Rural Northern China Research Articles

Design and performance evaluation of a solar-assisted biogas and air-source heat pump hybrid system for radiant heating applications

Energy and environmental crises have become critical challenges, making the efficient use of clean energy a focus of public attention. Although emerging clean energies have high economic and environmental values, these single energy sources are not well-developed. In colder climates, maintaining a stable fermentation temperature can be difficult, leading to the idling of many biogas digesters. Furthermore, despite extensive research on solar-assisted air-source heat pumps, these systems perform poorly in cold climates with low solar irradiance. To address these issues, this study investigates the integration of a solar-assisted biogas and air-source heat pump hybrid heating system (SBHP-HHS) for capillary radiant heating in rural North China, specifically adapted to local conditions. The system aims to utilize the combined benefits of various clean energy sources to improve system reliability in harsh climates. By combining experimental analysis with TRNSYS simulation, the system performance during the heating season in rural northern China was evaluated. Experimental results show that the hybrid system, utilizing the radiant capillary terminal, is capable of maintaining room temperatures above 20 °C, demonstrating its effectiveness. Simulation results show that the air-source heat pump achieves a coefficient of performance (COP) of 4.6. This efficiency level is generally favorable, ensuring stable operation. Additionally, the system achieves a solar-biogas hybrid utilization rate exceeding 75 % and a primary energy-saving rate of 78 %. Economically, the system offers an 8.23-year dynamic payback period and annual cost savings of 3055 CNY. Environmentally, it reduces CO2 emissions by 4263.6 kg annually. This study provides a solid experimental foundation for further research, offering empirical evidence to optimize system performance.

Characteristics of PM2.5 bounded carbonaceous aerosols, carbon dioxide and its stable carbon isotopes (δ13C) in rural households in northwest China: Effect of different fuel combustion

In order to fully understand the carbon emission from different fuels in rural villages of China, especially in the typical atmospheric pollution areas. The characteristics of carbonaceous aerosols and carbon dioxide (CO2) with its stable carbon isotope (δ13C) were investigated in six households, which two households used coal, two households used wood as well as two households used biogas and liquefied petroleum gas (LPG), from two rural villages in Fenwei Plain from March to April 2021. It showed that the fine particulate matter (PM2.5) emitted from biogas and LPG couldn't be as lower as expected in this area. However, the clean fuels could relatively reduce the emissions of organic carbon (OC) and element carbon (EC) in PM2.5 compare to the solid fuels. The pyrolyzed carbon (OP) accounted more total carbon (TC) in coal than the other fuels use households, indicating that more water-soluble OC existed, and it still had the highest secondary organic carbon (SOC) than the other fuels. Meantime, the coal combustions in the two villages had the highest CO2 concentration of 527.6 ppm and 1120.6 ppm, respectively, while the clean fuels could effectively reduce it. The average δ13C values (−26.9‰) was much lighter than almost all the outdoor monitoring and similar to the δ13C values for coal combustion and vehicle emission, showing that they might be the main contributors of the regional atmospheric aerosol in this area. During the sandstorm, the indoor PM2.5 mass and CO2 were increasing obviously. The indoor cancer risk of PAHs for adults and children were greater than 1 × 10−6, exert a potential carcinogenic risk to human of solid fuels combustion in rural northern China. It is important to continue concern the solid fuel combustion and its health impact in rural areas.

The uneven distribution of health benefits and economic costs from clean heating in rural Northern China

The uneven distribution of health benefits and economic costs from clean heating in rural Northern China

Harmony in Art: Sun Yinchang's Journey from Rural Realism to Contemporary Symbolism

The study explores the multifaceted artistic journey of Sun Yinchang, a self-taught "peasant painter" from rural northern China, whose fusion of realism and symbolism in oil paintings forms a captivating narrative. The study explores his unconventional artistic development, emphasizing his departure from academic paths and the attainment of professional competence through personal perception. Operating as an outsider within the artistic system, Sun's career as a freelance artist without a fixed income serves as a valuable case study for contemporary youth aspiring to become oil painters outside established institutional frameworks. His unwavering commitment to rural life, thematic continuity in his work, and symbolic representations of memory, such as corn and agricultural tools, distinguish him from stereotypical portrayals of "peasants" and secure recognition within the domestic art industry. The comprehensive exploration employs qualitative inquiry and visual analysis, drawing insights from interviews with Sun and meticulous examination of his celebrated series. The abstract further analyzes Sun Yinchang's distinctive realistic style, the interplay of compositional form, the "top-down" perspective, and the symbolic implications of his chosen motifs, providing sociological insights into art and offering inspiration for contemporary artists aligning their work with personal concepts.

Association between dietary glycine intake and the prevalence of hypertension, hyperlipidemia, overweight or obesity in rural northern China: a cross-sectional study.

The objective of this research is to investigate the relationship between dietary glycine consumption and the prevalence of hypertension, hyperlipidemia, and overweight or obesity in economically disadvantaged areas of northern China using a cross-sectional study design. A cross-sectional study involving 774 participants utilized a web-based dietary questionnaire (IDQC) and underwent physical measurements. Data analysis was conducted using IBM SPSS Statistics software (Version 21). Participants were stratified into four groups based on quartiles of their dietary glycine intake: Q1 (<1.32), Q2 (1.32-1.82), Q3 (1.82-2.26), and Q4 (>2.26). Continuous variables were reported as mean ± standard deviation and compared using ANOVA or the Kruskal-Wallis test, while categorical variables were presented as frequencies (%) and compared using the chi-square test. Finally, multivariable logistic regression with p-value of less than 0.05 was considered statistically significant. Significant differences in dietary glycine intake were observed between the highest quartile group (Q4) and the lowest quartile group (Q1), with corresponding dominance ratios of 0.590 (95% CI, 0.360-0.966), 0.547 (95% CI, 0.327-0.913), and 0.547 (95% CI, 0.353-0.850) for the risk of hypertension, hyperlipidemia, and overweight/obesity, respectively. Furthermore, no significant correlation was found between dietary glycine intake and hypertension or hyperlipidemia within each sex and age subgroup. There exists a potential correlation between increased dietary glycine intake and reduced prevalence of hypertension, hyperlipidemia, and overweight/obesity. However, additional research is necessary to validate this finding through larger-scale studies conducted at a population level.

Climate impact of coal-to-clean-energy shift policies in rural Northern China

China has implemented the coal-to-clean-energy shift policy in rural areas of northern China to improve air quality, optimize energy structure and reduce greenhouse gas emissions, resulting in a significant increase in natural gas and electricity consumption. The policies shifts can reduce CO2 emissions, but methane emissions from switching processes may contribute to short-term climate impacts. The climate impact during the policy transition is still unclear. Thus, this paper developed a lifecycle greenhouse gas (GHG) emissions framework for coal-to-clean-energy policies in rural northern China. The GHG emissions for heating and cooking, the two most energy intensive activities, were calculated. Four scenarios were designed based on energy types and equipment. Uncertainties in estimating lifecycle GHG emissions under different scenarios were analyzed. The technology warming potential values were calculated for the conversion of scenarios. Besides, the environmental benefits of natural gas versus electricity under emission reduction targets were compared. According to our findings, the total GHG emissions reduction of coal-to-clean-energy shift policies in rural northern China under global warming potential on a 100-year scale (GWP 100) is 1.83 million metric ton CO2 equivalent (MMT CO2 eq) in 2018. Since the climate benefits of policy shifts are driven by chosen technical routes, replacing coal with natural gas should be prioritized; heating with natural gas boilers can maximize GHG emissions reduction and climate benefits. By 2038, the climate benefits of electricity will be far superior to those of natural gas, based on emission reduction targets and electrical mix. There are numerous opportunities to reduce GHG emissions in China's energy sector, and there is a need for the energy industry to obtain better emissions data as well as to increase efforts to reduce GHG emissions.

The prevalence of insufficient physical activity and the influencing factors among Chinese adults in 2018

Objective: To understand the prevalence of insufficient physical activity among adults aged ≥18 years in China and to explore the influencing factors. Methods: The China Chronic Disease and Risk Factor Surveillance was conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥18 years. A questionnaire including Global Physical Activity Questionnaire was used to collect information about the participants' demographic characteristics and physical activity through face-to-face interview. A total of 183 769 participants completed the survey. After complex data weighting, the prevalence of insufficient physical activity, occupation, transportation, and leisure-time physical activity time was analyzed. Multivariate logistic regression models were used to analyze the influencing factors related to insufficient physical activity. Results: The prevalence of insufficient physical activity among adults aged ≥18 years was 22.3% (95%CI: 20.9%-23.7%) in China in 2018, with males [24.4% (95%CI: 23.0%-25.8%)] significantly higher than females [20.2% (95%CI: 18.6%-21.8%)]. Adults aged 70 years and above [28.4% (95%CI: 26.9%-29.9%)] were significantly higher than adults in other age groups, followed by adults aged 18-29 years [26.4% (95%CI: 24.4%- 28.3%)] and 30-39 years [23.4% (95%CI: 21.5%-25.3%)], and tended to increase with increasing education and total sedentary behavior time (P<0.001). The weekly occupation, transportation, and leisure-time physical activity time appeared 958.6 (95%CI: 911.4-1 005.8) minutes, 234.5 (95%CI: 224.7- 244.2) minutes, and 88.6 (95%CI: 83.5-93.7) minutes, respectively. Multivariate logistic regression analysis showed that males, adults living in rural areas or northern China, ≥70 years, with junior high school education, an annual household income per capita <6 000 yuan and institutional/clerical/ technical occupation and longer total sedentary behavior time were related to a higher prevalence of insufficient physical activity. Conclusions: In China, over one-fifth of the adults had lower physical activity levels. Adults who are male, young adults, more educated, institutional/clerical/technical occupation, and with more extended total sedentary behavior are the populations that need to be focused on to promote physical activity-related health.

Health-related quality of life and associated factors in elderly individuals with dyslipidemia in rural Northern China.

The purpose of the study was to investigate health-related quality of life (HRQOL) and its associated factors among elderly individuals with dyslipidemia in rural Northern China. A cross-sectional study was conducted on 457 elderly individuals. The EQ-5D-5L questionnaire was used to assess HRQOL. Sociodemographic, anthropometric, lifestyle and health information was collected using a structured and standardized questionnaire. The Tobit regression model and multiple linear regression analysis were used to assess factors associated with HRQOL parameters including utility index and visual analogue score (EQ-VAS). The mean age of the participating individuals was 68.04 ± 5.98years. The median utility index and EQ-VAS scores were 0.942 (P25-P75: 0.876-1.000) and 80 (P25-P75: 70-90), respectively. Pain/discomfort was the most frequently reported complaint among the five health dimensions (50.5%). Illiterate and primary education levels, unemployed, widowed, smoking, secondhand smoke exposure, with hypertension or DM, chronic disease core knowledge scores < 8, and daily sedentary time ≥ 6h were associated with lower HRQOL. Pain/discomfort dimension was the most affected problems. Education, occupation, marital status, smoking, secondhand smoke exposure, chronic disease core knowledge, comorbidities, and daily sedentary time were significantly associated with HRQOL in the present study.

Sustainable development of clean heating in rural northern China: Locally tailored energy options

Locally tailored energy options can better contribute to the sustainable development of clean heating in northern China. Based on sustainable development theory, this study constructed a comprehensive evaluation index system for clean heating energy options in rural northern China. A fuzzy comprehensive evaluation (FCE) method was used to design locally tailored heating energy options. The results indicate that, first, the comprehensive selection capacity of clean heating energy varies across northern China, with most provinces occurring in the medium range. Second, electric and biomass heating should constitute the main future clean heating trend in rural areas in northern China. Third, natural gas or electric heating is more suitable for provinces with high economic and renewable energy technology levels, while clean coal heating is temporarily suitable for remote provinces with low comprehensive selection capacities. Fourth, provinces with significant resource advantages should develop corresponding heating energy sources, and heat pump heating should be encouraged as a priority in the future.

Deposition effect of inhaled particles in the human: Accurate health risks of personal exposure to PAHs and their derivatives from residential solid fuel combustion

The drastic household clean heating renovation has been undertaken in rural northern China since 2017. A method incorporating the deposition efficiency of particulate matters (PMs) in the human respiratory tract is firstly introduced into the personal exposure (PE) study which is more accurately assess the health risks of homemakers inhaling PM-bound four subclasses polycyclic aromatic hydrocarbons (PAHs) emitted from different solid fuels (i.e., biomass, raw coal chunk, and clean coal). Homemakers using clean coal show the lowest exposure levels of all PAH subclasses (parent, alkylated, oxygenated, and nitro PAHs) and total quantified PAHs (ΣPAHs). Remarkable reductions of 93.9% and 89.0% on ΣPAHs in PE PM2.5 are observed with the substitutions of the raw coal chunk and biomass fuel by the clean coal, respectively. 86.8–96.8% of ΣPAHs are inhaled by the human body, while approximately 22.4–44.8% are deposited in the respiratory tract. The deposition concentrations (DC) of ΣPAHs in the biomass and raw coal chunk groups are 12 and 5 times the clean coal group, respectively. PAHs in coarse mode PE particles with an aerodynamic size between 2.5 and 100 μm mostly deposit in the head airway (HA) (98%). Moreover, the PAHs in fine particles (i.e., with aerodynamic size less than 2.5 μm) mainly deposit in the alveolar region (AR), accounting for 20–70% of ΣPAHs. Replacing biomass and raw coal chunk with clean coal reduced incremental lifetime cancer risks (ILCR) by 91% and 92%, respectively. This study improves the understanding of the PM-bound PAHs deposition in the human respiratory system and contributes to the promotion of domestic energy transition in rural northern China.

Blood pressure control and risk of post-stroke dementia among the elderly: A population-based screening study.

BackgroundPost-stroke dementia (PSD) has adverse effects on the quality of work and life in elderly stroke survivors. There are inconsistent results on the impacts of blood pressure control on the risk of PSD in people aged 65 years and above.ObjectiveThis study was performed to explore whether poorly-controlled blood pressure was associated with an increasing risk of PSD.MethodsThe study population was enrolled from cross-sectional research conducted in 106 communities of rural northern China. In Phase I, a total of 7,448 people aged ≥65 years, including 830 with stroke history, completed a questionnaire, a physical examination, and a cognitive assessment. Phase II further confirmed the diagnosis of PSD. Well-controlled blood pressure was defined as an average systolic blood pressure of <140 mmHg and average diastolic blood pressure of <90 mmHg over two readings in person. Failure to meet these criteria was considered as poorly-controlled blood pressure.ResultsThe crude prevalence rate of PSD among stroke survivors aged 65 years and over was 17.8% [95% confidence interval (CI) 15.2–20.4%]. Among the 830 stroke survivors, the proportions of PSD gradually increased with age and the crude prevalence rates for PSD were 10.2% (95% CI 5.6–14.9%), 14.8% (95% CI 10.1–19.5%), 18.8% (95% CI 14.1–23.5%), and 27.4% (95% CI 20.8–34.1%) in subjects aged 65–69, 70–74, 75–79 and ≥80 years, respectively. Participants in the poorly-controlled blood pressure group were more likely to suffer from PSD (28.4 vs.15.3%, P < 0.001), be older (75.81 ± 4.97 vs. 74.74 ± 5.83, P < 0.05), and have a worse cognitive level (22.26 ± 7.05 vs. 24.10 ± 6.02, P < 0.05). Compared with well-controlled blood pressure patients, poorly-controlled blood pressure in stroke survivors significantly increased risk of PSD (odds ratio = 2.20, 95% CI 1.45–3.32) after adjusting for age, gender, and education.ConclusionsThe crude prevalence of PSD among stroke survivors aged ≥65 years was 17.8% at community level. In addition to lower education level and older age, poorly-controlled blood pressure was also an independent risk factor for PSD among the elderly, which is amenable to intervention. Therefore, it is essential to control blood pressure to reduce PSD incidence.

Reproductive factors and cognitive impairment in natural menopausal women: A cross-sectional study.

IntroductionLittle information on rural older women in northern China has been reported, apart from three studies in southern and eastern China in the past decade. This study aims to evaluate the relationships between reproductive factors and the risk of cognitive impairment, including mild cognitive impairment (MCI) and dementia, in Chinese women with natural menopause.MethodsThe cross-sectional study was conducted in 112 community primary healthcare centers in rural northern China between April 2019 and January 2020. A total of 4,275 women aged ≥65 years who had natural menopause were included. Reproductive factors as well as the reproductive period (= age at menopause − age at menarche) were recorded. The relationships between reproductive factors and cognitive impairment were evaluated by correlation and logistic regression analysis.ResultsOverall, 28.6% and 11.4% of women were diagnosed with MCI or dementia, respectively. In natural menopause women, the age at menopause (adjusted r = 0.070, p < 0.001), reproductive period (adjusted r = 0.053, p = 0.001), and number of pregnancies (adjusted r = −0.042, p = 0.007) and parities (adjusted r = −0.068, p < 0.001) were correlated with Mini-Mental State Examination (Chinese version) scores, and with similar findings concerning MCI and dementia with Lewy bodies (DLB). Greater age at menopause and a long reproductive period significantly decreased the risk of MCI and Alzheimer’s disease (AD), and more parities significantly increased the risks of MCI (odds ratio (OR) = 1.111, 95% confidence interval (CI): 1.039–1.187, p = 0.002), dementia (OR = 1.162, 95% CI: 1.061–1.271, p = 0.001), particular AD (OR = 1.131, 95% CI: 1.010–1.266, p = 0.032), DLB (OR = 1.238, 95% CI: 1.003–1.528, p = 0.047), and vascular dementia (VaD) (OR = 1.288, 95% CI: 1.080–1.536, p = 0.005).ConclusionsThe prevalence rates of MCI and dementia were 28.6% and 11.4% in older women. Greater age at menarche, young age at menopause, shorter reproductive period, and larger numbers of pregnancies/parities were correlated with poor cognition and significantly increased the risks of MCI and dementia, particularly AD, DLB, and VaD.

Five-year incidence of primary glaucoma and related risk factors - The Handan eye study.

To determine the 5-year incidence of primary glaucoma and its associated risk factors in rural northern China. Population-based cohort study. A total of 5184 participants aged 30 years and older, without glaucoma at baseline, were subjected to comprehensive standardized interviews and ophthalmic and systemic examinations at baseline and after a 5-year interval in the Handan Eye Study. Incident glaucoma was diagnosed by a consensus panel of five senior glaucoma specialists. Univariate and multivariable logistic regression analyses were performed to identify the baseline risk factors that could predict the incidence of glaucoma. During the 5-year follow-up, incident primary glaucoma developed in 82 subjects (1.6%; 95% confidence interval [CI], 1.2%-1.9%). The age- and gender-standardized incidence of glaucoma among subjects ≥40 years old was 2.1% (0.4% annually), calculated according to the 2010 Chinese census. A higher age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; p <0.001), higher intraocular pressure (IOP) (OR, 1.11; 95% CI, 1.02-1.20; p =0.017), and vertical cup disc ratio (VCDR)≥ 0.60 (OR, 5.30; 95% CI, 3.22-8.73; p <0.001) were found to be associated with an increased risk of incident glaucoma. For each year, older age and each mmHg higher IOP, the risks of primary glaucoma increased by 1.2% and 2.0% per year, respectively. We reported the 5-year incidence of primary glaucoma in a rural Chinese population and found that older age, higher IOP, and VCDR≥ 0.60 at baseline could help in identifying those at highest risk of disease development.

Relationship Between Hypertension and Cognitive Function in an Elderly Population: A Population-Based Study in Rural Northern China.

The burden of cognitive impairment and dementia is particularly severe in low- and middle-income countries. Although hypertension is an important risk factor for cognitive impairment, the influence of different hypertension classification on cognitive impairment remains controversial. To explore the impact of hypertension and hypertension classification on cognitive function, this study was based on a low-income population aged over 60 years in northern China. This population-based, cross-sectional study was conducted from April 2014 to January 2015 in rural areas of Tianjin, China. A total of 1,171 participants aged ≥ 60 years were included. Participants were interviewed by professional researchers face-to-face, using the pre-designed questionnaire. Cognitive function was assessed using the Mini-mental State Examination (MMSE). Multivariate regression analysis was used to calculate the odds ratio (OR) value. There was a significant association between hypertension and cognitive impairment (OR, 1.415; 95% CI: 1.005–1.992; P = 0.047) and a significant positive association between stage 3 hypertension (OR, 1.734; 95% CI: 1.131–2.656; P = 0.012) and the prevalence of cognitive impairment. To prevent dementia, clinicians should consider the cognitive function and blood pressure control of low-income individuals aged over 60 years with hypertension in northern China, especially those with stage 3 hypertension. In addition, the inconsistent effects of blood pressure on different cognitive functions should also be considered; special attention should be paid to orientation and concentration.

Association between maternal exposure to chemical fertilizer and the risk of birth defects in a rural population in northern China: a population-based study.

Maternal exposure to pesticides during early pregnancy is associated with increased risks of birth defects, while the association between maternal exposure to chemical fertilizer during pregnancy and the risk of birth defects remains unknown. Data were from a population-based birth defects surveillance system between 2007 and 2012 in Pingding County, Shanxi Province, northern China. A total of 14074 births with 235 birth defects were used to estimate spatial clustering and correlations at the village level. A population-based case-control study of 157 cases with birth defects and 204 controls was performed to investigate the association between maternal chemical fertilizer exposure and the risk of birth defects by a two-level logistic model. The total prevalence of birth defects between 2007 and 2012 was 167.0/10000 births. The spatial analysis indicated a remarkable high-risk area of birth defects in the southeast of Pingding County and the use of chemical fertilizer was associated with the risk of birth defects at the village level. After adjusting for confounders at the individual level, mothers who live in villages with chemical fertilizer application ≥65 tons/y had an increased risk of birth defects (adjusted odds ratio 2.06 [95% confidence interval 1.23 to 3.46]) compared with those of <65 tons/y. Our findings suggest that the risk of birth defects may be associated with the use of chemical fertilizer in rural northern China. The findings must be cautiously interpreted and need to be investigated on larger samples.

A New Professional Ethos: E-commerce and Business Culture in a County of Rural Northern China

After a phase of slow development, e-commerce has become widespread in rural China, being promoted by both local governments and corporations. How has it changed business culture and business networks? Based on an ethnographic study conducted in a rural county in Henan, the article explores shifts in patterns of group formation and identity among local businesspeople. Fieldwork included 60 interviews with e-retailers, manufacturers, and local officials, as well as participant observation conducted from 2016 to 2019. The study suggests that online retailing has fostered the emergence of a shared ethos, which values quality and professionalism rather than the ability to build strong interpersonal ties through leisure and credit practices. This new ethos, congruent with state-sponsored, nationwide shifts in the economic structure, entails the emergence of a more far-flung integrated business community, while accentuating local processes of social differentiation.

The Association Between the Prevalence, Medication Adherence and Control of Hypertension and the Prevalence of Mild Cognitive Impairment in Rural Northern China: A Cross-Sectional Study.

IntroductionHigh blood pressure is one of the main modifiable risk factors for dementia. However, it remains unclear whether lowering the blood pressure effectively prevents cognitive impairment. Our objective was to explore the association between the prevalence, medication adherence and control of hypertension and mild cognitive impairment (MCI) among elderly individuals in northern China.MethodsA two-stage clustering sampling method was used, and 9036 participants aged ≥65 years were included in the analysis. The Mini-Mental State Examination and activities of daily living were used to assess participants’ cognitive function. Demographic characteristics (gender, age, marital status, education level, occupation), history and duration of hypertension, use of antihypertensive medications (AHMs) and its control effect were obtained.ResultsThe prevalence of MCI in all participants was 18.1%, and the prevalence of MCI was significantly higher in hypertensive subjects than in normotensive subjects (19.7% vs 16.2%, P < 0.01). Furthermore, in hypertensive patients, the prevalence of MCI was lower in those with good adherence (17.3%) than in those with poor adherence (23.7%, P < 0.01) and lower in those controlled (16.5%) than in those with uncontrolled adherence (20.8%, P < 0.01). In univariate analyses, being female gender, increased age, agriculture occupation, unmarried and widow, less than primary school and middle school were associated with MCI prevalence. The assessment of the hypertensive patients revealed the adjusted OR (95% CI) of having MCI in those with poor adherence to AHMs was 1.32 (1.14–1.54) compared with those having good adherence.ConclusionThere is an association between the prevalence of hypertension, adherence to AHMs and MCI, suggesting that hypertensives should be screened for MCI to provide improved diagnoses and optimal therapeutics for cognitive decline prevention, especially in poor AHM adherence.

The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation.

Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-year-long cluster-randomized controlled trial. This study reports the findings from the trial implementation and process evaluation that investigate the implementation of the intervention and inform factors that may influence the wider implementation of the intervention in the future.Methods: We developed an evaluation framework by employing both the RE-AIM framework and the MRC process evaluation framework to describe the implementation indicators, related enablers and barriers, and illustrate some potential impact pathways that may influence the effectiveness of the intervention in the trial. Quantitative data were collected from surveys and extracted from digital health monitoring systems. In addition, we conducted quarterly in-depth interviews with stakeholders in order to understand barriers and enablers of program implementation and effectiveness. Quantitative data analysis and thematic qualitative data analysis were applied, and the findings were synthesized based on the evaluation framework.Results: The SINEMA intervention was successfully implemented in 25 rural villages, reached 637 patients with stroke in rural Northern China during the 12 months of the trial. Almost 90% of the participants received all follow-up visits per protocol, and about half of the participants received daily voice messages. The majority of the intervention components were adopted by village doctors with some adaptation made. The interaction between human-delivered and technology-enabled components reinforced the program implementation and effectiveness. However, characteristics of the participants, doctor-patient relationships, and the healthcare system context attributed to the variation of program implementation and effectiveness.Conclusion: A comprehensive evaluation of program implementation demonstrates that the SINEMA program was well implemented in rural China. Findings from this research provide additional information for program adaptation, which shed light on the future program scale-up. The study also demonstrates the feasibility of combining RE-AIM and MRC process evaluation frameworks in process and implementation evaluation in trials.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03185858.

Hearing Status of Low-Income, Middle-Aged and Elderly Women in Northern China: A Population-Based, Cross-Sectional Study.

ObjectiveHearing impairment (HI) has become one of the most common causes of disability worldwide. To date, few studies have examined the hearing of women in these frequently rural regions. Thus, we explored the HI prevalence and risk factors among low-income, middle-aged, and elderly women in Tianjin, China.MethodsBetween October and November 2013, female residents aged ≥45 years of rural Tianjin, China were recruited into the study. The participants completed questionnaire surveys, physical examinations, and hearing tests. The hearing at frequencies of 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz was used to analyze the hearing characteristics of specific frequency bands, and HI was defined as the better ear pure tone averages (PTA) >25 dB HL.ResultsAmong the 1416 participants, the prevalence of HI was 46.0%. Among those aged 45–54-years, most (65.3%) demonstrated normal hearing; in other age groups, slight HI accounted for the largest proportions of individuals. Compared with women who did not drink, the odds ratio (OR) of HI among women who consumed alcohol was 4.2 (95% confidence interval [CI]: 1.844–9.574; P = 0.001). Compared with pre-menopausal women, the OR of HI among postmenopausal women was 1.8 (95% CI: 1.261–2.667; P = 0.001). Further, each 1-year increase in age in women resulted in a 7.1% increase in HI risk (P < 0.001).ConclusionThe burden of HI among women is heavy in rural northern China, especially among those who experienced menopause. Additionally, the results suggest that to further reduce the risk of developing HI, women in rural areas should stop consuming alcohol. The problem of HI among women in rural areas should be taken seriously; moreover, the measures implemented to prevent HI in high-risk women should be strengthened.

Household kindling behaviours and potential health risks of dioxins exposure in rural Northern China.

The study aimed to analyse the potential risk behind kindling behaviour in Chinese rural families and to provide insights for policymakers in environmental health. A cluster survey was performed on 113 participant's families who were living in the countryside in the north of China, using solid fuels for cooking and heating purpose. A questionnaire survey on their kindling behaviour and family information was administrated. Harmful kindling materials including plastic bottles, plastic planting plates, plastic film mulches, plastic bags, waste foams, and medium density fibreboard (MDF) are targeted in the survey. About one third of participant's families have ever used the listed harmful material for kindling. Based on literature review and the exposure proportion estimated from the questionnaire, we estimated the population attributable fractions (PAF) for all cancer type (10.48-19.48%) and type 2 diabetes (15.57-27.86%) attributable to dioxin exposure. The PAF estimates were greater than our expectation from the view of the global estimate PAF for cancer and T2D. Moreover, we found farming families are more likely to use their farming-related plastic byproducts as kindling material. There is a huge knowledge gap in environmental health in rural China. Although we were not able to measure the specific exposure data, our survey provided a new research aspect for environmental health research and health education. Strengthened environmental health education, better relevant laws, regulations, and supporting policies for regulating rural and farming waste disposal are highly recommended for policymakers in China.