR: 6, 13), respectively. Windless (wind speed <0.6 m·s−1) occupied most of the time (85.9%) at both locations. The average concentration of ambient PM2.5 at the smoking points (0 m) [mean ± standard deviation, (106±114) μg·m−3] was 4.2 times higher than that of the atmospheric background [(25±7) μg·m−3], the PM2.5 concentration showed a gradient decline with the increase of distance from the smoking points, and the average PM2.5 concentration at 9 m points [(35±22) μg·m−3] was close to the background level (1.4 times higher). The maximum concentration of CO2 [(628±23) μmol·mol−1] was observed at 0 m, and its average value was 1.3 times higher than that of the atmospheric background [(481±40) μmol·mol−1], and there was no gradient decrease in CO2 concentration with increasing distance at 0, 3, 6, and 9 m points. The regression analyses showed that, taking smoking point as the reference, every 3 m increase in distance was associated with a decrease of ambient PM2.5 by 24.6 [95% confidence interval (95%CI): 23.5, 25.8] μg·m−3 (23.2%) and CO2 by 54.1 (95%CI: 53.1, 55.1) μmol·mol−1 (8.6%). Every one extra smoker at the smoking point was associated with an average increase of PM2.5 and CO2 by 2.0 (95%CI: 1.7, 2.8) μg·m−3 and 1.0 (95%CI: 0.7，1.2) μmol·mol−1, respectively. The sensitivity analysis indicated that, under windless conditions, the concentrations of PM2.5 and CO2 at the smoking points were even higher but the decreasing and dispersion characteristics remained consistent. Conclusion Outdoor smoking points could significantly increase the PM2.5 concentrations in the surrounding air and the risks of secondhand smoke exposure, despite of the noticeable decreasing trend with increasing distance. Considering the inevitable poor dispersion conditions such as windless and light wind, outdoor smoking points are recommended to be set at least 9 m or farther away from non-smoking areas.
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Objective@#To describe the current status of the prevalence of co-morbid myopia and obesity among 7-18 years students in the Inner Mongolia Autonomous Region in 2021 and to analyze the moderating effect of lifestyle in this association ，so as to provide scientific basis for the establishment of the mechanism of Co-morbidity，Shared Etiology，and Shared Prevention of common diseases in children and adolescents.@*Methods@#A total of 139 630 primary and secondary school students aged 7-18 years from Inner Mongolia Autonomous Region were selected by stratified random cluster sampling method in September,2021. Myopia was determined using distance visual acuity examination and refractive error examination, and obesity was determined according to the BMI classification criteria for overweight, obesity screening of Chinese school age children and adolescents. Used a questionnaire, healthy lifestyles were determined according to the American Heart Association s Healthy Lifestyle Score by totaling the six scores for smoking, alcohol consumption, diet, exercise, screen time, and sleep duration.The χ 2 test was used to compare the association between group differences in the co-morbidity rate of myopia and obesity. The multivariable Logistic regression model was used to explore the influencing factors of the co-morbidity of myopia and obesity, and the stratified analysis was used to analyze the moderating effect of lifestyles on the prevalence of the co-morbidity.@*Results@#The prevalence of myopia and obesity co-morbidity among students aged 7-18 years old in the Inner Mongolia Autonmous Region in 2021 was 13.7%, higher among boys than girls ( 15.5 % vs. 11.8%), higher among those aged 10-12 years old than 7-9,13-15,and 16-18 years old (14.7%,13.7%, 13.3%, 12.0%), higher among other ethnic minorities than Han Chinese and Mongolians (15.3%, 14.0%, 12.5%), higher in urban areas than that in suburban areas(15.3%, 13.0%), and middle economic level tracts were higher than poor and good tracts (14.8%, 12.9 %, 12.6%) ( χ 2=392.37，115.73，62.80，119.02，121.60, P <0.05). Multivariable Logistic regression modeling showed that unhealthy lifestyles ( OR=1.24, 95%CI=1.19-1.29 ) and middle level of lifestyle score ( OR=1.15, 95%CI=1.10-1.19 ) students had higher prevalence of co-morbidity, and the results were statistically significant among both boys and girls, the age groups of 10- 12, 13-15, and 16-18 years old, as well as the Han and Mongolian ethnic groups (all P <0.05).@*Conclusion@#In 2021, the current situation of myopia and obesity co-morbidity and unhealthy lifestyles among primary and secondary school students in the Inner Mongolia Autonomous Region are not optimistic.
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Background Public places are frequently polluted by cigarette smoking, and there is a lack of accurate, real-time, and intelligent monitoring technology to identify smoking behavior. It is necessary to develop a tool to identify cigarette smoking behavior in public places for more efficient control of cigarette smoking and better indoor air quality. Objective To construct a model for recognizing cigarette smoking behavior based on real-time indoor concentrations of PM2.5 in public places. Methods Real-time indoor PM2.5 concentrations were measured for at least 7 continuous days in 10 arbitrarily selected places (6 public service providers and and 4 office or other places) from Oct. to Nov. 2022 in Pudong New Area, Shanghai. Indoor nicotine concentrations were monitored with passive samplers simultaneously. Outdoor PM2.5 concentration data were obtained from three municipal environmental monitoring stations which were nearest to each monitoring point during the same period. Mann-Whitney U test was used to compare indoor and outdoor means of PM2.5 concentrations, and Spearman rank correlation was used to analyze indoor PM2.5 and nicotine concentrations. An interactive plot and a random forest model was applied to examine the association between video observation validated indoor smoking behavior and real-time indoor PM2.5 concentrations in an Internet cafe. Results The average indoor PM2.5 concentration in the places providing public services [(97.5±149.3) µg·m−3] was significantly higher than that in office and other places [(19.8±12.2) µg·m−3] (P=0.011). The indoor/outdoor ratio (I/O ratio) of PM2.5 concentration in the public service providers ranged from 1.1 to 19.0. Furthermore, the indoor PM2.5 concentrations in the 10 public places were significantly correlated with the nicotine concentrations (rs=0.969, P<0.001). Among them, the top 3 highly polluted places were Internet cafes, chess and card rooms, and KTV. The results of random forest modeling showed that, for synchronous real-time PM2.5 concentration, the area under the curve (AUC) was 0.66, while for PM2.5 concentration at a lag of 4 min after the incidence of smoking behavior, the AUC increased to 0.72. Conclusion The indoor PM2.5 concentrations in public places are highly correlated with smoking behavior. Based on real-time indoor PM2.5 monitoring, a preliminary recognition model for smoking behavior is constructed with acceptable accuracy, indicating its potential values applied in smoking control and management in public places.
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In this paper,the constitute elements of Sino-US licensed doctors' practical skill examination evaluation index system are expounded.Through comparison,the differences on the formulation basis,classification principle,test content,and ability requirements are inferred;On the basis of referring to the advanced experience and practice of the United States,and by combining the requirements of the most basic requirements of global medical education,suggestions for improving the Chinese licensed doctors' practical skill examination evaluation index system are proposed in terms of integrating the test syllabus classification,adjusting the distribution of clinical practice ability examination content,increasing the proportion of medical humanities content test,as well as establishing a scientific examination evaluation index weight table.
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This paper briefly introduced the development course, present situation and characteris-tics of United States Medical Licensing Clinical skills examination. Based on the elaboration of four key elements, namely organization and management, subjects setting, method and form, and evaluation method-ology, we analyzed the advantages and disadvantages, to provide experiences and references for improving and perfecting our country's Medical Licensing Clinical skills examination.
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The result of medical licensing examination is an objective reflection of the quality of medical education. The average scores and pass rates of medical licensing examination of the military medical university including The Third Military Medical University, were under the national average levels, which made us find the problems, therefore, reflection on curriculum structure, teaching method, administration mode and continuing education should be integrated to the requirement of the medical licensing examination, so as to let the students meet the complex demand of the society, as well as the special requirement of military service.