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.

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.

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.

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.

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.

Review of Marxist Political Party Theory Innovation Over the 70 Years Since the Establishment of PRC

since the establishment of the People’s Republic of China,the central leader-groups from generation to generation have been continuously exploring and innovating Marxist political party theory in terms of its value target,ideological construction,working style,and organization developments.This process can be categorized into five stages:the founding stage in Mao Zedong’s era,the development stage in Deng Xiaoping’s ear,the promotion stage in Jiang Zemin’s times,the deepening stage under Hu Jintao’s leadership,and the stage of further innovation by Xi Jinping in the new era,with the characteristics of inheritance,development as well as scientificity and valuation.

The Prevalence and Risk Factors Associated with Otitis Media in Children under Five Years of Age in Mogadishu, Somalia: A Hospital-Based Cross-Sectional Study

Background: Otitis media (OM) is highly prevalent and is one of the most important causes of preventable hearing loss in developing countries and it may have long-term impacts on the children. Several hospital-based cross-sectional studies have been conducted in East African countries to assess the prevalence of OM;however, no similar studies have been conducted in Somalia. Therefore, we conducted a hospital-based cross-sectional study to identify the prevalence and the underlying risk factors of OM among children under the age of five in Mogadishu, Somalia. Methodology: A hospital-based cross-sectional study was conducted from July 2022 to November 2022 at three main hospitals in Mogadishu, Somalia. A total of 384 children aged less than 5 years were included. Parents of these children were interviewed with a questionnaire and a clinical examination was performed for each child. The Statistical Package for Social Sciences, SPSS (Version 22, IBM, Inc.), was used for the statistical analysis. Result: The prevalence of otitis media among the 384 children recruited was 31.25% (120/384). Otitis media was significantly associated with age less than one year (P = 0.006), malnutrition (P Conclusion: In summary, the present study found that otitis media was highly prevalent (31.25%) in Mogadishu, Somalia. The majority of the affected children were younger than one year. Age of the child, malnutrition, upper respiratory tract infections, feeding in lying position, and dripping something into a child’s ear were found to significantly increase the risk of developing otitis media in children. In contrast, breastfeeding for more than one year has been found to reduce the risk of developing otitis media in children.

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.

Morphological changes of silver and bighead carp in the Yangtze River over the past 50 years

Multivariate analysis was adopted to analyze 30 morphometrical characteristics of 121 one-year-old juvenile silver carp （Hypophthalmichthys molitrix） and bighead carp （Aristichthys nobilis） bred during the 1950s （＂the former population＂） and 2008 （＂the current population＂） and collected from the middle reach of the Yangtze River. The average discriminant accuracies of the former and current silver and bighead carp population were 94.2% and 98.0%, respectively. Discriminant analysis also revealed that significant differences in morphology occurred between the former and current populations of both carp in overall characteristics. One-way analysis of variance indicated that between former and current populations, silver carp showed highly significant differences （P0.01） in twelve of their characteristics and significant differences （P0.05） in eight of their characteristics, while bighead carp showed highly significant differences （P0.01） in eight of their characteristics and significant differences （P0.05） in eight of their characteristics. Six head morphology variables of the current silver and bighead carp were significantly or highly significantly larger than the former populations; fourteen characteristics of silver carp and ten characteristics of bighead carp of the current populations, mainly reflecting truck and tail morphology, were significantly or very significantly smaller than the former populations. Our results indicate that silver and bighead carp have developed a larger head and smaller truck and tail during the last 50 years. Due to such morphological changes, it seems apparent that the heads of these fish species need to be considered in regards to human diets, particularly in relation to economic and nutritious value.

Blason as a Means of Self-justification in John Ford’s ’Tis Pity She’s a Whore

The form of blason in John Ford's'Tis Pity She's a Whore provides a venue for its protagonist,Giovanni,not only to voice his socially-prohibited longings for incestuous love but also to normalise his amoral and murderous rhetoric.Changes in its contents and styles reflect the changes in its user's attitude towards social and cultural restrictions.The anachronism of the form of blason in the historical context of the play's performance also corresponds with Giovanni's refusal to comply with contemporary social and moral codes.His insistence on employing this mode of speech can be interpreted as a means of self-justification in his struggle between the external cultural norms and his internal call of nature.

The World's Largest Exhibition of Textile Machinery Goes to Italy in 2015 after 20 Years——MP International appointed to organize the show for the second time

Italy will host the 17th edition of ITMA, the world’s largest exhibition of textile machinery.It will be held at the Fiera Milano Rhoexhibition centre in Milan,from 12 to 19 November 2015.

Evolution of the “Zhejiang Spirit” During the Forty Years of Reform and Opening-up

The "Zhejiang spirit" refers to a theoretical summary of the group consciousness, mental state, value orientation and ideological realm, which is, as a motivating power, owned and recognized by all Zhejiang people, and carries Zhejiang peculiarities. President Xi Jinping, during his term of office in Zhejiang, launched a number of seminars and activities to seek "a Zhejiang spirit that moves with the times." Forty years of reform and opening-up, the "Zhejiang spirit" has experienced an evolution that can be summarized as three improvements: from spontaneous formation to deliberate cultivation, from something limited to eastern Zhejiang to an integrating force that spans the entire Zhejiang Province, and from a mere existence to a role that functions adequately. The "Zhejiang spirit" is extracted from the humanistic spirits shaped in all corners of Zhejiang province. It is "an instrumental ensemble played across the entire province," and represents a certain judgment and interpretation. The "Zhejiang spirit" not only describes and summarizes the past and present, but will also guide and motivate the future, and support people in their enterprising and industrious practices to move with the times.

Forest change of China in recent 300 years

Based on historical documents, modern survey and statistics, as well as the result of predecessor studies, the trend and main process of forest dynamics are recognized. The forest area and forest coverage rates for each province of China from 1700 to 1949 are estimated backward by every 50 years. Linking the result with modern National Forest Inventory data, the spatial-temporal dynamics of Chinese forest in recent 300 years （AD 1700-1998） is quantitatively analyzed. The study shows that in recent 300 years, the forest area in current territory of China has declined by 0.95×10^8 hm^2 （or 9.2% of the coverage rate） in total, with a trend of decrease and recovery. Before the 1960s, there was a trend of accelerated descending. The forest area was reduced by 1.66×10^8 hm^2 （or 17% of the coverage rate） in 260 years. While after the 1960s, there has been a rapid increase. The forest area increased by 0.7×10^8 hm^2 （or 8% of the coverage rate） in 40 years. The study also shows that there is a significant spatial difference in the dynamics of forest. The amplitudes of increasing and decreasing in western China are both smaller than the ones in eastern China. During the rapid declining period from 1700 to 1949, the most serious decrease appeared in the Northeast, the Southwest and the Southeast, where the coverage rate in most provinces dropped over 20%. In Heilongjiang Province, the coverage rate dropped by 50%. In Jilin Province, it dropped by 36%. In Sichuan Province and Chongqing Municipality, it dropped by 42%. In Yunnan Province, it dropped by 35%. During the recovery period 1949-1998, the western provinces, municipality and autonomous regions, including Ningxia, Gansu, Inner Mongolia, Sichuan-Chongqing, Yunnan, Tibet, Xinjiang and Qinghai, etc, the increase rates are all below 5%, while the eastern provinces, municipality and autonomous regions （except Heilongjiang, Hubei, Jiangsu-Shanghai） have achieved an increase over 5%, among which the Guangdong-Hainan, Guangxi, Anhui, Beijing-Tianjin-Hebei, Shandong, Henan, Zhejiang, and Fujian have an increase over 10%.

Esophageal cancer global burden profiles, trends, and contributors

Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.

China’s “Education for All” Effort Fruitful in 30 Years

Of major events in China over the past three decades, most Chinese would list the resumption of National Examination for the Entrance of University as number one. In December 1977, 5.7 million Chinese participated in the national exams, the first since the catastrophic Cultural Revolution （1966-76）. One year later, the country＇s reform, opening up and modernization drive was launched.

Years of Concentrated Work Leads to Successive Glory——Ye Weimin,Vice President of ZTE,Talks About ZTE's Development Strategy on WCDMA

Editor’s Note:After becoming theleading force in CDMAequipment manufacturingin China, ZTE rolled outits self-developed WCD-MA products that at-tracted much expert at-tention in the MTNETsecond phase single sys- tem testing completed inJune 2003. Thefollowing are the remarks of Ye Weimin,ZTE’s vice president, on ZTE’s strate-gies, advantages and achievements inthe development of WCDMA products.