Can family doctor system improve health service utilization for patients with hypertension and diabetes in China? A difference-in-differences study

BACKGROUND

Family doctors, serving as gatekeepers, are the core of primary health care to meet basic health needs, provide accessible care, and improve attainable health. The study objective was to evaluate the impact of the family doctor system on health service utilization among patients with hypertension and diabetes in China.

METHODS

Difference-in-Differences (DID) models are constructed to estimate the net effect of the family doctor system, based on the official health management records and medical insurance claim data of patients with hypertension and diabetes in an eastern city of China.

RESULTS

The family doctor system significantly increases follow-up visits (hypertension patients coef. = 0.13, diabetes patients coef. = 0.08, both p < 0.001) and outpatient visits (hypertension patients coef. = 0.08, diabetes patients coef. = 0.05, both p < 0.001) among the contracted compared to the non-contracted. The proportion of outpatient visits in community health centers among the contracted significantly rose (hypertension patients coef. = 0.02, diabetes patients coef. = 0.04, both p < 0.001) due to significantly more outpatient visits in community health centers and fewer in secondary and tertiary hospitals. It also significantly mitigates the increase in inpatient admissions among hypertension patients but not among diabetes patients.

CONCLUSIONS

The examined family doctor system strengthens primary care, both by increasing follow-up visits and outpatient visits and promoting a rationalized structure of outpatient utilization in China.

New energy vehicles' technology innovation coordination strategy based on alliance negotiation under dual credit policy

The development of new energy vehicles (NEVs) is one of the effective ways to alleviate carbon emissions, environmental pollution, and energy scarcity in the transportation sector. The Chinese government has innovatively proposed the "dual credit policy," but it is still a hot topic whether it can promote the NEVs' technological innovation. In this study, we construct game models and obtain the technological innovation strategies for NEVs under the dual credit policy, considering that the NEV supply chain contains one manufacturer and N suppliers. Further, we construct bargaining game models and study how to encourage manufacturers and suppliers to enhance technological innovation, realize supply chain coordination, and give the alliance strategy to maximize suppliers' profit. We found that the dual credit policy can effectively stimulate technological innovation, and the higher the credit price or technological innovation credit factor, the higher the technical level of NEVs. The findings could guide the government to adjust and revise the policy. Second, we found that the bargaining games could coordinate the NEV supply chain so that decentralized enterprises can achieve optimal technological innovation under centralized decision-making. Third, we found that suppliers can improve their profits by choosing a suitable alliance strategy under the manufacturer's different negotiating power.

Exploring the diverse definitions of 'evidence': a scoping review

OBJECTIVES

To systematically collect and analyse diverse definitions of 'evidence' in both health and social sciences, and help users to correctly use the term 'evidence' and rethink what is the definition of 'evidence' in scientific research.

DESIGN

Scoping review.

METHODS

Definitions of evidence in the health sciences and social sciences were included. We have excluded the definition of evidence applied in the legal field, abstracts without full text, documents not published in either Chinese or English and so on. We established a multidisciplinary working group and systematically searched five electronic databases including Medline, Web of Science, EBSCO, the Chinese Social Sciences Citation Index and the Chinese Science Citation Database from their inception to 26 February 2022. We also searched websites and reviewed the reference lists of the identified studies. Six reviewers working in pairs, independently, selected studies according to the inclusion and exclusion criteria, and extracted information. Any differences were discussed in pairs, and if there was disagreement, it was resolved via discussion or with the help of a third reviewer. Reviewers extracted document characteristics, the original content for the definitions of 'evidence', assessed definitions as either intensional or extensional, and any citations for the given definition.

RESULTS

Forty-nine documents were finally included after screening, and 68 definitions were obtained. After excluding duplicates, a total of 54 different definitions of 'evidence' were identified. There were 42 intensional definitions and 12 extensional definitions. The top three definiens were 'information', 'fact' and 'research/study'. The definition of 'evidence' differed between health and social sciences. The term 'research' appeared most frequently in the definitions.

CONCLUSIONS

The definition of 'evidence' has gradually attracted the attention of many scholars and decision-makers in health and social sciences. Nevertheless, there is no widely recognised and accepted definition in scientific research. Given the wide use of the term, we need to think about whether, or under what circumstances, a standardised, clear, meaningful and widely applicable definition of 'evidence' might be helpful.

Smart city construction and new-type urbanization quality improvement

First, utilising text quantitative analysis techniques, this paper analyses the smart city pilot policy in depth and clarifies its theoretical mechanism that influence the quality of new-type urbanisation. The revised entropy technique is then used to calculate the new-type urbanisation quality of 276 Chinese cities with a prefecture level or higher from 2007 to 2018. The above action mechanism is evaluated using the Difference-in-Difference model, employing the smart city pilot policy as a quasi-natural experiment (DID). The results indicate that the implementation of the smart city pilot policy can significantly enhance the quality of new-type urbanisation, and this conclusion is robust under a variety of conditions, including parallel trend testing, tendency score matching, exclusion of other policy interference and placebo testing. The analysis of heterogeneity indicates that the smart city pilot strategy has a greater impact on the qualitative improvement of new-type urbanisation in historic industrial bases, resource-based cities, and large-scale cities. The mechanism test confirmed that the construction of smart cities has improved the quality of new-type urbanisation primarily through the optimization and upgrading of industrial structure brought about by smart industrial policy and scientific and technological innovation fostered by smart government and smart people's livelihood policies.

Antibiotic prescription for children with acute respiratory tract infections in rural primary healthcare in Guangdong province, China: a cross-sectional study

OBJECTIVES

The objective of this study is to understand the characteristics and patterns of the first antibiotic prescriptions for children with acute respiratory infections (ARIs) in rural primary healthcare (PHC) in Guangdong province, China.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

We used prescription data generated from the electronic medical record system of 37 township hospitals in two counties of Shaoguan City, Guangdong province. 46 699 first prescriptions for ARIs in children aged 0-18 years were screened from 444 979 outpatient prescriptions recorded between November 2017 and October 2018.

OUTCOME MEASURES

Descriptive analyses were used to report sociodemographic characteristics and antibiotic prescribing profiles. χ2 analysis and binary logistic regression were used to analyse the factors associated with antibiotic prescriptions in children.

RESULTS

Of the 46 699 sampled cases, 83.00% (n=38 759) received at least one antibiotic as part of their first prescription. Of the 38 759 sampled cases treated with antibiotics, 40.76% (n=15 799), 56.15% (n=21 762) and 31.59% (n=12 244) received parenteral antibiotics, broad-spectrum antibiotics and two or more kinds of antibiotics, respectively. Multivariable analysis showed that children aged ≤5 years were less likely to be prescribed with antibiotics than those aged 16-18 years (OR 0.545, p<0.001). Those with health insurance were more likely to be prescribed with antibiotics than those without health insurance (OR 1.677, p<0.001).

CONCLUSIONS

Misuse and overuse of antibiotics were found in the prescriptions of children with ARIs in rural PHC. Antibiotic stewardship programme should be established to reduce the level of antibiotic prescriptions among children with ARIs in rural PHC, especially regarding the prescriptions of broad-spectrum antibiotics and parenteral antibiotics, tailored to different ages, sex and health insurance groups.

Factors associated with professional identity among ICU nurses during COVID-19: A cross-sectional study

AIM

To determine the associated factors of professional identity among intensive care unit (ICU) nurses during the COVID-19 pandemic in China.

DESIGN

Multicentre cross-sectional study.

METHODS

This study invited 348 ICU nurses in five hospitals in China from May to July 2020. Online self-report questionnaires were adopted to collect their demographic and occupational characteristics, perceived professional benefits and professional identity. Based on univariate and multiple linear regression analysis, a path analysis was performed to determine the associated factors' effects on professional identity.

RESULTS

The mean score of professional identity was 102.38 ± 16.46. Perceived professional benefits, doctor recognition level and family support level were associated with ICU nurses' professional identity. The path analysis revealed that perceived professional benefits and doctor recognition level had direct effects on professional identity. In addition, doctor recognition level and family support level had indirect effects on professional identity through the mediation of perceived professional benefits.

The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study

BACKGROUND

Blood transfusion and previous stroke history are two independent risk factors of venous thromboembolism (VTE) in stroke patients. Whether the potential interaction of transfusion history and previous stroke history is associated with a greater risk of VTE remains unclear. This study aims to explore whether the combination of transfusion history and previous stroke history increases the risk of VTE among Chinese stroke patients.

METHODS

A total of 1525 participants from the prospective Stroke Cohort of Henan Province were enrolled in our study. Multivariate logistic regression models were used to explore the associations among transfusion history, previous stroke history and VTE. The interaction was evaluated on both multiplicative and additive scales. The odds ratio (95% CI), relative excess risk of interaction (RERI), attributable proportion (AP), and synergy index (S) of interaction terms were used to examine multiplicative and additive interactions. Finally, we divided our population into two subgroups by National Institutes of Health Stroke Scale (NIHSS) score and re-evaluated the interaction effect in both scales.

RESULTS

A total of 281 (18.4%) participants of 1525 complicated with VTE. Transfusion and previous stroke history were associated with an increased risk of VTE in our cohort. In the multiplicative scale, the combination of transfusion and previous stroke history was statistically significant on VTE in both unadjusted and adjusted models (P<0.05). For the additive scale, the RERI shrank to 7.016 (95% CI: 1.489 ~ 18.165), with the AP of 0.650 (95% CI: 0.204 ~ 0.797) and the S of 3.529 (95% CI: 1.415 ~ 8.579) after adjusting for covariates, indicating a supra-additive effect. In subgroups, the interaction effect between transfusion history and previous stroke history was pronouncedly associated with the increased risk of VTE in patients with NIHSS score > 5 points (P<0.05).

CONCLUSIONS

Our results suggest that there may be a potential synergistic interaction between transfusion history and previous stroke history on the risk of VTE. Besides, the percentage of VTE incidence explained by interaction increased with the severity of stroke. Our findings will provide valuable evidence for thromboprophylaxis in Chinese stroke patients.

Financial price dynamics and phase transitions in the stock markets

ABSTRACT

Price dynamics in stock market is modelled by a statistical physics systems: Ising model. A comparative analysis of the historical dynamics of stock returns between the US, UK, and French markets is given. Since the Ising model requires binary inputs, the effect of binarization is studied. Then, using the TAP approximation method, external fields and coupling strengths are calculated. The fluctuation cycles of coupling strengths have a remarkable corresponding relationship with the important period of the financial market. The highlight of this paper is to verify the phase transition can also occur in the stock market and it reveals the transformation of the market state. The numerical solution in this paper is consistent with the exact solution obtained by Lars Onsager. Our findings can help to discover the economic cycles and provide more possibilities for studying financial markets using physical models.

Farmers' technology preference and influencing factors for pesticide reduction: evidence from Hubei Province, China

Based on the successful experience of pesticide reduction in China, this study uses survey data from Hubei Province to measure rice farmers' technology preferences for pesticide reduction considering their needs, and compare the heterogeneous factors influencing farmers' adoption behavior. The results show that large-scale farmers prefer drone services and efficient machinery, while small-scale farmers prefer scientific standards and biopesticides for pesticide reduction. Second, farmers' adoption behavior of pesticide reduction technologies is mostly influenced by education, risk attitude, income, agricultural labor, scale, rice price, residue testing, brand, training, subsidy, and demonstration. Among them, education, risk attitude, scale, rice price, cost, and training, significantly affect farmers' adoption level of multiple pesticide reduction technologies. Further, higher rice prices and participation in training could promote the use of pesticide reduction technologies in a larger area by farmers. Therefore, the real needs of farmers should be focused on the promotion of pesticide reduction technologies, and pesticide reduction programs in different regions should carry out precise intervention policies. These findings can provide practical policy guidance for effective pesticide reduction in the central region of China.

Environmental regulation, R&D investment, and green technology innovation in China: Based on the PVAR model

The unreasonable economic development model of human beings has caused the environmental pollution problem to become increasingly serious. In order to achieve a positive relationship and interaction between environmental regulation, research and development (R&D) investment, and green technology innovation, and effectively solve the "strange circle" problem between high-quality economic development and environmental pollution in China and even the world, this paper takes the panel data of industrial enterprises above designated size in Chinese mainland 31 provinces from 2009 to 2019 as a research sample. The comprehensive index of R&D investment and green technology innovation was established by the entropy method, and the panel vector autoregressive (PVAR) model was constructed from the dynamic endogenous perspective, and the dynamic interaction and regional heterogeneity between environmental regulation, R&D investment, and green technology innovation were empirically analyzed by using impulse response function and variance decomposition. We obtain the following findings: (1) Environmental regulation has a two-way interaction relationship with R&D investment and green technology innovation, and R&D investment has a promotion effect on the "green degree" of technological innovation, but its role is still weak and has lagging characteristics. (2) There is significant regional heterogeneity in the dynamic responses of the eastern, central and western parts of China. (3) In the long run, environmental regulation has a "negative crowding out effect" on R&D investment in the central region, and the phenomenon of "central collapse" still exists but will gradually weaken. Environmental regulation has a "positive innovation compensation effect" on green technology innovation. Green technology innovation and R&D investment have an obvious "Pareto improvement" effect on environmental regulation, especially in the eastern region. The conclusions of this study help to clarify the dynamic interaction between environmental regulation, R&D investment, and green technology innovation, further improve environmental regulatory policies and green technology innovation R&D decision-making, and provide an effective way to achieve green and sustainable development in China and other parts of the world.

Relationships between urbanization and CO2 emissions in China: An empirical analysis of population migration

China’s announcement of its goal of carbon neutrality has increased the practical significance of research on carbon dioxide (CO₂) emissions that result from urbanization. With a comprehensive consideration of population migration in China, this study examines the impact of urbanization on CO₂ emissions based on provincial panel data from 2000 to 2012. Two indicators (resident population and household registration population) are used to measure urbanization rate. The results reveal that the impact of urbanization on CO₂ emissions in China is closely correlated with the structure of urban resident population and interregional population migration. The estimation results are still robust by using generalized method of moments (GMM) estimator and two-stage least squares (2SLS) estimator. The proportion of temporary residents is introduced as a proxy variable for population migration. The panel threshold model regression results show that the proportion of temporary residents has a marginal effect on the relationship between urbanization and CO₂ emissions. In regions with a higher proportion of temporary residents, the positive effects of resident population urbanization on CO₂ emissions tend to be weaker. These findings are consistent with the theories of ecological modernization and urban environmental transition. This paper makes suggestions on China’s urbanization development model and countermeasures are proposed to minimize the CO₂ emissions caused by urbanization.

Nomogram for predicting cancer-specific survival in undifferentiated pleomorphic sarcoma: A Surveillance, Epidemiology, and End Results -based study

INTRODUCTION

The purpose of this study was to construct and validate a nomogram for predicting cancer-specific survival (CSS) in undifferentiated pleomorphic sarcoma (UPS) patients at 3, 5, and 8 years after the diagnosis.

METHODS

Data for UPS patients were extracted from the SEER (Surveillance, Epidemiology, and End Results) database. The patients were randomly divided into a training cohort (70%) and a validation cohort (30%). The backward stepwise Cox regression model was used to select independent prognostic factors. All of the factors were integrated into the nomogram to predict the CSS rates in UPS patients at 3, 5, and 8 years after the diagnosis. The nomogram' s performance was then validated using multiple indicators, including the area under the time-dependent receiver operating characteristic curve (AUC), consistency index (C-index), calibration curve, decision-curve analysis (DCA), integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

RESULTS

This study included 2,009 UPS patients. Ten prognostic factors were identified after analysis of the Cox regression model in the training cohort, which were year of diagnosis, age, race, primary site, histological grade, T, N, M stage, surgery status, and insurance status. The nomogram was then constructed and validated internally and externally. The relatively high C-indexes and AUC values indicated that the nomogram has good discrimination ability. The calibration curves revealed that the nomogram was well calibrated. NRI and IDI values were both improved, indicating that our nomogram was superior to the AJCC (American Joint Committee on Cancer) system. DCA curves demonstrated that the nomogram was clinically useful.

CONCLUSIONS

The first nomogram for predicting the prognosis of UPS patients has been constructed and validated. Its usability and performance showed that the nomogram can be applied to clinical practice. However, further external validation is still needed.

A chronological model for the Late Paleolithic at Shuidonggou Locality 2, North China

The site of Shuidonggou Locality 2 offers important evidence for the Late Paleolithic sequence of north China. The site not only contains one of the earliest instances of ornamental freshwater shell and ostrich eggshell beads in the region, but also stone artifacts with features arguably resembling the Initial Upper Paleolithic (IUP) blade technology found farther north. The appearance of these innovative archaeological forms have been attributed to the arrival of hominin populations, possibly modern humans, into the region during Marine Isotope Stage 3. Yet, the chronology of the site remains debated due to ambiguities in the existing dates. In this study, we conduct a systematical radiocarbon analysis of charcoal and ostrich eggshell samples obtained throughout the site sequence. Both acid-base-acid and the more stringent acid-base-oxidation pretreatment methods were applied to the charcoal samples. The resulting ages follow an age-depth relationship that is consistent with the stratigraphic profile. In line with previous stratigraphic assessments, Bayesian age modeling suggests that site formation history can be split into two phases: an early phase 43–35 cal kBP associated with a lacustrine depositional environment, and a later phase 35–28 cal kBP associated with rapid terrestrial silt accumulation. The chronology of the archaeological layers containing IUP-like artifacts are placed at 43–39 cal kBP and 35–34 cal kBP respectively. This finding supports the interpretation that an IUP-like blade technology appeared in the SDG region by at least ~41 ka.

Out-of-pocket expenses for myasthenia gravis patients in China: a study on patients insured by basic medical insurance in China, 2013-2015

BACKGROUND

Myasthenia gravis is a rare autoimmune neuromuscular disorder. The disorder requires long-term use of expensive medication to control clinical symptoms. This study analyzed the change in trends of total medical expenses and out-of-pocket expenses for patients with myasthenia gravis and explored the factors influencing them.

METHODS

In this retrospective study, data were derived from a survey of medical service utilization for patients insured by the Urban Basic Medical Insurance in China from 2013 to 2015. The cost data of 3347 patients with myasthenia gravis were included in this study. The baseline characteristics and medical expenses for patients with myasthenia gravis were analyzed using a descriptive method. The difference and influencing factors of the out-of-pocket ratio were analyzed from both outpatient and inpatient expenses by using the quantile regression method.

RESULTS

The total expenses reimbursed by the Urban Basic Medicine Insurance for all patients with myasthenia gravis fell progressively from 73.1 to 58.7% during the study period. Patients' out-of-pocket expenses increased gradually, of which expenses within the scope of Basic Medicine Insurance increased from 14.7 to 22.6% and expenses outside of the Basic Medicine Insurance scope increased from 12.6 to 18.7%. Moreover, the panel quantile results showed a positive correlation between the year of receiving treatment and the out-of-pocket ratio. In addition to the 25th quantile of the out-of-pocket ratio among outpatients with myasthenia gravis, there were significant differences in medical insurance and medical institution among all the other quantiles. Significant regional differences were found in all quantiles of the out-of-pocket ratio, except for the 75th quantile among inpatients. Lastly, age had a negative effect on inpatients with myasthenia gravis across all quantiles, but not on outpatients.

CONCLUSIONS

From 2013 to 2015, patients with myasthenia gravis's out-of-pocket expenses increased progressively. Moreover, the individual out-of-pocket ratio was affected by the year, medical insurance, medical institution, region, and age. The current medical insurance policy for the general public has a low ability to cater for patients with myasthenia gravis.