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Chen H, Zhao Y, Huang H, Xing Y, Yin Y, Shan E, Cheng D, Sun Y, Li X. Policy implementation deviation of government purchase of old age care services in Jiangsu, China: based on empirical and policy analysis. Health Res Policy Syst 2024; 22:25. [PMID: 38360665 PMCID: PMC10868005 DOI: 10.1186/s12961-024-01108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Government purchase of social forces to participate in old age care services can release the burden of social care. Current research on performance evaluation in this field mainly focussed on the establishment of appropriate evaluation indices. However, discussion on the policy implementation deviation is scarce. This study aimed to evaluate the performance of China's local government purchase of old age care services, analyse the characteristics of related policies and explore their deviation. METHODS The persons who participated in the Training of the Trainer (ToT) organized by the Red Cross Society were enrolled. The policy documents were obtained from the official websites. The K-means cluster was used to determine the project performance grades. We compared the project performance grades between service objects and undertakers with different characteristics utilizing the non-parametric test. Based on the framework of 'Collaborative Participation - Project Performance Objective', we analysed the content of relevant policy aiding by NVivo 12. RESULTS Data of project performance were collected from 306 participants. The standardized mean score of the efficiency dimension was the lowest (0.70 ± 0.24). The projects were divided into four grades: poor (17.0%), average (27.5%), good (12.4%) and excellent (43.1%). There were statistically significant differences in project performance grades only between advanced ageing groups (Z = 2.429, P = 0.015). As well, the policy also mentioned that the services focus should be tilted towards the oldest old. The purchasers mainly involved the Ministry of Civil Affairs and Health management departments in the policy. Respite services were less mentioned in the responsibilities of the undertakers. The requirement for efficiency and effectiveness was mentioned in less than half of the policy documents. CONCLUSION Policy attention is needed for the responsibilities and functions of the intermediate purchasing force, as well as more precise directions and responsibilities of undertakers. The purchasers and undertakers should improve management abilities and capacity of old age care services and focus on associated factors to achieve the best marginal benefit. In addition, the embedded performance evaluation needs to be updated periodically to bridge the deviation between policy implementation and policy formulation.
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Affiliation(s)
- Hongli Chen
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Hongxin Huang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, 211166, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Enfang Shan
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Daoxiang Cheng
- Red Cross Society of Jiangsu Branch, Nanjing, 210029, China
| | - Yanjian Sun
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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Wang Z, Dong L, Xing X, Liu Z, Zhou Y. Disparity in hospital beds' allocation at the county level in China: an analysis based on a Health Resource Density Index (HRDI) model. BMC Health Serv Res 2023; 23:1293. [PMID: 37996897 PMCID: PMC10668462 DOI: 10.1186/s12913-023-10266-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND As approximately 3/4 of the population lives in county-level divisions in China, the allocation of health resources at the county level will affect the realization of health equity. This study aims to evaluate the disparity in hospital beds at the county level in China, analyze its causes, and discuss measures to optimize the allocation. METHODS Data were drawn from the Chinese County/City Statistical Yearbook (2001-2020). The health resource density index (HRDI) was applied to mediate between the influence of demographic and geographical factors on the allocation of hospital beds. The trends of HRDI allocation were evaluated through the growth incidence curve and the probability density function. The regional disparity in the HRDI was examined through the Lorenz curve, and Dagum Gini coefficient. The contribution of the Gini coefficient and its change were assessed by using the Dagum Gini decomposition method. RESULTS From 2000 to 2019, the number of hospital beds per thousand people at the county level in China increased dramatically by 1.49 times. From the aspect of the HRDI, there were large regional disparities at the national level, with a Gini coefficient of 0.367 in 2019 and in the three subregions. In 2019, the Gini coefficient of the HRDI exhibited regional variations, with the highest value observed in the western region, followed by the central region and the eastern region. Decomposition reveals that the contribution of interregional disparity changed from the dominant factor to the least important factor, accounting for 29.79% of the overall disparity and the contribution of trans-variation intensity increased from 29.19% to 39.75%, whereas the intraregional disparity remained stable at approximately 31% and became the second most important factor. CONCLUSION The regional disparity in hospital beds allocation at the county level in China was large and has not improved substantially. Trans-variation intensity was the main reason for the overall disparity and changes, and the intraregional disparity was more important than the interregional disparity for the overall disparity.
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Affiliation(s)
- Zuobao Wang
- School of Humanities and Law, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, 110169, Liaoning Province, China.
| | - Lin Dong
- School of Humanities and Law, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, 110169, Liaoning Province, China
| | - XinYi Xing
- School of Humanities and Law, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, 110169, Liaoning Province, China
| | - Zhe Liu
- School of Humanities and Law, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, 110169, Liaoning Province, China
| | - Yuxiang Zhou
- School of Humanities and Law, Northeastern University, 195 Chuangxin Road, Hunnan District, Shenyang, 110169, Liaoning Province, China.
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Ye J, He L, Beestrum M. Implications for implementation and adoption of telehealth in developing countries: a systematic review of China's practices and experiences. NPJ Digit Med 2023; 6:174. [PMID: 37723237 PMCID: PMC10507083 DOI: 10.1038/s41746-023-00908-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
The rapid advancement of telehealth technologies has the potential to revolutionize healthcare delivery, especially in developing countries and resource-limited settings. Telehealth played a vital role during the COVID-19 pandemic, supporting numerous healthcare services. We conducted a systematic review to gain insights into the characteristics, barriers, and successful experiences in implementing telehealth during the COVID-19 pandemic in China, a representative of the developing countries. We also provide insights for other developing countries that face similar challenges to developing and using telehealth during or after the pandemic. This systematic review was conducted through searching five prominent databases including PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science. We included studies clearly defining any use of telehealth services in all aspects of health care during the COVID-19 pandemic in China. We mapped the barriers, successful experiences, and recommendations based on the Consolidated Framework for Implementation Research (CFIR). A total of 32 studies met the inclusion criteria. Successfully implementing and adopting telehealth in China during the pandemic necessitates strategic planning across aspects at society level (increasing public awareness and devising appropriate insurance policies), organizational level (training health care professionals, improving workflows, and decentralizing tasks), and technological level (strategic technological infrastructure development and designing inclusive telehealth systems). WeChat, a widely used social networking platform, was the most common platform used for telehealth services. China's practices in addressing the barriers may provide implications and evidence for other developing countries or low-and middle- income countries (LMICs) to implement and adopt telehealth systems.
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Affiliation(s)
- Jiancheng Ye
- Weill Cornell Medicine, New York, NY, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Lu He
- Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Molly Beestrum
- Galter Health Sciences Library and Learning Center, Northwestern University, Chicago, IL, USA
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Guo J, Shan S, Ali Khan Y. What are the impetuses Behind E-health applications' self-management services' ongoing adoption by health community participants? Health Informatics J 2023; 29:14604582231152801. [PMID: 36648056 DOI: 10.1177/14604582231152801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Over the past 20 years, the identification of interventions related to healthcare management has been greatly facilitated by improvements in the well-being and health of the entire population. However, regardless of the positive developments in smart health applications and e-health research, there are two important gaps, (1) the role of gamification variables in the continued use of eHealth applications has not been adequately assessed, and (2) the extent to which people's perception of the continued use of e-health applications is encouraged through habit. Customers and companies can derive considerable value from exploring E-Health applications' health self-management services. Accordingly, estimating such services' ongoing adoption by customers is aimed for in this research, with habits, intrinsic and extrinsic variables incorporated into a study model which is then tested. This paper examined perceived autonomy, perceived competence, perceived relatedness has positively related to enjoyment and habit. Reward has positively related to perceived autonomy and continued to use. Enjoyment and Habit have positively associated with the decision to continue to use in e-Health Apps. 269 individuals who have used Chinese e-health applications comprised the data collection sample, being reached via an online questionnaire. Data analysis was undertaken using Partial Least Squares Structural Equation Modelling (PLS-SEM). It was found that the ongoing adoption of e-health self-management services was perpetuated to a greater extent by intrinsic variables; in terms of strategizing for companies' e-services, the results can inform this process.
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Affiliation(s)
- Jin Guo
- Department of Management, Lincoln International Business School, 4547University of Lincoln, UK
| | - Shan Shan
- Business Analytics and Decision Making, 2706Coventry University, UK
| | - Yousaf Ali Khan
- Department of Mathematics and Statistics, 66934Hazara University, Pakistan
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Tian W, Wu B, Yang Y, Lai Y, Miao W, Zhang X, Zhang C, Xia Q, Shan L, Yang H, Yang H, Huang Z, Li Y, Zhang Y, Ding F, Tian Y, Li H, Liu X, Li Y, Wu Q. Degree of protection provided by poverty alleviation policies for the middle-aged and older in China: evaluation of effectiveness of medical insurance system tools and vulnerable target recognition. Health Res Policy Syst 2022; 20:129. [DOI: 10.1186/s12961-022-00929-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
China’s medical insurance schemes and poverty alleviation policy at this stage have achieved population-wide coverage and the system's universal function. At the late stage of the elimination of absolute poverty task, how to further exert the poverty alleviation function of the medical insurance schemes has become an important agenda for targeted poverty alleviation. To analyse the risk of catastrophic health expenditure (CHE) occurrence in middle-aged and older adults with vulnerability characteristics from the perspectives of social, regional, disease, health service utilization and medical insurance schemes.
Methods
We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database and came up with 9190 samples. The method for calculating the CHE was adopted from WHO. Logistic regression was used to determine the different characteristics of middle-aged and older adults with a high probability of incurring CHE.
Results
The overall regional poverty rate and incidence of CHE were similar in the east, central and west, but with significant differences among provinces. The population insured by the urban and rural integrated medical insurance (URRMI) had the highest incidence of CHE (21.17%) and health expenditure burden (22.77%) among the insured population. Integration of Medicare as a medical insurance scheme with broader benefit coverage did not have a significant effect on the incidence of CHE in middle-aged and older people with vulnerability characteristics.
Conclusions
Based on the perspective of Medicare improvement, we conducted an in-depth exploration of the synergistic effect of medical insurance and the poverty alleviation system in reducing poverty, and we hope that through comprehensive strategic adjustments and multidimensional system cooperation, we can lift the vulnerable middle-aged and older adults out of poverty.
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Qiao L, Liu X, Shang J, Zuo W, Xu T, Qu J, Jiang J, Zhang B, Zhang S. Evaluating the national system for rare diseases in China from the point of drug access: progress and challenges. Orphanet J Rare Dis 2022; 17:352. [PMID: 36088349 PMCID: PMC9463840 DOI: 10.1186/s13023-022-02507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are about 7000 rare diseases worldwide, of which only 5% of the diseases can be treated with medicines, showing that it’s important to improve patient access to orphan drugs. Recently, China has actively worked to set up a national system for rare diseases to improve the diagnosis and treatment capabilities and ensure the accessibility of drugs. However, the benefits of the system have yet not to be measured. This study aimed to provide an overview of orphan drug access based on the Compendium of China’s First List of Rare Diseases and National Network to Collaborate on Diagnosis and Treatment of Rare Diseases, expecting to map a blueprint for orphan drug access in China. Methods Framework of China’s national system for rare diseases was summarized. We surveyed the availability and affordability of 79 approved orphan drugs based on the Compendium of China’s First List of Rare Diseases in 30 leading provincial institutions from 2017 to 2020. The availability was measured annually at 3 levels (market, hospital and drug), and affordability was reflected by comparing costs of daily defined dose with per capita income of urban and rural residents, with the National Basic Medical Insurance considered. Results The market availability of orphan drugs in China showed an upward trend. As of 2020, the median hospital-level availability was 41.1% (increased by 1.5 times), highly available drugs increased by 16.5%. There were 64/74 orphan drugs that were affordable to rural/urban residents with the National Basic Medical Insurance considered (an increase of 14.1%), and the urban–rural gap of affordability ratio was narrowed (down by 6.0%). Comprehensive analysis showed the proportions of drugs with better availability and affordability in urban and rural areas by 2020 were 39.4% and 32.3%, respectively, which had increased but were still at a low level. Conclusions China’s national system for rare diseases has made great progress in orphan drug access, indicating that it’s been functioning under the joint reformation of medical treatment, medical insurance and medicines supply. The list of rare diseases will be updated and collaboration in networks will be enhanced to further improve the system. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02507-2.
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Does Food Insecurity in Early Life Make People More Depressed?—Evidence from CHARLS. SUSTAINABILITY 2022. [DOI: 10.3390/su14137990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Based on the China Health and Retirement Longitudinal Study (CHARLS) data, this paper estimates the long-term association between food insecurity and later adult health and health behaviors with the Probit model. The results show that food insecurity in early life significantly increases adults’ depression likelihood (measured by the CES-D scale). The food insecurity experience is also negatively and significantly associated with individual self-rated health status, memory, sleep quality, and life satisfaction. The negative association between food insecurity and cognitive ability and sleep hours is larger for females.
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8
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Wang C, Cui W. Supervision for the Public Health Services for Older Adults Under the Background of Government Purchasing: An Evolutionary Game Analysis Framework. Front Public Health 2022; 10:881330. [PMID: 35651859 PMCID: PMC9149156 DOI: 10.3389/fpubh.2022.881330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
As an important measure to involve services for older adults, the government procurement practices have become a key link for public health services. However, the information asymmetry between public health service purchasers and public health service undertakers triggers a supervision dilemma. Based on this background, this study uses the evolutionary game theory to analyze the symbiotic evolution between local governments and public health service institutions under different reward and punishment mechanisms, explore game evolution, strategy adjustment, and influencing factors of different game subjects, and analyze the necessity and appropriate intensity of dynamic rewards and punishment mechanisms. The results show that: under the static condition, the penalty can change the strategies of local governments to a certain extent, but it is still difficult to achieve complete self-discipline management of public health service institutions. If local governments implement a dynamic reward or penalty mechanism in the supervision process of public health services for older adults, the equilibrium between them tends to be evolutionary stable. For three dynamic mechanisms, a dynamic reward mechanism is more conducive to adopting a self-discipline behavior of public health service institutions, which is helpful to realize the supervision of public health services for older adults. Also, there is a positive correlation between the proportion of public health service institutions who adopt a "self-discipline behavior" strategy and the maximum punishment intensity, and a negative correlation with the reward intensity. This study provides theoretical and decision-making references for governments to explore the promotion and implementation of public health services in older adults.
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Affiliation(s)
- Canyou Wang
- School of Humanities, Chang'an University, Xi'an, China.,Shaanxi Provincial Public Science Literacy and Public Policy Research Center, Chang'an University, Xi'an, China
| | - Weifang Cui
- School of Humanities, Chang'an University, Xi'an, China
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9
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Adua E, Afrifa-Yamoah E, Frimpong K, Adama E, Karthigesu SP, Anto EO, Aboagye E, Yan Y, Wang Y, Tan X, Wang W. Construct validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian population. Health Qual Life Outcomes 2021; 19:180. [PMID: 34281537 PMCID: PMC8287694 DOI: 10.1186/s12955-021-01810-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure Suboptimal Health Status has been used worldwide, but its construct validity has only been tested in the Chinese population. Applying Structural Equation Modelling, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.
Methods The study involved healthy Ghanaian participants (n = 263; aged 20–80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.
Results The extracted domains were reliable with Cronbach’s \documentclass[12pt]{minimal}
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\begin{document}$$\alpha$$\end{document}α of 0.846, 0.820 and 0.864 respectively, for fatigue, immune-cardiovascular and cognitive. The CFA revealed that the model fit indices were excellent \documentclass[12pt]{minimal}
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\begin{document}$$\left( {{\text{RMSEA}} = 0.049~ < ~0.08,\,{\text{CFI}} = 0.903 > 0.9,\,{\text{GFI}} = 0.880 < 0.9,\,{\text{TLI}} = 0.907 > 0.9} \right)$$\end{document}RMSEA=0.049<0.08,CFI=0.903>0.9,GFI=0.880<0.9,TLI=0.907>0.9. The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts were smaller than the corresponding maximum shared variance. The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.
Conclusion The validity tests suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect chronic diseases especially in developing countries where access to facilities is diminished.
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Affiliation(s)
- Eric Adua
- Center for Precision Health, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia.,Shantou University of Medical College, Shantou, China.,Department of Biochemistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Afrifa-Yamoah
- School of Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia
| | - Kwasi Frimpong
- School of Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia.,Ghana Institute of Management and Public Administration, Accra, Ghana
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia
| | - Shantha P Karthigesu
- Center for Precision Health, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia
| | - Enoch Odame Anto
- Center for Precision Health, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia.,Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Aboagye
- Institute of Environmental Medicine, Karolinska Institute, Nobels Väg 13, 17177, Stockholm, Sweden
| | - Yuxiang Yan
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Xuerui Tan
- Shantou University of Medical College, Shantou, China
| | - Wei Wang
- Center for Precision Health, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Australia. .,Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, 100069, China.
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10
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Cheung H, Mazerolle L, Possingham HP, Biggs D. China's Legalization of Domestic Rhino Horn Trade: Traditional Chinese Medicine Practitioner Perspectives and the Likelihood of Prescription. Front Ecol Evol 2021. [DOI: 10.3389/fevo.2021.607660] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the international ban on the trade of rhino horn that has been in place since 1977, persistent demand for horn in Asia has driven a spike in poaching over the past decade. This has embroiled the conservation community in a debate over the efficacy of banning trade relative to other solutions. Proposals for trade to be legalized and supplied through the dehorning of live rhinos or the production of synthetic horn are contentious. The need for empirical research into the potential impacts of legalization on demand was made more urgent in 2018 when China publicized its intentions to reopen its domestic trade and permit the use of rhino horn in medical treatment. In this study, we interviewed 84 Traditional Chinese Medicine (TCM) practitioners in the Chinese province of Guangdong. While 58 (69.05%, n = 84) of our interviewees were in favor of trade legalization, only 32 (38.10%, n = 84) thought it likely that trade legalization would cause them to increase their prescription of rhino horn over current levels. This is probably because clinical cases in which rhino horn is medically appropriate are uncommon. We also found that 33 (39.29%, n = 84) practitioners were open to using synthetic horn for patient treatment, which has implications for the viability of synthetic horn as a conservation tool. This research contributes empirical insight to advance the discourse on rhino horn trade policy.
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11
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Li H, Hu YJ, Lin H, Xia H, Guo Y, Wu F. Hypertension and Comorbidities in Rural and Urban Chinese Older People: An Epidemiological Subanalysis From the SAGE Study. Am J Hypertens 2021; 34:183-189. [PMID: 32886761 DOI: 10.1093/ajh/hpaa146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/17/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is a lack of studies comparing hypertension and comorbidities in rural and urban older people in China. This study aimed to investigate the prevalence of hypertension and comorbidities in older people and to describe differences between patients from rural and urban areas in China. METHODS A cross-sectional study on global AGEing and adult health (SAGE) was conducted from 2007 to 2010 across 8 provinces in China. The current study included a nationally representative subsample of 7,403 respondents aged 60 years and above. Hypertension was either self-reported diagnosed hypertension or 1 elevated measured blood pressure measurement (≥140/90 mm Hg). Comorbidities were self-reported and included angina, arthritis, asthma, stroke, diabetes, depression, and chronic lung disease. RESULTS The prevalence of hypertension was 66.1%. Hypertension associated with 1 comorbidity was recorded in 35.9% of all participants. A large majority (73.6%) of participants with hypertension reported "good" or "very good" general health status. The prevalence of hypertension and the number of comorbidities increased with age. The prevalence rates of multiple comorbidities were higher for urban participants than their rural counterparts (27.8 vs. 42.4% for 1 morbidity; 7.7 vs. 16.4% for 2 comorbidities; 1.4 vs. 4.7% for 3 comorbidities; 0.4 vs. 1.2% for ≥4 comorbidities) after adjustment for sociodemographic factors. However, urban participants reported better general health status, irrespective of the number of comorbidities. CONCLUSIONS Our study implies that health promotion policies targeting older people should be developed. Rural areas should be a priority, and investment in the quality of health care in rural areas is urgently needed.
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Affiliation(s)
- Haitao Li
- Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen, China
| | - Yanhong Jessika Hu
- Murdoch Children’s Research Institute; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui Xia
- Longhua Center for Chronic Diseases Prevention and Control, Shenzhen, China
| | - Yanfei Guo
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Fan Wu
- School of Public Health, Fudan University, Shanghai, China
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12
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Ruan Y, Zhuang C, Chen W, Xie J, Zhao Y, Zhang L, Lin H. Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai. Int J Health Plann Manage 2021; 36:847-865. [PMID: 33615549 DOI: 10.1002/hpm.3134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors. METHODS A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well. RESULTS Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed. CONCLUSION 'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.
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Affiliation(s)
- Yuhui Ruan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Chenyang Zhuang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weisin Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinyu Xie
- Huashan Hospital, Affiliated to Shanghai Fudan University, Shanghai, China
| | - Yaodong Zhao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lufa Zhang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Institute of Medical Science Popularization, Fudan University, Shanghai, China
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13
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Xiong X, Cao X, Luo L. The ecology of medical care in Shanghai. BMC Health Serv Res 2021; 21:51. [PMID: 33422077 PMCID: PMC7796586 DOI: 10.1186/s12913-020-06022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background To better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai. Methods The data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence. Results This paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery. Conclusions Age is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.
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Affiliation(s)
- Xuechen Xiong
- Collaborative Innovation Center of Health Risks Governance, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Xiaolin Cao
- Collaborative Innovation Center of Health Risks Governance, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Li Luo
- Collaborative Innovation Center of Health Risks Governance, School of Public Health, Fudan University, Shanghai, 200433, China.
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14
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Wang W. Cardiovascular health in China: Low level vs high diversity. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2020; 3:100038. [PMID: 34327386 PMCID: PMC8315433 DOI: 10.1016/j.lanwpc.2020.100038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Wei Wang
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
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15
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Wang S, Wu J. Spatial heterogeneity of the associations of economic and health care factors with infant mortality in China using geographically weighted regression and spatial clustering. Soc Sci Med 2020; 263:113287. [PMID: 32818850 DOI: 10.1016/j.socscimed.2020.113287] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/18/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022]
Abstract
Economic factors and health care resources are important influential factors of infant mortality. We aimed to examine prefecture-level spatial heterogeneity and clustering of the associations of economic and health care factors with infant mortality rates (IMR) in China. IMR data in 348 prefectures were calculated and adjusted, and economic and health care data were collected in each prefecture in China, 2010. Stepwise regression was used to select important variables, and geographically weighted regression (GWR) was applied to examine the spatial variations of the relationships between economic and health care factors and IMR. The k-means clustering was developed to elucidate the spatial clustering patterns of the GWR coefficients. The results showed that three important variables were selected in the multivariable regression model, including per capita income of rural residents, Engel's coefficient of rural residents, and proportion of government health expenditure. The GWR with these three variables revealed spatial heterogeneity of the associations between IMR and economic and health care factors; western China generally had higher GWR R-squares and stronger associations between IMR and all the three variables than the middle-eastern part of China. Based on the GWR coefficients, three distinct spatial clusters were identified. This study contributes new findings on the spatial heterogeneity of the associations between economic and health care factors and infant mortality rate in China, which calls for region-specific policies to reduce infant mortality in China.
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Affiliation(s)
- Shaobin Wang
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
| | - Jun Wu
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
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16
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Examining Trans-Provincial Diagnosis of Rare Diseases in China: The Importance of Healthcare Resource Distribution and Patient Mobility. SUSTAINABILITY 2020. [DOI: 10.3390/su12135444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
(1) Background: Rare disease patients in China usually have to travel a long distance, typically across provinces, for an accurate diagnosis due to the uneven distribution of healthcare resources. This study investigated the impact factors of their trans-provincial diagnosis. (2) Methods: An analysis was made of 1531 cases (1032 adults and 499 children) garnered from the 2018 China Rare Disease Survey, representing a large patient community inflicted with 75 rare diseases from across 31 Chinese provinces. Logistic regression models were used for separate analysis of adult and child patient groups. (3) Results: Nearly half (47.2%) of patients obtained their accurate diagnosis outside their home provinces. The uneven geographical distribution of high-quality healthcare had a significant impact on variation in trans-province diagnosis. Adult patients with lower family income, rural hukou and severer physical disability were disadvantaged in accessing trans-provincial diagnosis. Families with a child patient tended to pour resources into obtaining the trans-provincial diagnosis. The rarity of the disease had only a minimal effect on healthcare utilization across the provinces. (4) Conclusions: In addition to medical care, more attention should be paid to the socioeconomic factors that prevent the timely diagnosis of a rare disease, especially the uneven geographical distribution of high-quality healthcare resources, the financial burden on the family and the differences between adult and child patients.
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17
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Sansone G, Fong GT, Yan M, Meng G, Craig L, Xu SS, Quah ACK, Wu C, Feng G, Jiang Y. Secondhand smoke exposure and support for smoke-free policies in cities and rural areas of China from 2009 to 2015: a population-based cohort study (the ITC China Survey). BMJ Open 2019; 9:e031891. [PMID: 31831539 PMCID: PMC6924814 DOI: 10.1136/bmjopen-2019-031891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine trends in smoking prevalence in key venues (workplaces, restaurants, bars) and in public support for comprehensive smoke-free laws, with comparisons between cities and rural areas in China. DESIGN Data are from Waves 3-5 (2009-2015) of the International Tobacco Control (ITC) China Survey, a cohort survey of smokers and non-smokers. Logistic regression analyses employing generalised estimating equations assessed changes in smoking prevalence and support for smoke-free laws over time; specific tests assessed whether partial smoking bans implemented in three cities between Waves 3 and 4 had greater impact. SETTING Face-to-face surveys were conducted in seven cities (Beijing, Changsha, Guangzhou, Kunming, Shanghai, Shenyang and Yinchuan) and five rural areas (Changzhi, Huzhou, Tongren, Yichun and Xining). PARTICIPANTS In each survey location at each wave, a representative sample of approximately 800 smokers and 200 non-smokers (aged 18+) were selected using a multistage cluster sampling design. MAIN OUTCOME MEASURES Prevalence of smoking (whether respondents noticed smoking inside restaurants, bars and workplaces); smoking rules inside these venues; and support for complete smoking bans in these venues. RESULTS Although smoking prevalence decreased and support increased over time, neither trend was greater in cities that implemented partial smoke-free laws. Smoking was higher in rural than urban workplaces (62% vs 44%, p<0.01), but was equally high in all restaurants and bars. There were generally no differences in secondhand smoke (SHS) exposure between smokers and non-smokers except in rural workplaces (74% vs 58%, p<0.05). Support for comprehensive bans was equally high across locations. CONCLUSIONS Partial laws have had no effect on reducing SHS in China. There is an urgent need for comprehensive smoke-free laws to protect the public from exposure to deadly tobacco smoke in both urban and rural areas. The high support among Chinese smokers for such a law demonstrates that public support is not a barrier for action.
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Affiliation(s)
- Genevieve Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Changbao Wu
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Guoze Feng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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18
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Legal reflections on the evolving role of general practitioners in China's primary care: an assessment of regulatory strategies. Prim Health Care Res Dev 2018; 20:e9. [PMID: 30113010 PMCID: PMC6476398 DOI: 10.1017/s1463423618000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To assess the regulation of the Chinese healthcare system in assisting a nationwide implementation of general practitioner (GP) services. Background Along with the perennial problems of unaffordable and inequitable healthcare, a rapidly ageing population and the increasing burden of non-communicable diseases pose challenges to the Chinese healthcare system. Recognising these challenges and to satisfy people’s demands for more and better healthcare, China has initiated a plan, named ‘Healthy China 2030’, based on the findings from a two-year joint study by the World Health Organization (WHO) and the World Bank Group (WBG) in collaboration with Chinese agencies. The Chinese healthcare plan, officially approved in 2016, is an attempt to use the people-centred, integrated care (PCIC) model recommended by the WHO and WBG to shape the Chinese healthcare system. In accordance with PCIC, China began the implementation of gatekeeping primary care by introducing GP services to local communities. Methods A comparative analysis was employed to point out the importance of introducing GP services. A systematic assessment was carried out to evaluate the regulatory sector of the Chinese healthcare system, including a critical review of related legal norms and a theoretical exploration of external impediments (eg, cultural attitudes, government capacity and interest groups). Findings Results demonstrate that the current regulatory sector of the Chinese healthcare system needs to be improved in order to assist the nationwide implementation of GP services and to strengthen its gatekeeping role. Major deficiencies include the problematic relationship between legal norms and health policies, the lack of effective and consistent new legislation, the low rate of social acceptance, and lack of support from agencies. To address those challenges, this paper recommends that preliminary efforts be devoted, in part, to two changes in the legal structure: enacting a specific law, and creating an independent regulatory oversight body.
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19
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Ma C. The prevalence of depressive symptoms and associated factors in countryside-dwelling older Chinese patients with hypertension. J Clin Nurs 2018. [DOI: 10.1111/jocn.14349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chunhua Ma
- School of Nursing; Guangzhou Medical University; Guangzhou China
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20
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Liu BP, Qin P, Jia CX. Behavior Characteristics and Risk Factors for Suicide Among the Elderly in Rural China. J Nerv Ment Dis 2018; 206:195-201. [PMID: 28825926 DOI: 10.1097/nmd.0000000000000728] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We examine the characteristics of suicide behavior and associated risk factors in the elderly in rural China, compared with the nonelderly. Paired case-control design and psychological autopsy were used for subject recruitment and data collection. The included cases were 104 suicides of the elderly aged 60 years or older, 86 suicides of the nonelderly, and sex- and age-paired controls from the same villages. Although the characteristics of suicide behavior were similar between the two age groups of victims, the elderly who died by suicide had a greater tendency to experience negative life events and not live with a spouse. Suicide of the nonelderly was associated with family history of suicide, poor social support, and impulsivity. The influence of negative life events on the risk of suicide was greater in the elderly. Thus, efforts for suicide prevention must be tailored to the needs of specific age groups.
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21
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Adua E, Frimpong K, Li X, Wang W. Emerging issues in public health: a perspective on Ghana's healthcare expenditure, policies and outcomes. EPMA J 2017; 8:197-206. [PMID: 29021830 DOI: 10.1007/s13167-017-0109-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/17/2017] [Indexed: 01/01/2023]
Abstract
Ghana's healthcare expenditure has increased over the past two decades. Increased healthcare expenditures are required to enhance the acquisition of better hospital resources that may improve healthcare. This study presents an overview of healthcare expenditures and health outcomes (i.e. infant mortality, under-5 mortality and life expectancy) from 1995 to 2014 in Ghana. Infant and under-5 mortalities have declined by 50 and 25%, respectively, as of 2014, while life expectancy has increased from 60.7 to 64.8 years. Private spending on health, especially out-of-pocket payments, declined but is higher than the World Health Organization's recommended financial threshold. Non-communicable diseases (NCDs) are rising with healthcare costs leading to catastrophically high healthcare expenditures in the future. While government's investments on healthcare have yielded positive results, the improvement in the health outcomes cannot be attributed to increased health expenditure alone. Therefore, this paper outlines policies on maternal health, national health insurance and healthcare reforms that have influenced health outcomes. In parallel, the paper highlights challenges of the Ghana health system of which the major ones are (1) inadequate financial investments in health and (2) limited health workforce and facilities. These challenges can be ameliorated by (1) establishing new health institutions and expanding existed ones; (2) providing incentives to discourage the exodus of health workers; (3) introduction of the concept of predictive, preventive and personalized medicine (PPPM) for treating NCDs; and (4) alternative insurance schemes for vulnerable groups. This, coupled with the will of the government to curb misappropriation of funds, will be important to achieving better health outcomes.
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Affiliation(s)
- Eric Adua
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Perth, WA 6027 Australia
| | - Kwasi Frimpong
- School of Natural Sciences, Edith Cowan University, Perth, WA 6027 Australia
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria 3083 Australia
| | - Wei Wang
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Perth, WA 6027 Australia.,Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, 100069 China.,School of Public Health, Taishan Medical University, Taian, Shandong 271000 China
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22
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Yu W, Li M, Nong X, Ding T, Ye F, Liu J, Dai Z, Zhang L. Practices and attitudes of doctors and patients to downward referral in Shanghai, China. BMJ Open 2017; 7:e012565. [PMID: 28373247 PMCID: PMC5387945 DOI: 10.1136/bmjopen-2016-012565] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. METHODS Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ2 test and stepwise logistic regression analysis were employed for statistical analysis. RESULTS Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. CONCLUSIONS To increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system.
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Affiliation(s)
- Wenya Yu
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Meina Li
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Xin Nong
- Maternal and Child Service Center of Rizhao City, Rizhao, China
| | - Tao Ding
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Feng Ye
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
- No 187th hospital of PLA, Haikou, China
| | - Jiazhen Liu
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Zhixing Dai
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Lulu Zhang
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
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23
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Olivares DEV, Chambi FRV, Chañi EMM, Craig WJ, Pacheco SOS, Pacheco FJ. Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: A Web-Based Interactive and Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030251. [PMID: 28257087 PMCID: PMC5369087 DOI: 10.3390/ijerph14030251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 02/08/2023]
Abstract
Global health agencies estimate an increase of chronic diseases in South America. Nevertheless, few studies have investigated chronic diseases and their risk factors in the perspective of multimorbidity. This research aimed to identify these aspects in a primary health care setting of central Argentina. The Pan America version of the STEP wise approach surveillance (STEPS) instrument of the World Health Organization was applied to 1044 participants, 365 men and 679 women, with a mean age of 43 years. High prevalence of overweight (33.5%), obesity (35.2%), central obesity (54%), dyslipidemia (43.5%), metabolic syndrome (21.1%), low intake of fruit and vegetables (91.8%), low levels of physical activity (71.5%), risky alcohol consumption (28%), and smoking (22.5%) were detected. Hypertension and diabetes were the most prevalent chronic conditions and the total prevalence of multimorbidity was 33.1%, with 2, 3, 4, 5 and 6 chronic conditions found in 19.9%, 9.1%, 2.6%, 1.1% and 0.4% of the population, respectively. Multimorbidity affected 6.4% of the young, 31.7% of the adults, and 60.6% of the elderly, and was more prevalent among women, and in participants with lower levels of education. Having multimorbidity was significantly associated with obesity, central obesity, and higher concentrations of total blood cholesterol, low-density lipoprotein cholesterol, triglycerides, and glucose. A website was made available to the participants in order to share the experimental results and health-promoting information.
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Affiliation(s)
- David E V Olivares
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Frank R V Chambi
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Evelyn M M Chañi
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Winston J Craig
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Department of Public Health, Nutrition and Wellness, School of Health Professions, Andrews University, Berrien Springs, MI 49104, USA.
| | - Sandaly O S Pacheco
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Fabio J Pacheco
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
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24
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Yan R, Li W, Yin L, Wang Y, Bo J. Cardiovascular Diseases and Risk-Factor Burden in Urban and Rural Communities in High-, Middle-, and Low-Income Regions of China: A Large Community-Based Epidemiological Study. J Am Heart Assoc 2017; 6:JAHA.116.004445. [PMID: 28167497 PMCID: PMC5523752 DOI: 10.1161/jaha.116.004445] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Most cardiovascular diseases occur in low‐ and middle‐income regions of the world, but the socioeconomic distribution within China remains unclear. Our study aims to investigate whether the prevalence of cardiovascular diseases differs among high‐, middle‐, and low‐income regions of China and to explore the reasons for the disparities. Methods and Results We enrolled 46 285 individuals from 115 urban and rural communities in 12 provinces across China between 2005 and 2009. We recorded their medical histories of cardiovascular diseases and calculated the INTERHEART Risk Score for the assessment of cardiovascular risk‐factor burden, with higher scores indicating greater burden. The mean INTERHEART Risk Score was higher in high‐ and middle‐income regions than in low‐income regions (9.47, 9.48, and 8.58, respectively, P<0.0001). By contrast, the prevalence of total cardiovascular disease (stroke, ischemic heart disease, and other heart diseases that led to hospitalization) was lower in high‐ and middle‐income regions than in low‐income regions (7.46%, 7.42%, and 8.36%, respectively, Ptrend=0.0064). In high‐ and middle‐income regions, urban communities have higher INTERHEART Risk Score and higher prevalent rate than rural communities. In low‐income regions, however, the prevalence of total cardiovascular disease was similar between urban and rural areas despite the significantly higher INTERHEART Risk Score for urban settings. Conclusions We detected an inverse trend between risk‐factor burden and cardiovascular disease prevalence in urban and rural communities in high‐, middle‐, and low‐income regions of China. Such asymmetry may be attributed to the interregional differences in residents’ awareness, quality of healthcare, and availability and affordability of medical services.
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Affiliation(s)
- Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Bo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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25
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Gao W, Qiao X, Wang Y, Wan L, Wang Z, Wang X, Di Z, Liu X. The Interactive Association of General Obesity and Central Obesity with Prevalent Hypertension in Rural Lanzhou, China. PLoS One 2016; 11:e0164409. [PMID: 27732655 PMCID: PMC5061332 DOI: 10.1371/journal.pone.0164409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the interactive association between obesity with different anthropometry indices and prevalence of hypertension in rural Lanzhou. METHODS A cross-sectional survey was conducted in rural Lanzhou from April to July in 2013. The available information of 1275 rural residents aged more than 35 years was collected with a unified questionnaire and their blood pressure and anthropometry indices were measured in the field. The male-to-female ratio was 1:1.1. A generalized estimate equation (GEE) linear model was used to determine the association between obesity with different indexes and hypertension. RESULTS There was a moderate prevalence of general obesity (~11%) and very high prevalence of central obesity (53.2~67%) among the adults of rural Lanzhou. The prevalence of hypertension approximated 28%. GEE linear models showed that obesity with any one of anthropometry indices was associated significantly with the increased prevalence of hypertension among both males and females. In females, general obesity increased the prevalence of hypertension by 37% (0.37, 95%CI: 0.27,0.47) but in males by 23% (0.23, 95%CI: 0.12,0.35). The hypertensive effect of all central obesity was much lower than that of general obesity but approximately comparable to that of overweight. In addition, the interactions of the classified body mass index (BMI) and central obesity showed that when general obesity or overweight coexisted with any one of central obesity, the prevalence of hypertension was increased significantly, and this effect was a little higher than the corresponding main effect of general obesity or overweight in females but was much higher in males. In addition, general obesity or overweight which did not coexist with central obesity was not significantly associated with the increased prevalence of hypertension, nor were the other situations of central obesity in the normal weight or underweight except for the situation of central obesity with waist-to-hip ratio in the males of normal weight or underweight. CONCLUSION In rural Lanzhou, higher BMI had larger associations with the increased prevalence of hypertension than central obesity indices. Only when general obesity or overweight coexisted with central obesity, the prevalence of hypertension was significantly increased. So, central obesity indices should be used jointly with BMI in evaluating the risk of hypertension.
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Affiliation(s)
- Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, P. R. China
| | - Xiaowei Qiao
- Lanzhou Center for Disease Prevention and Control, Lanzhou, Gansu, P. R. China
| | - Yuhong Wang
- Lanzhou Center for Disease Prevention and Control, Lanzhou, Gansu, P. R. China
| | - Liping Wan
- Lanzhou Center for Disease Prevention and Control, Lanzhou, Gansu, P. R. China
| | - Zengwu Wang
- Division of Prevention & Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xin Wang
- Division of Prevention & Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Zhaoxin Di
- Lanzhou Center for Disease Prevention and Control, Lanzhou, Gansu, P. R. China
| | - Xiaoyu Liu
- Yuzhong County Center for Disease Prevention and Control, Lanzhou, Gansu, P. R. China
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Zhang H, Deng M, Xu H, Wang H, Song F, Bao C, Paillard-Borg S, Xu W, Qi X. Pre- and undiagnosed-hypertension in urban Chinese adults: a population-based cross-sectional study. J Hum Hypertens 2016; 31:263-269. [PMID: 27654328 DOI: 10.1038/jhh.2016.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/28/2016] [Accepted: 08/12/2016] [Indexed: 01/19/2023]
Abstract
Hypertension is common in adults and often undiagnosed, and the prevalence of pre- and undiagnosed-hypertension remains unclear. We aimed to investigate the prevalence of pre- and undiagnosed-hypertension and their correlates among urban Chinese adults. A total of 7435 participants aged 20-79 were included in this study. Data on demographics, lifestyle and medical history were collected through a structured interview. Pre- and undiagnosed-hypertension was defined as systolic blood pressure/ diastolic blood pressure (SBP/DBP) of 120-139/80-89 mm Hg and SBP⩾140 mm Hg and/or DBP⩾90 mm Hg, respectively, in participants without a history of hypertension and use of antihypertensive medication. Prevalence rates were calculated and standardized using local age- and gender-specific census data. Data were analysed using multinomial logistic regression with adjustment for potential confounders. Of all the participants, 2726 (36.7%) were diagnosed with pre-hypertension and 919 (12.3%) with undiagnosed-hypertension. Undiagnosed-hypertension accounted for 37.3% of all participants with hypertension. The prevalence of pre-hypertension gradually decreased with age, while undiagnosed-hypertension increased, although presenting different changing patterns among men and women. In a fully adjusted multinomial logistic regression, age, male sex, low socio-economic status (SES), abdominal obesity, alcohol drinking, physical inactivity and type 2 diabetes mellitus (T2DM) were significantly associated with increased odds of pre- and undiagnosed-hypertension. In conclusions, the prevalence of pre- and undiagnosed-hypertension was ~50% among urban Chinese adults. Abdominal obesity, low SES, alcohol drinking, physical inactivity and T2DM may be indicators for pre- and undiagnosed-hypertension.
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Affiliation(s)
- H Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Fundamental Nursing, School of Nursing, Tianjin Medical University, Tianjin, China
| | - M Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - H Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - H Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - F Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - C Bao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - S Paillard-Borg
- Department of Medicine and Public Health, The Swedish Red Cross University College, Stockholm, Sweden
| | - W Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Aging Research Center (ARC), Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - X Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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A cross-sectional survey of medication adherence and associated factors for rural patients with hypertension. Appl Nurs Res 2016; 31:94-9. [DOI: 10.1016/j.apnr.2016.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/20/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022]
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Incident hypertension and its prediction model in a prospective northern urban Han Chinese cohort study. J Hum Hypertens 2016; 30:794-800. [PMID: 27251078 DOI: 10.1038/jhh.2016.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 11/09/2022]
Abstract
Trends in incidence and prevalence of hypertension are grave in China and identifying high-risk, non-hypertension individuals for intervention may delay hypertension onset. We aimed to investigate the incidence of hypertension in northern urban Han Chinese population and construct multivariable hypertension prediction models through the prospective cohort, which included 7537 men and 4960 women free of hypertension at baseline between 2005 and 2010. During 38 958 person-years of follow-up, 2785 participants (men, 72.57%; women, 27.43%) developed hypertension. The incidence density of hypertension was 71.48 per 1000 person-year. In multivariable backward cox analyses, age, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose and current drinking were retained for both men and women, while gamma-glutamyl transferase only for men, total cholesterol, neutrophil granulocyte and current smoking only for women. The area under receiver operating characteristic curve (AUC) was 0.761 (95% confidence interval (CI), 0.752-0.771) for men and 0.753 (95% CI, 0.741-0.765) for women, even after 10-fold cross-validation, the AUC was 0.760 (95% CI, 0.751-0.770) for men and 0.749 (95% CI, 0.737-0.761) for women. Through risk stratification, the absolute risk of incident hypertension in 5 years at moderate, high and very high risk level was 2.13, 3.84 and 6.14 times that of those who were at low risk in men, and 1.30, 2.56 and 6.01 times that of those who were at low risk in women. Our findings identified predictors of incident hypertension and indicated that the sex-specific multivariable prediction models would be simply used to estimate the risk of incident hypertension.
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Gong S, Wang Y, Pan X, Zhang L, Huang R, Chen X, Hu J, Xu Y, Jin S. The availability and affordability of orphan drugs for rare diseases in China. Orphanet J Rare Dis 2016; 11:20. [PMID: 26920579 PMCID: PMC4769558 DOI: 10.1186/s13023-016-0392-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Orphan drugs are intended to treat, prevent or diagnose rare diseases. In recent years, China healthcare policy makers and patients have become increasingly concerned about orphan drug issues. However, very few studies have assessed the availability and affordability of orphan drugs for rare diseases in China. The aim of this study was to provide an overview of the availability and affordability of orphan drugs in China and to make suggestions to improve patient access to orphan drugs. Methods Two components of the availability of orphan drugs were examined. Market availability was assessed by the extent to which orphan drugs were marketed in China with a comparison to orphan drugs in international markets, such as the U.S., EU and Japan. We conducted surveys and collected data from 24 tertiary public hospitals in China to measure hospital-level availability of orphan drugs. The affordability of orphan drugs was calculated using hospital dispensary prices and was expressed as days of average daily income required for the cost of a course of treatment. Affordability was also analyzed under the Chinese basic medical insurance system. Results Orphan drugs approved in the U.S., EU and Japan had 37.8 %, 24.6 % and 52.4 % market availability in China, respectively. Median availability of 31 orphan drugs surveyed at the 24 tertiary public hospitals was 20.8 % (very low). Within a periodic treatment course, the average treatment cost of 23 orphan drugs is approximately 4, 843. 5 USD, which equates to 505.6 days of per capita net income for an urban resident with a middle income (187.4 days for a high-income urban resident) or 1,582.8 days’s income for a rural resident with a middle income (657.2 days for a high-income rural resident). Except for homoharringtonine, 22 orphan drugs for 14 rare diseases were unaffordable for the most of residents in China. With 5 % out-of-pocket expenses, only three generics could be afforded by middle-income residents, whereas seven drugs for high-income urban residents. Conclusions The Chinese government can take more responsibility for improving the availability and affordability of orphan drugs through setting up incentive policies and public platforms for sharing of orphan drug information. Control of the high price of orphan drugs, combined with a joint funding model from both government and private enterprise can efficiently reduce the economic burden of affected patients in China. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0392-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiwei Gong
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Yingxiao Wang
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Xiaoyun Pan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
| | - Liang Zhang
- School of Health and Medicine Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Rui Huang
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Xin Chen
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Juanjuan Hu
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Yi Xu
- Department of Pharmacy Business and Administration, School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Si Jin
- Department of Endocrinology, Institute of Geriatric medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Physical and mental health conditions of young college students with different Traditional Chinese Medicine constitutions in Zhejiang Province of China. J TRADIT CHIN MED 2016; 35:703-8. [PMID: 26742318 DOI: 10.1016/s0254-6272(15)30163-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate Traditional Chinese Medicine (TCM) constitutions of youths in colleges, and their physical and mental health conditions of different TCM constitutions, so as to provide a theoretical basis for the TCM way to improve young people's physical and mental health. METHODS The Standard TCM Constitutions' Classification and Determination Questionnaire was used to measure the body health condition, and the Symptom Checklist 90 Questionnaire and the Questionnaire of the National Student Physical Health Standards were used to determine mental and physical health conditions respectively in 1421 young participants validly answering the questionnaires in Zhejiang Province. RESULTS The participants had a mean age of 19.96 years (SD = 0.95 years) with the majority of females (55.10%). One fourth of the 1421 participants were the Ping-he constitution and others were the tendency constitutions. Participants with Pinghe module (which has characteristics of moderate posture, rosy, energetic and is a healthy condition in TCM) were healthier than those with tendency constitutions in physical and mental health, with 65.81 ± 7.83 (men) and 77.99 ± 7.24 (women) scores in the physical test and around 1.25 scores in the mental health test. College students with combined biased constitutions were more likely suffer force, sensitive, depression and anxiety. CONCLUSION Most of college students have a tendency or biased constitution which could be more likely to suffer suboptimal health status and diseases. Youths in college themselves and health providers should pay more attention to their potential health issues and make proper healthcare plan according to their own TCM constitution.
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Li T, Lei T, Xie Z, Zhang T. Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example. BMC Health Serv Res 2016; 16:42. [PMID: 26846921 PMCID: PMC4743421 DOI: 10.1186/s12913-016-1276-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To ensure equity and accessibility of public health care in rural areas, the Chinese central government has launched a series of policies to motivate village doctors to provide basic public health services. Using chronic disease management and prevention as an example, this study aims to identify factors associated with village doctors' basic public health services provision and to formulate targeted interventions in rural China. METHODS Data was obtained from a survey of village doctors in three provinces in China in 2014. Using a multistage sampling process, data was collected through the self-administered questionnaire. The data was then analyzed using multilevel logistic regression models. RESULTS The high-level basic public health services for chronic diseases (BPHS) provision rate was 85.2% among the 1149 village doctors whom were included in the analysis. Among individual level variables, more education, more training opportunities, receiving more public health care subsidy (OR = 3.856, 95 % CI: 1.937-7.678, and OR = 4.027, 95% CI: 1.722-9.420), being under integrated management (OR = 1.978, 95% CI: 1.132-3.458), and being a New Cooperative Medical Scheme insurance program-contracted provider (OR = 2.099, 95% CI: 1.187-3.712) were associated with the higher BPHS provision by village doctors. Among county level factors, Foreign Direct Investment Index showed a significant negative correlation with BPHS provision, while the government funding for BPHS showed no correlation (P > 0.100). CONCLUSION Increasing public health care subsidies received by individual village doctors, availability and attendance of training opportunities, and integrated management and NCMS contracting of village clinics are important factors in increasing BPHS provision in rural areas.
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Affiliation(s)
- Tongtong Li
- School of Public Health of Peking University, 38 Xueyuan Road, Haidian District, Beijing, P. R. China.
| | - Trudy Lei
- School of Public Health of Columbia University, New York, USA.
| | - Zheng Xie
- School of Public Health of Peking University, 38 Xueyuan Road, Haidian District, Beijing, P. R. China.
| | - Tuohong Zhang
- School of Public Health of Peking University, 38 Xueyuan Road, Haidian District, Beijing, P. R. China.
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Jan S, Lee SWL, Sawhney JPS, Ong TK, Chin CT, Kim HS, Krittayaphong R, Nhan VT, Itoh Y, Huo Y. Catastrophic health expenditure on acute coronary events in Asia: a prospective study. Bull World Health Organ 2016; 94:193-200. [PMID: 26966330 PMCID: PMC4773930 DOI: 10.2471/blt.15.158303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/24/2015] [Accepted: 12/04/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate out-of-pocket costs and the incidence of catastrophic health expenditure in people admitted to hospital with acute coronary syndromes in Asia. METHODS Participants were enrolled between June 2011 and May 2012 into this observational study in China, India, Malaysia, Republic of Korea, Singapore, Thailand and Viet Nam. Sites were required to enrol a minimum of 10 consecutive participants who had been hospitalized for an acute coronary syndrome. Catastrophic health expenditure was defined as out-of-pocket costs of initial hospitalization > 30% of annual baseline household income, and it was assessed six weeks after discharge. We assessed associations between health expenditure and age, sex, diagnosis of the index coronary event and health insurance status of the participant, using logistic regression models. FINDINGS Of 12,922 participants, 9370 (73%) had complete data on expenditure. The mean out-of-pocket cost was 3237 United States dollars. Catastrophic health expenditure was reported by 66% (1984/3007) of those without insurance versus 52% (3296/6366) of those with health insurance (P < 0.05). The occurrence of catastrophic expenditure ranged from 80% (1055/1327) in uninsured and 56% (3212/5692) of insured participants in China, to 0% (0/41) in Malaysia. CONCLUSION Large variation exists across Asia in catastrophic health expenditure resulting from hospitalization for acute coronary syndromes. While insurance offers some protection, substantial numbers of people with health insurance still incur financial catastrophe.
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Affiliation(s)
- Stephen Jan
- George Institute for Global Health, King George V Building, 83-117 Missenden Road, Camperdown, NSW 2050, Australia
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | | | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | | | - Hyo-Soo Kim
- Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Yohji Itoh
- Clinical Science Division, AstraZeneca, Osaka, Japan
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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Prevalence, awareness, treatment and control of high blood pressure among Chinese rural population in Haimen, Jiangsu. J Hum Hypertens 2015; 30:225-30. [DOI: 10.1038/jhh.2015.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
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The Association Between Physical Activity, Mental Status, and Social and Family Support with Five Major Non-Communicable Chronic Diseases Among Elderly People: A Cross-Sectional Study of a Rural Population in Southern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13209-23. [PMID: 26506364 PMCID: PMC4627026 DOI: 10.3390/ijerph121013209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/17/2015] [Accepted: 10/08/2015] [Indexed: 11/16/2022]
Abstract
Background: Non-communicable chronic diseases (NCDs) have become the top threat in China. This study aimed to estimate the prevalence of major NCDs among the elderly population in rural areas in southern China and explore its associated social determinants. Methods: A multistage cluster random sampling methodology was adopted to select a total of 9245 rural elderly people from 3860 rural households in Guangdong Province. Interviews and physical examinations were performed to collect patient information. Descriptive and logistic regression analyses were conducted to explore factors associated with the presence of major NCDs. Results: Over one-third (38.5%) of the study population suffered from five major NCDs. The grade of activities of daily living (ADL), mental status, and social relationship of elderly people without NCDs were better than those with NCDs. The major factors associated with the presence of NCDs among the elderly people included age (70–79 years group and 80–89 years group), education level (senior high/technical secondary school and junior college and above), mental status (concentration, enrichment and happy life and memory), relationship with neighbours, activities of daily living (ADL) (being able to climb three floors and bend over), physical activity, marital status (bereft), and living conditions (with offspring and family members). Conclusions: The study identified several social determinants associated with the presence of major NCDs. A higher level of family support and physical exercise might contribute to improved physical condition, mental status, and ADL among the elderly people in rural areas in southern China.
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Epidemiological Characteristics of Hypertension in the Elderly in Beijing, China. PLoS One 2015; 10:e0135480. [PMID: 26295836 PMCID: PMC4546586 DOI: 10.1371/journal.pone.0135480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background/Objectives The prevalence rate of hypertension increases significantly with the aging society, and hypertension is obviously becoming a major health care concern in China. The aim of the study was to explore the epidemiological characteristics of hypertension in the elderly and to provide a basis for the prevention of hypertension. Design 3-cross sectional studies in 2000, 2004, and 2007, respectively. Setting Beijing, China. Participants A group of 2,832, 1,828, and 2,277 elderly residents aged ≥60 years were included this study in 2000, 2004, and 2007, respectively. Intervention None. Measurements Statistical sampling techniques included cluster, stratification, and random selection. Trained staff used a comprehensive geriatric assessment questionnaire and a standard survey instrument to complete the assessments. During the person-to-person interviews, the participants’ demographic characteristics, living conditions, and health status were collected, and their blood pressure was measured. Results The prevalence rates (69.2%, 61.9%, and 56.0%) of hypertension and the control rates (22.6%, 16.7%, and 21.5%) lowered annually, while the awareness rates (43.7%, 55.8%, and 57.6%) of the treatment elevated annually in 2000, 2004, and 2007, respectively. There was no increase in the control rates for males (26.2%, 16.7%, and 20.8%), younger participants (28.0%, 18.4%, and 21.0%), and rural residents (19.5%, 9.6%, and 13.4%) in 2000, 2004, and 2007, respectively. Conclusions Our study findings indicated that the prevalence of hypertension is high in rural elderly participants, while the rates of awareness, treatment, and control were low. This suggests that effective public measures need to be developed to improve the prevention and control of hypertension.
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Zeng W, Zhen J, Feng M, Campbell SM, Finlayson AE, Godman B. Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction. J Comp Eff Res 2015; 3:371-86. [PMID: 25275234 DOI: 10.2217/cer.14.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pharmaceutical expenditure has grown by 16% per annum in China, enhanced by incentives for physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, accounting for 46% of total hospital expenditure. Principal measures to moderate drug expenditure growth include pricing initiatives as limited demand-side measures. OBJECTIVE Assess current utilization and expenditure including traditional Chinese medicines (TCMs) between 2006 and 2012. METHODS Uncontrolled retrospective study of medicines to treat cardiovascular and cerebrovascular diseases in one of the largest hospitals in southwest China. RESULTS Utilization increased 3.3-fold for cerebrovascular medicines, greatest for TCMs, with expenditure increasing 4.85-fold. Low prices for generics were seen, similar to Europe. However, there was variable utilization of generics at 29-31% of total product volumes in recent years. There continued to be irrationality in prescribing with high use of TCMs, and the utilization of different medicines dropping significantly once they achieved low prices. CONCLUSION Prices still have an appreciable impact on utilization in China. Potential measures similar to those implemented among western European countries could improve prescribing rationality and conserve resources.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, Chongqing, China
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Zeng J. Nonparametric Optimization of Preference in Technical Efficiency in China. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2015. [DOI: 10.20965/jaciii.2015.p0430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Applying nonparametric path-converged approach, the research innovatively provides the measurement of preference in technical efficiency by the ratio of labor elasticity to capital elasticity and further attempts to realize the optimization of preference in technical efficiency by a strategy of 30% abolishment of initial Drug Addition and a strategy with combination of smoothed governmental fiscal expenditure, which sheds fresh light on promoting hospitals’ efficiency in China from perspective of management engineering. With sample data of provincial public hospitals in Zhejiang Province during period of 200901-201306, the research obtains following conclusions. First, benchmark preference in technical efficiency shows production has shifted from physical capital preference to labor skilled preference in technical efficiency. Second, the changing trend of preference in technical efficiency validates initial Drug Addition and governmental fiscal expenditure pushes and restrains the labor skilled preference in technical efficiency respectively. Third, the strategy of 30% abolishment of Drug Addition will strengthen labor skilled preference in technical efficiency with less promotion intensity of initial Drug Addition. The strategy with combination of governmental fiscal expenditure restrains labor skilled preference in technical efficiency. The facts validate great urgency of raising payments for doctors and nurses so as to promoting efficiency effectively.
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Zeng W, Finlayson AE, Shankar S, de Bruyn W, Godman B. Prescribing efficiency of proton pump inhibitors in China: influence and future directions. BMC Health Serv Res 2015; 15:11. [PMID: 25609265 PMCID: PMC4308879 DOI: 10.1186/s12913-014-0638-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/08/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables. METHODS Observational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China. RESULTS Appreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (-34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (-19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%. CONCLUSIONS Encouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing, 400074, China.
| | | | - Sushma Shankar
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, OX3 9DU, UK.
| | - Winnie de Bruyn
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, SE-141 86, Sweden. .,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK. .,Liverpool Health Economics Centre, Liverpool University, Chatham Street, Liverpool, L69 7ZH, UK.
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Hypertension prevalence, awareness, treatment and control among Han and four ethnic minorities (Uygur, Hui, Mongolian and Dai) in China. J Hum Hypertens 2015; 29:555-60. [PMID: 25589212 DOI: 10.1038/jhh.2014.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/02/2014] [Accepted: 11/18/2014] [Indexed: 11/09/2022]
Abstract
In the previous study, hypertension prevalence, awareness, treatment and control for Han and others four ethnic minorities (Uygur, Hui, Mongolian and Dai) has not been clearly documented in China. Therefore we used the baseline data of Prospective Urban and Rural Epidemiology (PURE) for further detailed study. Adjusted rate were estimated and compared through logistic regression after adjustment of age, sex, location and education. Among the total of 7137 participants (Han: 1626, ethnic minorities: 5511), hypertension prevalence, awareness, treatment and control were 2922(40.9%), 1199(41.0%), 873(29.9%) and 147(5.0%), respectively. The most commonly used antihypertensive drugs are traditional compound drugs (6.2%) and calcium channel blockers (5.2%). Hypertension prevalence in ethnic minorities was significantly higher than in Han (42.4% vs 34.4%, P<0.0001), while control rate (1.6% vs 9.8%, P=0.0198) and treated control rate (8.0% vs 25.0%, P=0.0200) were lower. Compared with Han counterparts, Dai had a higher prevalence (50.8% vs 29.9%, P<0.0001). Uygur had a lower treatment rate (33.2% vs 20.6%, P=0.0110). Mongolian had a lower control (5.1% vs 16.1%, P=0.0046) and treated control rate (14.1% vs 50.3%, P=0.0013). In conclusions, our study showed ethnic minorities had higher hypertension prevalence, especially for Dai and lower control and treated control rate for Mongolian. Hence, we need more attention with respect to hypertension in ethnic minorities.
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Zeng W, Gustafsson LL, Bennie M, Finlayson AE, Godman B. Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history. Expert Rev Pharmacoecon Outcomes Res 2014; 15:157-69. [PMID: 25348709 DOI: 10.1586/14737167.2015.963557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives. OBJECTIVES Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe. METHODOLOGY Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district. RESULTS Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (-54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices. CONCLUSION Considerable opportunities to improve prescribing efficiency in China.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing 400074, China
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Jia CX, Wang LL, Xu AQ, Dai AY, Qin P. Physical Illness and Suicide Risk in Rural Residents of Contemporary China. CRISIS 2014; 35:330-7. [DOI: 10.1027/0227-5910/a000271] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.
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Affiliation(s)
- Cun-Xian Jia
- School of Public Health, Shandong University, Jinan, China
- Center for Suicide Prevention and Research, Shandong University, Jinan, China
| | - Lin-Lin Wang
- School of Public Health, Shandong University, Jinan, China
| | - Ai-Qiang Xu
- Shandong Center for Disease Control and Prevention, Jinan, China
| | | | - Ping Qin
- Center for Suicide Prevention and Research, Shandong University, Jinan, China
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
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Ke Q, Qi M, Wu W, Luo B, Hanna M, Herr B, Griggs RC. Rare disease centers for periodic paralysis: China versus the United States and United Kingdom. Muscle Nerve 2014; 49:171-4. [PMID: 23893386 DOI: 10.1002/mus.23970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We have developed a rare disease center in China. METHODS In this study we analyzed how patients with periodic paralysis accessed centers in China vs. in the USA and UK. RESULTS A total of 116 patients with periodic paralysis were evaluated in Beijing and Hangzhou (2003-2012). These patients traveled long distances for outpatient specialist care without an appointment or physician referral. In contrast, at the University of Rochester in the USA, >90% of patients were referred from physicians throughout the country by identifying physician expertise or by referrals from a patient advocacy group. In the UK, a single center, supported by the National Health Service, provides assessment/genetic testing for all UK patients. CONCLUSIONS Rare disease centers in China require: (1) establishing a center for clinical characterization of the disease (e.g., periodic paralysis); (2) establishing a genetic diagnostic platform; (3) placing the center at a major city hospital; and (4) facilitating patient access through internet websites.
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Affiliation(s)
- Qing Ke
- Department of Neurology, The First Affiliated Hospital of School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China; University of Rochester Medical Center, Rochester, New York, USA
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Abstract
Heart failure (HF) is a serious disease associated with high morbidity and mortality. In China, as in other countries, it is a common cause for hospital admission; however, as yet there are few data documenting the epidemiology and management of HF in China, or quality of life-related considerations in this population. This review aims to identify relevant Chinese and English language publications that discuss the causes, risks, treatment, and health outcomes (costs, health-related quality of life) of HF in China (excluding Taiwan and Hong Kong). The prevalence of HF in China appears to be lower than that reported in many Western countries, including the US. Hypertension and coronary heart disease are the leading causes of HF in China, as they are in many Western nations, potentially highlighting the improvement in socioeconomic conditions in China. Evidence suggests that use of newer pharmacological agents for the treatment of HF is increasing; however, it is still believed that there is a lack of physician knowledge regarding newer, more effective treatment options, with rural (poor) areas appearing to be the most reliant on older, less expensive, medications. Interest in Chinese quality of life measures for HF has risen recently, with the development of valid and reliable rating scales in the Chinese population. Although the amount of available literature on HF in China is improving, there remain significant gaps in our understanding of the issue, and further research is needed to provide a reliable Chinese evidence base for the improvement of clinical practice.
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Zhang Z, Wang J, Jin M, Li M, Zhou L, Jing F, Chen K. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People's Republic of China. Clin Interv Aging 2014; 9:771-7. [PMID: 24855346 PMCID: PMC4020881 DOI: 10.2147/cia.s58771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The People's Republic of China's population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People's Republic of China. OBJECTIVE To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People's Republic of China. METHODS We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People's Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. RESULTS We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. CONCLUSION A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services.
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Affiliation(s)
- Zhenyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Jianbing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Mingjuan Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Mei Li
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Litao Zhou
- Quality Control Department, Zhejiang Hospital, Zhejiang, People's Republic of China
| | - Fangyuan Jing
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Kun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
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Wang W, Russell A, Yan Y. Traditional Chinese medicine and new concepts of predictive, preventive and personalized medicine in diagnosis and treatment of suboptimal health. EPMA J 2014; 5:4. [PMID: 24521056 PMCID: PMC3926271 DOI: 10.1186/1878-5085-5-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/31/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The premise of disease-related phenotypes is the definition of the counterpart normality in medical sciences. Contrary to clinical practices that can be carefully planned according to clinical needs, heterogeneity and uncontrollability is the essence of humans in carrying out health studies. Full characterization of consistent phenotypes that define the general population is the basis to individual difference normalization in personalized medicine. Self-claimed normal status may not represent health because asymptomatic subjects may carry chronic diseases at their early stage, such as cancer, diabetes mellitus and atherosclerosis. Currently, treatments for non-communicable chronic diseases (NCD) are implemented after disease onset, which is a very much delayed approach from the perspective of predictive, preventive and personalized medicine (PPPM). A NCD pandemic will develop and be accompanied by increased global economic burden for healthcare systems throughout both developed and developing countries. This paper examples the characterization of the suboptimal health status (SHS) which represents a new PPPM challenge in a population with ambiguous health complaints such as general weakness, unexplained medical syndrome (UMS), chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS) and chronic fatigue immune dysfunction syndrome (CFIDS). METHODS We applied clinical informatic approaches and developed a questionnaire-suboptimal health status questionnaire-25 (SHSQ-25) for measuring SHS. The validity and reliability of this approach were evaluated in a small pilot study and then in a cross-sectional study of 3,405 participants in China. RESULTS We found a correlation between SHS and systolic blood pressure, diastolic blood pressure, plasma glucose, total cholesterol and high-density lipoprotein (HDL) cholesterol among men, and a correlation between SHS and systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides and HDL cholesterol among women. CONCLUSIONS The SHSQ-25 is a self-rated questionnaire of perceived health complaints, which can be used as a new instrument for PPPM. An ongoing longitudinal SHS cohort survey (China Sub-optimal Health Cohort Study, COACS) consisting of 50,000 participants will provide a powerful health trial to use SHSQ-25 for its application to PPPM through patient stratification and therapy monitoring using innovative technologies of predictive diagnostics and prognosis: an effort of paradigm shift from reactive to predictive medicine.
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Affiliation(s)
- Wei Wang
- School of Medical Sciences, Edith Cowan University, Perth, Western Australia WA6027, Australia.
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Lin CW, Abdul SS, Clinciu DL, Scholl J, Jin X, Lu H, Chen SS, Iqbal U, Heineck MJ, Li YC. Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 113:585-592. [PMID: 24296075 DOI: 10.1016/j.cmpb.2013.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/05/2013] [Accepted: 10/07/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND China's healthcare system often struggles to meet the needs of its 900 million people living in rural areas due to major challenges in preventive medicine and management of chronic diseases. Here we address some of these challenges by equipping village doctors (ViDs) with Health Information Technology and developing an electronic health record (EHR) system which collects individual patient information electronically to aid with implementation of chronic disease management programs. METHODS An EHR system based on a cloud-computing architecture was developed and deployed in Xilingol county of Inner Mongolia using various computing resources (hardware and software) to deliver services over the health network using Internet when available. The system supports the work at all levels of the healthcare system, including the work of ViDs in rural areas. An analysis done on 291,087 EHRs created from November 2008 to June 2011 evaluated the impact the EHR system has on preventive medicine and chronic disease management programs in rural China. RESULTS From 2008 to 2011 health records were created for 291,087 (26.25%) from 1,108,951 total Xilingol residents with 10,240 cases of hypertension and 1152 cases of diabetes diagnosed and registered. Furthermore, 2945 hypertensive and 305 diabetic patients enrolled in follow-up. Implementing the EHR system revealed a high rate of cholecystectomies leading to investigations and findings of drinking water contaminated with metals. Measures were taken to inform the population and clean drinking water was supplied. CONCLUSIONS The cloud-based EHR approach improved the care provision for ViDs in rural China and increased the efficiency of the healthcare system to monitor the health status of the population and to manage preventive care efforts. It also helped discover contaminated water in one of the project areas revealing further benefits if the system is expanded and improved.
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Affiliation(s)
- Che-Wei Lin
- Graduate Institute of Medical Informatics, Taipei Medical University and Taipei Medical University Hospital, Taipei, Taiwan
| | - Shabbir Syed Abdul
- College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan
| | - Daniel L Clinciu
- College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Institute of Translational Medicine, Taipei Medical University, Taipei, Taiwan
| | | | | | - Haifei Lu
- Healthgrid Technology Inc., Beijing, China
| | | | - Usman Iqbal
- College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Maxwell J Heineck
- Institute of Industrial Management, King Fahd University, Dhahran, Saudi Arabia
| | - Yu-Chuan Li
- College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei, Taiwan.
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Shao S, Zhao F, Wang J, Feng L, Lu X, Du J, Yan Y, Wang C, Fu Y, Wu J, Yu X, Khoo K, Wang Y, Wang W. The ecology of medical care in Beijing. PLoS One 2013; 8:e82446. [PMID: 24340029 PMCID: PMC3855438 DOI: 10.1371/journal.pone.0082446] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. METHODS A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. RESULTS On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. CONCLUSIONS This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.
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Affiliation(s)
- Shuang Shao
- General Practice and Continue Education School, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Yan Jing Medical Sciences, Capital Medical University, Beijing, China
| | - FeiFei Zhao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Jing Wang
- Laboratory of Parallel Software and Mathematic Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Lei Feng
- General Practice and Continue Education School, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - XiaoQin Lu
- General Practice and Continue Education School, Capital Medical University, Beijing, China
| | - Juan Du
- General Practice and Continue Education School, Capital Medical University, Beijing, China
| | - YuXiang Yan
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Chao Wang
- Beijing Nuclear Industry Hospital, Beijing, China
| | - YingHong Fu
- School of Yan Jing Medical Sciences, Capital Medical University, Beijing, China
| | - JingJing Wu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - XinWei Yu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - KayKeng Khoo
- Lynwood Medical Centre, Lynwood, Western Australia, Australia
| | - YouXin Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical Sciences, Edith Cowan University, Perth, Australia
| | - Wei Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical Sciences, Edith Cowan University, Perth, Australia
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Chronic conditions and receipt of treatment among urbanized rural residents in China. BIOMED RESEARCH INTERNATIONAL 2013; 2013:568959. [PMID: 23998126 PMCID: PMC3753763 DOI: 10.1155/2013/568959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/19/2013] [Indexed: 11/28/2022]
Abstract
While undergoing the unprecedented urbanization process in the past few decades, China has also experienced a major epidemiological shift from predominantly infectious diseases to chronic conditions. Using data from a national survey of 1,288 respondents in urban China, this study examines the prevalence of chronic conditions and receipt of treatment among urbanized rural residents who have experienced in situ urbanization. Negative binomial and logistic regressions were applied to estimate the differences in chronic conditions, receipt of treatment, and concern of seeking medical treatment among urbanized rural residents as compared to urban residents and rural-to-urban migrants. The results indicate that urbanized rural residents have similar number or prevalence of chronic conditions with urban residents, but they are less likely to receive treatment particularly for cardiovascular conditions. The analysis further reveals that urbanized rural residents are more anxious about their potential inability to cover medical expenses than both urban residents and rural-to-urban migrants. The study stresses the converging prevalence of chronic conditions but the continuing divide in receipt of treatment between urban residents and urbanized rural residents. As China's urbanization continues with the epidemiological transition, there is an urgent need to address such disparities.
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Chen J, Chen S, Landry PF. Migration, environmental hazards, and health outcomes in China. Soc Sci Med 2013; 80:85-95. [DOI: 10.1016/j.socscimed.2012.12.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 11/15/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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