Journal of Shandong University (Health Sciences)

Roles of ferroptosis in asthmatic airway remodeling

SUN Congcong, CUI Wenjing, ZHANG Jintao, ZHANG Dong, LIU Xiaofei, PAN Yun, QI Qian, XU Jiawei, ZENG Rong, GUO Hongxi, DONG Liang

Journal of Shandong University (Health Sciences). 2024, 62(7): 1-9. doi:10.6040/j.issn.1671-7554.0.2024.0467

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Objective To explore the contribution of ferroptosis to airway remodeling in asthma by establishing a ovalbumin(OVA)-induced asthma mice model, and to provide new directions in the treatment of airway remodeling of asthma. Methods Twenty-four female C57BL/6 mice were stochastically divided into four groups: the control group(n=6), the OVA group(n=6), the ferrostatin(Fer)-1 group(n=6), and the Fer-1+OVA group(n=6). The association between ferroptosis and asthma was clarified by establishing the differentially expressed genes of lung tissues in the OVA-induced asthma mice and controls screened from public databases. The iron concentration was measured by iron detection kit and Perls stain, and the expression of glutathione peroxidase 4(GPX4)protein was evaluated by Western blotting and immunohistochemical staining. The levels of the lipid peroxidation product malondialdehyde(MDA)in lung tissue were assayed and the ultra-structural changes in the airway epithelium were observed using transmission electron microscopy(TEM). Lung tissue slices were stained with Masson staining to evaluate collagen deposition. To further verify the effect of ferroptosis inhibitor on the airway remodeling in asthma, the mice were intervened with Fer-1, and then collagen deposition was evaluated by MASSON staining, the expression of GPX4 protein was detected by immunofluorescence and Western blotting. Results The results of bioinformatics analysis showed that the ferroptosis signaling pathway was significantly enriched in OVA group, suggesting that ferroptosis played a certain role in the pathogenesis of asthma. Meanwhile, in this gene set, GPX4 was significantly decreased in OVA group. In asthma mice model, collagen deposition was accompanied by a series of ferroptosis features such as increased iron concentration, decreased GPX4 expression, MDA accumulation, increased collagen deposition, and characteristic ultra-structural changes in the airway epithelium, suggesting that ferroptosis was intimately linked with asthma airway remodeling. After treated with Fer-1, for the asthma model mice, the GPX4 expression was elevated, the collagen deposition was reducted, the expressions of airway remodeling indicators were suppressed, and epithelial cell markers were increased. Conclusion Ferroptosis participates in the pathogenesis of asthma airway remodeling, ferroptosis inhibitor Fer-1 attenuates airway remodeling in asthma, and the application of Fer-1 provides a new therapeutic target for asthmatic airway remodeling.

Construction and evaluation of an online clinical risk model for predicting in-hospital mortality in patients with ARDS based on SII

SUN Lina, BAI Hongyan, NIU Zongge, ZHANG Fushuai, QU Yiqing

Journal of Shandong University (Health Sciences). 2024, 62(7): 10-20. doi:10.6040/j.issn.1671-7554.0.2024.0004

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Objective To explore the risk factors of in-hospital mortality in patients with acute respiratory distress syndrome(ARDS)based on systemic immune inflammation index(SII), and to develop a prognostic prediction model. Methods The data of 219 patients who met the diagnostic criteria of ARDS in Qilu Hospital of Shandong University from December 2022 to September 2023 were collected and randomly divided into a training group(n=165)and a verification group(n=54)in a ratio of 3∶1. The receiver operating characteristic(ROC)curve was used to explore the predictive value of SII for in-hospital mortality in patients with ARDS. A nomogram model predicting the risk of in-hospital death in patients with ARDS using independent risk factors derived from multifactorial Logistic regression analysis was constructed. The prediction efficiency of the nomogram was evaluated by ROC area under the curve(AUC), calibration curve and decision curve analysis(DCA). Results Compared with novel inflammatory indexes such as platelet-to-lymphocyte ratio(PLR), monocyte-to-lymphocyte ratio(MLR), C-reactive protein-to-albumin ratio(CAR)and lactate dehydrogenase-to-albumin ratio(LAR), the AUC of SII was the most prominent(AUC=0.79). When the optimal cutoff value was 3 096.60×10⁹/L, the sensitivity and specificity of SII in predicting in-hospital mortality in patients with ARDS were 73.70% and 76.40%, respectively. Multivariate Logistic regression analysis showed that SII, age, CRP, chronic liver disease and chronic kidney disease were independent risk factors for in-hospital mortality in patients with ARDS(all P<0.05). The AUC of the nomogram model in the training group and the verification group were 0.876 and 0.848, respectively. The calibration curve and DCA confirmed that the model exhibited a satisfactory degree of clinical predictive efficacy. Conclusion The high levels of SII on admission are associated with increased risk of in-hospital death in patients with ARDS. The online nomogram constructed based on SII can early predict the in-hospital mortality of patients with ARDS, with high differentiation, accuracy and clinical practicability.

Identification of necroptosis-related biomarkers in asthma based on machine learning algorithms

WANG Jing, LIU Xiaofei, ZENG Rong, XU Changjuan, ZHANG Jintao, DONG Liang

Journal of Shandong University (Health Sciences). 2024, 62(7): 21-32. doi:10.6040/j.issn.1671-7554.0.2024.0114

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Objective To identificate and validate of potential necroptosis-related genes(NRGs)in asthma through bioinformatics analysis. Methods The Gene Expression Omnibus(GEO)database provided the gene expression profile dataset GSE76262, and R software was used to screen for potential differentially expressed NRGs. Protein-protein interactions(PPI)analysis, gene ontology(GO)enrichment analysis, and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis were performed on the differentially expressed NRGs. The up-regulated NRGs were analyzed by least absolute shrinkage and selection operator(LASSO)logistic regression and support vector machine-recursive feature elimination(SVM-RFE)algorithms. Common signature genes were identified as potential diagnostic markers, and receiver operator characteristic(ROC)curves were drawn to verify their diagnostic efficacy. The expression and diagnostic efficacy of the screened signature genes were further confirmed by GSE137268. Online tools were used to predict microRNAs(miRNAs)that can target and regulate the expression of signature genes. Results Thirty-three differentially expressed NRGs(13 up-regulated and 20 down-regulated)were identified in 118 asthma patients and 21 healthy controls. The PPI results indicated that 20 differentially expressed NRGs interacting. GO and KEGG enrichment analyses revealed enrichment items related to multiple signaling pathways, lymphocyte activation, apoptosis, and immune regulation. LASSO and SVM-RFE showed that seven up-regulated NRGs could be potential diagnosis genes. The ROC curves showed high diagnostic efficiency with the area under the curve(AUC)higher than 0.7. GSE137268 verified that seven signature genes showed the same expression trend as the training set(AUC>0.65). Hsa-miR-138-5p, hsa-miR-200b-3p and hsa-miR-30e-5p were predicted to regulate the expression of necroptosis genes in asthmatic patients. Conclusion BIRC3, HIF1A, FLOT1, NLRP3, RIPK2, GBE1 and PELI1 can serve as potential biomarkers for asthma. Hsa-miR-138-5p, hsa-miR-200b-3p and hsa-miR-30e-5p are upstream regulators of HIF1A, RIPK2 and PELI1, respectively.

Correlation between asthma and pertussis infection in children of Shandong Province, China

YAN Jinyan, YANG Chun, LI Lei, WU Fuling, JIAO Yongli, ZHANG Xiaowei, LI Jing, ZHANG Ruizhen, WANG Lei, MA Xiang

Journal of Shandong University (Health Sciences). 2024, 62(7): 33-41. doi:10.6040/j.issn.1671-7554.0.2024.0435

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Objective To assess the prevalence of pertussis infection in children with asthma across different stages and subtypes and to analyze the correlation between the two diseases via a multicenter prospective investigation. Methods Information was collected from children with asthma who had a cough ≥1 week through questionnaires, and pertussis toxin(PT)IgG antibodies levels and/or pertussis nucleic acid tests were performed to interpret the results. The distribution of pertussis antibody, infection and clinical characteristics of different groups were analyzed according to different age, asthma stage and pertussis infection. Results Among the 1,049 asthmatic children, the positive rate of PT-IgG was 26.22%, and the rate was significantly higher in ≥6 years old group compared with 3 months -< 3 years old group and 3 years -< 6 years old group(both P<0.001). The overall rate of pertussis infection in asthmatic children was 25.17%, with an increasing trend in infection rates corresponding to advancing age(P<0.001). The incidence rate of cough variant asthma combined with pertussis infection was significantly higher than classical asthma(28.00% vs. 22.59%, P=0.040). According to the clinical characteristics of 656 children, the incidence rate of pertussis infection was higher in patients with acute asthma attack than in chronic duration and clinical remission(26.15% vs. 10.46%, P<0.001; 26.15% vs. 8.00%, P=0.042). There was no significant difference between newly diagnosed and recurrent cases of asthma(P=0.189). Asthmatic children with pertussis were more likely to have spasmodic cough, facial redness, chickenlike echo and vomiting symptoms than those without pertussis(all P< 0.05). Morning cough was more common in asthmatic children without pertussis(9.36% vs. 4.20%, P=0.047). There was no significant difference in other cough phase characteristics at night, morning or night, day and after exercise between the two groups(all P>0.05). There were no significant differences in leukocyte count, neutrophil count, lymphocyte count, eosinophilic count, and IgE levels between the two groups(all P> 0.05). Conclusion The pertussis detection is prevalent in children with asthma, especially during acute asthma exacerbation. Clinical symptoms have certain significance to distinguish the two diseases, but laboratory examination results show no significance between the two diseases. It is recommended that routine screening for pertussis should be conducted for asthmatic children with cough for more than 2-4 weeks to better identify or judge and guide treatment.

Adult cystic fibrosis: a case report and literature review

CHEN Qian, QIU Yifan, CHEN Shilong, WANG Chao, DONG Liang, SUN Congcong

Journal of Shandong University (Health Sciences). 2024, 62(7): 42-47. doi:10.6040/j.issn.1671-7554.0.2024.0075

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Objective To report the treatment process and diagnosis of an adult patient with cystic fibrosis(CF)and review the literature, so as to improve clinicians awareness of this rare disease for early diagnosis, standardized treatment and management. Methods The clinical data of a CF patient with bronchiectasis and hemoptysis as the main manifestations admitted to the Department of Respiratory and Critical Care Medicine of Shandong Provincial Qianfoshan Hospital on April 9, 2022 were retrospectively analyzed. "Cystic Fibrosis" and "Case Reports" were used as keywords to search the related literature in China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and PubMed database. Results A 24-year-old female patient presented with "recurrent cough and expectoration, decreased activity endurance for more than 20 years, and hemoptysis for 6 years". According to the clinical symptoms and imaging changes such as bronchiectasis and hemoptysis, recurrent pulmonary infection, gastrointestinal insufficiency, and electrolyte disturbance, and genetic testing result of a homozygous mutation of c.320C>A:p.A107D, the patient was diagnosed with CF. Conclusion The incidence rate of CF in Chinese is low. The understanding of its etiology and clinical manifestations should be improved. When patients have multiple mucous rheological changes in the airways, digestive glands, digestive tract, sweat glands, and so on, CF needs to be considered. It is recommended to conduct gene testing, early diagnosis and timely treatment to improve the prognosis.

Mendelian randomization study of visceral adipose tissue and lung diseases

FENG Yue, YU Yifan, WU Sijia, LI Hongkai, XUE Fuzhong

Journal of Shandong University (Health Sciences). 2024, 62(7): 48-55. doi:10.6040/j.issn.1671-7554.0.2024.0534

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Objective To investigate the causal relationship between obesity and lung diseases using Mendelian randomization(MR)methodology. Methods Employing the inverse variance weighted(IVW)method in conjunction with six distinct MR methodologies, and utilizing summary data from genome-wide association studies(GWAS), the causal relationships between visceral adipose tissue(VAT)and lung diseases, including chronic obstructive pulmonary disease, sleep apnea, lung cancer, pneumonia, pulmonary embolism, idiopathic pulmonary fibrosis and tuberculosis, were assessed. Sensitivity analysis was performed using the leave-one-out method, Cochrans Q test, MR-Egger regression intercept term test, and MR-PRESSO test to evaluate the heterogeneity, pleiotropy, and stability of the instrumental variables. Results The results of the IVW method indicated that genetically predicted higher VAT was causally associated with higher occurrence risks of chronic obstructive pulmonary disease(OR=1.56, 95%CI: 1.33-1.84, P<0.001), sleep apnea(OR=1.76, 95%CI: 1.53-2.03, P<0.001), lung cancer(OR=1.39, 95%CI: 1.23-1.58, P<0.001), and pneumonia(OR=1.22, 95%CI: 1.15-1.30, P<0.001). Except for MR-Egger, the results of the other four MR methods were consistent with the main analysis results. In addition, there was evidence suggested that higher VAT would increase the occurrence risks of pulmonary embolism(OR=1.18, 95%CI: 1.04-1.34, P=0.009)and idiopathic pulmonary fibrosis(OR=1.00, 95%CI: 1.00-1.00, P=0.011). Conclusion VAT accumulation may increase the occurrence risks of chronic obstructive pulmonary disease, sleep apnea, lung cancer, pneumonia, pulmonary embolism and idiopathic pulmonary fibrosis.

Effect of vascular endothelial growth factor-B on the dopamine level in the retina of guinea pigs with form-deprivation myopia

JIANG Jun, GAO Honglian, SUN Ruiting, SUN Xin, PENG Qingsheng, ZHANG Shoukuan, ZHANG Lei

Journal of Shandong University (Health Sciences). 2024, 62(7): 62-71. doi:10.6040/j.issn.1671-7554.0.2024.0245

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Objective To study the effect of intravitreal injection of vascular endothelial growth factor-B(VEGF-B)on the level of dopamine(DA)in the retina of form-deprivation myopia(FDM)guinea pigs. Methods A Total of 147 healthy 3-week-old guinea pigs, male or female, were selected and randomly divided into 7 groups, with 21 guinea pigs in each group. The eyes of guinea pins in the blank group were not intervened,and the right eyes of the guinea pins in other 6 groups were covered with translucent latex balloon for 14 days to establish the FDM model. After preparation, 2.5 μL of PBS buffer and VEGF-B at concentrations of 0.25 ng, 2.5 ng, 5 ng and 50 ng were intravitreally injected into the right eye of the guinee pigs in the PBS group as well as the groups of 0.25 ng, 2.5 ng, 25 ng and 50 ng. Ocular refraction and axial length were recorded in both eyes of each animal before and after modeling. After 14 days, immunofluorescence was used to detect the number of tyrosine hydroxylase positive cells; Western blotting was used to detect the expression of TH protein in the retina; HE staining was used to observe the number of retinal vascular endothelial cell nuclei; and high performance liquid chromatography was used to determine DA and 3,4-dihydroxyphenylacetic acid(DOPAC)content and DA metabolic rate. Results Before modeling,there was no significant difference in the diopter and axial length of the right eye among the 7 groups(P>0.05). After modeling, compared with the blank group, refractive error was shifted to the myopic side in the FDM and PBS groups, the axes of the eyes grew, and the TH, DA, and DOPAC levels were reduced(P<0.05). Compared to the FDM group, the guinea pigs in the VEGF-B groups(0.25 ng, 2.5 ng, 25 ng and 50 ng)exhibited a decrease in myopia progression and inhibition of axial elongation, accompanied by increased expression levels of TH, DA, and DOPAC(all P<0.05). As the concentration of VEGF-B increased, there was a gradual enhancement in the suppression of axial growth and reduction in myopia severity while observing a progressive elevation in TH expression and other indicators. There was no significant difference in the metabolic rate of DA and the number of retinal vascular endothelial cell nuclei among the 7 groups(P>0.05). Conclusion The intravitreal injection of VEGF-B can enhance retinal DA levels and inhibit axial elongation, thereby effectively suppressing myopia development in FDM guinea pigs without inducing neovascularization. Notably, the impact of VEGF-B on DA was particularly pronounced in the 50 ng group.

Clinical efficacy of polymyxin B in treatment of patients infected with carbapenem resistant Gram-negative bacteria in intensive care unit

SUN Xiaodan, YANG Chuang

Journal of Shandong University (Health Sciences). 2024, 62(7): 72-77. doi:10.6040/j.issn.1671-7554.0.2024.0040

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Objective To investigate the efficacy and safety of intravenous polymyxin B in the treatment of patients infected with carbapenem-resistant gram-negative bacteria in intensive care unit(ICU). Methods Clinical data of 69 hospitalized patients diagnosed with carbapenem-resistant Gram-negative bacillus infections and treated with intravenous polymyxin B during their hospitalization in the ICU of The Second Hospital of Shandong University from January 2022 to December 2023 were retrospectively analyzed. According to their clinical outcomes, the patients were divided into clinically effective group and clinically ineffective group, and the general data, clinical efficacy and safety of the drugs were analyzed. The statistically significant variables were subjected to Logistic regression to explore the factors affecting the efficacy of polymyxin B. Results There were no significant differences in age, sex, type of drug-resistant bacteria, use of continuous renal replacement therapy, white blood cell, procalcitonin, and bilirubin before treatment between the clinically effective group and the clinically ineffective group. The treatment time of clinically effective group was longer than that of clinically ineffective group(P<0.05). The acute physiology and chronic health evaluation II(APACHEII)score of the clinically effective group was lower than that of the clinically ineffective group(P<0.05). More patients in the clinically ineffective group were treated with mechanical ventilation and vasoactive drugs(both P<0.05). The difference of interleukin-6, creatinine, urea nitrogen, and estimated glomerular filtration rate before treatment between the two groups were statistically significant(P<0.05). Logistic regression analysis showed whether vasoactive drugs were used(β=-0.256,OR=0.128,95%CI: 0.029-0.574,P=0.007)and APACHEII score at ICU admission(β=-1.515, OR=0.220,95%CI: 0.060-0.809,P=0.023)were independently correlated with clinical efficacy. The proportion of liver injury was 20.83%(10/48). Conclusion Polymyxin B has a good therapeutic effect on hospital-acquired infections caused by multidrug-resistant Gram-negative bacteria. APACHEII score at ICU admission and vasoactive drug are independent factors related to the clinical efficacy of polymyxin B.

Development of preoperative models for predicting positive esophageal margin in proximal gastric cancer based on machine learning

GUO Zhenjiang, WANG Ning, ZHAO Guangyuan, DU Liqiang, CUI Zhaobo, LIU Fangzhen

Journal of Shandong University (Health Sciences). 2024, 62(7): 78-83. doi:10.6040/j.issn.1671-7554.0.2024.0292

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Objective To develop machine learning models for preoperative prediction of positive esophageal margins in proximal gastric cancer and to compare its prediction performance with conventional Logistics models. Methods A total of 382 patients with proximal gastric cancer who received operation at the Department of Gastrointestinal Surgery of Hengshui Peoples Hospital from January 2013 to December 2022 were retrospectively analyzed and divided into the margin-positive group(n=30)and the margin-negative group(n=352)according to the pathologic diagnosis. The clinicopathological factors that might affect the positive esophageal margins of proximal gastric cancer were collected, and the study population were randomly divided into the training set(n=254)and the test set(n=128)in a ratio of 2∶1. The unbalanced data in the training set were processed by synthetic minority oversampling technique(SMOTE). Three machine learning models, that is, the random forest(RF), support vector machine(SVM)and extreme gradient boosting(Xgboost), and Logistic regression model were established based on the balanced SMOTE dataset. The predictive performance of the different models was compared by the AUC values of the above four models in predicting positive esophageal margins in the test set, and the importance of the predictors in the best predictive model was visually ranked. Results RF had the highest AUC value(0.772, 95%CI: 0.620-0.925), followed by SVM(AUC: 0.747, 95%CI: 0.604-0.891), the Logistic regression(AUC: 0.716, 95%CI: 0.537-0.895), and Xgboost(AUC: 0.710, 95%CI: 0.560-0.859). The RF model had the best predictive performance. Tumor size, tumor location, Borrmann staging, Lauren staging and cT staging were the top 5 important factors in the RF model. Conclusion The established random forest model for preoperative prediction of positive margins in proximal gastric cancer shows good performance, with tumor size, tumor location, Borrmann staging, Lauren staging and cT staging being the main predictive factors.

Effect of Yunkang granule on pregnancy outcome of frozen-thawed embryo transfer

DU Juan, LI Xiufang, LI Yuanmei, WANG Huidan

Journal of Shandong University (Health Sciences). 2024, 62(7): 84-90. doi:10.6040/j.issn.1671-7554.0.2024.0557

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Objective To investigate the effect of Yunkang granules on pregnancy outcomes in frozen-thawed embryo transfer(FET). Methods A retrospective analysis was conducted on the clinical data of 2,610 FET cycles performed in Institute of Women, Children and Reproductive Health, Shandong University from January 2021 to December 2023. Patients were divided into the treatment group(n=782)and the control group(n=1,828)based on whether they took Yunkang granule. Pregnancy outcomes were compared between the two groups. Additionally, subgroup analyses were performed based on the FET protocols, that is, natural cycle, hormone replacement cycle, ovulation induction cycle, and down-regulation hormone replacement cycle. Results The clinical pregnancy rate in the treatment group(55.88%)was significantly higher than that in the control group(51.58%), with a statistically significant difference ［OR(95%CI)=1.26(1.04-1.53), P=0.016］. No statistically significant differences were observed in other pregnancy outcomes between the two groups. In the ovulation induction protocol, the clinical pregnancy rate and ongoing pregnancy rate in the treatment group(63.08%, 53.85%)were significantly higher than those in the control group(44.57%, 32.57%), with a statistically significant difference ［OR(95%CI)=1.89(1.02-3.50), P=0.044; OR(95%CI)=2.33(1.26-4.33), P=0.007］. However, no statistically significant differences were observed in pregnancy outcomes between the treatment group and the control group in the natural cycle, hormone replacement cycle, and down-regulation hormone replacement cycle. Conclusion Yunkang granules can improve clinical pregnancy rates and pregnancy outcomes, particularly in the ovulation induction protocol of the FET cycles.

Incidence and influencing factors of influenza-like illness among college students in Jinan during the influenza peak period in November 2023

LIU Feng, MA Caixia, LI Chunyan, CHENG Haiying, JIN Leyu, LIU Zhong, LI Xuewen

Journal of Shandong University (Health Sciences). 2024, 62(7): 91-97. doi:10.6040/j.issn.1671-7554.0.2024.0279

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Objective To investigate the incidence and influencing factors of influenza-like illness(ILI)among college students in Jinan during the influenza peak period in November 2023, so as to provide targeted policy recommendations for the subsequent prevention and control of influenza in schools. Methods A questionnaire survey was conducted among the students in 7 medical and non-medical colleges randomly selected from the main urban area and surrounding counties of Jinan by multi-stage sampling and objective sampling. Influencing factors of influenza were analyzed by univariate analysis and multiple Logistic regression analysis. Results A total of 2,306 college students were included in the analysis, and the incidence of ILI was 27.1%. Binary Logistic regression analysis results showed that medical major, diet regularity and influenza vaccine injection were the protective factors for influenza, and the OR(95%CI) were 0.38(0.29-0.50), 0.58(0.45-0.76)and 0.73(0.59-0.89), respectively. The time of going to sleep(22:00-22:59 vs.before 21:59, 23:00-23:59 vs. before 21:59, after 24:00 vs. before 21:59)and monthly frequency of insomnia(1-3 vs. never, 4-6 vs. never, ≥ 7 vs. never)were risk factors for influenza, and the OR(95%CI) were 1.65(1.12-2.45), 2.16(1.45-3.23), 2.05(1.27-3.31), 1.88(1.41-2.50), 2.10(1.53-2.89), and 2.61(1.72-3.94), respectively. Conclusion During the peak period of influenza in November 2023, the epidemic intensity of influenza among college students in Jinan was relatively high, especially the incidence of ILI in non-medical colleges was more serious than that in medical colleges. Therefore, non-medical colleges need to strengthen the propaganda and education work on the prevention and control of common diseases such as influenza, and guide college students to cultivate good eating and rest habits.

Current situation and influencing mechanism of knowledge, attitude and practice about chronic disease management among elderly people in Shandong Provinces proactive health demonstration area

GUO Yantong, YU Yuanyuan, CHEN Yingying, FU Yu, ZHANG Botao, YUAN Ying, SUN Shuangshuang, ZHAO Yingqi, ZHU Gaopei, XUE Fuzhong

Journal of Shandong University (Health Sciences). 2024, 62(7): 98-105. doi:10.6040/j.issn.1671-7554.0.2024.0166

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Objective To explore the level of knowledge, attitude, and practice and its influential mechanism of chronic disease management among the elderly in the proactive health demonstration area of Shandong Province, China. Methods Using a multi-stage random sampling approach, a total of 5 447 elderly people aged ≥65 were selected for questionnaire survey. T-test and one-way analysis of variance(ANOVA)were used to compare the scores of knowledge, attitude, and practice in chronic disease management. A multiple linear regression model was performed to analyze the influencing factors, and mediation analysis was used to explore the influencing mechanism. Results In the proactive health demonstration area of Shandong Province, the average knowledge score was 7.47±2.83, the average attitude score was 8.47±2.47, and the average practice score was 4.94±1.79. Regression analysis revealed that gender, age, living style, and self-assessed health status were the influencing factors of knowledge; age and living style were influencing factors of attitude; gender and age were influencing factors of practice. The mediation analysis showed that knowledge had predictive effect on attitude(β=0.670 1, P<0.001), behavioral intention(β=0.046 8, P<0.01), and practice(β=0.305 6, P<0.001). Attitude had predictive effect on behavioral intention (β=0.169 8, P<0.001)and practice (β=0.216 1, P<0.001), and behavioral intention positively predicts practice (β=0.029 1, P<0.05). The direct effect value of knowledge on practice was 0.193 9, accounting for 56.46% of the total effect. The value of indirect effect was 0.149 5, accounting for 43.54% of the total effect. Conclusion The level of knowledge and attitude about chronic disease management among the elderly in the proactive health demonstration area of Shandong Province is relatively high, but the level of behavioral transformation needs to be further improved. Attitude and behavioral intention towards chronic disease management play a mediatory role between knowledge and practice, and attitude can also improve the level of practice by changing the behavioral intention.

Health risk assessment of cadmium and lead in a certain county with multi-pathways from 2018 to 2022

WANG Suwei, LIU Yigang, AN Yuqin, YUAN Shuhua, HAO Haiyan, DING Tingting

Journal of Shandong University (Health Sciences). 2024, 62(7): 106-113. doi:10.6040/j.issn.1671-7554.0.2024.0510

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Objective To evaluate the health risks of cadmium and lead in air fine particulate(PM_2.5), drinking water, and soil of a certain county. Methods The monitoring data of cadmium and lead in the air PM_2.5, drinking water, and soil of a certain county from 2018 to 2022 were collected. The environmental health risk assessment model was applied to evaluate both carcinogenic risk and chronic non-carcinogenic risk caused by median concentration of cadmium and lead. The proportion of different exposure routes and the change of results in different years were analyzed. Results The carcinogenic risk values were 8.02×10^-7 for cadmium, and 2.50×10^-7 for lead, which were less than 1×10^-6 and at an acceptable level. The chronic non-carcinogenic risk values were 6.95×10^-2 for cadmium, and 1.09×10^-2 for lead. The hazard coefficients were less than 1 and had no significant harm. The comparison of carcinogenic risks through different pathways showed that cadmium and lead had the highest proportion of PM_2.5 inhalation in the air. The comparison of chronic non-carcinogenic risks through different pathways showed that cadmium had the highest proportion of inhalation pathways in air PM_2.5, while lead had the highest proportion of oral intake pathways in water. The carcinogenic and chronic non-carcinogenic risks of cadmium and lead were both lower in 2022 than in 2018. Conclusion From 2018 to 2022, the chronic non-carcinogenic risks and carcinogenic risks of cadmium and lead were at an acceptable level in the county. The proportion of PM_2.5 inhalation route was the highest in the comparison of health risk of different routes, so the monitoring and pollution management of PM_2.5 should be strengthened.

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