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Triceps skinfold thickness (TSF) is a surrogate marker of subcutaneous fat. Evidence is limited about the association of sex-specific TSF with the risk of all-cause mortality among maintenance hemodialysis (MHD) patients. We aimed to investigate the longitudinal relationship of TSF with all-cause mortality among MHD patients. A multicenter prospective cohort study was performed in 1034 patients undergoing MHD. The primary outcome was all-cause mortality. Multivariable Cox proportional hazards models were used to evaluate the association of TSF with the risk of mortality. The mean (standard deviation) age of the study population was 54.1 (15.1) years. 599 (57.9%) of the participants were male. The median (interquartile range) of TSF was 9.7 (6.3–13.3 mm) in males and 12.7 (10.0–18.0 mm) in females. Over a median follow up of 4.4 years (interquartile range, 2.4-7.9 years), there were 548 (53.0%) deaths. When TSF was assessed as sex-specific quartiles, compared with those in quartile 1, the adjusted HRs (95%CIs) of all-cause mortality in quartile 2, quartile 3 and quartile 4 were 0.93 (0.73, 1.19), 0.75 (0.58, 0.97) and 0.69 (0.52, 0.92), respectively (P for trend =0.005). Moreover, when analyzed by sex, increased TSF (≥9.7 mm for males and ≥18mm for females) was significantly associated with a reduced risk of all-cause mortality (quartile 3-4 vs. quartile 1-2; HR, 0.70; 95%CI: 0.55, 0.90 in males; quartile 4 vs. Quartile 1-3; HR, 0.69; 95%CI: 0.48, 1.00 in females). In conclusion, high TSF was significantly associated with lower risk of all-cause mortality in MHD patients.
The emotion regulation network (ERN) in the brain provides a framework for understanding the neuropathology of affective disorders. Although previous neuroimaging studies have investigated the neurobiological correlates of the ERN in major depressive disorder (MDD), whether patients with MDD exhibit abnormal functional connectivity (FC) patterns in the ERN and whether the abnormal FC in the ERN can serve as a therapeutic response signature remain unclear.
Methods
A large functional magnetic resonance imaging dataset comprising 709 patients with MDD and 725 healthy controls (HCs) recruited across five sites was analyzed. Using a seed-based FC approach, we first investigated the group differences in whole-brain resting-state FC of the 14 ERN seeds between participants with and without MDD. Furthermore, an independent sample (45 MDD patients) was used to evaluate the relationship between the aforementioned abnormal FC in the ERN and symptom improvement after 8 weeks of antidepressant monotherapy.
Results
Compared to the HCs, patients with MDD exhibited aberrant FC between 7 ERN seeds and several cortical and subcortical areas, including the bilateral middle temporal gyrus, bilateral occipital gyrus, right thalamus, calcarine cortex, middle frontal gyrus, and the bilateral superior temporal gyrus. In an independent sample, these aberrant FCs in the ERN were negatively correlated with the reduction rate of the HAMD17 score among MDD patients.
Conclusions
These results might extend our understanding of the neurobiological underpinnings underlying unadaptable or inflexible emotional processing in MDD patients and help to elucidate the mechanisms of therapeutic response.
Cognitive impairment, a major determinant of poor functioning in schizophrenia, had limited responses to existing antipsychotic drugs. The limited efficacy could be due to regional differences in the dysregulation of the dopamine system. This study investigated striatal and peripheral dopaminergic makers in schizophrenia and their relationship with cognitive impairment.
Methods
Thirty-three patients with schizophrenia and 36 age- and sex-matched healthy controls (HC) participated. We evaluated their cognitive performance, examined the availability of striatal dopamine transporter (DAT) using single-photon emission computed tomography with 99mTc-TRODAT, and measured plasma levels of dopaminergic precursors (phenylalanine and tyrosine) and three branched-chain amino acids (BCAA) that compete with precursors for brain uptake via ultra-performance liquid chromatography.
Results
Schizophrenia patients exhibited lower cognitive performance, decreased striatal DAT availability, and reduced levels of phenylalanine, tyrosine, leucine, and isoleucine, and the ratio of phenylalanine plus tyrosine to BCAA. Within the patient group, lower DAT availability in the left caudate nucleus (CN) or putamen was positively associated with attention deficits. Meanwhile, lower tyrosine levels and the ratio of phenylalanine plus tyrosine to BCAA were positively related to executive dysfunction. Among all participants, DAT availability in the right CN or putamen was positively related to memory function, and plasma phenylalanine level was positively associated with executive function.
Conclusions
This study supports the role of dopamine system abnormalities in cognitive impairment in schizophrenia. The distinct associations between different dopaminergic alterations and specific cognitive domain impairments suggest the potential need for multifaceted treatment approaches to target these impairments.
Previous animal studies found beneficial effects of choline and betaine on maternal glucose metabolism during pregnancy, but few human studies explored the association between choline or betaine intake and incident gestational diabetes mellitus (GDM). We aimed to explore the correlation of dietary choline or betaine intake with GDM risk among Chinese pregnant women. A total of 168 pregnant women with GDM cases and 375 healthy controls were enrolled at the Seventh People’s Hospital in Shanghai during their GDM screening at 24–28 gestational weeks. A validated semi-quantitative FFQ was used to estimate choline and betaine consumption through face-to-face interviews. An unconditional logistic regression model was adopted to examine OR and 95 % CI. Compared with the controls, those women with GDM incidence were likely to have higher pre-pregnancy BMI, be older, have more parities and have higher plasma TAG and lower plasma HDL-cholesterol. No significant correlation was observed between the consumption of choline or betaine and incident GDM (adjusted OR (95 % CI), 0·77 (0·41, 1·43) for choline; 0·80 (0·42, 1·52) for betaine). However, there was a significant interaction between betaine intake and parity on the risk of GDM (Pfor interaction = 0·01). Among those women with no parity history, there was a significantly inverse correlation between betaine intake and GDM risk (adjusted OR (95 % CI), 0·25 (0·06, 0·81)). These findings indicated that higher dietary betaine intake during pregnancy might be considered a protective factor for GDM among Chinese women with no parity history.
By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences.
Methods
Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed.
Results
Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = −0.62 [95% confidence interval (CI), −1.07 to −0.17] for one type of social participation; β = −0.57 [95% CI, −1.04 to −0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65–0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61–0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress.
Conclusions
The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.
Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019.
Methods:
Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics.
Results:
Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services.
Conclusions:
TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.
Many protected areas worldwide have been established to protect the last natural refuges of flagship animal species. However, long-established protected areas do not always match the current distributions of target species under changing environmental conditions. Here we present a case study of the Asian elephant Elephas maximus in Xishuangbanna, south-west China, to evaluate whether the established protected areas match the species’ current distribution and to identify key habitat patches for Asian elephant conservation. Our results show that currently only 24.5% of the predicted Asian elephant distribution in Xishuangbanna is located within Xishuangbanna National Nature Reserve, which was established for elephant conservation. Based on the predicted Asian elephant distribution, we identified the most important habitat patches for elephant conservation in Xishuangbanna. The three most important patches were outside Xishuangbanna National Nature Reserve and together they contained 43.3% of the estimated food resources for Asian elephants in all patches in Xishuangbanna. Thus, we identified a spatial mismatch between immobile protected areas and mobile animals. We recommend the inclusion of the three identified key habitat patches in a new national park currently being planned by the Chinese authorities for the conservation of the Asian elephant.
We aimed to examine the association between the quantity and quality of dietary fat in early pregnancy and gestational diabetes mellitus (GDM) risk. In total, 1477 singleton pregnant women were included from Sichuan Provincial Hospital for Women and Children, Southwest China. Dietary information was collected by a 3-d 24-h dietary recall. GDM was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24–28 gestational weeks. Log-binomial models were used to estimate relative risks (RR) and 95% CI. The results showed that total fat intake was positively associated with GDM risk (Q4 v. Q1: RR = 1·40; 95 % CI 1·11, 1·76; Ptrend = 0·001). This association was also observed for the intakes of animal fat and vegetable fat. After stratified by total fat intake (< 30 %E v. ≥ 30 %E), the higher animal fat intake was associated with higher GDM risk in the high-fat group, but the moderate animal fat intake was associated with reduced risk of GDM (T2 v. T1: RR = 0·65; 95 % CI 0·45, 0·96) in the normal-fat group. Vegetable fat intake was positively associated with GDM risk in the high-fat group but not in the normal-fat group. No association between fatty acids intakes and GDM risk was found. In conclusion, total fat, animal and vegetable fat intakes were positively associated with GDM risk, respectively. Whereas when total fat intake was not excessive, higher intakes of animal and vegetable fat were likely irrelevant with increased GDM risk, even the moderate animal fat intake could be linked to lower GDM risk.
The structure, powder diffraction patterns and bandgap measurements of a series of manganese- and tungsten-containing alkaline-earth double perovskites (CaxSr2−x)MnWO6 (x = 0.25, 0.5, 0.75, 1.5, 1.75) have been investigated. Powder X-ray diffraction patterns of this series of compounds measured at room temperature have been submitted to be included in the Powder Diffraction File (PDF). These compounds crystallize in monoclinic space group P21/n (No.14). From (Ca1.75 Sr0.25)MnWO6 to (Ca0.25Sr1.75)MnWO6, lattice parameters a range from 5.6729(2) Å to 5.6774(4) Å, b from 5.5160(2) Å to 5.6638(4) Å, c from 7.8741(3) Å to 8.0051(4) Å, V from 240.39(2) Å3 to 257.410(12) Å3, and Z = 2. These compounds are pseudo-tetragonal. They all consist of distorted MnO6 and WO6 octahedra with rotational mismatch angles and tilt angles with respect to each other. For (CaxSr2−x)MnWO6, as x increases, the mismatch angles for MnO6 octahedra increase from 7.96 (6)° to 13.12(8)° and from 9.28(7)° to 14.87(9)° for WO6 octahedra. Correspondingly, the tilt angles range from 11.60(15)° to 14.20(3)° for MnO6, and from 13.34(2)° to 16.35(3)° for WO6. Bandgap measurements suggest that these compounds to be direct-allowed semiconductors with bandgaps ranging from 1.5 to 2.5 eV, indicating that members of (CaxSr2−x)MnWO6 are potential photocatalysts and photovoltaic materials that absorb visible light of the solar spectrum.
Ediacaran cap dolostone atop Marinoan glacial deposits contains complex sedimentary structures with extremely negative δ13Ccarb values in close association with oscillations in palaeoclimatic and oceanographic proxy records. However, the precise geological, geochronological and geochemical context of the cap dolostone is not clarified, which hampers us from correctly interpreting the extremely negative δ13Ccarb values and their causal relationships with the Snowball Earth hypothesis. In this study, we conducted detailed in situ geochronological and geochemical analyses on the calcite within the cap dolostone from the Ediacaran Doushantuo Formation in South China in order to define its formation and relationship to the Snowball Earth hypothesis. Petrographic observations show that formation of dolomite pre-dates precipitation of calcite and pyrite, which pre-dates quartz cementation in the basal cap carbonate. Calcite cement within the cap dolostone yielded a U–Pb age of 636.5 ± 7.4/17.8 Ma (2σ, MSWD = 1.6, n = 36/40), which is within uncertainty of a published dolomite U–Pb age of 632 ± 17 Ma (recalculated as 629.3 ± 16.7/22.9 Ma). These age constraints negate the possibility that the calcite cement was formed by late Ediacaran or Cambrian hydrothermal activity. The rare earth element distribution patterns suggest a dominant seawater origin overprinted by subsequent early Ediacaran hydrothermal activity. The combined age, petrographic and geochemical data suggest oxidization of methane clathrates in response to complicated interplay between eustasy and isostatic rebound and hydrothermal fluids.
Insulin-like growth factor 1 receptor (IGF1R) is a cell surface receptor, belonging to the tyrosine kinase receptor superfamily. IGF1R plays a role not only in normal cell development but also in malignant transformation, which has become a candidate therapeutic target for the treatment of human cancer. This study aimed to explore insertions and deletions (indels) in IGF1R gene and investigate their association with growth traits in four Chinese cattle breeds (Xianan cattle, Jinnan cattle, Qinchuan cattle and Nanyang cattle). The current paper identified a 28-bp indel by polymerase chain reaction within IGF1R gene. The analysis showed that there was a significant correlation between the locus and the hucklebone width of Nanyang cattle in four periods, in which it was highly correlated at 6, 12 and 18 months. At the age of 6 months, it was also significantly correlated with body height, body weight and body length. Association analysis showed that the locus in Jinnan cattle was extremely significantly correlated with body slanting length and body weight, and significantly correlated with chest circumference. There was no significant correlation between this locus and growth traits of Xianan cattle and Qinchuan cattle. The detected indel in the IGF1R gene was significantly associated with growth traits in Jinnan and Nanyang cattle, and could be used as a molecular marker for growth trait selection.
There are growing concerns about the impact of the COVID-19 pandemic on the mental health of older adults. We examined the effect of the pandemic on the risk of depression in older adults.
Methods
We analyzed data from the prospective cohort study of Korean older adults, which has been followed every 2 years. Among the 2308 participants who completed both the third and the fourth follow-up assessments, 58.4% completed their fourth follow-up before the outbreak of COVID-19 and the rest completed it during the pandemic. We conducted face-to-face diagnostic interviews using Mini International Neuropsychiatric Interview and used Geriatric Depression Scale. We performed generalized estimating equations and logistic regression analyses.
Results
The COVID-19 pandemic was associated with increased depressive symptoms in older adults [b (standard error) = 0.42 (0.20), p = 0.040] and a doubling of the risk for incident depressive disorder even in euthymic older adults without a history of depression (odds ratio = 2.44, 95% confidence interval 1.18–5.02, p = 0.016). Less social activities, which was associated with the risk of depressive disorder before the pandemic, was not associated with the risk of depressive disorder during the pandemic. However, less family gatherings, which was not associated with the risk of depressive disorder before the pandemic, was associated with the doubled risk of depressive disorder during the pandemic.
Conclusions
The COVID-19 pandemic significantly influences the risk of late-life depression in the community. Older adults with a lack of family gatherings may be particularly vulnerable.
In this paper, we present a method for generating a copula by composing two arbitrary n-dimensional copulas via a vector of bivariate functions, where the resulting copula is named as the multivariate composite copula. A necessary and sufficient condition on the vector guaranteeing the composite function to be a copula is given, and a general approach to construct the vector satisfying this necessary and sufficient condition via bivariate copulas is provided. The multivariate composite copula proposes a new framework for the construction of flexible multivariate copula from existing ones, and it also includes some known classes of copulas. It is shown that the multivariate composite copula has a clear probability structure, and it satisfies the characteristic of uniform convergence as well as the reproduction property for its component copulas. Some properties of multivariate composite copulas are discussed. Finally, numerical illustrations and an empirical example on financial data are provided to show the advantages of the multivariate composite copula, especially in capturing the tail dependence.
This study aims to identify error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment (PPE).
Methods:
A total of 56 health care workers, including 37 nurses and 19 physicians, were recruited to don and doff the PPE recommended by the Chinese Center for Disease Control and Prevention. Operational errors and sites of self-contamination were recorded using UV-fluorescent labeling and video surveillance.
Results:
Three main errors during donning were identified: choosing a loose-fitting coverall that was difficult to handle; ignoring to inspect the seal of N95 respirator or gloves; and forgetting to pull up the zipper completely. Four main errors during doffing were identified: removing the N95 respirator in a wrong way; touching the scrubs with contaminated hands and elbows; touching contaminated external surfaces of the goggles; and performing insufficient hand hygiene. Key sites that were easily contaminated during the doffing of PPE included left hand and wrist, left lower leg, chest, and left abdomen.
Conclusion:
Identifying the steps prone to errors and key sites of self-contamination in the process of PPE donning and doffing can facilitate the training of PPE use and provide detailed evidence for optimizing standardized protocols to reduce contamination.
Primary liver cancer is the third leading cause of cancer-related death worldwide. Most patients are diagnosed at late stages with poor prognosis; thus, identification of modifiable risk factors for primary prevention of liver cancer is urgently needed. The well-established risk factors of liver cancer include chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), heavy alcohol consumption, metabolic diseases such as obesity and diabetes, and aflatoxin exposure. However, a large proportion of cancer cases worldwide cannot be explained by current known risk factors. Dietary factors have been suspected as important, but dietary aetiology of liver cancer remains poorly understood. In this review, we summarised and evaluated the observational studies of diet including single nutrients, food and food groups, as well as dietary patterns with the risk of developing liver cancer. Although there are large knowledge gaps between diet and liver cancer risk, current epidemiological evidence supports an important role of diet in liver cancer development. For example, exposure to aflatoxin, heavy alcohol drinking and possibly dairy product (not including yogurt) intake increase, while intake of coffee, fish and tea, light-to-moderate alcohol drinking and several healthy dietary patterns (e.g. Alternative Healthy Eating Index) may decrease liver cancer risk. Future studies with large sample size and accurate diet measurement are warranted and need to consider issues such as the possible aetiological heterogeneity between liver cancer subtypes, the influence of chronic HBV or HCV infection, the high-risk populations (e.g. cirrhosis) and a potential interplay with host gut microbiota or genetic variations.
In the human population, influenza A viruses are associated with acute respiratory illness and are responsible for millions of deaths annually. Avian and human influenza viruses typically have a different α2-3- and α2-6-linked sialic acid (SA) binding preference. Only a few amino acid changes in the haemagglutinin on the surface of avian influenza viruses (AIV) can cause a switch from avian to human receptor specificity, and the individuals with pathognostic chronic diseases might be more susceptible to AIV due to the decreased expression level of terminal α2-3-linked SA in their saliva. Here, using lectin and virus histochemical staining, we observed the higher expression levels of α2-3/6-linked SA influenza virus receptors in the airway of HBV-transgenic mice compared with that of control mice due to the significant decrease in control mice during ageing, which imply that this is also a risk factor for individuals with pathognostic chronic diseases susceptible to influenza viruses. Our findings will help understand the impact on influenza virus pathogenesis and transmission.
Structure and optical properties have been successfully determined for a series of niobium- and tantalum-containing layered alkaline-earth silicate compounds, Ba3(Nb6−xTax)Si4O26 (x = 0.6, 1.8, 3.0, 4.2, 5.4). The structure of this solid solution was found to be hexagonal P-62m (No. 189), with Z = 1. With x increases from 0.6 to 5.4, the lattice parameter a increases from 8.98804(8) to 9.00565(9) Å and c decreases from 7.83721(10) to 7.75212(12) Å. As a result, the volume decreases from 548.304(11) to 544.479(14) Å3. The (Nb/Ta)O6 distorted octahedra form continuous chains along the c-axis. These (Nb/Ta)O6 chains are in turn linked with the Si2O7 groups to form distorted pentagonal channels in which Ba ions were found. These Ba2+ ions have full occupancy and a 13-fold coordination environment with neighboring oxygen sites. Another salient feature of the structure is the linear Si–O–Si chains. When x in Ba3(Nb6−xTax)Si4O26 increases, the bond valence sum (BVS) values of the Ba sites increase slightly (2.09–2.20), indicating the size of the cage becoming progressively smaller (over-bonding). While SiO cages are also slightly smaller than ideal (BVS range from 4.16 to 4.19), the (Nb/Ta)O6 octahedral cages are slightly larger than ideal (BVS range from 4.87 to 4.90), giving rise to an under-bonding situation. The bandgaps of the solid solution members were measured between 3.39 and 3.59 eV, and the x = 3.0 member was modeled by density functional theory techniques to be 3.07 eV. The bandgaps of these materials indicate that they are potential candidates for ultraviolet photocatalyst.
Personal protective equipment (PPE) is a necessary item in the period of unknown and high-risk emerging infectious disease. It is not only the necessary requirement of strict isolation, but also the last line of defense to protect medical staff.
Aim:
Compare the differences between contaminated frequency and sites under two types of PPE doffing.
Methods:
Recruited 56 health care workers (HCWs) who worked in clinical to follow the different PPE removal guidelines issued by the Chinese Center for Disease Control (CDC) and the World Health Organization (WHO) final resolution for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion (Glitter Bug Potion, On Solution Pty Lt). Then we recorded the frequency and sites of contamination of personnel after removal of contaminated PPE by the method of visual observation.
Results:
According to China’s CDC process, the parts that are easily contaminated during PPE removal are: left hand and wrist (7 times), left calf (7 times), front chest center and left and right chest (6 times each) and left abdomen (5 times). Contaminated parts of the PPE process in accordance with the WHO process from high to low were: right hand and wrist (13 times), left hand and wrist (12 times), middle of the abdomen (10 times), left chest (9 times), and left abdomen (6 Times). There was no statistical difference between the two kinds of PPE piercing and removal (Z=1.177, P > 0. 05).
Discussion:
Under the guidance of the two processes recommended by China CDC and WHO, there was no significant difference in the frequency of pollution after removing PPE. It is speculated that the PPE recommendation processes issued by WHO and China CDC are effective for personal protection against fulminating infectious diseases.
Proper use of personal protective equipment (PPE) is essential when facing emerging infectious diseases. Proper training methods can promote the use of the PPE correctly.
Aim:
To explore the effect of the training method of sequential operation training on medical staff to master PPE penetration and removal skills, and to study the memory attenuation after training.
Methods:
Fifteen medical staff with no experience of PPE operation in a hospital were trained to wear PPE in accordance with WHO standards by illustration and sequential operation method. The training included 30 minutes of theoretical teaching and 60 minutes of practical exercises. At the end of the training and 1 week after the training, the training objects were evaluated for PPE operation. A 2.5 x 2.5 cm fluorescent agent was applied on 6 parts, such as hands, chest, abdomen, and knees, to simulate contamination. After taking the PPE off, the parts of the whole body and the inner layer of clothing that were fluorescently contaminated were recorded. The whole operation process was recorded by video to evaluate whether the operation was correct. The error rates of two operations and the contamination position and frequency were compared.
Results:
The error rate of the operating PPE after training was 18.6%, rising to 31.9% after 1 week (Z=16.0, P<0.05). After the training, the average number of contaminated PPE removal was 1.96±1.56, which rose to 2.96±2.03 one month later. The difference was statistically significant (Z=8.92, P<0.05). The main vulnerable sites are the wrist, chest, abdomen, and left calf.
Discussion:
Illustrative sequential operation training is an important means to improve the way for medical staff to wear PPE, but it must be completed more than once to ensure that medical staff can firmly master the skills of wearing and removing PPE.