Epidemic of chronic diseases and the related healthy lifestyle interventions in rural areas of Shandong Province, China

Nutrition and Physical Activity Counseling by General Practitioners in China

Introduction

To reduce unhealthy lifestyles in China, it is critical to implement effective strategies. Counseling provided by physicians is important for assisting patients in improving their lifestyles, and general practitioners (GPs) are the main providers of lifestyle counseling to patients. However, few studies have focused on the lifestyle counseling practices by GPs in China, particularly in regard to nutrition and physical activity.

Objective

The aims of this study are: (i) to examine the current practice of Chinese GPs in counseling patients regarding nutrition and physical activity; (ii) to understand the common barriers to such counseling by Chinese GPs; and (iii) to study the association between GPs' personal lifestyle choices and their practices in lifestyle counseling.

Methods

A cross-sectional, self-reported online questionnaire was conducted among GPs in Hunan province, China. A total of 198 GPs completed the questionnaire.

Results

The majority of GPs provide nutrition and physical activity counseling to less than 40% of their patients, spending less than three minutes per counseling session. The main reported barriers to counseling on nutrition and physical activity are inadequate time and a lack of knowledge or experience. GPs primarily acquire knowledge through medical books and journals, followed by science popularization. Furthermore, GPs who maintain healthier lifestyle habits, possess a better understanding of lifestyle guidelines, conduct longer office visits, and exhibit higher self-efficacy are more likely to provide counseling to patients.

Conclusion

This study highlights the need for improvement in nutrition and physical activity counseling among Chinese GPs. GPs' personal nutrition and physical activity habits may measurably influence their counseling practice. We recommend that GPs themselves adopt healthier lifestyle habits to potentially improve their counseling practice. Moreover, proactive measures should be taken to assist GPs in overcoming barriers encountered with lifestyle counseling.

Strategies to Improve Long-Term Outcomes for Patients with Chronic Kidney Disease in China

Background

Chronic kidney disease (CKD) is an incurable disease requiring lifelong management. China has a high prevalence of CKD, which disproportionately affects older adults and those with chronic risk factors for CKD development. The rising prevalence of CKD in China places a substantial burden on the general population and the healthcare system.

Summary

In China, there are currently many unmet needs for patients with CKD and high-risk individuals, resulting from a lack of education and support to reduce risk factors, delayed diagnoses, limited knowledge of CKD among primary-care physicians, and poor access to treatments among some patient populations. An integrated, nationwide approach is required to improve the current situation of CKD management in China. There are currently several national healthcare frameworks in place that focus on new major health policies to prevent disease and encourage people to adopt healthier lifestyles, and while they do not directly target CKD, they may have a positive indirect impact. We explore the unmet needs for patients with CKD in China and discuss the potential strategies that may be required to overcome them. Such strategies include improving physician and patient education, establishing a targeted screening programme, supporting patients to improve self-management behaviours, accelerating the creation of medical consortia and medical satellite centres, and migrating from hospital- to community-based management. In addition to policy-driven strategies, development of novel therapies will be key to providing new solutions for the long-term management of CKD.

Key Messages

An integrated, nationwide approach is required, incorporating policy-driven changes to the clinical management of CKD, as well as the development of novel CKD treatments.

Emerging trends in wearable glove-based sensors: A review

Glove-based wearable chemical sensors are universal analytical tools that provide surface analysis for various samples in dry or liquid form by swiping glove sensors on the sample surface. They are useful in crime scene investigation, airport security, and disease control for detecting illicit drugs, hazardous chemicals, flammables, and pathogens on various surfaces, such as foods and furniture. It overcomes the inability of most portable sensors to monitor solid samples. It outperforms most wearable sensors (e.g., contact lenses and mouthguard sensors) for healthcare monitoring by providing comfort that does not interfere with daily activities and reducing the risk of infection or other adverse health effects caused by prolonged usage. Detailed information is provided regarding the challenges and selection criteria for the desired glove materials and conducting nanomaterials for developing glove-based wearable sensors. Focusing on nanomaterials, various transducer modification techniques for various real-world applications are discussed. The steps taken by each study platform to address the existing issues are revealed, as are their benefits and drawbacks. The Sustainable Development Goals (SDGs) and strategies for properly disposing of used glove-based wearable sensors are critically evaluated. A glance at all the provided tables provides insight into the features of each glove-based wearable sensor and enables a quick comparison of their functionalities.

Measurement and Spatial Differentiation of Farmers' Livelihood Resilience Under the COVID-19 Epidemic Outbreak in Rural China

Livelihood resilience is the ability of individuals, families or communities to withstand external shocks based on existing resources. It is an important research paradigm in sustainable development studies. The outbreak of COVID-19 and strict epidemic prevention policies have greatly impacted the production and life of rural farmers in China. The resilience of farmers' livelihoods during the epidemic is crucial to the sustainable development of their livelihoods and regional stability. This study uses classic buffer capacity, self-organization ability, and the capacity for learning a three-dimension livelihood resilience framework using the comprehensive index, OLS, and geographical detector methods based on Hubei province and neighboring Anhui and Chongqing. Rural household survey data investigate the background of epidemic hit the livelihood of farmers resilience and its spatial distribution pattern and identify the key influencing factors. The results show that the livelihood shock faced by farmers was higher than the risk of disease, and the overall level of livelihood resilience was low after the pandemic. Financial capital and social capital can effectively help farmers to eliminate livelihood difficulties. In contrast, natural capital has a limited driving force, and physical and human capital have no obvious impact. The spatial agglomeration differentiation is obvious, indicating that the impact of COVID-19 on livelihoods was closely related to the degree of local socio-economic development and geographical location. The results of this study provide targeted recommendations for the development of epidemic prevention and livelihood resilience policies tailored to local conditions, emphasizing the importance of boosting livelihood recovery at both the government and household levels.

Multiple chronic conditions among older adults in China: differences in socio-demographic characteristics

Objective

There are relatively few studies on multiple chronic conditions (MCC) among older adults in China. This study sought to assess the potential differences in the risk of MCC among different elderly populations, and thus to identify the most vulnerable populations at higher risk of developing the MCC.

Methods

A sample of 5320 adults aged 60 years or above from the China's Health-Related Quality of Life Survey for Older Adults 2018 (CHRQLS-OA 2018) were included in this study. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were conducted to identify the differences in the risk of having MCC among different populations.

Results

Overall, 52.6% of respondents had been clearly diagnosed with at least one chronic disease with 25.3% having MCC. The males ((adjusted odds ratio [AOR] = 0.84; 95% confidence interval [CI] = 0.73-0.98) were less likely to have MCC. This was also true among female elderly with a non-agricultural hukou (AOR = 0.75; 95% CI = 0.57-0.99). The elderly with a non-agricultural hukou aged 60-64 (AOR = 0.55; 95% CI = 0.34-0.88) had a lower risk of having MCC. Those whose average annual household income per capita were 15,000-30,000 RMB (AOR = 1.42; 95% CI = 1.03-1.96) were more likely to suffer from MCC. The odds ratios of having MCC were smaller as the personal savings increases in total samples (all P < 0.05).

Conclusions

The findings suggest that different policies or approaches should target these specific populations who are most in need and are most likely to suffer from MCC.

Long-term Care Facility and its Elderly Chronic Diseases in Jishou: Insights into Underdeveloped Area of China

Insight into the current status of long-term care facilities (LTCFs) and chronic diseases in underdeveloped areas in China is scant. Using a census method to survey older adults ≥60 years old (154 older adult residents) in all LTCFs in Jishou area. The International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF) was used to collect information and analyze the current status of chronic diseases among older adult residents. There were 62 187 residents ≥60 years old in Jishou area. According to the survey, there were only 154 older adult residents living in the LTCFs of Jishou, with a ratio was 0.3% of all older adult residents, which was much lower than China's 3.0%. Of respondents (109 older adult residents), the prevalence of chronic diseases was 70.6%. The prevalence increases with age, as well as in the female is higher than in the male. The top 3 chronic diseases were hypertension (41.3%), bone and joint disease (12.8%) and cerebrovascular disease (12.8%). It was found that different age groups and genders lead to differences in the prevalence and the order of chronic diseases. The prevalence of older adults with impaired balance ability, sleep disturbance and swallowing disturbance was higher than that of normal older adults. The results of the one-way analysis of variance showed that the age and balance ability of the older adults with chronic diseases were statistically significant (P < .05). In addition, the prevalence of chronic diseases in the LTCFs older adult was higher than the home care (HC) older adults in Jishou. The age and the prevalence of chronic diseases of LTCFs in older adults with professional nursing staff were higher than in those without. This study provides a theoretical basis for the healthcare distribution, prevention and treatment of chronic diseases in underdeveloped areas. The undeveloped area has lower LTCFs staying rate and chronic disease prevalence of older adults than relatively developed areas. More public health attention and capital investment are needed to increase the LTCFs number and strengthen disease testing and screening. As well as, the proportion of professional nursing staff and specialist doctors in LTCFs and improve the quality of care and medical treatment for older adults.

Relationship between internet use intensity and quality of life in chronic patients during the COVID-19 pandemic: The role of physical exercise and health insurance

The internet use intensity of human has increased substantially during the COVID-19 Pandemic, and it is severely impacting the well-being of chronic patients. This study aimed to explore the underlying mechanism of the relationship between internet use intensity and quality of life in chronic patients, based on the cross-sectional data from China Family Panel Studies (CFPS) during the COVID-19 Pandemic in 2020. The results showed that the internet use intensity had significant positive association with quality of life among chronic patients, and such association has been found in both urban and rural samples. Among the relationship of internet use intensity and quality of life in chronic patients, the mediating effect of physical exercise reached 10.25%. Furthermore, health insurance positively moderated this relationship. There are new insights for policy recommendations and clinical guidance on the role of physical activity and health insurance aimed at improving chronic patients' quality of life. Meanwhile, in both rural and urban governance, public health agencies should promote the "Internet + Healthcare" program to improve health insurance and physical activity literacy, thus providing a higher level of quality of life for patients with chronic diseases during the COVID-19 Pandemic.

Effect of Health Insurance Policy on the Health Outcomes of the Middle-Aged and Elderly: Progress Toward Universal Health Coverage

This population-based study aims to explore the effect of the integration of the Urban and Rural Residents' Basic Medical Insurance (URRBMI) policy on the health outcomes of the middle-aged and elderly. A total of 13,360 participants in 2011 and 15,082 participants in 2018 were drawn from the China Health and Retirement Longitudinal Study. Health outcomes were evaluated using the prevalence of chronic diseases. A generalized linear mixed model was used to analyze the effect of the URRBMI policy on the prevalence of chronic disease. Prior to the introduction of the URRBMI policy, 67.09% of the rural participants and 73.00% of the urban participants had chronic diseases; after the policy's implementation, 43.66% of the rural participants and 45.48% of the urban participants had chronic diseases. When adjusting for the confounding factors, the generalized linear mixed model showed that the risk of having a chronic disease decreased by 81% [odds ratio (OR) = 0.19; 95% confidence interval (CI): 0.16, 0.23] after the introduction of the policy in the urban participants; in the rural participants, the risk of having a chronic disease was 30% lower (OR = 0.70; 95% CI: 0.60, 0.82) than the risk in the urban participants before the policy and 84% lower (OR = 0.16; 95% CI: 0.14, 0.19) after the implementation of the policy; the differences in the ORs decreased from 0.30 prior to the policy to 0.03 after the policy had been introduced between rural and urban participants when adjusting for the influence of socioeconomic factors on chronic diseases. This study provides evidence of the positive effects of the URRBMI policy on improving the rural population's health outcomes and reducing the gap in health outcomes between rural and urban populations, indicating that the implementation of the URRBMI policy has promoted the coverage of universal health.

Individuals' Awareness of and Willingness to Accept Hospital-at-Home Services and Related Factors: A Cross-Sectional Study

Introduction

Hospital-at-home (HaH) services have become increasingly popular. However, the experience of HaH implementation in Asia is inadequate. Therefore, the purpose of this study was to investigate individuals' willingness to accept HaH services and the potential related factors.

Methods

The researchers visited households to select appropriate participants. An online questionnaire survey was conducted among the inhabitants of selected communities. An individual's awareness, willingness to accept HaH services, and demands such as ideal service providers and more detailed information to accept HaH care were investigated. The outcome measure was the willingness to accept HaH services. Chi-square tests and logistic regression models were used to analyze the factors.

Results

A total of 622 subjects participated in this study. The findings indicate that 55.9% of the participants were not aware of HaH services, while most of the subjects (88.4%) were willing to accept them. Regression models indicated that having health insurance (OR = 2.170, 95% CI: 1.003–4.697), an awareness of the necessity of HaH services (OR = 4.721, 95% CI: 2.471–9.019), very much hoping staff from central hospitals would be service providers (OR = 20.299, 95% CI: 5.718–72.068), and somewhat hoping that staff from central hospitals would be service providers (OR = 9.139, 95% CI: 2.714–30.775) were the factors associated with a greater willingness to accept HaH services.

Conclusion

The study indicates that compared to the awareness of HaH care, residents had a greater willingness to accept such care. The willingness to utilize HaH services among individuals was associated with enabling factors, predisposing factors, and HaH-related demand factors.

Oral Mucosa Status and Saliva Parameters of Multimorbid Adult Patients Diagnosed with End-Stage Chronic Kidney Disease

There has been an increasing number of patients diagnosed with chronic diseases. Many of those diseases determine changes in patients’ social and even professional life. The aim of the present work was to analyze saliva and oral mucosa parameters in adult patients diagnosed with chronic diseases. A total of 228 patients took part in the research. A total of 180 patients were hemodialyzed in Diaverum dialysis stations, and there were 48 patients from the Conservative Dentistry with Endodontics Clinic of the Academic Centre of Dentistry of Silesian Medical University in Bytom and patients from the dentistry division of the Arnika Clinic in Zabrze not diagnosed with any such diseases. Selected saliva parameters (secretion, pH and buffer capacity) and mucosa status were examined. In order to obtain information regarding xerostomia, patients were given a questionnaire. Patients assigned to the control group rarely used water to make swallowing easier or used candies to lessen the feeling of oral cavity dryness. They also rarely suffered from eye dryness. The feeling of dryness also did not influence their social life. The amount of produced saliva was higher in the control group. There was a significantly lower percentage of patients with a low buffer capacity of saliva. There were no differences in terms of saliva pH values between the two groups of patients. A significantly lower number of patients were diagnosed with ecchymosis, candidiasis, scrotal tongue and mechanical damages. Patients diagnosed with chronic diseases need to be provided with long-term care.

Application of Telemedicine Services Based on a Regional Telemedicine Platform in China From 2014 to 2020: Longitudinal Trend Analysis

BACKGROUND

Telemedicine that combines information technology and health care augments the operational model of traditional medical services and brings new opportunities to the medical field. China promotes telemedicine with great efforts, and its practices in the deployment of telemedicine platforms and delivery of services have become important references for the research and development in this field.

OBJECTIVE

Our work described in this paper focuses on a regional telemedicine platform that was built in 2014. We analyzed the system design scheme and remote consultations that were conducted via the system to understand the deployment and service delivery processes of a representative telemedicine platform in China.

METHODS

We collected information on remote consultations conducted from 2015 to 2020 via the regional telemedicine platform that employs a centralized architectural system model. We used graphs and statistical methods to describe the changing trends of service volume of remote consultation, geographical and demographic distribution of patients, and waiting time and duration of consultations. The factors that affect consultation duration and patient referral were analyzed by multivariable linear regression models and binary logistic regression models, respectively. The attitudes toward telemedicine of 225 medical practitioners and 225 patients were collected using the snowball sampling method.

RESULTS

The regional telemedicine platform covers all levels of medical institutions and hospitals in all 18 cities of Henan Province as well as some interprovince hospitals. From 2015 to 2020, 103,957 remote medical consultations were conducted via the platform with an annual increasing rate of 0.64%. A total of 86.64% (90,069/103,957) of medical institutions (as clients) that applied for remote consultations were tier 1 or 2 and from less-developed regions; 65.65% (68,243/103,945) of patients who applied for remote consultations were aged over 50 years. The numbers of consultations were high for departments focusing in the treatment of chronic diseases such as neurology, respiratory medicine, and oncology. The invited experts were mainly experienced doctors with senior professional titles. Year of consultation, tier of hospital, consultation department, and necessity of patient referral were the main factors affecting the duration of consultations. In surveys, we found that 60.4% (136/225) of medical practitioners and 53.8% (121/225) of patients had high satisfaction and believed that telemedicine is of vital importance for the treatment of illness.

CONCLUSIONS

The development of telemedicine in China shows a growing trend and provides great benefits especially to medical institutions located in less developed regions and senior citizens who have less mobility. Cases of remote consultations are mainly for chronic diseases. At present, the importance and necessity of telemedicine are well recognized by both patients and medical practitioners. However, the waiting time needs to be further reduced to improve the efficiency of remote medical services.

Association of leisure sedentary time with common chronic disease risk factors: A longitudinal study of China Health and Nutrition Surveys

BACKGROUND

Although the common risk factors were identified and controlled for many years, the overall prevalence of chronic diseases continued to increase in China.

OBJECTIVE

We presumed the leisure sedentariness as a latent but pivotal factor of chronic diseases, and examined its distribution and changing trend, analysed its interaction effects on common risk factors, which could provide a new perspective for the prevention and management.

METHODS

A total of 5013 participants were screened out from China Health and Nutrition Survey. Random-effects ordered logistic models were used for ordinal dependent variables, and fixed-effects or random-effects logit models were used for binary dependent variables.

RESULTS

From 2004 to 2011, the prevalence of high leisure sedentary time (LSED) increased by 58.58%. Members of the high LSED group were likely to choose fast food, salty snacks, soft drinks and more likely to smoke or drink alcohol compared with those of the low LSED group. However, they preferred walking, sports and body building more than those of the low LSED group.

CONCLUSIONS

For the unhealthy dietary, tobacco and alcohol consumption, more targeted introduction and guidance related to sedentary time should be promoted. Meanwhile, the appeal for physical exercise as well as adequate facilities should be initiated.