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Ma X, Li J, Zhou D, Yang R. Direct economic burden of patients with tuberculous meningitis in western China. Acta Neurol Scand 2021; 144:535-545. [PMID: 34131900 DOI: 10.1111/ane.13485] [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: 03/30/2021] [Revised: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate the direct economic burden of tuberculous meningitis (TBM) in China for the first time. METHODS Patients who were first diagnosed with TBM from December 2015 to December 2018 in Western China Hospital were enrolled. We retrospectively collected data on demographic and clinical features, resource utilization, costs, and long-term outcomes. The patients were followed up for 15-53 months. We performed a cost-of-illness study and analyzed the cost contributors with a generalized linear model. RESULTS In total, the cases of 154 TBM patients (95 males, 59 females, aged 14-82 years) were reviewed. The average total direct cost per person was USD (United States dollars) 9,484 (range 1,822-67,285), with a mean direct medical cost of USD 8,901 (range 1,189-67,049). The average inpatient cost and drug cost after discharge were USD 6,837 (range 845-52,921) and USD 1,967 (range 0-60,423), respectively. The mean direct nonmedical cost was USD 583 (range 33-3,817), which accounted for 6.2% of the total direct cost. The average length of stay (LOS) in hospital was 25.0 days (range 6-152). A total of 117 of the patients (76.0%) had good outcomes (mRS = 0-2). There was no significant difference in the costs, LOS, or outcomes between rural and urban patients. Contributors to total direct cost were definite TBM, fever, coma, seizures, multidrug resistance, hydrocephalus, and poor long-term outcome. CONCLUSIONS Although the accessibility of medical resources in remote and rural regions has significantly improved in China, the cost of TBM imposes a catastrophic burden on patients.
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Affiliation(s)
- Xue‐Ping Ma
- West China School of Nursing Sichuan University / Department of Neurology West China Hospital, Sichuan University Chengdu China
| | - Jin‐Mei Li
- Department of Neurology West China Hospital, Sichuan University Chengdu China
| | - Dong Zhou
- Department of Neurology West China Hospital, Sichuan University Chengdu China
| | - Rong Yang
- Department of Neurology West China Hospital, Sichuan University Chengdu China
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Gong QL, Chen Y, Tian T, Wen X, Li D, Song YH, Wang Q, Du R, Zhang XX. Prevalence of bovine tuberculosis in dairy cattle in China during 2010-2019: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009502. [PMID: 34138867 PMCID: PMC8241035 DOI: 10.1371/journal.pntd.0009502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/29/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bovine tuberculosis (bTB), caused by members of the Mycobacterium tuberculosis complex bacteria, mainly Mycobacterium bovis (M. bovis), is a major threat to public health and economic development. There has been no systematic epidemiological assessment concerning bTB in dairy cattle in China. METHODOLOGY/PRINCIPAL FINDINGS Literature related to bTB in China was retrieved from China National Knowledge Infrastructure (CNKI), PubMed, ScienceDirect, VIP Chinese Journals Database, and Wan Fang Database to build the first meta-analysis for estimating the prevalence and infection moderators of bTB in dairy cattle in China. A total of 100 relevant studies published from 2010 to 2019 were included. We estimated the overall prevalence of bTB was 2.4% (95% CI: 2.1-2.8) during this decade. In the sampling year subgroup, the prevalence was lowest in 2017 or later at 0.8% (95% CI: 0.3-1.5). The lowest prevalence was 0.7% (95% CI: 0.5-1.0) in Northwestern China. The lowest prevalence was 2.1% (95% CI: 1.8-2.5) using SIT test. Heifer cows had the highest prevalence, which was 27.1% (95% CI: 9.7-49.2). The prevalence in scale farming was 3.7% (95% CI: 3.1-4.3), significantly higher than that in free-range farming (1.7%, 95% CI: 1.1-2.4). The prevalence of bTB was highest in summer at 4.0% (95% CI: 1.7-7.0). In addition, the influence of different geographical factors (altitude, longitude, latitude, precipitation, temperature, humidity) on the prevalence was analyzed. CONCLUSIONS/SIGNIFICANCE The results showed that bTB was widespread in China but has been gradually reduced through concerted national intervention. It is suggested that different countries should formulate corresponding prevention and control measures according to the epidemic situation in its cattle industry. Enhanced monitoring of warm and humid areas may play an important role in reducing the incidence of bTB. In addition, when large-scale breeding is promoted, attention should be paid to standardizing breeding management and improving animal welfare to reduce the prevalence of bTB in cattle.
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Affiliation(s)
- Qing-Long Gong
- College of Chinese Medicine Materials, Jilin Agricultural University, Changchun, Jilin Province, PR China
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, PR China
| | - Yu Chen
- College of Animal Science and Veterinary Medicine, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang Province, PR China
| | - Tian Tian
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, PR China
| | - Xiaobo Wen
- College of Animal Science and Technology, Hainan University, Hainan Key Lab of Tropical Animal Reproduction and Breeding and Epidemic Disease Research, Haidian Island, Haikou, Hainan Province, PR China
| | - Dong Li
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, PR China
| | - Yu-Hao Song
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, PR China
| | - Qi Wang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, PR China
| | - Rui Du
- College of Chinese Medicine Materials, Jilin Agricultural University, Changchun, Jilin Province, PR China
- * E-mail:
| | - Xiao-Xuan Zhang
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao, Shandong Province, PR China
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Shanmugakani RK, Bonam W, Erickson D, Mehta S. An isothermal amplification-based point-of-care diagnostic platform for the detection of Mycobacterium tuberculosis: A proof-of-concept study. CURRENT RESEARCH IN BIOTECHNOLOGY 2021; 3:154-159. [PMID: 34308334 PMCID: PMC8301208 DOI: 10.1016/j.crbiot.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The timely diagnosis of active tuberculosis disease (TB) is crucial to interrupt the transmission and combat the spread of Mycobacterium tuberculosis (Mtb), the causative agent for TB. Here, we demonstrate the development of a specimen-direct rapid diagnostic method for TB which consists of an isothermal amplification device, Tiny Isothermal Nucleic acid quantification sYstem (TINY), coupled with helicase-dependent amplification (HDA). HDA, an isothermal amplification technique is established over TINY using pUCIDT-AMP vector carrying IS6110, the target DNA sequence for Mtb. The limit of detection of this technique for detecting the IS6110 within a threshold time of 50 min is 2.5 × 105 copies of IS6110. HDA in TINY for TB detection was evaluated using three IS6110-positive Mtb strains - H37Rv, CDC 1551, and Erdman wild-type and one IS6110-negative Mycobacterium avium. For spiked oral swabs, HDA in TINY detects IS6110 without any non-specificity in relatively short turnaround time (<1.5 h), highlighting its potential utility as a specimen-direct point-of-care diagnostic for TB. TINY does not require an uninterrupted power supply and its lightweight and small footprint offers portability and easier operation in clinical settings with poor infrastructure. Overall, HDA in TINY could serve as an efficient rapid, and portable platform for the qualitative detection of TB at the point-of-care.
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Affiliation(s)
- Rathina Kumar Shanmugakani
- Institute for Nutritional Sciences, Global Health, and
Technology, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
| | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - David Erickson
- Institute for Nutritional Sciences, Global Health, and
Technology, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
- Sibley School of Mechanical and Aerospace Engineering,
Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Institute for Nutritional Sciences, Global Health, and
Technology, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University,
Ithaca, NY, USA
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Yan C, Tadadej C, Chamroonsawasdi K, Chansatitporn N, Sung JFC. Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8610. [PMID: 33228187 PMCID: PMC7699543 DOI: 10.3390/ijerph17228610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. METHODS A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. RESULTS Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13-3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16-3.40). CONCLUSIONS Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.
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Affiliation(s)
- Chaofang Yan
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Charuwan Tadadej
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Natkamol Chansatitporn
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - John FC Sung
- Institute of Health and Development Studies, School of Public Health, Kunming Medical University, Kunming 650500, China;
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Zhang Y, Liu X, Yang L, Zhang G, Gu Z, Chen Z, Sun J. Barriers and Strategies: A Review of Access to Affordable Multi-Drug Resistant Tuberculosis Medication in China. Infect Drug Resist 2020; 13:3679-3687. [PMID: 33116687 PMCID: PMC7585516 DOI: 10.2147/idr.s256128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/26/2020] [Indexed: 01/06/2023] Open
Abstract
This study analyzed the barriers of patient access to affordable MDR-TB medication in China and the reasons behind, and proposed strategies towards removing the barriers based on literature review and key informant interviews. Reasons behind the high financial burden of MDR-TB patients in China are the lack of a coordinated and multi-sourced financing model to secure patients’ access to the expensive novel medicines, and the absence of the safety-net for the patients with low ability to pay the costs. Appropriate health insurance benefit packages and provider payment mechanisms, supportive legal framework, coordinated policies as well as incentives for off-label use of evidence-based repurposed medicines are missing. The observations identified key intervention areas including continued efforts to make the novel effective medicines affordable and to strengthen the legislative protection for off-label use of evidence-based medicines; increase incentives for pharmaceutical companies to expand indications of established medicines based on the evidence; implement public initiatives to support the use of repurposed medicines for diseases with major public health significance, and scale up good practices from local pilots to create a coordinated multi-sourced financing model. A comprehensive approach to address the barriers in the full treatment course of MDR-TB and a safety-net for low-ability-to-pay patients are also critical to secure universal access to affordable MDR-TB medication.
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Affiliation(s)
- Yuou Zhang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuan Liu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Linghe Yang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Guifang Zhang
- Institute of Geriatrics, Beijing Hospital, Beijing, People's Republic of China
| | - Zhaoru Gu
- Institute of Cancer, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhongdan Chen
- Hepatitis/TB/HIV/STI, World Health Organization, Office of the WHO Representative in China, Beijing, People's Republic of China
| | - Jing Sun
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Zhao Z, Jing S, Yan Z, Yu L. Social change and birth cohort decrease in social support for older adults in China: A cross-temporal meta-analysis, 1994-2018. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1438-1447. [PMID: 32378280 DOI: 10.1111/hsc.13004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Social support not only plays an important role in the physical and mental health of the elderly people but also constitutes an essential resource for healthy ageing. With the rapid economic and social development during the last 40 years in China, the acceleration of urbanisation, and the disintegration of traditional extended families, the social support that Chinese older adults receive may be declining, leading to deterioration in quality of life for the rapidly ageing population. Cross-temporal meta-analysis was employed to investigate changes in older Chinese adults' social support from 1994 to 2018. One hundred and thirty-six studies (N = 82,722; age ≥ 60) that used the social support rating scale (SSRS) were analysed. Additionally, social support scores were correlated with social indicators to explore the relationship between social support and the environment of social development. Results show that social support scores decreased by 5.09 and 0.73 standard deviations over the past 24 years. Correlation with social indicators suggests that a decrease in social connectedness and an increase in economic imbalance may be responsible for the reduction in social support.
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Affiliation(s)
- Zhang Zhao
- The Lab of Mental Health and Social Adaption, Southwest University, Chongqing, China
| | - Shuang Jing
- The Lab of Mental Health and Social Adaption, Southwest University, Chongqing, China
| | - Zhimin Yan
- The Lab of Mental Health and Social Adaption, Southwest University, Chongqing, China
| | - Lin Yu
- The Lab of Mental Health and Social Adaption, Southwest University, Chongqing, China
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Du L, Chen X, Zhu X, Zhang Y, Wu R, Xu J, Ji H, Zhou L, Lu X. Determinants of Medication Adherence for Pulmonary Tuberculosis Patients During Continuation Phase in Dalian, Northeast China. Patient Prefer Adherence 2020; 14:1119-1128. [PMID: 32753852 PMCID: PMC7354008 DOI: 10.2147/ppa.s243734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/11/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Medication adherence is crucial for decreasing the burden of tuberculosis, but few relevant studies have been conducted in northeast China. This study aimed to explore the level of medication adherence among pulmonary tuberculosis outpatients and the predictive factors based on the bio-psycho-social medical model. PATIENTS AND METHODS A cross-sectional multi-center survey was conducted in four tuberculosis medical institutions in Dalian, northeast China. Medication adherence was measured using the eight-item Chinese version of the Morisky Medication Adherence Scale, which divides adherence into three levels. The independent variables consisted of sociodemographic characteristics, treatment factors, knowledge about TB, mental health, and behavioral characteristics. Descriptive statistics, the chi-square test, and multivariate ordinal logistic regression were applied to analyze the data using Stata/MP 14.0. RESULTS Among the 564 eligible participants, 236 (41.84%) and 183 (32.45%) exhibited high and medium medication adherence, respectively, but 145 (25.71%) exhibited low medication adherence. Multivariate ordinal logistic regression showed that patients who were older (OR: 1.02, p=0.013) were employed (OR: 1.61, p=0.011), had better tuberculosis knowledge (OR: 1.34, p<0.001), and did not consume alcohol (OR: 1.84, p=0.032) exhibited higher medication adherence. However, patients who did not follow their doctors' advice to take adjuvant drugs (OR: 0.44, p=0.001), had a history of TB treatment (OR: 1.76, p=0.009), experienced adverse drug reactions (OR: 0.65, p=0.017), experienced stigma (OR: 0.67, p=0.032), and needed supervised treatment (OR: 0.66, p=0.012) exhibited lower medication adherence. CONCLUSION Tuberculosis patients' medication adherence was not very high and it was influenced by diverse and complex factors involving sociodemographic characteristics, treatment factors, knowledge about TB, mental health, and behavioral characteristics.
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Affiliation(s)
- Liang Du
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Yu Zhang
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
- Correspondence: Ling Zhou; Xiwei Lu Tel +86-411-8611-0368 Email ;
| | - Xiwei Lu
- Department of Tuberculosis Internal Medicine, Dalian Tuberculosis Hospital, Dalian, Liaoning116031, People’s Republic of China
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