Avoiding Premature Death

Wearing a seat belt in the front seat cuts the risk of dying in a crash by roughly half. For drivers and passengers in light trucks, the reduction is about 60%. Among U.S. crash victims in 2022 whose seat belt use was documented, half were not wearing one.

Cost

No cost at all. It only adds about 2 seconds to every trip.

Benefit

According to NHTSA estimates, seat belts lower the risk of fatal injury for front‑seat occupants of cars by 45% and for those in light trucks by 60%. In 2022, half of the U.S. fatalities in passenger cars had no recorded seat belt use. The World Health Organization states that seat belts can reduce the risk of death inside a vehicle by up to 50%. WHO also estimates that in 2021, 248,099 people died in road crashes in China, which translates to 17.4 deaths per 100,000 people.

Note

Seat belts must be worn in the back seat as well. In the same report, 60% of rear‑seat occupants killed in crashes were not wearing belts. The 45% and 60% figures are NHTSA estimates derived from crash‑database analysis (Kahane 2015), not from randomized trials. The Chinese death toll cited by WHO is a projection and is several times higher than official police statistics; the two figures cover different populations, so only the WHO estimate is used here.

Wearing a helmet and fastening the strap properly reduces a motorcyclist’s risk of dying in an accident by roughly 40%. The chance of suffering a head injury drops by about 70%. The strap must be tightened; a helmet that simply hangs loosely on the head does not count as being worn.

Cost

A helmet costs between 100 and 300 yuan. It takes just 5 seconds to put on each time.

Benefit

Cochrane pooled data from multiple studies. For motorcyclists wearing helmets, the risk of death fell by 42%. The original odds ratio was 0.58, with a 95% confidence interval ranging from 0.50 to 0.68. Head injuries were reduced by 69% (odds ratio 0.31; 95% CI 0.25–0.38).

Note

The helmet strap must be fastened securely. A helmet left hanging on the handlebars does not count as being worn. The figures above apply specifically to motorcycles. For e-bikes, no direct studies exist, but the mechanics of head injury in a crash remain the same.

A properly functioning smoke alarm can cut the risk of dying in a home fire by roughly 60%. Forty percent of fire victims are asleep at the time, so they won’t wake up just from the smell of smoke. For anyone heating their home with coal or gas during winter, adding a carbon monoxide alarm is essential. In China, 11,500 people died from carbon monoxide poisoning in 2018; 70% of those deaths occurred at home during the three winter months.

Cost

A smoke alarm costs between 30 and 100 yuan. A carbon monoxide alarm costs between 50 and 150 yuan. After installation, the batteries need to be replaced once a year.

Benefit

A study in North Carolina examined homes that had experienced fires versus those that hadn’t. It found that having a working smoke alarm lowered the death risk by about 60%. The odds ratio was 0.39, with a 95% confidence interval ranging from 0.18 to 0.83. Between 2018 and 2020, 24% of fatal residential fires in the U.S. happened in homes without smoke alarms, and 41% of victims were asleep when the fire started. In 2018, China reported 11,523 deaths from carbon monoxide poisoning; of these, 72.59% occurred at home in December, 67.42% in January, and 66.48% in February.

Note

This grade is assigned because only one study exists on smoke alarms; it compared past fire incidents in various homes rather than using a randomized trial design. No research has shown that carbon monoxide alarms reduce mortality rates. The reported benefits are inferred from the fact that most poisoning deaths happen at home during winter.

A compliant gas hose costs just a few dozen yuan. Replacing it when it expires is a user obligation clearly stated in the “Regulations on Urban Gas Management.” The same regulations explicitly forbid users from modifying piping or removing gas meters on their own. Additionally, the regulations state that gas companies cannot require customers to purchase specific products or services. Therefore, you may freely decline any sales pitches claiming that replacement is mandatory.

Cost

A compliant gas hose costs only a few dozen yuan. Stoves should be replaced every few years; during replacement, check whether they’ve passed their expiration date.

Benefit

The regulations designate “promptly replacing gas appliances and connecting hoses that have been phased out by the state or have exceeded their service life” as a user obligation; this means you must replace any stove or hose that has reached its expiration date or been discontinued. The same regulations also classify “unauthorized installation, modification, or removal of indoor gas facilities and metering devices” as prohibited actions, which includes any DIY attempts to alter piping or remove gas meters. Furthermore, the regulations explicitly forbid gas operators from mandating that users purchase particular products or accept specific services.

Note

Some individuals pose as gas inspectors and, after performing a check, attempt to sell self-closing valves and alarms. However, Article 20, Clause 6 of the regulations bars gas companies from requiring you to buy their designated products; you may decline such offers or even file a complaint. If you detect a gas odor, first shut off the main gas valve; in the case of bottled gas, close the cylinder valve as well. Then open doors and windows to ventilate the area, but avoid using exhaust fans. Do not turn on or switch off any electrical appliances—including lights and range hoods—and refrain from using lighters. After that, leave the premises immediately and call the gas company’s emergency line from a safe location. Carbon monoxide poisoning is a separate issue; refer to Section 13 for details.

In 2025 alone, there were 828 cases of mushroom poisoning across China, affecting 2,165 people, with 13 fatalities. That same year, 34 previously unknown poisonous mushroom species were identified. Myths such as using a silver needle to test for toxicity, assuming mushrooms safe if insects eat them, or that only brightly colored varieties are toxic are all false.

Cost

No expense involved. The hard part is giving up a seasonal delicacy.

Benefit

The Chinese CDC investigated 828 mushroom poisoning cases in 2025 involving 2,165 individuals; the mortality rate was 0.6%. From 2019 to 2024, annual cases ranged from 276 to 676, with mortality rates between 0.87% and 2.86%. In 2025 alone, 138 poisonous mushroom species were identified, including 34 new ones never documented before as causing poisoning.

Note

If you accidentally eat poisonous mushrooms, induce vomiting immediately and then go to the hospital with any remaining mushrooms or photos of them. There are several types of mushroom poisoning, and identifying the exact species is crucial for proper treatment. New poisonous species are discovered each year, so the assumption that “local people can recognize them” is unfounded. Claims such as silver needle testing, cooking with garlic, insect consumption indicating safety, or vivid colors signaling toxicity are all incorrect.

Pushing an electric bike into a stairwell, elevator, or charging it at home is strictly prohibited under the Ministry of Emergency Management’s regulations on fire safety in high-rise residential buildings. Those who violate the rules face fines of $500–$1,000 for individuals and $2,000–$10,000 for businesses. Even these fines are the least of the concerns — the real danger is that a fire could block your only escape route.

Cost

No direct cost. The tricky part is having to walk a few dozen meters each time to reach the designated charging stations downstairs.

Benefit

The regulations explicitly forbid parking or charging electric bikes in public lobbies, hallways, stairwells, or near emergency exits of high-rise buildings. Noncompliance results in the same fines mentioned above.

Note

Avoid buying modified batteries or generic chargers, and never leave a battery charging unattended overnight. Lithium-ion batteries can ignite within seconds of catching fire, producing highly toxic smoke. A fire in a stairwell essentially blocks your only way out. In 2021, there were 18,000 electric bike-related fires nationwide, causing 65 deaths; 3,782 of those occurred inside buildings, claiming 60 lives, most of whom were indoors. Following stricter enforcement in 2024, fire incidents dropped 42.2% year-on-year, with casualties falling by over 90% — exact figures for 2024 have not been released.

For every 10 mmHg drop in blood pressure, the risk of major cardiovascular problems falls by 20%, stroke risk drops 27%, heart failure risk drops 28%, and overall mortality risk declines by 13%. Among Chinese adults aged 35–75, 44.7% have hypertension, but only 7.2% have their blood pressure under proper control.

Cost

An electronic sphygmomanometer costs 100–200 RMB. Each measurement takes 1 minute. Most antihypertensive drugs cost just a few to dozens of RMB per month. The hard part is keeping the medication regimen even when there are no symptoms.

Benefit

Data from 123 clinical trials involving over 610,000 participants shows that a 10 mmHg reduction in systolic blood pressure lowers the incidence of major cardiovascular events by roughly 20%. The relative risk is 0.80, with a 95% confidence interval of 0.77–0.83. Systolic blood pressure is the higher of the two readings taken during a measurement. Stroke risk drops by 27% (RR 0.73), heart failure risk drops by 28% (RR 0.72), and overall mortality drops by 13% (RR 0.87, 95% CI 0.84–0.91). A screening program in China involving 1.7 million adults aged 35–75 found that 44.7% had hypertension; of these, 44.7% were aware of their condition, 30.1% were receiving treatment, and only 7.2% had their blood pressure under control.

Note

Start by getting your blood pressure measured at least once. Fewer than 1 in 10 Chinese adults with hypertension manage to keep their levels under control, so this single measurement is one of the most cost-effective actions you can take as outlined in this book. There is still some debate over what exact target level (130 or 140 mmHg) is ideal, but there is no dispute that knowing you have hypertension and taking steps to lower it is highly beneficial.

For just a few dozen yuan, a single blood test can detect prediabetes even when there are absolutely no symptoms at all. Official US screening guidelines recommend this test for anyone aged 35 to 70 who is overweight or obese. If the test comes back normal, they should repeat it every three years.

Cost

A fasting blood glucose test costs just a few dozen yuan. Testing for glycated hemoglobin is a bit pricier, still only a few dozen yuan. All it takes is one blood draw at a clinic.

Benefit

The US Preventive Services Task Force is the official body that issues screening recommendations in the US. Its current guidance states that adults aged 35 to 70 who are overweight or obese — even with no symptoms at all — should be screened for prediabetes and type 2 diabetes. Overweight is defined as a BMI of 25 or higher, while obesity means a BMI of 30 or higher. This recommendation is rated as a Grade B. The Task Force also explicitly notes: “It is reasonable to screen adults with normal blood glucose levels for prediabetes every three years.”

Note

Having a prediabetes diagnosis does not mean you must start taking medication right away. Many people can fully reverse this condition simply by making lifestyle changes. In China, only a small fraction of adults are aware they have diabetes; most only find out after developing complications.

On average, for every 1% increase in speed, the chance of a fatal crash rises by roughly 4%. There is no safe blood alcohol level for driving. Manipulating a mobile phone while driving makes a crash roughly 3.6 times more likely than attentive driving, and dialing increases it by 12.2 times. When a driver is visibly fatigued, crash risk increases by roughly 3.4 times.

Cost

There’s no direct cost. Driving a bit slower adds just a few minutes to each trip. The hard part is drinking less at social gatherings and resisting the urge to check notifications. On long road trips, stop and rest for at least 20 minutes every 4 hours.

Benefit

According to the World Health Organization (WHO), a 1% rise in average vehicle speed produces a 4% increase in fatal crash risk. Crash risk begins elevating even at very low blood alcohol concentrations. WHO also reports that drivers using mobile phones are approximately 4 times more likely to crash than those who do not, and hands-free sets offer little safety advantage. A naturalistic driving study using in-vehicle video cameras in over 3,500 vehicles analyzed 905 injury and property-damage crashes compared against baseline alert, attentive, sober driving: overall handheld cell phone manipulation increased crash odds by 3.6 times (odds ratio [OR] 3.6). Dialing increased risk by 12.2 times, texting/messaging by 6.1 times, reaching for the device by 4.8 times, browsing by 2.7 times, and handheld conversing by 2.2 times. Drivers exhibiting observable fatigue and drowsiness had a 3.4-fold increase in crash risk (OR 3.4).

Note

The 1% speed and 4% fatality ratio derives from traffic modeling rather than clinical randomized trials. For alcohol and driving, WHO indicates an upward exponential trend without a fixed harmless threshold. Odds ratios for cell phone distraction and drowsiness evaluate all-cause injury and property-damage crashes rather than fatal crashes specifically; baseline comparisons used ideal attentive driving conditions, slightly elevating relative ratios compared to everyday driving averages. Traffic laws prohibit handheld calls while driving (carrying fines and demerit points); while hands-free calls are legally permissible, WHO notes they do not significantly reduce cognitive distraction. Driving continuously for more than 4 hours without at least a 20-minute break is a statutory violation. If drowsy, pull over into a service station immediately to rest. Sedating medications like chlorpheniramine or diphenhydramine also induce marked driving impairment, as noted in Chapter 34, Rule 12. Persistent driving drowsiness combined with loud snoring warrants sleep apnea evaluation, detailed in Chapter 3, Rule 27.

For infants under one year old, using a car seat cuts the risk of a fatal injury in a crash by roughly 70%. For children aged 1 to 4, the risk drops by about half. Holding a child in your arms provides no such protection; in a sudden stop you simply cannot keep them secure.

Cost

A seat costs between 300 and 2,000 yuan and lasts several years. It adds about one minute to each trip to buckle the child in.

Benefit

According to the U.S. National Highway Traffic Safety Administration (NHTSA), car seats lower the risk of fatal injury for infants under one year old by 71% and for children aged 1 to 4 by 54%. The World Health Organization reports a similar 71% reduction in infant deaths.

Note

Follow the manufacturer’s instructions to install the seat correctly; a faulty installation offers no protection. Infants under one year must be placed rear‑facing. These figures are based on official U.S. crash data.

These window guards cost only a few dozen yuan each. New York City once offered free window guards to high-risk households and provided on-site guidance; as a result, child fall incidents reported in one borough dropped by half over three years. Eventually, New York even passed a law requiring landlords to install such guards in rental units with kids under 10. Screen windows, however, can be easily pushed open — they do not provide any real protection.

Cost

A set of window guards or child safety locks costs just a few dozen yuan to install, and the whole process takes only ten minutes.

Benefit

Since 1972, New York City has run a program called “Kids Can’t Fly,” which distributes free window guards in high-risk neighborhoods and offers on-site safety guidance. Between 1973 and 1975, child fall incidents reported in the Bronx dropped by 50%. Following this success, New York updated its health code to make it mandatory for landlords to install window guards in all apartments housing kids under 10 years of age.

Note

Avoid placing beds, sofas, boxes, or any other objects near windows or balconies that kids might climb onto. Screen windows only keep mosquitoes out; they can be easily pushed open, so never rely on them as a safety barrier. This protection is needed even on lower floors: most child falls recorded in U.S. data actually occur on the second floor or even lower.

Wearing a life jacket while in the water cuts the risk of drowning to roughly half compared to not wearing one. Drowning remains the leading cause of death among children aged 1–14 in China. The drowning mortality rate in rural areas is roughly twice that in cities.

Cost

Life jackets cost between 50 and 200 yuan. Additionally, parents must dedicate constant attention to watching their children.

Benefit

Research using U.S. Coast Guard data compared similar groups of people. For individuals who fell overboard while boating recreationally, wearing a life jacket lowered their drowning risk by about half. The unadjusted RR was 0.51, with a 95% CI of 0.35–0.74. In China, the drowning mortality rate among people under 20 fell from 6.60 per 100,000 in 2013 to 3.28 per 100,000 in 2021; rural rates remained roughly twice those in cities. Drowning continues to be the top cause of death for children aged 1–14. In 2021, drowning accounted for 31.1% of all injury-related deaths among those aged 0–19, while road traffic injuries accounted for 27.9%.

Note

The Grade A rating applies only to the protective effect of life jackets. The practice of keeping children within sight is widely accepted but only qualifies for a Grade C rating due to lack of randomized trials; no such trials are expected in the future. In China, drowning deaths occur most often in rural areas during summer months, and among males aged 15–19.

Doing balance exercises such as Tai Chi two or three times weekly can cut the overall number of falls among older adults by roughly 23%. It also reduces the proportion of people who have fallen at least once by about 15%. Adding simple home modifications — like anti-slip mats and handrails — can lower fall rates by another 20% or so. Falls are the leading cause of injury-related deaths among Chinese seniors aged 65 and above; alarmingly, over half of all falls happen right at home.

Cost

Aim to practice balance exercises two to three times per week, each session lasting 30 minutes — activities like Tai Chi work well. Installing non-slip mats, handrails, and night lights in bathrooms and stairways costs anywhere from a few dozen to several hundred yuan. The real challenge is maintaining this routine over the long term.

Benefit

Cochrane analyzed 108 separate trials involving 23,407 participants. Collectively, these studies show that regular exercise lowers fall rates among older adults by 23%. The relative risk of falls dropped to 0.77, with a 95% confidence interval ranging from 0.71 to 0.83. The proportion of individuals experiencing at least one fall also fell by 15% (relative risk 0.85). Professional home safety assessments and modifications further reduced fall rates by roughly 20% (RR 0.81; 95% CI 0.68–0.97). Practicing Tai Chi specifically lowered fall risk by about 29% (RR 0.71). In China, falls remain the top cause of injury-related mortality for seniors over 65; data from 2018 indicates that 55.97% of all falls among this age group occur at home.

Note

This recommendation applies to seniors aged 60 and above who live independently at home rather than in nursing homes. The studies referenced here focus on the total number of falls, not on actual mortality rates. It’s important to note that the path from a fall to a hip fracture — and ultimately death — can be very short for older adults.

The test itself is very inexpensive. In Qidong’s 30‑year follow‑up study, infants who received the hepatitis B vaccine at birth had an 84% lower risk of developing primary liver cancer and a 72% lower rate of carrying the hepatitis B virus compared to unvaccinated peers. Adults found to have no antibodies should receive three vaccine doses over six months at a cost of roughly 100–300 yuan.

Cost

The test costs just a few dozen yuan per person. For adults lacking antibodies, three doses of the hepatitis B vaccine cost between 100 and 300 yuan total, to be completed within six months.

Benefit

This Qidong trial used group randomization rather than individual assignment and was tracked for three decades. Vaccination at birth cut primary liver cancer incidence by 84% (95% CI 23%–97%). The prevalence of hepatitis B surface antigen (HBsAg) fell by 72% (95% CI 68%–75%), reflecting a comparable drop in the proportion of people carrying the virus. Nationwide in China, HBsAg prevalence dropped 52% between 1992 and 2014, and fell 97% among children under five.

Note

This recommendation applies to adults born before 1992 who never received the vaccine or whose antibodies have waned. The 84% cancer‑risk reduction pertains only to those immunized at birth; adolescents vaccinated later saw only a 21% reduction in virus carriage. For adults, the main goal is preventing new infection, not achieving the same cancer‑prevention benefit. Vaccination offers no protection to people already infected; they must see a hepatologist regularly. Infection is confirmed when the hepatitis B surface antigen (HBsAg) test result is positive.

Once tetanus sets in, about 1 out of every 10 people dies. The risk is highest for deep wounds or wounds contaminated with dirt. If a wound is dirty and it’s been 5 years or more since your last tetanus shot, you’ll need a booster. Getting treated the same day costs only a few dozen yuan — don’t wait until the wound starts swelling.

Cost

Seeing a doctor and having the wound treated typically costs a few dozen yuan. If a shot is recommended, the vaccine or immunoglobulin will add another few dozen to several hundred yuan.

Benefit

In the U.S., roughly 1 out of every 10 tetanus cases ends in death. Deep wounds and those exposed to dirt carry an even higher risk. China’s 2024 treatment guidelines classify wounds into two categories. Wounds treated within 6 hours that aren’t dirty and haven’t been exposed to feces, animal saliva, or soil are considered low‑risk. Wounds treated later, or those contaminated with such substances, as well as puncture wounds, avulsions, crush injuries, burns, frostbite, or wounds containing foreign bodies, are deemed high‑risk. If you’ve received three or more tetanus shots and the most recent one was less than 5 years ago, no further dose is needed. For high‑risk wounds, a booster is required if it’s been 5–10 years since your last shot; after 10 years, a booster is mandatory regardless of risk level. If you’ve never completed the three‑dose series or can’t recall when you last got a shot, you’ll need to finish the series and, for high‑risk wounds, also receive passive immunization (an injection of immunoglobulin or antitoxin that delivers antibodies directly).

Note

At the hospital, let the doctor make the decision — don’t guess on your own, and don’t hesitate to ask questions. Not every wound requires a tetanus shot; the doctor will assess the wound category and your vaccination history before deciding. The idea that “one shot in childhood provides lifelong protection” is a myth. If a wound is dirty, a booster is needed after 5 years, so try to recall when you last received a tetanus shot before heading to the clinic.

Data from 1.67 million Swedish women show that those who received the HPV vaccine before age 17 have only about one‑eighth the risk of developing invasive cervical cancer compared to unvaccinated women. For women vaccinated between 17 and 30, the risk is roughly half that of non‑vaccinated peers. Therefore, getting vaccinated earlier offers the greatest benefit.

Cost

Domestic bivalent vaccines cost around 300 RMB per dose, while imported 9‑valent vaccines cost about 1300 RMB per dose. A total of 2–3 doses are needed, and each visit takes half a day.

Benefit

Swedish research on 1.67 million women found that vaccinated individuals have a much lower incidence of invasive cervical cancer. Before age 17, vaccination reduces risk by roughly 88% (IRR 0.12, 95% CI 0.00–0.34). Vaccination between 17 and 30 still lowers risk by about 53% (IRR 0.47, 95% CI 0.27–0.75).

Note

The greatest benefit is seen when vaccination occurs between ages 9 and 14. Even for women aged 17–30, risk is still reduced by more than half. After age 30, the protective effect gradually diminishes. Vaccinated women still need regular cervical cancer screening; the vaccine does not replace screening — see item 18 for screening guidelines for women over 30.

For women aged 40 to 74, having a mammogram every two years is a clear recommendation in official US screening guidelines. For women over 75, and for those with dense breast tissue who need extra ultrasound or MRI scans, there is currently insufficient evidence to support such screening. If a health check package includes these extra tests at an extra charge, they are not necessary.

Cost

A mammogram costs around 200–300 yuan each time. Many regions also offer free screening programs. Each screening takes about half a day.

Benefit

The US Preventive Services Task Force is the official body that issues screening recommendations in the US. Its current recommendation reads: “We recommend screening mammography every two years for women aged 40 to 74.” Mammography is exactly what we commonly call a mammogram. This recommendation is rated as a Grade B. For women over 75, and for those with dense breast tissue who need additional ultrasound or MRI scans, the Task Force has concluded that there is not enough evidence to support such screening.

Note

The recommended starting age for screening varies by country. In China, some local guidelines and programs recommend starting at age 45. Women with a family history of breast cancer — such as parents, children or siblings who have had it — or those carrying BRCA mutations are at higher risk. They should consult a doctor individually to determine the right screening plan; the above recommendations do not apply to them.

In that rural Indian trial, women who underwent just one HPV test in their lifetime had roughly half the risk of dying from cervical cancer and about 50% lower odds of being diagnosed with advanced-stage disease. At a cost of just 100–200 yuan per test, a negative result provides protection for five years.

Cost

An HPV test costs between 100 and 300 yuan. Women with a negative result can get tested again only once every five years. The sampling process takes just a few minutes.

Benefit

This trial in rural India used group-level rather than individual randomization, involving women aged 30–59. A single HPV test cut the risk of death from cervical cancer by roughly 48% (hazard ratio 0.52; 95% CI 0.33–0.83). It also reduced the likelihood of detecting late-stage disease by about 53% (HR 0.47; 95% CI 0.32–0.69).

Note

Even women who have received the HPV vaccine still need screening, since the vaccine does not protect against all viral types. What makes this study unique is that it was a randomized screening trial with mortality as the primary outcome and only one round of testing performed.

Getting a low-cost fecal occult blood test every year or two lowers the chance of dying from colorectal cancer by roughly 16%. For people who’ve had at least one round of screening, this risk drops by about 25%. In the group invited to undergo a colonoscopy, the likelihood of developing colorectal cancer over the next decade fell from 1.20% to 0.98%.

Cost

Fecal tests cost just a few dozen yuan and can be done every 1–2 years. Colonoscopies cost several hundred to over a thousand yuan; those with negative results only need one every 10 years. Preparing for a colonoscopy requires setting aside a full day for bowel cleansing.

Benefit

Cochrane pooled data from multiple studies showing that individuals undergoing fecal occult blood screening have a roughly 16% lower risk of dying from colorectal cancer. The original RR was 0.84, with a 95% CI ranging from 0.78 to 0.90. For those who’ve had at least one screening round, this risk reduction reaches 25% (RR 0.75). The NordICC randomized trial likewise found that among participants invited to get a colonoscopy, colorectal cancer incidence dropped from 1.20% to 0.98% over 10 years; its RR was 0.82, with a 95% CI of 0.70–0.93.

Note

This topic remains debated. The NordICC trial tracked participants based on whether they were invited to get a colonoscopy; the difference in colorectal cancer mortality between groups was 0.28% versus 0.31% (RR 0.90, 95% CI 0.64–1.16), a gap well within statistical margins of error. This suggests earlier estimates of colonoscopy’s mortality benefits may have been overstated, while evidence for fecal tests’ impact on mortality is more robust. Most national guidelines recommend starting screening at ages 45–50; those with a family history of colorectal cancer should begin even earlier.

In a trial involving people after a heart attack, the yearly death rate dropped from 4.9% to 2.9% after they received the flu vaccine. For people with cardiovascular disease and older adults, getting one shot each autumn for just 50 to 150 yuan can make a real difference.

Cost

One shot costs 50 to 150 yuan. It should be given once each autumn.

Benefit

This trial included 2,571 participants after a myocardial infarction; neither doctors nor patients knew who got the vaccine or the placebo. Over 12 months, the overall death rate was 2.9% in the vaccine group versus 4.9% in the placebo group. The hazard ratio was 0.59, with a 95% confidence interval of 0.39 to 0.89. Cardiovascular death rates also showed a hazard ratio of 0.59. Another study pooled multiple trials and found that flu vaccination lowered the rate of major cardiovascular events to 3.6% from 5.4% in the control group; the relative risk was 0.66, with a 95% confidence interval of 0.53 to 0.83. Cardiovascular death risk showed a relative risk of 0.74, though this fell within the margin of error and was not statistically significant (95% CI 0.42 to 1.30).

Note

This recommendation is somewhat controversial. The Grade A rating applies only to people with cardiovascular disease. For otherwise healthy older adults, a Cochrane review offers only limited evidence. Flu vaccination also lowered the seasonal flu infection rate from 6% to 2.4%. The review rated the evidence for infection outcomes as “low” quality and the evidence for mortality as “very low” quality. This review was published in 2018 by Demicheli V et al.

In clinical trials, this vaccine proved 97% effective at preventing shingles across all age groups. The downside is that both doses cost several thousand yuan, all paid by the patient. In exchange, there’s a 97% reduction in the likelihood of developing shingles.

Cost

The recombinant shingles vaccine requires two doses, costing roughly 3,000 to 4,000 yuan in total. This expense must be paid out of pocket.

Benefit

This Phase 3 trial involved 15,400 participants from 18 countries. Participants were randomly assigned to receive either the vaccine or a placebo, with follow-up lasting an average of 3.2 years. Over that time, 6 cases of shingles occurred in the vaccine group versus 210 in the placebo group. Expressed per 1,000 person-years, these figures translate to 0.3 versus 9.1 cases. One thousand person-years represents the number of cases observed in a group of 1,000 people over one year. The original report states, “The overall vaccine efficacy against shingles is 97.2% (95% CI 93.7–99.0, P<0.001).” Effectiveness ranged from 96.6% to 97.9% across all age brackets.

Note

This option ranks low in terms of cost-effectiveness primarily due to its high price. While shingles itself rarely proves fatal, its most troublesome complication is post-herpetic neuralgia, which can persist for months or even years. After vaccination, a notable percentage of recipients experience pain at the injection site and fever. In particular, severe side effects (graded as Grade 3) occurred in 17.0% of vaccine recipients versus 3.2% of those given a placebo.

In a trial involving 84,500 seniors, the 13-valent pneumococcal vaccine cut cases of pneumonia caused by strains it targets by roughly 46%, and reduced instances of the most severe invasive infections by 75%. However, it showed no effect on pneumonia cases caused by any other pathogens, so it won’t prevent all types of pneumonia. The absolute confidence interval width is 95.2%.

Cost

Several hundred yuan. In some regions, it is provided free of charge for seniors.

Benefit

Researchers in the Netherlands randomly assigned 84,500 seniors over 65 to two groups for comparison. They used the 13-valent pneumococcal conjugate vaccine. Its effectiveness against pneumonia caused by strains it targets was 45.6%, with a 95% confidence interval of 21.8–62.5. This figure refers to the specific bacterial strains the vaccine can protect against. For the most dangerous form of pneumococcal disease, the effectiveness was 75.0% (95% CI 41.4–90.8). No protective effect was observed against pneumonia cases caused by any other pathogens.

Note

This vaccine only protects against the specific bacterial strains it targets; it does not prevent all types of pneumonia. The 23-valent polysaccharide vaccine commonly used for seniors in China is a different formulation from the 13-valent conjugate vaccine used in this trial, so the effectiveness figures here cannot be directly applied to that vaccine.

A 22-year follow-up study conducted in Linqu, Shandong, showed that individuals who had Helicobacter pylori eradicated had roughly half the risk of developing gastric cancer and about 40% lower risk of dying from it. Testing costs just 100–200 yuan, while eradication requires a two-week medication regimen.

Cost

The carbon-13 or carbon-14 breath test costs 100 to 200 yuan. Eradicating the bacteria requires taking four different medications for two weeks; the medication cost for that period is 200 to 500 yuan. The main difficulty is ensuring the full two-week course of medication is taken on schedule.

Benefit

This randomized trial in Linqu, Shandong, followed participants for 22 years. Those who underwent Helicobacter pylori eradication therapy saw their risk of gastric cancer drop by nearly half. The original odds ratio was 0.48, with a 95% confidence interval ranging from 0.32 to 0.71. Their risk of dying from gastric cancer also fell by roughly 38% (hazard ratio 0.62; 95% CI 0.39–0.99).

Note

Reinfection can still occur after eradication, so it is advisable for all household members to be tested and treated together. This trial involved residents of an area with a high incidence of gastric cancer; people living in regions with lower incidence may gain considerably less benefit.

Eligible heavy smokers who get a low-dose CT once a year have a 20% lower risk of dying from lung cancer and a 6.7% lower overall risk of death compared to those who only get regular chest X-rays. The trade-offs are extra follow-up tests after any suspicious findings and the resulting worry during the waiting period.

Cost

The test costs 200–400 yuan per session and takes just 10 minutes. You must also factor in follow-up tests after any false alarms, plus the anxiety that comes with waiting for results.

Benefit

The NLST trial in the U.S. enrolled 53,454 participants aged 55–74 with at least 30 pack-years of smoking history and who had quit smoking no more than 15 years prior. Those who underwent low-dose CT had a 20.0% relative reduction in lung cancer deaths versus those who only got chest X-rays. The 95% confidence interval is 6.8–26.7. Overall mortality dropped by 6.7% relative to controls, with a 95% CI of 1.2–13.6.

Note

This recommendation applies only to high-risk smokers. In the same study, 24.2% of CT recipients showed suspicious findings, yet 96.4% of those cases turned out to be false positives. For non-smokers, undergoing this test offers no benefit and only adds unnecessary anxiety.

Removing lethal items from easy reach is a proven way to cut suicide risk: after restricting access to painkillers, suicide rates linked to them dropped by 43%; installing barriers at locations where people often jump off cliffs cut rates by 86%. That’s why it’s a good idea to avoid storing sleeping pills and pesticides at home. If you’re feeling overwhelmed, call 12356 — this national helpline is available at least 18 hours a day.

Cost

There’s no cost involved. You just need to make one phone call. Plus, lock away any medications and keep pesticides out of the house.

Benefit

A recent review of nearly a decade’s worth of research confirms that limiting people’s access to lethal means is an effective suicide prevention strategy. After controls on painkiller availability were put in place, suicide cases tied to these drugs fell by 43%. Installing protective barriers at common suicide hotspots reduced rates by 86% (the 95% confidence interval ranges from 79% to 91%). School-based cognitive intervention programs also lowered rates of attempted suicide by roughly 55% (OR 0.45, 95% CI 0.24–0.85). Antidepressant medications and psychotherapy are also key components of suicide prevention. Starting May 1, 2025, the 12356 helpline will be available nationwide in China, operating at least 18 hours each day.

Note

The B rating is based on two factors: most evidence supporting restrictive measures comes from ecological studies that compare suicide rates before and after policy implementation; there is currently no direct evidence that the helpline itself reduces overall mortality rates. Suicidal impulses typically last only a few minutes to a few hours, so simply removing lethal items from immediate reach is a meaningful intervention on its own. Data on outcomes over longer time periods following suicide attempts, as well as information on long-term consequences for survivors, can be found in Item 32 of this section (“Tell someone close to you as soon as suicidal thoughts arise”).

Fire extinguishers, fire blankets, escape respirators, and first-aid kits are all included in the Emergency Management Department’s list of 11 essential items for household emergency preparedness. The whole set costs a few hundred yuan, and you only need to buy it once. Studies of home safety programs that included on-site guidance found these measures cut injury rates by roughly 25%.

Cost

A set of fire extinguishers, fire blankets, one respirator per person, and a first-aid kit costs a few hundred yuan. You only need to buy it once; after that, it takes just 10 minutes each year to inspect the items.

Benefit

The Emergency Management Department’s “National Recommended List of Basic Household Emergency Supplies” contains 11 items in total. Among them, “fire extinguishers and fire blankets” are recommended for “putting out small fires at the initial stage”, and the list also notes that “fire blankets can be draped over the body to aid escape”. The “escape respirators” listed are “firefighting filtering self-rescue respirators designed for use during fire escapes”. “External medical supplies” refer to “hemostatic powder, adhesive bandages, gauze bandages, and other items used to treat wounds”. Cochrane analyzed 98 studies involving 2,605,044 participants in total. Home safety interventions lowered injury rates to an IRR of 0.89; the 95% confidence interval for this figure is 0.78 to 1.01. For interventions that included on-site guidance, injury rates dropped by around 25% (IRR 0.75, 95% CI 0.62 to 0.91).

Note

This finding is somewhat controversial. The same Cochrane meta-analysis found that interventions that did not provide emergency supplies also lowered injury rates by roughly 20%. The original IRR for those interventions was 0.78, with a 95% confidence interval of 0.66 to 0.92. Providing emergency supplies alone did not yield better results than other measures. The main effect of these interventions comes from on-site education and home modifications, so the benefit of supplying emergency supplies is rated as “moderate” rather than “significant”. When buying fire extinguishers, look for the CCC certification mark; for pre-pressurized extinguishers, make sure the pressure gauge needle points to the green zone. Details on smoke alarms and carbon monoxide detectors are covered in section 3 of this chapter. Instructions for using tourniquets can be found in section 13, item 12. Guidance on how to select, store, and replace each item can be found in [docs/.md](../../docs/research/.md).

Among people aged 60 and older, the chance of ultimately being diagnosed with bladder cancer after experiencing one episode of visible blood in urine is about 2.8%. For those aged 40–59, that figure is roughly 1.2%. These percentages may not seem very high, but they’re high enough to justify getting checked — even if the bleeding stops the very next day.

Cost

A routine urine test costs just a few dozen yuan, while a urinary-system ultrasound runs around 100–200 yuan. If a doctor deems it necessary, a cystoscopy can be added at a cost of roughly 1,000 yuan.

Benefit

A UK study analyzed electronic medical records from primary-care clinics, comparing 4,915 patients diagnosed with bladder cancer against 21,718 controls. Among patients with visible blood in urine, the proportion ultimately found to have bladder cancer was 2.8% for those aged 60+, with a 95% confidence interval of 2.5–3.1. For ages 40–59, the figure was 1.2%, with a 95% CI of 0.6–2.3. This proportion is known as the positive predictive value. Blood visible only under a microscope also carries significance; the odds ratio is 20, with a 95% CI of 12–33. For those over 60, this figure is 1.6%, with a 95% CI of 1.2–2.1.

Note

The absence of pain is a key clue. Blood in urine caused by kidney stones or infections usually comes with abdominal or flank pain, plus frequent, urgent, or painful urination. Cancer-related bleeding, however, often causes no discomfort at all and may disappear for a few days before returning — which is why many people overlook it. Taking anticoagulant medications is not a valid reason to skip testing. Blood in urine after intense exercise or during a woman’s menstrual period can be re-evaluated before deciding on further checks. The benefit is rated “low” because it reflects only detection rates, not any measurable reduction in mortality resulting from early diagnosis.

Men with erectile dysfunction later develop cardiovascular disease at roughly 40% higher rates than other men, and heart attacks at about 60% higher rates. The younger a man is, the greater this difference becomes. This problem often shows up before any chest pain does. Therefore, it’s wise to check blood pressure, blood sugar, and cholesterol levels rather than simply self‑medicating.

Cost

A doctor’s visit costs just a few dozen yuan. Measuring blood pressure and running tests for blood sugar and cholesterol adds another hundred or so yuan. One trip to the hospital yields results after a few days.

Benefit

One meta‑analysis combined data from 14 long‑term studies involving 92,757 men, followed for an average of 6.1 years. Compared with men without erectile dysfunction, those with the condition faced higher risks as follows: overall cardiovascular events rose by roughly 44% (RR 1.44, 95% CI 1.27–1.63). Heart attacks increased by about 62% (RR 1.62, 95% CI 1.34–1.96). Cerebrovascular events rose by roughly 39% (RR 1.39, 95% CI 1.23–1.57). All‑cause mortality went up by about 25% (RR 1.25, 95% CI 1.12–1.39). No significant difference appeared for cardiovascular‑related deaths (RR 1.19, 95% CI 0.97–1.46). The risk elevation was greater in younger men and in those whose baseline cardiovascular risk was moderate. Studies that used questionnaire‑based diagnosis reported an RR of 1.61 (95% CI 1.38–1.86), while studies asking just one question gave an RR of 1.27 (95% CI 1.18–1.37).

Note

These 14 studies tracked groups of men over time; they are not randomized controlled trials. Hence the “40% higher” figure reflects an association, not a proven cause‑and‑effect relationship. Occasional episodes do not count; the condition is considered present only when symptoms persist for three months or more. The tests recommended — blood pressure measurement, fasting blood‑glucose testing, plus cholesterol checks, smoking status assessment, and waist‑circumference measurement — are the same as those listed in sections 7 and 8 of this chapter. Avoid purchasing “male‑enhancement” supplements online; legitimate medications for this purpose are prescription drugs, and their instructions list nitrates as a contraindication — meaning men already taking nitroglycerin or similar drugs must not use them, as doing so can cause a sudden drop in blood pressure. For ways to improve erectile function, see section 29 (weight loss and smoking cessation can help). The benefit is rated “moderate” rather than “large”: the 44% figure represents the difference between two groups, not the actual reduction in mortality achieved by testing. It is also not “small”; unlike the situation described in section 27 (visible blood in urine), where detection alone is the benefit, here hypertension, diabetes, and abnormal cholesterol levels each have established treatments available.

Managing cardiovascular risk factors naturally leads to better erectile function. When multiple randomized trials are combined, questionnaire scores improve by an average of 2 to 3 points. This questionnaire has a maximum score of 25, with scores above 22 considered normal.

Cost

There is no cost involved; in fact, it may even save money. The real challenge is staying consistent over time — eating healthily, exercising regularly, and quitting smoking.

Benefit

One meta-analysis evaluated six randomized controlled trials involving 740 men. Interventions included lifestyle changes or medication to control cardiovascular risk factors, with follow-ups lasting at least six weeks. Overall, erectile function scores on the IIEF-5 questionnaire rose by an average of 2.66 points (95% CI: 1.86–3.47). When two trials using statins (143 participants) were excluded, the remaining four trials relying solely on lifestyle changes still showed an average improvement of 2.40 points (95% CI: 1.19–3.61). A total of 597 men participated in these four trials. The IIEF-5 consists of five questions scored from 5 to 25; scores between 22 and 25 indicate no erectile dysfunction, while scores of 5–7 indicate severe impairment.

Note

These six trials used different interventions — some combined weight loss and exercise, while others used medication to control blood pressure and lipids. With only 740 participants overall, the results confirm a positive trend, though the exact degree of improvement varies per individual. The benefit is rated as “minor” because the outcome measured was solely questionnaire scores, not actual reductions in disease incidence. However, similar lifestyle changes have been shown to produce measurable health benefits elsewhere: quitting smoking (see Section 2, Item 1), maintaining a BMI between 20–25 through weight control (Section 2, Item 33), and managing blood pressure with medication when necessary (Section 7). Prescription medications are acceptable when prescribed by a doctor; caution is advised with over-the-counter “health supplements,” which may contain unregulated amounts of active ingredients. For guidance on identifying safe products, see Section 28, Item 4.

Using a condom every time throughout sex cuts the chance of HIV transmission between heterosexual partners by roughly 70% or more. “Most of the time” just isn’t enough — that still leaves the risk nearly as high as not using one at all. Condoms also protect against syphilis, gonorrhea, and other STIs.

Cost

A single condom costs just one or two yuan. The challenge isn’t the price, but making sure to use one every single time — and putting it on right from the start.

Benefit

One study pooled data from 25 separate studies involving 10,676 heterosexual couples in which one partner was HIV‑positive and the other was not. Compared to couples who never used condoms, those who consistently used them saw their HIV transmission risk drop by about 71%. The reported relative risk was 0.29, with a 95% confidence interval of 0.20–0.43. When compared to couples who used condoms only intermittently, the risk was lower by roughly 77% (RR = 0.23; 95% CI 0.13–0.40). The authors concluded that although condoms are not perfect, “consistent use can reduce HIV transmission by more than 70%.” This same level of protection also applies to syphilis, gonorrhea, chlamydia, and other sexually transmitted infections.

Note

The difference between “infrequent use” and “no use” is minimal; the whole benefit hinges on the phrase “every time, throughout.” Sharing needles is a separate, highly effective route of transmission that has nothing to do with sex — this includes drug injection, tattooing, and piercing. For people at high risk, pre‑exposure prophylaxis (PrEP) offers another option: taking medication in advance to block infection. Pooled data from 18 studies show that when at least 70% of participants adhered to the regimen, PrEP cut HIV risk by about 70% compared to placebo (RR = 0.30; 95% CI 0.21–0.45). Trials with lower adherence rates showed no protective effect. PrEP is a prescription medication; consult an infectious‑disease specialist or public‑health clinic rather than ordering it online. Information on what to do after potential exposure can be found in Section 13.

Testing for HIV at the Chinese CDC costs nothing. According to the “National Measures for HIV Testing Management,” staff are prohibited from disclosing your name, address, or test results. A positive result does not mean a death sentence: people who adhere to treatment and keep their viral load undetectable cannot transmit the virus to sexual partners. One major study followed more than 700 couples through over 70,000 unprotected acts; there were zero transmissions between partners.

Cost

There is no charge. You simply visit the Chinese CDC or a designated medical facility and provide a blood sample. The only real hurdle is mustering the courage to get tested at all.

Benefit

Article 23 of the “Regulations on HIV/AIDS Prevention and Control” mandates that local health authorities designate medical institutions to provide free counseling and initial screening to anyone who voluntarily seeks testing. Early detection is far more than a psychological comfort — modern antiretroviral therapy can drive the virus down to undetectable levels. The World Health Organization states that individuals on such treatment with an undetectable viral load pose no risk of HIV transmission. The PARTNER study observed 782 same‑sex couples (serodiscordant pairs) for a total of 1,593 person‑years; despite 76,088 unprotected encounters, only 15 new infections occurred, and genetic analysis proved none originated from the partner. The same national measures also forbid any disclosure of patients’ personal data or test outcomes.

Note

The “window period” determines when a test becomes reliable. The Guangdong Provincial CDC reports that nucleic‑acid tests can detect HIV after roughly one week, fourth‑generation antigen‑antibody tests after about two weeks, and third‑generation antibody tests after three weeks. It is advisable to wait at least two weeks post‑exposure and then retest after another two to four weeks; after three months, 99.99% of people can be certain they are not infected. A positive home‑test result is not a diagnosis — confirmation must come from the Chinese CDC or a certified lab. Article 3 of the regulations guarantees that no one may discriminate against HIV‑positive individuals or their families; their rights to marriage, employment, medical care, and education are protected by law. Article 38 also requires infected persons to inform any sexual partners of their status. Screening for HIV, syphilis, and hepatitis B during pregnancy and related prevention measures are covered in Section 27.

Among 82 people who attempted suicide, 47.6% reported that only 10 minutes or less passed from the first appearance of suicidal thoughts to the actual attempt. What they had to endure was not a lifetime of mental anguish, but just those few minutes. Of the same group, 76.8% had some contact with others during that time, though they did not voice their feelings. Looking ahead, about 2% of people who ended up in the hospital due to self-harm died by suicide within a year, while roughly 7% did so after nine years or more; the vast majority did not follow that path.

Cost

No cost involved. The hard part is actually speaking up at that moment and admitting you can’t be alone for a few hours.

Benefit

Interviews conducted within three days of admission with those 82 individuals showed that 47.6% (39 people) stated the interval between the first emergence of suicidal thoughts and the actual attempt was no more than 10 minutes. Those whose process took longer displayed significantly higher scores on measures of suicidal intent. However, impulse scores showed no correlation with the duration of this period. Additionally, 76.8% (63 people) reported having some sort of interaction with a partner, family member, or friend during those minutes. The authors conclude that the window for intervention is usually very brief, leaving limited room for professionals to step in; thus, it is crucial to spread awareness of warning signs and basic intervention methods to ordinary people. Another systematic review compiled findings from 90 follow-up studies. For those seeking medical care after self-harm, the median rate of repeated self-harm without resulting in death was 16% after one year, while the suicide mortality rate at that point stood at 2%. After nine years or more of follow-up, roughly 7% had died by suicide.

Note

Grade B is assigned for two main reasons: the Deisenhammer study involved only 82 participants from a single hospital and relied on retrospective recollections; Owens’s review aggregated median figures from 90 studies employing different methods, rather than producing a single combined statistic. That same review also emphasizes that the suicide risk among self-harm patients remains hundreds of times higher than in the general population. Consequently, the statement “the vast majority did not follow that path” describes the overall trajectory of this group, not a guarantee for any individual; appropriate medical care must still be sought. For advice on removing lethal means and contacting the helpline 12356, see item 25 in this section. Steps to take when feeling down are outlined in item 19 of Section 3. Long-term consequences following survival are discussed in item 33 of this section. Finally, actions you can take if someone close to you expresses such thoughts are detailed in item 15 of Section 8.

There is no antidote for paraquat. Gastric lavage is not recommended, and neither hemofiltration nor dialysis alters its disease progression. Paraquat actively enters lung tissue against its concentration gradient, causing pneumonia and pulmonary fibrosis, while also damaging kidneys and liver. Among 257 cases treated at ten hospitals in Bangladesh, the mortality rate reached 43.2%. Carbon monoxide produces similar outcomes: six weeks after exposure, 46.1% of patients receiving normal oxygen still suffered cognitive impairment, compared to 25.0% of those receiving hyperbaric oxygen therapy. No treatment pathway yields a completely clean outcome; the most common result is lasting health complications.

Cost

No cost involved. It simply helps you understand this reality up front.

Benefit

A systematic review on paraquat poisoning highlights its extremely high mortality rate, stemming from its intrinsic toxicity and lack of effective treatments. Paraquat is actively transported into lung tissue against its concentration gradient, resulting in pneumonia, pulmonary fibrosis, kidney and liver damage. The review explicitly advises against gastric lavage; hemofiltration and dialysis are unlikely to alter clinical outcomes. Evidence supporting corticosteroids or immunosuppressants remains weak. It also notes that mortality rates remain high across all centers despite varying treatment approaches. In Bangladesh, 257 out of 1,420 cases admitted to ten tertiary hospitals between 2013 and 2024 resulted in death (43.2%). Common symptoms included lower limb swelling due to acute kidney failure (71.2%), vomiting (65.8%) and abdominal pain (58.0%). Another randomized, double-blind trial involving 76 patients per group examined acute carbon monoxide poisoning; six weeks later, 25.0% of those receiving hyperbaric oxygen therapy and 46.1% of those receiving normal oxygen still had cognitive impairments (P=0.007; adjusted OR 0.45, 95% CI 0.22–0.92). A separate study of 73 patients found 30% developed cognitive impairments and 12% showed hyperintense signals in white matter on brain imaging. Since July 1, 2014, China has banned the registration and production of paraquat aqueous solutions; sales and usage ceased by July 1, 2016. As of September 26, 2020, soluble concentrate formulations are also prohibited nationwide. Official documents cite frequent suicide attempts involving paraquat as the primary reason for these strict controls.

Note

Grade B is assigned because these studies involve general poisoning patients rather than solely suicide attempt survivors; the carbon monoxide trial even included accidental poisoning cases. Consequently, observed complication rates cannot be directly interpreted as probabilities specific to suicide attempts. This entry does not compare mortality rates across different treatment methods nor recommend any specific actions. The sole certainty is that no treatment pathway guarantees a completely clean outcome. On-site management of carbon monoxide poisoning is detailed in Section 13, Item 19. For accidental ingestion of pesticides or medications, avoid inducing vomiting and seek medical help while bringing the container along (Section 13, Item 20). Finally, refrain from storing pesticides or sedatives at home (Section 13, Item 25).

A trauma ICU in southern Xinjiang evaluated patients who fell from heights. Only 5.5% died either in the hospital or within 30 days. The vast majority survived, but at a price: 47.1% suffered injuries to three or more body parts, 36% needed ventilators, and the median length of stay in the ICU was 8 days — with some patients remaining for as long as 132 days. The median fall height for this group was just 3 meters. Follow‑up showed that 58% of those with serious injuries eventually returned to work.

Cost

No cost at all. It simply helps you see the full picture.

Benefit

From April 2020 to July 2024, the same ICU recorded 289 cases of falls from heights; the average age of patients was 40.3 years. The median fall height was 3 meters; 26.6% fell from heights above 5 meters and 11.4% from heights above 10 meters. The median Injury Severity Score was 24, a higher score indicating more severe injuries; 63.3% of patients scored above 20. In addition to the multiple injuries, 18.3% suffered damage to four or more body parts. Mechanical ventilation was required for 36% of patients, with a median duration of 103.5 hours. The median ICU stay was 8 days, ranging from 1 day to 132 days. The in‑hospital or 30‑day mortality rate was 5.5% (16 out of 289). A German trauma center reported similar results: among 84 patients with an ISS of 25 or higher, 58% returned to work after follow‑up. Age, length of ICU treatment, and self‑reported health status were identified as predictive factors. Nationwide, the average cost per hospital stay in 2024 was 9,870 yuan, a 4.3% decrease from the previous year; total health expenditures reached 9,089.55 billion yuan, of which personal spending accounted for 2,500.75 billion yuan, or 27.5% of the total.

Note

Grade B is assigned because the fall‑related data come from a single hospital’s retrospective chart review without distinguishing between accidental and self‑inflicted falls. The figure on return‑to‑work is based on only 84 patients in Germany; neither dataset can be taken as a reliable predictor of outcomes for any individual who falls from a height. The average national hospital cost is an overall figure, not specific to fall injuries; it is included only to provide a baseline for comparison. No direct correlation between fall height and injury severity is presented, as the source only supplies the height distribution of this group. For information on pressure ulcers that often develop during prolonged bed rest, see Section 17, Item 8. Deep‑vein thrombosis and pulmonary embolism are discussed in Section 13, Item 11 (sudden swelling of one leg). If suicidal thoughts arise, refer to Section 32 of this chapter. Details on paraquat poisoning are covered in Section 33 — remember that “being saved” does not guarantee a completely uncomplicated recovery. The timeline described here reflects the author’s own experience: after falling from the fourth floor, he initially believed he would recover in a few weeks, but ended up hospitalized for a full year, undergoing multiple surgeries, wearing steel plates, and unable to sit up on his own for half a year; his family had to take on debt to cover the expenses.

First, consider the best-case scenario: legitimate donors who pass rigorous screening and receive post‑surgery follow‑up. In U.S. data from nearly 96,000 donors, only 31 per 10,000 developed end‑stage renal disease within 15 years after donation. Among equally healthy, eligible non‑donors, that figure was just 4 per 10,000. On the other side, a study of 305 kidney sellers in India found that six years later, 86% reported poorer health, and three‑quarters still carried debt. Legitimate donors get screening and monitoring; kidney sellers get none of that.

Cost

No cost at all. It simply requires a clear look at the facts.

Benefit

U.S. researchers compared 96,217 living kidney donors with 20,024 similarly healthy non‑donors drawn from the NHANES III survey. After 15 years, the estimated risk of developing end‑stage renal disease (ESRD) was 30.8 per 10,000 donors (95% CI 24.3–38.5) versus 3.9 per 10,000 non‑donors (95% CI 0.8–8.9; P<0.001). Over a lifetime, ESRD risk was 90 per 10,000 donors, 14 per 10,000 non‑donors, and 326 per 10,000 in the general population. A Norwegian study of 1,901 donors (median follow‑up 15.1 years) showed a 30% higher overall mortality (HR 1.30, 95% CI 1.11–1.52), a 40% higher cardiovascular mortality (HR 1.40, 95% CI 1.03–1.91), and roughly tenfold higher ESRD risk (HR 11.38, 95% CI 4.37–29.6). Among 3,698 U.S. donors, 11 developed ESRD — an incidence of 180 per million person‑years, compared with 268 per million in the general population. Of those re‑examined after an average of 12.2 years, 255 remained healthy, and 85.5% retained a glomerular filtration rate of at least 60 ml/min/1.73 m², the clinical lower limit of normal. Hypertension affected 32.1% and proteinuria 12.7%. In Chennai, India, 96% of 305 kidney sellers acted to pay debts; they received an average of $1,070. Six years post‑surgery, family income fell by one‑third (P<0.001), poverty rose, and three‑quarters remained indebted; 86% said health worsened, and 79% would not recommend kidney selling to others. The absolute numbers from these studies are 32,621 donors, 24.9 years of follow‑up, 302 ESRD cases, and 9.2 years of average follow‑up after surgery.

Note

Controversy exists: Ibrahim’s study used ordinary citizens as controls and found no difference in survival or ESRD risk between donors and non‑donors. Muzaale and Mjøen compared donors to equally healthy, eligible non‑donors and found markedly higher risks. The disagreement concerns the control group, not the donors themselves. All three studies agree that absolute risks remain low (30.8 per 10,000 over 15 years). Thus the key points are two: first, the remaining kidney does bear extra strain, as shown by higher rates of hypertension and proteinuria; second, these figures apply only to donors who undergo pre‑ and post‑operative screening and medical care — conditions absent for illegal kidney sellers, whose outcomes differ sharply according to Indian follow‑up data. Original studies provide only self‑reported health decline, proteinuria, hypertension, and ESRD rates; no figures on bed‑bound status are included here. Legal restrictions on organ sales, fines, and criminal penalties for relatives are detailed in Section 9, Article 22. Dialysis patients may use cross‑regional settlement and long‑term medication programs described in Section 16, Articles 1 and 2.

Radiation has no smell, color, or temperature. Most radioactive sources look like ordinary pieces of metal, so “it looks harmless” is not a reliable indicator. The chance of an ordinary person encountering one is extremely low — fewer than one incident occurs per 10,000 sources each year. Yet when such an encounter does happen, the consequences are irreversible. In 1987, four people died in Brazil after dismantling a radiotherapy machine from an abandoned clinic.

Cost

No cost involved. If you see unfamiliar metal cylinders, lead containers, or parts removed from equipment, simply steer clear — don’t pick them up, take them apart, or put them in your pocket.

Benefit

As of 2025, roughly 178,000 radioactive sources and 355,000 radiation devices are in use nationwide. The annual rate of radiation incidents involving sources remains below one per 10,000 sources. Classification is as follows: loss, theft, or uncontrolled release of Category I or II sources constitutes a major radiation incident; Category III is a relatively serious incident. Loss or theft of Category IV or V sources, or exposure exceeding annual dose limits, counts as a minor incident. Official example: In June 2020, a γ‑ray inspection was performed during pipeline upgrades at a steel plant in Ningxia. A Category II iridium‑192 source exposed three workers to radiation; one suffered third‑degree acute skin damage, another had fourth‑degree injuries on several fingers, and a third had first‑ to second‑degree burns. All three received doses far above legal limits; both responsible firms had their radiation licenses revoked and were fined 70,000 yuan. International example: In 1987, 50.8 TBq of cesium‑137 was removed from a radiotherapy machine in Goiânia, Brazil, after the device was dismantled; the source’s protective casing was ruptured. About 112,000 people were screened; 249 showed internal or external contamination, 129 of whom required moderate to severe medical care. Four people ultimately died. (National and international statistics)

Note

If you ever encounter such a source, move away, note its location, do not touch it, and call 110. Reporting is mandatory to environmental, police, and health authorities. Distance and time are the only effective safeguards; plastic bags or pockets offer no protection. Devices such as X‑ray machines or CT scanners emit radiation only when powered; once turned off, they pose no residual risk. The real danger lies in the sealed radioactive source inside them. Radiotherapy machines, pipeline and boiler inspection devices, well‑logging tools, and level gauges all contain such sources, which look identical to ordinary metal parts. Therefore, never try to identify a source — simply avoid picking up, selling, or taking home any unidentified equipment parts. Workers in scrap recycling, dismantling, hardware, and construction face higher risks; they should steer clear of any area marked with the clover warning symbol. Nuclear plant leaks represent a different type of incident, with an even lower probability of affecting the general public. The primary beneficiaries of these precautions are you and anyone else present at the scene.

Individuals who have sought treatment for gambling problems are 15 times more likely to die by suicide and 1.8 times more likely to die overall compared to their peers. Depression serves as a key warning sign for potential suicide. Therefore, if you find yourself gambling despite owing money and feeling persistently down, call 12356 right away.

Cost

No cost involved. Simply make one phone call and give your bank cards, payment passwords, and gambling apps to a family member. The hardest part is admitting that you’ve lost control over your gambling behavior.

Benefit

A nationwide Swedish registry study examined 2,099 individuals diagnosed with gambling disorder between 2005 and 2016. Gambling disorder is defined as an inability to control gambling habits, which negatively impacts daily life. Compared to the general Swedish population aged 20–74, these individuals showed a 1.8-fold increase in overall mortality and a 15-fold increase in suicide mortality (these figures represent standardized mortality ratios). Over the follow-up period, 67 participants died, including 21 from suicide. Depression proved to be a reliable predictor of suicide risk. In a 2023 correction, researchers reported that the suicide risk was 12.1 times higher for men and 16.1 times higher for women. Starting May 1, 2025, China launched a nationwide mental health hotline at 12356, available at least 18 hours per day.

Note

This grade is assigned because only one study exists, and it includes only individuals who sought specialist care — a group with relatively severe conditions. Consequently, the 15-fold suicide risk increase cannot be generalized to all gamblers. Handing over financial control to family members is a widely practiced approach, though lacking direct research support; thus it receives a C grade. Legal boundaries regarding gambling are outlined in Section 9, Article 13 (prohibiting bookmaking and online gambling). Whether family members should repay gambling debts incurred by a spouse is discussed in Section 8, Article 44 (such debts do not qualify as joint marital obligations). For guidance on responding to suicidal thoughts, refer to Rule 32 of this section (inform a trusted person immediately). The primary beneficiaries are the gamblers themselves; however, family members who notice warning signs can also encourage them to follow these steps.

People who aren’t yet infected can take an antiviral drug called pre-exposure prophylaxis to protect themselves. Those who take it consistently cut their risk of infection by about 70%. On the other hand, people who take it intermittently see almost no benefit. Because it’s a prescription drug, a medical checkup is mandatory before obtaining it, and regular follow-ups are necessary thereafter.

Cost

This is a prescription medication, so in most places it must be paid for out of pocket. Prices range from several hundred to several thousand yuan. Before prescribing it, doctors must test for HIV, kidney function, and hepatitis B. Follow-up tests are required every three months. The main challenge is remembering to take the pills every day without fail.

Benefit

This medication is a fixed-dose combination of emtricitabine and tenofovir. In the iPrEx trial, 2,499 men who have sex with men and transgender women were assigned to either take this drug daily or receive a placebo. The group taking the medication saw a 44% reduction in infections (95% CI 15–63). Among participants whose blood tests confirmed they were taking the drug, the protective effect was even stronger. The UK’s PROUD trial involved 544 men who have sex with men; those who started treatment immediately had an 86% lower infection rate compared to those who delayed treatment for a year (90% CI 64–96). France’s IPERGAY trial evaluated on-demand dosing before and after sex; results showed an 86% drop in infections (95% CI 40–98). A meta-analysis compiled by WHO concluded that overall, the relative risk of infection dropped to 0.49 (0.33–0.73, roughly a 51% reduction). In trials where adherence exceeded 70%, the relative risk fell to 0.30 (0.21–0.45, about a 70% reduction); when adherence stayed below 40%, the relative risk was 0.95, essentially indicating no effect. In August 2020, China’s National Medical Products Administration approved this drug for pre-exposure prophylaxis use in adults and adolescents weighing at least 35 kg (both domestically and internationally).

Note

The participants in these trials were primarily men who have sex with men; therefore, they are the group most encouraged to seek this treatment. Others at high risk of infection can also consult doctors to determine suitability. Prior to prescribing, it is essential to confirm that patients are not already infected; taking the medication while infected can foster viral resistance. Self-test results cannot be used as a basis for prescription. For individuals with hepatitis B, discontinuing treatment may trigger a flare-up, so testing is mandatory beforehand. WHO currently recommends on-demand dosing only for men who have sex with men engaging in sex fewer than twice a week; the regimen involves taking two tablets 2–24 hours prior to sex, followed by one tablet 24 and 48 hours afterward. Women and hepatitis B carriers must adhere to daily dosing. Trials involving on-demand dosing reported more gastrointestinal and kidney-related side effects than placebo groups; hence, regular medical checkups are indispensable. Since 2019, China has been piloting this program among men who have sex with men; official plans for 2024 emphasize “standardized implementation.” No nationwide free distribution program has been confirmed. Prospective patients should call local disease control centers to identify designated HIV clinics or STD/AIDS outpatient departments offering this treatment. Importantly, this medication does not protect against sexually transmitted infections such as syphilis or gonorrhea; condoms must still be used consistently, as noted in Section 30 of this chapter. In cases where exposure has already occurred, emergency post-exposure prophylaxis is available per Section 13, Item 38 (within 72 hours). Ultimately, this treatment safeguards both the individual and their sexual partners.

Women aged 65 and older, and postmenopausal women with osteoporosis risk factors, should have bone density measured once. When screening starts with fracture-risk assessment and treats those at high risk, hip fractures fall by about 17%. That works out to about 5 fewer hip fractures per 1,000 people screened. Overall mortality did not change.

Cost

A hospital DXA scan of the lumbar spine and hip takes a few minutes lying down. Out-of-pocket cost is usually 100–200 yuan, varying by region. Heel ultrasound at a checkup can screen but cannot diagnose.

Benefit

The U.S. Preventive Services Task Force 2025 recommendation is osteoporosis screening for women aged 65 and older (Grade B). Postmenopausal women under 65 at high fracture risk by assessment should also be screened (Grade B). Evidence for men is insufficient; no recommendation. The evidence review for that guidance pooled 3 randomized trials with 42,009 older European women. Screening meant assessing fracture risk first, measuring bone density in those at high risk, and treating those found high risk. Hip fractures in the screening group were about 17% lower (RR 0.83, 95% CI 0.73 to 0.93). In absolute terms, screening avoided 5 hip fractures per 1,000 people. In the UK SCOOP trial of 12,483 women aged 70 to 85, hip fractures in the screening group were about 28% lower (HR 0.72, 95% CI 0.59 to 0.89); mortality did not differ. The Chinese Medical Association 2017 guideline recommends DXA for women aged 65 and older and men aged 70 and older, and earlier when osteoporosis risk factors are present. In a 2017–2018 national survey, osteoporosis prevalence among adults over 40 was 20.6% in women and 5.0% in men (China).

Note

Controversy: SCOOP's prespecified primary outcome was all osteoporotic fractures; the screening group did not show a clear reduction (HR 0.94, 95% CI 0.85 to 1.03)—only hip fractures fell. All three trials used "assess risk, then measure bone density"; none compared bone density testing alone. The evidence review also estimated 11.8% to 24.1% overdiagnosis—people who would never have fractured from this cause in their lifetime. For men, the U.S. says evidence is insufficient; China's guideline sets age 70—follow your doctor. This item is about whether bone can survive a fall; avoiding falls themselves is item 13 (balance and leg strength)—do both. After osteoporosis is found, see item 40 (treat with medication). Primary beneficiaries are you and your parents.

If osteoporosis is confirmed, or you have already fractured from a light fall, following a doctor's drug plan cuts hip fractures by about half and symptomatic spine fractures by a bit more than half. In older people who start yearly infusion within 90 days after hip-fracture surgery, new fractures over two years fall by about 35%. Calcium alone cannot replace these drugs.

Cost

Prescription required; use continues for years. Common options include once-weekly oral drugs and once-yearly infusions. Bone density should be rechecked yearly at first, then every 1 to 2 years once stable. The hard part is continuing when you feel fine.

Benefit

Fragility fracture means a fracture from minor trauma or everyday activity. The Chinese Medical Association 2017 guideline lists three groups for treatment: prior fragility fracture of spine or hip; bone density T-score −2.5 or lower regardless of prior fracture; or low bone mass plus fragility fracture of wrist, upper arm, or pelvis, or high calculated fracture risk. The guideline states: "There is currently insufficient evidence that calcium supplementation alone can replace other anti-osteoporosis drug therapy." Cochrane's 2025 update on alendronate in postmenopausal women with osteoporosis or prior fracture found hip fractures about 51% lower in the treated group (RR 0.49, 95% CI 0.25 to 0.96) and symptomatic vertebral fractures about 55% lower (RR 0.45, 95% CI 0.28 to 0.73). The HORIZON trial enrolled 2,127 people mean age 74.5 after hip-fracture surgery; yearly zoledronic acid starting within 90 days post-op, median follow-up 1.9 years. New fractures fell from 13.9% to 8.6% (about 35% relative reduction). Death fell from 13.3% to 9.6% (about 28% relative reduction). The guideline notes about 20% of people die from complications within one year after hip fracture. In the 2017–2018 national survey, only 1.4% of women and 0.3% of men with diagnosed osteoporosis or prior fracture were on medication (China).

Note

Controversy: A meta-analysis of 38 trials did not show these drugs lowering overall mortality (RR 0.98, 95% CI 0.91 to 1.05). Zoledronic acid alone was also not significant (RR 0.88, 95% CI 0.68 to 1.13). The authors concluded these drugs should be used to prevent fractures, not to cut death rates. Cochrane rated those fracture estimates low to moderate certainty. In women without prior fracture and lower risk, alendronate did not clearly reduce hip fractures (RR 0.76, 95% CI 0.43 to 1.32). Rare harms such as jaw osteonecrosis and atypical femur fracture may not show up in trials of a few years—keep follow-up visits and do not change dose on your own. Injection versus pills depends on the doctor. How to find osteoporosis is item 39 (bone density testing). Primary beneficiaries are you and your parents.

Official safety standards require ice to be at least 15 cm (6 inches) thick before adults can safely skate on it. Guidelines in the United States and Canada set a baseline of 10 cm (4 inches) for walking or ice fishing, but that applies strictly to clear, newly formed blue ice. White snow ice is only about half as strong and requires double the thickness. On the same body of water, ice can measure a foot thick in one spot and only an inch or two just steps away, so you must measure continuously as you move.

Cost

The most cost-effective option is to use managed, regulated ice rinks, which incurs no extra outdoor gear cost. If you must venture onto natural outdoor ice, carry an ice auger or chisel to measure thickness, along with a pair of chest-mounted ice rescue picks (safety spikes with handles). These cost under $15–$30. Measuring every few paces as you advance requires some extra time.

Benefit

Official meteorological and water safety guidance states that ice must reach 15 cm in thickness before an adult can safely walk or skate on it, and outdoor municipal rinks are generally not cleared for public use below this threshold. Regulated natural rinks typically require a sustained thickness of 15 cm following a full week of continuous sub-zero temperatures (-8°C to 1°C) with low winds before opening. Natural outdoor ice frequently harbors holes drilled by ice anglers, which refreeze poorly and create persistent weak structural points. The Minnesota Department of Natural Resources (DNR) safety guidelines specify that for newly formed, clear ice: stay off if under 4 inches (10 cm); 4 inches is the minimum safe threshold for walking and ice fishing. White ice formed by melted and refrozen snow carries only about half the load-bearing strength of clear ice, requiring twice the thickness. Furthermore, ice thickness varies dramatically across a single water body—it may measure twelve inches in one area and barely one or two inches just a few feet away. Ice over moving water (streams, rivers, beneath bridges, and around culverts) is notoriously hazardous and unpredictable, and shoreline ice is often thinner than open areas. The U.S. National Weather Service sets identical thresholds: under 4 inches is unsafe for walking, fishing, or skating. The Canadian Centre for Occupational Health and Safety (CCOHS), citing Canadian Red Cross recommendations, advises a minimum of 15 cm for small groups walking or skating, and 20 cm for larger group skating gatherings. These benchmarks represent standardized physical safety engineering guidelines rather than empirical epidemiological cohorts.

Note

Official safety agencies emphasize that no outdoor natural ice is 100% safe. Meeting minimum thickness is merely a baseline qualification, never a guarantee. The early winter freeze-up and early spring thaw are the most dangerous periods. If you fall through, do not strip off your clothes: trapped air inside winter clothing provides crucial temporary buoyancy. Turn immediately toward the direction you came from, as that ice was solid enough to hold you moments earlier. Place your forearms on the ice shelf, drive your rescue ice picks into the surface, kick your legs horizontally behind you, and pull yourself out. Once out, do not stand immediately—roll horizontally away from the hole until you reach safe ground, then seek warm shelter immediately. If you witness someone else fall through, never run across the ice to grab them: follow emergency rescue protocol (shout for help, call emergency services, extend a pole, or throw a rope from a safe distance), as detailed in Chapter 13, Rule 25. Primary beneficiaries are yourself and children you accompany outdoors.

Angle grinders spin at extreme speeds (over 10,000 RPM). If an abrasive disc shatters, fragments fly out at ballistic velocity, and mounting a toothed woodworking blade causes violent, sudden kickbacks. Multiple fatal occupational accidents have documented workers mounting saw blades without guards: one severed a femoral artery, another severed a carotid artery, and neither survived. Safety guards, dual-layer eye/face protection, and a two-handed grip cost very little but prevent fatal injuries.

Cost

A pair of impact-rated safety goggles and a full-face shield cost $15–$30. Checking the guard and disc before powering on, and unplugging the tool before changing discs, takes one or two extra minutes. The primary friction is resisting the temptation to remove the protective guard or operate the tool one-handed for convenience.

Benefit

Safety directives from the Canadian Centre for Occupational Health and Safety (CCOHS) and Workplace Health and Safety Queensland specify clear operating standards: inspect the protective guard and abrasive disc prior to operation; never use discs that are cracked, chipped, or warped. The maximum rated RPM marked on the disc must never be lower than the grinder's spindle speed. Ensure arbor size and disc diameter match manufacturer specifications precisely. Disconnect power before changing discs. Clamp workpieces securely before grinding or cutting. Wear safety glasses or goggles beneath a full-face shield. Maintain a balanced stance with both hands on the tool handles. Never use cutting discs for side-grinding, which causes structural disc failure. Do not put the tool down until the disc has come to a complete stop. Direct sparks and debris away from people and combustible materials. Queensland workplace alerts note that disc edge velocity typically reaches 70 meters per second; fitting a larger 356 mm disc onto a 230 mm tool elevates edge speed beyond 120 m/s, rapidly causing explosive disintegration. In February 2016, an Australian worker using a 230 mm angle grinder was fatally injured when projectile disc fragments penetrated his chest. Formal accident investigations in other jurisdictions record similar fatalities: in 2019, a worker in Harbin fitted a toothed circular saw blade without a guard onto an angle grinder to cut wood; the blade caught his trousers, severed his femoral artery, and caused fatal blood loss before medical aid arrived. In 2024, a renovator in Shenzhen fitted a toothed woodworking saw blade without a guard or auxiliary handle to cut a doorframe; the tool kicked back violently, severing his carotid artery and causing instant death. National and international safety standards (including GB 3883.3 and equivalent ISO/IEC norms) strictly prohibit mounting saw chains, wood-carving blades, or toothed saw blades to handheld grinders. Emergency department injury surveillance in South Korea between 2011 and 2018 tracked 8,697 injuries from high-speed rotating tools, with 4,603 cases caused by grinders: 46.4% sustained hand injuries and 23.0% suffered head/facial trauma. Compared to other rotating tools, angle grinders carried over twice the odds of severe injury (OR 2.07, 95% CI 1.88–2.29). In a hospital study of 36 patients with ocular grinder trauma, 10 sustained permanent post-surgical visual acuity below 0.05 (legal blindness). An orthopedic study of 742 acute forearm and hand injuries in Turkey found angle grinders responsible for 82 cases, of which 44% occurred among retirees doing DIY home repairs. A Japanese trauma series of 15 grinder injuries found 9 were caused by improper attachments such as woodworking blades, resulting in complete finger amputations.

Note

Grade C is assigned because protocols derive from safety engineering standards and forensic accident investigations rather than randomized controlled trials. Outcomes range from fatal arterial exsanguination to permanent blindness and traumatic limb amputations, exclusively concentrated among grinder operators. Manufacturers explicitly warn against attaching toothed saw blades; woodworking should strictly utilize purpose-built tools such as hand saws, jigsaws, or circular saws with appropriate guards. Ensure loose clothing, jewelry, and long hair are tied back to prevent entanglement. Grinding generates significant airborne particulates and hazardous noise; respiratory and hearing protection standards are detailed in Chapter 19, Rule 10. In the event of acute arterial laceration, immediately apply direct, continuous, heavy manual pressure, as described in Chapter 13, Rule 12. Primary beneficiaries are yourself and bystanders assisting with home renovation.

The widespread fear that asking someone about suicide puts the idea in their head is directly refuted by scientific evidence. In randomized trials where high school students were asked detailed questions about suicidal ideation, participants experienced no increase in distress and no rise in suicidal thoughts compared to unasked peers. In fact, students with existing depressive symptoms reported less distress, and those with previous suicide attempts experienced a measurable decrease in suicidal ideation.

Cost

Zero financial cost. Asking takes seconds, followed by taking time to listen attentively without judgment. The primary difficulty is psychological hesitation, as many people fear that mentioning suicide will introduce the thought into someone's mind.

Benefit

In a randomized controlled trial published in JAMA involving 2,342 students across six New York high schools, classrooms were randomly assigned to complete a survey that either included or omitted explicit questions regarding suicidal ideation. Immediately following the survey and at two-day follow-up, emotional distress levels showed no statistically significant difference between groups (P = .66 and P = .41). Two days later, reported suicidal ideation was 4.7% in the surveyed group versus 3.9% in the unasked group—a statistically indistinguishable difference (P = .49). Crucially, students who were already experiencing depressive symptoms experienced significantly lower distress after being asked (P = .01), and individuals with prior suicide attempts showed a significant reduction in subsequent suicidal thoughts (P = .02). A 2022 systematic review and meta-analysis evaluating 17 studies pooled 8 comparative trials of asked versus unasked participants: screening or directly inquiring about suicide did not produce any significant increase in immediate or subsequent suicidal ideation, suicide attempts, non-suicidal self-injury, or psychological distress. Across 8 randomized controlled trials evaluated, risk of bias was low or unclear. An earlier 2014 systematic review in Psychological Medicine arrived at identical conclusions: zero identified studies demonstrated an increase in suicidal ideation following direct questioning.

Note

Grade B is assigned because while trials conclusively prove that direct inquiry causes no harm, trials cannot ethically measure reductions in completed suicides. Benefit magnitude is rated Low because it reflects surrogate endpoints (ideation frequency rather than absolute mortality counts). Most trial protocols utilized clinical interviews or standardized screening questionnaires rather than informal peer conversations, though clinical guidelines generalize this finding to friends and family. If someone confirms they are having suicidal thoughts, do not leave them unattended: stay with them, connect them immediately to a crisis helpline (such as 988 in the US/Canada or 12356/111 nationally), and remove access to lethal means (medications, sharp objects, chemicals), as outlined in Chapter 1, Rule 25. If they express intent to harm others or have active preparations underway, immediate emergency services or hospital evaluation is necessary, as described in Chapter 8, Rule 15. The interval between acute ideation and action is often mere minutes, as noted in Chapter 1, Rule 32. Primary beneficiaries are family members, partners, friends, and colleagues.

Atrial fibrillation (AFib) causes the heart's upper chambers to beat chaotically, allowing blood to pool and form clots; if a clot travels to the brain, it triggers a devastating ischemic stroke. Taking doctor-prescribed anticoagulants reduces the risk of stroke by roughly 60% and lowers overall mortality by about 30%. Antiplatelet drugs like aspirin reduce stroke risk by only about 20% and cannot serve as an effective substitute. In national surveys, only a tiny fraction of high-risk patients with AFib were taking anticoagulants.

Cost

A standard ECG costs just a few dozen yuan (under $10). Warfarin is inexpensive but requires regular blood tests (INR monitoring) to adjust the dosage. Newer direct oral anticoagulants (DOACs) do not require routine blood monitoring but are more expensive. The primary challenge is maintaining daily adherence even in the absence of symptoms, and remembering to inform dentists and surgeons that you take anticoagulants before any invasive procedure.

Benefit

AFib causes chaotic atrial quivering, leading to blood stasis and thrombus formation. The most common symptoms are palpitations, exertional fatigue, and chest discomfort, though approximately 25% of individuals report no noticeable symptoms. A single-lead ECG recording lasting >=30 seconds or a standard 12-lead ECG lasting >=10 seconds provides definitive diagnosis. A 2007 meta-analysis pooled 29 randomized controlled trials with 28,044 participants: compared to control/placebo, dose-adjusted warfarin reduced stroke by 64% (95% CI 49%–74%), whereas antiplatelet therapy (such as aspirin) reduced stroke by only 22% (95% CI 6%–35%). In direct head-to-head trials, warfarin reduced stroke by an additional 39% compared to antiplatelets. Absolute increase in major extracranial hemorrhage was under 0.3% per year. A Cochrane review evaluating 2,313 individuals with no prior stroke found warfarin lowered all-cause mortality by roughly 30% (OR 0.69, 95% CI 0.50–0.94). Four landmark trials totaling 71,683 patients comparing direct oral anticoagulants (DOACs) to warfarin demonstrated DOACs further reduced stroke and systemic embolism by 19% (RR 0.81, 95% CI 0.73–0.90) and all-cause mortality by 10% (RR 0.90, 95% CI 0.85–0.95), with a 52% reduction in intracranial hemorrhage (RR 0.48), despite a 25% increase in gastrointestinal bleeding (RR 1.25). Aspirin cannot replace anticoagulation: in 5,599 patients unsuitable for warfarin, apixaban reduced stroke and systemic embolism by 55% compared to aspirin (HR 0.45, 95% CI 0.32–0.62) with no significant difference in major bleeding (1.4% vs 1.2% per year; HR 1.13, 95% CI 0.74–1.75). In the BAFTA trial of 973 seniors aged >=75, warfarin reduced fatal or disabling stroke, intracranial hemorrhage, or arterial embolism by 52% compared to aspirin (RR 0.48, 95% CI 0.28–0.80) with similar extracranial bleeding (1.4% vs 1.6% per year). Chinese 2023 AFib guidelines utilize the CHA2DS2-VASc-60 score (congestive heart failure, hypertension, age >=65 [2 points], diabetes, prior stroke/TIA [2 points], vascular disease, age 60–64, female sex [1 point each]): oral anticoagulation is strongly recommended for males with score >=2 and females with score >=3, and considered for males with score 1 and females with score 2 after weighing bleeding risk. Guidelines explicitly advise against antiplatelet monotherapy for AFib stroke prevention. ACC/AHA 2023 guidelines emphasize anticoagulation decisions depend on thromboembolic risk, regardless of whether AFib is paroxysmal, persistent, or permanent, and bleeding scores should be used to address modifiable bleeding risks rather than inappropriately withhold anticoagulation. National epidemiological surveys (2014–2016) in China of adults aged >=45 found an AFib prevalence of 1.8% (~7.9 million individuals), with awareness at 78.3% in urban areas but only 35.3% in rural areas; among high-risk patients, only 6.0% were receiving anticoagulation. A 2020–2021 nationwide survey found 43.8% of identified AFib cases were newly detected, and among previously diagnosed individuals, only 32.1% were using anticoagulants (19.8% in rural areas).

Note

Controverted in terms of asymptomatic population screening, though anticoagulation following diagnosis is undisputed. Evidence remains insufficient regarding whether asymptomatic individuals should undergo targeted mass screening. The USPSTF (2022) concluded evidence is insufficient to assess the balance of benefits and harms of routine screening. The Swedish STROKESTOP trial in 75–76 year-olds found a modest 4% composite reduction in stroke, mortality, and severe bleed after ~7 years, just reaching statistical significance. The Danish LOOP study in 70–90 year-olds with implantable loop recorders detected AFib in 31.8% vs 12.2%, yet saw no significant difference in stroke rates. Chinese 2023 guidelines suggest pulse palpation or opportunistic ECG during routine clinic visits for seniors aged >=65. Thus, individuals with symptoms must be evaluated, and seniors aged >=65 should ask their doctor to check their pulse during visits, but buying dedicated commercial consumer screening monitors is unnecessary. Once on anticoagulants, do not self-administer NSAIDs like ibuprofen without medical supervision, as noted in Chapter 34, Rule 3. Anticoagulants must be taken long-term; never stop them simply because you feel fine, as described in Chapter 16, Rule 1. Hypertension is also a key risk factor, as detailed in Chapter 1, Rule 7. Individuals with AFib do not necessarily need to eliminate coffee, as discussed in Chapter 2, Rule 26. If sudden facial drooping or unilateral limb weakness develops, call emergency services immediately regardless of medication status, as detailed in Chapter 13, Rule 3. Primary beneficiaries are yourself and elderly family members.

Hepatitis C virus (HCV) can silently damage the liver for decades without causing any symptoms; a simple antibody blood test, followed by an RNA test if positive, establishes the diagnosis. For those with active infection, an 8- to 12-week course of oral antivirals clears the virus in over 95% of cases. Achieving viral clearance cuts subsequent overall mortality risk by roughly 60% and liver cancer risk by around 70%. In China, national price negotiations incorporated these therapies into basic health insurance in 2019, slashing medication costs by over 85%.

Cost

An anti-HCV antibody blood test costs a few dozen yuan ($5–$15) out of pocket. If positive, a follow-up HCV RNA PCR test determines active viral infection. Confirmed patients obtain prescribed direct-acting antivirals (DAAs) at designated infectious disease clinics; most regimens consist of one tablet daily for 8 to 12 weeks, with medication costs largely covered by national health insurance. The primary challenge is that asymptomatic individuals rarely think to get tested.

Benefit

Hepatitis C is a blood-borne viral infection with no preventive vaccine. The World Health Organization (WHO) notes that chronic hepatitis C typically remains asymptomatic for decades, often discovered only after severe liver fibrosis or cirrhosis develops. Antibody positivity reflects past exposure; an HCV RNA test is required to confirm whether active infection is present. Approximately 30% of infected individuals clear the virus spontaneously within 6 months without treatment. WHO states that direct-acting antivirals (DAAs) taken orally for 8 to 12 weeks cure almost all treated patients. An evidence review conducted for the USPSTF pooled 49 treatment trials: sustained virologic response (SVR, defined as undetectable HCV RNA 12 weeks post-treatment) exceeded 95% across all genotypes, with serious adverse events occurring in only 1.9% and discontinuation due to adverse effects in 0.4%. Pooling 13 observational cohort studies, achieving SVR was associated with a 60% reduction in all-cause mortality (adjusted HR 0.40, 95% CI 0.28–0.56) and a 71% reduction in hepatocellular carcinoma (adjusted HR 0.29, 95% CI 0.23–0.38 across 20 cohorts). In a French prospective cohort of 9,895 chronic HCV patients tracked for a median of 33.4 months, DAA therapy was associated with a 52% decrease in all-cause mortality (HR 0.48, 95% CI 0.33–0.70) and a 34% reduction in hepatocellular carcinoma (HR 0.66, 95% CI 0.46–0.93) after adjusting for age, fibrosis stage, and alcohol consumption. Among 15,059 U.S. veterans with advanced liver disease treated with DAAs (mean follow-up 1.6 years), mortality was 2.6 deaths per 100 person-years in those achieving SVR versus 12.3 in those who did not, representing a 74% reduction in risk (adjusted HR 0.26, 95% CI 0.22–0.31). The USPSTF (2020) recommends screening all adults aged 18 to 79 (Grade B), with a single lifetime screen sufficient for most people. Chinese 2022 guidelines recommend universal screening for all adults, regular screening for high-risk populations, and immediate RNA testing for all antibody-positive individuals. A 2006 national survey in China found an anti-HCV seroprevalence of 0.43% among ages 1–59; meta-analyses estimated 0.60% in the general population, 48.67% among people who inject drugs, and 6.59% among hemodialysis patients. China's National Healthcare Security Administration reported that before negotiation, full DAA treatment courses often exceeded 50,000 RMB; the 2019 national insurance catalog inclusion lowered prices by over 85%.

Note

Controverted by Cochrane (2017), which restricts its evaluation strictly to randomized trials; finding that 138 trials were mostly short-term and assessed surrogate virologic clearance rather than clinical morbidities or long-term mortality, Cochrane asserted that whether SVR translates to reduced mortality has not yet been directly demonstrated in randomized controlled trials. Mortality and liver cancer data presented above originate from extensive prospective longitudinal observational cohorts. No trials directly randomize patients to screening versus no screening. High-risk populations designated for screening include individuals undergoing major surgery, blood transfusion, endoscopy, or hemodialysis; those with unexplained liver enzyme elevations; individuals with a history of intravenous drug use, paid plasma donation, multiple sexual partners, or men who have sex with men; people living with HIV; and regular sexual partners of HCV-infected individuals. In China, many chronic cases trace back to transfusions or plasma donations prior to 1993. Transmission can also occur through unsterilized tattooing, ear piercing, or shared razors and toothbrushes; casual contact (hugging, sharing utensils or cups) does not spread HCV. After successful treatment, antibody tests remain positive for life; RNA testing is required to verify cure or identify re-infection. Successful cure does not confer immunity against re-infection; active injection drug users should undergo annual RNA testing. If discovered during pregnancy, curative treatment is deferred until after delivery and cessation of breastfeeding; strict contraception is required during treatment. Patients with established cirrhosis require ongoing ultrasound surveillance for hepatocellular carcinoma even after viral clearance. Avoiding shared needles is detailed in Chapter 1, Rule 30. Hepatitis B requires a separate diagnostic panel, described in Chapter 1, Rule 14. HIV screening is discussed in Chapter 1, Rule 31. Guidelines caution that combining chronic HCV with excessive alcohol markedly accelerates progression to hepatic failure; alcohol limitations are detailed in Chapter 2, Rule 19. Primary beneficiaries are yourself, your spouse, and intimate partners.

Septic tanks, manholes, cesspools, and sealed vegetable cellars accumulate lethal concentrations of toxic gases (like hydrogen sulfide) and suffer severe oxygen deficiency, knocking an entrant unconscious within seconds. Across official industrial accident registries, a single worker collapses, and coworkers or relatives rush in consecutively to rescue them, only to die alongside them. Official statistics show over half of all confined space fatalities are would-be rescuers. If someone collapses inside, never enter: call emergency dispatch (such as 119 and 120) immediately.

Cost

Zero financial cost. Opening all covers and ventilation shafts and waiting upwind takes some extra time. Household septic tanks are safest when emptied by licensed professional service teams with proper equipment. The main difficulty is overcoming the instinct to rush in when a companion or family member collapses.

Benefit

A "confined space" refers to enclosed or partially enclosed spaces not designed for continuous human occupancy, including septic tanks, sewage pits, manholes, storage cellars, and industrial vats. An analysis by the Ministry of Emergency Management of China of major confined space accidents since 2013 showed that poisoning and asphyxiation accounted for 96.8% of accidents and 96.9% of fatalities, driven primarily by hydrogen sulfide, carbon monoxide, nitrogen, and carbon dioxide. Accidents involving blind, unequipped rescue attempts accounted for 87.4% of incidents and 86.8% of deaths. The Ministry's 2020 Safety Guidance Manual highlighted that nearly 80% of confined space disasters saw casualties escalate due to impromptu, unprotected rescue attempts, and over 50% of total fatalities were would-be rescuers. In 2018, the State Council Work Safety Committee reported eight separate confined space incidents that initially involved only one worker in distress, but due to successive unequipped rescue entries, resulted in 3 to 4 deaths each. In 2019, during a sewage pit cleaning at a paper mill in Dongguan, three workers collapsed from hydrogen sulfide; six workers entered consecutively to attempt a rescue, resulting in seven deaths. In 2020 at a noodle manufacturing plant in Jiaozuo, one worker fell into a fermentation tank; five coworkers rushed in to assist, resulting in six deaths. The U.S. National Institute for Occupational Safety and Health (NIOSH) investigated 70 fatal confined space incidents between 1983 and 1993 involving 109 deaths: 39 victims (36%) entered specifically to rescue others, and only 4 of those 39 were trained emergency personnel. A 1986 NIOSH alert estimated that approximately 60% of confined space fatalities were would-be rescuers. Safety manuals explain that while hydrogen sulfide smells like rotten eggs at low levels, high concentrations rapidly cause olfactory paralysis—the human nose completely loses the ability to smell it. Concentrations exceeding 1,000 mg/m³ cause instantaneous "knockdown" and death within seconds. Similarly, extreme carbon dioxide concentrations induce loss of consciousness in seconds. Emergency guidelines strictly mandate: if local personnel lack breathing apparatus and retrieval gear, immediately call 119/120; "under no circumstances should forced entry be attempted." Rescuing an occupant from the outside requires that the entrant was already wearing a full-body harness attached to an external retrieval winch line. Ministerial Order No. 13 mandates that industrial work strictly follow the rule: "ventilate first, test next, enter last." Unventilated subterranean vegetable cellars also pose acute asphyxiation risks because stored root vegetables consume oxygen and release dense carbon dioxide; authorities advise opening all cellar hatches for prolonged natural ventilation, testing air, wearing safety ropes, and maintaining surface observers before entry.

Note

Grade C is assigned because data stem from occupational casualty registries and safety engineering codes rather than clinical intervention trials. Benefit magnitude is rated Moderate: while the event outcome is frequently fatal (often taking multiple lives at once), exposure is concentrated among individuals who access these subterranean structures. Common domestic encounters include cleaning septic or biogas tanks and descending into winter vegetable storage cellars. Never rely on smell to judge atmospheric safety; absence of odor does not mean toxic gas is absent. If assigned by an employer to enter shafts or tanks without mechanical ventilation, gas testing equipment, continuous surface monitoring, or safety harnesses, workers have the statutory right to refuse, as detailed in Chapter 19, Rule 10. If someone collapses inside, shout for help and dial emergency dispatch (119 and 120); external actions are limited to removing covers and using fans or blowers from outside. Once an unconscious victim is extracted to fresh air, check for breathing and initiate chest compressions if breathing is absent, as outlined in Chapter 13, Rule 1. The protocol remains identical whether the victim is a coworker, neighbor, or stranger, adhering to the same safety boundary as Chapter 13, Rule 25 (do not jump into water if you see someone drowning). Carbon monoxide risks from indoor fuel burning are covered in Chapter 1, Rule 3. Primary beneficiaries are yourself (as the prospective rescuer) and coworkers or family members.

For individuals aged 45 and older in high-risk categories for gastric or esophageal cancers, undergoing gastroscopy is associated with a roughly 50% lower mortality from these cancers in observational studies. However, people who proactively schedule screenings generally maintain healthier lifestyles, which inflates observational estimates; in rigorous randomized community trials, the reduction in esophageal cancer mortality was approximately 20%, falling within the margin of error. Clinical guidelines advise against routine gastroscopy for average-risk individuals outside high-risk groups.

Cost

A standard diagnostic gastroscopy costs a few hundred yuan ($40–$80); painless gastroscopy with sedation adds several hundred yuan, varying by region. Patients must fast overnight, occupying half a day. Sedated procedures require an accompanying adult. The primary physical discomfort is the passing of the endoscope through the throat during unsedated procedures.

Benefit

The 2024 screening protocols issued by the National Health Commission of China define high-risk criteria starting at age 45 with any of the following: (1) residence in high-incidence counties (age-standardized incidence >20 per 100,000 for gastric cancer, or >15 per 100,000 for esophageal cancer); (2) first-degree family history (parents, offspring, siblings) of upper GI cancer; (3) Helicobacter pylori infection (specifically for gastric cancer); (4) lifestyle risks (smoking, heavy alcohol intake, high-salt diet, preserved/pickled foods, or frequent consumption of scalding food/beverages); or (5) personal history of premalignant lesions (atrophic gastritis, gastric ulcers, gastric polyps, Barrett's esophagus, or reflux esophagitis). Screening is recommended between ages 45 and 74, using endoscopy as the primary modality, generally performed every 5 years. The 2022 national guidelines explicitly advise against population screening outside high-risk groups. A population-based cohort study across six high-incidence regions in China tracked ~637,500 individuals aged 40–69: those undergoing a single endoscopic screen had a 57% lower risk of upper GI cancer mortality compared to uninvited controls (unadjusted RR 0.43, 95% CI 0.40–0.47) and a 23% lower cancer incidence (RR 0.77). Screening uptake was 33.53%; on an intention-to-treat basis across the entire invited population, mortality decreased by 31% (RR 0.69, 95% CI 0.66–0.72). In a 10-year non-randomized village screening study in a high-incidence esophageal cancer region, cumulative esophageal squamous cell carcinoma mortality was 3.35% in the screened cohort versus 5.05% in the control cohort. In the Korean National Cancer Screening Program, undergoing endoscopy was associated with a 47% reduction in gastric cancer mortality (adjusted OR 0.53, 95% CI 0.51–0.56), whereas upper GI barium series showed no significant benefit (OR 0.98); protection increased with frequent screening. A meta-analysis pooling 10 Asian studies found endoscopic screening was associated with a 40% reduction in gastric cancer mortality (RR 0.60, 95% CI 0.49–0.73), without significant change in cancer incidence. In northern China, the ESECC cluster-randomized trial enrolled 33,800 participants aged 45–69 across villages followed for 9 years: esophageal cancer mortality in the screening group was 18% lower (HR 0.82, 95% CI 0.53–1.26), which did not reach statistical significance, and incidence was 19% lower (HR 0.81, 95% CI 0.60–1.09), also non-significant. A 2023 systematic review and meta-analysis adjusted for healthy screener bias: among individuals who actually received endoscopic screening, gastric cancer mortality was 48% lower (RR 0.52, 95% CI 0.39–0.79), but on an intention-to-screen programmatic basis across all invited individuals, the reduction was non-significant (RR 0.94, 95% CI 0.71–1.28).

Note

Controverted in literature. Most evidence demonstrating mortality reduction stems from observational cohorts comparing volunteers who attend screening against non-participants; self-selected participants tend to have higher health consciousness, exaggerating estimated benefits. The 2023 Lancet Regional Health meta-analysis classified study bias risk as moderate to serious. In the cluster-randomized ESECC trial, 9-year mortality differences did not reach statistical significance. The 2022 national guidelines cite potential harms including overdiagnosis, false positives, missed diagnoses, hemorrhage, perforation, cardiopulmonary complications, aspiration pneumonia, and infection. Overdiagnosis refers to detecting indolent early lesions that would never cause symptoms during a lifetime. For those who cannot tolerate standard endoscopy, clinical protocols specify procedures can be performed under sedation or anesthesia. Individuals aged >=45 with positive Helicobacter pylori are categorized as high gastric cancer risk. Eradication of H. pylori is detailed in Chapter 1, Rule 23, but eradication does not eliminate the need for endoscopic screening—both are required. Upper GI barium swallow, serum pepsinogen alone, tumor biomarker panels, and PET-CT scans are not recommended for screening. Commercial tumor marker panels are reviewed in Chapter 6, Rule 7. Those diagnosed with chronic atrophic gastritis, intestinal metaplasia, or intraepithelial neoplasia require shorter endoscopic surveillance intervals per gastroenterologist guidance. Residents can inquire with local CDCs or county hospitals regarding whether their area qualifies as high-incidence. Anyone already experiencing alarm symptoms like dysphagia, hematemesis, or melena requires urgent diagnostic medical care rather than screening, as outlined in Chapter 34, Rule 6. Avoiding scalding hot tea is detailed in Chapter 2, Rule 30. Primary beneficiaries are yourself and aging parents.

Black fungus and tremella (silver ear) soaked for extended periods, improperly stored fresh wet rice noodles, and home-fermented corn flour products can be contaminated by Burkholderia gladioli pathovar cocovenenans, producing bongkrekic acid—a lethal bacterial toxin. Bongkrekic acid cannot be broken down by 100°C boiling or pressure cooking, and there is no known medical antidote. Across nationwide foodborne outbreak surveillance in China over eleven years, nearly 30% of individuals poisoned by bongkrekic acid died.

Cost

Zero financial cost. Soak only the quantity of wood ear or silver ear needed for a single meal, and discard any leftovers. Buy only enough fresh wet rice noodles for same-day consumption. The primary difficulty is reluctance to discard surplus soaked fungus, and regional culinary habits of preparing homemade fermented cornmeal dishes (such as suantangzi).

Benefit

According to the China National Foodborne Disease Outbreak Surveillance System, between 2010 and 2020, 19 bongkrekic acid poisoning outbreaks were reported, involving 146 illnesses, 139 hospitalizations, and 43 deaths, representing a case-fatality rate of 29.5%. By food category: 9 outbreaks involved homemade fermented corn flour products, causing 33 deaths; 5 outbreaks involved wet rice noodles, causing 7 deaths; and 3 outbreaks involved soaked black fungus, resulting in 5 illnesses and 3 deaths. In 2020 nationwide food poisoning fatalities (143 deaths), bongkrekic acid caused 12 deaths, ranking behind wild poisonous mushrooms (80 deaths) and methanol (14 deaths). Market regulation safety alerts confirm bongkrekic acid is heat-stable and resistant to 100°C boiling and pressure cooking; currently no specific antidote exists. In Guangdong Province, regulatory mandates enacted in 2018 required wet rice noodles to be prepackaged, sealed in small portions, and clearly labeled with expiration dates; post-implementation surveillance showed average annual poisoning cases dropped from 6.25 to 0.5.

Note

In October 2020 in Jidong County, Heilongjiang Province, family members consumed homemade fermented cornmeal noodles (suantangzi) for breakfast; all 9 individuals who ate the food died (100% case-fatality). Dried black fungus requires only 1 to 2 hours of cold-water soaking; market guidelines stipulate soaking should never exceed 8 hours. If soaked fungus feels slimy, loses elasticity, gives off a sour or unpleasant odor, or if soaking water becomes turbid, discard the entire batch immediately. If symptoms like vomiting, dizziness, or profound weakness appear after eating, induce vomiting immediately, preserve remaining food samples, and seek urgent hospital emergency care. Anyone who consumed the same food must undergo medical evaluation even if currently asymptomatic. Wild toxic mushrooms are covered in Chapter 1, Rule 5.