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Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [ABSTRACT FROM AUTHOR]

In this paper, we explore the strong familial responsibility sense of people living with HIV (PLHIV) in rural western China, based on the data obtained from in-depth interviews. The data show that PLHIV were coping positively with a poor family economic status, caring for their family more than themselves, and taking concrete steps to fulfill their familial obligations. However, unique economic, cultural, and social factors exert negative impact on their ability to achieve their aims. The findings from our study illustrate that proper governmental and social interventions should be launched based on the actual situation and needs of local PLHIV and their families. [ABSTRACT FROM PUBLISHER]

The COVID-19 outbreak and related confinement have highly impacted psychological health among children and adolescents. This study aimed to explore the potential risk factors for depression among primary and middle school students and provide advices for psychological interventions during the outbreaks. An online cross-sectional survey was conducted among 18 primary and middle school students via quota sampling in Beijing during March 2020. The Center for Epidemiological Studies Depression Scale (CES-D) was used to assess depression. Differences between characteristics and depression were examined by chi-square tests. Multivariate logistic regression was used to reveal the potential risk factors for depression. A total of 7377 participants were included. The proportion of depression was 29.7%. Students in rural areas, with higher school categories, in graduating grades, with poor or excessive sleep duration, and without daily exercise were associated with a higher proportion of depression. Furthermore, students with a higher knowledge performance of COVID-19 showed a lower proportion of depression (odds ratio [OR] = 0.900, 95% confidence intervals [95% CI]: 0.888–0.913). Students who worried about academic performance (OR = 1.919, 95% CI: 1.718–2.144) or COVID-19 infection (OR = 1.450, 95% CI: 1.268–1.658) exhibited a high proportion of depression. The proportion of depression among primary and middle school students was negatively associated with the knowledge score and positively associated with their worry. Our findings suggest that psychological intervention might be more necessary for students with specific characteristics. [ABSTRACT FROM AUTHOR]

Most of the rural long-term care (LTC) facilities in China are ill-equipped to manage the physical and psychological needs of older residents with dementia. These facilities mostly consist of older male Tekun (socially and economically vulnerable) adults. Preventing or delaying the onset of dementia is especially crucial for these older Tekun adults. A sample of 711 older male Tekun adults from rural LTC facilities in the Anhui province of China was used to investigate the association between psychological resilience and cognitive functioning, and to examine the moderating effect of activities of daily living (ADLs) on that association. Linear and quantile regression found that resilience was positively associated with cognitive functioning for the total sample, with a greater effect among those with a lower level of cognitive functioning. The benefit of resilience on cognitive functioning was observed only in participants with disability in ADLs. Our findings present evidence in support of interventions to foster psychological resilience and potentially improve cognitive functioning among vulnerable older adults. Resilience-promoting intervention is a strength-based approach that aligns with social work values and can be used in practice. The implications for social work practice were discussed. [ABSTRACT FROM AUTHOR]

In rural China, where families serve as critical safety-nets for their vulnerable members, grandparents play an essential role caring for the offspring of their migrant children. Evidence is mixed as to whether caring for grandchildren provides health benefits or incurs health risks. In this article, we used six waves of data from a study in rural China to examine the impact of caregiving for grandchildren on grandparents' emotional and cognitive health. Further, we examined financial transfers from adult children as a resource that potentially moderates the impact of high intensity caregiving on these outcomes. Data derived from six waves (2001–2015) of the Longitudinal Study of Older Adults in Anhui Province, China. We constructed 2,835 person-interval observations derived from 1,067 grandparents to examine lagged change in depressive symptoms and cognitive ability. Results show that caregiving frequency is not by itself harmful or beneficial to the emotional and cognitive health of grandparents, but it does appear to be harmful in the context of custodial care that is less economically supported by adult children. These results are discussed in terms of their relevance to intergenerational reciprocity in a filial culture, time-for-money exchange expectations, and the need for financial resources among caregiving grandparents in rural China. [ABSTRACT FROM AUTHOR]

Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden. This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships. This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work. 68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656–2.236), IADL limitation (1.522, 1.326–1.748), limited work due to health problems (1.868, 1.601–2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390–2.020; for employed non-agricultural work, 2.418, 1.245–4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group. Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society. [ABSTRACT FROM AUTHOR]

The purposes of the current study were to explore the applicability of the Health Action Process Approach (HAPA) model for interpreting changes in physical exercise behavior and to examine the key determinants of changes in physical exercise. The participants were 639 rural middle school students in Sichuan province, China, who did not perform physical exercise. Three surveys and two interventions were completed in the same participants within 1.5 years. The HAPA model elements and physical exercise were estimated by a self-reported questionnaire. The results showed that 158 students (24.7%) formed a habit of physical exercise. The structural equation model for the pre-intention stage and behavior stage showed acceptable goodness of fit. Outcome expectancies (β=0.136, P=0.014) and action self-efficacy (β=0.314, P=0.001) directly predicted intention of physical exercise, the latter directly predicted physical exerciseplanning (β=0.537, P<0.001), andplanning subsequently predicted physical exercise (β=0.324, P<0.001). Maintenance self-efficacy indirectly predicted physical exercise through planning (95%CI: 0.014, 0.053). The findings suggested that the HAPA model was a very useful tool for predicting changes in physical exercise behavior, as this model explains the process of changing physical exercise habits and reveals the weak link in such behavioral changes among Chinese rural adolescents. [ABSTRACT FROM AUTHOR]

Objective:This study compared urban and rural factors associated with life satisfaction among older adults in mainland China. Method:Study data were extracted at random from 10% of the Sample Survey on Aged Population in urban/rural China in 2006 for 1980 participants aged 60 and older, including 997 from urban cities and 983 from rural villages. Results:In this study, 54.6% of urban older adults and 44.1% of rural older adults reported satisfaction with their lives. Binary logistic regression analysis showed that financial strain, depressive symptoms, filial piety, and accessibility of health services were significantly associated with life satisfaction for both urban and rural participants, but age and financial exchange with children were only associated with life satisfaction among urban older adults. Conclusion:Findings are consistent with some previous studies that indicated the importance of financial strain, depressive symptoms, filial piety, and accessibility of health services to life satisfaction among the older adults in both urban and rural areas. This study also demonstrated the importance of age and family financial exchange to the life satisfaction of urban older adults. [ABSTRACT FROM PUBLISHER]

Grandparent-grandchild relationships are important in Chinese society and the middle generation plays an important role in them. The present study drew on data from the 2009 wave of the Longitudinal Study of Older Adults in Anhui Province, China, to examine variation in emotional closeness between grandparents and their grandchildren. Our focus was on the middle generation as a relational bridge to grandchildren in terms of grandparents’ gender, emotional closeness to their adult children, and kinship status (paternal versus maternal lineage). We analyzed reports from 926 grandparents about their relationships with 1,982 grandchildren. Logistic cluster regression analyses revealed that closeness between grandparents and their adult children was strongly associated with grandparent-grandchild closeness. Paternal grandparents reported closer relationships with their grandchildren than did maternal grandparents, and these relationships were particularly strong for paternal grandmothers. Contrary to what we had hypothesized, the influence of emotional closeness to adult children was not moderated by lineage. We conclude that the middle generation provides an important bridge between grandparents and grandchildren and that gender and lineage type serve as strong facilitators of these relationships. [ABSTRACT FROM AUTHOR]

Objectives:To investigate the prevalence of insomnia (DIS: difficulty initiating sleep; DMS: difficulty maintaining sleep; and EMA: early morning awakening), its socio-demographic and clinical correlates, and the treatment patterns in older adults in rural China. Method:A sample of 263 subjects was recruited in Mianyang and interviewed using standardized instruments. Basic socio-demographic and clinical data were collected. Results:The expected mean total sleep time (TST) of the whole sample was 6.8 ± 2.2 hours, and the actual mean TST was 6.3 ± 2.1 hours. The 1-year prevalence of at least one type of insomnia was 7.6%; the rates of DIS, DMS, and EMA were 5.7%, 7.2%, and 6.8%, respectively. On multivariate analyses, female sex and psychiatric disorders were independently associated with more frequent insomnia. Conclusion:Insomnia is not uncommon in older adults in rural China, and the low percentage of subjects treated suggests that improved access to treatment might be indicated. [ABSTRACT FROM PUBLISHER]

To determine the level of antiretroviral treatment adherence and explore the correlated factors of perceived burden of taking antiretroviral medications among people living with HIV (PLH) in a rural area of China. Data were collected from 66 PLH who were currently receiving antiretroviral treatment. Face-to-face interviews were conducted during August to October, 2009. Approximately 18.2% of participants failed to adhere to antiretroviral treatment in the previous 30 days. A majority of PLH reported that taking antiretroviral medications posed a burden to them. Those who perceived a higher level of burden were more likely to be women, to have lower annual income, and to report a high level of depressive symptoms, poor physical health, and strained family interactions. Findings suggest that future programs in promoting adherence to antiretroviral treatment should address issues related to psychosocial well-being and PLH's interactions with their family members. [ABSTRACT FROM AUTHOR]