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.

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.

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.

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.

A Dear Price to Regret Over:On Mr.Stevens’Dignity and Professionalism in The Remains of the Day

The Remains of the Day is one of Kazuo Ishiguro’s renowned novels.The protagonist Stevens is an English butler whose life is deeply entwined with the concepts of dignity and honor.Set against the backdrop of post-World War II Britain and reflecting on the interwar period,the novel examines Stevens’devotion to his role and the traditional values of English aristocracy.The essay discusses how Stevens’identity is shaped by his unwavering commitment to professionalism and his admiration for British gentleman culture and highlights the identity crisis Stevens faces as he realizes the flawed nature of his employer and the outdated ideals he upheld.Through Stevens’journey of self-reassessment and eventual epiphany,the essay delves into the complexities of his internal struggle to reconstruct his identity,ultimately advocating for a more authentic understanding of dignity and honor.

Interrelationships between Length of the Day, Moon Distance, Phanerozoic Geodynamic Cycles, Tidal Dissipation and Earth’s Core: Review and Analysis

The rotation of the Earth and the related length of the day (LOD) are predominantly affected by tidal dissipation through the Moon and the growth of the Earth’s core. Due to the increased concentration of mass around the rotation axis of the spinning Earth during the growth of the core the rotation should have been accelerated. Controversially the tidal dissipation by the Moon, which is mainly dependent on the availability of open shallow seas and the kind of Moon escape from a nearby position, acts towards a deceleration of the rotating Earth. Measurements of LOD for Phanerozoic and Precambrian times open ways to solve questions concerning the geodynamical history of the Earth. These measurements encompass investigations of growth patterns in fossils and depositional patterns in sediments (Cyclostratigraphy, Tidalites, Stromatolites, Rhythmites). These patterns contain information on the LOD and on the changing distance between Earth and Moon and can be used as well for a discussion about the growth of the Earth’s core. By updating an older paper with its simple approach as well as incorporating newly published results provided by the geoscientific community, a moderate to fast growth of the core in a hot early Earth will be favored controversially to the assumption of a delayed development of the core in an originally cold Earth. Core development with acceleration of Earth’s rotation and the contemporaneous slowing down due to tidal dissipation during the filling of the ocean may significantly interrelate.

Analysis of the disease entities and typical characteristics of day surgery based on three Public Tertiary A hospitals in China

Background:In recent years,day surgery has gained widespread attention in the medical industry.This thesis focuses on three tertiary general hospitals in different regions in China where day surgery has been carried out earlier,is more developed,has a more comprehensive range of day surgery procedures,and has an annual volume of 10,000 or more day surgery cases.The study will provide hands-on experience for other medical institutions to carry out day surgery.Methods:67,337 valid items of data were retrieved from the Hospital Information Systems of the three hospitals.In this thesis,descriptive analysis was carried out on basic information about day surgery patients,including composition of patients’major diseases,hospitalization costs.Non-parametric tests were used to compare the data in each group,the median and interquartile range were used to show the trend in the concentration of the relevant indicators.The difference was considered statistically significant at P<0.05.Results:The largest proportion of day surgery patients were between the ages of 51 and 70.About 57.30%of day surgery patients paid for their medical care with the basic medical insurance of urban employees.Senile cataract,benign breast tumor,and endometrial polyp were the top three major diagnoses of day surgery patients.The average inpatient expenditure for day surgery patients was 8982.10 yuan,with consumables cost representing the highest proportion at approximately 46.01%of the total hospitalization cost,followed by treatment cost at around 31.01%of the total cost.Conclusions:Day surgery is more suitable for middle-aged patients and may not be the best choice for children and elderly patients over 80 years old.Most day surgery cases are elective surgeries for non-emergency situations.The distribution of day surgery patients is primarily concentrated in ophthalmic,breast,and reproductive system diseases,although each hospital has its own unique characteristics.The development of day surgery presents both economic and social benefits.

A Study on the Pedagogical Application of Chinese New Year Culture in International Chinese Language Education

Culture teaching is an inseparable part of International Chinese Language Education,and it has great significance in international Chinese language teaching.Students can enhance their interest in Chinese language learning and improve their learning effect through understanding the excellent traditional Chinese culture,at the same time,culture teaching can help to disseminate the Chinese culture and promote the development of a multicultural world.Taking the teaching of Chinese New Year culture as an example,we analyze the current teaching materials involving Chinese New Year culture with high popularity and acceptance,put forward effective teaching methods matching the feasibility of teaching Chinese New Year culture,and then present the specific teaching design of Chinese New Year culture,in order to provide references for the teaching of culture in International Chinese Language Education.

Analysis of the Spirit of Struggle in the New Era Based on General Secretary Xi Jinping’s New Year’s Greetings in the Past Decade

In order to realize the national rejuvenation,General Secretary Xi Jinping attaches great importance to the spiritual strength of struggle,and has repeatedly advocated that all people should exalt the spirit of strive on different occasions.According to his New Year’s greetings since 2014,Xi Jinping has illustrated the connotation of the spirit of enterprising,the necessity of carrying forward and the requirements for practicing the spirit of struggle from different perspectives,pointing out that all Chinese must keep in mind both domestic and international situations,strive in unity,work creative and industrious with the enthusiasm of seizing every minute,catch the opportunity and solve the problem,make substantial progress on the new journey to construct China into a great modern socialist country in all respects.

Analysis of China's Haze Days in the Winter Half-Year and the Climatic Background during 1961–2012

The characteristics of haze days and the climatic background are analyzed by using daily observations of haze,precipitation,mean and maximum wind speed of 664 meteorological stations for the period of 1961–2012.The results show that haze days occur significantly more often in eastern China than in western China.The annual number of haze days is 5–30 d in most parts of central-eastern China,with some areas experiencing more than 30 d,while less than 5 d are averagely occurring in western China.Haze days are mainly concentrated in the winter half-year,with most in winter,followed by autumn,spring,and then summer.Nearly 20%of annual haze days are experienced in December.The haze days in central-eastern China in the winter half-year have a significant increasing trend of 1.7 d per decade during 1961–2012.There were great increases in haze days in the 1960s,1970s and the beginning of the 21st century.There was also significant abrupt changes of haze days in the early 1970s and 2000s.From 1961 to 2012,haze days in the winter half-year increased in South China,the middle-lower reaches of the Yangtze River,and North China,but decreased in Northeast China,eastern Northwest China and eastern Southwest China.The number of persistent haze is rising.The Longer the haze,the greater the proportion to the number persistent haze.Certain climatic conditions exacerbated the occurrence of haze.The correlation coefficient between haze days and precipitation days in the winter half-year is mainly negative in central-eastern China.The precipitation days show a decreasing trend in most parts of China,with a rate of around–4.0 d per decade in central-eastern China,which reduces the sedimentation capacity of atmospheric pollutants.During the period of 1961–2012,the correlation coefficients between haze days and mean wind speed and strong wind days are mainly negative in central-eastern China,while there exists positive correlation between haze days and breeze days in the winter half-year.The mean wind speed and strong wind days are decreasing,while breeze days are increasing in most parts of China,which is benefitial to the reduction of the pollutants diffusion capacity.As a result,haze occurs more easily.

Characteristics of Temperature Change in China over the Last 2000 years and Spatial Patterns of Dryness/Wetness during Cold and Warm Periods

This paper presents new high-resolution proxies and paleoclimatic reconstructions for studying climate changes in China for the past 2000 years. Multi-proxy synthesized reconstructions show that temperature variation in China has exhibited significant 50–70-yr, 100–120-yr, and 200–250-yr cycles. Results also show that the amplitudes of decadal and centennial temperature variation were 1.3℃ and 0.7℃, respectively, with the latter significantly correlated with long-term changes in solar radiation, especially cold periods, which correspond approximately to sunspot minima. The most rapid warming in China occurred over AD 1870–2000, at a rate of 0.56°± 0.42℃（100 yr）^（-1）; however, temperatures recorded in the 20 th century may not be unprecedented for the last 2000 years, as data show records for the periods AD 981–1100 and AD1201–70 are comparable to the present. The ensemble means of dryness/wetness spatial patterns in eastern China across all centennial warm periods illustrate a tripole pattern： dry south of 25°N, wet from 25°–30°N, and dry to the north of 30°N. However, for all centennial cold periods, this spatial pattern also exhibits a meridional distribution. The increase in precipitation over the monsoonal regions of China associated with the 20 th century warming can primarily be attributed to a mega El Nino–Southern Oscillation and the Atlantic Multidecadal Oscillation. In addition, a significant association between increasing numbers of locusts and dry/cold conditions is found in eastern China. Plague intensity also generally increases in concert with wetness in northern China, while more precipitation is likely to have a negative effect in southern China.

The sub-fossils of leaf fragments in sediments as an indicator of mangrove development in the Yingluo Bay, Guangxi, Southwest China over the last 130 years

Located in the intertidal zone of the tropical and subtropical coasts, mangrove forests are an important ecosystem in the global carbon cycle and serve as a protector of local seashores. Under the double impacts of climate change,especially sea-level rise, and human activity, mangrove forests around the world have faced degradation, against which the reconstruction of the historical development of mangrove forests using an effective indicator has been regarded as a necessary strategy for designing a predictable model. As the primary product of mangrove forest, it is reasonable that the content of leaf fragments of mangrove(CLFM) buried in sediments in the form of sub-fossils potentially has the same indicative function for the development of mangrove forests as that of widely-used mangrove pollen. In this study, the leaf fragments of mangrove in two sediment cores(YLW02 and YLW03) drilled in the Yingluo Bay in Guangxi, Southwest China were picked out and weighted for calculation of CLFM, which was used as an indicator of mangrove development after examination of parallelism and a statistical correlation of the CLFM with the concentration of mangrove pollen. The results clearly show that the vertical distribution of the CLFM for the core taken from the landward margin of mangrove forests(YLW03) only parallels that of the local mangrove species(Rhizophora. stylosa) with a significantly positive correlation(R=0.56, P=0.05), while the vertical distribution of the CLFM for the core taken from the interface between seaward margin of mangrove forest and the trunk of tidal creeks of the bay(YLW02) parallels the summed concentration of mangrove pollen(SCMP) with a more positive correlation than that of YLW03(R=0.85, P=0.01), indicating that the trunk outlet of tidal creeks must have been the site where mangrove production gathered from the overall forest rather than from local production. The variations in the CLFM of both cores indicate that overall the mangrove forests in the Yingluo Bay have increasingly flourished over the last 130 years except for the interval of 1940–1950 AD in response to an increase in air temperature and decrease in rainfall, which would have resulted in an increase in seawater salinity;while the coupled extreme increases in air temperature and in rainfall in summer, which would have resulted in extreme decreases in seawater salinity, would be responsible for the relative degradation of mangrove forests in the interval of 1940–1950 AD.

Analysis of Climate Change in the Coastal Zone of Eastern China, against the Background of Global Climate Change over the Last Fifty Years: Case Study of Shandong Peninsula, China

The climate change in Shandong Peninsula, China was analyzed in this paper by the non-parametric Mann-Kendall test, Accumulated Difference Curve and Order Cluster Analysis methods, based upon the datas of annual mean, maximum and minimum temperature and annual precipitation, precipitation from June to September over the past 50 years. Results obtained showed a number of observations: 1) The annual mean temperature of Shandong Peninsula showed a significant increasing trend, with a distinct abrupt change point detected around 1990, during the past 5 decades. The warming of the Peninsula over the last 50 years was due mainly to the significant increase of annual minimum temperature. The annual maximum temperature demonstrated a mixed trend of decreasing and increasing, but was statistically insignificant, and no abrupt change was detected;2) The annual precipitation exhibited a decreasing trend during the past 5 decades, with an abrupt change detected around 1980 at most stations;but there was an earlier transition point at 1966, at a few stations. The reduction in precipitation, from June to September, was responsible mainly for the decrease of annual precipitation. Besides, the proportion of the June-September precipitation in the year declined slightly over the last 50 years;3) In comparison, the temperature evolution in Shandong Peninsula was basically consistent with most parts of China, but warmed at a faster rate over the same period;the decreasing trend of precipitation was more significant compared with the other climate zones of China. Within the Peninsula, the abrupt change of temperature and precipitation in the Southeast was earlier than that in the Northwest;the reduction of precipitation was larger in the Southeast while the increase of temperature was more significant in the Northwest. This research was of great importance to understand the climate change and its environmental effects in the coastal zone.

Preliminary Analysis of Climatic Variation during the Last 39 Years in China

The preliminary analysis of climatic variation in China during the last 39 years has been made in this paper. The results show that although the global climate is getting warmer, some parts of China are cooling. The warming only occurs in Northeast, North and the west part of Northwest China while the areas between about 35°N and Nanling Mountain, east of the Tibetan Plateau in China are getting cooler. The cooling centers are located in Sichuan, the south part of Shaanxi and the north part of Yunnan respectively. According to the theory of greenhouse effect, there are much precipitation at low and high latitudes and less precipitation in middle latitude. However, the precipitation in the most parts of China has been decreased, especially in North and Northwest China.

Spatial distributions and interannual variations of snow cover over China in the last 40 years

By using the observational snow data of more than 700 weather stations,the interannual temporal and spatial characteristics of seasonal snow cover in China were analyzed.The results show that northern Xinjiang,northeastern China–Inner Mongolia,and the southwestern and southern portions of Tibetan Plateau are three regions in China with high seasonal snow cover and also an interannual anomaly of snow cover.According to the trend of both the snow depth and snow cover days,there are three changing patterns for the seasonal snow cover:The first type is that both snow depth and snow cover days simultaneously increase or decrease;this includes northern Xinjiang,middle and eastern Inner Mongolia,and so on.The second is that snow depth increases but snow cover days decrease;this type mainly locates in the eastern parts of the northeastern plain of China and the upper reaches of the Yangtze River.The last type is that snow depth decreases but snow cover days increase at the same time such as that in middle parts of Tibetan Plateau.Snow cover in China appears to have been having a slow increasing trend during the last 40 years.On the decadal scale,snow depth and snow cover days slightly increased in the 1960s and then decreased in the 1970s;they again turn to increasing in the 1980s and persist into 1990s.

Inhomogeneous trends in the onset date of extreme hot days in China over the last five decades

Using a homogenized daily maximum temperature(T_(max))dataset across China,this study characterized the spatiotemporal variation of the onset date of extreme hot days in a year(i.e.,FirstEHD)during 1960-2018.Inhomogeneous trends of FirstEHD over China during 1960-2018 can be found,with the advanced trend of FirstEHD over most parts in China,while a number of stations in North-Central China(NC)show the delayed trend of FirstEHD.Moreover,there exist interdecadal changes of FirstEHD trend,with a remarkable difference in the trend magnitude before and after the 1990s over South China(SC),and the sign of trend can even reverse from negative to positive after the 1990s in Xinjiang(XJ)and Yangtze River Basin(YR),and from positive to negative in NC.The overall trends of FirstEHD over NC,YR,and XJ during 1960-2018 are dominated by the trends before the 1990s,while they are dominated by the sharp advance after the 1990s over SC.It is further found that the trend of FirstEHD can generally be explained by the long-term trend in T_(max) over most parts of China,but the contribution from T_(max) variabilities is also non-negligible and can even account for more than 75% of the overall trend over NC.The possible factors responsible for the decadal changes in FirstEHD trends are also discussed.

Has Sperm Count Declined in the General Male Danish Population during the Last Several Decades?A Study on the Relation of Sperm Count and Birth Year

It has been hypothesized that during the last several decades human sperm count has declined because of prenatal exposure to environmental chemicals. We examined the relation between semen quality and birth year among 8608 men born from 1922 to 1971 and who from 1968 to 1992 consulted 4 Danish medical centers because of barren marriage. Data were obtained from medical records and by a postal questionnaire to a subset of the population. The sperm concentration was significantly declining with increasing year of birth in 2 of the 4 centers, but this association disappeared when confounders were adjusted for. Within the subset of men born during 1955~1970 comprising 36% of the entire population we revealed a decrease of the average sperm concentration by 1.6 million /ml (95% CI:0.7~2.5) per one advancing year of birth.This finding was consistent across all the 4 centers and robust to adjustment for effects of calendar period, season and duration of sexual abstinence. Effects of age were accounted for by restriction of the sample to men between 20 and 45 years. The findings are compatible with environmental impact in the prenatal period after 1955 but are far from unequivocal evidence that the sperm count in the general male Danish population has changed during the past decades.