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The purpose of this study was to examine the dietary views and practices and to identify associated barriers to and facilitators of healthy eating of rural residents emerging from poverty in the context of rapid socio-economic development. A qualitative design with semi-structured interviews was utilized to collect detailed insights into the dietary behaviors of 22 rural residents from 10 villages in Fengshan town, Dafang county, Guizhou province, China. Thematic analysis was applied to interpret the interview data, guided by the socio-ecological model. Four themes were identified: traditional eating patterns, factors influencing food choice, limited knowledge of healthy diet, and lack of nutritional guidance. Barriers to healthy eating included traditional but unhealthy foods, limited nutritional knowledge, inadequate understanding of nutritional requirements, overwhelming nutritional information, and limited professional guidance. Facilitators encompassed healthy traditional eating patterns, household composition, home gardening, preference for traditional bean and soy products, improved food supply and availability owing to poverty alleviation efforts, and being open to receiving professional dietary guidance. As a preliminary investigation into the dietary views and practices of this population, the study highlights a significant gap in the nutritional knowledge and guidance available to rural residents in China, emphasizing the need for comprehensive strategies that address the complex socio-ecological factors influencing dietary behaviors. [ABSTRACT FROM AUTHOR]

(1) Background: Low-income rural residents in China are disadvantaged due to their financial vulnerability and insufficient access to resources, and this situation demands more research effort. This study examined the pattern of outpatient service satisfaction and its determinants among low-income adults in rural China. (2) Methods: Rural low-income respondents who used outpatient services in their local healthcare facilities in Jiangsu, China evaluated the access, cost, environment, doctor–patient interaction, and other topics during their outpatient visit (N = 662). Latent class analysis was used to identify the groups characterized by various dimensions of outpatient satisfaction. Multinomial logistic regression explored the determinants of class membership. (3) Results: Three latent classes were identified: 28.70% had low satisfaction, unsatisfied with every dimension; 20.69% reported medium satisfaction that valued doctor–patient relationships; and 50.60% had high satisfaction but thought that costs were high. Both low and medium satisfaction were associated with a higher proportion of self-paid fees. (4) Conclusions: Healthcare costs were an important determinant of outpatient service satisfaction. Medical social workers are suggested to be included in the medical team to help patients identify financial assistance. Special aid programs may be developed to help relieve rural low-income patients' medical cost-related burden. [ABSTRACT FROM AUTHOR]

Background. Effective functional family was beneficial for older adults' health, which may affect the quality of life (QoL) in hypertension patients. This study aimed to clarify the association between family function, anxiety, and QoL for older adults with hypertension in low-income communities. Methods. A questionnaire survey was conducted on 363 older adults with hypertension in low-income communities in Wuhan from September 2019 to November 2019. The relationships among the variables were examined by Pearson's correlation analysis. Predictor effects were tested using hierarchical multiple regressions, controlling for demographic characteristics. The structural equation model (SEM) was used to test the mediation effects of anxiety on the pathway from family function to QoL. Results. Family function was negatively correlated with the self-rating anxiety scale (SAS) score and positively correlated with the mental component score (MCS), but had no influence on the physical component score (PCS). Both PCS and MCS were negatively correlated with SAS. Anxiety was the negative predictor of MCS and PCS. Family function was the positive predictor of MCS, but had no influence on PCS. The path model indicated that anxiety significantly mediated the link between family function and QoL (R2 = 32.8%), but only partially. Conclusion. A significant correlation between anxiety, family function, and QoL was found. Anxiety had a partial mediating effect on the relationship between family function and QoL. Further research should focus on increasing the level of family function and reducing the perceived anxiety of older adults with hypertension to improve their QoL level. [ABSTRACT FROM AUTHOR]

Background: The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries. Methods: The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation. Results: We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged. Conclusions: Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands. [ABSTRACT FROM AUTHOR]

Background Previous reports about health-related quality of life (HRQoL) of type 2 diabetes mellitus (T2DM) concentrated on general patients rather than patients in rural areas with poor infrastructure and limited resources. Thus, the aims of this study were to evaluate the HRQoL of diabetics in the countryside and explore its influencing factors. Methods A total of 23 053 participants aged from 18 to 79 years were drawn from the Henan Rural Cohort Study for this cross-sectional study. The HRQoL of participants were assessed by utility index and VAS-score of European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Binary logistic regression, generalized linear and tobit regression models were used to estimate the potential influencing factors on HRQoL. Results This study (23 053 participants) included 2231 T2DM patients with a crude prevalence of 9.68%. The utility index and VAS-score in health group were 0.96 ± 0.10 and 78.85 ± 14.53, while in T2DM group were 0.93 ± 0.15 and 74.09 ± 16.09, respectively. In total, most diabetics reported problem about pain/discomfort dimension. Being old, poverty, low physical activity, and with comorbidities was negatively related to HRQoL of diabetics, while high educational level was positively related to HRQoL. Conclusion HRQoL of rural T2DM patients depended on several sociodemographic factors. More attention should be paid to diabetics with poor socioeconomic status in rural areas. Clinical trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375. [ABSTRACT FROM AUTHOR]

Background: Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. Methods: Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. Results: For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from − 0.0636 (95 % CL: −0.0846, − 0.0430) before the policy to − 0.0457 (95 % CL: −0.0684, − 0.0229) after it. In addition, the horizontal inequity index decreased from − 0.0284 before the implementation of the policy to − 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from − 0.0532 (95 % CL: −0.0868, − 0.0196) before the policy was implemented to − 0.1105 (95 % CL: −0.1333, − 0.0876) afterwards; the horizontal inequity index of IHSU increased from − 0.0066 before policy implementation to − 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. Conclusions: The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy's original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage. [ABSTRACT FROM AUTHOR]

We tracked the motor skill development of young children aged 3–6 years and investigated the influence of middle-income home environment on the development of motor skill. 268 children were selected from kindergartens in Beijing. The Test of Gross Motor Development (TGMD) tool was used to test the development of locomotor and object-control skills (LS and OS), and a survey of children's behaviour and home environment was conducted. During the follow-up, the LS and OS of children aged 3–6 years continued to grow, with an annual growth rate of 20% and 30%. Five LS indicators and two OS indicators were significantly higher in the 3–4-year group than in the 4–5 and 5–6-year groups (p < 0.01). The age-sex trend model showed that girls' locomotor skill developed at a significantly higher rate than that of boys (β = 6.3004 and 4.6782, p < 0.001). Three-year-old boys performed significantly better than girls on object-control motor skill (p < 0.05). Factors affecting the rate of children's motor skill development in middle-income families included the frequency of playing with friends (β = 0.133 , p = 0.032) and the frequency of bicycling, skateboarding, dancing, running, and jumping (β = 0.041 , p = 0.042). Family income, parents' education level, and family activity area did not significantly affect the growth rate of motor skills. For middle-income families, the improvement of material environment at home like more playing spaces and toys did not speed up the motor development, while more opportunities to play with friends and engage in a variety of sports activities could promote children's motor skill development. [ABSTRACT FROM AUTHOR]

Background: Health expenditure for tuberculosis (TB) care often pushes households into catastrophe and poverty. New Cooperative Medical Scheme (NCMS) aims to protect households from catastrophic health expenditure (CHE) and impoverishment in rural China. This article assesses the effect of NCMS on relieving CHE and impoverishment from TB care in rural China. Methods: Three hundred fourty-seven TB cases are included in the analysis. We analyze the incidence and intensity of CHE and poverty, and assess the protective effect of NCMS by comparing the CHE and impoverishment before and after reimbursement. Results: After out-of-pocket (OOP) payment for TB care, 16.1 % of non-poor fall below poverty line. The NCMS reduces the incidence of CHE and impoverishment by 11.5 % and 7.3 %. After reimbursement, 46.7 % of the households still experience CHE and 35.4 % are below the poverty line. The NCMS relieves the mean gap, mean positive gap, poverty gap and normalized positive gap by 44.5 %, 51.0 %, US$115.8 and 31.6 % respectively. Conclusions: The NCMS has partial effect on protecting households from CHE and impoverishment from TB care. The limited protection could be enhanced by redesigning benefit coverage to improve the "height" of the NCMS and representing fee-for-service with alternative payment mechanisms. [ABSTRACT FROM AUTHOR]

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6–14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number=4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6·1 % in the entire studied population and 16·3 % in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1·14 v. 0·96; P=0·043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3·08; 95 % CI 1·47, 6·46; P=0·003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community. [ABSTRACT FROM PUBLISHER]

Background: China poverty reduction policy (PRP) addresses two important elements: the targeted poverty reduction (TPA) project since 2015 in line with social assistance policy as national policy; and reducing inequality in health services utilization by making provision of medical financial assistance (MFA). Therefore, this study aims to assess the effects of the PRP in health services utilization (both inpatient and outpatient services) among the central and western rural poor of China. Methods: The study conducted household survey and applied propensity score matching (PSM) method to assess the effects of the PRP on health services utilization among the rural poor of Central and Western China. A sensitivity test was also performed on the PSM results to test their robustness. Results: Key findings showed 17.6% of respondents were the beneficial of PRP. The average treatment effects on the treated (ATT) of the PRP on the inpatient visits within one year was found significantly positive (P = 0.026). Conclusion: There has been relationship between PRP with medical financial assistance and reduction of inequality in health services utilization by the poorer, in particular to accessing the inpatient services from the county or township hospitals of China. Policy makers should pay attention for making provision of improving responsiveness of supply, when subsidizing on the demand side. [ABSTRACT FROM AUTHOR]