Regional Disparity of Medical Resources and Its Effect on Mortality Rates in China

Examining dynamic developmental trends: the interrelationship between age-friendly environments and healthy aging in the Chinese population-evidence from China Health and Retirement Longitudinal Study, 2011-2018

BACKGROUND

The objective of this research is to investigate the dynamic developmental trends between Age-Friendly Environments (AFE) and healthy aging in the Chinese population.

METHODS

This study focused on a sample of 11,770 participants from the CHARLS and utilized the ATHLOS Healthy Aging Index to assess the level of healthy aging among the Chinese population. Linear mixed model (LMM) was used to explore the relationship between AFE and healthy aging. Furthermore, a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM) were used to examine the dynamic developmental trends of healthy aging, taking into account both Between-Person effects and Within-Person effects.

RESULTS

The results from LMM showed a positive correlation between AFE and healthy aging (β = 0.087, p < 0.001). There was a positive interaction between the geographic distribution and AFE (central region * AFE: β = 0.031, p = 0.038; eastern region * AFE: β = 0.048, p = 0.003). In CLPM and RI-CLPM, the positive effect of healthy aging on AFE is a type of Between-Person effects (β ranges from 0.147 to 0.159, p < 0.001), while the positive effect of AFE on healthy aging is Within-Person effects (β ranges from 0.021 to 0.024, p = 0.004).

CONCLUSION

Firstly, individuals with high levels of healthy aging are more inclined to actively participate in the development of appropriate AFE compared to those with low levels of healthy aging. Furthermore, by encouraging and guiding individuals to engage in activities that contribute to building appropriate AFE, can elevate their AFE levels beyond the previous average level, thereby improving their future healthy aging levels. Lastly, addressing vulnerable groups by reducing disparities and meeting their health needs effectively is crucial for fostering healthy aging in these populations.

Spatial distribution and influencing factors of CDC health resources in China: a study based on panel data from 2016-2021

Background

Measuring the development of Chinese centers for disease control and prevention only by analyzing human resources for health seems incomplete. Moreover, previous studies have focused more on the quantitative changes in healthcare resources and ignored its determinants. Therefore, this study aimed to analyze the allocation of healthcare resources in Chinese centers for disease control and prevention from the perspective of population and spatial distribution, and to further explore the characteristics and influencing factors of the spatial distribution of healthcare resources.

Methods

Disease control personnel density, disease control and prevention centers density, and health expenditures density were used to represent human, physical, and financial resources for health, respectively. First, health resources were analyzed descriptively. Then, spatial autocorrelation was used to analyze the spatial distribution characteristics of healthcare resources. Finally, we used spatial econometric modeling to explore the influencing factors of healthcare resources.

Results

The global Moran index for disease control and prevention centers density decreased from 1.3164 to 0.2662 (p < 0.01), while the global Moran index for disease control personnel density increased from 0.4782 to 0.5067 (p < 0.01), while the global Moran index for health expenditures density was statistically significant only in 2016 (p < 0.1). All three types of healthcare resources showed spatial aggregation. Population density and urbanization have a negative impact on the disease control and prevention centers density. There are direct and indirect effects of disease control personnel density and health expenditures density. Population density and urbanization had significant negative effects on local disease control personnel density. Urbanization has an indirect effect on health expenditures density.

Conclusion

There were obvious differences in the spatial distribution of healthcare resources in Chinese centers for disease control and prevention. Social, economic and policy factors can affect healthcare resources. The government should consider the rational allocation of healthcare resources at the macro level.

Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China

BACKGROUND

Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR.

METHODS

This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021.

RESULTS

COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05).

CONCLUSIONS

Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.

Application of machine learning methods for predicting childhood anaemia: Analysis of Ethiopian Demographic Health Survey of 2016

Childhood anaemia is a public health problem in Ethiopia. Machine learning (ML) is a growing in medicine field to predict diseases. Diagnosis of childhood anaemia is resource intensive. The aim of this study is to apply machine learning (ML) algorithm to predict childhood anaemia using socio-demographic, economic, and maternal and child related variables. The study used data from 2016 Ethiopian demographic health survey (EDHS). We used Python software version 3.11 to apply and test ML algorithms through logistic regression, Random Forest (RF), Decision Tree, and K-Nearest Neighbours (KNN). We evaluated the performance of each of the ML algorithms using discrimination and calibration parameters. The predictive performance of the algorithms was between 60% and 66%. The logistic regression model was the best predictive model of ML with accuracy (66%), sensitivity (82%), specificity (42%), and AUC (69%), followed by RF with accuracy (64%), sensitivity (79%), specificity (42%), and AUC (63%). The logistic regression and the RF models of ML showed poorest family, child age category between 6 and 23 months, uneducated mother, unemployed mother, and stunting as high importance predictors of childhood anaemia. Applying logistic regression and RF models of ML can detect combinations of predictors of childhood anaemia that can be used in primary health care professionals.

Effect of Consultation Number on the Assessment and Treatment of Polycystic Ovary Syndrome

Background

The basic medical education stage is not enough to support physicians to fully diagnose and evaluate polycystic ovary syndrome (PCOS). The study aims to discover the difference in treatment choice between participants with different annual consultation number of PCOS, to promote lifelong learning, and drive balanced development within healthcare.

Methods

This is a multicenter cross-sectional survey. Participants' basic information, knowledge of PCOS and treatment options were collected online. According to the annual consultation number of patients with PCOS, physicians were divided into three groups: 0-50 people/yr, 50-200 people/yr, and >200 people/yr, and the results were derived from χ2 test, Fisher exact test, and multivariate logistic regression analysis.

Results

The study analyzed 1689 questionnaires, and 1206 physicians (71.4%) received less than 50 women per year, 388 physicians (30.0%) with an annual number of 50-200 women, and 95 physicians (5.6%) with patient turnover for more than 200 people. Reproductive endocrinologists generally have higher access to the clinic. As the number of visits increases, more and more physicians would perceive patients as more likely to have abnormal blood glucose and heavy weight. Physicians with large numbers of consultations are more likely to use Asian or Chinese standards to assess obesity. The multivariate analysis involved variables such as age, hospital level, specialty, and patient turnover annually, and more young doctors actively assessed lipid profile (odds ratio (OR) 1.56, 95% confidence interval (CI) (1.16, 2.16)), and primary hospitals (OR 0.65 CI (0.44, 0.89)) chose OGTT for blood glucose assessment less than tertiary hospitals. Physicians in secondary hospitals are more aggressive in evaluating androgens.

Conclusion

Our survey found differences in endocrine assessment, metabolic screening, and treatment in PCOS women in terms of the number of obstetrician-gynecologists who received different patient consultation numbers. The importance of continuing education for physicians is emphasized, to promote lifelong learning.

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study

BACKGROUND

After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap.

OBJECTIVE

This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia.

METHODS

We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS.

RESULTS

The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI≥28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020.

CONCLUSIONS

The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide.

Does digital infrastructure improve public Health? A quasi-natural experiment based on China's Broadband policy

This study proposed a scheme for improving people's health from the perspective of digital infrastructure construction. We used the China Family Panel Studies conducted between 2010 and 2020 and the digital infrastructure construction marked by the Broadband China policy between 2014 and 2016 as a quasi-natural experiment. We adopted the multi-time difference-in-differences method to identify the causal relationship between digital infrastructure and people's health. We found that digital infrastructure construction significantly improved people's health, and the effect was more prominent among young and middle-aged residents and those with less than a university education. Moreover, digital infrastructure construction improved the utilization of medical services, helped residents develop healthy lifestyles, and increased people's health investments. Additionally, digital infrastructure reduced health inequality among people and promoted health equity. The findings could guide future policies to improve people's health and well-being.

Exposure to ambient air pollution and chronic bronchitis: Findings from over 6.6 million adults in northwestern China

BACKGROUND

Ambient air pollution increases the risk of respiratory mortality and morbidity, but evidence concerning effects of air pollution on chronic bronchitis (CB) is scarce. This study aimed to evaluate the associations of a set of air pollutants with the burden of CB, and to explore potential modifiers on the associations.

METHODS

In 2020, a total of 6,556,440 adults living in the Northwestern region of China were recruited. The Space-Time Extra-Trees model was employed to assess the annual average concentrations of six air pollutants for the three years (2017-2019) before 2020 , and subsequently allocated to the participants based on the latitude and longitude of their home addresses. We investigated the associations between the levels of various air pollutants and the odds of CB using generalized linear mixed models, and conducted multiple sensitivity analyses and subgroup analyses.

RESULTS

The odds of CB displays an approximately linear association with particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5), particulate matter with aerodynamic diameter ≤10 μm (PM10), while it shows a non-linear relationship with gaseous pollutants. In the adjusted model, the odds ratios and 95% confidence intervals for CB per 10 μg/m3 increase in PM2.5, PM10, and sulfur dioxide (SO2) were 1.297 (1.262-1.332), 1.072 (1.064-1.080), and 2.587 (2.186-3.063), respectively. Furthermore, several additional sensitivity analyses demonstrated the stability of these associations. Subgroup analyses found that the aforementioned associations were greater among participants aged below 50 years old and those who smoked and had no leisure time exercise.

CONCLUSION

Long-term exposure to ambient air pollutants may increase the odds of CB, especially among younger people and those with unhealthy lifestyles.

Spatial and temporal analysis of China's healthcare resource allocation measurements based on provincial data: 2010-2021

Background

With the development of society, industrialization, urbanization, aging, lifestyle and social transformation, environmental degradation, global warming and other factors have had a great impact on the health of the population, and there is an urgent need to take a series of practical actions to promote the improvement of national health. Among them, healthcare resource allocation plays a key role in advancing the level of national health, treatment of chronic diseases, and leisure and healthcare.

Methods

This article collected panel data on healthcare resource allocation in all provinces of China from 2010 to 2021, and comprehensively applied Analytic Hierarchy Process, comprehensive scoring method, regional difference analysis and spatial autocorrelation analysis to reveal regional differences, spatial-temporal patterns and development characteristics of healthcare resource allocation in China.

Results

In terms of regional differences, intra-regional differences in healthcare resource allocation tend to narrow and inter-regional differences tend to widen. In terms of spatial pattern, the western provinces on the left side of the Hu Huanyong line generally have higher scores, while the central and eastern provinces on the right side of the Hu Huanyong line have lower scores, and healthcare resource allocation in the provinces on the left side of the Hu Huanyong line, such as Tibet, Xinjiang, Qinghai, Ningxia, Gansu, Inner Mongolia, Sichuan, have the spatial characteristics of HH clusters in terms of geographic location, while the southeast coastal provinces, such as Zhejiang, Fujian, Guangdong, Hainan, have the spatial characteristics of LL clusters in terms of geographic location. From the quadrant analysis, the 2010-2021 healthcare resource allocation in the first quadrant concentrates most of the provinces in the western and northeastern regions, while the third quadrant concentrates most of the provinces in the eastern region.

Conclusion

The allocation of healthcare resources in China's four major zones has undergone a process of change from "unbalanced quantity to relatively balanced quantity," but high-quality healthcare resources are highly concentrated in the eastern part of the country, and the problem of contradiction between people and doctors is prominent. It is recommended that Internet plus healthcare technology be used to reshape the regional allocation of high-quality healthcare resources.

Telenursing needs and influencing factors in patients with type 2 diabetes mellitus: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to determine the relationship between the demand for telenursing and the chronic illness resources available to patients with type 2 diabetes mellitus (T2DM), as well as the factors that affect this requirement.

DESIGN

Cross-sectional.

METHODS

This study included 586 participants with T2DM. A telenursing needs questionnaire developed by the research team was used to assess the telenursing needs of patients with T2DM, and the Chinese version of the Chronic Illness Resources Survey was used to assess the participants' community chronic disease resources. A one-way ANOVA and multiple regression analysis were used to determine the factors influencing the demand for telenursing and to estimate the relationship between chronic illness resources and the need for telenursing. The STROBE checklist was followed.

RESULTS

The patients' telenursing needs, ranked from high to low, are as follows: individualized skills and safety; basic disease care; psychological and spiritual needs; respect and social support; and high-level health management. The chronic disease resource score was 3.47 ± .02, which suggested that patients with T2DM have relatively rich disease resources. Multiple regression analyses showed that resources for chronic diseases, the course of diabetes and complications, family income and other chronic diseases accounted for 79.6% of the variance in T2DM patients' telenursing needs.

CONCLUSIONS

The telenursing needs of patients with T2DM are prominent, and primarily focus on basic nursing needs for the disease. To some extent, chronic disease resources affect the telenursing needs of patients with T2DM.

RELEVANCE TO CLINICAL PRACTICE

It is crucial to pay attention to research on telenursing for T2DM patients from the patients' perspective. Enhancing resources for chronic diseases may help meet the telenursing needs of T2DM patients.

PATIENT OR PUBLIC CONTRIBUTION

Parents and diabetes management specialists participated in designing the telenursing needs questionnaire.

Shared decision-making in healthcare in mainland China: a scoping review

Background

Shared decision-making (SDM) facilitates the participation of healthcare professionals and patients in treatment decisions. We conducted a scoping review to assess SDM's current status in mainland China, referencing the Ottawa Decision Support Framework (ODSF).

Methods

Our review encompassed extensive searches across six English and four Chinese databases, and various gray literature until April 30, 2021. Results were synthesized using thematic analysis.

Results

Out of the 60 included studies, we identified three key themes based on the ODSF framework: decisional needs, decision support, and decisional outcomes. However, there appears to be a lack of comprehensive understanding of concepts related to decisional needs in China. Only a few studies have delved into feasibility, preference, choice, and outcome factors in the SDM process. Another challenge emerges from an absence of uniform standards for developing patient decision aids (PDAs). Furthermore, regarding health outcome indicators, their predominant focus remains on physiological needs.

Conclusion

SDM is in its infancy in mainland China. It is important to explore the concept and expression of decisional needs in the context of Chinese culture. Subsequent studies should focus on constructing a scientifically rigorous and systematic approach for the development of PDAs, and considering the adaptation of SDM steps to the clinical context in China during SDM implementation. Concurrently, The focus on health outcomes in Chinese SDM studies, driven by the unique healthcare resource landscape, underscores the necessity of prioritizing basic needs within limited resources.

Systematic review registration

https://inplasy.com/?s=202130021.

Spatial price differences of medical services: evidence from the Yangtze River Delta in China

BACKGROUND

Price differences of medical services across regions may affect equity in health financing. This study aimed to estimate the spatial price index of medical services to measure price levels across regions in the Yangtze River Delta, China.

METHODS

Gini-Éltetö-Köves-Szulc method and minimum spanning tree method based on the purchasing power parities were used in this study.

RESULTS

According to the Gini-Éltetö-Köves-Szulc method, Shanghai and Anhui province had price levels that are 127.55% and 103.45% respectively of the price level in Zhejiang province, whereas in Jiangsu medical services were priced at 92.71% of that in Zhejiang province. The spatial price index of medical services in the Yangtze River Delta based on the minimum spanning tree method provided similar results.

CONCLUSIONS

Regions in the Yangtze River Delta had significant gaps in medical services price levels. And the price levels tended to not correlate with socioeconomic levels. It is necessary to promote the regional coordination of medical services price and better achieve equity in health.

Social media engagement in the maritime industry during the pandemic

The maritime sectors are suffering severe disruptions as a result of COVID-19. Maritime companies have turned to social media to interact with partners and clear up confusion. However, not every social media post receives the same engagement levels especially during a pandemic. For a more holistic analysis of social media engagement during a pandemic, the Protection Motivation Theory and classical theories such as user gratification and media richness theories were included. The research uses hierarchical regression analysis on information gathered from Facebook posts about COVID-19 made by eighteen different companies from four distinct maritime sectors. It was found that the rate of stakeholder engagement is highly influenced by informational, relational, and entertaining content as well as content that fosters self-efficacy, severity, and vulnerability. Additionally, the stakeholder engagement rate is greatly influenced by posts with greater vividness and fluency, which are characterized by providing external links. This is the first study to look into why stakeholders interact with posts linked to COVID-19 on social media. The findings will help maritime organisations use social media as a management and communication instrument.

A pilot study of Kangaroo mother care in early essential newborn care in resource-limited areas of China: the facilitators and barriers to implementation

BACKGROUND

Implementation of Kangaroo Mother Care (KMC) in resource-limited areas of China may face unique barriers, such as a lack of resources, geographic location and more traditional culture among others. This qualitative study analyses the facilitators and barriers to implementing KMC in county-level health facilities in resource-limited areas of China for the promotion of KMC on a larger scale.

METHODS

Participants from 4 of the 18 pilot counties where early essential newborn care was implemented through the Safe Neonatal Project and 4 control counties not enrolled in Safe Neonatal Project were selected using purposive sampling. A total of 155 participants were interviewed, including stakeholders of the Safe Neonatal Project such as national maternal health experts, relevant government officials and medical staff. Thematic analysis was used to process and analyse the interview content in order to summarise the facilitators and barriers to implementing KMC.

RESULTS

KMC was accepted in the pilot areas but still faced certain challenges due to institutional regulation, resource provision and the perceptions of health staff, postpartum mothers and their families as well as COVID-19 prevention and control regulations. The facilitators identified were government officials and medical staff acceptance and the incorporation of KMC into routine clinical care. The barriers identified were a lack of dedicated funding and other resources, the present scope of health insurance and KMC cost-sharing mechanism, providers' knowledge and practical abilities, parental awareness, postpartum discomfort, fathers' inadequate involvement, and the impact from COVID-19.

CONCLUSION

The Safe Neonatal Project pilot experience indicated the feasibility of implementing KMC in more areas of China. Optimising institutional regulations, providing necessary supporting resources and enhancing education and training may help to refine the implementation and scale-up of KMC practice in China.

Prevalence and correlators of burnout among health professionals during different stages of the COVID-19 pandemic in China

Background

Persistently increased workload and stress occurred in health professionals (HPs) during the past 3 years as the COVID-19 pandemic continued. The current study seeks to explore the prevalence of and correlators of HPs' burnout during different stages of the pandemic.

Methods

Three repeated online studies were conducted in different stages of the COVID-19 pandemic: wave 1: after the first peak of the pandemic, wave 2: the early period of the zero-COVID policy, and wave 3: the second peak of the pandemic in China. Two dimensions of burnout, emotional exhaustion (EE) and declined personal accomplishment (DPA), were assessed using Human Services Survey for Medical Personnel (MBI-HSMP), a 9-item Patient Health Questionnaire (PHQ-9), and a 7-item Generalized Anxiety Disorder (GAD-7) to assess mental health conditions. An unconditional logistic regression model was employed to discern the correlators.

Results

There was an overall prevalence of depression (34.9%), anxiety (22.5%), EE (44.6%), and DPA (36.5%) in the participants; the highest prevalence of EE and DPA was discovered in the first wave (47.4% and 36.5%, respectively), then the second wave (44.9% and 34.0%), and the third wave had the lowest prevalence of 42.3% and 32.2%. Depressive symptoms and anxiety were persistently correlated with a higher prevalence risk of both EE and DPA. Workplace violence led to a higher prevalence risk of EE (wave 1: OR = 1.37, 95% CI: 1.16-1.63), and women (wave 1: OR = 1.19, 95% CI: 1.00-1.42; wave 3: OR =1.20, 95% CI:1.01-1.44) and those living in a central area (wave 2: OR = 1.66, 95% CI: 1.20-2.31) or west area (wave 2: OR = 1.54, 95% CI: 1.26-1.87) also had a higher prevalence risk of EE. In contrast, those over 50 years of age (wave 1: OR = 0.61, 95% CI: 0.39-0.96; wave 3: OR = 0.60, 95% CI: 0.38-0.95) and who provided care to patients with COVID-19 (wave 2: OR = 0.73, 95% CI: 0.57-0.92) had a lower risk of EE. Working in the psychiatry section (wave 1: OR = 1.38, 95% CI: 1.01-1.89) and being minorities (wave 2: OR = 1.28, 95% CI: 1.04-1.58) had a higher risk of DPA, while those over 50 years of age had a lower risk of DPA (wave 3: OR = 0.56, 95% CI: 0.36-0.88).

Conclusion

This three-wave cross-sectional study revealed that the prevalence of burnout among health professionals was at a high level persistently during the different stages of the pandemic. The results suggest that functional impairment prevention resources and programs may be inadequate and, as such, continuous monitoring of these variables could provide evidence for developing optimal strategies for saving human resources in the coming post-pandemic era.

Critical Dynamics in Black and Latino Parents' Perceptions of Childhood COVID-19 Vaccination: How the "Middle" Moves

National and state data show low adoption of childhood COVID-19 vaccinations, despite emergency use authorizations and availability. We conducted 24 in-depth, semi-structured interviews with Black and Latino parents in New York City (15 in English, 9 in Spanish), who were undecided or somewhat likely to vaccinate their 5 to 11-year-old children in early 2022. The interviews explored the evolution of parental perceptions on childhood COVID-19 vaccines, and were analyzed using a matrix-driven rapid approach to thematic analysis. We present our findings as themes oriented around trust at three levels of the social ecological model. In summary, we found that structural positionality and historical traumas of participants seeded mistrust in institutions and government. This led to parental reliance on personal observations, conversations, and norms within social groups for vaccine decision-making. Our findings also describe key features of trust-building, supportive conversations that shaped the thinking of undecided parents. This study demonstrates how relational trust becomes a key factor in parental vaccine decision-making, and suggests the potential power of community ambassador models of vaccination promotion for increasing success and rebuilding trust with members of the "movable middle."

Violence on the front line: a qualitative comparative analysis of the causes of patient violence towards medical staff in China during the COVID-19 pandemic

COVID-19, reduced funding and a shortage of healthcare workers has led to growing international concern about patient violence towards medical staff in medical settings. As the number of reported physical and verbal assaults increases, many medical staff are considering leaving their positions due to the resulting impact on their mental and physical wellbeing, creating a critical need to understand the causes for violence towards medical staff working on the front line. This study aims to examine the causes for patient violence towards medical staff in China during the COVID-19 pandemic. A case library was created containing twenty reported incidents of patient violence towards medical staff during the pandemic in China. Based on the Triadic Reciprocal Determinism (TRD) theory, we identify the personal, environmental, and behavioral factors, that cause incidents of violence towards medical staff. The outcome was set as 'Medical Staff Casualties', referring to whether, due to the violence experienced, the medical staff member was injured or died, or only experienced threatening or insulting behavior. Data was analyzed using Qualitative Comparative Analysis (QCA) to clarify the relationship between the different conditions and their relationship with the outcome. The study's results reveal that Relationship Closeness is a necessary condition for patient violence in the presence of outcome. Secondly, four distinct types of causes for patient violence towards medical staff were identified: Strong Relationship Oriented Violence, Healthcare Resources and Services Mismatched Violence, Violence caused by Ineffective Patient-Physician Communication, and Ineffective Communication Superimposed Low Patient Compliance Violence. Scientific guidance is provided for the creation of measures to prevent future violence towards medical staff from occurring. Strict precautions should be taken for preventing violence to protect a healthy society and harmonious medical environment, emphasizing the need for joint governance of multiple participants.

Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study

OBJECTIVES

Since the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist.

DESIGN

We applied the meta-frontier and slacks-based measurement-undesirable data envelopment analysis model to measure the medical service efficiency with or without medical quality constraints of the county-level public general hospitals (CPGHs). The assessment includes four inputs, three desirable outputs and one undesirable output. We conducted the assessment via Max-DEA V.8.19 software. Moreover, we analyse the factors affecting CPGHs' medical service efficiency based on the fractional response model.

SETTING

A total of 77 sample CPGHs were selected from Shanxi province in China from 2013 to 2018.

RESULTS

The results of this study showed that the efficiency level of county-level public hospitals in Shanxi Province is relatively low overall (the mean value of efficiency is 0.61 without quality constraints and 0.63 under quality constraints). This showed that ignoring medical quality constraints will result in lower efficiency and lower health resource usage for high medical quality hospitals. The medical service efficiency of CPGHs differs greatly among different regions. Under the meta-frontier, the hospitals in the central region had the highest efficiency (efficiency score 0.70), followed by those in the south (efficiency score 0.63) and the hospitals in the north had the lowest efficiency (efficiency score 0.54). Factors that have larger impacts on the service efficiency of county public hospitals are the average length of hospital stay, per capita disposable income and financial subsidy income.

CONCLUSIONS

To improve CPGHs' medical service efficiency, the government should increase investment in the northern region, and hospitals should improve the management level and allocate human resources rationally.

Mobile health-based home rehabilitation education improving early outcomes after anterior cruciate ligament reconstruction: A randomized controlled clinical trial

Objective

This study aimed to assess changes in joint range of motion (ROM) and knee joint function between patients who received the mobile health-based intervention and those who received regular care at 2 and 6 weeks after anterior cruciate ligament (ACL) reconstruction to provide better interventions in the future.

Methods

Patients who underwent ACL reconstruction were randomized into the experimental [Mobile health-based intervention (MHI); n = 62] and control (CON) groups (n = 63). The CON group underwent home-based rehabilitation exercise following the paper rehabilitation schedule, while the intervention group received additional mobile health-based education at weeks 1-6 after surgery. ROM, thigh circumference difference, and flexion pain were the primary outcomes. The secondary outcomes were the international knee documentation committee knee evaluation form (IKDC) scores and rehabilitation compliance scores. All the outcomes were measured 1 day before surgery as references and at 2 and 6 weeks after surgery.

Results

There was no statistical difference in the patients' ROM, thigh circumference difference, and VAS scores at the 2-week follow-up. At the 6-week follow-up, the ROM of the affected leg was (118.1 ± 20.5)° in the CON group and (126.6 ± 20.5)° in the MHI group, and the difference was statistically significant (P = 0.011). The difference in thigh circumference was 3.0 (2.0, 3.5) cm in the CON group and 2.5 (1.0, 3.0) cm in the MHI group. The difference was statistically significant (P < 0.001). The VAS score in the CON group was 3.0 (2.0, 4.0), and the MHI group was 2.5 (1.0, 3.0). The difference was statistically significant (P < 0.05). At the 6-week follow-up, the compliance score of patients in the MHI group was significantly higher than that in the CON group (P = 0.047, β = 2.243, 95%CI: 0.026-4.459). There is no statistically significant difference in IKDC scores.

Conclusion

Mobile health-based intervention positively affected patients undergoing ACL reconstruction surgery, particularly in improving the clinical outcome indicators of the knee joint.

Secular Trends of Liver Cancer Mortality and Years of Life Lost in Wuhan, China 2010-2019

BACKGROUND

Liver cancer has caused a heavy burden worldwide. This study aimed to estimate the trends in the mortality and years of life lost (YLL) due to liver cancer and decompose the total deaths into three contributors: population growth, population aging, and mortality change.

METHODS

Our study used data from the cause-of-death surveillance system in Wuhan. The mortality and YLL rates were standardized according to the sixth national population census in China. This study calculated the estimated annual percentage change (EAPC) to estimate the trends in the age-standardized mortality rate (ASMR) and age-standardized YLL rate (ASYR). Meanwhile, a decomposition analysis was used to explore the effect of population growth, population aging, and age-specific mortality change on the change in liver cancer deaths.

RESULTS

The ASMR of liver cancer declined at an annual rate of 4.6% from 30.87 per 100,000 people in 2010 to 20.29 per 100,000 people in 2019, while the ASYR was at an annual rate of 5.6% from 969.35 per 100,000 people in 2010 to 581.82 per 100,000 people in 2019. Similar downward trends were seen in men and women. The decomposition analysis found that total deaths number changed by -12.42% from 2010 to 2019, of which population growth and population aging caused the total death numbers to increase by 9.75% and 21.15%, while the age-specific mortality change caused the total death numbers to decrease by 43.32%.

CONCLUSION

Although the ASMR of liver cancer has declined in recent years in Wuhan, it still causes a heavy burden with the increasing population and rapid population aging and remains an essential public health issue. The government should take measures to reduce the burden of liver cancer, especially among men.

Incidence and risk factors of SARS-CoV-2 infection among workers in a public health laboratory in Tunisia

The aim of this study was to measure the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among workers at the Institut Pasteur de Tunis (IPT), a public health laboratory involved in the management of the COVID-19 pandemic in Tunisia, and to identify risk factors for infection in this occupational setting. A cross-sectional survey was conducted on IPT workers not vaccinated against coronavirus disease 2019 (COVID-19). Participants completed a questionnaire that included a history of reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection. Immunoglobulin G antibodies against the receptor-binding domain of the spike antigen (anti-S-RBD IgG) and the nucleocapsid protein (anti-N IgG) of the SARS-CoV-2 virus were detected by enzyme-linked immunoassay (ELISA). A multivariate analysis was used to identify factors significantly associated with SARS-CoV-2 infection. A total of 428 workers were enrolled in the study. The prevalence of anti-S-RBD and/or anti-N IgG antibodies was 32.9% [28.7-37.4]. The cumulative incidence of SARS-CoV-2 infection (positive serology and/or previous positive RT-PCR test) was 40.0% [35.5-44.9], while the proportion with asymptomatic infection was 32.9%. One-third of the participants with RT-PCR-confirmed infection tested seronegative more than 90 days postinfection. Participants aged over 40 and laborers were more susceptible to infection (adjusted OR [AOR] = 1.65 [1.08-2.51] and AOR = 2.67 [1.45-4.89], respectively), while tobacco smokers had a lower risk of infection (AOR = 0.54 [0.29-0.97]). The SARS-CoV-2 infection rate among IPT workers was not significantly different from that detected concurrently in the general population. Hence, the professional activities conducted in this public health laboratory did not generate additional risk to that incurred outside the institute in day-to-day activities.

Communication with Kin in the Wake of the COVID-19 Pandemic

This study investigates patterns of communication among non-coresident kin in the aftermath of the COVID-19 pandemic using data from the New York City Robin Hood Poverty Tracker. Over half of New Yorkers spoke to their non-coresident family members several times a week during the pandemic and nearly half increased their communication with non-coresident kin since March 2020. Siblings and extended kin proved to be especially important ties activated during the pandemic. New Yorkers were most likely to report increased communication with siblings. A quarter of respondents reported that they increased communication with at least one aunt, uncle, cousin, or other extended family member. While non-Hispanic White respondents reported the highest frequency of communication with kin, it was those groups most impacted by COVID-19 - foreign-born, Black, and Hispanic New Yorkers - who were most likely to report that they increased communication with kin in the wake of the pandemic.

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.

Fiscal autonomy of subnational governments and equity in healthcare resource allocation: Evidence from China

Objectives

Promoting equity in healthcare resource allocation (EHRA) has become a critical political agenda of governments at all levels since the ambitious Universal Health Coverage was launched in China in 2009, while the role of an important institutional variable-fiscal autonomy of subnational governments-is often overlooked. The present study was designed to determine the effect of FASG on EHRA and its potential mechanism of action and heterogeneity characteristics to provide empirical support for the research field expansion and relative policies making of EHRA.

Methods

From the start, we utilized the Theil index and the entropy method to calculate the EHRA index of 22 provinces (2011-2020) based on the medical resource data of 287 prefecture-level cities. Furthermore, we used the two-way fixed effects model (FE) to identify and analyze the impact of FASG on EHRA and then used three robustness test strategies and two-stage least squares (2SLS) regression to verify the reliability of the conclusions and deal with potential endogeneity problems, respectively. At last, we extend the baseline regression model and obtain the two-way FE threshold model for conducting heterogeneity analysis, which makes us verify whether the baseline model has nonlinear characteristics.

Results

The static value and the trend of interannual changes in the EHRA values in different provinces are both very different. The regression results of the two-way FE model show that FASG has a significant positive impact on EHRA, and the corresponding estimated coefficient is - 0.0849 (P < 0.01). Moreover, this promotion effect can be reflected through two channels: enhancing the intensity of government health expenditure (IGHE) and optimizing the allocation of human resources for health (AHRH). At last, under the different economic and demographic constraints, the impact of FASG on EHRA has nonlinear characteristics, i.e., after crossing a specific threshold of per capita DGP (PGDP) and population density (PD), the promotion effect is reduced until it is not statistically significant, while after crossing a particular threshold of dependency ratio (DR), the promotion effect is further strengthened and still statistically significant.

Conclusions

FASG plays an essential role in promoting EHRA, which shows that subnational governments need to attach great importance to the construction of fiscal capability in the allocation of health care resources, effectively improve the equity of medical and health fiscal expenditures, and promote the sustainable improvement of the level of EHRA.

Construction of a three-level enteral nutrition nursing system under the "Internet + medical" mode and an evaluation of its effect in clinical application

Objective

This study aimed to explore the construction of a three-level enteral nutrition nursing system under the "Internet + medical" mode and the clinical application effect.

Methods

A total of 40 nurses from four primary and secondary hospitals in Jiangxi Province and 100 patients treated with enteral nutrition between January 2020 and December 2021 were enrolled in this study. Patients in the control group received routine enteral nutrition nursing. In the study group, a three-level enteral nutrition nursing system was applied under the "Internet + medical" mode to train and guide the implementation of clinical enteral nutrition. The changes in nurses' cognition and behavior in enteral nutrition safety nursing, comprehensive core competence before and after training, and the effect of enteral nutrition nursing were compared between the two groups.

Results

After 3 months of training, nurses' cognition and behavior scores in enteral nutrition safety nursing were higher than those before training (t = 11.780, P < 0.05), and nurses' core competence scores were higher than before training (P < 0.05). After 1 week of nursing, the nutritional risk screening 2002 (NRS2002) score decreased, and the levels of albumin and hemoglobin increased in both groups (P < 0.05). However, after 1 week of nursing, the NRS2002 score of the study group (2.89 ± 0.75) was lower than that of the control group (3.25 ± 0.82), and the levels of albumin (39.89 ± 3.21) and hemoglobin (119.57 ± 8.78) were higher in the study group than in the control group (albumin 36.25 ± 3.45, hemoglobin 113.66 ± 9.55) (P < 0.05).

Conclusion

Three-level enteral nutrition nursing linkage assisted by the "Internet + medical" mode can improve the cognition and behavior of medical staff in enteral nutrition safety nursing, as well as the comprehensive core competence of nurses, achieving good clinical effects.

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Multiple pathways and mediation effects of built environment on kidney disease rate via mitigation of atmospheric threats

Air pollution and high temperatures can increase kidney disease rate, especially under climate change. A well-designed urban environment has mediating effects on atmospheric environmental threats and promoting human health, but previous studies have overlooked these effects. This study used partial least squares modeling and urban-scale data from Taiwan to identify the crucial effects (i.e., direct, indirect, and total effects) and pathways of urban form (i.e., urban development intensity, land-use mix, and urban sprawl), urban greening (i.e., green coverage), urban industrial status (e.g., industrial level), atmospheric environment (i.e., high temperature and air pollution), and socioeconomic status (i.e., elderly ratio, medical resources, and economic status) on kidney disease rate. Maximizing land-use mix and green coverage and minimizing urban development intensity, urban sprawl, and industrial levels could help reduce kidney disease rate. Air pollution and high temperature had a mediation effect of built environment on kidney disease rate; with the mediation effect of air pollution was greater than that of high temperature. Furthermore, air pollution, high temperature, and elderly ratio increased kidney disease rate, whereas medical resources decreased kidney disease rate. This study is the first to consider the impact (i.e., direct, indirect, and total effects) and pathways of built environment characteristics on kidney disease rate. The findings revealed that an appropriate urban policy might be a practical strategy and lower kidney disease rate for a healthy city development. Moreover, this study provides a new approach for clarifying complex relationships and identifying crucial factors.

Prevalence of stroke in China, 2013-2019: A population-based study

Background

The stroke burden in China has increased during the past 40 years. The present study aimed to determine the recent trends in the prevalence of stroke from 2013 to 2019 stratified by sociodemographic characteristics, including sex, age, residence, ethnicity, and province within a population-based screening project in China.

Methods

We made use of data generated from 2013 to 2019 in the China Stroke High-risk Population Screening Program. All living subjects with confirmed stroke at interview were considered to have prevalent stroke. All analyses of prevalence of stroke were weighted and results were presented as percentage and 95% confidence interval (CI).

Findings

A total of 4229,616 Chinese adults aged ≥40 years from 227 cities in the 31 provinces were finally included. The enrollment rate ranged from 58.8% (2017) to 67.8% (2013). The weighted prevalence of stroke increased annually from 2013 to 2019, being 2.28% (95% CI: 2.28-2.28%) in 2013, 2.34% (2.34-2.35%) in 2014, 2.43% (2.43-2.43%) in 2015, 2.48% (2.48-2.48%) in 2016, 2.52% (2.52-2.52%) in 2017, 2.55% (2.55-2.55%) in 2018, and 2.58% (2.58-2.58%) in 2019 (p for trend <0.001). The weighted prevalence of stroke was higher for male sex, older age, and residence in rural and northeast areas.

Interpretation

The prevalence of stroke in China and most provinces has continued to increase in the past 7 years (2013-2019). These findings, especially in provinces with high stroke prevalence, can help public health officials to increase province capacity for stroke and related risk factors prevention.

Fundings

This study was supported by grants from the National Major Public Health Service Projects.

Does direct settlement of intra-province medical reimbursements improve financial protection among middle-aged and elderly population in China? Evidence based on CHARLS data

In low- and middle-income countries, social health insurance schemes are the main focus of efforts to achieve universal health coverage (UHC) by promoting access to health care and financial protection. Problems with financial protection in China are caused mainly by health insurance fragmentation and a rapid rise in medical expenditure. In this context, China implemented a policy of direct settlement of intra-provincial medical reimbursement in 2014. We evaluated the impact of the policy on financial protection with a population aged 45 and above based on the China Health and Retirement Longitudinal Study from 2011 to 2018. We estimated the policy effects using the difference-in-differences method, based on coarsened exact matching. We found that the policy significantly reduced the catastrophic health expenditures (CHEs) rate by approximately 10% in the population, whether middle-aged or elderly. Subgroup analyses indicated that middle-aged and elderly people living in western China and with lower household incomes received greater protection from the policy. The CHEs rate for the two age groups in western China was reduced by 16.26% and 20.12%, respectively. The CHEs rate was reduced by 24.51% and 17.32% for middle-aged individuals in the lowest and second household income quartiles, respectively, and by 21.31% for older adults in the second household income quartile. The new rural cooperative medical scheme exerted a smaller protective effect than urban medical insurance among the participants aged 60 and older. We found that in addition to optimizing health insurance schemes, more health care reform measures, such as adopting more efficient payment methods and rationalizing medical expenditures, should be combined to help reduce health inequities and accelerate progress toward achieving UHC and the Sustainable Development Goals.

Mobile internet-based mixed-reality interactive telecollaboration system for neurosurgical procedures: technical feasibility and clinical implementation

OBJECTIVE

To increase access to health interventions and healthcare services for patients in resource-constrained settings, strategies such as telemedicine must be implemented for the allocation of medical resources across geographic boundaries. Telecollaboration is the dominant form of surgical telemedicine. In this study, the authors report and evaluate a novel mobile internet-based mixed-reality interactive telecollaboration (MIMIT) system as a new paradigm for telemedicine and validate its clinical feasibility.

METHODS

The application of this system was demonstrated for long-distance, real-time collaboration of neuroendoscopic procedures. The system consists of a local video processing workstation, a head-mounted mixed-reality display device, and a mobile remote device, connected over mobile internet (4G or 5G), allowing global point-to-point communication. Using this system, 20 cases of neuroendoscopic surgery were performed and evaluated. The system setup, composite video latency, technical feasibility, clinical implementation, and future potential business model were analyzed and evaluated.

RESULTS

The MIMIT system allows two surgeons to perform complex visual and verbal communication during the operation. The average video delay time is 184.25 msec (range 160–230 msec) with 4G mobile internet, and 23.25 msec (range 20–26 msec) with 5G mobile internet. Excellent image resolution enabled remote neurosurgeons to visualize all critical anatomical structures intraoperatively. Remote instructors could easily make marks on the surgical view; then the composite image, as well as the audio conversation, was transferred to the local surgeon. In this way, a real-time, long-distance collaboration can occur. This system was used for 20 neuroendoscopic surgeries in various cities in China and even across countries (Boston, Massachusetts, to Jingzhou, China). Its simplicity and practicality have been recognized by both parties, and there were no technically related complications recorded.

CONCLUSIONS

The MIMIT system allows for real-time, long-distance telecollaborative neuroendoscopic procedures and surgical training through a commercially available and inexpensive system. It enables remote experts to implement real-time, long-distance intraoperative interaction to guide inexperienced local surgeons, thus integrating the best medical resources and possibly promoting both diagnosis and treatment. Moreover, it can popularize and improve neurosurgical endoscopy technology in more hospitals to benefit more patients, as well as more neurosurgeons.

Hospital sewage treatment facilities witness the fighting against the COVID-19 pandemic

Real-time evaluation of the fighting activities during a sudden unknown disaster like the COVID-19 pandemic is a critical challenge for control. This study demonstrates that the temporal variations of effluents from hospital sewage treatment facilities can be used as an effective indicator for such evaluation. Taking a typical infection-suffering city in China as an example, we found that there was an obvious decrease in effluent ammonia and COD concentrations in line with the start of city lockdown, and its temporal variations well indicated the major events happened during the pandemic control. Notably, the lagging period between the change point of effluent residual chlorine and the change points of COD and ammonia concentration coincided with a period in which there was a deficiency in local medical resources. In addition, the diurnal behavior of effluents from designated hospitals has varied significantly at different stages of the pandemic development. The effluent ammonia peaks shifted from daytime to nighttime after the outbreak of the COVID-19 pandemic, suggesting a high workload of the designated hospitals in fighting the rapidly emerging pandemic. This work well demonstrates the necessary for data integration at the wastewater-medical service nexus and highlights an unusual role of the effluents from hospital sewage treatment facilities in revealing the status of fighting the pandemic, which helps to control the pandemic.

Spatio-Temporal Disparity and Driving Forces of the Supply Level of Healthcare Service in the Yangtze River Delta

The equalization of healthcare supply is not only related to the people's need for a better life, but can also provide a strong guarantee for the high-quality and sustainable development of the Yangtze River Delta integration. By using exploratory spatial analysis techniques, this study analyzed the spatio-temporal evolution characteristics and heterogeneous influence effects of the supply level of healthcare service in the Yangtze River Delta from 2007 to 2019. It was found that the supply level of healthcare service in the Yangtze River Delta had improved significantly. The differences in the supply level of healthcare service between cities had tended to narrow without polarization, and the supply level of healthcare service generally showed a high spatial pattern in the south delta and low spatial pattern in the north delta. The higher the supply level of healthcare service was, the weaker the interannual variability was. The supply level of healthcare service in the Yangtze River Delta region presented obvious spatial association and differentiated tendency of local high and low spatial clusters. The relative length and curvature of the supply level of healthcare service in the Yangtze River Delta generally presented a spatial pattern with low values in the northeast and high values in the southwest. Population density and urban-rural income gap generally exhibited negative spatio-temporal impact on the supply level of healthcare service across most cities. On the other hand, urbanization level and per capita disposable income generally had positive spatio-temporal impact on the supply level of healthcare service across most cities. Per capita gross domestic product (GDP) showed an increasingly positive spatio-temporal impact on the supply level of healthcare service across most cities. While per capita fiscal expenditure exhibited significantly negative impact on the supply level of healthcare service across most cities in space.

Stillbirth trends by maternal sociodemographic characteristics among a large internal migrant population in Shenzhen, China, over a 10-year period: a retrospective study

BACKGROUND

Cities such as Shenzhen in southern China have large immigrant populations, and the reproductive health issues of pregnant women in these populations have not received sufficient attention. Stillbirth seriously threatens their health and is becoming a social issue worthy of attention. We conducted this study to estimate the trend in stillbirths at 28 or more gestational weeks and the related sociodemographic characteristics of pregnant women among a large internal migrant population in South China.

METHODS

A stillbirth is defined as a baby born with no signs of life after a given threshold, and are restricted to births of 28 weeks of gestation or longer, with a birth weight of at least 1000 g for international comparison. A population-based retrospective cohort of all births from January 2010 to December 2019 in Baoan, Shenzhen, was conducted using the Shenzhen Birth Registry Database. The overall stillbirth rate and year-specific stillbirth rate were calculated as the number of foetal deaths ≥28 gestational weeks or a birth weight ≥ 1000 g divided by the number of births over the last decade or in each year, respectively. The associations between the risk of stillbirth and maternal sociodemographic status were assessed using logistic regression. Spearman's rank correlation was calculated to evaluate the correlation between the economic status of the maternal birthplace and the stillbirth.

RESULTS

An overall stillbirth rate of 4.5 per 1000 births was estimated in a total of 492,184 births in our final analysis. Migrant women accounted for 87% of the total population but had a higher stillbirth rate (4.8 per 1000 births) than the permanent population (2.8 per 1000 births). The stillbirth rate varied by region of maternal birthplace, from 4.1 per 1000 births in women from East China to 5.7 per 1000 births in women from West China. The GDP per capita of the maternal birthplace was strongly correlated with the stillbirth rate.

CONCLUSIONS

Large disparities in the stillbirth rate exist between migrant and permanent populations and among regions of maternal birthplace in China. Strategies targeting migrant women based on their maternal birthplace are needed to further reduce the burden of stillbirth.

What is the general Chinese public's awareness of and attitudes towards Helicobacter pylori screening and associated health behaviours? A cross-sectional study

OBJECTIVE

To evaluate the general population's awareness of and attitudes toward Helicobacter pylori (HP) screening and health behaviours.

DESIGN

Cross-sectional study.

SETTING

Hengyang, Hunan Province, China.

PARTICIPANTS

Using stratified cluster random sampling, a pretested structured questionnaire was used to interview members of the general population aged ≥18 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge of and attitudes toward HP screening and associated health behaviours, sociodemographic factors associated with HP knowledge, and screening behaviours.

RESULTS

This study featured 1042 participants. The average knowledge score was 11 (Q_L=4, Q_U=20, range 0-29). Approximately 68.9% of the participants said they had heard of HP, but 67.5% had never had an HP test. The most common reasons for not undergoing screening were 'no symptoms' (55.7%) and 'lack of knowledge regarding the benefits of the test' (21.1%). Independent factors related to knowledge included age, education level, occupation, HP infection, frequency of drinking unboiled water (p<0.05). Factors independently associated with screening behaviour included occupation, average monthly income, presence/absence of indigestion, stomach discomfort or pain, and/or stomach disease and knowledge score (p<0.05). Overall, 941 (90.3%) participants never used anti-HP toothpaste, and 442 (40.5%) never used serving spoons or chopsticks. The risk factors for HP infection included eating out and eating in groups (p<0.05).

CONCLUSION

In China, the general population has poor knowledge of HP, but most people have a positive attitude towards HP screening. Being asymptomatic and lacking knowledge about testing were the main reasons for reluctance to be screened. These results highlight the urgent need for educational activities to raise awareness, enhance screening rates for HP, and encourage people to adopt a healthy lifestyle.

The Structural Characteristics of Economic Network and Efficiency of Health Care in China

With the rapid development of the economy of China, the interactivity between provinces and the mobility of the population is increasing. Some patients who could have received the same treatment in their residential areas still choose to receive services in areas with higher economic development and concentrated high-quality medical resources, resulting in a huge waste of medical resources. Blindly increasing medical resources everywhere does not necessarily increase the output effectively. In this study, the data envelopment analysis (DEA) model, social network analysis (SNA), cluster analysis, and regression analysis are used to analyze the structural characteristics of the economic network structure and efficiency of health care in China. The results show that indegree and eigenvector centrality have a significant positive correlation with the efficiency of health care, and the clustering coefficient has a significant negative correlation with the efficiency of health care in China. This study uses a k-means algorithm to classify 31 provinces into three groups and extract their characteristics. As for the supply of health care resources, the government should command and dispatch the resources in the whole country through a top-down design based on the characteristics of each province.

Does High-Speed Rail Opening Affect the Health Care Environment?-Evidence From China

Using the panel data of 280 prefecture-level cities in China from 2004 to 2014, this paper examines the effects of high-speed rail opening on health care environment based on Difference-in-Differences method (DID). Through an empirical analysis, the results proved that high-speed rail opening can significantly promote the health care environment and this effect is different in regions with different levels of economic development. Finally, we tested the mechanisms of how the high-speed rail opening affects the healthcare environment. High-speed rail opening improves the healthcare environment by increasing road accessibility and promoting economic development. Our results support the view that high-speed rail opening has an important contribution to the improvement of health care conditions.

Does Economic Support Have an Impact on the Health Status of Elderly Patients With Chronic Diseases in China? - Based on CHARLS (2018) Data Research

Objective: The economic support of elderly patients with chronic diseases may affect their health status. This study assessed the impact of economic support on the health status of elderly patients with chronic diseases in China and explored the relationship between regional economic differences and the impact of economic support on health status. Methods: This study used the data of 3,416 elderly patients with chronic diseases from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. Logit model and stepwise regression method were used to analyze and compare the influence of economic support on self-rated health, mental health, and activities of daily living (ADL) of elderly patients with chronic diseases. Sub-regional comparison was used for the research of regional differences in the impact of economic support on health. Results: we find that economic support has a positive effect on the health status of elderly patients with chronic diseases in China. Socioeconomic support has a positive effect on self-rated health and mental health of elderly patients with chronic diseases, and the effect on activities of daily living (ADL) is no longer significant after the gradual inclusion of control variables. Family economic support has no significant impact on the health dimensions of elderly patients with chronic diseases. With respect to regional differences, socioeconomic support can improve mental health in central China and improve self-rated health in western China, while it can improve overall health status in eastern China. The influence of family economic support on different health dimensions in different regions is still insignificant. Conclusions: The health status of elderly patients with chronic diseases is affected by socioeconomic support in China. In order to improve the health of elderly patients with chronic diseases, it is necessary to increase socioeconomic support. Meanwhile, it is also essential to pay attention to the differences in economic support between different regions and increase the socioeconomic support for elderly patients with chronic diseases in undeveloped regions so as to improve their health status.

Physical Activity Patterns, Psychosocial Well-Being and Coping Strategies Among Older Persons with Cognitive Frailty of the "WE-RISE" Trial Throughout the COVID-19 Movement Control Order

PURPOSE

Older persons have been identified as a vulnerable population with respect to the novel coronavirus outbreak, COVID-19. Aiming to "flatten the curve" a strict Movement Control Order (MCO) was implemented in Malaysia. Older adults with cognitive frailty are prone to physical, cognitive and psychosocial decline. This study aims to compare physical activity patterns, psychological wellbeing and coping strategies of older persons with cognitive frailty in the "WE-RISE" trial (intervention versus control) throughout this period.

MATERIALS AND METHODS

This study was conducted as a sub-analysis of the ongoing "WE-RISE" randomized controlled trial. This study included 42 community-dwelling older adults, aged 60 years and above, with cognitive frailty, stratified into intervention (n=21) and control (n=21) groups who are receiving a multi-domain intervention and usual care, respectively, within the Klang Valley, Malaysia. Phone call interviews were conducted during the MCO period. Physical activity patterns were assessed using International Physical Activity Questionnaire (IPAQ) and Functional Activities Questionnaire (FAQ). Psychological wellbeing was assessed using Flourishing Scale (FS) and General Health Questionnaire (GHQ-12), while the Brief Coping Orientation to Problems Experienced (COPE) assessed coping strategies. Data were analysed descriptively and with independent samples t-test.

RESULTS

The WE-RISE intervention group had significantly higher levels of estimated resting energy expenditure (MET) for "walking activity" (I:μ=1723.1±780.7;C:μ=537.4±581.9)(p<0.001), "moderate activity" (I:μ=1422.8±1215.1;C:μ=405.7±746.9)(p=0.002) and "total physical activity" (I: μ=3625.9±3399.3;C:μ=994.6±1193.9)(p=0.002). The intervention group was also significantly more independent in functional activities (μ=1.76±1.73) as compared to the control group (μ=5.57±8.31) (p<0.05). Moreover, significant higher self-perception of living a meaningful life and feeling respected (p<0.05) was demonstrated in regard to psychological well-being in the intervention group. Regarding coping strategies, the intervention group relied significantly on the domains of religion (I:μ=6.43±0.99;C:μ=6.09±1.09)(p<0.05) and planning (I:μ=4.81±0.75; C:μ=4.04±1.28)(p<0.05) whilst the control group relied on humour (C:μ=3.14±1.19; I:μ=2.38±0.74)(p<0.05).

CONCLUSION

Participants of the WE-RISE intervention group were more physically active, functionally independent and had higher self-perceived social-psychological prosperity regarding living a meaningful life and feeling respected; whilst both groups relied on positive coping strategies during the MCO. These results indicate that it is vital to ensure older persons with cognitive frailty remain physically active and preserve their psychosocial wellbeing to be more resilient in preventing further decline during a crisis such as the COVID-19 pandemic.

Multiple impacts and pathways of urban form and environmental factors on cardiovascular mortality

Air pollution and heat are significant threats to public health, especially in urban areas with intensive human activities under the trend of climate change. However, the mediation effects of urban form on health via air pollution and heat have been overlooked in previous investigations. This study explored the potential impacts and pathways of urban form on cardiovascular mortality through air pollutants and heat by using partial least squares model with data from Taiwan. The measurable characteristics of urban form include city size, urban sprawl, and mixed land use. Other factors that influence cardiovascular mortality, such as urban industrial level, economic status, aging population, and medical resource, were also considered in the model. Results revealed that maximizing mixed land use and minimizing city size and urban sprawl can help reduce cardiovascular mortality, and the minimizing city size was the most important one. Urban industrial level, economic status, aging population, and medical resource were also influential factors. This is the first study to consider the pathways and impacts of urban form on cardiovascular mortality, and our results indicate that proper urban planning and policy could reduce cardiovascular mortality.

Regional Heterogeneity of Application and Effect of Telemedicine in the Primary Care Centres in Rural China

The increasing concerns of the geographical maldistribution of medical resources have sparked worldwide interests in exploring the potential of telemedicine in the rural health system. This study aimed to investigate the application and effect of telemedicine as well as their regional heterogeneity in the primary care centres in rural China. Based on the stratified multistage cluster sampling, a cross-sectional study was conducted among 358 township health centres (THCs) from eastern, central and western China. A self-administered questionnaire was used and the data of the Health Statistical Annual Reports in 2017 were collected to investigate the implication of telemedicine as well as the performance and other characteristics of each THCs. Propensity score matching was used to estimate the effect of telemedicine application on the bed occupancy rate and the number of annual outpatient visits of the THCs, with comparison among the regions. The overall prevalence of telemedicine application was 58.66% in 2017, and it was found to increase the bed occupancy rate of the THCs in the national range (p < 0.1). When divided into different regions, telemedicine was found to improve the number of annual outpatient visits in western China (p < 0.05) and the bed occupancy rate in eastern China (p < 0.1). Disparities in the degree of remoteness and the capability of THCs among the regions were also found in this study, which may be the reasons for the regional heterogeneous effects of telemedicine. These findings suggested the potential of telemedicine in improving the utilization of primary care centres in rural areas. Further studies were needed to investigate the underlying reasons for its regional heterogeneous effects.