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Most acquired and inherited cardiomyopathies are characterized by regional left ventricular involvement and nonischemic myocardial scars, often with a disease-specific pattern. Irrespective of the etiology and pathophysiological mechanisms, myocardial disorders are invariably associated with cardiac fibrosis, which contributes to dysfunction and electrical instability. Accordingly, cardiac magnetic resonance plays a central role in the diagnostic work-up and prognostic risk stratification of cardiomyopathies, particularly with the increasing correlation between genetic background and specific disease phenotype. Starting from pattern and distribution of myocardial fibrosis at cardiac magnetic resonance, we provide a practical regional atlas of nonischemic myocardial scar to guide the diagnostic approach to nonischemic cardiomyopathies.

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BACKGROUND: Equitable geographical distribution of health resources, such as hospital beds, is fundamental in ensuring public accessibility to healthcare services. This study examines the distribution of hospital beds across Saudi Arabia's 20 health regions. METHODS: A secondary data analysis was conducted using the 2022 Saudi Ministry of Health Statistical Yearbook. The study focused on calculating the hospital beds-per-1,000-people ratio across Saudi Arabia's 20 health regions. The analysis involved comparing regional bed distributions using the Gini index and Lorenz curve to assess the distribution of hospital beds. RESULTS: The national average beds-per-1,000-people ratio was 2.43, serving a population of approximately 32.2 million. The calculated mean Gini index for bed distribution was 0.15, which indicates a relatively equitable distribution. Further analysis revealed some regional disparities, with health regions like Makkah and Jeddah displaying critically low bed-to-population ratios. In contrast, others like Al-Jouf and the Northern region reported higher ratios. The study also identified the need for an additional 17,062 beds to meet international standards of 2.9 beds per 1,000 people. CONCLUSIONS: The findings revealed a national average beds-per-1,000-people ratio of 2.43, with some regional disparities. The study highlights the critical need for targeted healthcare planning and policy interventions to address the uneven distribution of hospital beds across Saudi Arabia. TRIAL REGISTRATION: Not applicable.

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BACKGROUND: Bats have garnered increased attention in the field of life sciences for their typical biological characteristics of carrying a variety of zoonotic viruses without disease, long lifespans, low tumorigenesis rates, and high metabolism. When it was found that bats can carry the rabies virus, over 60 years of research revealed that bats host over 4100 distinct viruses, including Ebola virus and SARS-CoV. OBJECTIVES: This paper primarily reviews the profiles of zoonotic viruses carried by bats across various regions globally. The review aims to provide a foundation and reference for future research on monitoring zoonotic viruses in diverse global regions and bat species, exploring the coevolutionary relationship between bats and viruses, understanding the tolerance mechanisms of bat B cells, prevention, and treatment of zoonotic diseases caused by bats. SOURCES: The search used 'bat', 'bats', 'rabies virus', 'Dengue virus', 'West Nile virus', 'Zika virus', 'St. Louis encephalitis virus', 'Japanese encephalitis virus', 'Hantavirus', 'Novel hantavirus', 'Rift Valley fever virus', 'Crimean Congo hemorrhagic fever virus', 'Paramyxovirus', 'Nipah virus', 'Hendra virus', 'Menangle virus', 'Tioman virus', 'Marburg Virus', 'Bombali virus', 'Ebola virus', 'Influenza A virus', 'coronavirus', 'Hepatitis B virus', and 'Hepatitis E virus' as text in PubMed. CONTENT: A total of 147 references were obtained. Surveys on severe zoonotic virus carriage have been limited to only 83 bat species belonging to nine families, which are distributed all over the world. We also briefly describe the antibody responses and B-cell molecules in bats. IMPLICATIONS: Several viruses have been found in different species of bats. This suggests that bats may be important hosts for future viral infectious diseases. Particularly in recent years, the close correlation between human infection pandemics caused by coronaviruses and bats highlights the pressing need to comprehend the species, tolerance, and coevolutionary mechanisms of zoonotic viruses carried by different bat species.

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BACKGROUND: Kidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana. METHODS: A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana. RESULTS: There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4-10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana. CONCLUSION: There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.

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Nutrient elements are essential for human health. The intake of nutrient elements (Na, K, Ca, Mg, P, Mn, Fe, Zn, Cu, Se, Mo, and Cr) in the general Chinese population was comprehensively evaluated via a recent total diet study (2016-2019), covering more than two-thirds of the total population. The contents of nutrient elements in 288 composite dietary samples were determined by ICP-MS. The dietary sources, regional distribution, the relationship with the earth's crust, dietary intake, and health effects were discussed. Plant foods were the main source of both macro-elements and trace elements, accounting for 68-96% of total intake. Trace elements in food were compatible with their abundance in the earth's crust. Na intake reduced by 1/4 over the last decade but was still high. The average intake of Ca, Mg, Zn, and Se did not reach the health guidance values, while the average intake of K, P, Mn, Fe, Cu, Mo, and Cr fell within a reasonable range. No element exceeded the UL. However, an imbalance was identified in the dietary Na/K ratio and Ca/P ratio. This paper provides a most recent and national-representative assessment of nutrient element intake, indicating the significance of salt reduction and dietary structure optimization for the population.

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Background: Essential medicines are the backbone of healthcare and meet the priority healthcare needs of the population. However, approximately one-third of the global population does not have access to essential medicines. Although China formulated essential medicine policies in 2009, the progress of availability of essential medicines and regional variations remains unknown. Therefore, this study was conducted to evaluate the availability of essential medicines, their progress, and regional distribution in China in the last decade. Methods: We searched eight databases from their inception to February 2022, relevant websites, and reference lists of included studies. Two reviewers selected studies, extracted data, and evaluated the risk of bias independently. Meta-analyses were performed to quantify the availability of essential medicines, their progress, and regional distribution. Results: Overall 36 cross-sectional studies conducted from 2009 to 2019 were included, with regional data for 14 provinces. The availability of essential medicines in 2015-2019 [28.1%, 95% confidence interval (CI): 26.4-29.9%] was similar to that in 2009-2014 (29.4%, 95% CI: 27.5-31.3%); lower in the Western region (19.8%, 95% CI: 18.1-21.5%) than Eastern (33.8%, 95% CI: 31.6-36.1%) and Central region (34.5%, 95% CI: 30.6-38.5%); very low for 8 Anatomical Therapeutic Chemical (ATC) categories (57.1%), and low for 5 categories (35.7%) among all ATC groups. Conclusion: The availability of essential medicines in China is low compared with the World Health Organization goal, has not changed much in the last decade, is unequal across regions, and lacks data for half of provinces. For policy-making, the monitoring system of the availability of essential medicines is to be strengthened to enable long-term surveillance, especially in provinces where the data has been missing. Meanwhile, Joint efforts from all stakeholders are warranted to improve the availability of essential medicines in China toward the universal health coverage target. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=315267, identifier: PROSPERO CRD42022315267.

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Pharmaceutical plants are an essential source of antibiotics emitted into the aqueous environment. The monitoring of target antibiotics in pharmaceutical plants through various regions is vital to optimize contaminant release. The occurrence, distribution, removal, and ecological risk of 30 kinds of selected antibiotics in 15 pharmaceutical plants in the Pearl River Delta (PRD) were investigated in this study. Lincomycin (LIN) showed the highest concentration (up to 56,258.3 ng/L) in the pharmaceutical plant influents from Zhongshan city. Norfloxacin (NFX) showed a higher detection frequency than other antibiotics. In addition, the spatial distribution of antibiotics in pharmaceutical plants showed significant differences, with higher concentrations of total antibiotics found in pharmaceutical plant influents in Shenzhen City than those of different regions in PRD. The treatment processes adopted by pharmaceutical plants were commonly ineffective in removing antibiotics, with only 26.7% of antibiotics being effectively removed (average removal greater than 70%), while 55.6% of antibiotics had removal rates of below 60%. The anaerobic/anoxic/oxic (AAO)-membrane bioreactor (MBR) combined process exhibited better treatment performance than the single treatment process. Sulfamethoxazole (SMX), ofloxacin (OFL), erythromycin-H2O (ETM-H2O), sulfadiazine (SDZ), sulfamethazine (SMZ), norfloxacin (NFX), and ciprofloxacin (CIP) in pharmaceutical plant effluents posed high or moderate ecological risk and deserve particular attention.

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Changle goose in Fujian, China is a rare genetic resource and in urgent need to be protected. Understanding the characteristics of digestive physiology and spatial variation of gastrointestinal microbiota is crucial for developing nutritional intervention strategies to improve intestinal health and production performance of goose. Hence, histomorphological assay was used for observing development status of proventriculus, jejunum, and cecum in 70-day-old Changle geese, whereas digesta from 6 alimentary canal locations (crop, proventriculus, gizzard, jejunum, cecum, and rectum) were collected for 16S rRNA gene sequencing and short chain fatty acids (SCFAs) quantitative analysis. The histomorphological observation indicated that the jejunum and cecum of Changle goose were well developed. The alpha diversity analysis revealed that, except rectum, microbiota in other noncecum sections were in high diversity as cecum. The Nonmetric MultiDimensional Scaling (NMDS) analysis showed that microbial community of proventriculus, gizzard, and jejunum formed a cluster, which distinctly discrete with the microbiota of the other gastrointestinal locations. Additionally, the proportions of Proteobacteria, Bacteroidota, and Campilobacterota at the phylum level and Lactobacillus, Streptococcus, Helicobacter, and Subdoligranulum at the genus level exhibited tremendous alternations among different gastrointestinal locations. The characteristic bacterial composition in each section was further disclosed by analyzing the core and feature Amplicon Sequence Variants (ASVs) and SCFAs pattern. Importantly, 7 body-weight-associated ASVs and 2 cecum-development-related ASVs were identified via correlation analysis. In a whole, our findings provided the first insights into the specialized digestive physiology of Changle geese and distinctive regional distribution of gastrointestinal microbiota, which laid the important foundation for improving growth performance through microbiota manipulation in geese.

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OBJECTIVE: To analyze the intakes of main food among the children of 6-17 years in different regions of China from 2019 to 2021, and to provide a scientific basis for evaluation and guiding Chinese children to make reasonable diet. METHODS: Multistage stratified random sampling method was used to collect data in east China, north China, central China, south China, southwest, northwest and northeast seven areas of each random two provinces, randomly selected from each province one urban survey site and one rural survey site, 28 sites of the 13th Five Year National Science and Technology Basic Resources Survey Project-Chinese children aged 0-18 investigation and application of nutrition and health system in 14 provinces of China. The study included 6413 children aged 6 to 17. Three consecutive 24-hour recalls method combined with weighing were used to collect the information of food intake. According to the food classification in the standard version of the food composition list, the food was divided into cereals, tubers, fresh vegetables, fresh fruits, meat and poultry, fish and shrimp, eggs, milk, etc. , and the intake of various foods was calculated for boys and girls aged 6-8, 9-11, 12-14 and 15-17 in different regions. RESULTS: Compared with the average daily food intake of children of the same sex and age in the urban and rural, The average daily intake of cereals and tubers for boys aged 9-17, cereals for girls aged 9-17, tubers for girls aged 12-17, and fish and shrimp for boys of edible population aged 15-17 were higher in rural areas than in urban areas. There were differences in the average daily food intake and consumption rate of fresh vegetables, fresh fruits, meat and poultry, eggs and milk of the same sex and age, which were higher in urban than in rural areas(P<0.05). Compared with the average daily food intake of children of the same sex and age in the south and the north, the average daily intake of cereals and eggs for boys aged 9-14, cereals for girls aged 6-8, and fresh fruits for boys and girls of edible population aged 6-17 were higher in the north than in the south. There were differences in average daily intake and consumption rates of tubers, fresh vegetables, meat and poultry, milk and fish and shrimp of the same sex and age, which were higher in the south than in the north(P<0.05). Compared with the average daily food intake of children of the same sex and age in the eastern, central and western regions, the average daily intake of cereals for boys aged 6-14, cereals for girls aged 6-17, fresh fruits for boys and girls of edible population aged 6-17, and fish and shrimp for boys and girls of edible population aged 15-17 were lower in the eastern region than in the central and western regions. The average daily intake of tubers for boys aged 9-11 and 15-17, for girls aged 9-17 were higher in the western regions than the eastern and central regions. The average daily intake of eggs for boys and girls aged 12-17 was lower in western regions than the eastern and central regions. There were differences in average daily intake and consumption rates of fresh vegetables, meat and poultry and milk of the same sex and age, which were higher in the eastern region than in the central and western regions. (P<0.05). The proportion of coarse grains to cereals was low, between 3.7% and 10.1%. The proportion of pork to meat and poultry was high, between 56.1% and 71.4%. CONCLUSION: In China, there are differences in daily intake of main food for children aged 6 to 17 years old in urban and rural areas, north and south areas, east, central and west areas.

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Background: The number of people with mental disorders is increasing in China, but there are few studies on the temporal trends and population distribution of mental disorder mortality. Methods: The mortality of mental disorders were derived from the China Health Statistics Yearbook published by the National Health and Family Planning Commission. Temporal trends in mortality were examined with a joinpoint regression using annual percent change (APC) and average annual percent change (AAPC). A Poisson regression model was utilized to test the population-level risk factors associated with the death of people with mental disorders. Results: The mortality of mental disorders in rural Chinese residents showed a decreasing trend from 2002 to 2020 [AAPC -2.06%, 95% confidence interval (CI) -3.16 to -0.91%]. The mortality of mental disorders in urban Chinese residents declined between 2005 and 2011 (APC -13.01%, 95% CI -21.08 to -4.13%). The mortality rate of mental disorders has decreased for urban males with an APC of -2.71% (95% CI -4.52 to -0.71) from 2002 to 2020. Urban women showed an increase in mental disorder mortality from 2002 to 2005 and from 2012 to 2020 with APCs of 19.65% (95% CI 0.64-42.32%) and 6.16% (95% CI 2.22-10.33%), respectively. Age was a significant risk factor for mental disorder mortality (odds ratio 1.28, 95% CI 1.23-1.32). Conclusion: The dissemination of medical and health information, investment in medical and health resources, and the modification and optimization of regulations have led to a decrease in mental disorder mortality in China. It is vital to devote greater attention to elderly individuals suffering from mental disorders.

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BACKGROUND: Pharmacists in Canada are assuming an increasingly important role in the provision of primary care services. This raises questions about access to pharmacy services among those with medical care needs. While there is evidence on proximity of residents of Ontario and Nova Scotia to community pharmacies, there is little evidence for the rest of Canada. I thus measured the availability of pharmacist services, both the number of community pharmacies and their hours of operation, at both the provincial and sub-provincial level in Canada. Next, I measured associations of indicators of medical need and the availability of pharmacist services across sub-provincial units. METHODS: I collected data, for each Forward Sortation Area (FSA), on medical need, measured using the fraction of residents aged 65 + and median household income, and pharmacist service availability (the number of community pharmacies and their hours of operation, divided by the FSA population). Linear regression methods were used to assess associations of FSA-level service availability and medical need. RESULTS: There are between 2.0 and 3.3 community pharmacies per 10,000 population, depending on the province. There are also provincial variations in the number of hours that pharmacies are open. Quebec pharmacies were open a median of 75 h a week. In Manitoba, pharmacies were open a median of 53 h a week. The per capita number of pharmacies and their total hours of operation at the FSA level tend to be higher in less affluent regions and in which the share of residents is aged 65 or older. Provincial differences in pharmacy availability were still evident after controlling for medical need. CONCLUSION: Community pharmacies in Canada tend to locate where indicators of health needs are greatest. The impact on patient health outcomes of these pharmacy locational patterns remains an area for future research.

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Oil-based drilling cuttings (OBDC) are hazardous wastes produced during the extensive use of oil-based drilling mud in oil and gas exploration and development. They have strong mutagenic, carcinogenic, and teratogenic effects and need to be properly disposed of to avoid damaging the natural environment. This paper reviews the recent research progress on the regional distribution, properties, treatment technologies, and resource utilization of OBDC. The advantages and disadvantages of different technologies for removing petroleum pollutants from OBDC were comprehensively analyzed, and required future developments in treatment technologies were proposed.

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The outbreak of the novel coronavirus 2019 (COVID-19) pandemic has resulted in the increased human consumption of medicines. Antibiotics are of great concern due to their adverse effects, such as increased bacterial resistance and dysbiosis of gut microbiota. Nevertheless, very little is known about the changes in self-medication with antibiotics during the COVID-19 pandemic and the resultant potential health risks. Herein, we examined the concentration profiles of some commonly used antibiotics in human urine collected from several geographical regions in China between 2020 and 2021. Antibiotics were found in 99.2% of the urine samples at concentrations ranging from not detected (nd) to 357 000 (median: 10.2) ng/mL. During the COVID-19 pandemic, concentrations of urinary antibiotics were remarkably higher than those found either before the pandemic or in the smooth period of the pandemic. Moreover, elevated levels of antibiotics were determined in urine samples from the regions with more confirmed cases. The exposure assessment showed that hazard index values >1 were determined in 35.2% of people. These findings show that human exposure to antibiotics increased during the COVID-19 pandemic, and further research is imperative to identify the public health risks.

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Objectives: The provide a descriptive analysis of the available population-level aggregated data on committed suicides in the Republic of Croatia, in the 2004-2018 period, showing emerging trends in suicide incidence focusing on sex/age/geographical distribution of suicides and the primary and secondary causes of suicide mortality, as well as making comparisons with similar neighboring neighboring countries. Methods: The aggregated suicide data were obtained from the Croatian Committed Suicides Registry, a national registry maintained by the public health authority. The raw data extract was organized into tables according to several variables (age, sex, place of birth, place of residence, and cause of death). Simple descriptive statistics were performed on the structured data. Results: Despite being among the highest in the world and EU, the number of committed suicides in Croatia is in decline since 2004. A higher number of suicides by males was observed when compared to females. Most of the suicides occur during spring and summer. The wealthier, northern continental region of the country had the highest average rate of committed suicides per 1,00,000 population, contrary to some of the findings in the published literature associating economic instability with suicide. The most common way to commit suicide for both sexes in all age groups is self-harm by hanging, strangulation and suffocation. Suicide by firearm and explosive devices discharge remains higher than the global average. Conclusions: Despite its steadily declining incidence rates in the past 20 years, suicides remain a major public health challenge in Croatia. Results may bolster the Ugro-Finnish suicide hypothesis, linking higher suicide rates to regions with populations of Hungarian descent.

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In 2016, China began to execute the consistency evaluation policy of generic drugs. Many scholars believed that the policy would stimulate pharmaceutical firms to increase R&D investment with a theoretical perspective, but few have conducted empirical studies. Therefore, we conduct a difference-in-differences (DID) model and use panel data of 111 A-share listed pharmaceutical firms from 2012 to 2020 to empirically study the impact of the consistency evaluation policy of generic drugs on pharmaceutical firms' R&D investment intensity. The result shows that the policy has a significant positive impact on the R&D investment intensity of firms with chemical generics, robust under the test for parallel trend test, placebo test, and the propensity score matching and difference-in-differences (PSM-DID) test. In addition, we further analyzed the impact of this policy on the R&D intensity of pharmaceutical firms according to the heterogeneity of enterprise's operational nature, regional distribution and profitability. From the perspective of time changes and the average effect, the R&D investment intensity of private pharmaceutical firms is more affected by the policy than state-owned enterprises; the R&D investment intensity of pharmaceutical firms in the eastern region is more affected by this policy than those in the central and the western; the R&D investment intensity of high-profitability pharmaceutical firms is more affected by the policy than those with low-profitability. The consistency evaluation policy is still being implemented, and its impact on pharmaceutical firms needs to be studied from different empirical research perspectives in the future.

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In this study, hexabromocyclododecane (HBCD) was detected in 114 fish samples collected from 6 administrative regions of Xiamen city, China. HBCD amounts ranged between ND (not detected) and 2.216 ng g-1 ww (mean, 0.127 ± 0.318 ng g-1 ww). Besides, α-HBCD was the main diastereoisomer in these fish specimens, followed by ß-HBCD. Meanwhile, γ-HBCD was not detected in any of the samples. Significant differences were recorded among fish species. The results indicated that the levels and detection rates of HBCD were higher in Trachinotus ovatus compared with other aquatic organisms. Therefore, Trachinotus ovatus could be used as a marine biological indicator of HBCD. Within the regions investigated, Siming was significantly different from Jimei, Haicang, and Xiang'an. The spatial distribution of HBCD concentrations indicated higher mean levels in samples collected from Haicang, Jimei, and Xiang'an, respectively, with the highest detection rates in Jimei and Xiang'an, which might be related to geographical location and intense industrial and urban activities. Estimation of daily HBCD intake was performed according to fish consumption in Xiamen residents. The medium bound HBCD amounts in fish were approximately 0.073 and 0.088 ng kg bw-1d-1 for male and female residents of Xiamen, respectively. Exposure doses of HBCD indicated no health concern for Xiamen residents.

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INTRODUCTION: There is currently a global nurse shortage. Initial nursing education is the primary preparation for a robust nursing workforce that must be strengthened. OBJECTIVES: To describe the developing trends of initial nursing education in China from 2006 to 2017 and to analyze related characteristics and issues. DESIGN: A descriptive study with secondary data analysis. METHODS: The numbers, educational-level composition and regional distribution (i.e., East, Central, West, and Northeast regions) of students recruited into initial nursing education programs from 2006 to 2017 were analyzed. Changes in the numbers of the nursing workforce from 2006 to 2020 were compared with the changes in education sector to facilitate an interpretation of the development trend of initial nursing education. RESULTS: The number of recruits into initial nursing education programs has increased from 0.38 million in 2006 to 0.44 million in 2008, and maintained between 0.5 million and 0.54 million during 2009 to 2017. Students recruited to secondary diploma, advanced diploma, and baccalaureate degree programs accounted for 50.55% (71.46% in 2009), 39.36% and 10.09% of the total in 2017, respectively. There were 3.34 nurses per 1000 population in 2020, a substantial increase from 1.09 in 2006. The regional distribution of recruits was imbalanced, with more recruits per 1000 population in the West (0.49), Central (0.40), Northeast (0.34) and the least in the East (0.26) in 2017. The distribution of nurses was relatively balanced among the four regions. CONCLUSIONS: The development in initial nursing education in China is significant from 2006 to 2017. The education sector recruited and graduated about 0.5 million nursing students respectively per year in recent years. If simply considering the number of recruits, it could meet the workforce demands, however, to further upgrade nurses' educational preparation, the recruits into advanced diploma and baccalaureate degree programs need to be increased. A maldistribution of recruits among regions persists, while the distribution of nurses is relatively balanced. Multiple strategies should be adopted to achieve a balance between the supply and demand of nurses, with providing more higher-educated nurses in all regions across mainland China.

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Objective:To analyze the situation and changing trend of Traditional Chinese Medicine(TCM)resources in China, for reference in rationalizing TCM service resources distribution.Methods:Data were collected from the China Health Statistics Yearbooks(2014-2021). The quantitative distribution and variations of TCM medical institutions as well as their beds and manpower in 31 provinces of China were analized by the ArcGis 10.8 software. Grey correlation analysis was used to analyze the factors that have a greater impact on the changes of TCM medical resources.Results:The number of TCM medical institutions, manpower and beds in China increased from 41 966, 894 690 and 794 160 in 2013 to 72 355, 1 513 024 and 1 432 900 in 2020 respectively. The ranking of the total TCM medical resources in each province remained relatively stable. Sichuan, Guangdong and Shandong ranked the highest, while the central and western regions ranked lower generally. TCM outpatient departments(clinics) contributed the most to the growing numbers of TCM medical institutions( r=0.96), while TCM medicine contributed the most to the growth of the number of TCM manpower and beds( r=0.65, r=0.66). Conclusions:The total TCM resources in China keep a rapid growth in recent years, yet with a relatively uneven distribution. Therefore, we should combine the actual situation at the grass-roots level, focuse on building a team of featured talents, improve the supervision and assessment system, perfect the talent training mechanism, strengthen the policy preference in key regions and the exemplary role of typical regions, to optimize the cultural atmosphere of TCM, and promote the development of TCM services.

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BACKGROUND: Healthy lifestyle behaviours are effective means to reduce the burden of diseases. This study was aimed to fill the knowledge gaps on the distribution, associated factors, and potential health benefits on mortality of four healthy lifestyle behaviours in China. METHODS: During 2015-2019, participants aged 35-75 years from 31 provinces were recruited by the China PEACE Million Persons Project. Four healthy lifestyle behaviours were investigated in our study, including non-smoking, none or moderate alcohol use, sufficient leisure time physical activity (LTPA), and healthy diet. RESULTS: Among 903,499 participants, 74.1% were non-smokers, 96.0% had none or moderate alcohol use, 23.6% had sufficient LTPA, 11.1% had healthy diet, and only 2.8% had all the four healthy lifestyle behaviours. The adherence varied across seven regions; the highest median of county-level adherence to all the four healthy lifestyle behaviours was in North China (3.3%) while the lowest in the Southwest (0.8%) (p < 0.05). Participants who were female, elder, non-farmers, urban residents, with higher income or education, hypertensive or diabetic, or with a cardiovascular disease (CVD) history were more likely to adhere to all the four healthy lifestyle behaviours (p < 0.001). County-level per capital Gross Domestic Product (GDP) was positively associated with sufficient LTPA (p < 0.05 for both rural and urban areas) and healthy diet (p < 0.01 for urban areas), while negatively associated with none or moderate alcohol use (p < 0.01 for rural areas). Average annual temperature was negatively associated with none or moderate alcohol use (p < 0.05 for rural areas) and healthy diet (p < 0.001 for rural areas). Those adhering to all the four healthy lifestyle behaviours had lower risks of all-cause mortality (HR 0.64 [95% CI: 0.52, 0.79]) and cardiovascular mortality (HR 0.53 [0.37, 0.76]) after a median follow-up of 2.4 years. CONCLUSIONS: Adherence to healthy lifestyle behaviours in China was far from ideal. Targeted health promotion strategies were urgently needed.

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