Frigid Zone Medicine

Factors influencing the management of chronic non-communicable diseases in cold regions: a qualitative study from Northeast China

Rui Jiang, Yuhan Zhou, Min Yang, Lu Yue, Lyuzhuang Huang, Yongchen Wang

2025, 5(1): 1-9. doi: 10.1515/fzm-2025-0001

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Abstract:
Background and Objectives Non-Communicable Diseases (NCDs) represent a significant public health burden in China, particularly in cold regions where environmental factors further limit access to healthcare. To address this challenge, China has implemented the National Essential Public Health Service Package (NEPHSP) to improve NCD management through primary healthcare services. However, research on the effectiveness of NEPHSP in cold regions is limited. This study aims to identify the key factors influencing the implementation of NCD management services in cold regions, focusing on both barriers and facilitators. Methods This qualitative study was conducted in three purposively selected cold regions in Northeast China (Harbin, Qiqihar, and Jiamusi). Data were collected through semi-structured interviews and focus group discussions, guided by the RE-AIM framework. Participants included local health administrators, primary healthcare workers, and community-dwelling individuals with NCDs. Thematic analysis was employed to code and extract key themes from the data. Results A total of 72 participants (59.7% female, mean age 49.1 ± 6.24 years) took part in the study. Major barriers to NCD management included low health literacy, limited awareness of NCDs, insufficient medical resources, poor public awareness, inadequate multisectoral collaboration, and the absence of effective audit and feedback systems. Key facilitators included the affordability and accessibility of primary healthcare services, strong patient-physician relationships, and the high priority given to NCD management by local governments. Furthermore, harsh environmental conditions and limited healthcare accessibility in cold regions complicated the management of NCDs, highlighting the need for tailored interventions that address the specific challenges of these regions. Conclusions This study identifies significant facilitators and barriers to the implementation of NCD management services under the NEPHSP in cold regions of China. The unique challenges posed by cold climates necessitate the adaptation of healthcare services to local needs, with a focus on improving health literacy, enhancing healthcare infrastructure, and fostering multisectoral collaboration. These findings provide valuable insights for optimizing NCD prevention and management strategies within China's primary healthcare system.

Study on the status and countermeasures of disease self-management ability in chronic kidney disease patients in cold regions

Xinrui Wei, Chunlian Li, Hongmei Yu, Lingling Xu, Siwen Meng, Chun Xing, Qiang Gao, Guangming Chang, Yongchen Wang

2025, 5(1): 10-21. doi: 10.1515/fzm-2025-0002

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Abstract:
Objective Effective Chronic Kidney Disease (CKD) management is particularly important in cold regions of China, where climate and lifestyle factors play significant roles. However, there is a lack of relevant studies in this area. Therefore, the purpose of this study was: (1) to assess the status of self-management capacity in individuals with CKD in cold regions of China and analyze the factors influencing it; (2) to identify strategies to improve CKD management in primary care settings in these regions; and (3) to understand patients' attitudes toward eHealth services. Methods This was a regional, cross-sectional observational study. A questionnaire measuring CKD patients' self-management abilities was derived from the Perceived Kidney Disease Self-Management Scale, the Kidney Disease Behavioral Inventory (KDBI), and the Health Literacy Questionnaire. Data were collected from hospitalized CKD patients in Heilongjiang Province and analyzed using One-Way Analysis of Variance (ANOVA), Hierarchical Regression Analysis, and K-prototype cluster analysis. Results A total of 957 participants were tested. Of these, 70.64% had less than a bachelor's degree, and 56.27% had been diagnosed with hypertensive or diabetic nephropathy. The KDBI scale showed a lower overall score compared to the PKDSMS. Factors such as CKD stage 4 (F = 2.367, P = 0.042), last year's medical expenses (F = 3.974, P = 0.004), and poor self-rated health (F = 33.352, P < 0.01) were found to influence scores on both scales. The health literacy questionnaire revealed significant differences (P < 0.01) in health knowledge, except by sex. Additionally, healthcare expenditures and poor self-rated health were negatively associated with self-management capacity. Conclusions This study provides valuable insights into the self-management challenges faced by CKD patients in cold regions of China. Despite some difficulties in improving self-management, patients showed positive attitudes toward enhancing CKD management services in primary care and developing digital management tools. These findings offer useful references and recommendations for future clinical practice and research in this field.

SPSB4 as a risk factor for papillary thyroid cancer: Enhancing cell vitality under excess iodine exposure

Zhiwei Zhang, Yongjin Long, Ming Li, Chunpeng Lyu, Xianglan Chen, Qiaoyu Wang, Kunying Yang, Jiahui Li, Wei Zhang, Dianjun Sun

2025, 5(1): 22-41. doi: 10.1515/fzm-2025-0003

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Abstract:
Objective The varying environmental exposure to iodine has long been a topic of interest, particularly given the noticeable increase in the incidence of papillary thyroid carcinoma (PTC) compared to other histopathological subtypes globally. This rise in thyroid cancer incidence has been attributed to several factors, including improved detection of early tumors, a higher prevalence of modifiable individual risk factors, and differing exposure to environmental risk factors such as iodine levels. This study aims to explore the epigenetic mechanisms that promote thyroid cancer progression under excess iodine exposure. Materials and methods This study outlines the following strategy: (i) risk factors were identified through statistical analysis of questionnaire responses in a retrospective iatrogenic study; (ii) following the identification of risk factors, RNA sequencing was performed using tissues from iodine-adequate (IA) and iodine-excess (IE) regions; (iii) candidate hub genes were selected via bioinformatics analysis; (iv) molecular biological techniques were employed to verify the functionality of the key gene. Results Through careful selection, we focused on SPSB4, a ubiquitin ligase previously unreported in relation to both iodine and thyroid cancer. By optimizing the dosage of PTC cell line activities, we determined how varying iodine levels can either enhance or impair the vitality of thyroid cancer cells. As anticipated, migration and invasion assays revealed significant changes when SPSB4 function was disrupted at the critical dose of KIO3. Conclusions In terms of epigenetic alterations, SPSB4 emerges as a promising candidate for further investigation, particularly in understanding thyroid cancer progression and potential carcinogenesis. Moreover, E3 ubiquitin ligases, including SPSB4, play a role in orchestrating adipose thermogenesis to maintain body temperature during cold stimuli. This study could also shed light on the influence of iodine on thermogenesis mediated by SPSB4 under cold conditions, while suggesting future exploration of SPSB4's effects on thyroid cancer in colder regions.

Metabolomics study on dibenz[a, h]anthracene exposure-induced pulmonary injury in rats after intratracheal instillation

Zhen Kang, Qianqi Hong, Fei Yan, Tianyi Yu, Yuna Bai, Xiaobo Liu, Xiaolin Na, Cheng Wang

2025, 5(1): 42-49. doi: 10.1515/fzm-2025-0004

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Abstract:
Background Northern residents predominantly rely on coal-fired heating during winter, leading to severe air pollution. Polycyclic aromatic hydrocarbons (PAHs) adsorbed on atmospheric particulate matter pose significant health risks. Among PAHs, dibenz[a, h]anthracene (DahA), though present at lower environmental concentrations compared to other PAHs, exhibits a carcinogenic potency that is 10 or more times greater than benzo[a]pyrene (BaP), underscoring its potential harm. Despite reports on DahA's multiple toxic effects, its impact on metabolic networks remains poorly understood. Methods Based on the respiratory volume of adult rats and the concentration of PM_2.5-bound DahA in heavily polluted cities of northern China, adult Sprague-Dawley rats were treated with DahA (0.07 μg/kg and 0.2 μg/kg) twice weekly for four weeks via intratracheal instillation. Metabolomic profiling of serum was performed using rapid resolution liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (RRLC/Q-TOF-MS) to elucidate metabolic disruptions caused by DahA exposure. Results DahA exposure induced significant oxidative stress and inflammatory responses in rats, accompanied by notable alterations in the serum metabolome. A total of 11 metabolites were found to be decreased, and 2 metabolites were increased, with disruptions observed in folate biosynthesis, glycerophospholipid metabolism, and nitrogen metabolism pathways. Additionally, metabolic dysregulation may interfere with the tricarboxylic acid cycle and compromise nucleotide homeostasis. Conclusion These findings enhance our understanding of the toxicological effects of DahA exposure and its role in lung damage. The results suggest that metabolic disturbances caused by DahA may contribute to the exacerbation of respiratory diseases associated with particulate matter-bound PAH pollution during the heating season in cold regions.

Association of dietary phytosterols with prevalence of metabolic dysfunction-associated fatty liver disease in adult population of Northeastern China: An internet-based cross-sectional study

Jiayu Zhu, Jiaqi Zhang, Qi Yu, Liyan Liu, Rennan Feng

2025, 5(1): 50-57. doi: 10.1515/fzm-2025-0005

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Abstract:
Objective The benefits of phytosterols have attracted growing interest, but their association with Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) has rarely been reported in population-based studies. This research aimed to investigate the correlation between dietary phytosterols and MAFLD. Methods Phytosterols intake was evaluated using an internet-based dietary questionnaire targeted at the Chinese population. Conditional logistic regression models were employed to investigate dose-response relationships between phytosterol intake and MAFLD, as well as the potential preventive role of phytosterols. Restricted Cubic Spline (RCS) analyses were conducted to examine associations between phytosterols intake and MAFLD. Additionally, a quantile-based g-computation (qgcomp) method was applied to explore the combined effect of campesterol, stigmasterol, β-sitostelane, campestane, and β-sitosterol on MAFLD. Results Significant inverse relationships were found between total phytosterols and MAFLD (OR, 0.19; 95% CI, 0.11-0.32; P < 0.001), campesterol (OR, 0.22; 95% CI, 0.13-0.37; P < 0.001), stigmasterol (OR, 0.17; 95% CI, 0.10-0.30; P < 0.001), β-sitostelane (OR, 0.26; 95% CI, 0.16-0.45; P < 0.001), campestane (OR, 0.23; 95% CI, 0.14-0.39; P < 0.001), and β-sitosterol (OR, 0.17; 95% CI, 0.10-0.29; P < 0.001). The qgcomp analysis showed a significant negative association between the five phytosterols and MAFLD (OR, 0.58; 95% CI, 0.50-0.67; P < 0.001). Additionally, the qgcomp analysis revealed that the combination of these five phytosterols was inversely associated with MAFLD, with stigmasterol contributing the most (weight = 0.70). Conclusion Higher intake of phytosterols was associated with a reduced prevalence of MAFLD, with stigmasterol showing the most significant inverse relationship. Further research is needed to clarify the relationship between phytosterols and MAFLD.

Cold environments and health: proteomic analysis of health impacts

Hongquan Song, Rui Zhang, Zixin Lu, Xiaohui Jiao, Jiaqun Yan

2025, 5(1): 58-64. doi: 10.1515/fzm-2025-0006

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Abstract:
Background Cold temperatures cause blood vessels to constrict, shallow breathing, and slight thickening of the blood. Working in extremely cold environments can have negative effects on health, yet there are currently no effective biomarkers to monitor these health conditions. Proteins are important intermediate phenotypes that can provide a theoretical basis for understanding disease pathophysiology. Proteins in the circulatory system reflect the physiological status of individuals, and plasma proteins have significant potential as biomarkers for various health conditions. Methods In this study, we employed the Mendelian randomization (MR) method to analyze the effects of freezing temperatures on over 2900 plasma proteins. Subsequently, the selected plasma proteins were subjected to causal analysis in relation to 55 diseases, including respiratory disorders, cardiovascular diseases, various cancers, and oral diseases. The aim was to identify proteins that could serve as biomarkers for health status. Results Our results indicate that cold environments may affect the concentrations of 78 plasma proteins. Further MR analysis revealed that nine of these plasma proteins are associated with the risk of respiratory disorders, cardiovascular diseases, various cancers, and oral diseases. Conclusion These proteins show promise as biomarkers for monitoring the hazards and risks faced by individuals working in cold environments. These findings provide valuable insights into the biological mechanisms underlying occupational hazards.

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