Effects of Social Support on Medication Adherence Among Patients with Schizophrenia: Serial Multiple Mediation Model.

Purpose: This study aims to explore the serial mediating effect of stigma and depression on the association between social support and medication adherence. Patients and Methods: A cross-sectional survey was undertaken in the Changning District of Shanghai using a five-part questionnaire from August to December 2023. A convenient sampling method was employed, and 35 patients with schizophrenia were invited from each of the 9 streets in Changning District to participate in the survey, resulting in a total of 305 valid questionnaires collected. The questionnaire measured social support, stigma, depression, medication adherence, and demographic characteristics. Data analysis involved descriptive statistics, independent samples t-tests, ANOVA, Pearson correlation analysis, and the bootstrap method. Results: There was a direct and significantly positive association between social support and medication adherence (ß = 0.69, p < 0.001). Moreover, increased levels of stigma (ß = - 0.45, p = 0.013) and depression (ß = - 0.09, p = 0.017) were both associated with a decline in medication adherence. Bootstrapping analysis revealed that the association between social support and medication adherence operated indirectly through stigma (ß = 0.11, 95% CI: 0.03, 0.18). Additionally, social support was indirectly associated with medication adherence through depression (ß = 0.15, 95% CI: 0.04, 0.30). Further analysis indicated that social support had an indirect association with medication adherence through both stigma and depression (ß = 0.04, 95% CI: 0.01, 0.07). Conclusion: Stigma and depression serially mediate the association between social support and medication adherence among patients with schizophrenia. This serial multiple mediation model underscores the importance of integrating social support interventions with psychological interventions aimed at reducing stigma and depression, thereby effectively enhancing medication adherence in patients with schizophrenia.

Adsorption and desorption of heavy metals at water sediment interface based on bayesian model.

Estuarine areas are not only the main gathering point for human sewage but also the place where one-way and two-way fluids interact, thus forming a complex and changeable geochemical physical field. Here, heavy metals (HMs) are adsorbed and desorbed due to physical, chemical, and biochemical processes. However, the adsorption and desorption behavior of HMs in the aquatic environment is complex, and physicochemical processes occurring in the estuarine sediment-water interface control the direction and boundaries of the system. This study analyzed the migration and distribution of HMs in rivers and lakes, and established a Bayesian network model to quantitatively understand the impact of nutrients and key environmental factors on the adsorption-desorption behavior of HMs in lake and estuaries, as well as the competitive relationship between environmental factors. The influence of environmental factors and the occurrence of HMs are both important model inputs. Our findings indicated that the migration risk of Cd in Qinghai Lake was high. Environmental factors such as Cation exchange capacity (CEC), Organic matter (OM), Soluble fluoride (SFL), and pH play the most important role in the adsorption and desorption of HMs. Our findings also indicated that the exchange and activity of HMs in sediments were much higher than in the overlying water. The organic matter content was the most complex environmental factor affecting HMS adsorption and desorption at the water-sediment interface. Additionally, the mass concentration of dissolved oxygen (DO) has a linear relationship with bioavailable HMs in river and lake sediments, but has no linear relationship with the concentration of water-soluble HMs. Interestingly, there are synergistic effects between environmental factors, which directly or indirectly affect the release of bioavailable HMs. However, it is important to determine whether the effects of different environmental factors on the exchange of bioavailable HMs are negative or positive. Our findings suggested that Bayesian network (BN) signals (positive or negative) could provide insights into the transfer direction of metals in the water-sediment interface.

Spatial distribution, ecological risk, and human health assessment of heavy metals in lake surface sections - a case study of Qinghai Lake, China.

Qinghai Lake is the largest inland saltwater lake in China, with a drainage area of 29,661 km2. This study sought to conduct an ecological and human health risk assessment of metals and heavy metals, including copper, as well as investigate their concentration, distribution, and source distribution. In terms of seasonal variation, the increases in Fe, Cr, As, Pb, and Hg were relatively large, and the spatial distribution of metals presented a three-level stepped distribution trend, gradually increasing from east to west. By further exploring the source and migration path of pollutants, our study found that the source of metals in the sediments of Qinghai Lake is mainly controlled by five rivers entering the lake. Enrichment factor (EF) calculations indicated that the metal accumulation or enrichment capacity of the three central points in Qinghai Lake Basin was strong. Interestingly, the enrichment capacity of Cu and Zn was the strongest among all metals but occurred at low and medium concentration levels, respectively. The Igeo and [Formula: see text] ecological risk assessment results indicated that the individual metals posed little to no ecological risks to the Qinghai Lake Basin. However, the multi-element environmental risk comprehensive index (RI) indicated that Hg (RI = 147.97) represented a slight ecological hazard, Mn (RI = 181.13) posed moderate ecological hazards, and Zn (RI = 386.66) posed strong ecological hazards. The human health risk assessment results showed that the heavy metals in the surface sediments of Qinghai Lake currently do not pose a threat to human health. This information may facilitate the implementation of more stringent monitoring programs in the aquatic ecosystem by the relevant regulatory authorities.

Dual risk-aversion programming for regional industrial structure adjustment with water-energy nexus: A case study of Tianjin, China.

The water-energy nexus (WEN) system is a large-scale complex system that comes with diverse forms of risks owing to many challenges in the process of maintaining economic-resource-environmental sustainability. First, the rapidly increasing demand for water and energy subjects many regions to the high risk of water and energy shortages. Second, decision makers face difficulties in weighing system benefits and loss risks under a series of stricter water-energy policies. To handle the aforementioned dual risks of WEN, in this study we propose copula-based stochastic downside risk-aversion programming (CSDP) for regional water-energy management. CSDP integrates the superiority of the copula analysis method and downside risk-aversion programming into a framework, which can not only reveal the risk interactions between water resources and energy demand by using copula functions under different probability distributions, even previously unknown correlations, but also control economic risk, tackle systemic uncertainties, and provide an effective linkage between system stability and conflicting economic benefits. The proposed model was applied to a water-energy system case study in Tianjin City, China. Optimal solutions for various water resources and energy demand copulas associated with different scenarios and hierarchical risk levels were examined in the CSDP model. The results showed that water resources have a greater influence than energy on industrial structure adjustment in Tianjin, with consequent effects on system benefits, optimal output value schemes, and environmental protection strategies. In addition, the tertiary industry provides a new opportunity for economic growth based on a large amount of water-energy consumption, and its potential resources and water-air pollution risks also deserve extensive attention.

[Distribution and Potential Ecological Risk Assessment of Heavy Metals in Sediments of Lake Qinghai].

Lake Qinghai is the largest closed saltwater lake in China. In recent years, because of the rapid development of industry, agriculture, and tourism, the lake has been increasingly affected by human activities, which has attracted the attention of many scholars. In order to understand the distribution of heavy metals in the surface sediments of Lake Qinghai, the contents of Zn, Cu, Pb, Co, Ni, As, Cd, and Cr were investigated, the metal fractions were extracted, and the sources, as well as potential ecological risks, were analyzed. The results showed that:① the ω(As) (13.21 mg·kg-1) and ω(Cd) (0.21 mg·kg-1) in the surface sediments of Lake Qinghai were 1.13 and 1.53 times higher than the environmental background values, respectively, and the other heavy metal contents were all lower than the environmental background values. There were similar spatial distribution characteristics of analyzed metals except for As, with higher values measured in the northwestern area of the lake and the 151 Terminal. ② Except for Cd, the analyzed heavy metals mainly existed in the form of the residual state; by contrast, Cd mainly existed in the form of the bioavailable state, which has high potential toxicity to aquatic organisms. ③ Combined with the results of the correlation and principal component analysis, the metals including Zn, Cu, Pb, Co, Ni, Cd, and Cr were thought to mainly come from the natural environment, whereas the source of As was related to human activities, such as agricultural production. ④ According to potential risk analyses, the average of the metal potential ecological risk factors was 76.57, which indicated a slight ecological hazard level. However, it should be noted that the potential ecological hazard level and release risk of Cd at each site were higher than those of the other metals, especially in the regions nearing the estuary of Heima River, Lake Gahai, and the sand island, which showed higher levels of enrichment and potential release risk. Therefore, further attention should be paid to the potential impacts of Cd in sediments of these regions on the water environment and ecosystem.

A coupling simulation and optimization method developed for environmental-economic management of Lake watershed.

Many lake basins are facing the challenge of mitigating water shortage and water pollution while maintaining economic growth. Existing planning method for water pollution control often focus on how to alleviate water pollution effectively at the lowest cost, but rarely pay attention to the dynamic feedback and synergy effects between water pollution abatement, water conservation and social economy. This article proposes a method which consists of system dynamics model (SDM), Soil and Water Assessment Tool (SWAT) and objective programming model (OPM). It could be used to create insights on basin-wide water problems from a systematic perspective. The case study on Yilong Lake Watershed evaluates the proposed measures in existing local planning, calculates the optimal scheme, and discusses issues including the uncertainty of effectiveness, choice between recycling sewage and transferring outside, and the necessity of restricting food processing industry. This method could be improved on the simulation of social and industrial economy, the simulation of water cycle, and the spatial planning.

Dynamic metabolism network simulation for energy-water nexus analysis: A case study of Liaoning Province, China.

Faced with gradually serious energy and water crisis, the exploration of energy-water nexus metabolism relationships could provide a new direction for achieving the resources conservation and consumption reduction. In this paper, a comprehensive assessment for energy-water metabolic network is proposed to search the dynamic evolution and quantify the sectoral metabolic processes in Liaoning Province, China. Input-output analysis (IOA) and ecological network analysis (ENA) are integrated to clarify the embodied linkages and the complicated system interactions in the energy-water nexus network. The coefficients of "water-related energy" and "energy-related water" are explored through the system dynamics model (SDM) based on the consecutive input-output tables from 2012 to 2018. In addition, energy-water nexus efficiency index (EWEI) is constructed to evaluate the metabolism circulation efficiency of energy-water nexus network. The results indicate that (a) the energy and water outflow sectors mainly concentrate in primary industries and tertiary industries, while inflow sectors mainly concentrate in secondary industries; (b) the sectoral relationship provides effective pathways to implement collaborative resource saving and efficiency improvement measures, and the key sectors with the highest correlation with other sectors in energy-water nexus are AGR (agriculture), MIN (mining) and WRC (wholesale, retail and catering services). (c) the EWEI shows a gradually downward trend and the state of the energy system would determine the health of the energy-water nexus metabolism more strongly than water system.

Effects of the virgin forests to the dissolved organic matters in small forested watershed: a case study of the Tangwang River in Northeast China.

Making clear of the background values of different watersheds is an important mission for water resource management and assessment. The background values of the virgin forested watershed with less human activities sometimes have high COD values. In order to investigate this issue, this study take the Tangwang River watershed as a study case, analyzing the monitoring data of COD, BOD, and DO from the year of 2014 to 2018, and taking the water samples in the wet, normal, and dry season of 2019 to make clear the relationships between COD and DOM, the composition, and source of DOM. The non-degradation and terrigenous source DOM contributed to the most of COD values through the fitting analysis. The DOM in the Tangwang River mostly consisted of the humic-like acid and fulvic-like acid. Along with the river, the concentration of DOM had a little decrease, but the composition of DOM did not change obviously, so that the DOM coming from the virgin forest did not degrade in the river, and the river water only had the dilution effect with the tributaries fed in spatially. The organic matters in the virgin forest were easily washed away, so that the DOM concentration had an increase in the wet season temporally. The background COD values of the small virgin forested watershed were usually high as for the leaching effects of the organic matters from the forest, which was worthy noted when conducting the management project of this kind of watershed, in order to adjust measures to local conditions.

Assessment of energy use and environmental impacts of wastewater treatment plants in the entire life cycle: A system meta-analysis.

Wastewater treatment plants (WWTPs) play a critical role in the sustainable development of water resources due to its outstanding ability of removing pollutants from complex influent wastewater and generating clean and safe effluent. This paper innovatively adopted the meta-analysis method in view of published LCA studies to assess the energy use and environmental impacts of WWTPs during their life cycle. The search and screening process determined a useful data source with 54 LCA literatures covering 109 relevant case studies. The meta-analysis results revealed that, compared with other regions, the WWTPs in China have the higher intensity in terms of energy use, global warming potential (GWP), eutrophication potential (EP), acidification potential (AP), photochemical oxidation (PHO), freshwater ecotoxicity potential (FETP) and terrestrial ecotoxicity potential (TETP) categories, implying that the energy conservation and emission reduction strategies are necessary to wastewater treatment industry in China. Moreover, compared with A/A/O and CASS processes, the A/O process consumes less energy and results in lower GWP and AP intensity, but affects adversely the natural water-body protection due to undesirable treatment efficiency. Furthermore, the treatment capacities of medium and large scales (i.e. 5-20 × 104 m3/d) are most reasonable sizes for WWTPs since their intensity of energy use, GWP, EP and AP are under a relatively low level. Finally, a strict effluent discharge standard is highly recommended from the perspective of protecting aquatic environment, although it leads to a higher energy consumption. The findings of this study could provide valuable references for promoting healthy and sustainable wastewater treatment industry.

Research on sulfur oxides and nitric oxides released from coal-fired flue gas and vehicle exhaust: a bibliometric analysis.

A bibliometric method was used to evaluate the global scientific publications about sulfur oxides and nitric oxides released by coal-fired flue gas and vehicle exhaust from 1995 to 2018 and to provide insights into the characteristics of the articles and tendencies that may exist in the publications. Performance of publications, research tendency, and hotspots were analyzed. The article number had an explosive growth in 2004 and, then, began to grow steadily. China had an absolutely advantage in publication quantities; however, America had a leading position considering publication cited times. The simultaneous removal of mercury, particulate matter, and CO2 was a research hotpot in sulfur oxide and nitric oxide control process; oxidation, absorption, and catalytic reduction were the central control methods that had the most strength in relation with sulfur dioxide and nitric oxide. Considering the study of traditional flue gas pollutant control method (limestone-gypsum method, selective catalytic reduction, etc.) was perfection, it was speculated that adsorption by ionic liquid, electricity charging, advanced oxidation progress, and multi-pollutant removal, simultaneously, would be the new research orientation in flue gas pollutant control. One of the hot points of controlling the vehicle exhaust was the application of the "green energy" biodiesel; lots of keywords concerning human health suggested that quite a lot studies were focused on the health hazard brought by sulfur oxides and nitric oxide.

An inexact multistage fuzzy-stochastic programming for regional electric power system management constrained by environmental quality.

Electric power system involves different fields and disciplines which addressed the economic system, energy system, and environment system. Inner uncertainty of this compound system would be an inevitable problem. Therefore, an inexact multistage fuzzy-stochastic programming (IMFSP) was developed for regional electric power system management constrained by environmental quality. A model which concluded interval-parameter programming, multistage stochastic programming, and fuzzy probability distribution was built to reflect the uncertain information and dynamic variation in the case study, and the scenarios under different credibility degrees were considered. For all scenarios under consideration, corrective actions were allowed to be taken dynamically in accordance with the pre-regulated policies and the uncertainties in reality. The results suggest that the methodology is applicable to handle the uncertainty of regional electric power management systems and help the decision makers to establish an effective development plan.

Effectiveness of a rehabilitative program that integrates hospital and community services for patients with schizophrenia in one community in Shanghai.

BACKGROUND: One possible reason for the less than satisfactory long-term outcomes for schizophrenia is the lack of coordination between inpatient and community-based services. AIM: Assess the effectiveness of a rehabilitation model for schizophrenia that integrates hospital and community services. METHODS: Ninety patients with schizophrenia participating in an integrated rehabilitation program at 10 community centers in Changning, Shanghai (intervention group) and 52 community-based patients with schizophrenia randomly selected from all patients in Changning participating in routine outpatient care (control group) were assessed at enrollment using the Positive and Negative Syndrome Scale (PANSS) and the Morningside Rehabilitation Status Scale (MRSS) and then re-assessed 1 year later by clinicians who were blind to the group assignment of the patients. The patients' registered guardians (the vast majority were co-resident family members) were assessed at the same times using the Family Burden Scale (FBS), the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS) and the Social Support Rating Scale (SSRS). RESULTS: At enrollment the clinical status of patients in the two groups (assessed with PANSS) was similar but the social functioning measures assessed by MRSS were significantly worse in the intervention group than in the control group. After one year the improvement of both clinical symptoms and social functioning measures were significantly greater in the intervention group than in the control group. In the year of follow-up, 3 individuals (3.3%) in the intervention group and 6 individuals (11.5%) in the control group were re-hospitalized (Fisher Exact Test, p=0.074). The feelings of burden, depression, anxiety and reported social support among guardians of patients in the intervention group were not significantly different from those for guardians of patients in the control group either at the time of enrollment or after the 1-year intervention. However, guardians in the intervention group showed a significant decrease in depressive and anxiety symptoms over the one-year follow-up. CONCLUSIONS: Rehabilitative approaches that integrate hospital and community services can improve clinical and social outcomes for patients with schizophrenia. Further development of these programs is needed to increase the proportion of patients who achieve regular employment (i.e., 'community re-integration') and to provide family members with better psychosocial support.