This study aims to evaluate the direct effects of work stress, health status and presenteeism on task performance, and further explore the mediating effects of health status and presenteeism, hoping to provide theoretical basis for improving the performance of medical staff.A cross-sectional study was conducted among medical staff in Jilin Province, Northeast China. The Challenge and Hindrance-Related Self-Reported Stress scale, Short Form-8 Health Survey scale, Stanford Presenteeism Scale and Task Performance Scale were adopted to assess the work stress, health status, presenteeism and task performance of medical staff.P < 0.05). Work stress  and presenteeism  were negative predictors of task performance. Health status  was positive predictor of task performance. Health status  and presenteeism  mediated the relationship between work stress and task performance (P < 0.001). Presenteeism mediated the relationship between health status and task performance .A total of 4,347 questionnaires were distributed among medical staff, and 4261 were valid, for an effective rate of 98.02%. The mean scores for work stress, health status, presenteeism and task performance were 2.05 ± 0.84, 4.18 ± 0.68, 2.15 ± 0.79 and 4.49 ± 0.64, respectively. The ANOVA results showed that there were significant differences in the task performance scores between different genders, ages, marital statuses, professional titles, departments and work years (Work stress and presenteeism had significant negative impact on the task performance of medical staff; health status had a significant positive effect on task performance. Meanwhile, health status and presenteeism played a mediating role in the relationship between work stress and task performance, and presenteeism played a mediating role in the relationship between health status and task performance. Reasonable assignment of tasks can reduce the work stress, but to improve the performance of medical staff, we should pay more attention on improving health, such as making health-related safeguard measures, raising awareness, building a platform, etc. Since the end of 2019, there have been outbreaks of infectious diseases caused by coronavirus disease 2019 (COVID-19) worldwide. COVID-19 was declared a pandemic by the World Health Organization in January 2020 and listed as a public health emergency and a matter of international concern . MedicalThe evaluation of the performance of health professionals has been the focus of scientific research in recent decades, and the efficient work of health technicians was the basis for improving the quality of health services . There hThe following subsections describe the hypotheses considered in this study.Work stress refers to the mismatch between work requirements and individuals under the interaction of work situations and individual characteristics, affecting individuals' physiology, psychology and behavior . COVID-1Based on the above discussion, the following hypothesis was proposed.Hypothesis 1 (H1): Work stress has a significant, negative effect on task performance.The World Health Organization defines health as a good state of physical, mental and social wellbeing . Health Based on the above discussion, the following research hypotheses were proposed:Hypothesis 2 (H2): Health status has a significant positive effect on task performance.Hypothesis 3 (H3): Health status mediates the relationship between work stress and task performance.Presenteeism refers to “the phenomenon of people who normally need rest and absence from work going to work despite poor health” . StudiesBased on the above discussion, the following research hypotheses are proposed:Hypothesis 4 (H4): Presenteeism has a significant negative effect on task performance.Hypothesis 5 (H5): Presenteeism mediates the relationship between health status and task performance.Hypothesis 6 (H6): Presenteeism mediates the relationship between work stress and task performance.Based on the above discussion, a hypothetical path was proposed as shown in To validate the hypotheses, a cross-sectional survey was conducted in January 2020 in Jilin Province, Northeast China. Medical staff members in public hospitals were selected by stratified random sampling as the subjects of the study. In this process, all areas of Jilin Province were divided into cities and counties, and hospitals were also divided into urban public hospitals and county-level public hospitals. Due to the high clustering of urban public hospitals, these hospitals were stratified by region, type and level and randomly selected at a rate of 1/4. Because of the dispersion of different counties, city hospitals and traditional Chinese medicine hospitals were selected from each county as samples. Finally, a total of 109 hospitals, including 29 urban public hospitals and 80 county-level public hospitals, were selected as sample hospitals. Through quota sampling, 40 medical staff members, including doctors, nurses and medical technicians, were selected from each hospital to be investigated. The questionnaire was administered on site by trained investigators and was recovered on site. Finally, 4,347 questionnaires were distributed, and 4,261 valid questionnaires were collected. The valid response was 98.02%.The study was approved by the Medical Ethics Committee of the author's institution (No. 2019-12-03). Participants were provided with a complete explanation of the purposes of the study. Participants were informed that the information collected would be used solely for the study and that they could withdraw at any time.The measuring instrument was a questionnaire, which was developed by adapting previously validated scales to the context of the study. The questionnaire was divided into two parts. The first part collected demographic characteristics of the respondents, including gender, age, marriage status, education background, professional title, department and working years. The second part measured respondents' task performance, work stress, health status and presenteeism.Work stress was assessed using the Challenge-and Hindrance-Related Self-Reported Stress Measures (CHSS) developed by Cavanaugh et al. . It inclThe Short Form-36 (SF-36) Health Survey is the most popular instrument for investigating health-related quality of life (HRQOL) , and it At work, I was able to focus on achieving my goals despite my health problem” and “Despite having my health problem, I was able to finish hard tasks in my work” are scored in reverse order. The sum of the six items then produces a total attendance score, and the higher that the score is, the greater that the health impact on work status is. In this study, the Cronbach's alpha for the SPS-6 was 0.756.The Stanford Presenteeism Scale (SPS-6) was adapted to measure the effect of health status on task performance . The SPSThe measurement of task performance (TP) was adapted from Williams's  and Jesst tests and one-way analysis of variance (ANOVA) were performed to examine differences in the task performance scores among medical staff members of different genders, ages, marital statuses, educational levels, professional titles, departments, and working years. Pearson's correlation analysis was applied to analyze the correlations between the study variables. Structural equation modeling (SEM) has the characteristics of Confirmatory factor analysis (CFA) and Path analysis (PA), and has incomparable advantages. PA tests the causal relationship between the observed variables, CFA tests the causal relationship between the observed variables and the latent construct, and SEM tests the causality between the observed variables and the latent construal as well as the interior of several latent construal A total of 4,261 medical staff participated in the survey. In this sample, most of the respondents were female (68.95%) and married (78.85%), with college degrees (58.60%) and with middle or junior titles (68.72%). The medical staff members were aged 37.55 ± 9.11 years old, had worked for 13.73 ± 9.73 years and scored 4.49 ± 0.64 on task performance. Mean scores for task performance differed across the distributions of gender, age, marital status, professional titles, departments and working years. However, there were no differences in the scores among medical staff members with different marital statuses and educational levels. The demographic characteristics and task performance scores are shown in r = −0.606, P < 0.01; r = −0.503, P < 0.01) and positively correlated with task performance . Work stress was positively correlated with presenteeism  and negatively correlated with task performance . Presenteeism was negatively correlated with task performance .t and P values for each path were calculated in AMOS to test the research hypothesis. The results of the structural equation model are presented in The P < 0.001; β = −0.171; P < 0.001); moreover, the better that health status is, the better that task performance is , so H1, H2, and H4 were supported. At the same time, the bootstrapping technique in AMOS was used to explore the mediating roles of presenteeism and health status, and the 95% confidence intervals of the indirect effects were obtained with 5,000 bootstrap resamples. The results showed that work stress significantly affected the task performance of medical staff through presenteeism  or health status , and health status significantly affected the task performance of medical staff through presenteeism , so H3, H5 and H6 were supported as shown in P < 0.001) and 0.170 (P < 0.001), respectively. The results showed that the higher that the work stress is, the more serious that presenteeism is, and the worse that the task performance is  was established and validated, and it was helpful for understanding the influence of physical and mental aspects on task performance. The data collection and processing in this study were strictly controlled, and the results could be considered a valuable reference for improving the task performance of medical staff. Based on the results of this study, it is now possible to revisit and reflect on the hypotheses established at the beginning of this study.The survey results of this study showed that the mean score of task performance was 4.49, while the mean score of task performance of nurses in Malaysia was 3.85 as shown by Nasurdin et al. . This diStudies have shown that work stress, health status, and presenteeism were associated with task performance. Work stress and presenteeism had significant negative influence on medical staff's task performance, and health status had significant positive influence on it. The hypotheses proposed in this paper have been well verified in the structural equation model. The occupation of medical staff is special. Medical work is a high-risk occupation. The work of medical staff is characterized by high risk and urgency, especially during the epidemic period, facing with huge risks and long workloads, competing with time for patients' lives, research has shown that extreme work stress was a great challenge to the health status of medical staff, on the contrary, it would lead to anxiety, tension and other negative emotions, serious and even health problems, not conducive to work . Health The study also found that health status and presenteeism played an mediating role between work stress and task performance, and presenteeism played an mediating role between health status and task performance. The hypotheses were verified in the structural equation model. Research has shown that work stress was linked to health status, when working in a high-pressure environment, health problems were more likely to occur, health was threatened, medical staff also insisted on working with diseases, not only would lead to work errors, work inefficiency, it also exacerbated the negative health effects of the disease, creating a vicious circle and even placing a physical or work burden on others, which was detrimental to the health and well-being of individuals and society as a whole , 65. OccRegarding advantages of this study, previous studies have not addressed the relationships among work stress, health status, presenteeism, and task performance. We established these associations and explored the direct and indirect roles among them. This study investigated a large population, carried out strict quality control, and was highly scientific and representative. Regarding disadvantages, although this study explored and verified the relationships among the four variables, it inevitably has limitations. First, this study was a cross-sectional study, so it is impossible to determine the causal relationships among the variables. In the future, longitudinal study design should be used to collect data as far as possible. Second, this is only one province of China, there may be differences between different provinces, which might have affected the generalizability of the results. When conditions permit, representative sample data can be selected from the whole country for analysis. Third, the method of quota sampling may produce research bias. However, after consulting with local health authorities and health experts, stratified random sampling was applied to capture hospitals and medical staff to minimize bias.In conclusion, our results showed that work stress and presenteeism had a significant negative effect on task performance of medical staff; health status had a significant positive effect on task performance. At the same time, health status or presenteeism played a mediating role between medical staff's work stress and task performance, and presenteeism played a mediating role between medical staff's health status and task performance. To improve task performance, priority should be given to starting from ideological cognition, platform construction, safety assurance and other aspects, and continuously strengthen the health management of medical institutions and medical personnel.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Medical Ethics Committee of the School of Public Health Jilin University. The patients/participants provided their written informed consent to participate in this study.HJ and PS: methodology and writing—original draft preparation. SG, JY, and PC: data curation and investigation. XY: funding acquisition, conceptualization, and supervision. All authors contributed to the article and approved the submitted version.This work was supported by the MOE (Ministry of Education of the People's Republic of China) Project of Humanities and Social Sciences (Grant Number 18YJAZH118). The funding agencies had no role in design, analysis, interpretation, or writing of this study.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


During the COVID-19 pandemic, there was a growing awareness about the importance of building a health and safety net based on digital healthcare systems, such as ICT-based local community online services and patient monitoring technology. This study was conducted with the aim of evaluating the formative usability of a three-way digital healthcare system, which had been developed to build a health and safety net for people with disabilities and deriving the directions for system improvement in order for them to be used as basic data for further system enhancement. A formative usability evaluation of a three-way digital healthcare system was performed with the participation of 43 healthcare professionals, using the 10-item System Usability Scale (SUS) and five items for satisfaction evaluation. Each item was rated on a five-point Likert scale, with the result converted to a scale of 100. Analysis was performed using the average score and the acceptable system usability level. The overall mean SUS score was 62.4, which corresponds to Grade D according to the SUS grading scale, and the below-average items were complexity (Q2), convenience (Q8), simplicity (Q3), professionalism  , and learnability (Q7). The overall mean user satisfaction was 71.2 points, where overall satisfaction, system architecture and understandability, and continuous use intention were marked with below-average scores. The SUS D grade is interpreted as “fair” and the water solubility is “almost acceptable”. For the usability enhancement of the newly developed a three-way digital healthcare system, the overall direction for system architecture improvement was analyzed centering on complexity (Q2), convenience (Q8), professionalism  , learnability (Q7), and simplicity (Q3). Efforts need to be directed at enhancing system satisfaction and continuance rate by deriving detailed system improvement strategies and achieving system enhancement to reflect the opinions of not only experts but also users. The challenges posed by the COVID-19 pandemic situation, notably to people with disabilities, include incidence and deterioration of health problems, exposure to lifestyle-related diseases , and restrictions on healthcare utilization and information acquisition, which necessitates a wide range of supports with regard to healthcare utilization, mental health, transportation, and personal care . In addiIn order to support the health, safety, quality of life, and daily life of people with disabilities, various services such as non-face-to-face services using information and communication technology (ICT) and PC or mobile health  based on patient monitoring technology a digital healthcare system is being developed and utilized ,5.The iMHere system, for example, developed by the University of Pittsburgh, USA, is a three-way (patient–caregiver–physician) linkage system for patients with chronic diseases and disabilities. This system allows efficient health management, increased drug compliance, and smooth communication, preventing the development of further complications. The iMHere system improves the quality of life of patients .Similarly, the ePRO system, developed by the University of Toronto, Canada, is a three-way linkage system for patients with chronic diseases and disabilities. This system allows patients, caregivers, and healthcare professionals to utilize the My Goal Tracker  and the Hospital CheckOut program .Digital healthcare technology is emerging as a potentially low-cost scalable platform that decreases the burden on caregivers . CaregivCurrently, there is no health management service that records the health information of both people with disabilities and their caregivers, even with the use of information and communication technology. Since the key element of health promotion behavior among people with disabilities is family support, a three-way sharing-based digital healthcare system for people with disabilities and their caregivers should be established. This would allow access to good physical and psychological health among people with disabilities and their caregivers.Therefore, considering that the main factor in the health promotion behavior of the disabled is family support , it is nA previous study examined, during the COVID-19 pandemic, changes in the health status and healthcare routine of the disabled and caregivers, as well as changes in caregiving, daily life, social relationships, and usage of services and facilities, acquirement of information on responses to infectious diseases, and the requirement of non-face-to-face services. Additionally, we confirmed the need for the organic linkage of community and public resources in times of disaster. We also established the urgency of preparing specific and detailed support measures customized for various subjects who belong to vulnerable social groups .Recently, a prototype three-way digital healthcare system for people with disabilities and their caregivers has been developed to support the safety and health management of people with disabilities and their caregiver’s in the COVID-19 pandemic and to respond quickly in crisis situations .The usability evaluation includes a formative usability evaluation, conducted in the middle part, and a general usability evaluation, conducted in the latter part according to its time and purpose . TherefoIn this study, with the participation of healthcare professionals, a formative usability evaluation was performed on a three-way digital healthcare system for people with disabilities and their caregivers with the aim of deriving the directions for system improvement in order for them to be used as basic data for system enhancement in the future.After the first development of a Three-Way Digital Healthcare System, a usability evaluation was conducted targeting healthcare professionals to identify problems through the first formative evaluation. Forty-three healthcare professionals related to people with disabilities  were randomly selected from the Seoul metropolitan area based on convenience sampling, and a questionnaire survey was conducted for usability evaluation of the newly developed a three-way digital healthcare system for the people with disabilities and their caregivers.After understanding the purpose of the study via the explanations given in the questionnaire, the participants provided their consent to participate in the study. The questionnaire included explanations about the main features of the digital healthcare system based on the health and safety net for people with disabilities, system architecture, and user interface (UI), a 15-item questionnaire consisting of the 10-item System Usability Scale (SUS), 5 items for user satisfaction, and an open-ended expert questionnaire. The completed questionnaires were retrieved online for analysis.Since the key element of health promotion behavior among people with disabilities is family support, a three-way sharing-based digital healthcare system for people with disabilities and their caregivers was established by healthcare professionals. People with disabilities and their caregivers receive health status monitoring and appropriate health management services through a Three-Way Digital Healthcare System. At this time, the people with disabilities and the caregiver could mutually know each other’s health status information . Through this system, healthcare professionals could identify the health conditions of both the disabled and caregivers and provide appropriate coaching and health, safety, and welfare services . A three-way, sharing-based digital healthcare system for people with disabilities and their caregivers was established in four steps. STEP 1. The desired mobile application requirements were collected and analyzed. -> STEP 2. Designing the daily health mobile application . -> STEP 3. Implementation of the mobile application. -> STEP 4. Testing of the mobile application .The main features: (1) providing customized health management content for people with disabilities; (2) encouraging healthy life of people with disabilities and their caregivers by sharing information on health and healthy life among people with disabilities, caregivers, and healthcare professionals; (3) providing information on health, safety, and welfare; and (4) identifying health and safety needs at any given time. The system consists of six sections and a user interface (UI).The 6 sections of the digital healthcare system are: (1) My health at a glance, (2) My profile, (3) My health, (4) My wellbeing assistant, (5) Health together, and (6) Communities. Sub-sections are outlined in SUS is a questionnaire that can be used for evaluating the usability of various products and services. SUS is a practical and reliable tool for measuring perceived simplicity by providing a rapid and efficient means to assess the usability of a product or design. It can be applied to a wide range of digital products and services to help user experience (UX) professionals determine whether a design solution has any usability problems . Each item was rated on a 5-point Likert scale . Of the 10 assessment items, odd-number items are positive questions, where a higher score indicates a superior system, and even-number items are negative questions, where a lower score indicates a superior system. The score of each item was converted to a scale of 100. For odd-number items, the total score was subtracted by 5 to obtain (X), and for even-number items, the total score was subtracted from 25 to obtain (Y).Then, the sum of the two values (X + Y) was multiplied by 2.5 to obtain the overall SUS score . FinallyUser satisfaction was evaluated using 5 assessment items on the overall system satisfaction, architecture and understandability, degree of interest, recommendation, and continuous use intention. Each item was rated on a 5-point Likert scale as in the SUS items. An item score was obtained by subtracting 1 from the point gained and multiplying the resulting value by 25, thus converting to a scale of 100 (range: 0–100). Data analysis was performed on the sociodemographic variables  to calculate frequency and percentage using Microsoft Office Excel 2007 software. Overall mean SUS and user satisfaction scores and individual item scores were compared, and SUS score classification was compared and analyzed.For usability evaluation, 43 physical disability-related healthcare professionals participated in the study. Their sociodemographic characteristics were analyzed as follows: gender distribution was 38 men (88.4%) and five women (11.6%); the most frequent age group was the 40s , followed by the 30s ; occupation distribution was 26 academics (60.5%), nine public health and welfare professionals (20.9%), and eight industrial practitioners (18.6%); the most frequent career length was 10–19 year  .The overall SUS mean score was 62.4, which corresponds to grade “D” on the grade scale in the SUS score classification . Items wThe overall satisfaction mean score was 71.2, with the item’s overall satisfaction, architecture and understandability, and continuous use intention marking lower scores than the overall mean value .In this study, we conducted a formative usability evaluation of a three-way digital healthcare system, which was developed to build a health and safety net for people with disabilities, with the participation of healthcare professionals with the aim of deriving the directions of system improvement and providing basic data for further system enhancement.SUS scores are divided into rating categories of best imaginable, excellent, good, fair, poor, and worst imaginable, and a SUS score lower than 69 (the 50th percentile) indicates problems requiring investigation or solution ,18. In tFormative usability evaluation has resulted in low usability during the evaluation since the expert’s objective identification and analysis were utilized rather than the users’ point of view.Among the 10 SUS items, four items scored above average (≥62.4): utility (69.2), integration (75.0), unity (66.3), and satisfaction (63.4), and six items scored below average (<62.4): complexity (56.4), simplicity (58.1), professionalism (technician support) (57.6), learnability (59.3), convenience (59.3), and professionalism (prior learning) (59.9). Thus, it was confirmed that the overall system architecture needs to be improved, focusing on complexity, simplicity, professionalism, learnability, and convenience. In particular, the fact that simplicity and complexity marked the lowest scores highlights the urgency of improving the system towards simplicity and convenience . To imprThe mean user satisfaction score was calculated at 71.2. Among the satisfaction items, the overall satisfaction score was 68.6, which is higher than system architecture and understandability (67.4) and continuous use intention (68.0) and lower than the degree of interest (75.0) and recommendation (76.7) . These rFactors affecting the usability and durability of healthcare-related wearable devices include various technological factors, interactive factors, and psychological factors such as motivation and sense of achievement . Among tIn this study, we meticulously examined all system problems and improvement needs and sought methods to improve system simplicity for ease of use and efficient user environments. By building an online health and safety net for people with disabilities, it is possible to help them live healthy lives and respond to emergency situations in this COVID-19 era. It is expected that a self-directed health management environment can be created by enabling people with disabilities to report patient-generated health data (PGHD) for themselves and caregivers and to implement the monitoring system. In this context, it is also hoped that standardized health management guidelines for people with disabilities will be provided for professionals in related health and welfare facilities, as well as remote healthcare delivery to people with disabilities in crisis situations such as COVID-19 in linkage with primary care physicians of people with disabilities, community health centers, and local healthcare centers for people with disabilities. By implementing the improved tripartite health information sharing system, various effects are expected, such as the health and safety of people with disabilities and their caregivers, promotion of healthy living, mutual encouragement to lead a healthy life, enhancement of quality of life, communication, and participation.At the current stage of app development, this utility evaluation study was conducted first with healthcare professionals. To develop a high-performing app, it is first necessary to improve an existing app, then to perform usability evaluation with the participation of people with disabilities, who are target users, and their caregivers, and finally to further improve the app based on the results of usability evaluation.A successfully upgraded app can be an effective healthcare service model for the comprehensive health management of not only people with disabilities but also their caregivers. In addition, it would be a highly significant system solution to integrate the tripartite sharing-based digital healthcare system into the envisaged local community health management project system for people with disabilities in that it can become a high-usability integrated health and welfare service model for people with disabilities.This study analyzed comprehensive improvement directions for system architecture improvement centering on complexity (Q2), simplicity (Q3), professionalism  , learnability (Q7), and convenience (Q8) with the aim of enhancing the usability of a newly developed digital healthcare system. It is necessary to make continuous efforts to improve system satisfaction and continuous use intention by deriving concrete system improvement needs and addressing those needs through system enhancement. In addition, usability evaluations of improving digital healthcare systems are required by end users, such as people with disabilities and their caregivers. It is expected that such research outcomes will contribute to developing an effective healthcare management service model that addresses all problems facing people with disabilities and their caregivers.


New events were defined as the composite endpoint of stroke or CVD requiring hospitalization, initiation of hemodialysis or peritoneal dialysis, or all-cause mortality. The cumulative survival rate without new events at 24 months was significantly higher in the intervention group  than in the control group . Two-way analysis of variance revealed a significant effect of the group factor on high density lipoprotein-cholesterol (HDL-C) which was higher in the intervention group than in the control group (p = 0.004); eGFRcr showed a significant effect of the time factor, which was lower at 24 months than before intervention (p = 0.043). No interactions were observed for all items. In conclusion, aerobic exercises combined with upper and lower limb muscle strengthening for six months reduce the risk of developing CVD and all-cause mortality in patients with DKD.This study aimed to determine the effect of long-term exercise on the risk of developing cardiovascular diseases (CVD) and all-cause mortality in patients with diabetic kidney disease (DKD). A single-center, prospective intervention study using propensity score matching was performed over 24 months. The intervention group ( The global diabetic population in 2021 was 536.6 million, estimated to increase to 783.2 million by 2045, with the Western Pacific region, including Japan, reported as having the largest diabetic population worldwide [DKD is strongly affected by cardiovascular diseases (CVD) associated with diabetes mellitus. Notably, diabetes mellitus is an independent and definitive risk factor for CVD ,10. FurtSince the risk of death from CVD increases with the development of DKD , preventConsequently, we hypothesized that increased physical activity through regular aerobic exercise would be an effective therapeutic tool to reduce the incidence of CVD in patients with DKD. Therefore, this study aimed to determine the impact of increased physical activity through a long-term hybrid exercise program (supervised sessions + home-based sessions) under the guidance of physical DKD therapists on the risk of developing CVD and all-cause mortality.A total of 850 patients registered in our hospital’s outpatient database of diabetes mellitus were included in this study. Of these, 187 cases were excluded, including patients who were difficult to follow up on due to interruption of hospital care, death, and transfer to another hospital and those for whom DKD severity classification was impossible due to lack of data. Of the final 663 participants included in the study, interventions were provided to 89 with consecutive prescriptions for exercise instruction by a physician. Twenty-two patients dropped out during the intervention, and the remaining 67 were classified as the intervention group. A propensity score matching was performed from the historical cohort group based on the basic information of the intervention group and blood sampling data; 67 cases were selected as the control group for this study . InclusiThis is a single-center, prospective interventional study. The observation period was between August 2016 and August 2019; the intervention period was six months. The follow-up period was set as 24 months after the intervention, and the data after 24 months were used for analysis. The study was conducted per the Declaration of Helsinki guidelines and the ethics guidelines for clinical research from the Ministry of Health, Labor, and Welfare . Furthermore, the protocol was reviewed and accepted by the ethics committee of Dokkyo Medical University Nikko Medical Center (Nikko 27001). Written informed consent was obtained from all participants in the intervention group. In addition, informed consent was obtained using the opt-out system in the non-intervention group; those who rejected it were excluded.The educational session on exercise instruction was designed to help the participants acquire an exercise habit and included diabetes self-management education (DSME) . BecauseThese educational interventions were conducted by physical therapists certified as cardiac rehabilitation instructors and Certified Diabetes Educators from Japan.In the control group, the physical therapists did not provide exercise instruction using the DSME. Conversely, diabetic nurses and dietitians provided lifestyle and nutritional guidance to both groups. Therefore, the difference in intervention between the two groups was the physical therapists’ presence or absence of DSME-based exercise instruction.The home-based exercise program consisted of aerobic exercises and eight muscle-strengthening exercises ,23. The (1)Walking as a mild-to-moderate aerobic exercise for at least 20 min/day and at least three times/week , with a (2)® and bodyweight resistance for major muscle groups in the upper and lower extremities at least three days per week, with no more than two consecutive days. Participants performed eight resistance exercises , with 8–12 repetitions at an intensity that felt somewhat tight  [Resistance exercises were performed using TheraBandale: 13) ,24. If tTo increase adherence to exercise and establish an exercise habit, we measured and recorded the extent of daily physical activity. Consequently, the participants were lent an activity meter  and instructed to wear it from when they woke up to when they went to bed for five months, from the second to the sixth month of the exercise instruction intervention. In addition, a self-management notebook was distributed to the participants; they were instructed to record the number of steps, walking time, resistance exercise, weight, and blood pressure at the end of each day.In this study, physical activity was assessed in the intervention group using an activity meter and a short-form of the International Physical Activity Questionnaire (IPAQ) .A 3-axis acceleration sensor was built to measure the amount of physical activity; it can be used with commercially available activity meters ,27. The www.ipaq.ki.se (accessed on 10 August 2020)). Using the definition for a MET as the ratio of work metabolic rate to a standard resting metabolic rate of 1.0 (4.184 kJ) ·kg−1·h−1, 1 MET was considered a resting metabolic rate obtained during quiet sitting [IPAQ estimates were obtained verbally and face-to-face with each participant by trained physical therapists. Physical activity in IPAQ was assessed separately for weekdays and weekends, and these estimates were used to calculate physical activity per week . Physical activity was calculated using the type of activity , frequency of exercise of 10 min or more (days/week), and duration of exercise (minutes/day) as intensity and type components. Then, METs were calculated and applied to each activity; MET intensity levels used for IPAQ scores were vigorous (8 METs), moderate (4 METs), and walking , Urinary Albumin/Creatinine ratio (Urinary Alb/Cre ratio), body weight, blood pressure, Triglyceride (TG), High-density lipoprotein cholesterol (HDL-C), LDL-C, DKD Stage, HbA1c, and Hb. The values of these endpoints were obtained from blood and urine collection data during outpatient visits or hospitalization.2) = 194 × serum creatinine − 1.094 × Age − 0.287  [eGFR was calculated using the Japanese eGFR equations based on standardized serum creatinine levels as follows: eGFRcr  . ® Pro, Version 14.0  was used for statistical analyses. Statistical significance was set as a two-tailed p-value of <5%.Data are presented as mean ± standard deviation for continuous variables and as numbers and percentages for categorical variables. Baseline comparisons were conducted using the Wilcoxon rank sum test, Student’s t-test, chi-squared test, and Fisher’s exact test. In addition, groups  and by-time  repeated-measures analyses of variance were performed to examine interactions. The log-rank test was used to compare the cumulative survival rate against new events within the observation period. COX regression analysis was performed to calculate hazard ratios for CVD occurrence and all-cause mortality risk. JMP In diabetes, the relative risk of the higher physical activity group is reportedly 0.61 (range: 0.52–0.70) compared with that of the lower physical activity group . In thisThe clinical characteristics of the study participants  are shown in p = 0.016), with fewer new events. The hazard ratio for combined risk, including all event occurrences, was significantly higher in the control group . There were 27 cases of new events during the observation period. In the control group, there was 1 case of stroke, 12 of CVD, 1 of HD, and 5 of all-cause mortality. In contrast, in the intervention group, there was one case of stroke, four of CVD, 2 of HD, 1 of all-cause mortality, and fewer cases of CVD and all-cause mortality (p = 0.01).After 24 months of observation, the cumulative survival rate was significantly higher in the intervention group (0.881) than in the control group (0.715). ; eGFRcr showed a significant effect of the time factor, which was lower at 24 months than before intervention . However, no interaction was observed for all items  = 8.28, ll items .The activity meter data of the intervention group are shown in p = 0.0052), fourth (p = 0.003), and fifth months (p = 0.0013) was significantly higher. The amount of physical activity before and during the intervention period is shown in the To our knowledge, this is the first study in which exercise guided by a trained physical therapist decreases the risk of new cardiovascular and all-cause death in patients with DKD. This study’s results contribute to future planning for adequate care and rehabilitation for DKD.This study showed that increased physical activity through exercise was associated with reduced risk of CVD and all-cause mortality in patients with DKD. The present promising results could have been obtained through consistent instruction provided by the expert physical therapist regarding diabetes management and cardiac rehabilitation instruction . This suOn the other hand, the 25% dropout rate in this study raises an essential question of how to support these individuals. Notably, there are two main categories of non-participants in the DSME: those who are unable to participate for logistical, medical, or financial reasons  and those who feel that there is no benefit in participating or who have emotional or cultural concerns  . EffortsIn this study, HDL-C levels were significantly higher in the intervention group at 24 months than in the control. This may be because exercise improved HDL-C levels, which is not easy to obtain with drug treatment, and possibly reduced the risk of CVD and all-cause mortality. Increased physical activity through exercise reportedly prevents atherosclerosis  and is aCarotid artery echo and flow-mediated dilation (FMD) are essential to evaluate blood vessels’ functional and morphological changes due to atherosclerosis. The intima-media thickness obtained by carotid artery echo is closely related to the risk of stroke  and CVD The eGFRcr showed a significant main effect of the time factor and was lower after 24 months in both groups; therefore, we could not show that exercise improved renal function in patients with DKD . HoweverAn RCT study of exercise and caloric restriction in patients with stage III DKD showed that they reduced inflammation and oxidative stress and delayed renal fibrosis in the intervention group . Low- toThere are some limitations to this study. First, the sample size was limited to a single institution. Therefore, the study can be limited to a small part of the population that can be influenced by different factors. Second, we were not able to assess vascular function. Third, the amount of physical activity in the control group could not be assessed. Finally, given that about 25% of the intervention group dropped out, the study may have been limited to participants with relatively high adherence.Exercise in diabetic patients is an effective treatment to reduce the risk of CVD development and death, which may also be effective in DKD. In this study, in patients with DKD, increasing physical activity through a 6-month exercise instruction intervention reduces the risk of developing CVD and all-cause mortality. Our findings indicate that long-term exercise for DKD is an effective means of reducing CVD incidence and all-cause mortality and may be applied to future DKD treatment.


SD = 1.0). We administered neuropsychological tests to evaluate executive functions and the Juvenile Victimization Questionnaire (JVQ) to evaluate exposure to violence. We used the following neuropsychological instruments: Wechsler Abbreviated Scale of Intelligence (WASI), Stroop Color-Word Interference task, digits subtest of the Wechsler Intelligence Scale for Children, and an N-back task. We generated a composite score from neuropsychological test scores and investigated the association of that score, and individual test scores, with exposure to violence and socioeconomic status (SES). Results suggest, first, that exposure to violence is associated with a 0.5-point lower intelligence quotient score for every reported victimization event in the Juvenile Victimization Questionnaire. Results also show that the digits backward subtest scores showed a significant negative correlation with exposure to violence ; both analyses were adjusted for the level of schooling of parents or guardians, which was also found to be significantly associated with lower intelligence quotient scores. We discuss results in the light of the existing literature on the effects of exposure to violence on adolescent development, and the amounting evidence that suggests an association of exposure to violence, and of victimization, with tests that evaluate constructs of executive functions. The study struggled with low compliance from participants, and we underscore the challenges of carrying out empirical studies aimed at better understanding the development of underrepresented youths, such as those from Central and Latin America.We carried out an exploratory study of the association between exposure to violence, intelligence, and executive functions in Brazilian preadolescents. The study included 56 participants  aged 8 to 14 years old (mean = 11.3, The online version contains supplementary material available at 10.1186/s41155-023-00249-z. Violence impacts development and quality of life. There is robust evidence that early-life stressors affect cognitive and emotional development . The inclusion criteria were the following: youths regularly enrolled in school, aged between 9 and 14 years, and literate ; the exclusion criteria, in turn, were as follows: neurological or mental disorders and an intelligence quotient (IQ) below 70 . Neurological or mental disorders were excluded based on the interview with parents or guardians. Table n = 54) and socioeconomic status (SES) (n = 52) than the total sample because demographic information was not obtainable for children who were wards of the state as a result of their parents having lost custody.We invited participants who attended schools located in neighborhoods that had the highest rates of violence in an urban environment which, at the time of the study years 2017–2018), was among the most violent in Brazil and in the world , attention and task switching (Trail Making Test), and working memory span (N-back and Digit span), and intellectual capacity, as construed by the intelligence quotient score   . We calculated standardized (z) scores using the raw scores for Stroop Word-Color page, TMT parts B-A, N-back — third list, and Digit Backwards span. First, the means and standard deviations of each of these test sections were calculated for the sample of 56 subjects. From these data, z-scores were derived by the formula z = (x–x̅)/SDsample, where x is the raw score, x̅ is the mean of the sample, and SD is the standard deviation of the sample. The standardized score was then obtained for each of the desired sections of the tests, for each of the subjects. The standardized scores were then averaged. Thus, we analyzed the association between exposure to violence (JVQ) and the composite z-score, for exposure to violence and each of four different executive function tests , and for exposure to violence and IQ. We also investigated correlations for the test scores and the composite score with demographic variables and for the multiple linear regression analyses.The IQ was estimated using the Wechsler Abbreviated Scale of Intelligence (WASI), and scores were classified as very superior, superior, high average, average, low average, borderline, or extremely low according to the norms for this population , which measures the effect on the instruments of each 1-point increase, along with the 95% confidence interval. In addition, we calculated the coefficient of determination (R2) to assess the proportion of the variance in the neuropsychological evaluations that were explained by exposure to violence (JVQ-R2). We adopted the significance level of 5% (p < 0.05) and carried out the analyses using the Statistical Package for the Social Sciences (SPSS), version 29.0.Quantitative variables were described as mean and standard deviation or median and interquartile range, depending on the data distribution. Categorical variables were described by absolute and relative frequencies. We used Student’s p < 0.05; Fig. p = 0.053), N-back sum , TMT B-A , and the composite score . Multiple linear regression analysis showed a statistically significant association between exposure to violence and Digit Backwards span and IQ . For a more in-depth discussion of the results on total exposure to violence, and the effects of experiencing two, three, or more violent events, “polyvictimized” youths, see de Azeredo et al.  and Buchn = 36) were from lower/middle-lower income, and a quarter were from middle-income families , whereas the average for the participants who did not report sexual victimization was 94.8 (SD = 9.8). Thus, the average IQ for the subgroup of participants who reported sexual victimization was in the “low-average” range of the IQ norming for this demographic (low-average range 80.0 to 90.0); the average for the participants who were not a victim of sexual abuse is within the “average” range of IQ norms (average range 90 to 109) ; the mean for the entire group was 8.1 (SD = 6.3). Peer or sibling victimization, in turn, was negatively associated with the composite executive function score and IQ score. Witnessing violence did not individually show a statistically significant association with test scores  and sex (Supplementary Table z-score). This finding underscores that specific types of victimization may have a stronger impact on executive functions.The present study suggests that exposure to violence is significantly associated with lower scores in executive functions tests, i.e., digit span backwards, and in intelligence scores. Results show that for every experience of violence reported , youths scored half a point lower in the IQ test. The regression model suggests that exposure to violence explains 22.2% of the variability of Digit Backwards spans and 30.9% of the variability in IQ scores. Thus, for each point scored in the JVQ instrument, there was a 0.46-point reduction in IQ and a 0.07-point reduction in the Digit Backwards span. Maltreatment and sexual abuse, specifically, showed a significant negative correlation with the N-back and composite  among Brazilian adolescents  due to voluntary withdrawal, inability to read and comprehend text, frequent absence from school, among other reasons , total victims and victimization by sex (no significant differences between sexes). Supplementary Table 4. Correlation between types of exposure to violence and executive function tests and IQ scores.


Muskmelon pedicel is the fruit stalk of muskmelon and one of the traditional Chinese medicines, which can be used to treat jaundice, diabetes and neuropathy. However, in recent years, agricultural soil heavy metal cadmium (Cd) pollution has become serious, coupled with the imperfect sales management of herbal medicine, increasing the potential health risk of contaminated herbal medicine in the human body. In this paper, the comprehensive quality of contaminated muskmelon was tested. The results showed that Cd stress significantly inhibited the growth of muskmelon plants, reduced the anthocyanin and chlorophyll contents, and increased the fruit size and sweetness of muskmelon. In addition, heavy metal Cd can also cause oxidative stress in plants, resulting in a series of changes in antioxidant enzyme activities. In the experimental group, the content of polyphenols and saponins increased by 27.02% and 23.92%, respectively, after high-concentration Cd treatment, which may be a mechanism of plant resistance to stress. This paper reveals that the content of bioactive substances in Chinese herbal medicine is high, but the harm in heavy metals cannot be underestimated, which should be paid attention to by relevant departments. Cucumis melo L.) are members of the gourd family and are widely grown worldwide in temperate, subtropical, and tropical regions. The leading muskmelon producers are China, the United States, Spain, Turkey, and Iran. Muskmelons are also considered an important source of natural plant products, and the physical, biochemical, and phenotypic characteristics of muskmelons vary greatly depending on climate regions and local preferences  × extract volume (mL)/sample weight (g) . The conmple (g) . CAT actple (g)) . Ascorbi2O2 solution was added to the reaction system and was heated in a boiling water bath for 0.5 h. The filtrate was cooled and deionized water was added to dilute it to an appropriate concentration. The soil samples were extracted by diethylenetriamine pentaacetic acid (DTPA) and then filtered by shaking table for 2 h and diluted with deionized water. The Cd concentrations in various parts of muskmelon plants and soil were determined by Avanta M atomic absorption spectrophotometer [The content of Cd in plants was extracted by the nitrate method . Leaves otometer .C is the concentration of plant-heavy metals on the surface (mg/kg), IngRveg is the ingestion rate of vegetable (g/day), EF is the exposure frequency (day/year), ED is the duration of exposure (year), BW is body weight (kg), AT is the average time , RfD is the reference dose for herbs intake, and SF is the cancer slope factor for herbs.For heavy metal (HM) pollution, USEPA established a health risk model in 2006. According to the health risk model, a threshold hazard quotient (THQ) was used to evaluate individual non-carcinogenic risk (1). The threshold carcinogenic risk (TCR) is a recognized parameter used to determine an individual’s incremental risk of developing cancer over a lifetime, and the TCR for carcinogenic HMs is calculated using Equation (2) .THQ =  orthogonal experiment table for the orthogonal experiment [According to the results of the single-factor experiment, each factor selects three levels to design the L9  fetal bovine serum and 1% antibody (penicillin and streptomycin) and cultured in a cell incubator at 37 °C and 5% CO2.Human cervical cancer cells (HeLa cells) and mouse fibroblast cells (L929 cells) were purchased from China Typical Culture Collection Center  . The medThe muskmelon pedicle extract was lyophilized and then dissolved with a cell culture medium. The cells were treated with different concentrations of drugs, and their activities were determined by CCK8 kit . The HeLa cell suspension was obtained, and 100 μL of the cell suspension (about 4000 cells) was added to a 96-well culture plate and cultured in a cell incubator for 24 h. The medium was discarded and replaced with 100 μL medium containing different concentrations of samples for 24 h. The culture medium was discarded, and 100 μL culture medium and 10 μL CCK8 were added to each well for 2 h. The absorbance at 450 nm was measured by a microplate reader . The L92Cell inhibition rates were calculated by the following formula: cell proliferation inhibition rate (%) = /OD value of blank control group by 100%.p < 0.05. Multiple comparison (LSD-T test) was used for cell inhibition rate data, * means p < 0.05, significant; ** means p < 0.01, very significant; *** means p < 0.001, extremely significant. Software origin 2020  is used for drawing.For each measurement, the value is expressed as mean ± standard deviation (SD). SPSS 22  was used for data analysis. Univariate analysis was used for statistical analysis of the experimental data, and Ducan multiple comparisons were used to test the significance of In the study, Cd stress significantly inhibited the growth of melon plants and reduced the contents of chlorophyll and anthocyanin in muskmelon leaves. Cd stress significantly increased the fruit weight, fruit longitudinal diameter, fruit transverse diameter and flesh thickness and increased the sugar content of the fruit. A total of 50 mg/kg Cd induced oxidative stress in muskmelon plants, which increased the activities of anthocyanin and antioxidant enzymes, such as SOD, POD, and APX. When the concentration of Cd increased to 200 mg/kg, the activity of antioxidant enzymes decreased sharply. MDA content increased dramatically, indicating that high Cd stress caused oxidative damage to muskmelon plants. The toxicity of heavy metals to herbal medicine is not only in physiological and biochemical aspects but also in the aspects of bioactive substances. A total of 200 mg/kg Cd increased the content of polyphenol saponins and polysaccharides in the pedicel, while 50 mg/kg Cd inhibited the content of flavonoids. In addition, 50 and 200 mg/kg Cd-stressed extracts of pedicels inhibited the cell activity of normal cells. Under Cd treatment, the cytotoxicity of the crude extract of pedicel to normal cells and cancer cells was lower than that without Cd treatment. The Cd content in all parts is at risk of cancer and exceeds the maximum tolerance of the human body. It is interesting to note in our study that Cd treatment increases the effective components of phenomena, which means that the content of effective components is not representative of the overall quality of bioactive substances in traditional Chinese medicines. It is still necessary to combine the risk assessment of heavy metals, physiological and biochemical tests, and other comprehensive evaluations, which is a problem that relevant departments need to pay attention to. Therefore, the traceability information and quality management of herbs deserve further study.


The average concentration of copper in the air, e.g. in the USA it ranges from 5–20 ng/m3, in soil from 5–70 mg/kg, and the intake of copper from food is 1.0–1.3 mg/days for adults (0.014–0.019 mg/kg/day) . The effect of lipoic acid is reflected in the intensification of ATP synthesis, participates in the assimilation of lactic acid, activates the enzyme cycle of tricarboxylic acid, stimulates the growth of lactic acid bacteria by replacing acetate (acetate transfer factor), stimulates CoA synthesis (fatty acid utilization), prevents liver damage by various toxins, normalizes aldolase and transferase levels.The aim of this study is to show the useful role of a supplement, lipoic acid, as an antioxidant in the prevention of oxidative stress.All procedures were performed after anesthesia of albino rats with ketal in accordance with the principles of sacrifice in laboratories. After medial laparotomy albino rates Wistar soy, a 10% homogenate of brain tissue was made in an appropriate medium and an analysis of acid and alkaline DNase activity was performed .DNases are thought to be the main executors of apoptosis, responsible for internucleosomal DNA fragmentation, which is the breakdown of chromosomal DNA into oligonucleosome-sized fragments. Administration of lipoic acid has been shown to protect against oxidative stress caused by copper.Based on the results of this research, it can be concluded that lipoic acid is a powerful and powerful antioxidant.No significant relationships.


To evaluate the effect of blood donation before pregnancy on neonatal birth weight.A total of 14996 women with singleton pregnancies at full-term in Ningbo Medical Center Lihuili Hospital and Ningbo Women’s and Children’s Hospital from November 2019 to November 2020 were enrolled in this study. Detailed records of whole blood donation before pregnancy were obtained through Alipay software. The records were classified into three groups: nondonors, low-frequency donors and high-frequency donors according to the total numbers of blood donations in the 3-year period before pregnancy. The demographics and clinical information of the enrolled participants and their fetuses were collected from electronic medical records (EMRs). The effect of blood donations in the 3-year period before pregnancy on neonatal birth weight was analyzed.P = 0.373). In line with this, there was no association between the number of blood donations in the 3-year period before pregnancy and neonatal birth weight  in the bootstrapped multivariate linear regression analysis models, adjusted for maternal age, number of pregnancies, number of deliveries, gestational age, mode of delivery, years of education and blood type in pregnant women. Compared to the nondonors, the risk of fetal macrosomia was higher in both low-frequency donors and all donors , in the bootstrapped binary logistic regression analysis models after adjusting for the variables mentioned above.There was no significant difference in neonatal birth weight among the three groups (Our study showed that maternal blood donation in the 3-year period before pregnancy may not lead to a reduction in neonatal birth weight, but may be associated with the incidence of fetal macrosomia. Iron is essential for some physiological processes . Iron deIntervals between blood donations range from 8 weeks to 6 months in different countries, which may cause varied degrees of iron recovery. In our country, the interval between whole blood donations must be more than 6 months. Although iron is not detected directly, hemoglobin must be measured before blood donation. If signs of anemia are discovered, blood donation must be postponed until hemoglobin returns to normal.It has been found that iron deficiency during pregnancy is associated with an increased risk of small for gestation infants  and low To date, few studies have directly focused on the effect of blood donation before pregnancy on neonatal birth weight, with slightly different results reported –19. A DaThis was a multicenter, prospective cohort study performed at Ningbo Medical Center Lihuili Hospital and Ningbo Women’s and Children’s Hospital from November 2019 to November 2020.In this study, women with singleton pregnancies at full-term  were eligible for inclusion. After 4 women were excluded because they were less than 18 years old, 14996 pregnant women were enrolled in the study. The detailed records of whole blood donation of women in Zhejiang Province before pregnancy were obtained through Alipay software v10.1 (Alipay (China) Network Technology Co., Ltd., China). The demographics and clinical information, including maternal age, number of pregnancies, number of deliveries, gestational age, mode of delivery , years of education and blood type in pregnant women, and fetal sex and birth weight, were obtained by electronic medical records  .A previous study found that blood type is associated with ferritin levels in blood donors ; therefoIn light of the fact that blood donors were allowed to donate whole blood up to two times per year in China, women were stratified into three groups according to the total number of blood donations in the 3-year period before pregnancy: nondonors who had no donation activity, low-frequency donors who provided 1–2 donations, and high-frequency donors who provided at least 3 donations.According to fetal birth weight, newborns were divided into 3 groups: low birthweight (<2500 g), normal birthweight (2500 g– 3999 g) and macrosomia (≥4000 g) , 20.During the recruitment process, an invitation was sent to potential qualified pregnant women interested in participating in the study at the doctor’s office, where the doctor obtained verbally informed consent, and mobile recording was conducted simultaneously. The notification and consent included instructions to conduct the research, risk determination, maternal blood donation data procurement, clinical information, fetal sex and birth weight, confidentiality of information, etc. This study was approved by the ethics committee of Ningbo Medical Center Lihuili Hospital  and was conducted in a designated clinical environment.P value less than 0.05 was considered statistically significant. All data were analyzed by SPSS statistical software, version 19.0 .Categorical variables were reported as number (%), and significance was tested by the chi-square test. Abnormally distributed variables were expressed as medians and interquartile ranges (IQRs), and significance was detected by the Kruskal–Wallis H test. A bootstrapped multivariate linear regression analysis of fetal birth weight as an outcome was performed by taking the number of donations before pregnancy and all potential confounders  as independent variables. Bootstrapped binary logistic regression analysis was performed to assess the association of the frequency of donations before pregnancy and fetal macrosomia while controlling all potential confounders as mentioned above. A A total of 14996 pregnant women who delivered from November 2019 to November 2020 were included in this study. Detailed records of whole blood donation for the patients in Zhejiang Province before pregnancy were obtained by Alipay software . The bloP<0.001), number of pregnancies (P<0.001), number of deliveries (P<0.001), years of education (P<0.001), and natural birth (P = 0.001) among the three groups  (P = 0.900) and blood type (P = 0.992) of pregnant women or fetal sex (P = 0.169) among the three groups  . Howevere groups .P = 0.373) (P = 0.094)  . In line= 0.094) .P = 0.055)  after adjusting for maternal age, number of pregnancies, number of deliveries, gestational age (≥39 weeks), natural birth, years of education (≥15 years) and O blood type of pregnant women  . In contnt women . Howevernt women  showed tP = 0.088)  . However= 0.088)  showed tIn this multicenter, prospective cohort study, we found that there was no association between blood donation in the 3-year period before pregnancy and neonatal birth weight. On the other hand, the incidence of fetal macrosomia in both low-frequency donors and all donors was higher than that in nondonors, which was an interesting discovery.Because blood donation may affect iron stores  and causIn addition, the rates of fetal macrosomia were reported to be higher in donors than in nondonors (13.7% vs. 10.8%) in a previous study , althougIn our opinion, the following reasons may account for the differences. First, blood donation policies in different countries are diverse –24. For There are several strengths in our research. First, blood donation records were obtained from maternal Alipay software. On January 16, 2018, the Zhejiang Blood Center cooperated with Alipay software to launch the first electronic blood donation card on the Alipay platform in China. Individuals can query the exact blood donation data and blood destinations in Zhejiang Province by Alipay. Therefore, we took advantage of Alipay to research the frequency of blood donations before pregnancy and neonatal birth weight directly on a large local scale. To the best of our knowledge, this is the first study using the patient’s Alipay to obtain blood donation history. In addition, and to the best of our knowledge, we conducted a direct study on blood donation before pregnancy and neonatal birth weight, which is the first relevant study in China.However, there are some limitations in our study. First, due to the backwardness of the blood donation information system, the records of blood donation were only obtained from Zhejiang Province and not from the entire country in the study period. Fortunately, the history of donations in the entire country is readily available by Alipay, which is also the direction of our follow-up research. Second, demographics and clinical information, such as pre-pregnancy body mass index and detailed paternal information were not sufficiently obtained from EMR. Third, the association between the amount of donated blood and fetal birth weight was not analyzed. Fourth, the sample size in the study was relatively small, especially of low birthweight in low-frequency and high-frequency donors and fetal macrosomia in high-frequency donors, so it may not be representative of a larger population. Therefore, more multicenter studies with larger sample sizes are warranted.Our study showed that blood donation in the 3-year period before pregnancy may not lead to a reduction in neonatal birth weight, but may be associated with the incidence of fetal macrosomia. However, more research is needed to further verify this hypothesis.S1 File(PDF)Click here for additional data file.


Recently, the importance of mechanical facilities in charge of the safety and comfort of occupants in buildings has once again been highlighted in accordance with global social issues such as the spread of COVID-19. In response, various ventilation systems are being developed to improve indoor air quality, and efforts are being made to satisfy the indoor comfort of the occupants. Such advanced facilities allow occupants to secure indoor air quality, while frequent ventilation systems can affect the cooling and heating load in the building, and there is also a problem that it can occupy a relatively large amount of space in the building. This study proposes an integrated, outdoor fan-ventilated cooling device and analyzes its performance and economic efficiency. The EnergyPlus simulation program was used to model two types of systems for comparison: an existing (base) model with a condenser located in the outdoor unit, and a developed model with the condenser integrated within the cooling system. The state of the air passing through the condenser was analyzed prior to comparing the efficiency of the integrated, outdoor fan-ventilated cooling device, followed by an in-depth analysis of the performance and economic efficiency based on total energy consumption. In Case 1, the air passing through the cooling system was approximately 5  ThereJeong et al. classified ventilation methods as natural, mechanical, or hybrid . NaturalMost domestic ventilation systems combine evaporative cooling in dedicated outdoor air systems and apply thermal energy reuse through heat exchangers . RecentlSantos et al. applied thermal energy storage technology using phase change material (PCM) to an integrated mechanical ventilation system and to reduce the error of simulated results via onsite ventilation and air conditioning measurements . The inc−1 and absorption height was 0.1 m. Combining DPV, RFCS, and DV demonstrated that the local thermal environment near the occupant and indoor air quality could be improved.Jiying et al. quantified the local thermal comfort and ventilation effects near humans by performing computational fluid dynamics (CFD) simulations on a radiant floor cooling system (RFCS) and displacement ventilation (DV), and combined, ductless, personalized ventilation (DPV) . The lowPinar et al. studied the application of energy-efficient, evaporative cooling, from which a high efficiency rate and cost effectiveness was derived in high-temperature and dry climatic zones . SubsequWang et al. developed an integrated condensing, heat recovery device to analyze the energy consumption of the system and calculate the annual recovery in static and dynamic investments . The opeBordignon et al. studied integrated systems that combined heat exchangers for heating and cooling residential structures . The impErjian Chen et al. studied Absorption-compression hybrid systems that consist of absorption and vapor compression cycle have advantages on both energy cost-effectiveness . In thisGauray et al. a small-scale triple-hybrid air-conditioning system operated by biomass and solar energy resources is experimentally investigated . In thisGauray et al. thermally driven vapor absorption-based air-conditioning systems possess many advantages over the compression-based systems . In thisAlthough many individual studies have been conducted on the efficiency of ventilation systems, cooling systems, and energy savings, studies on systems that combine them are insufficient. While such advanced arrangements improve indoor air quality, frequent application of ventilation systems may affect the cooling and heating load. Therefore, a study quantitatively analyzing the efficiency and energy savings of the system combined with the existing ventilation system and cooling system is essential and has new novelty.In addition, there is an advantage in space utilization because an outdoor unit installation space is not required separately. This paper proposes an integrated, outdoor fan-ventilated device to address the abovementioned limitations and analyzes its performance and economic efficiency.22.1In the existing system, heat recovery ventilation system, heat pump, and air purifier are installed separately in the building for cooling, ventilation, and air purification. The integrated, outdoor fan-ventilated cooling device proposed in this paper and its structure of application are shown in The operation mode of integrated, total heat exchanger cooling system is shown in In the ventilation mode (b), contaminated indoor air and fresh outdoor air are mixed in the heat exchanger and supplied to the room through the UVC/HEPA filter. Like a typical ventilation system, contaminated air in the room can be exchanged for fresh outside air.The automatic switching mode of cooling/fast ventilation + cooling (outdoor air cooling) (c) automatically switches to rapid ventilation + cooling mode by detecting indoor fine dust and carbon dioxide concentration during cooling operation, and automatically switches to cooling mode when indoor air pollution becomes comfortable. The amount of ventilation through the typical ventilation system is 0.5 times/h, but if this mode is operated, ventilation is possible 4 to 5 times/h, and the effect of ventilating by opening the window can be obtained. It is possible to quickly remove indoor pollutants in a shorter time than in a typical ventilation mode and recover them to a clean state.The air cleaning mode (d) automatically adjusts the air volume according to the indoor fine dust and carbon dioxide concentration and resupplies it indoors through a UV/HEPA filter. It is possible to clean the air volume of 300CMH or more, and it is possible to automatically adjust the air volume by detecting indoor pollutants.In the dehumidification mode (e), external air passes through the condenser and the inverter compressor. And is mixed with indoor air in the evaporator, and the dehumidified air is supplied to the room. It is possible to dehumidify by automatically adjusting the air volume according to the user’s set humidity, and there is an advantage that indoor premise dehumidification is possible with one device.The bypass mode (f) is a mode that enables ventilation with fresh air without heat exchange on a day when the temperature difference between indoor and outdoor is small, and prevents intersection of supply and discharge.2.22, was chosen as the subject. The modeling image of the unit to be analyzed is shown in A dynamic simulation program, EnergyPlus, was used to analyze the performance of the integrated, outdoor fan-ventilated cooling device. By considering the capacity of the developed cooling system and applying weather data, Incheon City, a small-scale residential structure with an actual operating area of 33 m2.32.3.1total was calculated  of Eq. c and d can be adjusted to 0.The constant in Eq. If the total ton of refrigeration (RT) is determined by the above equation, the amount of heat released from the condenser can be obtained by Eq. A total heat exchanger and air-cooled, packaged air conditioner currently used in South Korea was used to process the hourly air conditioner energy consumption in summer from June 1 to September 31, 2021. Two types of system operation were used, an outside air condenser cooling, and condenser cooling using air near the total heat exchanger output. Standard meteorological data based on TMY/ISO 15927-4:2005 was used for the corresponding region .Table 1S33.13.1.1The temperature around the outdoor fan room, where the condenser was mounted, was ∼5 3.1.2−1 during its operation.In Case 1, the maximum energy consumption was 3134.60 Wh at 08:00, which was the.Onset of occupancy, demonstrating an 11% peak load reduction compared to the maximum energy consumption of 3270.81 Wh of the existing method, which utilizes the air within the outdoor fan room. This improvement in performance was attributed to enhanced condensation efficiency as the temperature and humidity of the exhaust gas from the total heat exchanger was similar to the air indoors rather than the outdoor fan room. Given the current system that is heavily determined by electricity bills, the difference in energy consumption between Case 1 and the Base Model was proportional to the duration of peak load. Therefore, it was determined that applying the developed model in commercial structures would be cost effective.3.1.33.2In Section In In 4Previous literature on systems that combine ventilation, cooling, and heating analyzed efficiency and payback period based on recovering exhaust gas energy. In addition, in the case of a system that integrates cooling and heating and heat exchangers, literature on increasing energy consumption has also been reported.This study compared the performance and economic efficiency of the Base Model, a commonly used cooling device that places the condenser in an outdoor fan room, and an integrated, outdoor fan ventilation cooling device system (Case 1).The air passing the cooling system in Case 1 was ∼5 This study also has a limitation in that analysis was conducted only on small residential buildings according to the air volume and size of the developed combined system. In addition, in order to increase energy efficiency, it is necessary to analyze the energy saving rate by controlling strategy of cooling and heating period. In future studies, the research results will be generalized by comparing measurement data and simulation data for empirical buildings by control strategy and verifying energy savings.When designing in the existing method, cooling facilities such as air conditioners were selected through cooling loads per area, and ventilation facilities were selected based on the standard of ventilation volume per person. On the other hand, when designing a combined system, there is no outdoor unit in the construction part, so it is possible to use the part advantageous for the space. In addition, cooling and ventilation can be performed through mode switching, and the cost reduction effect is excellent compared to each existing equipment. The results of this study are expected to be used for energy efficiency policies such as green remodeling and zero energy building certification systems.5This study developed an integrated, outdoor fan-ventilated cooling device and analyzed its efficiency relative to a standard model. Positive results were obtained in overall energy efficiency. However, application is limited to the experimental results derived from a relatively small-scale, residential structural unit. Therefore, subsequent research on the operational methods associated with larger air conditioners is considered necessary for widespread application of the equipment.Ja-Kang Yang, Doo-Yong Park: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.Hyun-Je Lee, Sun-Hyo Park, Young-Tae Chae, Jong-Soo Choi: Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data.10.13039/501100014189IPET) and Korea Smart Farm R&D Foundation (KosFarm) through Smart Farm Innovation Technology Development Program, funded by Ministry of Agriculture, Food and Rural Affairs (10.13039/501100003624MAFRA) and Ministry of Science and ICT (10.13039/501100014188MSIT), Rural Development Administration (10.13039/501100003627RDA)(grant number. 421008-04-2-HD080). And also this work is supported by the 10.13039/501100007694Korea Agency for Infrastructure Technology Advancement (10.13039/501100007694KAIA) grant funded by the 10.13039/501100003565Ministry of Land, Infrastructure and Transport (grant number. 22PIYR-B153277-04).This work was supported by Korea Institute of Planning and Evaluation for Technology in Food, Agriculture and Forestry (Data included in article/supplementary material/referenced in article.The authors declare no conflict of interest.


Relevant research focusing on young adults with Unipolar Depression (UD) and Bipolar Depression (BD) is limited. The current research aims to investigate childhood trauma and personality traits in young adults with UD and BD.n = 79), UD (n = 131), and BD (n = 104) groups. Factors independently associated with mood disorders and BD were determined using binary logistic regression analyses.Two hundred and thirty-five patients in a first depressive episode (diagnosed UD and BD), 16–25 years old, were recruited from Second Xiangya Hospital. And 79 healthy controls (HC) were recruited from the community to form the comparison group. Patients' childhood trauma was measured by the Childhood Trauma Questionnaire (CTQ), and personality was measured by Eysenck Personality Inventory (EPI). The Kruskal-Wallis test was used to compare depression, anxiety, CTQ, and EPI scores between the HC , emotional neglect , and neuroticism  were associated with significantly increased odds of mood disorders. Whereas, higher extraversion scores were a protective factor for mood disorders. Compared with UD, BD had more severe anxiety symptoms, and higher CTQ, than extraversion and neuroticism personality scores. Anxiety  and extraversion  were associated with significantly increased odds of BD.Interventions to prevent childhood trauma may improve young adults' mental health. Using childhood trauma and personality to anticipate BD and UD creates more accurate treatment for young adults with first depression. In 2022, the World Health Organization (WHO) estimates that there are 280 million people with depression in the world, accounting for 3.8% of the total population and resulting in a high global burden, particularly in low and middle-income countries where 75% of the population receive no treatment . Based oAs stated, BD and UD are prevalent in young adult, especially in the case of childhood trauma. In a multivariate model of the pathogenesis of depression, childhood trauma is a common psycho-social factor. Specifically, it is closely related to chronic depression with a long duration of the illness and higher severity of symptoms. Childhood trauma usually refers to adverse events that occurred in childhood, including abuse and neglect of physical and mental health . AccordiPrevious studies have shown that severe depression, atypical symptoms of depression, parental history of BD, comorbid psychotic symptoms, and childhood trauma are all risk factors for UD developing into BD . The etiIn China, the lifetime prevalence rate of depression is 6.9%, and more than 95 million people suffer from depression, accounting for 7.3% of the total population, which is the largest number of depressed patients in the world . TherefoThis study is part of the Youth Depression Cohort  study (YDC-XY), which was conducted in the Second Xiangya Hospital of Central South University from January 1st, 2018 to June 2nd, 2021. A flowchart describing the patient recruitment procedure is presented in A total of 235 young adults in a current depressive episode  who met the eligibility criteria were included in this study. Then, outpatients were divided into two groups (1) UD group and (2) BD group, using the diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Among the 235 outpatients, 131 (55.7%) patients were diagnosed with UD  and 104 (44.2%) with BD . Meanwhile, 79 HC individuals  were recruited and matched by age, sex, and years of education.A face-to-face interview confirmed a psychiatric diagnosis of UD or BD, which was completed by a senior psychiatrist using the Mini-International Neuropsychiatric Interview (M.I.N.I). In addition, a short structured psychiatric diagnostic interview was designed to meet the need for a quick but accurate structured interview procedure. Socio-demographics and clinical data were collected including age, sex, educational level (years of schooling), marital status , nationality , and occupation . A history of smoking, drinking, and drug use, as well as a family history of psychiatric disorders, were also captured.Beck Depression Inventory (BDI), is a self-rated depression scale. There are many versions, in this study the shortened Beck Depression Inventory (BDI-13)  was usedBeck Anxiety Inventory (BAI)  was usedThe Childhood Trauma Questionnaire-Short Form (CTQ-SF), compiled by Bernstein et al. , is a 28There are many versions of the Eysenck Personality Inventory, in this study the Chinese version of the Eysenck Personality Inventory (EPI-RSC) was used. EPI-RSC was used to measure personality traits of young adults in this study, which is based on the EPQ-R short Scale (EPQ-RS) and had satisfactory reliability and validity in Chinese youth 16 years or older . It is aP < 0.1 in the Kruskal-Wallis test were entered into the regression model as independent variables. Moreover, the association between the subscale score of the EPI and CTQ was tested using Spearman's correlation coefficient. Significance level was set at P < 0.05 two-sided.All data were analyzed using SPSS 25.0. Quantitative data are expressed in the form of mean ± standardized deviation (SD). The Kruskal-Wallis test and Chi-squared tests were used to compare differences in demographic and clinical data between groups. Binary logistic regression models were executed to examine the independent variables associated with mood disorders and risk factors of BD. Variables with The socio-demographic and clinical data of the three groups are shown in P < 0.05). While, the HC group presented with higher scores on the extraversion personality. The difference between the two groups (BD vs. UD) showed that patients with BD were more likely to suffer from higher scores on childhood trauma. Inclusive of the total score of the CTQ , subscales of emotional abuse , and sexual abuse . Furthermore, patients with BD presented with more severe anxiety symptoms , and the results of EPI showed that the BD group presented with higher scores on the extraversion and neuroticism personality traits than the UD. And the neuroticism personality of BD is highest among the three groups. There was no significant difference in the remaining subscales  showed that the BDI score, BAI score, total CTQ-SF score plus subscale score, and the EPI neuroticism score and psychoticism score, in the UD and BD groups were significantly higher than the HC group  and higher anxiety scores  were the risk factors associated with BD  = 1.47, 95% CI = 1.08–2.01)] and emotional neglect , as well as neuroticism , were all risk factors associated with mood related depression. Higher scores in extraversion  was considered a personality trait with protective factors associated with mood related depression see . Similarh BD see .Spearman's correlation analysis revealed that the extraversion personality trait was negatively associated with childhood trauma. However, neuroticism and psychoticism personality traits were positively associated with childhood trauma. Notably, there was no significant correlation between childhood trauma and neuroticism or psychoticism personality traits in BD see .P < 0.001) and high anxiety scores , which was more likely to be found in depressed young adults who had experienced more childhood trauma than the HC . The prevalence of childhood trauma in our sample is mostly aligned with previous work from census surveys like the Netherlands Study of Depression and Anxiety, which reports point prevalence in Dutch individuals, where those who self-report childhood trauma have either a current or remitted mood disorder (88.6%)  and compared them with HC. As our results show, depression in young adults display obvious clinical symptoms, which are manifested in the high depression scores  . Similar (88.6%)  found th (88.6%)  further  (88.6%) . The resThere was a statistically significant association between most forms of childhood trauma, especially emotional abuse, emotional neglect, physical abuse, and physical neglect with relation to depression in present study. The association of depression with childhood trauma is consistent with findings from other studies, where childhood trauma increases the risk for depression. Childhood trauma is linked to more severe impairment in individuals with depression , for insAnother important finding of this study is that a high score on the extraversion personality traits and anxiety symptoms are risk factors for patients in a current depressive episode that result in a diagnosis of BD. Previous studies show that, when compared to UD patients, BD patients have shown lower, higher, or equal neuroticism scores, and higher or equal extraversion scores. The reason for this disunity may be that personality has a certain degree of heredity. In support, a twin study implied that the quality of personality traits (extraversion) can be influenced by heredity . ExtraveFinally, the results of the correlation between childhood trauma and personality traits show that childhood trauma was positively correlated with neuroticism and psychoticism personality traits, and negatively correlated with extraversion among the total participating young adult. In the BD group participants self-reported more severe childhood trauma, but it seems that the BD's personality is not closely related to childhood trauma like UD and HC. The correlation indicated that the relationship between childhood trauma and personality traits in the BD group was not a simple linear correlation. Our research suggests that the etiological factor and pathogenesis of UD show a preference for environmental factors, such as childhood trauma, while the etiological factor and pathogenesis of UD show a preference for genetic factors, with 30–40% of occurrences of BD involving a genetic factor, according to epidemiological research . UnderstThe strengths of this study included a large sample of medication-naive young adults in a current depressive episode. The results suggested that high scores on extraversion and anxiety were the risk factors for developing BD. This study explored the relationship between childhood trauma and personality among UD, BD, and HC, and provides some indications for future clinical interventions, which is of significance for the early identification of UD and BD. However, some methodological limitations need to consider when explaining our findings. Firstly, although our study has 3 months to 2 years follow-up, which is just used to determine the participants' diagnosis, the design of this study is still a cross-sectional design. Therefore, a causal relationship between personality traits, mood depression, and associated risk factors could not be generated. Secondly, other potentially associated factors of mood depression, such as residential instability and socioeconomic status were not examined . ThirdlyIn summary, childhood trauma, as an environmental stimulus, during the early stages of growth, is related to the susceptibility to developing a mood disorder. Personality traits may play an assumed role in the susceptibility to mood disorders by influencing the individual's response to environmental stimuli and stress. Our findings also indicated that different patterns of personality traits persisted in the subtypes of BD and UD, with BD participants showing higher scores on the extraversion personality trait and anxiety symptoms. The combination of personality traits and childhood trauma can be regarded as individual vulnerability factors for developing mood disorders and other related behavioral problems. Our findings add empirical support to the applicability of personality measurement in the study of mood disorders, especially for patients with BD.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.The study approval was granted by the Ethics Committee of the Second Xiangya Hospital of Central South University  on December 27th, 2018. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.JL, JZ, and XCa conceived and designed the study. XCh, PL, HT, and CL participated in the acquisition of data. JL analyzed the data and drafted the manuscript. YW, AW, YT, XW, XCa, and JZ revised the manuscript. All authors read and approved the final manuscript.