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Background: Equity is the core of primary care. The issue of equity in health has become urgent, and China has attached increasing attention to it. With rapid economic development and great changes in medical insurance policy, the pattern of equity in health has changed tremendously. The reform of healthcare in Zhejiang Province is at the forefront in China, and studies on Zhejiang Province are of great significance to the entire country. This paper aimed to measure health equity from the perspectives of health needs and health-seeking behavior and to provide suggestions for the next policy formulations, with respect to timeliness. Methods: The investigator's household survey was conducted in August 2016. A sample of 1000 households, which included 2807 individuals in Zhejiang, China, was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and chi-square tests were adopted in the analysis. The value of the concentration index was used to measure the equity. Results: This study found that the poor have more urgent health needs and poorer health situations than the rich. Through studies on health-seeking behavior, the utilization of outpatient services was almost equitable, while the utilization of hospitalization showed a pro-rich inequity (i.e., the rich use more services). Individuals with employerbased medical insurance used more outpatient services than those with rural and urban medical insurance. More people in the poorer income groups did not use inpatient services due to financial difficulties. Conclusions: Absolute medical prices and medical insurance may explain the equity in the utilization of outpatient services and the inequity in the utilization of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor. [ABSTRACT FROM AUTHOR]

Background: As a common social phenomenon, nurses' occupational burnout has a high incidence rate, which seriously affects their mental health and nursing level. The current assessment mostly uses the total score model and explores the influence of external factors on burnout, while the correlation between burnout items or dimensions is less explored. Ignoring the correlation between the items or dimensions may result in a limited understanding of nurse occupational burnout. This paper explores the item and dimension network structure of the Maslach Burnout Inventory-General Survey (MBI-GS) in Chinese nurses, so as to gain a deeper understanding of this psychological construct and identify potential targets for clinical intervention. Methods: A total of 493 Chinese nurses were recruited by cluster sampling. All participants were invited to complete the survey on symptoms of burnout. Network analysis was used to investigate the item network of MBI-GS. In addition, community detection was used to explore the communities of MBI-GS, and then network analysis was used to investigate the dimension network of MBI-GS based on the results of community detection. Regularized partial correlation and non-regularized partial correlation were used to describe the association between different nodes of the item network and dimension network, respectively. Expected influence and predictability were used to describe the relative importance and the controllability of nodes in both the item and dimension networks. Results: In the item network, most of the strongly correlated edges were in the same dimension of emotional exhaustion (E), cynicism (C) and reduced professional efficacy (R), respectively. E5 (Item 5 of emotional exhaustion, the same below) "I feel burned out from my work", C1 "I have become more callous toward work since I took this job", and R3 "In my opinion, I am good at my job" had the highest expected influence (z-scores = 0.99, 0.81 and 0.94, respectively), indicating theirs highest importance in the network. E1 "I feel emotionally drained from my work" and E5 had the highest predictability (E1 = 0.74, E5 = 0.74). It shows that these two nodes can be interpreted by their internal neighbors to the greatest extent and have the highest controllability in the network. The spinglass algorithm and walktrap algorithm obtained exactly the same three communities, which are consistent with the original dimensions of MBI-GS. In the dimension network, the emotional exhaustion dimension was closely related to the cynicism dimension (weight = 0.65). Conclusions: The network model is a useful tool to study burnout in Chinese nurses. This study explores the item and domain network structure of nurse burnout from the network perspective. By calculating the relevant indicators, we found that E5, C1, and R3 were the most central nodes in the item network and cynicism was the central node in the domain network, suggesting that interventions aimed at E5, C1, R3 and cynicism might decrease the overall burnout level of Chinese nurses to the greatest extent. This study provides potential targets and a new way of thinking for the intervention of nurse burnout, which can be explored and verified in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Burnout is very important to nurses' physical and mental health and career development. Current approaches to assessing nurse burnout tend to use a total score modeling paradigm to explore the impact of external factors on burnout. The purpose of this study is to delve into the item-level relationship between nurse burnout and its influencing factors at both the social and psychological levels using a network analysis approach. Methods: This study was conducted in June 2023 and 1,005 nurses from 4 hospitals out of 8 tertiary care hospitals in Harbin were selected to participate in this study using whole cluster sampling method. Measurements included a general demographic questionnaire, Trait coping styles questionnaire, Organizational commitment questionnaire, Work-family conflict scale, Transformational leadership questionnaire, and Maslach Burnout Inventory-General Survey. Results: Our results suggest that "C1 Time-Based work interference with family" showed the strongest centrality and bridging in the overall network. This finding underscores its centrality to burnout. Other strongest bridge symptoms included "E2 Reduced personal accomplishment" and "A1 Positive coping styles" indicating their strongest connections to other clusters. Conclusions: Nurse administrators should be encouraged to pay more attention to nurses' work situations and family distress, and to help nurses in a flexible way. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice. Methods: The study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses. Results: A total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master's degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest. Conclusions: ANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the primary causes of disability in China and around the world, having an impact on the health and well-being of stroke patients. The importance of spiritual needs for stroke patients has always been a controversial topic internationally, partly because related research was mostly qualitative and may not directly reflect the degree of spiritual needs. In addition, most studies focus on the same cultural background, there is a lack of research that delves into the nuances of Chinese culture and background. The goal of this study is to evaluate the level of spiritual needs and influencing factors in Chinese stroke patients and to explore the mediating role and pathways of these variables on spiritual needs. Methods: From August 2022 to January 2023, we conducted a cross-sectional questionnaire survey of 422 stroke patients in the affiliated hospitals of Hunan University of Chinese Medicine in Changsha Province by cluster sampling. We measured the patient's spiritual needs, quality of life, anxiety and depression levels, and family support using the Spiritual Needs Questionnaire (SPNQ), the MOS36 item Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Family Support Self Rating Scale (PSS-Fa). We used the General Information Questionnaire to gain insight into the sociodemographic characteristics of the patients. Nonparametric tests and multiple linear regression models were used to analyze the independent relationship between spiritual needs and quality of life, anxiety, depression, and family support. The mediation model in AMOS 24.0 software was used to analyze the mediating role among the five variables. Results: The score of spiritual needs of people with stroke included in this study was 37 points [IQR 33 to 40)]. The influencing factors of spiritual needs included primary economic sources for disease-related expenditures (p = 0.044), number of stroke occurrences (p = 0.001), duration of illness (p = 0.023), activities of daily living (p = 0.006), depression scores(p = 0.034), and family support scores(p = 0.008). Anxiety (β = 0.347, p = 0.004), depression (β = 0.368, p = 0.005), and family support (β = 0.167, p = 0.023) had directly or indirectly affected the spiritual needs of people with stroke. Quality of life (β=-0.202, p = 0.017) had a direct effect on spiritual needs. Conclusions: The spiritual needs of people with stroke were at an intermediate level. Our findings highlight that the SPNQ score is associated with anxiety, depression, quality of life, and family support. Therefore, nurses should identify the spiritual needs of patients and provide them with effective and comprehensive spiritual care by reducing negative emotions and enhancing social support, promoting the development and progress of spiritual care in China. This study offers a theoretical basis for the spiritual care of clinical people with stroke and constructing a stroke spiritual care model. [ABSTRACT FROM AUTHOR]

Background: Studies has suggested that receiving social support improves the professional identity of health professional students. According to the two-way social support theory, social support includes receiving social support and giving social support. However, the effect of the two-way social support on health professional students' professional identity has not been clarified yet. Methods: To explore the mechanism of how two-way social support affects health professional students' professional identity, an observational, cross-sectional study was conducted among a convenience and cluster sample of 1449 health professional students from two medical schools in western China. Measures included a short version of the two-way social support scale, a health professional students' professional identity questionnaire, an achievement motivation scale, and a meaning in life scale. (Data were analyzed by use of SPSS26.0 software, Amos 28.0 software, and PROCESSv4.0 plug-in.). Results: Receiving social support, giving social support, achievement motivation, meaning in life, and professional identity were positively correlated with each other. Receiving and giving social support not only directly predicted health professional students' professional identity, but also indirectly predicted health professional students' professional identity through the mediating roles of achievement motivation and meaning in life, and the chain mediating roles of achievement motivation and meaning in life, respectively. The effectiveness of predicting health professional students' professional identity varied among different types of two-way social support, which could be depicted as two-way social support > mainly giving social support > mainly receiving social support > low two-way social support. Conclusion: In the medical education, the awareness and ability of health professional students to receive and give social support should be strengthened. More attention should be drawn on the chain mediating effect of achievement motivation and meaning in life between two-way social support and professional identity. The current results shed new light on exploring effective ways of improving health professional students' professional identity, which suggested that more attention should be paid to the positive effects of mainly giving social support and two-way social support rather than only on the effects of receiving social support. [ABSTRACT FROM AUTHOR]

Background: Social consensus in the nursing industry is that the job is accompanied by dirtiness. It is generally accepted that negative cognition about a career is an important determinant in reducing nursing students' professional commitment. However, the impact of nursing students' perceived work dirtiness on professional commitment and its mechanism remains unclear. This study aimed to analyze the association between perceived work dirtiness and professional commitment and to examine the mediating role of career adaptability and the moderating role of social support among nursing students in mainland China. Methods: A cross-sectional online study was conducted among 341 nursing students from three medical universities in Henan, China. The participants' perceived work dirtiness, career adaptability, professional commitment, and social support were obtained. SPSS 26.0 and Amos 23.0 software were used for the statistical analysis. Results: Perceived work dirtiness was negatively related to career adaptability and professional commitment (P < 0.001). Career adaptability played a partial mediating role (β= -0.177, P < 0.001) in the relationship between perceived work dirtiness and professional commitment. Social support played a moderating role (β = 0.134, P < 0.01) in the relationship between perceived work dirtiness and career adaptability. Moreover, social support moderates the mediating role of career adaptability. Conclusions: Nursing students' perceived work dirtiness is an important factor in reducing professional commitment. Therefore, nursing educators must enhance courses focusing on professional qualities, providing avenues for nursing students to access social support. This proactive approach aims to mitigate the adverse impact of perceived work dirtiness on professional commitment among nursing students. [ABSTRACT FROM AUTHOR]

Background: The shortage of nurses has been a global human resources problem. A good professional growth environment is essential to developing potential nursing students and attracting nurses to join, and it has great significance in reducing nurse turnover. However, nurses' comprehensive perceptions of professional growth have not yet been examined. Methods: A cluster sampling method was used to conduct a professional growth questionnaire survey on young nursing talents from a large Chinese public tertiary A hospital in March 2022. Results: The score of professional growth among 243 young nursing talents was 57.92 ± 9.607, with a scoring rate of 77.23%. The scores for dimensions of professional growth, from lowest to highest, were rehabilitation growth, promotion speed, professional goal progress, and professional ability development. Attitudes towards participating in training, service as the quality manager or clinical teacher, self-efficacy, professional title, work-family support, education, and organizational commitment of young nursing talents were significantly associated with professional growth. Conclusion: The professional growth of young nursing talents was at a moderate level and needed to be strengthened. Nursing leaders and managers are expected to develop management practices to enhance young nursing talents' professional growth in combination with the related factors. [ABSTRACT FROM AUTHOR]

Background: In public health emergencies, nurses are vulnerable to adverse reactions, especially job burnout. It is critical to identify nurses at risk of burnout early and implement interventions as early as possible. Methods: A cross-sectional survey of the hospitals in Xiangyang City was conducted in January, 2023 using stratified cluster sampling. Anonymized data were collected from 1584 working nurses. The Impact of Events Scale-Revised (IES-R) and the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) were used to evaluate the post-traumatic stress disorder (PTSD) and burnout of nurses in public health emergencies. Logistic regression analysis was established to screen for risk factors of burnout, and a nomogram was developed to predict the risk of burnout. A calibration curve and the area under the receiver operating characteristic (ROC) curve were used to validate the nomogram internally. Results: This study showed that only 3.7% of nurses were completely free of PTSD during a public health emergency. We found that PTSD varied by age, marital status, procreation status, length of service, employee status, and whether working in the ICU. The nurses aged 30 ~ 40 years old, single, married without children, non-regular employees, worked for less than three years or worked in the ICU had higher levels of PTSD. Regarding the prevalence of burnout, 27.4%, 48.5%, and 18.6% of nurses had a high level of emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA), respectively. There, 31.1% of nurses had more than two types of job burnout. The number of night shifts, the type of hospital, marital status, and the severity of PTSD were all associated with higher rates of exhaustion among nurses. As a graphical representation of the model, a nomogram was created and demonstrated excellent calibration and discrimination in both sets (AUC = 0.787). Conclusions: This study confirmed the PTSD and burnout are common problems for in-service nurses during public health emergencies and screened out the high-risk groups of job burnout. It is necessary to pay more attention nurses who are single and working in general hospitals with many night shifts, especially nurses with severe PTSD. Hospitals can set up nurses' personal health records to give timely warnings to nurses with health problems, and carry out support interventions to relieve occupational stress. [ABSTRACT FROM AUTHOR]

Background: This study aimed to elucidate the characteristics of symptom network of childhood trauma (CT) and sleep disorder (SD) in Chinese adolescents, with the influence of depressive symptoms taken into account. Method: A total of 1301 adolescent students were included, and their CT, SD and depressive symptoms were measured using the Pittsburgh sleep quality index (PSQI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and The Patient Health Questionnaire-9 (PHQ-9), respectively. Central symptoms and bridge symptoms were identified based on centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. Results: In CT and SD symptom network, emotional abuse and sleep quality symptoms had the highest centrality values, and two bridge symptoms, i.e., emotional abuse and sleep disturbance symptoms, were also identified. In symptom network for CT, SD, and depressive symptoms, sleeping difficulty symptoms, daily dysfunction symptoms, and emotional abuse appeared to be potential bridge symptoms. In symptom network of CT, SD, and depressive symptoms (excluding the symptom of sleeping difficulty), daily dysfunction symptoms, emotional abuse, and sleep disturbance symptoms appeared to be bridge symptoms. Conclusions: In this study, emotional abuse and poor sleep quality were found to be central symptoms in the CT-SD network structure among Chinese adolescent students, with daytime dysfunction as the bridge symptom in the CT-SD-depression network structure. Systemic multi-level interventions targeting the central symptoms and bridge symptoms may be effective in alleviating the co-occurrence of CT, SD and depression in this population. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the prevalence and independent risk factors of SDB, and explore its association with malocclusion among 6–11-year-old children in Shanghai, China. Methods: A cluster sampling procedure was adopted in this cross-sectional study. Pediatric Sleep Questionnaire (PSQ) was applied to evaluate the presence of SDB. Questionnaires including PSQ, medical history, family history, and daily habits/environment were completed by parents under instruction, and oral examinations were implemented by well-trained orthodontists. Multivariable logistic regression was applied to identify independent risk factors for SDB. Chi-square tests and Spearman's Rank Correlation were used to estimate the relationship between SDB and malocclusion. Results: A total of 3433 subjects (1788 males and 1645 females) were included in the study. The SDB prevalence was about 17.7%. Allergic rhinitis (OR 1.39, 95% CI 1.09–1.79), adenotonsillar hypertrophy (OR 2.39, 95% CI 1.82–3.19), paternal snoring (OR 1.97, 95% CI 1.53–2.53), and maternal snoring (OR 1.35, 95% CI 1.05–1.73) were independent risk factors for SDB. The SDB prevalence was higher in children with retrusive mandibles than in proper or excessive ones. No significant difference was observed in the correlation between SDB and lateral facial profile, mandible plane angle, constricted dental arch form, the severity of anterior overjet and overbite, degree of crowding and spacing, and the presence of crossbite and open bite. Conclusions: The prevalence of SDB in primary students in the Chinese urban population was high and highly associated with mandible retrusion. The independent risk factors included Allergic rhinitis, adenotonsillar hypertrophy, paternal snoring, and maternal snoring. More efforts should be made to enhance public education about SDB and related dental-maxillofacial abnormalities. [ABSTRACT FROM AUTHOR]

Background: The flipped classroom (FC) method is becoming increasingly popular in China's nursing education. It is an important breakthrough improvement in the quality of learning in nursing education reforms. Purpose: This study aimed to determine the effects of blended task-oriented flipped classroom (TFC) on nursing students undertaking the Fundamentals of Nursing course. Methods: A pre-and post-test quasi-experimental design was adopted. This study was conducted in the Autumn semester, 2021 academic year in a Chinese university. Using cluster sampling technique, this study enrolled second-year undergraduate nursing students from six classess who were studying Fundamentals of Nursing course. A blended TFC was developed and implemented with three classes (experimental group: n = 152). In-class traditional lectures were applied to the other three classes (control group: n = 151). The Self-Directed Learning Instrument, Problem-Solving Inventory, and California Critical Thinking Disposition Inventory were used to evaluate students' learning outcomes, and final examinations were conducted at the end of after course. In addition, students in the flipped classroom group were required to answer five open-ended questions concerning their flipped classroom learning experiences. Results: Students in the experimental group showed significant improvement in academic performance compared to those in the control group (p = 0.001). Considering total scale and factors, students in the experimental grouped recorded significantly higher scores in self-directed learning ability, problem-solving skills, and critical thinking ability compared to those in the control group (p < 0.05). Furthermore, improved abilities and skills such as team cooperation, communication, presentation, identifying /solving clinical problems, and accountability were reported. Conclusion: A blended TFC teaching approach positively impacted students' core competencies and improved learning outcomes in the Fundamentals of Nursing course. [ABSTRACT FROM AUTHOR]

Background: While single-method studies have reported on the effectiveness of simulated interprofessional teaching, our understanding of its full effects remains incomplete. Teaching design also provides no relevant theoretical guidance, which reduces the scientific quality and rigor of research. The purpose of this work was to study the effects of the simulated interprofessional education (SIPE) teaching model based on the 3P theory on the course of "Clinical Critical Thinking Training" through a convergent mixed method, and to provide the basis for future teaching design. Methods: A convergent mixed-method design was used, which consisted of a survey and a semi-structured interview. Data collection took place from September 2021 to July 2022. A cluster sampling method was used to select 60 full-time nursing students from a school in China, and randomly divide them into a control group of 36 and an experimental group of 24. According to the principle of voluntary participation, 6 students majoring in clinical medicine and 6 students majoring in pharmacy were recruited to join the experimental group to form an interprofessional team. The students studied "Clinical Critical Thinking Training" together, in which the control group used traditional simulation teaching and the experimental group used SIPE. The CCTDI (California Critical Thinking Disposition Inventory) and AITCS-II Student (Assessment of Interprofessional Team Collaboration in Student Learning Scale) were used for quantitative evaluation before and after the course, and descriptive statistics and Mann–Whitney U test were used to compare the critical thinking and interprofessional collaboration skills of the two groups of students. Semi-structured interviews were used for qualitative evaluation. Thematic analysis was used to understand student development on the basis of inter-professional core competencies and learning experience. Results: The students' interprofessional cooperation abilities and critical thinking scores improved compared with the beginning of the course, but the scores of the experimental group were significantly higher than the control group (p < 0.05). Three themes emerged regarding simulated interprofessional teaching: clarifying team positioning, improving team efficiency, and optimizing the learning experience. Conclusion: SIPE can build students' critical thinking, teamwork, and interprofessional core competencies, which makes it a useful teaching design. [ABSTRACT FROM AUTHOR]

Background: High adherence and proper usage of micronutrient powder (MNP) influence child nutritional outcomes, yet few studies explore the role of delivery patterns. This study explores the association between MNP delivery patterns and MNP feeding behaviors among Han and minority caregivers in rural Western China.Methods: In August 2019, a total of 1021 caregiver-child pairs were selected through a four-stage cluster sampling process. A cross-sectional survey collected information on caregiver demographics, MNP delivery patterns (channel and frequency), and MNP feeding behaviors (proper usage and adherence). Using logistic regression, we examined which delivery channels and delivery frequencies were associated with proper usage and high adherence.Results: The results indicated that minority caregivers had lower levels of proper MNP usage than did Han caregivers (89.2%), with Tibetan caregivers' reporting the lowest rates of adherence (32.6%). Logistic regression revealed that that township-based channel was significantly correlated with proper usage among Tibetan and Yi caregivers (Odds Ratio, OR = 2.0, p < 0.01; and OR = 3.5, p < 0.001). Overall, the township-based and home-visit channels were significantly correlated with high adherence (OR = 1.7 and OR = 2.3, respectively; p < 0.001); delivery frequency was significantly correlated with high adherence (2 months: OR = 2.2, p < 0.001 and ≤ 1 month: OR = 3.5, p < 0.001) but not correlated with proper usage among the whole sample and individual ethnic groups.Conclusions: In conclusion, the study finds evidence of a correlation between MNP delivery channel and both proper usage and high adherence as well as a correlation between MNP delivery frequency and high adherence. [ABSTRACT FROM AUTHOR]

Background: Critical thinking (CT) is an essential competency for medical students. This study's aim was to evaluate Chinese medical students' disposition for CT and to explore the impact of current trends in medical education on students' CT development. Methods: We used multistage stratified cluster sampling to recruit a total of 1241 medical students among five different years of training and from three medical institutions in China. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) and self-reported information were used to collect cross-sectional data. Based on the data from the CTDI-CV, 112 medical students in clinical course training from a single institution continued one-year follow-up. Their one-year CTDI-CV score changes were collected regarding various medical education variables. Results: The mean CTDI-CV score of the 1241 medical students was 287.04 with 729 (58.7%) students receiving a score of 280 or higher. There were statistically significant differences in schools attended(F = 3.84, P < 0.05), year of school attended(F = 10.32, P < 0.001), GPA(F = 6.32, P < 0.01), weekly time spent learning after class(F = 14.14, P < 0.001), attitude toward medicine(F = 28.93, P < 0.001), desire to be a doctor after graduation(t = − 3.35, P < 0.001), familiarity with CT(F = 20.40, P < 0.001), and perception of importance of CT(F = 22.25, P < 0.001). The participants scored the highest on the CTDI-CV subscales of "inquisitiveness" and the lowest on "truth seeking." The 112 students in the longitudinal study had significantly lower total CT scores after one academic year follow-up. Conclusions: Chinese medical students generally exhibited positive CT dispositions. The cross-sectional survey and one-year longitudinal study indicated that students' CT disposition diminished as they progressed through traditional medical training. Our study contributes to understanding the status of Chinese medical education of and influential factors on medical students' CT disposition. [ABSTRACT FROM AUTHOR]

Background: China carried out a comprehensive drug price reform (CDPR) in 2017 to control the growing expense of drug effectively and reduce the financial burden of inpatients. However, early studies in pilot regions found the heterogeneity in the effectiveness of CDPR from different regions and other negative effects. This study aimed to evaluate the effects of the reform on medical expenses, medical service utilisation and government financial reimbursement for inpatients in economically weaker regions. Methods: Shihezi was selected as the sample city, and 238,620 inpatients, who were covered by basic medical insurance (BMI) and had complete information from September 2016 to August 2018 in public hospitals, were extracted by cluster sampling. An interrupted series design was used to compare the changing trends in medical expenses, medical service utilisation and reimbursement of BMI for inpatients before and after the reform. Results: Compared with the baseline trends before the CDPR, those after the CDPR were observed with decreased per capita hospitalisation expenses (HE) by ¥301.9 per month (p < 0.001), decreased drug expense (DE) ratio at a rate of 0.32% per month (p < 0.05) and increased ratio of diagnosis and treatment expenses (DTE) at a rate of 0.25% per month (p < 0.01). The number of inpatients in secondary and tertiary hospitals declined by 458 (p < 0.001) and 257 (p < 0.05) per month, respectively. The BMI reimbursement in tertiary hospitals decreased by ¥254.7 per month (p < 0.001). Conclusion: The CDPR controlled the increase in medical expenses effectively and adjusted its structure reasonably. However, it also reduced the medical service utilisation of inpatients in secondary and tertiary hospitals and financial reimbursement for inpatients in tertiary hospitals. [ABSTRACT FROM AUTHOR]

Background: Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China. Method: This cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors. Result: A total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university. Conclusions: This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities. [ABSTRACT FROM AUTHOR]

Background: Cryptosporidium is a genus of common intestinal protozoa, members of which cause diarrhea in a wide variety of hosts. Previous studies on Cryptosporidium in China have mainly focused on diarrhea sufferers, children, and immunodeficient individuals such as HIV/AIDS patients. However, the epidemiological characteristics of Cryptosporidium in the population in rural areas remain unclear. Herein, we investigated the prevalence of, and risk factors for, Cryptosporidium in rural areas of Binyang County, Guangxi Zhuang Autonomous Region, China, and genetically characterized the Cryptosporidium isolates we obtained.Methods: From August to December 2016, two villages in Binyang County, Guangxi, were sampled using a random cluster sampling method. Fresh fecal samples were collected from all eligible residents (residence time > 6 months). Molecular characterization of Cryptosporidium was carried out based on its SSU rRNA, gp60, actin and hsp70 gene sequences. Fisher's exact test were conducted to assess the risk factors for Cryptosporidium infection.Results: A total of 400 fecal samples were collected from 195 males (48.8%) and 205 females (51.2%). Two samples (0.5%) were positive for Cryptosporidium and were identified as C. viatorum and C. occultus respectively. Moreover, a new C. viatorum subtype XVaA3h was identified based on the sequence of the gp 60 gene.Conclusions: To our knowledge, this is the first report of C. viatorum and C. occultus infections in humans in China and of C. viatorum subtype XVaA3h. The findings provide important information on the prevalence of Cryptosporidium in the Chinese population, and expand the range of Cryptosporidium species known to infect people in China. [ABSTRACT FROM AUTHOR]

Background: Changning District of Shanghai pioneered in implementing Family Doctor and Medical Insurance Payment Coordination Reform. The survey aimed to assess the effect of the reform to provide a decision-making basis for ensuring the "gatekeeper" role of the family doctor. Methods: A cross-sectional survey was conducted using a self-designed questionnaire in Changning District of Shanghai during January and February in 2014. Multi-stage random cluster was applied and 3040 residents were selected. Comparisons were made with statistically test between the contracted and non-contracted residents in four policy targeted dimensions, doctor-visiting behavior, health management and status, medical cost control and satisfaction. Results: Compared with the non-contracted residents, the contracted residents (72.9%) presented a higher prevalence rate of chronic diseases (32.6%), a higher proportion (51.9%) in first-contact in the community health service center and a higher proportion to refer to specialists as well (P < 0.001).The result showed that the average annual medical expense were significantly higher than non-contracted residents (P < 0.001), however, the difference disappeared after age, medical insurance and other socio-demographic variables were controlled. In terms of self-management of non-communicable diseases and complication prevention, the blood pressure control rate and blood glucose control rate for the contracted group were also higher than the counterparts, reaching up to 85.6 and 72.7% respectively. Conclusion: The preliminary analysis indicated that the contracted residents performed better in orderly doctor visiting behavior, health management behavior, health status and satisfaction. Follow up survey is necessary to further analyze the policy effect. [ABSTRACT FROM AUTHOR]

Background: In order to achieve the Millennium Development Goals (MDG) 4 and 5, the Chinese Government has invested greatly in improving maternal and child health (MCH) with impressive results. However, one of the most important barriers for further improvement is the uneven distribution of MCH human resources. There is little information about the distribution, quantity and capacity of the Chinese MCH human resources and we sought to investigate this.Methods: Cities at prefectural level were selected by random cluster sampling. All medical and health institutions providing MCH-related services in the sampled areas were investigated using a structured questionnaire. The data were weighted based on the proportion of the sampled districts/cities. Amount, proportions and numbers per 10,000 population of MCH human resources were estimated in order to reveal the quantity of the Chinese MCH human resources. The capacity of MCH human resources was evaluated by analyzing data on the education level and professional skills of the staff.Results: There were 77,248 MCH workers in China in 2010. In general, 67.6% and 71.9% of the women's and children's health care professionals had an associate degree or higher, whereas around 30% had only high-school or lower degrees. More than 40% of the women's health workers were capable of providing skilled birth attendance, but these proportions varied between different institutions and locations.Conclusions: Evidence from this study highlights that Chinese MCH human resources are not in shortage in the national level. However, the quantity and capacity of MCH human resources are not evenly distributed among different institutions and locations. Finally there is a need in the improvement of the MCH services by improving the quality of MCH human resources. [ABSTRACT FROM AUTHOR]

Background: Inappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients. Methods: A total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates. Results: For the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = − 0.12, p = 0.003) and shorter length of stay (LOS) (difference = − 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = − 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = − 0.169, p = 0.043). Conclusion: Inappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management. [ABSTRACT FROM AUTHOR]

Background: Most epidemiologic studies reporting prevalence of allergic rhinitis (AR) and nonallergic rhinitis (NAR) have assessed solely self-reported prevalence, without confirmation by objective measures. Furthermore, reports of prevalence of NAR in Chinese subjects are scarce. Thus, we aimed to explore the prevalence and risk factors of AR and NAR in a Chinese, based on both clinical manifestation and allergic status. Methods: We conducted a population-based cross-sectional survey, involving 1084 local residents from a rural area of Beijing, China. Participants were enrolled using a stratified two-stage cluster sampling method. All adult participants or the guardians of children completed standardized questionnaires to provide relevant demographic and clinical information. Skin prick tests were also performed to determine sensitization to specific aeroallergens. AR/NAR was classified according to Allergic Rhinitis and its Impact on Asthma criteria. Results: Prevalence of self-reported AR was 46.80%. Based on SPT results, the confirmed standardized prevalence of AR and NAR were 16.78% and 24.60%, respectively. Severity scores for nasal itching, sneezing, rhinorrhea and congestion were significantly higher in subjects with AR, than subjects with NAR (P < 0.05 for all). The three most common aeroallergens in self-reported AR group were Blattella germanica (16.6%), Dermatophagoides farinae (14.6%), and Dermatophagoides pteronyssinus (13.9%). Family history of AR and atopic dermatitis were significantly associated with AR (adjusted OR: 4.97 and 2.69, respectively), whereas family history of AR and asthma were significantly associated with NAR (adjusted OR: 3.53 and 2.45, respectively). Similarly, comorbid asthma, CRS, and atopic dermatitis were significant risk factors for both AR and NAR. Conclusions: Combination of standardized questionnaires and specific allergen tests may provide more accurate estimates of prevalence of AR and NAR and associated risk factors. [ABSTRACT FROM AUTHOR]