Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

比较YEARS评分与简化Wells联合年龄校正D-二聚体评分用于疑似肺栓塞患者的诊断价值

目的通过前瞻性研究比较YEARS评分与简化Wells联合年龄校正D-二聚体评分(sWells-Age)用于疑似肺栓塞患者的诊断价值。方法纳入2021年3月3日到2022年4月30日于宜宾市第二人民医院就诊且符合纳排标准的可疑肺栓塞病人522名,采用前瞻性观察研究,由临床医师对照YEARS评分收集患者基线信息,计算患者YEARS评分及sWells-Age评分判断其目前肺栓塞临床可能性。所有排除肺栓塞且未进行抗凝治疗的患者进行3个月随访。以CTPA检查结果作为诊断金标准,分别计算YEARS评分及sWells-Age评分敏感度、特异度、κ值等指标,绘制两者ROC曲线并计算AUC值。结果sWells-Age评分及YEARS评分灵敏度分别为85.71%、93.41%(P<0.001),特异度分别为69.23%、56.92%(P<0.001),AUC值分别为0.775(95%CI 0.688~0.816)、0.752(95%CI 0.711~0.838),与CTPA的κ值分别为0.526、0.465,均>0.410,结果一致性均属于中等,两者灵敏度比较(χ^(2)=5.143,P<0.025),差异具有统计学意义,两者特异度比较(χ^(2)=12.500,P<0.001),差异具有显著统计学意义。结论sWells-Age评分优于YEARS评分,但YEARS评分项目少,灵敏度及安全性高,可应用于早期肺栓塞患者的筛查。

Bowel preparation protocol for hospitalized patients ages 50 years or older:A randomized controlled trial

BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years.Therefore,the population that is≥50 years in age requires long-term and regular colonoscopies.Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies.The standard bowel preparation regimen of 4-L polyethylene glycol(PEG)is effective but poorly tolerated.AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients≥50 years in age.METHODS Patients were randomly assigned to group 1(2-L PEG+30-mL lactulose+a lowresidue diet)or group 2(4-L PEG).Adequate bowel preparation was defined as a Boston bowel preparation scale(BBPS)score of≥6,with a score of≥2 for each segment.Non-inferiority was prespecified with a margin of 10%.Additionally,the degree of comfort was assessed based on the comfort questionnaire.RESULTS The proportion of patients with a BBPS score of≥6 in group 1 was not significantly different from that in group 2,as demonstrated by intention-to-treat(91.2%vs 91.0%,P=0.953)and per-protocol(91.8%vs 91.0%,P=0.802)analyses.Furthermore,in patients≥75 years in age,the proportion of BBPS scores of≥6 in group 1 was not significantly different from that in group 2(90.9%vs 97.0%,P=0.716).Group 1 had higher comfort scores(8.85±1.162 vs 7.59±1.735,P<0.001),longer sleep duration(6.86±1.204 h vs 5.80±1.730 h,P<0.001),and fewer awakenings(1.42±1.183 vs 2.04±1.835,P=0.026)than group 2.CONCLUSION For hospitalized patients≥50 years in age,the bowel preparation regimen comprising 2-L PEG+30-mL lactulose+a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.

Epidemiology of Cardiovascular Mortality in Patients under 60 Years Old in a Cardiology Department in West Africa, Dakar-Senegal

Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.

From Research on TCM Images to Historiography of TCM Images——Comments on History of Chinese Image Culture:Medical Image Volume

1 Introduction.Chinese medicine has a long and rich history,dating back to the classics of the Qin and Han dynasties and extending to the integration of Chinese and Western medicine in the modern era.The vast amount of literature and scholarly works in this field makes it essential to thoroughly study the history of traditional Chinese medicine(TCM)in order to understand its development path throughout the ages and boost innovation based on tradition.This is why the sages emphasized the importance of“classifying the works into different schools and tracing back to their origins”(辨章学术,考镜源流).

Characteristics of the HIV/AIDS Epidemic among People Aged≥50 Years in China during 2018–2021

Objective This study aimed to determine the current epidemiological status of PLWHA aged≥50 years in China from 2018 to 2021.It also aimed to recommend targeted interventions for the prevention and treatment of HIV/AIDS in elderly patients.Methods Data on newly reported cases of PLWHA,aged≥50 years in China from 2018 to 2021,were collected using the CRIMS.Trend tests and spatial analyses were also conducted.Results Between 2018 and 2021,237,724 HIV/AIDS cases were reported among patients aged≥50 years in China.The main transmission route was heterosexual transmission(91.24%).Commercial heterosexual transmission(CHC)was the primary mode of transmission among males,while non-marital non-CHC([NMNCHC];60.59%)was the prevalent route in women.The proportion of patients with CHC decreased over time(Z=67.716,P<0.01),while that of patients with NMNCHC increased(Z=153.05,P<0.01).The sex ratio varied among the different modes of infection,and it peaked at 17.65 for CHC.The spatial analysis indicated spatial clustering,and the high-high clustering areas were mainly distributed in the southwestern and central-southern provinces.Conclusion In China,PLWHA,aged≥50 years,were predominantly infected through heterosexual transmission.The primary modes of infection were CHC and NMNCHC.There were variations in the sex ratio among different age groups,infected through various sexual behaviors.HIV/AIDS cases exhibited spatial clustering.Based on these results,the expansion of HIV testing,treatment,and integrated behavioral interventions in high-risk populations is recommended to enhance disease detection in key regions.

Effect of a Nutrition Education Intervention on Food Safety Knowledge, Attitudes and Practices of Mothers of Children under 5 Years in the Peri-Urban Areas of Bobo-Dioulasso: Before and after Study

Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were administered the FAO questionnaire for food safety knowledge, attitudes, and practices assessment during two cross-sectional surveys, before and after the intervention, in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on food safety KAP of mothers of children under 5 years. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of them were between 20 and 29 years old. One for knowledge (cooking thoroughly with, p-value = 0.0001) and another for attitudes (perceived benefits of reheating leftovers before eating them, p-value = 0.0001), significantly increased after the intervention. In terms of food safety practices, all the indicators (cleaning of dirty surfaces, plates and utensils and storage of perishable foods) significantly increased (all p = 0.0001 Conclusion: This study provided some evidence of an effective nutrition education intervention for improving maternal KAP on food safety for their child’s feeding.

Review of Two Years of Surgical Activities of the General Surgery Department of the Reference Health Center of Commune I of Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.

Simulating Responses of Rice Yield and Nitrogen Fates to Ground Cover Rice Production System under Different Types of Precipitation Years

The Ground Cover Rice Production System(GCRPS)has considerable potential for securing rice production in hilly areas.However,its impact on yields and nitrogen(N)fates remains uncertain under varying rainfall conditions.A two-year field experiment(2021–2022)was conducted in Ziyang,Sichuan Province,located in the hilly areas of Southwest China.The experiment included two cultivation methods:conventional flooding paddy(Paddy,W1)and GCRPS(W2).These methods were combined with three N management practices:N1(no-N fertilizer),N2(135 kg/hm^(2)urea as a base fertilizer in both W1 and W2),and N3(135 kg/hm^(2)urea with split application for W1 and 67.5 kg/hm^(2)urea and chicken manure separately for W2).The WHCNS(Soil Water Heat Carbon Nitrogen Simulator)model was calibrated and validated to simulate ponding water depth,soil water storage,soil mineral N content,leaf area index,aboveground dry matter,crop N uptake,and rice yield.Subsequently,this model was used to simulate the responses of rice yield and N fates to GCRPS under different types of precipitation years using meteorological data from 1980 to 2018.The results indicated that the WHCNS model performed well in simulating crop growth and N fates for both Paddy and GCRPS.Compared with Paddy,GCRPS reduced N leaching(35.1%–54.9%),ammonia volatilization(0.7%–13.6%),N runoff(71.1%–83.5%),denitrification(3.8%–6.7%),and total N loss(33.8%–56.9%)for all precipitation year types.However,GCRPS reduced crop N uptake and yield during wet years,while increasing crop N uptake and yield during dry and normal years.Fertilizer application reduced the stability and sustainability of rice yield in wet years,but increased the stability and sustainability of rice yield in dry and normal years.In conclusion,GCRPS is more suitable for normal and dry years in the study region,leading to increased rice yield and reduced N loss.

Factors Associated with Mortality in Children Aged 1 Month to 15 Years Hospitalized in the Pediatric Ward of the Kalaban-Coro Reference Health Center: Cross-Sectional Study

Introduction: Infant and child mortality is a worldwide concern, but developing countries such as Mali are more affected. The aim of this study was to investigate morbidity and factors associated with mortality in children aged 1 month to 15 years. Methodology: This was a cross-sectional study which took place from January 1 to December 31, 2020 covering children aged 1 month to 15 years hospitalized at the Kalaban-Coro CSRéf. Data were entered into Excel and analyzed using SPSS version 20 software. Results: Five hundred children aged 1 months to 15 years were included. The age range 1 to 5 years (53.6%) and male sex (58.2%) were the most represented. Malaria (72.2%), acute respiratory infections (6.2%) and diarrhea/dehydration (3%) were the main morbidities. Mortality was estimated at 10.6%, and the two main causes of death were malaria (56.6%) and acute respiratory infections (7.54%). Univariate analysis revealed a statistically significant association between the dependent variable (death) and age (p Conclusion: This study confirms the high rate of infant and child morbidity and mortality in our health facilities. Strengthening human resources and intensifying behavior-change communication can help reverse the trend.

Quality-adjusted life years and surgical waiting list:Systematic review of the literature

BACKGROUND The quality-adjusted life year(QALY)is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures.Surgical waiting lists(SWLs)represent a pressing problem in public healthcare.The QALY measure has rarely been used in the context of surgery.It would be interesting to know how many QALYs are lost by patients on SWLs.AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.An unlimited search was carried out in PubMed,updated on January 19,2024.Data on the following variables were investigated and analyzed:Specialty,country of study,procedure under study,scale used to measure QALYs,the use of a theoretical or real-life model,objectives of the study and items measured,the economic value assigned to the QALY in the country in question,and the results and conclusions published.RESULTS Forty-eight articles were selected for the study.No data were found regarding QALYs lost on SWLs.The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery,with 15 articles each.The country in which the most studies of QALYs were carried out was the United States(n=21),followed by the United Kingdom(n=9)and Canada(n=7).The most studied procedure was organ transplantation(n=39),including 15 kidney,14 liver,5 heart,4 lung,and 1 intestinal.Arthroplasty(n=4),cataract surgery(n=2),bariatric surgery(n=1),mosaicplasty(n=1),and septoplasty(n=1)completed the surgical interventions included.Thirty-nine of the models used were theoretical(the most frequently applied being the Markov model,n=34),and nine were real-life.The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions,but in 32 articles the survey was not specified.The willingness-to-pay per QALY gained ranged from$100000 in the United States to€20000 in Spain.CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature.The rate of QALYs lost on SWLs has not been determined.Future research is warranted to address this issue.

Shaanxi History Museum

It is one of the must-visit history museums,known for its vast collection of historical artifacts,attracting around three million domestic and international visitors each year.THE Shaanxi History Museum(SHM),in the renowned historic city of Xi’an in Shaanxi Province,is often regarded as one of the museums most difficult to get a ticket to in China.Each day,approximately 12,000 free online tickets are made available and are fully booked within just a couple of minutes.Its vast collection of treasured relics and numerous national treasures leave visitors in awe.

70 Years of China’s Finance:History,Contributions and Prospects

Over the past 70 years since the founding of the People’s Republic of China,great changes have been seen in the financial industry in terms of its nature,function,scale,structure and other features.It has experienced six stages of development,namely,inception and consolidation,arduous growth,exploration and restructuring,segmentation,fictitious economy orientation,and real economy promotion and risk prevention.The tremendous success and useful experience made during this period have largely bolstered the prosperity and stability of the Chinese economy,improved Chinese people’s living standards,and exerted a profound impact on China’s economy and society.Based on its development pattern,the Chinese financial sector will expect further openingup at home and abroad and a growing capacity in serving the real economy,while new business forms and models will emerge rapidly and stronger preventive measures against financial risks will be needed.In response to the financial development in the new era,proactive and pragmatic measures need to be in place to safeguard the stable and sound development of the financial industry.

Ancient Counties of Thousand Years’ History:Xiuwu County

正Lurking in the rocky hills and valleys of Taihang Range in Northwest Henan Province, a mysterious mountain is covered by changeable clouds and mists almost all year round. This is how it gets its name "Yuntai Mountain", which literally means "the cradle of clouds". Roughly 1,000 years ago, on lunar Sep. 9th the Chongyang Festival, a young man topped the major summit "Evodia Summit" of the Yuntai Moutain. There he saw evodia flourishing all over the hills and valleys, and

Nation Ballet of China:Reviewing the 60 Years' History and Looking Forward to the New Journey

Within a period of more than half a century,the National Ballet of China has sprung up and become a world-class ballet,which has helped this western art take root,grow up,blossom and yield fruit.

History of the Establishment and Development of X-Ray Analysis Methods in Russia--The USSR. First 20 Years

2012 is a year of celebrate centenary of X-ray discovery information about Laue＇s （Fridrich and Knipping） experiment was This discovery spread quickly in different countries. The history of written in the paper. Also history mention of Laue＇s experiment in Russia was presented. The system group of X-ray diffraction was created in 1919/1920 in Petrograd （A. Ioffe, State Physical Technical Institute） and Moscow. Themes of research results, scientific newness and scientific rate were presented. The organization, political and other reasons which retarded the active progress of the method in 1930 were described. Initial stage of progress of the method in Russia-USSR was studied by historian of science partly. The reasons of it are： closed of scientific community, political system of country, Cyrillic barrier, etc.. This paper acquaints western scientific community with non-famous Russian materials on theme.

Zhang Quanwen and His Painting, Five Thousand Years of History

Recently,the Ezhou Municipal Government provided the funds for Zhang to mount Five Thousand Years of History,so that Chinese.people everywhere may have the chance to see and appreciate his work.

A New finding pushes back the history of flying mammals by 70 million years

Teaming up with their US coworkers, CAS paleontologists have discovered, in Ningcheng of northern China’s

Exploring seven hundred years of transhumance, climate dynamic, fire and human activity through a historical mountain pass in central Spain

A high-altitude peat sequence from the heart of the Spanish Central System(Gredos range) was analysed through a multi-proxy approach to determine the sensitivity of high-mountain habitats to climate, fire and land use changes during the last seven hundred years, providing valuable insight into our understanding of the vegetation history and environmental changes in a mountain pass close to a traditional route of transhumance. The pollen data indicate that the vegetation was dominated by shrublands and grasslands with scattered pines in high-mountain areas, while in the valleys cereals, chestnut and olive trees were cultivated. Strong declines of high-mountain pines percentages are recorded at 1540, 1675, 1765, 1835 and 1925 cal AD, which may be related to increasing grazing activities and/or the occurrence of anthropogenic fires. The practice of mountain summer farming and transhumance deeply changed and redesigned the landscape of the high altitudes in central Spain(Gredos range) since the Middle Ages, although its dynamics was influenced in some way by climate variability of the past seven centuries.

Historic ChangesIn Rural AreasOver the Past 40 Years

EDITOR’S NOTE: It has been 40 years since the Democratic Reformabolishing feudal serfdom in Tibet was carried out in 1959. What haschanged, especially in the past 20 years of the reform and opening proqram introduced nationwide by the Central Government? A recent surveyof rural areas Provides an answer to this question.