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.

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.

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.

DEBRIS FLOW STUDIES IN CHINA IN THE LAST 30 YEARS

By summarizing the results of debris flow studies in China and integating with the knowledge and experience gained by the authors in their research work, thes paper makes a review and outlook on debris flow studies in China in the last 30 years. Corresponding opinions and suggestions are proposed in view of the circumstances and disasters in China.

Kunqu Opera in the Last Hundred Years in China

Kunqu,literally means kun melody,is one of the most ancient forms of Chinese opera.Originally her melody derives from Kunshan zone of Jiangsu province therefore it has been named Kunshan melody before,now Kunqu also known as Kunju,which means Kunqu opera.This paper mainly focuses on the development of Kunqu in the past 100 years and the influence of historical social and humanistic changes behind the special era on Kunqu,and compares the attitudes of scholars of different schools of thought in different eras to Kunqu and the social public to compare and analyze the degree of love of Kunqu.

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.

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。

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.

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.

Power Grid Development in 60 Years since the Foundation of P.R.C.

Foreword Since the foundation of P.R.C.,the China's power grid develops with a high rate.By now,grids in all provinces except Xinjiang,Tibet,Hainan and Taiwan are AC/DC interconnected together,forming the structure of power grid interconnection in the whole country.

CNPC turned a profit last year

ＣＮＰＣｔｕｒｎｅｄａｐｒｏｆｉｔｌａｓｔｙｅａｒＦｏｒｔｈｅｆｉｒｓｔｔｉｍｅｓｉｎｃｅ１９８８，Ｃｈｉｎａ＇ｓｏｎｓｈｏｒｅｐｅｔｒｏｌｅｕｍｉｎｄｕｓｔｒｙｔｕｒｎｅｄａｐｒｏｆｉｔｌａｓｔｙｅａｒ－ｔｈａｎｋｓｔｏｏｉｌｐｒｉｃｅａｄｊｕｓｔ...

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.

Xiao Hui Wang “My Last 100 Years”(Self-portrait)

封面作品是旅德著名摄影艺术家王小慧近两年创作的大量自拍系列"我的前世今生"中"逍遥年代"之一。二十年来王小慧一直拍摄自拍像,早期那些被她自己称为"视觉日记"的作品好像是一种旷日持久的行为艺术。其中最有名的一组车祸后在医院里的自拍像被艺术评论家称为"摄影史上最真实的自拍像"。

Development during last 30 years' reform and opening up in China's printing,printing equipment and material industries(Ⅰ)

As the industry of knowledge diffusion and civilization spreading, printing industry has been paid much attention by Party and Government.

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.

Three Development Stages for the Tibetan Family and Tibet's Modernization——A Survey of Social Changes in Tibet in Last 50 Years

I Since 1990, as a person in charge of key research projects of the China Tibetology Research Center, I have had opportunities almost every year to conduct field surveys on anthropology in Tibet together with my colleagues. Our investigations focus on the family. The purpose of our surveys is to see social changes in Tibet during the 50 years after the Democratic Reform through the study of the family as a social cell.

Tibet's Dramatic Changes Over the Last 60 Years

The days when Wangdu was a serf are long gone, since democratic reform in Tibet in 1959 declared the endof serfdom there. However, he won fame and was remembered as Serf Champa.