ABSTRACT
The tertiary industry, led by service sectors, usually have "clean" production processes and thus is ignored by current PM2.5 pollution mitigation strategies in China. Actually, the tertiary industry heavily relies on the supplies from its upstream industries, resulting in pollutant emissions and economic benefits transferring among different regions. With the application of the multiregional input-output (MRIO) model, our study explores the emission contribution from the tertiary industry's consumption activities in China and analyses the accompanying emission-economy relationship. We find that the production process of tertiary industry (with the sector Transportation excluded) contributes only â¼1 % of China's PM2.5-related emissions in 2017. However, its consumption-based emission contributions could increase to 11 %-17 %, among which >95 % are indirectly contributed. More than 40 % of tertiary industry consumption-based emissions, accompanied by 25 % of the consumption-based value added, are transferred via interprovincial trade. The proportion of transferred emissions even exceeds 50 % for the top 10 importers. The spatial pattern of value-added flows is nearly opposite to that of emission flows. Our results also reveal that among the 30 provinces and 870 interprovincial trading pairs, 6 provinces are experiencing environmental-economic win, 7 provinces are experiencing environmental-economic loss, and in detail 326 trading pairs are experiencing environmental-economic win or loss. To reduce the unexpected emissions and inequalities embodied in seemingly "clean" industries, consumption activities should be considered and strengthened in China's new-stage environmental policies.
ABSTRACT
Household consumption in China is associated with substantial PM2.5 pollution, through activities directly (i.e., fuel use) and/or indirectly (i.e., consumption of goods and services) causing pollutant emissions. Urban and rural households exhibit different consumption preferences and living areas, thus their contributions to and suffering from air pollution could differ. Assessing this contrast is crucial for comprehending the environmental impacts of the nation's ongoing urbanization process. Here we quantify Chinese urban and rural households' contributions to ambient PM2.5 pollution and the health risks they suffer from, by integrating economic, atmospheric, and health models and/or datasets. The national premature deaths related to long-term exposure to PM2.5 pollution contributed by total household consumption are estimated to be 1.1 million cases in 2015, among which 56% are urban households and 44% are rural households. For pollution contributed indirectly, urban households, especially in developed provinces, tend to bear lower mortality risks compared with the portions of deaths or pollution they contribute. The opposite results are true for direct pollution. With China's rapid urbanization process, without adequate reduction in emission intensity, the increased indirect pollution-associated premature deaths could largely offset that avoided by reduced direct pollution, and the indirect pollution-associated urban-rural inequalities might become severer. Developing pollution mitigation strategies from both production and consumption sides could help with reducing pollution-related mortality and associated urban-rural inequality.
Subject(s)
Air Pollution , Environmental Pollutants , Humans , Particulate Matter/adverse effects , Air Pollution/adverse effects , Urbanization , China/epidemiologyABSTRACT
BACKGROUND: Heart failure (HF) management has markedly improved, but a clinically meaningful improvement in functional capacity and quality of life is perhaps more important for patients than living longer. OBJECTIVE: This study aimed to review the improvement in quality of life with sacubitril/valsartan in patients with HF and reduced/preserved ejection fraction (EF) from prospective clinical trials. METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) and prospective cohort studies published from inception to July 2021. A total of 6 clinical trials and 16854 patients with HF were included. The primary outcome was the change from baseline in KCCQ clinical summary score. The secondary outcomes were scores in other domains of KCCQ, the occurrence of serious adverse events (AEs), and overall mortality. P-values <0.05 were considered statistically significant. RESULTS: Treatment of sacubitril/valsartan showed significantly higher KCCQ-CSS compared to the control (WMD=0.975, 95% CI: 0.885, 1.064, p<0.001; I2=94.8%, pheterogeneity<0.001). A significant decrease in the mortality rate was observed in the sacubitril/valsartan group compared to the control group (RR=0.895, 95%CI:0.831, 0.965, p=0.004; I2=43.6%, pheterogeneity=0.150). Nevertheless, no significant reduction in the occurrence of serious AEs was found among HF patients treated with sacubitril/valsartan compared to the control group (RR=0.950, 95%CI: 0.879, 1.027, p<0.001; I2=68.1%, pheterogeneity=0.024). CONCLUSIONS: Our study demonstrated that sacubitril/valsartan might significantly improve the HRQL compared to other treatments according to the results in KCCQ-CSS and some subdomains in the KCCQ index during the follow-up in patients with HF.
FUNDAMENTO: O manejo da insuficiência cardíaca (IC) tem melhorado acentuadamente, mas uma melhora clinicamente significativa na capacidade funcional e na qualidade de vida talvez seja mais importante para os pacientes do que viver mais. OBJETIVO: Este estudo teve como objetivo revisar a melhora na qualidade de vida com sacubitril/valsartan em pacientes com IC e fração de ejeção (FE) reduzida/preservada a partir de ensaios clínicos prospectivos. MÉTODOS: PubMed, Embase e Cochrane Library foram pesquisados em busca de ensaios clínicos randomizados (ECRs) e estudos de coorte prospectivos publicados desde o início até julho de 2021. Um total de 6 ensaios clínicos e 16.854 pacientes com IC foram incluídos. O desfecho primário foi a alteração da linha de base na pontuação do resumo clínico do KCCQ. Os desfechos secundários foram pontuações em outros domínios do KCCQ, ocorrência de eventos adversos graves (EAs) e mortalidade geral. Valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: O tratamento de sacubitril/valsartan mostrou KCCQ-CSS significativamente maior em comparação com o controle (DMP=0,975, IC 95%:0,885, 1,064, p<0,001; I2=94,8%, pheterogeneidade<0,001). Uma diminuição significativa na taxa de mortalidade foi observada no grupo sacubitril/valsartan em comparação com o grupo controle (RR=0,895, IC 95%: 0,831, 0,965, p=0,004; I2=43,6%, pheterogeneidade=0,150). No entanto, nenhuma redução significativa na ocorrência de EAs graves foi encontrada entre pacientes com IC tratados com sacubitril/valsartan em comparação com o grupo controle (RR=0,950, IC 95%: 0,879, 1,027, p<0,001; I2=68,1%, pheterogeneidade= 0,024). CONCLUSÕES: Nosso estudo demonstrou que o sacubitril/valsartan pode melhorar significativamente a QVRS em comparação com outros tratamentos de acordo com os resultados do KCCQ-CSS e alguns subdomínios do índice KCCQ durante o acompanhamento em pacientes com IC.
Subject(s)
Heart Failure , Tetrazoles , Humans , Aminobutyrates/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Drug Combinations , Heart Failure/drug therapy , Quality of Life , Stroke Volume , Tetrazoles/therapeutic use , Valsartan/adverse effects , Clinical Trials as TopicABSTRACT
Resumo Fundamento: O manejo da insuficiência cardíaca (IC) tem melhorado acentuadamente, mas uma melhora clinicamente significativa na capacidade funcional e na qualidade de vida talvez seja mais importante para os pacientes do que viver mais. Objetivo: Este estudo teve como objetivo revisar a melhora na qualidade de vida com sacubitril/valsartan em pacientes com IC e fração de ejeção (FE) reduzida/preservada a partir de ensaios clínicos prospectivos. Métodos: PubMed, Embase e Cochrane Library foram pesquisados em busca de ensaios clínicos randomizados (ECRs) e estudos de coorte prospectivos publicados desde o início até julho de 2021. Um total de 6 ensaios clínicos e 16.854 pacientes com IC foram incluídos. O desfecho primário foi a alteração da linha de base na pontuação do resumo clínico do KCCQ. Os desfechos secundários foram pontuações em outros domínios do KCCQ, ocorrência de eventos adversos graves (EAs) e mortalidade geral. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: O tratamento de sacubitril/valsartan mostrou KCCQ-CSS significativamente maior em comparação com o controle (DMP=0,975, IC 95%:0,885, 1,064, p<0,001; I2=94,8%, pheterogeneidade<0,001). Uma diminuição significativa na taxa de mortalidade foi observada no grupo sacubitril/valsartan em comparação com o grupo controle (RR=0,895, IC 95%: 0,831, 0,965, p=0,004; I2=43,6%, pheterogeneidade=0,150). No entanto, nenhuma redução significativa na ocorrência de EAs graves foi encontrada entre pacientes com IC tratados com sacubitril/valsartan em comparação com o grupo controle (RR=0,950, IC 95%: 0,879, 1,027, p<0,001; I2=68,1%, pheterogeneidade= 0,024). Conclusões: Nosso estudo demonstrou que o sacubitril/valsartan pode melhorar significativamente a QVRS em comparação com outros tratamentos de acordo com os resultados do KCCQ-CSS e alguns subdomínios do índice KCCQ durante o acompanhamento em pacientes com IC.
Abstract Background: Heart failure (HF) management has markedly improved, but a clinically meaningful improvement in functional capacity and quality of life is perhaps more important for patients than living longer. Objective: This study aimed to review the improvement in quality of life with sacubitril/valsartan in patients with HF and reduced/preserved ejection fraction (EF) from prospective clinical trials. Methods: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) and prospective cohort studies published from inception to July 2021. A total of 6 clinical trials and 16854 patients with HF were included. The primary outcome was the change from baseline in KCCQ clinical summary score. The secondary outcomes were scores in other domains of KCCQ, the occurrence of serious adverse events (AEs), and overall mortality. P-values <0.05 were considered statistically significant. Results: Treatment of sacubitril/valsartan showed significantly higher KCCQ-CSS compared to the control (WMD=0.975, 95% CI: 0.885, 1.064, p<0.001; I2=94.8%, pheterogeneity<0.001). A significant decrease in the mortality rate was observed in the sacubitril/valsartan group compared to the control group (RR=0.895, 95%CI:0.831, 0.965, p=0.004; I2=43.6%, pheterogeneity=0.150). Nevertheless, no significant reduction in the occurrence of serious AEs was found among HF patients treated with sacubitril/valsartan compared to the control group (RR=0.950, 95%CI: 0.879, 1.027, p<0.001; I2=68.1%, pheterogeneity=0.024). Conclusions: Our study demonstrated that sacubitril/valsartan might significantly improve the HRQL compared to other treatments according to the results in KCCQ-CSS and some subdomains in the KCCQ index during the follow-up in patients with HF.
ABSTRACT
BACKGROUND: Parkinson disease (PD) is a worldwide spread neurodegenerative disorder. Dopamine replacement therapy is currently the mainstream treatment, which can alleviate the symptoms but induces motor complications. Acupuncture therapy is effective for PD. As a form of acupuncture, the abdominal acupuncture has been used to relieve symptoms in patients with PD, but its effectiveness and safety have not yet reached a definitive conclusion. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the efficacy and safety of abdominal acupuncture for PD patients. METHODS: Six English databases (PubMed, Web of Science, MEDLINE, EMBASE, Springer Cochrane Library, and WHO International Clinical Trials Registry Platform) and 4 Chinese databases (Wan Fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, and Chinese Biomedical Literature Database) will be searched normatively according to the rule of each database from the inception to August 20, 2022. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. The analysis will be conducted by RevMan 5.3 software according to Cochrane Handbook. RESULTS: The aim of this systematic review is to provide high-quality evidence to assess the efficacy and safety of abdominal acupuncture for patients in Parkinson's disease. The efficacy and safety of abdominal acupuncture for PD will be comprehensively assessed from the outcomes, including the effectiveness rate. The Unified Parkinson Disease Rating Scale (UPDRS) and Webster scale, Motor symptom scores utilizing UPDRS III scale, Dopamine (DA) content, and Nonmotor symptom scores employing UPDRS I scale, Activities of daily living using UDPRS II; Complications of treatment applying UPDRS IV, antioxidant ability: super oxide dismutase activity and Lipide Peroxide (LPO) content, Content of inflammatory cytokines, tumor necrosis factor-α and interleukin-1ß, and adverse events as the secondary outcome. CONCLUSION: This systematic review will explore whether abdominal acupuncture is an effective and safe intervention for patients in Parkinson's disease.
