Chinese Public Health Research Articles

Development and validation of the Information Literacy Measurement Scale (ILMS-34) in Chinese public health practitioners

BackgroundPublic health professionals (PHPs) have increasing information needs to inform evidence-based public health decisions and practice, which requires good information literacy. A comprehensive and reliable assessment tool is necessary to assess PHPs' literacy and guide future promotion programs. However, there is a lack of measurement tools specifically for the information literacy of PHPs.ObjectivesThis study aimed to develop an information literacy assessment tool for PHPs and test its psychometric properties among PHPs.MethodsA 34-item Information Literacy Measurement Scale (ILMS-34) for PHPs was developed based on an extensive literature review, the Delphi method, and pilot testing. The ILMS-34 was further validated among 526 PHPs recruited from four cities in Guangdong Province, China, using convenience sampling. The sample was randomly divided into two equal groups for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Other psychometric testing included item analysis, Cronbach's α coefficient, three-week test–retest reliability, and known-group validity.ResultsEFA yielded four dimensions for the ILMS-34: information consciousness, information knowledge, information ability, and information ethics. Subsequent CFA showed a good model fit of the four-factor structure (χ2/df = 1.485, RMSEA = 0.043, SRMR = 0.038, TLI = 0.977, CFI = 0.979). There were significant differences in each item between the high and low-scoring groups (p < 0.001), indicating good item discrimination. The ILMS-34 demonstrated good internal consistency with a Cronbach's α coefficient of 0.97 for the total scale (four subscales: 0.92, 0.92, 0.98, and 0.91, respectively). It also showed good test–retest reliability after three weeks with an ICC coefficient of 0.67. The DSE-MS scores varied by various sample characteristics, verifying the known-group validity.ConclusionThe ILMS-34 is a multidimensional instrument with good psychometric properties and can be used as an effective tool to measure information literacy among PHPs. Further validation in other samples across various cultures is needed to test its broad application.

Disease burden comparison and associated risk factors of early- and late-onset neonatal sepsis in China and the USA, 1990-2019.

The morbidity and mortality rates of neonatal sepsis are high, with significant differences in risk factors and disease burden observed between developing and developed countries. To provide evidence to support recommendations on improving public health policies using a comparative systematic analysis of the disease burden. Using data from the Global Burden of Disease Study 2019, the prevalence and incidence of early- and late-onset neonatal sepsis and the disability-adjusted life years (DALYs) due to both countries in both China and the United States of America (USA) were assessed. Furthermore, the DALYs and summary exposure values for the primary risk factors (short gestation and low birthweight) were analysed. Joinpoint regression models were used to analyse temporal trends in epidemiological indicators of neonatal sepsis. Between 1990 and 2019, the incidence and prevalence of neonatal sepsis demonstrated a significant upwards trend in China, whereas both were largely stable in the USA. A decreasing trend in the DALYs due to neonatal sepsis caused by short gestation and low birthweight in both sexes was observed in both countries, whereas a fluctuating increasing trend in years lived with disability was observed in China. The aim of the Chinese public health policy should be to control risk factors, learning from the advanced health policy planning and perinatal management experiences of developed countries.

The connection between social capital and Chinese public health: an analysis of six Chinese general social surveys

This study examines the connection between social capital and the perceived health status for the Chinese public. Extending from previous research that uses unrepresentative samples, the current project analyzes nationally representative samples of approximately 60,000 respondents. The data are drawn from six waves of the Chinese General Social Survey conducted in 2010, 2012, 2013, 2015, 2017, and 2018, respectively. The multilevel regression approach is used for statistical estimation. Findings show a consistent pattern that social capital, encompassing social network and generalized trust, is positively related to one’s perceived health status across these years. In addition, the moderating impact of personal capital on the link between social capital and perceived health status is identified. Social capital has a greater health impact on those with lower personal capital than those with higher personal capital. This study complements current literature and has implications for public health policies.

A qualitative exploration of disseminating research findings among public health researchers in China

BackgroundResearch dissemination is essential to accelerate the translating of evidence into practice. Little is known about dissemination among Chinese public health researchers. This study aimed to explore the understanding and practices of disseminating research findings and to identify barriers and facilitators that influence dissemination activities to non-research audiences.MethodsThis study deployed an exploratory qualitative design with purposive and snowball sampling. One focus group with 5 participants and 12 in-depth interviews were conducted with participants working in diverse fields from universities (n = 10), the National Chinese Center for Disease Control and Prevention (n = 4), the Chinese National Cancer Center (n = 1), the Chinese National Center for Cardiovascular Disease (n = 1), and China office of a global research institute (n = 1) from May to December 2021 to reach saturation. Data were initially analyzed using inductive thematic analysis. The designing for dissemination (D4D) logic model was then used to organize themes and subthemes. Two coders independently coded all transcripts and discussed disparities to reach a consensus.ResultsOut of 17 participants, 12 misunderstood the concept of dissemination; 14 had disseminated to non-research audiences: 10 to the public, 10 to practitioners, and 9 to policymakers. We identified multiple barriers to dissemination to non-research audiences across four phases of the D4D logic model, including low priority of dissemination, limited application of D4D strategies, insufficient support from the research organizations, practice settings, and health systems, and overemphasis on academic publications.ConclusionsThere was a lack of understanding and experience of dissemination, indicating a lack of emphasis on active dissemination in China. We provide implications for raising awareness, building capacity, facilitating multidisciplinary collaboration, providing incentives and infrastructure, changing climate and culture, establishing communication and executive networks, and accelerating systematic shifts in impact focus.

A (Dis)orderly Progression: The Lasting Impact of Pandemic on Community-Based Organizations

ABSTRACT Community-based organizations (CBOs) serving older ethnic minority adults, especially older immigrants, are vital to satisfy their complex social, health, and behavioral health needs. This study uses organizational theories and a case study approach to examine how the organizational responses to the multifaceted impact of the COVID-19 pandemic and progress beyond the pandemic-related responses. Four CBOs serving older Chinese immigrants in New York City were examined. Results indicate that driven by unmet psychosocial needs of older Chinese immigrants and public health measures, CBOs modified practice protocols and established (or strengthened) collaborative relationships with medical providers and other CBOs. COVID-19 responses include CBOs’ transformations in organizational structures (e.g. collaboration) and operational activities (e.g. telehealth). Successful transformations of CBOs were primarily due to prior adaptiveness to integrated care reform and assured needed resources before the pandemic; the transformation reflected orderly organizational progress rather than a temporary management strategy.

Impact of the COVID-19 Pandemic on the Incidence of Notifiable Infectious Diseases in China Based on SARIMA Models Between 2013 and 2021.

During the COVID-19 pandemic, the Chinese government implemented nationwide public health interventions to control its spread. However, the impact of these measures on other infectious diseases remains unclear. The incidence of three types of notifiable infectious diseases in China were analyzed between 2013 and 2021. The seasonal Mann-Kendall test and Mann-Kendall mutation test were employed to examine trends and mutations in the time series. Based on the counterfactual inference, historical incidence rates were employed to construct SARIMA models and predict incidence between January 2020 and December 2021. Differences between reported and predicted incidences during the pandemic were compared using the Mann-Whitney U test. Between 2013 and 2019, the incidence rate of three types of notifiable infectious diseases fluctuated between 494.05/100,000 and 550.62/100,000. No discernible trend was observed for types A and B infectious diseases (Z = -1.344, P = 0.18). A significant upward trend was observed for type C infectious diseases (Z = 2.56, P = 0.01). In 2020, the overall incidence rate of three types of notifiable infectious diseases decreased to 367.08/100,000. Compared to predicted values, the reported incidence of three types of infectious diseases was, on average, 30.05% lower in 2020 and 16.58% lower in 2021. The public health interventions implemented during the pandemic had a positive consequence on the prevention and control of other infectious diseases, with a particularly notable effect on type C infectious diseases. Among the diseases with different transmission routes, respiratory diseases and gastrointestinal or enteroviral diseases decreased significantly.

Differences in socio-demographics status, risk behaviours, healthcare uptake and HIV/ sexually transmitted infections (STIs) between brothel-based and street-based female sex workers in Yunnan, China.

Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China's epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects. A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs. A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs. Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

China’s Compliance to International Health Law and Its Implication to Global Health Security

The Covid 19 pandemic presented a defining challenge to public health and global security. The outbreak of the pandemic in China and its global implications raised persistent doubts of states’ compliance to international health laws. The pandemic therefore, provides an opportunity for us to ascertain the extent to which China adhered to the International Health Regulations. Though a great deal of experts have scrutinized Chinese public health policies in the aftermath of the pandemic, China’s compliance to the 2005 International Health Regulation and its implication to global health security remained unclear. The analysis is largely derived from the Global Health Security-GHS Index and other primary legal texts. The GHS Index represents the first comprehensive unit of measurement of global health security across 195 countries that are parties to the 2005 International Health Regulations. The outcome of the analysis exposed significant gaps in China’s compliance to international health laws. It also indicates that, though international health laws provide useful guidance to prevent, respond and manage pandemics, they are implemented in an ad hoc manner and generally have few tools at their disposal to enforce compliance. China’s failure to timely and adequately discharge its duties under the International Health Regulation prior to and in the wake of Covid 19 shows that the international community needs a new legal enforcement mechanism to ensure that states act promptly, transparently and effectively to protect the world’s population against pandemics. The challenge of a lack of statutory enforcement mechanism is insurmountable and it remains uncertain what the future holds for global health security.

Feminization of the health workforce in China: exploring gendered composition from 2002 to 2020.

Feminization of health workforce has been globally documented, but it has not been investigated in China. This study aims to analyze changes in the gendered composition of health workforce and explore the trend in different types of health workforce, health organizations and majors within China's health system. The data were collected from China Health Statistical Yearbook from 2002 to 2020. We focused on health professionals including doctors, nurses, and pharmacists in health organizations. Trend analysis was employed to examine the change in the ratio of female health workforce over 18years. The estimated average annual percent change (AAPC) was estimated, and the reciprocals of variances for the female ratios were used as weights. In China, health professionals increased from 4.7 million in 2002 to 10.68 million in 2020. Health professionals per 1000 population increased from 3.41 in 2002 to 7.57 in 2020. The ratio of female health professionals significantly increased from 63.85% in 2002 to 72.4% in 2020 (AAPC = 1.04%, 95% CI 0.96-1.11%, P < 0.001). Female doctors and pharmacists increased 4.7 and 7.9 percentage points from 2002 to 2020. Female health workers at township health centers, village clinics, centers for disease control and prevention had higher annual increase rate (AAPC = 1.67%, 2.25% and 1.33%, respectively) than those at hospital (0.70%) and community health center (0.5%). Female doctors in traditional Chinese medicine, dentistry and public health had higher annual increase rate (AAPC = 1.82%, 1.53% and 1.91%, respectively) than female clinical doctor (0.64%). More women are participating in the healthcare sector in China. However, socially lower-ranked positions have been feminizing faster, which could be due to the inherent and structural gender norms restricting women's career. More collective and comprehensive system-level actions will be needed to foster a gender-equitable environment for health workforce at all levels.

Reflection on the blockchain application in Chinese public health financial institutions governance

This paper identifies three aspects of challenges in blockchain practices through textual analysis and case studies in the governance of Chinese public health financial institutions. First, given the conflict of interest in corporate governance, under the background of shareholder activism, the attitude of controlling shareholders towards blockchain technology can become a crucial force in technology commercialization. Second, the massive amount of data derived from blockchain technology can lead to privacy protection problems in the financial development of the public health industry. Third, the lack of business customs can become a commercial factor hindering the application of blockchain technology. Therefore, reflecting on blockchain technology in corporate governance can facilitate the public health industry to adapt to the new opportunities brought by technological changes and cope with risks in advance. These findings are innovative and could provide insights into the future cross-border governance of blockchain technology.

Optimization of Collaboration Levels and Health Behaviors in Public Institutes: Exploring the Role of Psychological Rescue Collaboration Efforts

Objectives: In this study we aimed to (1) determine the factors contributing to the successful impact of collaboration on health behavior in Chinese Public health institutes PRC and (2) investigate the associated challenges of collaboration on health behavior in Chinese public health institutes for PRC. Methods: We used a qualitative approach in which semi-structured interviews were conducted with mental health professionals employed in public health institutes in China. Results: We found that impacting social order and national health is significantly associated with health behavior in China (83%). Public health institutes play a significant role in promoting health behavior to enhance PRC with the collaboration of mental health institutes (16%). Social environment and communication distance are notable challenges for public institutions that hinder their path to promote health behavior (60%) efficiently. Work plans and improved communication are significant strategies for Chinese public institutes to promote PRC to achieve optimized health behavior (75%). Conclusion: With an in-depth analysis of the impact of collaboration on health behavior in public institutes for PRC, this study is an important contribution in theoretical and practical domains with implications for policymakers and practitioners of Chinese public health institutes.

Declaration on high-quality development of public health education

On July 15, 2023, National Joint meeting of Deans/Directors of Schools of Public Health was held in Taiyuan, Shanxi Province, China. Focusing on the theme of"accelerating the construction of high-quality public health education system,"the conference had a warm discussion on the construction of high-level schools of public health, as well as the synergistic development of universities and the Centers for Disease Control and Prevention (CDCs). All meeting members reached a consensus and released the"high-quality development of public health education,"which is the first declaration issued by Chinese public health experts and of milestone significance in the new era of China's public health system construction and public health talent cultivation, as well as the critical year of the construction of high-level schools of public health.

Adaptation of the CUGH global health competency framework in the Chinese context: a mixed-methods study

BackgroundIn 2014, the Consortium of Universities for Global Health (CUGH) developed a global health competency framework and called for its validation. Given China's increasing engagement in global health over the past decade, there is a need for a tailored competency framework to enhance the capacity of its workforce. This study aimed to localize the CUGH global health framework within the Chinese context, offering guidance to public health professionals in China to bolster their capabilities for international endeavors.MethodsEmploying a modified Delphi consultation approach, this study adapted the CUGH global health competency framework through three consultation rounds and a panel discussion. A questionnaire employing a five-point Likert scale was developed to gather opinions from 37 experts on the significance and feasibility of each competency within the Chinese setting. Profiling information, judgment criteria, and familiarity with each competency were collected to assess experts' authority levels. Furthermore, a priority survey was administered to 51 experts to identify key competencies and provide recommendations for bolstering the capabilities of China's public health professionals. Data analysis was performed using Microsoft Excel.ResultsThe adapted framework comprises 10 domains and 37 competencies including: 1. Global Burden of Disease; 2. Social-economic, Environmental and Behavioral Determinants of Health; 3. The Impact of Globalization on Population Health, Health Systems, and Healthcare; 4. Major Global health initiatives and efforts; 5. Ethics, Health Equity and Social Justice; 6. Sociocultural, Political Awareness and Policy Promotion; 7. Personal Competencies and Professional Practice; 8. Capacity strengthening; 9. Collaboration, Partnering and Communication; 10. Programme Management. The priority survey underscored Domain 9, 10, and 4 as the foremost concern for Chinese public health professionals, urging active learning, critical thinking, open communication, experiential learning, and case-based studies. Institutions were advised to enhance their capacity, foster partnerships, and discern China's distinct role in the global health arena.ConclusionsThis study adapted the CUGH framework within the Chinese context, evaluating the significance and feasibility of each competency. The adapted framework can serve as a tool for developing global health curricula and delineating roles for Chinese public health professionals. To ensure contextual compatibility, testing of the framework with diverse public health professionals is recommended, enabling precise refinement of competencies based on empirical results.

Valuation of EQ-5D-5L health states from cancer patients' perspective: a feasibility study.

To assess the feasibility of estimating an EQ-5D-5L value set using a small study design in cancer patients and to compare the EQ-5D-5L values based on the preferences of cancer patients with those of the general public. Patients with clinically diagnosed cancers were recruited from two hospitals in Shanghai, China. In face-to-face interviews using the EQ-PVT survey, health states were valued by cancer patients using both cTTO and DCE methods. cTTO data was modelled alone or jointly with DCE data. Forty-eight models using different model specifications (cross-attribute level effect [CALE] and additive models), random/fixed effects model assumptions, data heteroscedasticity and censoring were estimated. The best performed model was identified in terms of monotonicity of estimated model coefficients and out-of-sample prediction accuracy. Data collected from 221 cancer patients who participated in the study were included. The hybrid CALE model using both TTO and DCE data performed best in terms of prediction accuracy (Lin's concordance coefficient = 0.989; root mean squared error = 0.058) and suggested that pain/discomfort and anxiety/depression were the most undesirable health problems. Compared to values based on general Chinese public's health preferences, the values based on cancer patients' preferences were much higher and lower for health states characterized by extreme mobility problems and severe/extreme pain or discomfort, respectively. This study demonstrated the feasibility of using a small design to develop EQ-5D-5L value sets based on cancer patients' health preferences. Since there were signs of differences between preferences of patients and general population, it may be valuable to develop patient-specific value sets and use them in clinical decision making and economic evaluations.

Are public health researchers designing for dissemination? Findings from a national survey in China

BackgroundResearch findings are not always disseminated in ways preferred by audiences, and research dissemination is not always considered a priority by researchers. While designing for dissemination (D4D) provides an active process to facilitate effective dissemination, use of these practices in China is largely unknown. We aimed to describe the designing for dissemination activities and practices among public health researchers in China.MethodsIn January 2022, we conducted a cross-sectional survey in 61 sub-committees of four national academic societies which include a wide range of health disciplines. The sample mainly involved researchers at universities or research institutions, the Centers for Disease Control and Prevention at national or regional levels, and hospitals. Participants completed a 42-item online questionnaire. Respondent characteristics, dissemination routes, dissemination barriers, organizational support, and personal practice of D4D were examined with descriptive analyses.ResultsOf 956 respondents, 737 were researchers. Among these researchers, 58.1% had disseminated their research findings. Although there were some variation in the commonly used routes among different groups, academic journals (82.2%) and academic conferences (73.4%) were the most frequently used routes. Barriers to dissemination to non-research audiences existed at both organizational level (e.g., a lack of financial resources, platforms, and collaboration mechanisms) and individual level (e.g., a lack of time, knowledge, and skills, and uncertainty on how to disseminate). About a quarter of respondents (26.7%) had a dedicated person or team for dissemination in their unit or organization, with university researchers reporting a significantly higher proportion than their counterparts (P < 0.05). Only 14.2% of respondents always or usually used frameworks or theories to plan dissemination activities, 26.2% planned dissemination activities early, and 27.1% always or usually involved stakeholders in the research and dissemination process. Respondents with working experience in a practice or policy setting or dissemination and implementation training experience were more likely to apply these D4D strategies (P < 0.05).ConclusionConsiderable room exists for improvement in using impactful dissemination routes, tackling multiple barriers, providing organizational support, and applying D4D strategies among Chinese public health researchers. Our findings have implications for structural changes in academic incentive systems, collaborations and partnerships, funding priorities, and training opportunities.

Perceived Stress and Mental Health Literacy Among Chinese Preschool Teachers: A Moderated Mediation Model of Anxiety and Career Resilience.

Chinese public mental health is currently characterized by a high prevalence of mental ill health and a low consultation rate, due primarily to the nation's low mental health literacy. Previous studies have shown that occupational stress may be a risk factor for mental health literacy. In China, preschool teachers are under high pressure; however, few studies have examined the mechanisms that mediate and moderate the relationship between preschool teachers' feelings of stress and their mental health literacy. A questionnaire was administered to 2352 preschool teachers to explore the relationship between their stress perceptions and mental health literacy. Preschool teachers' perceived stress was significantly and negatively associated with their mental health literacy, with anxiety playing a partially mediating role. Preschool teachers' career resilience moderated the relationship between perceived stress and anxiety. Perceived stress positively predicted anxiety for teachers with low levels of career resilience; for teachers with high levels of career resilience, perceived stress still positively predicted anxiety, and the higher the level of career resilience, the weaker the positive prediction of stress perception on anxiety. Perceived stress directly predicted mental health literacy among preschool teachers, and also indirectly predicted mental health literacy through the mediating role of anxiety. Career resilience moderated the relationship between stress perception and anxiety. These findings provide new perspectives on the treatment and prevention of preschool teachers' mental ill health.

Understanding professional development challenges of Chinese public health professionals: association and prediction analyses with data validity screening.

Little is known about the public health professionals engaged in educating and training new or future researchers in public health. Research in this direction identifies their issues, concerns, challenges, and needs. This study focused on the professional development challenges of Chinese public health professionals. Snowball sampling was utilized. A total of 265 public health professionals participated. An instrument of 6 dimensions (burnout, sleep issue, mood issue, friends' support, exercise, and challenges) was developed, revised, and administered online. Two different approaches, the conventional and data screening approaches, were applied. The former started with item quality analyses, whereas the latter began with data quality checks. The chi-square tests of associations and logistic regressions were performed on both approaches. 19.25% of the participants were detected and deleted as careless respondents. Using both approaches, six professional development challenges except one ("Multidisciplinary learning") were significantly associated with various demographic features. The two approaches produced different models though they converged sometimes. The latent variables of exercise predicted professional development challenges more frequently than other latent variables. Regarding correct classification rates, results from the data screening approach were comparable to those from the conventional approach. The latent variables of exercise, such as "Exercise effects," "Expectations of exercise," and "Belief in exercise," might be understudied. More research is necessary for professional development challenges using exercise as a multidimensional construct. Based on the current study, screening and deleting careless responses in survey research is necessary.

Association between work stress and mental health in Chinese public health workers during the COVID-19 epidemic: mediating role of social support and self-efficacy.

Little is known about the mediating mechanisms underlying the association between work stress and mental health, especially among primary public health workers (PHWs). We aimed to evaluated the association between work stress and mental health among PHWs, and explore the mediating roles of social support and self-efficacy. A large-scale cross-sectional survey was conducted among 3,809 PHWs from all 249 community health centers in 16 administrative districts throughout Shanghai, China. Pearson correlation and hierarchical linear regression were used to explore the associations among work stress, social support, self-efficacy and mental health. Structural equation modeling (SEM) was conducted to examine the mediation effects. The prevalence of depression and anxiety symptoms among primary PHWs was 67.3 and 55.5%, respectively. There is a significant positive direct effect of work stress on mental health (β = 0.325, p < 0.001). Social support and self-efficacy partially mediated the relationship between work stress and mental health, respectively. Meanwhile, the chained mediating effects of social support and self-efficacy also buffered the predictive effects of work stress on anxiety and depression symptoms (β = 0.372, p < 0.001). Work stress has significant direct and indirect effects on mental health among primary PHWs. Enhancing social support and self-efficacy may be effective psychological interventions to mitigate the effects of work-related stress on mental health. These findings highlight the severity of mental health problems among primary public health workers and provide new evidence for early prevention and effective intervention strategies.

Representing cervical cancer in a government social media health campaign in China: moralizing and abstracting women’s sexual health

This article analyses an award-winning film produced as part of the Chinese government’s ‘Healthy China Initiative’ to increase awareness of cervical cancer among young women. The film was designed to be social media friendly, using a more accessible popular style, and it achieved over 350 million views on Chinese social media. The aim had been to shift away from a tradition of more formal, authoritative public information content. Using multimodal critical discourse analysis in the broader tradition of critical health communication studies, the findings support other critics of Chinese public health information in relation to women’s reproductive health. Despite the accessible style, the authors find a highly conservative ideology of womanhood, where the actual nature of cervical cancer, caused by the very common Human Papillomavirus, is obscured in a highly moralized message about sexual abstinence. The film also represents a view of Chinese health services that glosses the difficulty of access for many, as well as public concerns about corruption and clientelism.

HCl-assisted KOH activated Chinese medicine residue biochar as a new method to improve the purification capacity of lead-containing wastewater: Experimental and mechanism studies

Activated biochar (CMRBKOH) was prepared by activating Chinese medicine residue with KOH. And modified by HCl. XRD, SEM, and BET characterization were used to investigate the physiochemical properties of CMRB and CMRBKOH. The best concentration of hydrochloric acid as modifier is 2.5%. The adsorption capacity is 74.38 mg g−1 under the condition that the dose of the adsorbent is 0.4 g L−1, the initial concentration is 100 mg L−1, and pH 5.0. The pseudo-second-order kinetic model (R2 = 1.00) and Langmuir isotherm model (R2 = 1.00) were found to be highly consistent with the data by data fitting. The thermodynamic analysis revealed that chemisorption dominated the adsorption process. The surface functional groups (C–O, CO, and O–H) on the surface of the original biochar were dramatically improved by activation, enables CMRBKOH to adsorb Pb(II) with more effective surface complexation, electrostatic attraction, ion exchange, co-precipitation, and coordination. Compared with the work done in other literatures, the material properties of this study are excellent. In addition, after eight cycles of experiments, the adsorption capacity is still 87.22%, and the adsorbent shows excellent regeneration capacity. As a whole, CMRBKOH could be considered an emerging Pb(II) adsorbent material with significant promise for Chinese medicine residue resource utilization, environmental quality, and public health protection.