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Coexisting physical diseases and depressive symptoms exacerbate morbidity and disability, but their incremental economic burden remains unclear. We used cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2018 to estimate the economic burden associated with depressive symptoms among middle-aged and elderly people with chronic diseases. A multivariable regression model was used to assess the annual health care utilization, expenditures, and productivity loss of depressive symptoms among people with 12 common chronic diseases. We found that depressive symptoms were associated with higher incremental economic burdens, as the total health care costs increased by 3.1% to 85.0% and annual productivity loss increased by 1.6% to 90.1%. Those with cancer or malignant tumors had the largest economic burden associated with depressive symptoms, with CNY 17,273.7 additional annual health care costs and a loss of CNY 2196.2 due to additional annual productivity loss. The effect of depressive symptoms on the economic burden of patients with chronic conditions did not increase by the number of chronic conditions. Considering the high economic burden associated with depressive symptoms among patients with chronic conditions, it is important to consider the mental health of patients in chronic disease treatment and management.

Depression is one of the most common comorbidities in patients with chronic lung diseases (CLDs). Depressive symptoms have an obvious influence on the health function, treatment, and management of CLD patients. In order to investigate the additional medical expenditure caused by depressive symptoms among middle-aged and elderly patients with CLDs in China, and to estimate urban–rural differences in additional medical expenditure, our study used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) investigation. A total of 1834 middle-aged and elderly CLD patients were included in this study. A generalized linear regression model was used to analyze the additional medical expenditure on depressive symptoms in CLD patients. The results show that depressive symptoms were associated with an increase in medical costs in patients with CLDs. Nevertheless, the incremental medical costs differed between urban and rural patients. In urban and rural patients with more severe comorbid CLD and depressive symptoms (co-MCDs), the total additional medical costs reached 4704.00 Chinese Yuan (CNY) (USD 711.60) and CNY 2140.20 (USD 323.80), respectively. Likewise, for patients with lower severity co-MCDs, the total additional medical costs of urban patients were higher than those of rural patients (CNY 4908.10 vs. CNY 1169.90) (USD 742.50 vs. USD 176.90). Depressive symptoms were associated with increased medical utilization and expenditure among CLD patients, which varies between urban and rural areas. This study highlights the importance of mental health care for patients with CLDs.

Background China has stepped into an era of aging society, where the impending considerable economic burden attributed to high prevalence of dementia in the elderly appears to be one of the most important health and social issues to deal with for the country. However, population-based quantification and projections for the economic burden of dementia in China are lacking for further health action and policy making. Objective To estimate and predict the costs of managing dementia in the elderly population aged 60 and above from 2010 to 2050 in China. Methods Data were collected from a six-province study (n = 7072) and other multiple sources for calculation of the economic burden of dementia. With the convincing data from published studies, we quantified and projected the costs attributed to dementia in China from 2010 to 2050. Results The national cost of dementia in 2010 was estimated to be US$22.8 billion by the opportunity cost method and US$26.4 billion by the proxy method. In 2050, the costs would increase to US$372.3 billion by the opportunity cost method and US$430.6 billion by the proxy method, consuming 0.53% and 0.61% of China’s total GDP, respectively. A series of sensitivity analyses showed that the changes in the proportions of informal caregiving led to the most robust changes in the total burden of care for dementia in China. Conclusion Dementia represents an enormous burden on China’s population health and economy. Due to the changes in policies and population structure, policymakers should give priority to dementia care.

People with hypertension are more prone to incur depressive symptoms, while depressive symptoms have an obvious influence on the healthy functioning, treatment, and management of hypertensive patients. However, there have been limited studies on the association between depression and the economic burden of hypertension. We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) to estimate the additional annual direct and indirect economic burden of depressive symptoms among middle-aged and elderly hypertensive patients with a multivariable regression model. The depressive symptoms were associated with substantial additional direct and indirect economic burden. Compared with non-co-MHDS (non-co-morbid hypertension and depressive symptoms) patients, the direct economic burden of lower co-MHDS (co-morbid hypertension and depressive symptoms) patients and higher co-MHDS patients increased 1887.4 CNY and 5508.4 CNY, respectively. For indirect economic burden, the lower co-MHDS patients increased 331.2 CNY and the higher co-MHDS patients increased 636.8 CNY. Both direct and indirect economic burden were incremental with the aggravation of depressive symptoms. The results showed depressive symptoms increased total healthcare costs by increasing the utilization and expenditure of primary healthcare services. Depressive symptoms also led to economic loss of productivity, especially for agricultural workers. This study highlights the importance of mental healthcare for hypertensive patients.

Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.

Hyperuricemia (HU) is a risk factor for different kinds of chronic noncommunicable diseases, and eating away from home (EAFH) may play an important role in their development, which has been ignored greatly so far. This study aimed to investigate the association between EAFH and HU in different models. A cross-sectional study involving 8,322 participants of the China Health and Nutrition Survey (CHNS) was conducted. Logistic regression models were used to analyze the data. We found that participants who consumed more away-from-home food had a higher risk for HU, and the adjusted odds ratio (aOR) and 95% confidence interval (CI) (for each increment in grades of EAFH) were 1.11 (1.02, 1.20) in a multiadjusted model (adjusted for age, gender, province, net individual income, body mass index, smoking, leisure-time physical activities, energy intake, and sleep duration). As for stratified analyses, the aOR (95% CI) of EAFH was 1.12 (1.01, 1.24) for men and 1.06 (0.92, 1.21) for women. Similar results can be found in the middle-aged and obese population, with aOR (95% CI) of EAFH as 1.17 (1.05, 1.30) and 1.15 (1.03, 1.29), respectively. In conclusion, EAFH is positively associated with the prevalence of HU.

Professionalism is crucial in all professions and is particularly important in the medical field. Measuring students' perceptions of professionalism can help to form education targeting the enhancement of professionalism. This study aimed to validate an effective assessment tool for the measurement of medical students' perceptions of medical professionalism in mainland China. The cross-sectional survey was conducted in three medical colleges in Guangdong, China. Of the 2103 eligible medical students, 1976 responded, and 1856 questionnaires were deemed valid. Students from clinical medicine in these three medical colleges were randomly selected by cluster sampling. First, a Simplified Chinese Version questionnaire to measure Student's Perception of Medical Professionalism (SCV-SPMP) was constructed. Second, questionnaires from 1856 students majoring in clinical medicine at three medical colleges were included in the analysis. Third, exploratory factor analysis, Cronbach's alpha, item-subscale correlation, and confirmatory factor analysis were conducted to test the validity and reliability of the SCV-SPMP. Nine items were eliminated following exploratory factor analysis, and four subscales were extracted from the analysis. All internal consistency reliability exceeded the minimum standard. The overall Cronbach's alpha was 0.94, and four subscales' alphas were 0.82 (Accountability and excellence), 0.81 (Duty), 0.89 (Honor and integrity), and 0.85 (Practice habits and respect for others), respectively. The model fit was good. The convergent validity and discriminant validity were acceptable. The modified SCV-SPMP was found to be a valid and reliable tool to capture the main features of Chinese students' perceptions of medical professionalism in four dimensions, and it provides a quantitative method for the measurement of the students' perceptions in mainland China..

Objective This study was performed to assess the reliability and validity of the Chinese version of the Snizek-revised Hall’s Professionalism Inventory Scale (C-SR-HPIS). Methods Exploratory factor analysis and confirmatory factor analysis were used to evaluate the construct validity of the C-SR-HPIS. The average variance extracted (AVE) and square root of the AVE were calculated and correlation analyses were performed to test the convergent validity and discriminant validity, respectively. Cronbach’s alpha (α) coefficient was used to test the internal consistency reliability. Results Data for 355 clinical nurses in mainland China were collected. Five factors were extracted, accounting for 58.86% of the total explained variance, and 20 items were selected for the C-SR-HPIS. The confirmatory factor analysis suggested good fitness of the modified model. The AVE was acceptable for convergent validity. The square roots of the AVE of the five factors were larger than their correlation coefficients with other factors, showing suitable discriminant validity. Cronbach’s α coefficient of internal consistency reliability of the overall scale was 0.76, indicating good reliability of the scale. Conclusions This study demonstrated good reliability and validity of the C-SR-HPIS and provides a quantitative tool for the assessment of nursing professionalism in China.

In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems.Dans la plupart des pays, la demande de soins intégrés pour les personnes atteintes de maladies chroniques augmente à mesure que la population vieillit. Cette demande nécessite une réorientation majeure des systèmes de soins de santé vers des dispositifs de prestation de services plus intégrés. Pour effectuer cette réorientation en Chine, l'Organisation mondiale de la Santé, la Banque mondiale et le gouvernement chinois ont proposé un système de soins de santé à plusieurs niveaux selon un dispositif de soins intégrés axés sur l'être humain. Cette approche a été utilisée pour la première fois dans le district de Luohu de la ville de Shenzhen de 2015 à 2017 en tant que modèle de pratique. En septembre 2017, le ministère chinois de la Santé a appliqué à l'ensemble du pays ce dispositif de soins intégrés axés sur l'être humain. Nous décrivons les caractéristiques du modèle de Luohu par rapport aux principaux domaines d'action et aux stratégies de mise en œuvre proposées et nous résumons les données extraites d'une évaluation des deux premières années du programme. Nous examinons les difficultés rencontrées lors de la mise en œuvre et les leçons tirées de ces difficultés pour d'autres systèmes de soins de santé. Nous réfléchissons aux moyens d'améliorer la collaboration entre les institutions, de changer le comportement de la population concernant l'utilisation des services de santé des collectivités comme premier point de contact et de gérer efficacement les ressources pour éviter les déficits budgétaires. Enfin, nous décrivons les prochaines étapes à suivre dans le cadre du modèle de Luohu et son application potentielle pour renforcer les soins de santé dans d'autres systèmes urbains de soins de santé.En la mayoría de los países, la demanda de atención integrada para las personas con enfermedades crónicas aumenta a medida que la población envejece. Esta demanda requiere un cambio fundamental de los sistemas de atención sanitaria hacia modelos de prestación de servicios más integrados. Para lograr este cambio en China, la Organización Mundial de la Salud, el Banco Mundial y el gobierno chino propusieron un sistema escalonado de prestación de servicios sanitarios de acuerdo con un modelo de atención integrada centrada en las personas. El enfoque se introdujo en el distrito de Luohu de la ciudad de Shenzhen de 2015 a 2017 como modelo para la práctica. En septiembre de 2017, el Ministerio de Salud de China introdujo este enfoque de atención integrada centrada en las personas en todo el país. Se describen las características del modelo de Luohu en relación con las áreas centrales de acción y las estrategias de implementación propuestas y se resumen los datos de una evaluación de los dos primeros años del programa. Se exponen los desafíos enfrentados durante la implementación y las lecciones aprendidas de la misma para otros sistemas de atención sanitaria. Se considera cómo mejorar la colaboración entre las instituciones, cómo cambiar el comportamiento de la población sobre el uso de los servicios sanitarios comunitarios como primer punto de contacto y cómo gestionar eficazmente los recursos para evitar déficits de presupuesto. Por último, se esbozaron los próximos pasos del modelo de Luohu y su posible aplicación para fortalecer la atención sanitaria en otros sistemas urbanos de atención sanitaria.في معظم الدول، يتزايد الطلب على خدمات الرعاية المتكاملة للأشخاص المصابين بأمراض مزمنة كلما ازداد عدد السكان. ويتطلب ذلك تحولا أساسيا في نظم الرعاية الصحية باتجاه نماذج لتقديم الخدمات أكثر تكاملا. ولتحقيق هذا التحول في الصين، اقترحت كل من منظمة الصحة العالمية، والبنك الدولي، والحكومة الصينية نظاماً لتقديم الرعاية الصحية المتدرجة وفقاً لنموذج للرعاية المتكاملة المرتكزة على الأشخاص. ظهر هذا النهج في منطقة لوهو بمدينة شنتشن من عام 2015 إلى عام 2017 كنمط للممارسة. في سبتمبر/أيلول 2017، قدمت وزارة الصحة الصينية هذا النهج للرعاية المتكاملة المرتكزة على الأشخاص للدولة بأكملها. نحن نصف مزايا نموذج لوهو فيما يتعلق بمجالات العمل الأساسية واستراتيجيات التنفيذ المقترحة، كما أننا نلخص البيانات من تقييم للسنتين الأوليين من البرنامج. كذلك، فإننا نناقش التحديات التي تمت مواجهتها أثناء التنفيذ، والدروس المستفادة منها في أنظمة الرعاية الصحية الأخرى. نحن ننظر في كيفية تحسين التعاون بين المؤسسات، وكيفية تغيير سلوك السكان بخصوص استخدام الخدمات الصحية للمجتمع كنقطة اتصال أولى، وكيفية إدارة الموارد بفعالية لتجنب العجز في الميزانية. وأخيرًا، فإننا نوجز الخطوات التالية لنموذج لوهو وتطبيقه المحتمل، لتعزيز الرعاية الصحية في أنظمة الرعاية الصحية الحضرية الأخرى.随着人口老龄化的加剧，大多数国家的慢性病病人对整合型卫生服务的需求也在不断增加。这种需求要求当前的卫生服务体系从根本上向着更加整合的服务提供模式转变。为帮助中国实现这一转变，世界卫生组织、世界银行和中国政府提出根据以人为本的一体化服务模式打造分级诊疗的卫生服务提供体系。深圳市罗湖区作为实践模板率先于2015年至2017年试点引入该模式。2017年9月，中国国家卫生和计划生育委员会向全国推介罗湖以人为本的整合型服务提供模式。我们描述罗湖模式的核心行动领域及相应的实施策略，并且总结该模式的第一个两年评估结果。我们讨论罗湖模式实施过程中所面临的挑战，以及它为其他卫生体系提供的经验。这些经验包括，如何促进机构间协作、如何改变居民的行为使其到社区卫生服务机构首诊、如何有效整合资源以避免医保基金赤字。最后，我们概述罗湖模式接下来的行动计划，以及该模式在加强其他城市卫生体系的潜在应用。.В большинстве стран по мере старения населения растет потребность в комплексном уходе для лиц, страдающих хроническими заболеваниями. Эта потребность требует изменения основополагающих принципов системы здравоохранения и сдвига в сторону моделей, в большей мере ориентированных на предоставление комплексных услуг. Для достижения этого сдвига в Китае Всемирная организация здравоохранения, Всемирный банк и Правительство Китая предложили внедрить многоуровневую систему предоставления услуг в соответствии с социально ориентированной моделью комплексного ухода. В качестве образца этот подход впервые был применен в районе Луоху города Шэньчжэнь в период с 2015 по 2017 год. В сентябре 2017 года Министерство здравоохранения Китая ввело принцип социально ориентированного комплексного ухода для всей страны. Авторы описывают характерные черты модели Луоху применительно к ключевым областям действия и предложенные стратегии внедрения этой модели, а также приводят итоговые данные, полученные в результате оценки первых двух лет проведения программы. Обсуждаются проблемы, с которыми медицинские работники столкнулись при ее внедрении, а также тот опыт, который может быть полезен для других систем здравоохранения. Авторы рассматривают такие вопросы, как улучшение взаимодействия между организациями, изменение поведения населения при использовании учреждений общественного здравоохранения в качестве пунктов первоочередного обращения за медицинской помощью, а также эффективное использование имеющихся ресурсов с целью исключения дефицита бюджета. Наконец, описываются дальнейшие этапы модели Луоху и ее потенциальное применение для укрепления здравоохранения в других аналогичных городских системах.

Aims The aim of this study was to determine the association between social determinants of health and direct economic burden on Chinese middle-aged and elderly individuals living with diabetes in China. Methods This study used data from the baseline wave of The China Health and Retirement Longitudinal Study (CHARLS) database, covering 17,708 middle-aged and elderly residents in China. The population with diabetes was grouped into those diagnosed with diabetes mellitus (DDM) and those undiagnosed with diabetes mellitus (UDM). Direct economic cost data, including total direct medical costs (TC) and out-of-pocket (OOP) payments, were extracted as outcome variables. A two-part model was applied to analyze the association between social determinants of health and direct economic burden. Results In our analysis, we included 958 patients with DDM and 1,285 patients with UDM. The mean TC and OOP payments were 11,193 CNY (US $1,733; 6.46 CNY = 1 USD) and 7,266 CNY (US $1,125) in DDM patients, and 3,700 CNY (US $573) and 3,060 CNY (US $474) in UDM patients. Rural-urban status (p Conclusion Although progress has been made in the development of current health policies intended to contain the direct economic burden of diabetes, the gaps in that burden in populations with different social characteristics remains a burning issue. More policy breakthroughs are needed to achieve health equity.

Background The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. To translate and adapt the original care provider version of the RMIC-MT and evaluate its psychometric properties by a pilot study in Chinese primary care systems. Methods The translation and adaptation process were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 1610 community care professionals in all 79 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method and promax rotation was used to assess the construct validity. Cronbach’s alpha was utilized to ascertain the internal consistency reliability. Lastly, confirmation factor analysis was used to evaluate the exploratory factor analysis model fit. Results During the translation and adaptation process, all 48 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Six factors (person- & community-centeredness, care integration, professional integration, organizational integration, cultural competence and technical competence) with 45 items were determined by exploratory factor analysis, accounting for 61.46% of the total variance. A standard Cronbach’s alpha of 0.940 and significant correlation among all items in the scale (> 0.4) showed good internal consistency reliability of the tool. And, the model passed the majority of goodness-to-fit test by confirmation factor analysis. Conclusions The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT provider version. Its application in China will promote the development of people-centered integrated primary care. However, further psychometric testing is needed in multiple primary care settings with both public and private community institutes.

The COVID-19 outbreak spread rapidly throughout the globe, with worldwide infections and deaths continuing to increase dramatically. To control disease spread and protect healthcare workers, accurate information is necessary. We searched PubMed and Google Scholar for studies published from December 2019 to March 31, 2020 with the terms “COVID-19,” “2019-nCoV,” “SARS-CoV-2,” or “Novel Coronavirus Pneumonia.” The main symptoms of COVID-19 are fever (83–98.6%), cough (59.4–82%), and fatigue (38.1–69.6%). However, only 43.8% of patients have fever early in the disease course, despite still being infectious. These patients may present to clinics lacking proper precautions, leading to nosocomial transmission, and infection of workers. Potential COVID-19 cases must be identified early to initiate proper triage and distinguish them quickly from similar infections. Early identification, accurate triage, and standardized personal protection protocols can reduce the risk of cross infection. Containing disease spread will require protecting healthcare workers.

With age, our blood vessels are prone to aging, which induces cardiovascular disease. As an important basis for diagnosing heart disease and evaluating heart function, the electrocardiogram (ECG) records cardiac physiological electrical activity. Abnormalities in cardiac physiological activity are directly reflected in the ECG. Thus, ECG research is conducive to heart disease diagnosis. Considering the complexity of arrhythmia detection, we present an improved convolutional neural network (CNN) model for accurate classification. Compared with the traditional machine learning methods, CNN requires no additional feature extraction steps due to the automatic feature processing layers. In this paper, an improved CNN is proposed to automatically classify the heartbeat of arrhythmia. Firstly, all the heartbeats are divided from the original signals. After segmentation, the ECG heartbeats can be inputted into the first convolutional layers. In the proposed structure, kernels with different sizes are used in each convolution layer, which takes full advantage of the features in different scales. Then a max-pooling layer followed. The outputs of the last pooling layer are merged and as the input to fully-connected layers. Our experiment is in accordance with the AAMI inter-patient standard, which included normal beats (N), supraventricular ectopic beats (S), ventricular ectopic beats (V), fusion beats (F), and unknown beats (Q). For verification, the MIT arrhythmia database is introduced to confirm the accuracy of the proposed method, then, comparative experiments are conducted. The experiment demonstrates that our proposed method has high performance for arrhythmia detection, the accuracy is 99.06%. When properly trained, the proposed improved CNN model can be employed as a tool to automatically detect different kinds of arrhythmia from ECG.

Thus far, there have been no studies adapting the Mandarin 36-Item Short Form Health Survey (the SF-36) questionnaire for assessment of the health-related quality of life (HRQOL) of medical students in China. This study aimed to explore the feasibility of that form and analyse its impact factors. The study involved 498 randomly sampled medical students stratified by their academic majors, and general information was collected. The effective response rate was 83.53%. Split-half reliability coefficients and Cronbach&rsquo, s &alpha, coefficients of seven dimensions were more than 0.7 with the exception of the social function (SF) dimension. Spearman&rsquo, s correlation analysis results were basically in accord with the theoretical construction of the SF-36. The HRQOL of the students was scored from 43.83 (the RE dimension) to 93.34 (the PF dimension). The primary impact factors affecting the HRQOL of medical students included major, sleep quality, degree of physical exercise, post-exercise status, relationship with roommate, and satisfaction with family. These findings suggested that the Mandarin SF-36 was reliable for measuring the HRQOL, that the HRQOL of medical students in a Chinese university was relatively poor, and that its improvement requires concerted efforts.

Background: Dementia is one of the public health priorities in China. This study aimed to examine the hospitalization costs of patients with dementia and analyzed the factors associated with their inpatient costs. Methods: This was a prevalence-based, observational study using claims data derived from two urban insurance schemes during the period from 2008 through 2013 in Guangzhou. The extended estimating equations model was performed to identify the main drivers of total inpatient costs. Results: We identified 5747 dementia patients with an average age of 77.4. The average length of stay (LOS) was 24.2 days. The average hospitalization costs per inpatient was Chinese Yuan (CNY) 9169.0 (CNY 9169.0 = US$1479.8 in 2013). The mean inpatient costs for dementia patients with the Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY 9425.0 = US$1521.1) were higher than those for patients with the Urban Resident-based Basic Medical Insurance scheme (CNY 7420.5 = US$1197.6) (p &lt, 0.001). Having UEBMI coverage, dementia subtypes, having hypertension, being admitted in larger hospitals, and longer LOS were significantly associated with hospitalization costs of dementia. Conclusions: The costs of hospitalization for dementia were high and differed by types of insurance schemes. Dementia was associated with substantial hospitalization costs, mainly driven by insurance type and long LOS. These findings provided economic evidence for evaluating the burden of dementia in China.

Background Depression is regarded as a major public health concern in our society. While living arrangements as a structural factor of social support may contribute to older adults’ depression. Our study aims to investigate the association between living arrangements and depressive symptoms among older adults in the whole China, and to explore whether such influences differ by genders. Methods Data were obtained from the 2015 China Health and Retirement Longitudinal Study. The sample was comprised of 6001 individuals aged ≥60 years. Depressive symptoms were measured by the 10-item Short-Form Center for Epidemiological Studies Depression. Independent variables were divided into 4 groups, considering living with/without a spouse and living with/without a child. The multivariate logistic regression was used to estimate the relationship between living arrangements and depressive symptoms in four models. Results Compared with living only with a spouse, people living with a spouse and child, or living alone were more likely to have depressive symptoms (odds ratio = 1.23 95% CI 1.06–1.42 and 1.40 95% CI 1.03–1.92, respectively). Women were more associated with depressive symptoms (odds ratio = 2.13), but there were no significant associations between living arrangements and depressive symptoms among women. Men living with a spouse and a child had stronger positively depressive symptoms (odds ratio = 1.37). Conclusions Older adults living alone, or living with both a child and spouse were more likely to have depressive symptoms. It is important to provide more social services for those older adult, particularly for men living with a spouse and child. Electronic supplementary material The online version of this article (10.1186/s12889-019-7350-8) contains supplementary material, which is available to authorized users.

This paper presents a high precision and low computational complexity premature ventricular contraction (PVC) assessment method for the ECG human-machine interface device. The original signals are preprocessed by integrated filters. Then, R points and surrounding feature points are determined by corresponding detection algorithms. On this basis, a complex feature set and feature matrices are obtained according to the position feature points. Finally, an exponential Minkowski distance method is proposed for PVC recognition. Both public dataset and clinical experiments were utilized to verify the effectiveness and superiority of the proposed method. The results show that our R peak detection algorithm can substantially reduce the error rate, and obtained 98.97% accuracy for QRS complexes. Meanwhile, the accuracy of PVC recognition was 98.69% for the MIT-BIH database and 98.49% for clinical tests. Moreover, benefiting from the lightweight of our model, it can be easily applied to portable healthcare devices for human-computer interaction.

Background and objective Electrocardiogram (ECG) is a useful tool for detecting heart disease. Automated ECG diagnosis allows for heart monitoring on small devices, especially on wearable devices. In order to recognize arrhythmias automatically, accurate classification method for electrocardiogram (ECG) heartbeats was studied in this paper. Methods Based on weighted extreme gradient boosting (XGBoost), a hierarchical classification method is proposed. A large number of features from 6 categories are extracted from the preprocessed heartbeats. Then recursive feature elimination is used for selecting features. Afterwards, a hierarchical classifier is constructed in classification stage. The hierarchical classifier is composed of threshold and XGBoost classifiers. And the XGBoost classifiers are improved with weights. Results The method was applied to an inter-patient experiment conforming AAMI standard. The obtained sensitivities for normal (N), supraventricular (S), ventricular (V), fusion (F), and Unknown beats (Q) were 92.1%, 91.7%, 95.1%, and 61.6%. Positive predictive values of 99.5%, 46.2%, 88.1%, and 15.2% were also provided for the four classes. Conclusions XGBoost was improved and firstly introduced in single heartbeat classification. A comparison showed the effectiveness of the novel method. The method was more suitable for clinical application as both high positive predictive value for N class and high sensitivities for abnormal classes were provided.

BackgroundIllness-related costs experienced by tuberculosis patients produce a severe economic impact on households, especially poor families. Few studies have investigated the full costs, including direct and indirect costs, at the patient and household levels in south-east China.MethodsA case follow-up study was conducted in the Bao'an district of Shenzhen City, China. Eligible new and previously treated individuals with pulmonary tuberculosis (TB) during January 1st 2013 to June 30th 2013 were enrolled. Medical and non-medical costs as well as income loss were calculated in diagnosis and treatment periods, respectively. Factors associated with costs due to TB diagnosis, treatment and TB care (diagnosis + treatment) were explored respectively with a linear regression model.ResultsOf the total 514 TB patients enrolled, 95% were from the migrant population, and 65% were males, with a mean age of 32.25 (±10.11). The median costs due to TB diagnosis and TB treatment were 79 United States dollar (USD), 748USD (6.2897 China Yuan (CNY) = 1USD, 2013) per patient, respectively. The median costs due to TB care (diagnosis and treatment) per patient was 1218USD, corresponding to 26% of patients' annual income pre-illness. Those who visited more times to health facilities, hospitalized, received higher education, or occupied in national civil servant/services/retired staff might expense more before diagnosis. Costs due to TB treatment was significantly higher among migrant patients, sputum smear positive patients, and widowed/divorced population. Factors associated with less total costs were native patients, fewer times of visiting to health-care facilities and those with no hospitalization history due to TB.ConclusionsAlthough a free TB control policy is in force, patients with TB are still facing a heavy economic burden. More available interventions to reduce the financial burden on tuberculosis patients are urgently needed.

Objectives: Fragmented healthcare in China cannot meet the needs of the growing number of type 2 diabetes patients. The World Health Organization proposed an integrated primary care approach to address the needs of patients with chronic conditions. This study aims to measure type 2 diabetes patients&rsquo, preferences for urban integrated primary care in China. Methods: A discrete choice experiment was designed to measure type 2 diabetes patient preferences for seven priority attributes of integrated care. A two-stage sampling survey of 307 type 2 diabetes mellitus (T2DM) patients in 16 community health stations was carried out. Interviews were conducted to explore the reasons underpinning the preferences. A logit regression model was used to estimate patients&rsquo, willingness to pay and to analyze the expected impact of potential policy changes. Results: Travel time to care providers and experience of care providers are the most valued attributes for respondents rather than out-of-pocket cost. Attention to personal situation, the attentiveness of care providers, and the friendliness and helpfulness of staff were all related to interpersonal communication between patients and health care providers. Accurate health information and multidisciplinary care were less important attributes. Conclusions: The study provides an insight into type 2 diabetes patients&rsquo, needs and preferences of integrated primary care. People-centered interventions, such as increasing coverage by family doctor and cultivating mutual continuous relationships appear to be key priorities of policy and practice in China.

While emergency medical service (EMS) response time (ERT) is a major factor associated with the survival of patients with cardiovascular disease (CVD), relatively few studies have explored the factors associated with ERT. This study aimed to assess the current status of ERT and to identify the factors affecting ERT in patients with CVD in China. Between January 1, 2011 and December 31, 2015, EMS responses to CVD incidents in Guangzhou, China, were examined. The primary outcome was ERT, defined as the time from receipt of an emergency call to the arrival of paramedics on the scene. Factors associated with ERT were evaluated by multivariable logistic regression. A total of 44 383 CVD incidents were analysed. The median ERT was 12.58 min (interquartile range=9.98-15.67). Among the risk factors, distance (OR=13.73, 95% CI=11.76-16.04), level of hospital (OR=1.57, 95% CI=1.40-1.75), and site of the incident (OR=1.53, 95% CI=1.38-1.69) were the top three significant factors affecting the ERT. Our results suggest that greater attention should be given to factors affecting the ERT. It is essential to make continuous efforts to promote the development of effective interventions to reduce the response time.

ObjectivesDoctor–patient conflict is a phenomenon that has become one of the major social problems affecting China’s medical system today. This study aimed to analyse the nature of medical dispute incidents arising from dental practice, discover the related factors that may have incited such disputes and explore measures whereby the incidents of patients’ conflicts towards dentists can be reduced.MethodsA survey conducted in six public hospitals in Guangzhou, one of the largest cities in China, showed that more than two million patients received dental treatment between 2008 and 2012. χ2test and binary logistic regression analysis were used to identify statistically significant differences in incident rates.ResultsIn a total of more than two million outpatients, 541 reported dental disputes and lodged complaints with the medical service centre. Male patients reported higher dispute rates than did females (χ2=9.74, PConclusionsGender, specialties, cause of dispute, mode of payment and resolution duration are associated with the incidence of dental conflicts, suggesting that medical quality is positively correlated to dental disputes, the coverage of stomatology in medical insurance should be expanded and detailed negotiation system should be developed for resolving dental disputes.

Anatomical study of surgical approaches of endoscopic minimally invasive thyroidectomy (eMIT) and transoral partial parathyroidectomy (TOPP) was conducted to evaluate their safety and feasibility.After performing an eMIT- and TOPP-procedure on fresh frozen human cadavers, a layer-by-layer dissection of the floor of the mouth and the anterior cervical region was carried out in five specimens. The blood vessels, nerves and muscles related to the surgical approach were exposed.The anterior region of the neck can be reached through the midline of the mouth floor and the suprahyoid muscles. No important nerves and vessels were found in the approach of eMIT. TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The hypoglossal nerve and the lingual nerve as well as their accompanying blood vessels were anatomically related to the approach and could be injured during the procedure. The surgical space is much limited in TOPP (20 mm in diameter) and current surgical instruments still did not match the requirement of this technique.This study demonstrated that the transoral approach of eMIT is anatomically safer and more feasible than that of TOPP.

1. This study investigates the effects of verapamil on the pharmacokinetics of dihydromyricetin in rats and clarifies its main mechanism.2. The pharmacokinetic profiles of oral or intravenous administration of dihydromyricetin in Sprague-Dawley rats with or without pretreatment with verapamil were investigated. In addition, the effects of verapamil on the transport and metabolic stability of dihydromyricetin were investigated using Caco-2 cell transwell model and rat liver microsomes.3. In the oral group, verapamil could significantly increase Cmax, and decrease oral clearance of dihydromyricetin (p

MicroRNAs (miRNAs) are a class of highly conserved, small endogenous single-strand non-coding RNAs. They are aberrantly expressed in the circulation and tissue of patients with cancer. Therefore, it has been suggested that they may act as key regulators of carcinogenesis. The aim of the present study was to examine the expression level of miR-195-5p in human breast cancer and its potential role in carcinogenesis. The expression level of miR-195-5p was measured in 40 breast cancer specimens and adjacent normal breast tissues by quantitative polymerase chain reaction (qPCR). Next, to explore the potential function of miR-195-5p, we used MDA-MB-231 human breast cancer cells and carried out MTT, colony formation, Transwell chamber migration and cell cycle assays. The dual-luciferase reporter assay was also performed to determine putative targets of miR-195-5p, which were validated using qPCR and western blot assays. We found that miR-195-5p expression was significantly decreased in the 40 breast cancer specimens when compared with that in the adjacent normal breast tissues (P

MicroRNAs (miRNAs) are a small class of non-coding RNAs that are widely dysregulated in various cancers. They act as either oncogenes or tumor suppressor genes in human cancer. The purpose of this study was to examine the expression levels of miR-15a in human breast cancer and its potential role in disease pathogenesis. The expression levels of miR-15a were measured by quantitative polymerase chain reaction (qPCR) in 40 breast cancer specimens and adjacent normal breast tissues. MTT assays, colony formation assays, transwell chamber migration assays, cell cycle and apoptosis assays were used to explore the potential function of miR-15a in MDA-MB-231 human breast cancer cells. Luciferase reporter assays were performed to validate the regulation of a putative target of miR-15a, in corroboration with qPCR and western blot assays. We found that the expression of miR-15a was lower in breast cancer specimens compared with adjacent normal tissues (p

Objective We aimed to develop a questionnaire for quantitative evaluation of the autonomy of public hospitals in China. Method An extensive literature review was conducted to select possible items for inclusion in the questionnaire, which was then reviewed by 5 experts. After a two-round Delphi method, we distributed the questionnaire to 404 secondary and tertiary hospitals in Guangdong Province, China, and 379 completed questionnaires were collected. The final questionnaire was then developed on the basis of the results of exploratory and confirmatory factor analysis. Results Analysis suggested that all internal consistency reliabilities exceeded the minimum reliability standard of 0.70 for the α coefficient. The overall scale coefficient was 0.87, and 6 subscale coefficients were 0.92 (strategic management), 0.81 (budget and expenditure), 0.85 (financing), 0.75 (financing, medical management), 0.86 (human resources) and 0.86 (accountability). Correlation coefficients between and among items and their hypothesised subscales were higher than those with other subscales. The value of average variance extracted (AVE) was higher than 0.5, the value of construct reliability (CR) was higher than 0.7, and the square roots of the AVE of each subscale were larger than the correlation of the specific subscale with the other subscales, supporting the convergent and discriminant validity of the Chinese version of the Hospital Autonomy Questionnaire (CVHAQ). The model fit indices were all acceptable: χ 2 /df=1.73, Goodness of Fit Index (GFI) = 0.93, Adjusted Goodness of Fit Index (AGFI) = 0.91, Non-Normed Fit Index (NNFI) = 0.96, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.04, Standardised Root Mean Square Residual (SRMR) = 0.07. Conclusions This study demonstrated the reliability and validity of a CVHAQ and provides a quantitative method for the assessment of hospital autonomy.

To explore the application of Monte Carlo simulation in optimizing and adjusting the reimbursement scheme with regard to the New Rural Cooperative Medical System (NCMS) to scientific steering practice. Optimization of the reimbursement scheme in rural areas of China was also studied.A multi-stage sampling household survey was conducted in Sihui county, with 4 433 rural residents from 1 179 households from 13 towns in Guangdong province surveyed by self-designed questionnaire. Probit Regression Model was applied in fitting data and then estimating the own-price elasticity and cross elasticity of healthcare demand for both outpatients and inpatients. Monte Carlo simulation model was constructed to estimate the reimbursement effects of various alternative reimbursement schemes, by replicated simulation for one thousand times and each sampling on five hundred households. In this way, optimization of the implemented reimbursement scheme in Sihui county was conducted.Own-priced elasticity of demands for outpatient visit, inpatient visit in the township hospital center, secondary hospital and tertiary hospital were -0.174, -0.264, -0.675 and -0.429, respectively. Outpatient demand was affected by the per-visit price of township hospital center and secondary hospital. The cross-priced elasticity of demands for outpatient visit appeared to be 0.125 and 0.150. The reimbursement effects of Scheme B7 showed that the efficiency of NCMS fund was 17.85% , the reimbursement ratio for healthcare was 25.63%, and the decreased percentages of poverty caused by illness was 18.25%, more than 9.37%, from the implemented scheme A. So the implemented scheme was in need for optimization.Monte Carlo simulation technique was applicable to simulate the effects of the optimized alternative reimbursement scheme of NCMS and it provided a new idea and method to optimize and adjust the reimbursement scheme.

Background and aim: Protein Kinase (casein kinase 2, CK2) is a pleiotropic serine-threonine kinase that is frequently dysregulated in many human tumors; microRNAs (miRNAs) are a class of small noncoding RNAs which play important roles in human cancers. This study aimed to investigate the role of CK2 and miRNA expression in breast cancer. Methods: Casein kinase 2 in MCF-7 breast cancer cell line was inhibited by the CK2 inhibitor TBB (4,5,6,7-tetrabromobenzotriazole), then cell proliferation was studied using MTT assay, and cell cycle distribution and apoptosis were detected by flow cytometry. The alteration of microRNAs expression profile was determined by microarray technology, followed by RT-PCR confirmation. Results: Here, we for the first time showed that inhibition of CK2 in MCF-7 breast cancer cells causes suppressed cell growth, which was related with dysregulation of the miRNA profile and altered expression. CK2 inhibition induced the up-regulated expression of 17 miRNAs and 10 down-regulated microRNAs which contributed to the impaired growth, inhibited cell cycle progress and increased apoptosis of MCF-7 cells by a CK2 inhibitor. Conclusions: These findings highlight the potential role of dysregulated miRNA expression regulated by CK2 in breast cancer.

To evaluate the dietary pattern and nutritional status of urban residents in southeast coastal area.A dietary survey concerning 1332 persons aged 18 and over was carried out with dietary inquiry and 24-hour recall methods from August to December in 2009.The intakes of cereal, meat, eggs, seafood were enough. The consumption of milk and dairy products, vegetables, fruits was insufficient while the amount of oil was too high. Among them, the intake of milk and dairy products was only 1/3 of suggested values in Dietary Guideline and Balanced Diet Pagoda for Chinese Residents. The intakes of protein, retinol, iron and selenium were sufficient, while those of calcium, thiamine, riboflavin, ascorbic acid were too less than the dietary reference intakes (DRIs).The dietary pattern of urban residents in Ningbo was not reasonable. Nutrition education should be strengthened to guide residents for planning reasonable and balanced diets.

Background Few studies have evaluated health impacts, especially biomarker changes, following implementation of a new environmental policy. This study examined changes in water fluoride, urinary fluoride (UF), and bone metabolism indicators in children after supplying low fluoride public water in endemic fluorosis areas of Southern China. We also assessed the relationship between UF and serum osteocalcin (BGP), calcitonin (CT), alkaline phosphatase (ALP), and bone mineral density to identify the most sensitive bone metabolism indicators related to fluoride exposure. Methods Four fluorosis-endemic villages (intervention villages) in Guangdong, China were randomly selected to receive low-fluoride water. One non-endemic fluorosis village with similar socio-economic status, living conditions, and health care access, was selected as the control group. 120 children aged 6-12 years old were randomly chosen from local schools in each village for the study. Water and urinary fluoride content as well as serum BGP, CT, ALP and bone mineral density were measured by the standard methods and compared between the children residing in the intervention villages and the control village. Benchmark dose (BMD) and benchmark dose lower limit (BMDL) were calculated for each bone damage indicator. Results Our study found that after water source change, fluoride concentrations in drinking water in all intervention villages (A-D) were significantly reduced to 0.11 mg/l, similar to that in the control village (E). Except for Village A where water change has only been taken place for 6 years, urinary fluoride concentrations in children of the intervention villages were lower or comparable to those in the control village after 10 years of supplying new public water. The values of almost all bone indicators in children living in Villages B-D and ALP in Village A were either lower or similar to those in the control village after the intervention. CT and BGP are sensitive bone metabolism indicators related to UF. While assessing the temporal trend of different abnormal bone indicators after the intervention, bone mineral density showed the most stable and the lowest abnormal rates over time. Conclusions Our results suggest that supplying low fluoride public water in Southern China is successful as measured by the reduction of fluoride in water and urine, and changes in various bone indicators to normal levels. A comparison of four bone indicators showed CT and BGP to be the most sensitive indicators.