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Lin L, Dong J, Wang Y, Song L, Ye X, Chen X, Miao C, Lin J. Digital therapeutics-based lifestyle intervention for gestational diabetes mellitus prevention of high-risk pregnant women: a study protocol for a non-randomised controlled trial. BMJ Open 2024; 14:e077336. [PMID: 38926141 PMCID: PMC11216049 DOI: 10.1136/bmjopen-2023-077336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Digital therapeutics have been approved as a treatment aid for various medical conditions and are increasingly prevalent. Despite numerous studies on the potential of digital therapeutic interventions in preventing gestational diabetes mellitus (GDM), there is a critical need for more high-quality, large-scale studies to validate their effectiveness. This need arises from the inconsistencies in results and variations in the quality of previous research. METHODS AND ANALYSIS We propose a non-randomised controlled trial involving 800 high-risk pregnant women in 6 maternity and child health hospitals in Fujian, China. This study aims to investigate the role and effectiveness of digital therapeutics-based lifestyle intervention in managing the health of pregnant women at high risk for GDM. The study will compare the differences in GDM prevalence, pregnancy weight management and other pregnancy-related health outcomes between pregnant women who received digital therapeutics-based lifestyle intervention and those in the control group. The intervention includes dietary guidance, a personalised physical activity programme and lifestyle improvement strategies delivered through a smartphone app. Primary outcomes include the incidence of GDM at 24-28 weeks gestation and gestational weight gain (GWG). Secondary outcomes comprise improvements in individual lifestyle and risk factors, nutritional issues, implementation outcomes and other pregnancy-related outcomes. ETHICS AND DISSEMINATION SECTION The trial was approved by the Ethics Committee of Fujian Maternity and Child Health Hospital (approval number: 2023KY046), Jianyang Maternity and Child Health Hospital (approval number: A202401), Fuqing Maternity and Child Health Hospital (approval number: FY2024003), Changting Maternity and Child Health Hospital (approval number: 202401), Datian Maternity and Child Health Hospital (approval number: dtfy202401) and Quanzhou Maternity and Child Health Hospital (approval number: 2024(50)). We will disseminate our findings by publishing articles in leading peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2300071496.
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Affiliation(s)
- Lihua Lin
- Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China
| | - Jiayi Dong
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, Fujian, China
| | - Youxin Wang
- North China University of Science and Technology School of Public Health, Tangshan, Hebei, China
| | - Libin Song
- Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, Fujian, China
| | - Xiaoyan Ye
- Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, Fujian, China
| | - Xingying Chen
- Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, Fujian, China
| | - Chong Miao
- Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China
| | - Juan Lin
- Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China
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Zhang X, Matheï C, Vermandere M, Zuo X, Wang Q, Leng H, Li T, Buntinx F. Inhibitors and facilitators to the utilization of postpartum care in China: an integrative review. Arch Public Health 2022; 80:247. [PMID: 36474282 PMCID: PMC9724330 DOI: 10.1186/s13690-022-01000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Postpartum care is an expanding concept in China, and it is gaining vast attention in Chinese society. However, due to some Chinese traditions and rituals during the postpartum period, the utilization of modern postpartum care should be improved on both individual and community levels from different aspects. This integrative review outlined the inhibitors and facilitators of postpartum care utilization in China. METHODS Writing an integrative review, a literature search was conducted in Chinese and English databases including Wan Fang, China National Knowledge infrastructure, Medline, Web of Science, and Embase till 31 October 2021 to capture citations covering 'postpartum care', 'utilization' and 'China'. Titles and abstracts were screened independently by three reviewers. Included studies were critically appraised using tools and checklists independently for both qualitative and quantitative studies by two different reviewers who also performed thematic synthesis. RESULTS Of the 4359 citations screened, 41 studies (450,788 patients) were selected. Categorization of the factors influencing postpartum care utilization revealed five components: sociocultural (25 studies); educational (24 studies); organizational (12 studies); economic (19 studies); and physical (6 studies). Factors influencing postpartum care utilization both on individual and community levels were identified. They included facilitated factors such as higher mother's and partner's education level, higher socioeconomic status, lower parity, better insurance coverage, urban geographical location, Han ethnicity, and better transportation. Inhibitory factors such as under-managed policy regulation, migrants without domicile, and lower quality of care were also reported. CONCLUSION This review has identified the inhibitors and facilitators of postpartum care utilization in China. Five major aspects including sociocultural, educational, organizational, economic, and physical components have been analysed. Results can be used to improve the utilization of modern postpartum care on both individual and community levels in Chinese society.
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Affiliation(s)
- Xiaoqian Zhang
- grid.5596.f0000 0001 0668 7884Academic Center for General Practice, Catholic University of Leuven, Leuven, Belgium ,Qingdao United Family Hospital, Qingdao, China
| | - Catharina Matheï
- grid.5596.f0000 0001 0668 7884Academic Center for General Practice, Catholic University of Leuven, Leuven, Belgium
| | - Mieke Vermandere
- grid.5596.f0000 0001 0668 7884Academic Center for General Practice, Catholic University of Leuven, Leuven, Belgium
| | - Xiaoli Zuo
- Qingdao United Family Hospital, Qingdao, China
| | - Qian Wang
- grid.5596.f0000 0001 0668 7884Department Translational Research in Gastrointestinal Disorders, Catholic University of Leuven, Leuven, Belgium
| | - Hui Leng
- grid.5596.f0000 0001 0668 7884Department Translational Research in Gastrointestinal Disorders, Catholic University of Leuven, Leuven, Belgium
| | - Tang Li
- grid.412521.10000 0004 1769 1119The Affiliated Hospital of Medical College Qingdao University, Qingdao, China
| | - Frank Buntinx
- grid.5596.f0000 0001 0668 7884Academic Center for General Practice, Catholic University of Leuven, Leuven, Belgium
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You H, Yu T, Gu H, Kou Y, Xu XP, Li XL, Cui N, Bai L. Factors Associated With Prescribed Antenatal Care Utilization: A Cross-Sectional Study in Eastern Rural China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019865435. [PMID: 31370723 PMCID: PMC6681245 DOI: 10.1177/0046958019865435] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With relatively sufficient antenatal health service supplies in eastern rural
China, the utilization still needs to be improved. The objective of this study
was to identify factors that correlate with antenatal care (ANC) utilization
from the demand-side in Jiangsu, China. In a cross-sectional survey, a sample of
896 rural women who had a childbearing history in the previous 5 years answered
ANC questions and formed the final analysis. Questionnaire was designed based on
Andersen’s behavioral model. The outcome variables included receiving times and
items of prescribed ANC utilization, and the explanatory variables were
organized into 3 hierarchical levels: predisposing, enabling, and need factors.
Univariate analysis and multivariate logistic regression analysis were
conducted. In the results of multivariate logistic regression, factors
significantly associated with ANC examination times included income, odds ratio
(OR) (95% confidence interval [CI]) = 2.90 (1.92-4.39); the distance from the
nearest hospital, OR (95% CI) = 0.67 (0.47-0.95); chronic disease, OR (95% CI) =
1.77 (1.15-2.72); and parity, OR (95% CI) = 0.66 (0.46-0.95), while factors
significantly associated with ANC examination items included education, OR (95%
CI) = 8.02 (1.08-59.67); income, OR (95% CI) = 3.90 (1.72-8.85); female medical
staff in towns and villages, OR (95% CI) = 2.64 (1.39-5.02); and parity, OR (95%
CI) = 0.41 (0.23-0.75). In reducing inadequate ANC utilization in rural area,
efforts should be made not only to target the rural women with lower income,
lower educational level, and multi-parity, but also to further improve the
accessibility of the primary medical facilities and female staff at the
grassroots level.
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Affiliation(s)
- Hua You
- 1 Nanjing Medical University, China.,2 Nanjing University, China
| | | | - Hai Gu
- 2 Nanjing University, China
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Huang Y, Martinez-Alvarez M, Shallcross D, Pi L, Tian F, Pan J, Ronsmans C. Barriers to accessing maternal healthcare among ethnic minority women in Western China: a qualitative evidence synthesis. Health Policy Plan 2019; 34:384-400. [PMID: 31219555 DOI: 10.1093/heapol/czz040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 12/20/2022] Open
Abstract
Quantitative evidence suggests that ethnic disparities in maternal healthcare use are substantial in Western China, but the reasons for these remain under-researched. We undertook a systematic review of English and Chinese databases between January 1, 1990 and February 23, 2018 to synthesize qualitative evidence on barriers faced by ethnic minority women in accessing maternal healthcare in Western China. Four English and 6 Chinese language studies across 8 provinces of Western China and 13 ethnic minority groups were included. We adapted the 'Three Delays' framework and used thematic synthesis to categorize findings into six themes. Studies reported that ethnic minority women commonly held traditional beliefs and had lower levels of education, which limited their willingness to use maternal health services. Despite the existence of different financial protection schemes for services related to delivery care, hospital birth was still too costly for some rural households, and some women faced difficulties navigating reimbursement procedures. Women who lived remotely were less likely to go to hospital in advance of labour because of difficulties in arranging accommodation; they often only sought care if pregnancies were complicated. Poor quality of care in health facilities, particularly misunderstandings between doctors and patients due to language barriers or differences in socio-economic status, and clinical practices that conflicted with local fears and traditional customs, were reported. The overall evidence is weak however: authors treated different ethnicities as if they belonged to one homogeneous group and half of the studies failed in methodological rigour. The current evidence base is very limited and poor in quality, so much more research elucidating the nature of 'ethnicity' as a set of barriers to maternal healthcare access is needed. Addressing the multiple barriers associated with ethnicity will require multi-faceted solutions that adequately reflect the specific local context.
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Affiliation(s)
- Yuan Huang
- School of Public Health, Kunming Medical University, No. 1168 Chunrong West Road, Kunming, China.,London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Melisa Martinez-Alvarez
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,MRC-Gambia at the London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, Gambia
| | - David Shallcross
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Li Pi
- West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Fan Tian
- West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Jay Pan
- West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China.,West China Research Center for Rural Health Development, Sichuan University, No. 16 Renmin South Road, Chengdu, China
| | - Carine Ronsmans
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, China.,West China Research Center for Rural Health Development, Sichuan University, No. 16 Renmin South Road, Chengdu, China
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Zhang X, Zhou L, Antwi HA. The impact of China's latest population policy changes on maternity insurance-a case study in Jiangsu Province. Int J Health Plann Manage 2018; 34:e617-e633. [PMID: 30295341 DOI: 10.1002/hpm.2677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/12/2022] Open
Abstract
This study aims to examine the impact of China's population policy changes on social insurance. Nearly 4 decades ago, China ushered in the 1-child policy as a family planning policy to control the adverse effect of high population growth. The current maternity insurance system in China is designed to fit the operations of the 1-child policy. However, the implementation of the comprehensive 2-child policy can pose a challenge to the sustainability of the current maternity insurance scheme hence the call for reform. The study empanels a novel and comprehensive system dynamic model that incorporates all the related factors that influence the income and expenditure of maternity insurance in the Jiangsu Province. Data are mainly derived from the historical data of the Statistical Yearbook of Jiangsu Province and the National Bureau of Statistics of China. These are used to construct and simulate a system dynamic model to determine a sustainable contribution rate for maternity insurance. In conclusion, if the rate of contribution of the current maternity insurance policy is not increased, the burden of implementing the comprehensive 2-child policy will exacerbate the current deficit balance of the maternity insurance fund. The existing maternity insurance benefits thus cannot be maintained, and women's health will be threatened. In the short term, the study proposes an increase in the rate of premium payment to prolong the life of the maternity insurance. In the long term, there is a need to improve the level of coordination and expand the coverage of maternity insurance.
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Affiliation(s)
- Xiaotian Zhang
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Lvlin Zhou
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Henry Asante Antwi
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China
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Xu T, Dainelli L, Yu K, Ma L, Silva Zolezzi I, Detzel P, Fang H. The short-term health and economic burden of gestational diabetes mellitus in China: a modelling study. BMJ Open 2017; 7:e018893. [PMID: 29203507 PMCID: PMC5736026 DOI: 10.1136/bmjopen-2017-018893] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/08/2017] [Accepted: 11/10/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) is associated with a higher risk for adverse health outcomes during pregnancy and delivery for both mothers and babies. This study aims to assess the short-term health and economic burden of GDM in China in 2015. DESIGN Using TreeAge Pro, an analytical decision model was built to estimate the incremental costs and quality-of-life loss due to GDM, in comparison with pregnancy without GDM from the 28th gestational week until and including childbirth. The model was populated with probabilities and costs based on current literature, clinical guidelines, price lists and expert interviews. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results. PARTICIPANTS Chinese population who gave birth in 2015. RESULTS On average, the cost of a pregnancy with GDM was ¥6677.37 (in 2015 international $1929.87) more (+95%) than a pregnancy without GDM, due to additional expenses during both the pregnancy and delivery: ¥4421.49 for GDM diagnosis and treatment, ¥1340.94 (+26%) for the mother's complications and ¥914.94 (+52%) for neonatal complications. In China, 16.5 million babies were born in 2015. Given a GDM prevalence of 17.5%, the number of pregnancies affected by GDM was estimated at 2.90 million in 2015. Therefore, the annual societal economic burden of GDM was estimated to be ¥19.36 billion (international $5.59 billion). Sensitivity analyses were used to confirm the robustness of the results. Incremental health losses were estimated to be approximately 260 000 quality-adjusted life years. CONCLUSION In China, the GDM economic burden is significant, even in the short-term perspective and deserves more attention and awareness. Our findings indicate a clear need to implement GDM prevention and treatment strategies at a national level in order to reduce the economic and health burden at both the population and individual levels.
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Affiliation(s)
- Tingting Xu
- China Center for Health Development Studies, Peking University, Beijing, China
| | | | - Kai Yu
- Consumer Research & Public Health, Nestlé Research Center, Beijing, China
| | - Liangkun Ma
- Peking Union MedicalCollege Hospital, Beijing, China
| | | | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
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Guan M. Should the poor have no medicines to cure? A study on the association between social class and social security among the rural migrant workers in urban China. Int J Equity Health 2017; 16:193. [PMID: 29115960 PMCID: PMC5678794 DOI: 10.1186/s12939-017-0692-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022] Open
Abstract
Background The rampant urbanization and medical marketization in China have resulted in increased vulnerabilities to health and socioeconomic disparities among the rural migrant workers in urban China. In the Chinese context, the socioeconomic characteristics of rural migrant workers have attracted considerable research attention in the recent past years. However, to date, no previous studies have explored the association between the socioeconomic factors and social security among the rural migrant workers in urban China. This study aims to explore the association between socioeconomic inequity and social security inequity and the subsequent associations with medical inequity and reimbursement rejection. Methods Data from a regionally representative sample of 2009 Survey of Migrant Workers in Pearl River Delta in China were used for analyses. Multiple logistic regressions were used to analyze the impacts of socioeconomic factors on the eight dimensions of social security (sick pay, paid leave, maternity pay, medical insurance, pension insurance, occupational injury insurance, unemployment insurance, and maternity insurance) and the impacts of social security on medical reimbursement rejection. The zero-inflated negative binomial regression model (ZINB regression) was adopted to explore the relationship between socioeconomic factors and hospital visits among the rural migrant workers with social security. Results The study population consisted of 848 rural migrant workers with high income who were young and middle-aged, low-educated, and covered by social security. Reimbursement rejection and abusive supervision for the rural migrant workers were observed. Logistic regression analysis showed that there were significant associations between socioeconomic factors and social security. ZINB regression showed that there were significant associations between socioeconomic factors and hospital visits among the rural migrant workers. Also, several dimensions of social security had significant associations with reimbursement rejections. Conclusions This study showed that social security inequity, medical inequity, and reimbursement inequity happened to the rural migrant workers simultaneously. Future policy should strengthen health justice and enterprises’ medical responsibilities to the employed rural migrant workers. Electronic supplementary material The online version of this article (10.1186/s12939-017-0692-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China.
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Correction: Comparing Maternal Services Utilization and Expense Reimbursement Before and After the Adjustment of the New Rural Cooperative Medical Scheme Policy in Rural China. PLoS One 2017; 12:e0170617. [PMID: 28099481 PMCID: PMC5242432 DOI: 10.1371/journal.pone.0170617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0158473.].
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