Alcohol Consumption Patterns for Excessive Drinkers in a Multi-Ethnic Society Short Running Title: Drinking Patterns and Health Education.

Objective: Culture and eating habits, which vary greatly across different ethnic groups, have a substantial impact on drinking behavior. This study aimed to examine whether the drinking patterns and reasons differ by ethnic groups, and provide useful insights for multi-ethnic areas that seek to cut down alcohol intake. Methods: We recruited excessive drinkers and collected the drinking patterns and motivations by questionnaire in a multi-ethnic society. Multiple linear regressions were used to evaluate the variations in drinking characteristics among different ethnic groups. Results: We recruited 1287 participants through convenience sampling (a non-probability sampling technique used in research where the researcher selects participants or units for a study based on their accessibility and proximity), among whom 439 excessive drinkers were eligible. The mean age was 38 years for the 439 participants, 92.9% were men, 36.0% were Han, and 64.0% were minorities mainly composed of the Yi. The majority of the participants were married (75.9%) and did physical work (58.1%). Ethnic minorities consumed more alcohol on a single occasion than Han people did (47.3 vs 41.8g/session) while drinking less frequently. For the minority and Han participants, 67% and 42% were not used to drinking with food, respectively. Peer pressure and fostering a good atmosphere were the most common drinking reasons for the minority and Han, respectively. Conclusion: We found substantial differences in drinking patterns and reasons between ethnic minorities and Han ethnicity, attributable to their culture and customs. Findings highlight the importance of drinking habits and motivations in exploring alcohol control education strategies in the context of ethnic integration and population immigration.

Association between air temperature and emergency admission for esophagogastric variceal bleeding: a case-crossover study in Beijing, China.

BACKGROUND AND AIMS: Studies concerning the impact of air temperature on esophagogastric variceal bleeding (EGVB) have yielded conflicting results. Our study aimed to evaluate the correlation between air temperature and EGVB. METHODS: A time-stratified case-crossover study design was performed. Patients received emergency gastroscopic hemostasis for upper gastrointestinal bleeding between Jan 1, 2014, and Dec 31, 2018 in the Fifth Medical Center of PLA General Hospital were enrolled. Conditional logistic regression analysis was applied to determine the association between air temperature and EGVB for different lag structures. RESULTS: A total of 4204 cirrhotic patients diagnosed with EGVB and received emergency gastroscopic hemostasis were enrolled. The mean number of daily EGVB cases peaked in October (2.65 ± 1.69) and fell to the lowest level in July (1.86 ± 1.38), and was 2.38 ± 1.58 in spring, 2.00 ± 1.46 in summer, 2.37 ± 1.58 in autumn, and 2.45 ± 1.58 in winter, respectively (P < 0.0001). In conditional logistic regression analysis, no significant correlations between air temperature and EGVB were observed and no significant difference were found when stratified by age, sex, etiology, liver cancer status, and grade of varices. CONCLUSION: Emergency admission for EGVB showed significant monthly and seasonal fluctuations, while in conditional logistic regression analysis, no association between minimum temperature and emergency admission for EGVB were observed.

A review on ergonomics evaluations of virtual reality.

BACKGROUND: Virtual reality (VR) is a combination of technologies that allow the user to interact with a computer-simulated environment with the experience of immersion, interactivity, and imagination. However, ergonomic problems related to virtual reality have adverse effects on the health and experience of users, which restrict the application of virtual reality technology. OBJECTIVE: The paper aims to provide an overview of the ergonomics evaluation of VR for further development of software and hardware of VR. METHODS: This paper describes and discusses the ergonomics issues involved in the software and hardware of VR from three aspects: visual, physiological, and cognitive. The paper also summarizes the research methods and evaluation metrics. RESULTS: Many attempts have been made to study ergonomics issues of VR, mainly including pressure, muscle fatigue, thermal comfort, visual fatigue, and motion sickness. Ergonomics studies are very valuable for research related to virtual reality. There is a summary table that lists the main evaluation metrics and methods. CONCLUSIONS: According to current research, this review gives three recommendations for further research on VR, which will be helpful for further human-centered research and design work within the VR industry.

Effect of a brief intervention with small financial incentives on alcohol consumption in China: study protocol for a randomised controlled trial.

INTRODUCTION: Alcohol consumption is the seventh leading risk factor for disability-adjusted life years in the world, according to the Global Burden of Disease Study 2017. As the largest developing country, China has a substantial population of alcohol consumers who suffer from related health risks. Despite having made significant advancements in eradicating absolute poverty, many people still live in relative poverty, which suggests that the adverse health effects caused by alcohol consumption among vulnerable populations in China warrant more attention. This paper aims to provide an overview of alcohol consumption among ethnic populations in China and test the feasibility and efficacy of a brief advice intervention with a small financial incentive in reducing harmful drinking behaviours. METHODS: This study is a three-arm, single-blinded, pragmatic, individually randomised controlled trial with follow-ups at 1,2 and 3 months after randomisation. A total of 440 daily drinkers living in Xichang will be recruited and divided into three groups: brief intervention group, financial incentive group and control group. All participants will receive a urine ethyl glucuronide (EtG) test, which detects alcohol consumption in the past 80 hours. Additionally, participants in the brief intervention group will receive three free counselling sessions alongside multimedia messages on the topic of alcohol consumption after each session. The participants in the financial incentive group will receive the same interventions as well as cash incentives according to the results of the EtG test. The primary outcomes are the self-reported drinking quantity, binge drinking frequency, drinking intensity and the proportion of participants who pass the EtG test. ETHICS AND DISSEMINATION: This protocol was approved by the Peking University Health Science Center Institutional Review Board (IRB00001052-20049). Findings will be published in peer-reviewed journals and presented at local, national and international conferences to publicise and explain the research to key audiences. TRIAL REGISTRATION NUMBER: NCT04999371.

The burden of sulfur dioxide pollution on years of life lost from chronic obstructive pulmonary disease: A nationwide analysis in China.

BACKGROUND: Sulfur dioxide (SO2) is one of the major gaseous pollutants in China and other developing countries. Few multicity studies have been done to examine the short-term effect of SO2 on cause-specific years of life lost (YLL). This study was designed to investigate the burden of chronic obstructive pulmonary disease (COPD) associated with SO2 exposure. METHODS: A 5-year time-series study was conducted in 48 Chinese cities from 2013 to 2017. Generalized additive models were first used to estimate the city-specific relationship. Then, random-effects meta-analyses were applied to pool the estimates. Furthermore, the roles of potential modifiers and the related economic loss estimated by the method of value per statistical life year were also evaluated. RESULTS: The annual mean concentration of SO2 was 27.1 µg/m3. A 10 µg/m3 increase in 4-day moving average (lag03) of SO2 concentration was associated with 0.83% (95% CI: 0.13%, 1.53%) relative increment in YLL from COPD, and relevant percent change of mortality was 0.78% (95% CI: 0.16%, 1.41%). Moreover, a significantly higher effect was observed in the warm season, particularly in the south region. SO2 exposure was estimated to account for 1.89% of the total economic loss due to YLL from COPD. CONCLUSIONS: Our findings showed a positive association between short-term exposure to SO2 and YLL from COPD and highlighted the importance of continuous control of SO2 pollution to reduce corresponding attributable disease burden.

Ambient sulfur dioxide and years of life lost from stroke in China: a time-series analysis in 48 cities.

BACKGROUND AND OBJECTIVES: Sulfur dioxide (SO2) is a ubiquitous air pollutant and its concentration in China remains at a higher level in the world. However, evidence regarding short-term effect of SO2 on years of life lost (YLL) from stroke is scarce. We aim to estimate the short-term association between SO2 pollution and YLL for stroke and the related excess life years and economic loss. METHODS: A national time-series study was conducted in 48 Chinese cities from 2013 to 2017. Generalized additive model coupled with random-effects model were used to explore the effects of SO2 on YLL from stroke. Stratified analyses were performed by demographical and geographical factors, and the effect modification of city-level factors was estimated. In addition, the related economic loss was calculated using the method of the value per statistical life year (VSLY). RESULTS: Averaged daily mean SO2 concentration was 27.1 µg/m3 in 48 Chinese cities from 2013 to 2017. Per 10 µg/m3 increase in the concentration of SO2 (lag03) was associated with an increment of 0.70% (95% confidence interval: 0.27%,1.13%), 0.51% (-0.01%,1.04%), 0.71% (0.14%,1.28%) increase in YLL from total stroke, hemorrhagic and ischemic stroke, respectively. The effect of short-term ambient SO2 exposure on YLL from stroke was more pronounced in the less-educated population and those living in the south. The corresponding excess economic loss during the study period due to SO2-related YLL from stroke accounted for 0.08% (0.03%, 0.13%) of the GDP in China. CONCLUSIONS: Our results provide evidence from China that short-term exposure to SO2 is positively associated with YLL from stroke and its major subtypes in certain subgroups of population. This study calls for greater awareness of the adverse health effect due to SO2 in China and other developing countries, as well as local-specific implementation of air pollution mitigation measures.

Early estimation of the case fatality rate of COVID-19 in mainland China: a data-driven analysis.

BACKGROUND: An ongoing outbreak of pneumonia caused by a novel coronavirus [severe acute respiratory syndrome coronavirus (SARS-CoV)-2], named COVID-19, hit a major city of China, Wuhan in December 2019 and subsequently spread to other provinces/regions of China and overseas. Several studies have been done to estimate the basic reproduction number in the early phase of this outbreak, yet there are no reliable estimates of case fatality rate (CFR) for COVID-19 to date. METHODS: In this study, we used a purely data-driven statistical method to estimate the CFR in the early phase of the COVID-19 outbreak. Daily numbers of laboratory-confirmed COVID-19 cases and deaths were collected from January 10 to February 3, 2020 and divided into three clusters: Wuhan city, other cities of Hubei province, and other provinces of mainland China. Simple linear regression model was applied to estimate the CFR from each cluster. RESULTS: We estimated that CFR during the first weeks of the epidemic ranges from 0.15% (95% CI: 0.12-0.18%) in mainland China excluding Hubei through 1.41% (95% CI: 1.38-1.45%) in Hubei province excluding the city of Wuhan to 5.25% (95% CI: 4.98-5.51%) in Wuhan. CONCLUSIONS: Our early estimates suggest that the CFR of COVID-19 is lower than the previous coronavirus epidemics caused by SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV).

Attributable risk and economic cost of hospital admissions for mental disorders due to PM2.5 in Beijing.

BACKGROUND: Few studies have estimated the attributable risk and economic cost of mental disorders (MDs) due to particulate matters with aerodynamic diameter of <2.5 µm (PM2.5) exposure in Beijing. OBJECTIVES: This study aims to identify the possible correlation between PM2.5 and risk of hospital admissions (HAs) for MDs in Beijing and calculate the attributable risk and economic cost. METHODS: A generalized additive model (GAM) with controlling for time trend, meteorological conditions, holidays and day of the week was used to estimate the associations. Stratified analyses were performed by age, gender and season. We further estimated the health and economic burden of HAs for MDs attributable to PM2.5. FINDINGS: A total of 17,252 HAs for MDs were collected. A 10 µg/m3 daily increase in PM2.5 was associated with a statistically significant risk increase of 3.55% for HAs for MDs. The effects of PM2.5 exposures on HAs for MDs were more pronounced in males, elderly (≥65 years old) individuals and in cold seasons. Using WHO's air quality guidelines as the reference, 15.12% of HAs and 16.19% of the related medical expenses for MDs were attributed to PM2.5 during the study period. NOVELTY: PM2.5 accounts for substantial morbidity and economic burden of MDs for both the society and households, which shows environmental protections are essential to improve mental health status of the population.

Spatial patterns and effects of air pollution and meteorological factors on hospitalization for chronic lung diseases in Beijing, China.

Chronic obstructive pulmonary disease (COPD), lung cancer (LC) and tuberculosis (TB) are common chronic lung diseases that generate a large disease burden and significant health care resource use in China. The aim of this study was to quantify spatial patterns and effects of air pollution and meteorological factors on hospitalization of COPD, LC and TB in Beijing. Daily counts of hospitalization for 2010 were obtained from the Beijing Urban Employees Basic Medical Insurance (UEBMI) system. Bayesian hierarchical Poisson regression models were applied to identify spatial patterns of hospitalization for COPD, LC and TB at the district level and explore associations with inhalable particulate matter (aerodynamic diameter <10 µm, PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), mean temperature and relative humidity. There were 18,882, 14,295 and 2,940 counts of hospitalizations for COPD, LC and TB respectively, in Beijing in 2010. Clusters of high relative risk were in different locations for the three diseases. The effect of relative humidity on COPD hospitalization was most significant with a relative risk (RR) of 1.070 (95%CI: 1.054, 1.086) per one percent increase. For lung cancer hospitalization, exposure to ambient SO2 was associated with a RR of 1.034 (95%CI: 1.011, 1.058) per µg m-3 increase. For tuberculosis, the effect of mean temperature was significant with a RR of 1.107 (95%CI: 1.038, 1.180) per °C increase. Risk factors and spatial patterns were different for hospitalization of non-infectious and infectious chronic lung disease in Beijing. Even over a short time period (one year), associations were apparent with air pollution and meteorological factors.

Satellite-based short- and long-term exposure to PM2.5 and adult mortality in urban Beijing, China.

Severe and persistent haze accompanied by high concentrations of fine particulate matter (PM2.5) has become a great public health concern in urban China. However, research on the health effects of PM2.5 in China has been hindered by the lack of high-quality exposure estimates. In this study, we assessed the excess mortality associated with both short- and long-term exposure to ambient PM2.5 simultaneously using satellite-derived exposure data at a high spatiotemporal resolution. Adult registries of non-accidental, respiratory and cardiovascular deaths in urban Beijing in 2013 were collected. Exposure levels were estimated from daily satellite-based PM2.5 concentrations at 1 km spatial resolution from 2004 to 2013. Mixed Poisson regression models were fitted to estimate the cause-specific mortality in association with PM2.5 exposures. With the mutual adjustment of short- and long-term exposure of PM2.5, the percent increases associated with every 10 µg/m3 increase in short-term PM2.5 exposure were 0.09% (95% CI: -0.14%, 0.33%; lag 01), 1.02% (95% CI: 0.08%, 1.97%; lag 04) and 0.09% (95% CI: -0.23%, 0.42%; lag 01) for non-accidental, respiratory and cardiovascular mortality, respectively; those attributable to every 10 µg/m3 increase in long-term PM2.5 exposure (9-year moving average) were 16.78% (95% CI: 10.58%, 23.33%), 44.14% (95% CI: 20.73%, 72.10%) and 3.72% (95% CI: -3.75%, 11.77%), respectively. Both associations of short- and long-term exposure with the cause-specific mortality decreased after they were mutually adjusted. Associations between short-term exposure to satellite-based PM2.5 and cause-specific mortality were larger than those estimated using fixed measurements. Satellite-based PM2.5 predictions help to improve the spatiotemporal resolution of exposure assessments and the mutual adjustment model provide better estimation of PM2.5 associated health effects. Effects attributable to long-term exposure of PM2.5 were larger than those of short-term exposure, which should be more concerned for public health.

The effects of interaction between particulate matter and temperature on mortality in Beijing, China.

BACKGROUND: the effects of interaction between temperature and inhalable particulate matter (aerodynamic diameter < 10 µm, PM10) on mortality have been examined in some previous studies, but the results were inconsistent. This study aims to explore whether the effects of PM10 on daily non-accidental, cardiovascular and respiratory mortality were modified by temperature levels in Beijing from 2006 to 2009. METHODS: we applied a bivariate response surface model and temperature-stratified model based on time-series Poisson generalized additive models (GAMs) to examine the interactive effects in single- and two-pollutant models. The modification of age and gender was examined in subgroup analyses. RESULTS: the median of temperature (15.9 °C) and visualized turning point (20 °C) were chosen as cut-offs to define the temperature strata as two levels (low and high). Results showed that the effect estimates of PM10 were stronger at the high temperature level for non-accidental, cardiovascular and respiratory mortality than at the low temperature level. When controlling the moving average lag of temperature for 14 days, the effect estimates per 10 µg m-3 increase in PM10 for non-accidental, cardiovascular and respiratory mortality increased 0.14% (95% CI: 0.05, 0.22), 0.12% (95% CI: 0.02, 0.23) and 0.14% (95% CI: -0.06, 0.34) when the temperature was low and 0.24% (95% CI: 0.12, 0.35), 0.17% (95% CI: 0.01, 0.34) and 0.45% (95% CI: 0.13, 0.78) at the high temperature level, respectively. In the two-pollutant model, the effects of PM10 were attenuated at both high and low temperatures at all lags after adjusting SO2 and NO2. The PM10 effects were stronger at the high temperature level for females and elderly people (≥65 years old). CONCLUSION: the findings suggest that daily mortality attributed to PM10 might be modified by temperature. The interaction between air pollution and global climate change has potential strategy and policy implications.

The association between ambient inhalable particulate matter and the disease burden of respiratory disease: An ecological study based on ten-year time series data in Tianjin, China.

There is limited evidence available worldwide about the quantitative relationship between particulate matter with an aerodynamic diameter of less than 10µm (PM10) and years of life lost (YLL) caused by respiratory diseases (RD), especially regarding long-term time series data. We investigated the quantitative exposure-response association between PM10 and the disease burden of RD. We obtained the daily concentration of ambient pollutants (PM10, nitrogen dioxide and sulphur dioxide), temperature and relative humidity data, as well as the death monitoring data from 2001 to 2010 in Tianjin. Then, a time series database was built after the daily YLL of RD was calculated. We applied a generalized additive model (GAM) to estimate the burden of PM10 on daily YLL of RD and to determine the effect (the increase of daily YLL) of every 10µg/m3 increase in PM10 on health. We found that every 10µg/m3 increase in PM10 was associated with the greatest increase in YLL of 0.84 (95% CI: 0.45, 1.23) years at a 2-day (current day and previous day, lag01) moving average PM10 concentration for RD. The association between PM10 and YLL was stronger in females and the elderly (≥65 years of age). The association between PM10 and YLL of RD differed according to district. These findings also provide new epidemiological evidence for respiratory disease prevention.