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Evidence regarding the association between dietary choline intake and mortality in individuals with diabetes remains limited. This study aimed to evaluate the relationship between dietary choline intake and all-cause, cardiovascular disease (CVD), and cancer-related mortality among adults with diabetes. A total of 4,712 participants with diabetes were included from the NHANES 2007-2018 cycles. Dietary choline intake was estimated using two 24-hour dietary recalls, and mortality outcomes were ascertained via linkage to National Death Index records through December 31, 2019. Cox proportional hazards models and Kaplan-Meier analyses were employed to assess the associations between choline intake and mortality. Restricted cubic spline models were used to examine potential non-linear relationships, and threshold analyses were conducted to identify inflection points. Over a median follow-up of 6.42 years, 805 deaths were documented, including 267 from CVD and 126 from cancer. A U-shaped association was observed between dietary choline intake and all-cause mortality (p for non-linearity < 0.0001). Compared with the lowest quartile, multivariable-adjusted hazard ratios (HRs) for all-cause mortality were 0.64 (95% CI: 0.47-0.88) for the second quartile, 0.59 (0.43-0.82) for the third, and 0.69 (0.43-1.09) for the highest quartile. No significant associations were found between choline intake and either CVD or cancer mortality. These findings indicate a U-shaped relationship between dietary choline intake and all-cause mortality in individuals with diabetes, with intakes between 286.77 and 538.86 mg/day associated with the lowest risk—providing potential implications for dietary guidance in diabetes management.
Accurate and up-to-date epidemiological data on the prevalence and treatment of common mental disorders are essential for evidence-based healthcare policy and resource allocation. However, large-scale, representative epidemiological surveys on common mental disorders in China—particularly those incorporating insomnia disorder and applying the latest diagnostic criteria alongside validated assessment tools—remain notably lacking.
Methods
We conducted a population-based, cross-sectional epidemiological survey to assess the prevalence and treatment of common mental disorders among adults in Beijing, China, using a multistage clustered probability sampling design (n = 10,778). Licensed psychiatrists administered standardized diagnostic interviews based on DSM-5 criteria to assess both lifetime and current mental disorders through a single-stage assessment protocol.
Results
Among all lifetime mental disorders assessed, depressive disorders constituted the most prevalent diagnostic category (7.7%), with major depressive disorder representing the most common specific diagnosis (5.4%). Individuals aged 65 years and older exhibited significantly higher 1-month prevalence of both depressive disorders and insomnia disorder compared with younger age groups. Alcohol-related disorder was more prevalent in men than in women, and in urban residents than in rural residents. Help-seeking patterns revealed a predominant reliance on informal support over professional services among individuals with lifetime mental disorders. Only 13.4% sought help from mental health professionals, and 12.7% received mental health professional treatment.
Conclusions
The improved access to treatment did not translate into a reduction in population-level mental disorder prevalence, which may be attributable to the low rate of professional mental health treatment. Governments must optimize mental healthcare access.
This chapter has two parts. The first part investigates how the Party controls courts. It finds that the Party maximizes its political control over judicial affairs by normalizing its political prerogative in judicial decision-making. The normalization process takes two steps. First, all judges within a court are embedded in a chain of command—from Party leaders to court leaders, divisional heads, and frontline judges—tasked with processing and translating political directives into partial judicial outcomes that serve Party-state interests when needed. The legality of these demands or their immunity from legal scrutiny is derived from the Party’s political prerogative. This practice is then replicated across all courts and among all judges nationwide. The second part of this chapter analyzes reported cases of judicial corruption to identify what has caused the spread of judicial corruption. It concludes that the root cause is the very normalization of the Party’s political prerogative. Because this prerogative is inherently arbitrary and vulnerable to abuse, its institutionalization creates systemic opportunities for corruption across the political-legal apparatus. As a result, what begins as political control ultimately facilitates the pervasive spread of judicial corruption.
This concluding chapter outlines the contours of the Party-state and develops a conceptual framework to explain its distinctive mode of governance. At its core is a dual normative system: a legal system grounded in popular sovereignty is overseen and constrained by a power-based normative system designed to uphold the absolute authority of the Party Center—an organizing principle essential to maintaining the structural integrity of the Party-state. The chapter argues that the governance logic of the Party-state is best captured by the theory of Normalized Political Prerogative (NPP). According to this theory, governance unfolds through a three-step process: operationalization, normalization, and regulation. Together, these constitute the formal institutional foundation of Party-state rule. The NPP framework elucidates the systemic proliferation of corruption as an inherent byproduct of this mode of governance, the role of the Party’s disciplinary apparatus as a self-correcting mechanism to mitigate its adverse effects, and the evolving dynamics between institutions and leadership that shape politicking and power struggles within the Politburo.
In this chapter, I analyze the methodology of the Party’s anticorruption program under Xi Jinping. This program has two goals. The first is to shock and awe. This goal has been achieved successfully through the anti-corruption campaign in 2012-2017, which is attributable to two main factors: leadership qualities of both Xi himself and the campaign’s chief director Wang Qishan and the institutional infrastructure provided by the Party’s disciplinary system that had been built by Xi’s predecessors. The campaign’s success also shows that the institutional performance of the Party is susceptible to leadership influence, under which the same tools, devices, and mechanisms can be employed and exploited to different effects. The second goal of Xi’s anti-corruption program is to provide long-term solutions to some of the perpetuating problems of the Party’s disciplinary system. This reform marks a significant transformation in the Party-state relationship: instead of undermining the state for its own preservation, the Party now strengthens its political governance by empowering the state and drawing legitimacy from it. Lastly, I also discuss two recent developments: the gradual decline of Wang Qishan’s influence and the retraction of power from the CCDI.
This chapter seeks to explain the recurrence of judicial corruption despite waves of reforms. To that end, I track major reforms launched by the Supreme People’s Court (SPC) over past decades and find a pattern: Most of them revolved on redistribution of judicial decision-making power. Instead of confronting the issue of institutionalized judicial partiality caused by normalized political prerogative, these reforms were designed to divide, centralize, decentralize, and recentralize judicial decision-making power. Since these measures are not geared to eliminate judicial partiality, they work best in redistributing rather than uprooting corruption. Recent reforms made efforts to set boundaries for the exercise of political prerogatives by banning “improper” interference while retaining “proper” interference. The reform may lift the costs of corruption, thereby reducing but not eliminating it, because the power that is most prone to corruption is the one that is entitled to “proper” interference. In the last section, I use a recent SPC scandal to expose the limits of the current judicial reforms and to illustrate the reach and the entrenchment of the prerogative-based judicial interference power.
Unlike anticorruption institutions elsewhere, China’s anticorruption practices follow a self-regulatory model: it is regulated by the very institution that is targeted by anticorruption. Compared with its role in judicial affairs, the Party’s involvement in anticorruption investigation is much more forefront, direct, and prominent. In this chapter, I track the origin and institutional evolution of the Party’s disciplinary system during 1927-2012. I point out that the Party’s institutional design is founded on the cardinal principle to preserve the unified (absolute) command of the Party Center. Thereby, how to reconcile between the imperative to uphold this principle and the need to provide a measure of autonomy for disciplinary institutions to avoid capture has been the main theme of the disciplinary institution-building process. The introduction of a tiered interlocking disciplinary decision-making structure, the segmented investigation process, and the “dual-leadership” model are the direct outcomes of the Party’s efforts to balance the conflicting needs mentioned above. These arrangements had fueled the rise of the CCDI but also brought several problems and challenges, including legal deficiency, jurisdictional frictions, resource shortage, incentive issues, and abuse, which had set the stage for Xi Jinping’s unprecedented anti-corruption campaign and disciplinary reform upon his taking power in 2012.
Through investigating how exactly bribery take place, this chapter examines why guanxi is a necessary conduit of corruption in China. I argue that guanxi-practice embodies an alternative contracting mechanism of corruption with three functions. First, it allows corruption practitioners to communicate their intent to exchange without explicitly expressing it. Second, it minimizes the otherwise prohibitively high transactional costs and reduces the moral and cognitive barriers of corruption. Third, it contains a self-enforcing mechanism that allows the terms of corruption to be negotiated and enforced. Performed with tactics and etiquettes, guanxi-practice seamlessly grafts a corrupt and immoral agreement upon a social setting, in which venality is neutralized and rationalized. In this redefined social reality of corruption, an instrumental relationship is perceived or at least presentable as a reciprocal relationship based on social commitment. Lastly, I draw attention to the emergence of professional guanxi-brokers that has marketized guanxi and extended the otherwise highly restricted opportunity to engage in parochial corruption to a much-broadened user base.