a member of the Chinese "Back to Jerusalem Evangelistic Band" An American professor came to China in 1909 to preach the gospel So Zhou grew up in the church and became a Christian at 16 In 1939 she studied in a Bible school founded by the Methodist church in Kaifeng Later she visited the church in the United States and an American university president exceptionally recruited her into a program at the university Four years later she graduated with honors and helped her adoptive mother take care of orphans she worked in a local school for poor children and later served in churches in Henan and Chongqing In 1950 Zhou became a teacher at Northwest Spiritual Training Institute and three years later she began voluntary evangelism.In 1959 she was arrested on false charges of "historical counter-revolution and spying for the US" she was acquitted and taught English in a school for employees of a reform-through-labor farm. The 65-year-old preacher rejoined the ministry of Lanzhou Shanzishi Church when it was reopened in 1979 she worked as an English teacher for 13 years and preached to people who loved English at the same time In 1993 Zhou quit her teaching job at Lanzhou University and worked full-time in the church She successively served as a member of the standing committee of the Gansu CC&TSPM and the main leader of the Lanzhou CC&TSPM She never married and adopted three orphans.  This site has not been designed for your version of Internet Explorer. To get the best experience we recommend you upgrade to the latest version of Internet Explorer, Firefox or Chrome. Allen & Gledhill Partners Koh En Ying, Tham Hsu Hsien, and Alexander Yap and Counsel Gloria Goh contributed the Singapore chapter to the International Comparative Legal Guide: Digital Health 2025 (6th Ed) Issues covered in the chapter include the digital health regulatory framework This site uses cookies and by using the site you are consenting to this. Find out why we use cookies and how to manage your settings. More about cookies The economic evaluation will be used to establish the value of the SINEMA intervention in the Chinese rural setting, which has great potential to be adapted and implemented in other resource-limited settings. Volume 14 - 2023 | https://doi.org/10.3389/fneur.2023.1145562 This article is part of the Research TopicDevelopment of Stroke Systems of Care across the GlobeView all 22 articles Introduction: Secondary prevention of stroke is a leading challenge globally and only a few strategies have been tested to be effective in supporting stroke survivors The system-integrated and technology-enabled model of care (SINEMA) intervention a primary care-based and technology-enabled model of care has been proven effective in strengthening the secondary prevention of stroke in rural China The aim of this protocol is to outline the methods for the cost-effectiveness evaluation of the SINEMA intervention to better understand its potential economic benefits Methods: The economic evaluation will be a nested study based on the SINEMA trial; a cluster-randomized controlled trial implemented in 50 villages in rural China The effectiveness of the intervention will be estimated using quality-adjusted life years for the cost-utility analysis and reduction in systolic blood pressure for the cost-effectiveness analysis Health resource and service use and program costs will be identified and valued at the individual level based on medication use The economic evaluation will be conducted from the perspective of the healthcare system Conclusion: The economic evaluation will be used to establish the value of the SINEMA intervention in the Chinese rural setting which has great potential to be adapted and implemented in other resource-limited settings it is necessary to emphasize the prevention of recurrent strokes in the rural setting previous economic evaluations were mainly conducted in developed countries and the cost-effectiveness of an integrated mobile health intervention on secondary stroke prevention in a resource-constrained setting like rural China remains unclear the economic evaluation of the SINEMA intervention is necessary This protocol describes the methods for the economic evaluation of the SINEMA program based in a rural Chinese setting This protocol describes the methods for the economic evaluation of the SINEMA program, which is nested in the SINEMA trial (8) This study aims to provide an economic evaluation of the SINEMA program to identify and value key resource and outcome impacts from the SINEMA intervention model compared with usual care for stroke secondary prevention in rural China A within-trial economic evaluation will be conducted to calculate the within-trial incremental cost-effectiveness ratio to determine the value of the SINEMA intervention model we will adopt the conventional approach by considering the benchmark as 1.5 times of gross domestic product per capita Participants were recruited between 23 June 2017 and 21 July 2017 and followed until 27 July 2018 The SINEMA intervention involved provider-side components and patient-facing components and was supported by a digital health system received training based on the train-the-trainer to train model They were also equipped with the SINEMA app they conducted monthly follow-up visits to patients financial incentives were also provided to encourage their ongoing commitment to deliver quality healthcare services Stroke patients received monthly follow-up visits delivered by village doctors at the village clinics or their own homes if they had difficulty visiting the clinics they were provided with suggestions about medication use and physical activities Participants who had access to their own or shared cell phones received one voice message for delivering health education information regarding medication adherence and physical activities The intervention effectiveness will be measured by comparing the systolic blood pressure reduction and the QALYs between the intervention and control arm over the 12-month follow-up period Blood pressure (BP) was measured as the primary outcome in the SINEMA trial at baseline and 1-year later following the sample measurement protocol and approach among all participants Blood pressure was measured on the right upper arm with participants seated and after 5 min of rest with an electronic BP monitor (Omron HEM-7052) If the difference between the two systolic BP measures was larger than 10 mmHg and the mean value of the last two readings was calculated with 1 representing the value of full health and −0.391 representing the worst state and all-cause mortality were measured by using questionnaires at one-year follow-up Medical and deaths records were also extracted from four major hospitals in the region These data provide information about the status and trajectory of stroke during the trial period The aim of the economic evaluation is to inform decision-makers about the costs and cost-effectiveness of introducing the SINEMA intervention to stroke patients in rural regions the economic evaluation will mainly be performed from the health sector perspective reflecting the cost and values of the healthcare system The resources used to support the SINEMA program include as follows: (1) the cost used to support SINEMA program delivery and (2) the health resources used to support the healthcare service delivery to stroke patients. Table 1 describes the detailed measurement and valuation of costs including the investigator's time and data collection The costs of designing the SINEMA intervention and the digital health system and other “one-off” costs were excluded but the operation and maintenance costs of the digital health system were included in the analysis Resource use information collected and measured for cost Program costs are captured based on a detailed inventory of all resources that are used to support the design and delivery of the SINEMA program This consists of the administrative cost of headcounts of local project manager and printing materials the cash support that compensates for the time and efforts of the village doctors and county physicians in delivering the SINEMA intervention over the trial period and the resources used for maintaining the digital component of the SINEMA intervention (including daily voice messages to patients and labor cost related to system maintenance) The data analyses will be performed using STATA software (StataCorp For the within-trial cost-effectiveness analysis two incremental cost-effectiveness ratios (ICERs) will be calculated to evaluate the incremental cost per QALY and the incremental cost per 1 mmHg reduction in systolic blood pressure Multivariable or multilevel models (with levels defined as villages considering the cluster design) will be employed to explore factors associated with health resource use Generalized linear regression modeling of costs with gamma distributions and log linked for multivariable analyses that adjust for age Several sensitivity analyses will be considered to quantify the level of decision uncertainty. Deterministic sensitivity analyses will be performed on chosen variables to identify key determinants for the results, as presented in Table 2 We will generate cost-effectiveness scatterplots to explore the uncertainties around incremental costs and effectiveness A cost-effectiveness acceptability curve (CEAC) will be created to explore the probabilities of the SINEMA intervention being cost-effective at a range of cost-effectiveness thresholds This manuscript details the study protocol of the economic evaluation that aims to assess the cost-effectiveness of the SINEMA intervention among stroke patients in rural China As one of a few studies that evaluate the economic value of community-based technology-enabled intervention for stroke prevention and management this study employs a within-trial evaluation to analyze the incremental cost-effectiveness ratios the findings from this study will provide robust evidence to policymakers in low- and middle-income countries for adopting and scaling up similar interventions our study may shed light on the field by detailing our methodology for evaluating the cost-effectiveness of a community-based technology-enabled intervention We also include the development cost in our sensitivity analysis This approach enables us to estimate the long-term economic impact of the SINEMA intervention we tend to underestimate the inpatient costs if there are relatively more inpatients in the control group the analysis may underestimate some of the labor costs the village doctors may provide blood pressure assessments during clinic visits for free and the payment scheme may not be set by the number of services provided at the clinic visits thus were not included in the financial analysis This article details the study protocol of the economic evaluation of the SINEMA intervention the SINEMA intervention has a high potential to be adapted and implemented in other settings to benefit more people with stroke The studies involving human participants were reviewed and approved by Duke University The patients/participants provided their written informed consent to participate in this study and YL contributed to the manuscript revision LS supervised the study design and data analysis plan All authors approved the final version for publication This study was funded by the United Kingdom Medical Research Council This study was also supported by the Non-Profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No LLY was also supported by the National Science Foundation of China (Grant No EG was supported by the National Science Foundation of China (Grant No 82204171).The funders had no role in the study design We would like to thank the independent International Steering Committee Chair (Yangfeng Wu) and members (Eric Peterson and Craig Anderson) and Advisory group members (Alba Amaya-Burns and Cheng Sun) who have provided great advice in designing and implementing the study We also thank DD and his team (Xingtai City Center for Disease Prevention and Control) Zhenli Xu and his team (Nanhe County Center for Disease Prevention and Control) Congxuan Wu and his team (Ren County Center for Disease Prevention and Control) and all staff members from township healthcare centers and village clinics and all patients who participated or supported the project The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest The reviewer WW declared a shared parent affiliation with the author ZL to the handling editor at the time of review All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher China stroke statistics: an update on the 2019 report from the National Center for Healthcare Quality Management in Neurological Diseases China National Clinical Research Center for Neurological Diseases National Center for Chronic and Non-Communicable Disease Control and Prevention Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations Stroke recurrence as a challenge for countries PubMed Abstract | CrossRef Full Text | Google Scholar Stroke in the 21(St) century: a snapshot of the burden PubMed Abstract | CrossRef Full Text | Google Scholar Economic burden of stroke: a systematic review on post-stroke care The economic burden of stroke: a systematic review of cost of illness studies System-integrated technology-enabled model of care to improve the health of stroke patients in rural china: protocol for sinema—a cluster-randomized controlled trial Effectiveness of a primary care-based integrated mobile health intervention for stroke management in rural China (Sinema): a cluster-randomized controlled trial Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events The implementation of a primary care-based integrated mobile health intervention for stroke management in rural China: mixed-methods process evaluation Development and local contextualization of mobile health messages for enhancing disease management among community-dwelling stroke patients in rural China: multimethod study A smart and multifaceted mobile health system for delivering evidence-based secondary prevention of stroke in rural China: design Estimation of the cost-effective threshold of a quality-adjusted life year in China based on the value of statistical life Health-related quality of life measured using the Eq-5d−5l: South Australian population norms Chinese version of the Eq-5d preference weights: applicability in a chinese general population Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis A community-based intervention for managing hypertension in rural South Asia Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (cobin): an open-label Budget impact and cost-effectiveness analyses of the cobra-bps multicomponent hypertension management programme in rural communities in Bangladesh Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (cobin): a retrospective analysis Potential bias associated with modeling the effectiveness of healthcare interventions in reducing mortality using an overall hazard ratio Biases in individualized cost-effectiveness analysis: influence of choices in modeling short-term mortality risk reduction and post-trial life expectancy A systematic review of economic evaluations of mhealth solutions Economic evaluation of digital health interventions: methodological issues and recommendations for practice China kadoorie biobank of 0.5 million people: survey methods baseline characteristics and long-term follow-up Does having a usual primary care provider reduce patient self-referrals in rural China's rural multi-tiered medical system A retrospective study in Qianjiang District Si L and Yan LL (2023) An economic evaluation of a primary care-based technology-enabled intervention for stroke secondary prevention and management in rural China: a study protocol Received: 25 January 2023; Accepted: 04 April 2023; Published: 02 May 2023 Copyright © 2023 Gong, Yang, Chen, Li, Li, Bettger, Oldenburg, Dong, Si and Yan. 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Yan, bGlqaW5nLnlhbkBkdWtla3Vuc2hhbi5lZHUuY24=; Lei Si, bC5zaUB3ZXN0ZXJuc3lkbmV5LmVkdS5hdQ== †These authors have contributed equally to this work and share first authorship Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish The dates displayed for an article provide information on when various publication milestones were reached at the journal that has published the article activities on preceding journals at which the article was previously under consideration are not shown (for instance submission Journal of Hazardous MaterialsCitation Excerpt :As these microorganisms metabolize processes like biotransformation and biodegradation degrade organic pollutants in ecosystems bioremediation has been used to remove a variety of organic pollutants phenolic substances and heavy metal pollutant [11,7,9] recent studies indicate that directly introducing specific microorganisms into polluted water or soil can also achieve various degrees of remediation [30,33] GeodermaCitation Excerpt :Ureolysis can degrade soil organic N and urea The degradation of aromatic compounds is crucial for maintaining an optimal soil environment and ensuring plant growth as certain aromatic compounds can be toxic and inhibit plant and microbial growth (Chen et al. aromatic compounds not only exhibit inhibitory effects on plant growth but also can limit the colonization of rhizosphere microbes (Yun et al. All content on this site: Copyright © 2025 Elsevier B.V. 2022–Alisa Glinka on Aachen won the World Cup Grand Prix Freestyle Sunday in the bid by the Moldovan combination for a second straight Final appearance Alisa and her 11-year-old Oldenburg scored 74.355% for the win in the Central European qualifier for the final of the world championship to be staged in Omaha next April The duo was one of two from Central Europe to compete at the 2021-22 Final in Leipzig Germany last April and also rode at last year’s European Championships Lithuania’s Sandra Sysojeva on Jack Daniel’s 11-year-old Portuguese Sport Horse stallion Hungary’s Csaba Szokola on Enying placed fourth on 70.500% to remain atop of the Central European standings adding to the 20 points earned from the opening qualifier two weeks ago Follow along here on our 2025 Legislative Hub We sent a letter to the USD 233 Olathe School District Board and Superintendent regarding potential constitutional violations in a reported policy or practice requiring teachers to report all students' pronoun and name change requests to school principals and/or counselors and requiring that such requests only be honored if the student's parents provide consent The potential violation of transgender students' rights is clear Mandatory outing of students' gender identity or sexual orientation violates their privacy rights and runs afoul of the Family Educational Rights and Privacy Act schools can lawfully and should refer to transgender students by the name and pronouns of the students' choosing and enying them the right to use their preferred names and pronouns may violate Title IX of the Educational Amendents of 1972 and the Equal Protection Clause of the United States Constitution USD 233's policy or practice of requiring reporting of pronoun and name change requests and parental permission violates the District's own anti-discrimination policy which specifically prohibits descrimination on the basis of sexual orientation and gender identity The ACLU of Kansas calls on USD 233 to promptly adopt a comprehensive LGBTQ+ inclusive policy to ensure directives like this and any others that may harm LGBTQ+ students are not promulgated in the future Ohio’s state school board will vote next week on a four-page resolution against a new federal rule which requires schools to investigate claims of discrimination based on sexual orientation or gender identity or risk losing their school breakfast and lunch funding proposed by Ohio Board of Education member Brendan Shea — a financial business owner who has five homeschooled children — states that sex is “an unchangeable fact," and it says "[d]enying the reality of biological sex destroys foundational truths upon which education rests and irreparably damages children." The resolution says "proposed regulations would require that K-12 schools socially transition minor children to a different gender without requiring parental notification or involvement." It goes on to say those regulations would harm children The resolution says kids — who are allowed to gender transition by their schools — “will then pursue medical and surgical interventions which have irreversible life-altering consequences for school age children." Bills that have been proposed in the state legislature to ban trans athletes from girls sports are supported by the resolution It says that the federal rules would require access to restrooms and sports teams "based on gender identity rather than on biological sex." The resolution argues that would increase the risk for "harassment and sexual assault" along with competition on an "unfair basis against males for athletic opportunities and scholarships." LGBTQ advocates have adamantly opposed anti-transgender measures that are being considered in the Ohio General Assembly such as the ban on trans student athletes and a ban on gender transition procedures for minors Equality Ohio has said these policies are a form of government overreach that marginalize transgender youth — people who are already at a high risk of mental health issues The resolution says the board believes the new rules are without legal force and urges the 100,000 public and private schools and residential childcare institutions in Ohio to defy them The resolution estimates 516,000 Ohio children qualify for food programs served by those facilities Five of the 11 elected state school board seats are up this year and there are four appointed seats that would be filled by the candidate who wins the governor’s race Groups that support and oppose the resolution are calling on those who feel the same to send emails or attend Tuesday’s meeting to speak out This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page Diabetes and hypertension are major global public health problems with high and increasing prevalence and other health consequences and share common lifestyle risk factors Scientific evidence shows that lifestyle modifications such as having a healthful dietary pattern and being physically active could prevent hypertension or diabetes and reduce the risk of developing these conditions among high-risk individuals not yet having these diseases (1,2) Some translational studies show how these lifestyle modifications can be adopted in a community setting (3–5) few studies have examined whether these lifestyle modifications (with or without other medical therapies) can be effective for patients with hyperglycemia and hypertension (6–8) According to the noncommunicable diseases surveillance report the prevalence of hypertension and diabetes was 33.5% and 9.7% Chinese health care reform mandated the prevention and management of hypertension and diabetes as national public health priorities and delegated such responsibilities mainly to primary care providers and community health care centers (10) evidence from community-based studies on lifestyle modification programs for hypertension and diabetes prevention and control are urgently needed To address the increasing burden of diabetes and hypertension and the lack of evidence on lifestyle intervention programs for the management of diabetes and hypertension among patients we conducted a community-based individualized lifestyle intervention study in China The intervention was based on well-established theories including energy balance in terms of physical activity and dietary energy intake The aim of our study was to investigate and evaluate the effectiveness of this lifestyle intervention program delivered by community physicians on managing hypertension and diabetes and improving health indicators in a community health care setting in China The hypothesis for this study is that the 3-month intensive intervention will significantly improve the following biophysical indicators (weight and 2-hour postprandial glucose) in comparison with the control group A community-based controlled trial was conducted from September 2008 to March 2009 in 5 local community health clinics in Tianjin City The recruitment was based on a waitlist control design and participants were assigned to early group or late group the early group volunteers who were eligible and interested in participating in the intervention program were assigned to the early group and other eligible participants were assigned to the late group the early group received a 3-month intensive lifestyle intervention program on improving physical activity and dietary patterns while the late group received usual standard health care serving as controls; during phase II of the study the early group received a 3-month follow-up without any intervention while the late group received the 3-month intensive lifestyle intervention (Figure 1) The study participants were recruited consecutively by community physicians in the local clinics during usual visits The inclusion criteria were fasting blood glucose between 5.6 and 14 mmol/L postprandial blood glucose between 7.8 and 17 mmol/L The exclusion criteria were inability to perform physical activity independently or other severe medical conditions such as diabetes nephropathy and hypertensive encephalopathy there were 287 study participants registered and assigned to the 2 study groups Fourteen patients in the late group withdrew 2 weeks before baseline data collection leaving 273 study participants (early group n = 175; late group n = 98) No participant withdrew during the intervention The intervention is called “zhiji management”; zhiji is a Chinese word meaning “bosom friends.” Zhiji management is a 3-month lifestyle intervention program designed to quantify and balance dietary energy intake and energy consumption from physical activity and to provide practical suggestions on positive and safe lifestyle changes All participants kept their medical treatment as usual Each participant was supplied with an electronic accelerometer-like energy consumption monitor (Zhiji Energy Monitor China) to wear all day long except when sleeping or showering The monitor recorded physical activity in terms of duration in minutes and intensity measured by metabolic equivalent (MET) of the activities (11) Effective physical activity was defined as any activity between 3 and 6 METs and lasting at least 6 minutes Because most study participants were chronically ill older people we adopted a shorter duration than the 10 minutes recommended in the US guideline (12) Participants were also instructed to keep a dietary diary at least 2 days a week a workday (Monday through Friday) and a weekend day Health-related individualized consultations were provided during the 3-month intervention Trained community physicians in each clinic aided with customized computer software designed for the zhiji intervention met study participants individually for weekly consultation sessions in the first month and biweekly sessions in the following 2 months the community physicians downloaded physical activity data from the accelerometer to the computer in the clinic and converted the information from the dietary diary to computerized data The software produced a detailed physical activity and dietary intake status illustrated by charts and tables and individualized “prescriptions” for lifestyle modification Community physicians explained these results to each participant and encouraged the participant to engage in appropriate and effective physical activity and to follow dietary recommendations in line with the Chinese dietary guidelines (13) The physicians also suggested ways to balance energy intake and consumption The computer printouts with measurable targets and the prescription were given to the participants to take home as visual aids and reminders and self and family medical history were collected through a standardized questionnaire administered by community physicians During each of the 8 interventional sessions SBP and DBP were measured by community physicians Body weight was measured by an electronic scale (Xihen China) with subjects wearing light indoor clothing and no shoes Waist circumference was measured at a level midway between the lowest rib and the iliac crest by a measuring tape blood pressure was measured twice with an electronic blood pressure meter (Omron HEM-7200 China) and the average values were used in all analyses the early group had 2 additional measurements in the second and third month during the 3-month postintervention follow-up period and the late group had 2 measurements in the first and second month and glycated hemoglobin (HbA1c) were performed during the intervention and follow-up on a voluntary basis We compared selected characteristics of the early and late groups (percentages for categorical variables; mean and standard deviation for continuous variables) Within-group (preintervention and postintervention) and between-group differences in categorical variables were tested by χ2 tests and continuous variables with paired t tests and independent t tests Intention-to-treat analysis using the method of “last observation carried forward” was applied for all measures Multivariable analysis was conducted to test the effect of demographic characteristics on the outcomes All data analyses were performed by using SPSS version 15 for Windows (SPSS Inc The study followed the principles of the Declaration of Helsinki This study was approved by the Project Examination Committee of the Tianjin Department of Labor and Social Security All participants gave their written informed consent before participating in the study The average age of the 273 participants was 60.6 years; 56% were female, 92% were married, 32% had a college education, and 64% were retired; and 54% had known diabetes and 68% had known hypertension (Table 1) There was no significant difference between the 2 groups in any of these characteristics (all P values > .05) After the intervention, daily effective physical activity increased significantly (P < .001) in total energy expenditure (54.6 kcal) and duration of exercise (9.6 min) (Table 2) Daily total energy intake decreased significantly (P < .001) (328.5 kcal) with a small increase in total energy from protein and a small decrease from fat Results were generally consistent between the early and the late group for the 3 months of the intervention phase During phase I, body weight, waist circumference, SBP, and DBP decreased significantly (P < .001) in the early group that received the 3-month intervention, and most indicators worsened in the late group that served as controls during the same phase (Table 3) The net between-group reductions were substantial and significant for weight (−2.6 kg) and DBP (−4.0 mm Hg); all P values < .001 Results were similar for the subgroup of patients with diabetes for whom we had glucose and HbA1c data Multivariable analysis was conducted to control for other potential dependence-associated factors The outcome variables were the 7 biophysical indicators and the independent variables included group (intervention vs control) the outcome variable’s corresponding baseline level The multivariable results confirmed that the net differences between the early group (intervention phase) and late group (control phase) were highly significant for all the following biophysical indicators assessed: weight the intervention significantly improved 2-hour postprandial glucose and HbA1C results (P < .01) but the effect on fasting glucose levels was borderline significant (P = .08) a generally consistent pattern of gradual improvement was observed for all markers and both intervention groups (Figure 2) No further improvement was observed during the follow-up in the early group for whom such data were available the effect of the intervention was maintained for all markers assessed Additional analyses based on participants without any missing values for all sessions (early group = 135 late group = 78) revealed consistent results This study was one of the first community-based lifestyle modification studies in China among people with mild diabetes (including prediabetes) or hypertension (including prehypertension) instead of among people who did not have the conditions but were at high risk of developing them Significant increases in effective physical activity and decreases in total dietary energy intake were achieved after the 3-month zhiji intervention led by community physicians that included computer-aided individualized consultation on lifestyle during 8 sessions The intervention group had significantly greater net reductions in all biophysical indicators than did the control group The improvements in these markers were maintained during the approximately 3-month follow-up period The intensive zhiji intervention led by community physicians was effective in encouraging the participants to adopt and maintain a healthier lifestyle in terms of physical activity and diet This finding is consistent with the findings of most other studies of this kind including the Diabetes Prevention Program (DPP) the Look AHEAD (Action for Health in Diabetes) research group found that lifestyle intervention was effective among diabetes patients (6) our study added further evidence showing that a community-based intensive lifestyle intervention is effective at getting patients with mild diabetes (including prediabetes) or hypertension (including prehypertension) to adopt and maintain a healthier lifestyle We found that total physical activity did not increase but total effective physical activity significantly increased through the intervention the concept of effective physical activity was emphasized with patients instructed to engage in physical activities that reach a certain level of intensity (at least 3 METs) to achieve health benefits but are not too strenuous to be unsafe (more than 6 METs) The instantaneous quantification of activity intensity in MET was made possible by the energy consumption monitor which had more sophisticated functions than pedometers The zhiji intervention program in this study shares some common features with other programs such as the DPP (2) being delivered by a case manager (in our study and having frequent contact between physician and patient unlike the DPP or other studies (2,4,18–20) that used goal-based behavioral intervention and a structured diet and physical activity plan for the core curriculum our study adopted a “free choice” lifestyle modification model operating under well-established guidelines This model may have empowered patients’ self-management skills through enabling them to select the most comfortable and easy to adopt behavioral changes Significant reductions were observed in anthropometrics (weight and waist circumference) These findings were consistent with those of previous studies in which intensive individual-based dietary and physical activity modification programs produced similar mean losses in weight (17,19,21,22) Most previous studies were conducted among individuals at high risk of developing diabetes or hypertension Our study demonstrated that intensive lifestyle modification in the community setting could also lead to improvements in these markers in patients with mild diabetes (including prediabetes) and hypertension (including prehypertension) The chronic care model provides a framework for a systematic approach with 6 key elements that are critical to effective management of chronic diseases (26–29) Although not explicitly designed on the basis of this model this intervention program incorporated all 6 of those elements the late group served as controls during phase I of the study and provided a way to assess net changes in many measures instead of only pre–post comparison both groups had similar demographic characteristics follow-up data were limited to the early group and lasted only 3 months the long-term effect of the 3-month intervention could not be assessed our study sample was derived from volunteer participants in 5 community clinics and it was possible that these participants were not representative of all patients with hypertension or diabetes no systematic differences were detected between the early and the late group there may be contamination for the late group while serving as controls because they lived in the same community with the early group participants undergoing intervention the outcomes improved in the early group while most of them worsened in the late group the intervention program was carefully designed to use established physical activity and dietary guidelines the program was well accepted by study participants and completeness of data collection for behavioral and clinical measures was better than they were for most other studies our study provides important evidence regarding the effectiveness of these interventions at not only preventing diabetes and hypertension but also at managing these conditions the zhiji program was implemented in more communities in several cities in China such as Beijing The burden of diabetes and hypertension has been rising fast in developing countries Previous evidence on the effect of lifestyle modification focused on prevention of hypertension and diabetes among people who did not have these conditions but were at high risk of developing them Highlights of the innovative features of our intervention included training and delivery of the intervention by community physicians supplying participants with energy monitors using computer software for electronic decision support and for printing a tailored intervention program for each participant and empowering patients with self-management skills and community support This community-based individualized lifestyle intervention program produced short-term beneficial changes in activity and clinical parameters in patients with diabetes or hypertension Its cost-effectiveness or feasibility in scaling up into more communities is not yet clear Future large-scale research with longer follow-up is needed to fully evaluate the cost-effectiveness and feasibility of such a lifestyle intervention among patients with diabetes and Hanliang Wang contributed equally to conducting this study and writing the article The authors would like to thank Changping Jin (Tianjin Department of Labor and Social Security) Yun Zhao (Tianjin Health Insurance Research Association) Weishu Ma (Tianjin Chinese Traditional Medicine University) and Yishan Zhu (The George Institute for Global Health) for their assistance and all of the community physicians and patients in this study for their cooperation and participation This study was financially supported by the Tianjin Department of Labor and Social Security and the UnitedHealth Group Chronic Disease Initiative Except for project approval and financial support the funders have not been involved in study design Tianjin Health Insurance Research Association The George Institute for Global Health at Peking University Health Science Center National Center for Medical Education Development The First Affiliated Hospital of Tianjin Chinese Traditional Medicine University All P values for comparison between the early and late groups were > .05.b Number of missing values: marital status a Values shown are mean (standard deviation) unless otherwise noted.b Paired t test glycated hemoglobin.a Values shown are mean (standard deviation) unless otherwise noted.b Paired t test.c Difference between change in intervention group and change in the control group.d Intention to treat analysis using the method of “last observation carried forward” (n = 4 in diabetes in the early group How do I view different file formats (PDF, DOC, PPT, MPEG) on this site?  in her first competition since switching studs rode Fiderdance to victory in the CDI3* Grand Prix Friday The Australian Olympic team rider and the 13-year-old Oldenburg stallion scored 69.761% for the win Fiderdance was competed at Big Tour by Germany’s Lena Waldman for Gestüt Bonhomme near Potsdam The 30-year-old Simone moved from Gestüt Sprehe to succeed Lena who is setting up her own training and competition facility Fellow Australian Warwick Mclean on Hendrix Peter Gmoser of Austria on Banderas was third on 67.435% Lithuania’s Sandra Sysojeva and Jack Daniel’s won the World Cup Short Grand Prix on a score of 67.947% Csaba Szokola of Hungary and Enying placed third on 67.342% This year many famous Christians and pastoral leaders from at home and abroad passed away including world-famous evangelist Billy Graham (The article below is a list in chronological order and not in any particular order of importance) Chinese church leader Wang Yongxin passed away at 93 Pastor Wang Yongxin left the world on January 4 of Pacific Time Wang was born into a Christian family in Beijing in 1925 under the influence of the Ecumenical Conference in Lausanne he together with dozens of Chinese church representatives initiated the worldwide Chinese Gospel Movement preaching the gospel until Christ's return" he served as the vice chairman of the World Lausanne Gospel Ministry Committee as well as the director of the Lausanne Movement International Renowned senior preacher Bian Yunbo died at 93 On February 14, Bian Yunbo, the author of the epic "To the Unknown Evangelist", passed away in Ningbo He became a Christian when he graduated from high school in 1944 and afterward joined the Christian fellowship when he was studying in the Department of Education of Nanjing Central University in 1945 He became a missionary during that time and twice declined the opportunity to study in Edinburgh he went to the southwest frontier area of China to preach and establish churches amongst the minority groups From the time he became a preacher until his death He is best known for his epic poem "To the Unknown Evangelist" written shortly after graduating from college in 1948 The poem's theme was to encourage Christians to serve faithfully and not forget the way of the cross Bian Yunbo also had experience serving with Preacher Wang Mingdao After ministering in the southwest frontier area he went to Shanghai to help Wang Mingdao with his writing work he went to the United States to serve Chinese churches he was taken back to China according to his wishes member of the Chinese Back to Jerusalem Evangelistic Band On March 6, 2018, Missionary Zhou Enying, a member of the Back to Jerusalem Band, died at the age of 105 She was abandoned by her birth parents and adopted by an American university professor This female American professor came to China as a missionary in 1909 at the age of 36 She became the foster mother of Missionary Zhou Missionary Zhou was converted to the Lord when she was 16 years old Missionary Zhou studied at the Methodist established Bible School in Kaifeng she finished her studies with outstanding scores at an American university spending half a year helping her foster mother raise orphans Missionary Zhou worked in the Refugee Children School in Shaanxi Province the Gu Ying Zhen Church in Henan Province and the church in Chong Qing Gansu Province to teach at the Northwest Spiritual Convent in 1953 she went as a volunteer evangelist to Jiuquan Christian Church in Gansu Province to work with Missionary Wang Jixian Missionary Zhou was arrested on trumped-up charges of "Historical Anti-Revolutionary Activities and American Spying " she taught English at a school for workers on a local labor farm when the church reopened under the opening-up policy that the church in Lanzhou began to hold public meetings had been employed as an English teacher in two universities in Lanzhou for 13 years she preached the gospel to some English students She cultivated a large number of English talents for the university and when she was teaching she participated in church service work as well Zhou resigned from her university teaching position and became a full-time minister of the church She served successively as a member of the standing committee of Gansu Province's CCC and TSPM and the chief person in charge of Lanzhou's CCC and TSPM Church formor senior pastor of the church in Nanjing Xu Enci, the former chief pastor of Nanjing Mochou Road Church, passed away at her home in Nanjing on March 21 Xu graduated from Nanjing Mingde Girls' Middle School in 1949 and graduated from Shanghai Christian Theological Seminary hosted by Pastor Jia Yuming in 1953 she ministered in Jiangsu Province until she was designated as a rightist in 1958 until 1978 she worked in Nanjing city and the suburbs of Nanjing for labor reform She was the Vice President of the Nanjing Christian Association the former lead pastor of the Mochou Road Church and the sixth CPPCC member of Gulou District winner of the Golden Horse award for Best Actor and a Christian hpilanthropist On May 1, 2018, Sun Yueh, the winner of best actor at the Golden Horse awards, a Christian charity promoter, and beloved "Uncle Sun", died in Taiwan Many Taiwanese entertainers mourned the man they highly respected and many Christians in mainland China mourned him as a good servant of the Lord Sun won the Best Actor Award at the Golden Horse Awards There were continuous offers from movie makers and he held the record for making 9 films at the same time behind the dazzling mask was his unbeknown struggle with vanity and emptiness He had long dealt with the negative mood of self-doubt and even had three bouts of suicide Sun Yue began attending church and became a Christian He decided that every year he would only spend four months filming and the remaining eight months devoting himself to public welfare issues His interests ranged from tobacco control and blood and organ donation to helping vulnerable families Theologian and educator Professor Chen Zemin died at 101 Chen Zemin, a theologian, former vice president of Jinling Union Theological Seminary, Christian musician and renowned religious scholar, died in Nanjing on June 4 Professor Chen was the only pastor in the Christian church in China who received a special State Council Allowance He graduated from Hujiang University in 1941 with a Bachelor of Arts degree he graduated from the Research Department of Jinling Theological Seminary with a Bachelor's degree in theology He was awarded a Doctor of theology from the University of the Philippines in 1995 Historical Theology and Church Music at Jinling Union Theological Seminary He was the Dean and Vice Dean of Jinling Theological Seminary and the lead pastor of St Professor Chen's family has been devout Christians for three generations Song's spirit-filled sermon and wanted to become a pastor after he graduated from junior high school Professor Chen had been in contact with foreign missionaries ever since he was very young Professor Chen Zemin was also a big music fan and had written many very popular Chinese hymns He could play both Chinese songs on the Chinese Guzheng and western hymns on the piano and organ Seeking and Witnessing -- Selected Works of Chen Zemin was published It is a collection of collected works based on professor Chen life-long learnings and a complete display of his theological thoughts Hong Hon-yee who turned from "The Mafia Leader" to preacher passed away at 70 Hong died of cancer at the age of 70 in a Hong Kong hospital on June 16 people who were familiar with him posted pictures of themselves with him on social networking sites saying they looked forward to seeing him in heaven one day he was the most influential underworld boss in Hong Kong He established the largest mafia network in Asia made up of more than 1 million "younger brothers" around the world And he claimed to be the one who was specifically against Jesus he gave up all of his "side business" and the huge income it generated became an entrepreneur that did honest business through his own efforts established the largest church in Hong Kong ministering to gang members particularly helping them get off of drugs His biggest dream was to share the gospel around the world Hong also shared about visions he had had about heaven and hell, However some Christians questioned whether these descriptions of heaven and hell in his testimony were biblical Hong Kong philanthropist Tin Ka-ping passed away at 95 Tin Ka-ping, a well-known philanthropist and Christian, died at the age of 95 on July 10 The Tin Ka-ping Foundation published an obituary of the life of Tin Ka-ping who started his business in Southeast Asia in the early years of his life his family moved to Hong Kong and established a chemical enterprise the most familiar story about Tin was that he donated money to establish hundreds of schools 2013 at the Grace and Blessing Church of the Hong Kong Missionary Association Many people didn't understand why a "good man" like Tin Ka-ping believed in Jesus and I'm not embarrased to say that I'm a good man and I don't need Jesus at all even good men in their own eyes have emotions and desires and will make mistakes as others do but in the eyes of God they are also a sinner.. everyone can be righteous in the eyes of God if he or she is willing to accept Jesus as their Savior" Elder Fu Xianwei, former chairman of the Three Self Patriotic Movement (TSPM), died at the age of 74 at Huashan Hospital in Shanghai on August 20 Elder Fu Xianwei was born in Shanghai in 1944 He grew up in a Christian family and was baptized into the church at an early age After the Shanghai church resumed its activities in the early 1980s Fu took an active part in the church's work as a volunteer he dedicated himself to serving full time in the church he was elected as the Elder of Mu-En Church in Shanghai Fu Xianwei successively served as the director of the office of the Shanghai Municipal Committee of Christian Affairs and the Shanghai Municipal Committee of Christian Affairs Elder Fu Xianwei was appointed as the eighth chairman of the TSPM he had been the Chairman of Jinling Union Theological Seminary he was re-elected as the ninth Chairman of the TSPM On November 3, 2018, many media outlets in Hong Kong broke the news that Lam had died alone Yammie Lam's life was legendary and at the same time to be pitied she was famous for her stunning appearance and outstanding acting talent leaving the audience with many classic film and television images Yammie Lam's fate had a terrible misfortune Several times she experienced being ignored by TV stations and generally experienced great emotional and spiritual trauma she started to grey and had lost her relationships and career Hong Kong's urban media's snobbish attitude towards her was also hurtful Many times she had been photographed and the media reported that she had had mental issues she converted to Christianity and took a minibus to church every week there was a group of Christians around her to take care of her 2021–Simone Pearce rode Destano won the World Cup Grand Prix Freestyle Saturday on an Australian record score for a musical performance to give the likely Olympic team partnership all three Big Tour records for her homeland Simone and the 14-year-old Hanoverian stallion were awarded 81.385% for only their second Grand Prix Freestyle The score beat the previous Australian record of 80.145% set by Mary Hanna on Calanta in February last year The latest result means the 29-year-old Simone and her top ranked Destano hold all three Aussie records–of 76.261% in the Grand Prix and 77.894% for the Grand Prix Special It was also the fourth straight win for the partnership in the past six weeks Although the Australian team of three riders and horses has not yet been announced the Germany-based Simone and Destano are one of only four combinations that have been able to earn qualifying scores or have had enough preparation as a result of the Covid-19 pandemic well into its second year The other three combinations are Mary Hanna on Calanta Kristy Oatley on Du Soleil and Kelly Layne on Samhitas Hungary’s Csaba Szokola on Enying placed second on 72.925% with Katarzyna Milczarek of Poland on Guapo third on 72.145% The success here on Destano capped a dominating show for the Australian who earlier Saturday won the CDI4* Grand Prix Special on Double Joy on a score of 70.553% a day after winning the Grand Prix with a result of 71.826% that met qualification for consideration for the Australian team Both Destano and Amandori are owned by the German stud Gestüt Sprehe GmbH and Simone while Double Joy is owned by Sabine Rüben Russia’s Maria Klementieva on Doctor Wendell MF placed second in the Special on 70.447% with Anikó Losonczy of Hungary on Dior S third on 68.893% Third Eye Blind guitarist Kevin Cadogan claims that Liam Gallagher allegedly once ‘threatened to stab him’ for accidentally throwing a can of Coke at him Speaking to Billboard about their history to celebrate the 20th anniversary of their self-titled debut album, Cadogan revealed that things turned ugly between the pair backstage where the ‘Semi Charmed Life’ stars were supporting Oasis in the US “That was a really cool move to get us that opening gig in San Francisco,” said Cadogan I got threatened by Liam that night with physical violence I was drinking a can of Coke and had finished it and crumpled it up and was going to throw it The can hit someone who was in the corner — I just saw this glowing ash and the can rolled over to it ‘You could have gotten stabbed.’ Literally said that ‘What are you talking about?’ He was like Cadogan continued: “Noel [Gallagher] was studying one of my guitars We were told by their management not to get too upset when we get stuff thrown at us at our hometown show.” NME has contacted Liam Gallagher’s team for a response Meanwhile, today saw Gallagher among over 90 new acts added to Reading & Leeds festival 2017 – marking his only UK festival show this year He is reported to have signed up Pete Doherty’s bassist and Babyshambles bandmate Drew McConnel as part of his new live band The world’s defining voice in music and pop culture: breaking what’s new and what’s next since 1952 Uganda | THE INDEPENDENT |Three suspects are in custody at Kiryandongo Central Police Station for the illegal possession of wildlife products a resident of Kibiramatu village in Kigumba Sub County a resident of Nanda village in Nyamaswa Sub County The suspects were arrested on Saturday after being found in possession of 134 pieces of suspected rhino and hippopotamus teeth the police and Uganda Wildlife Authority (UWA) were able to apprehend the suspects after receiving intelligence-led information and a tip-off from a whistleblower called on communities living near national parks to appreciate the benefits of wildlife conservation and protect the survival of wildlife He suspected that the suspects could be wildlife traffickers or being used by them to traffic illegal wildlife products through Uganda Hangi appealed to citizens not to allow themselves to be used by wildlife traffickers Kiryandongo District borders Murchison Falls National Park and it is not clear whether the suspects killed protected species in the park to obtain the wildlife products and website in this browser for the next time I comment