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Background: Turnover intention (TI) indicates an employee's intention to depart from their current role within a defined timeframe. In China, the Targeted Admission Medical Education (TAME) program, initiated in 2010, offers tuition-free education to cultivate rural doctors. Despite continuous professional development (CPD) being considered a viable retention strategy, TI of alumni doctors from the TAME program remains high in recent years. This study aims to describe the prevalence of "turnover intention" among alumni doctors of the TAME program doctors in rural placements, and associated factors that predict high turnover intention. Methods: A snowball sampling method was adopted to collect survey responses from 1,369 alumni doctors of the TAME program in Jiangxi Province, China. Based on the survey data, a binary variable was constructed to measure the turnover intention, and multivariate binary logistic regression models were used to investigate the relationship between doctors' turnover intention and demographic characteristics, work environment characteristics, and CPD activities. Results were presented using adjusted odds ratios with 95% confidence intervals. Results: Among the 1,369 alumni doctors of the TAME program surveyed in this study, 392 (28.6%) expressed intentions to leave their current positions. Of the respondents, 620 (45.3%) were female, and 930 (67.9%) were married. Additionally, 1,232 respondents (90%) indicated that their fathers were engaged in farm work. Strong associations with turnover intention were notably found among individuals who had undergone training at a higher-level healthcare institution for more than three months (aOR = 6.810, 95% CI: 3.333 to 13.909, p-value < 0.001), particularly those who had participated in CPD through a graduate degree program (aOR = 1.818, 95% CI: 1.272 to 2.597, p-value < 0.001). Conclusion: Rural doctors in China from the tuition-free medical education program exhibit high turnover intention, especially those in graduate degree programs as CPD. To retain these highly qualified rural doctors, it is vital to offer competitive efficiency wages aligned with their skills and provide ample long-term career growth opportunities within the rural healthcare system. Highlights: Retaining rural doctors in China who graduated from the tuition-free medical education program continues to pose a significant challenge. High turnover intention is particularly prevalent among those enrolled in CPD graduate degree programs. Offering competitive efficiency wages and creating abundant long-term career growth opportunities within the rural healthcare system are essential measures. [ABSTRACT FROM AUTHOR]

Background: Due to China's rapid urbanization, many farmers have relocated to urban resettlement regions. There is limited research on the glycemic control of Type 2 diabetes mellitus (T2DM) farmers in these areas. This study examined their blood glucose control and its determinants. Methods: This study took place from March 2021 to January 2022 in a resettlement community in Yiwu, Zhejiang Province, China. In the first phase, a quantitative survey of 181 T2DM farmers was conducted using a questionnaire to gather demographic data, blood glucose control status, disease cognition levels, and treatment compliance. Inclusion criteria were migrant workers with ≥ 3 months of residence and local household registration and T2DM patients who met the diagnostic criteria of the Chinese guidelines. In the second phase, qualitative research involved face-to-face, semi-structured interviews with 15 patients with varying blood glucose control levels to analyze their experiences. Results: The blood glucose control rate in this particular group was 27.62%, and the average disease cognition score was 2.5 ± 0.75. Many patients (67.96%) had inadequate treatment compliance, specifically in monitoring compliance (4.45 ± 1.92) and regular review compliance (3.58 ± 1.74). Conclusion: There is a need for tailored programs to improve glycemic control among resettled farmers. Enhancing disease awareness and treatment compliance through targeted education and support is crucial. Further studies are needed to evaluate different treatment regimens' impact on glycemic control. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Since 2020, China has piloted an innovative payment method known as the Diagnosis-Intervention Packet (DIP). This study aimed to assess the impact of the DIP on inpatient volume and bed allocation and their regional distribution. This study investigated whether the DIP affects the efficiency of regional health resource utilization and contributes to disparities in health equity among regions. Methods: We collected data from a central province in China from 2019 to 2022. The treatment group included 508 hospitals in the pilot area (Region A, where the DIP was implemented in 2021), whereas the control group consisted of 3,728 hospitals from non-pilot areas within the same province. We employed the difference-in-differences method to analyze inpatient volume and bed resources. Additionally, we conducted a stratified analysis to examine whether the effects of DIP implementation varied across urban and rural areas or hospitals of different levels. Results: Compared with the non-pilot regions, Region A experienced a statistically significant reduction in inpatient volume of 14.3% (95% CI 0.061–0.224) and a notable decrease of 9.1% in actual available bed days (95% CI 0.041–0.141) after DIP implementation. The study revealed no evidence of patient consultations shifting from inpatient to outpatient services due to the reduction in hospital admissions in Region A after DIP implementation. Stratified analysis revealed that inpatient volume decreased by 12.4% (95% CI 0.006–0.243) in the urban areas and 14.7% in the rural areas of Region A (95% CI 0.051–0.243). At the hospital level, primary hospitals experienced the greatest impact, with a 19.0% (95% CI 0.093–0.287) decline in inpatient volume. Furthermore, primary and tertiary hospitals experienced significant reductions of 11.0% (95% CI 0.052–0.169) and 8.2% (95% CI 0.002–0.161), respectively, in actual available bed days. Conclusions: Despite efforts to curb excessive medical service expansion in the region following DIP implementation, large hospitals continue to attract a large number of patients from primary hospitals. This weakening of primary hospitals and the subsequent influx of patients to urban areas may further limit rural patients' access to medical services. The implementation of the DIP may raise concerns about its impact on health care equality and accessibility, particularly for underserved rural populations. [ABSTRACT FROM AUTHOR]

There is growing evidence that differences exist between rural and urban residents in terms of health, access to care and the quality of health care received, especially in low- and middle-income countries (LMICs). To improve health equity and the performance of health systems, a diagnosis-related group (DRG) payment system has been introduced in many LMICs to reduce financial risk and improve the quality of health care. The aim of this study was to examine the impact of DRG payments on the health care received by rural residents in China, and to help policymakers identify and design implementation strategies for DRG payment systems for rural residents in LMICs. Health impact assessment. This study compared the impact of DRG payments on the healthcare received by rural residents in China between the pre- and post-reform periods by applying a difference-in-difference (DID) methodology. The study population included individuals with three common conditions; namely, cerebral infarction, transient ischaemic attack (TIA), and vertebrobasilar insufficiency (VBI). Data on patient medical insurance type were assessed, and those who did not have rural insurance were excluded. This study included 13,088 patients. In total, 33.63% were from Guangdong (n = 4401), 38.21% were from Shandong (n = 5002), and 28.16% were from Guangxi (n = 3685). The DID results showed that the implementation of DRGs was positively associated with hospitalization expense (β 4 = 0.265, P = 0.000), treatment expense (β 4 = 0.343 , P = 0.002), drug expense (β 4 = 0.607, P = 0.000), the spending of medical insurance funds (β 4 = 0.711, P = 0.000) and out-of-pocket costs (β 4 = 0.164, P = 0.000). The findings of this study suggest that the implementation of DRG payments increases health care costs and the financial burden on health systems and rural patients in LMICs. This is contrary to the original intention of implementing the DRG payment system. [ABSTRACT FROM AUTHOR]

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

The health of women of childbearing age in rural areas is crucial for the development of individuals, families, and society. Research on the identification and influencing factors of health vulnerability in impoverished and disadvantaged groups is important for adjusting and implementing health poverty alleviation policies. However, there is limited research on the health vulnerability of women of childbearing age in rural Western China. Based on panel data from the Rural Residents' Family Health Status Survey in 2019 and 2022, the vulnerability to health poverty of women of childbearing age in rural areas was constructed using the three-stage feasible generalized least squares method. Variables from four dimensions—physical capital, financial capital, social capital, and human capital—were included in the sustainable livelihood analysis framework for analysis. The Tobit model was used to analyze the influencing factors of vulnerability to health poverty among women of childbearing age in rural Western China, and the contribution rates of various factors were studied using the Shapley value decomposition method. In 2019 and 2022, under the poverty line standards of $1.90 and $2.15, respectively, the vulnerability to health poverty among rural women of childbearing age exceeded 20%. Tobit regression analysis revealed that the type of drinking water being well water significantly increased the vulnerability to health poverty of rural women of childbearing age (P < 0.05), whereas the separation of housing and kitchen, registered poor households, household loans, annual per capita household income, expenditures on social interactions, educational level, self-assessed health status, respondent age, and the utilization of hospital services significantly reduced the vulnerability to health poverty of rural women of childbearing age (P < 0.05). Shapley's decomposition shows that annual per capita household income, expenditures on social interactions, respondent age, and household loans are the factors contributing most to the vulnerability to health poverty of rural women of childbearing age, while other variables have a smaller contribution rate. The health poverty situation of women of childbearing age in rural Western China is not optimistic. Preintervention for health poverty should be strengthened among rural women of childbearing age, early warning mechanisms for the risk of falling back into poverty due to illness should be established, the precise identification of highly vulnerable rural women of childbearing age should be improved, and the medical insurance system for rural women of childbearing age should be enhanced to help improve their current health poverty situation. [ABSTRACT FROM AUTHOR]

Promoting sustainable agricultural development is pivotal to realizing sustainable development goals. This study initially constructs a comprehensive indicator to delineate the landscape of agricultural sustainable development (ASD) across China. While ASD in China demonstrates an upward trajectory, it remains relatively low and exhibits disparities across regions. Ensuring food security with minimal energy consumption in agriculture is particularly critical for China, and fostering access to affordable and clean energy services in rural areas is essential for expediting the transition to sustainable agriculture. This study investigates the impact of rural energy poverty (REP) on ASD across 30 Chinese provinces from 2000 to 2017, revealing that the eradication of REP yields tangible benefits for ASD. Furthermore, considering regional disparities, the elimination of REP significantly enhances ASD, particularly in non-major grain-producing areas compared to major grain-producing regions. These findings underscore the imperative of integrating efforts to alleviate energy poverty with initiatives aimed at advancing ASD. Such integration is indispensable for driving the overarching transition toward sustainable agriculture. [ABSTRACT FROM AUTHOR]

Background: There is a high prevalence of childhood maltreatment among Chinese children and adolescents, but little is known about its impact on alcohol and tobacco use trajectories and how positive school and neighborhood environments moderate the associations. The objective of this study was to assess the association between multiple forms of childhood maltreatment and longitudinal alcohol and tobacco use trajectories, and to assess the possibility that perceived connections to school and neighborhood moderate these associations. Methods: This longitudinal cohort study included 2594 adolescents (9 to 13 years) from a low-income rural area in China. Childhood exposure to abuse and neglect was assessed using the Childhood Trauma Questionnaire. Participants reported past-month alcohol and tobacco use at three time points over 1 year. Results: Growth curve models revealed that childhood sexual abuse was associated with a higher risk of past-month drinking (OR = 1.53, 95% CI 1.19–2.03, p < 0.001) and smoking (OR = 1.82, 95% CI 1.30–2.55, p < 0.001). Neglect was associated with a higher risk of past-month drinking (OR = 1.52, 95% CI 1.06–1.90, p < 0.05) and smoking (OR = 2.02, 95% CI 1.34–3.02, p < 0.001). None of the maltreatment forms predicted a faster increase in either drinking or smoking. These associations were found independent of personal, family, and contextual characteristics. School and neighborhood connection moderated the association between physical abuse and past-month drinking, such that physical abuse was associated with a greater risk of drinking only for youth who perceived low school or neighborhood connections. Conclusions: Findings demonstrate the importance of early experiences of childhood maltreatment for adolescent alcohol and tobacco use. Enhancing school and neighborhood connectedness for physically abused youth may help protect them from alcohol use. [ABSTRACT FROM AUTHOR]

Background: Village doctors are the main health service providers in China's rural areas. Compared with other rural groups, they will have a sense of relative deprivation, which has an impact on their practice mentality and job stability. This study aims to analyze the changes and causes of relative deprivation among village doctors, so as to improve the stability of them. Methods: The data were collected from two surveys conducted in Shandong Province in 2015 and 2021. In 2015, 322 village doctors were surveyed and 307 questionnaires were collected, with a recovery rate of 95.3%. In 2021, 394 village doctors were surveyed and 366 questionnaires were collected, with a recovery rate of 92.9%. Descriptive and univariate analysis were used to compare the changes before and after the survey. Results: The scores of vertical deprivation of village doctors increased from 2.77 ± 0.81 in 2015 to 3.04 ± 0.83 in 2021, with a statistically significant difference (P < 0.001). The reference group selected by village doctors changed from village teachers to ordinary villagers. Compared to village teachers, the horizontal deprivation score of village doctors increased from 3.47 ± 0.87 to 3.97 ± 0.77, with a statistically significant difference (P < 0.001). Compared to villagers, only the professional reputation deprivation score increased, from 2.38 ± 0.93 to 2.68 ± 0.76, with a statistically significant difference (P < 0.05). Conclusions: As time goes by, village doctors fail to reach the expected level in terms of economic income, social status, professional reputation and living standards, resulting in a sense of relative deprivation. This may have a negative impact on village doctors' work motivation and behavior, and will fail to guarantee the sustainability of the team. We should pay attention to this unbalanced mentality of village doctors. [ABSTRACT FROM AUTHOR]

Objectives: In the rural regions of China, characterized by a pronounced aging demographic and limited resources, a substantial proportion of middle-aged and older adults engage in grandparenting roles. Yet, the literature lacks consistent evidence regarding the effects of grandparenting on the mental health of this cohort. Accordingly, this study aimed to explore the impact of grandparenting on the mental health of rural middle-aged and older adults, as well as the underlying mechanisms. Methods: This analysis encompassed 10,881 middle-aged and older adults, utilizing data from the 2018 Harmonized China Health and Retirement Longitudinal Study (CHARLS). The mental health of participants was assessed using the Center for Epidemiological Studies Depression-10 (CESD-10) scale, while support from children was categorized into financial and emotional types. The study employed logistic and OLS regression models to identify the mediating role of child support and utilized the Karlson-Holm-Breen (KHB) method for decomposing this mediating effect. Results: The findings demonstrated that grandparenting had a significant negative impact on depression among rural middle-aged and older adults. Furthermore, children's support played a vital role in mediating this relationship, accounting for approximately one-third of the overall influence. Moreover, the decomposition analysis revealed that both emotional and economic support from adult children equally contributed to the declination of depression among rural middle-aged and older adults. Conclusion: Grandparenting significantly enhances mental well-being in rural middle-aged and older adults, with the support from adult children serving as a vital pathway for this positive impact. Both economic and emotional assistance from children hold equal importance in this dynamic. It underscores the necessity of fortifying the family support system to amplify the support provided by children, which in turn could significantly enhance the mental health of rural middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Background: Healthcare providers play important roles in supporting breastfeeding. Although there has been insufficient actual breastfeeding support from healthcare providers in China, little research has been conducted to understand Chinese healthcare providers' perceived barriers to providing breastfeeding support, especially in rural China. This study aims to identify these perceived barriers to providing breastfeeding support in Northwestern rural China. Methods: This study was conducted during the period from March 2018 to December 2018. Forty-one healthcare providers were recruited through purposive sampling in two rural counties in Northwest China that are in close proximity to each other and share similar demographic features. Participants included obstetrician-gynecologists, midwives, nurses, "village doctors", and township and village maternal and child health workers. Qualitative data were collected through one-on-one in-depth semi-structured interviews and focus group discussions. Transcripts were thematically analyzed. Results: Analysis of interview data resulted in four themes that the participants perceived as barriers to supporting breastfeeding: (1) lack of medical resources, within which inadequate staffing, and lack of financial incentives were discussed, (2) lack of clear and specific responsibility assignment, within which no one takes the lead, and mutual buck-passing were discussed, (3) healthcare providers' lack of relevant expertise, within which lack of knowledge and skills, and low prestige of village healthcare providers were discussed, (4) difficulties in accessing mothers, within which medical equipment shortages reduce services utilization, mothers' housing situation, mothers' mobility, and cultural barriers were discussed. Conclusions: The study identified HCPs perceived barriers to providing breastfeeding support. Unique to China's Tri-Level Healthcare System, challenges like staffing and financial incentives are hard to swiftly tackle. Recommendations include mHealth enhancement and clarified responsibilities with incentives and tailored training. Further research is crucial to evaluate these strategies in rural Northwestern China and comparable underdeveloped areas nationwide. [ABSTRACT FROM AUTHOR]

Rural‒urban migration is accompanied by urbanization in China, and its effect on individual well-being has received much scholarly attention. However, research on whether and how rural‒urban migration affects rural migrants' health is still lacking. Using nationally representative data from three waves of the China Labor Force Dynamic Survey, this research investigates the impact of rural‒urban migration on the health of rural migrants and its potential mechanisms. We find that controlling for the endogeneity issue, rural‒urban migration has a negative impact on rural migrants' health, lowering their self-rated health (SRH) and increasing their probability of illness. Analyses of potential mechanisms show that subjective social status is crucial in explaining the negative effects of rural‒urban migration on SRH and illness. To better understand the health deterioration of rural‒urban migrants, the local social and cultural contexts in China should be considered so that targeted measures can be implemented to promote migrants' health more effectively. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the effects of community-based home health care (HHC) on the physical and mental health of older adults with chronic diseases in China. Methods: The study data were retrieved from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Ordinary least squares regression model was used to assess the effects of community-based HHC on the health. Entropy balancing was used to test the robustness of the regression results. Results: A total of 5571 older adults with chronic diseases were included. The results showed that older adults who had received community-based HHC reported significantly better self-rated health (coefficient = 0.051, 95%CI [0.004, 0.098]), less physical discomfort (coefficient = − 0.021, 95%CI [− 0.042, − 0.001]), lower depression scores (coefficient = − 0.263, 95%CI [− 0.490, − 0.037]), and lower anxiety scores (coefficient = − 0.233, 95%CI [− 0.379, − 0.088]) compared with those who had not received community-based HHC. Overall, community-based HHC conferred greater positive effects on the health of rural older adults, older adults with multiple chronic diseases, and older adults with low incomes. Conclusion: Community-based HHC was beneficial for improving self-rated health and reducing physical discomfort, depression, and anxiety in older adults with chronic diseases, thus improving their quality of life. It is important to promote its development nationwide in China. [ABSTRACT FROM AUTHOR]

With the rapid development of multimedia technology, short video apps have become a common form of entertainment for the elderly. Studies showed that participation in short video apps have positive impact on the elderly. However, research on the elderly's preference for apps designed for them is limited. In this study, the target subjects--the population in demand for using short video apps -- are the elderly aged 55-75 years old and in good health in rural areas of northern Anhui. The two objectives of this study are: (1) to analyze the well-known we-media software related to short videos in China; (2) to investigate and explore the elderly's demand for short video apps through Kano model questionnaire. The results showed the preference of the elderly for interface design, functional content, interaction mode, and information display. The enhancement of these four qualities in the development and design of we-media will not only provide more positive experience for elderly users, but also ensure the design suitability of we-media for them. [ABSTRACT FROM AUTHOR]

The fact that rural hydropower stations are scattered in sites and discharge facilities differ widely in their forms causes the high costs of ecological flow discharge monitoring in China. Meanwhile, the irregularity of river sections and the randomness of hydrological situations also increase the difficulty of flow monitoring, impeding the extensive application of regular monitoring equipments. Under such circumstances, non-contact video recognition is an effective alternative. Based on the data extracted from a large number of ecological flow discharge videos, the authors develop a video recognition intelligent algorithm, which can be used to identify whether the ecological flow has been discharge or not. By combining a main algorithm and a sub-model, this system ensures not only the universality and ease of use of the identification, but also the accuracy of the identification results. The authors also develop a water conservancy video AI general component system, which integrates the video recognition intelligent system and the identification business process, and has been put into use in 499 rural hydropower stations through a period of five months. The effectiveness and promotion value of this system is testified by the statistics of all recognition results: after ruling out the cases where the videos or images are blurred, the average recognition accuracy under normal conditions is 97.8%. [ABSTRACT FROM AUTHOR]

Background: The overall level of negative affect (NeA) has been linked to impaired health. However, whether the diurnal timing of NeA matters and whether the NeA-health relationship is mediated by sleep quality remain unclear. Methods: Using a longitudinal dataset (2006, 2009 and 2014 waves) consisting of 1959 participants, we examined the within-person impact of both bedtime NeA and non-bedtime NeA measured by Day Reconstruction Method (DRM) on subjective health measured by Visual Analogue Scale (VAS), and the mediating effect of sleep quality on the NeA-health relationships by fixed effect models. Results: Bedtime NeA predicted poorer health, while non-bedtime NeA was unrelated to health. The deleterious impact of bedtime NeA reduced and became non-significant after sleep quality was controlled for. Bedtime NeA also significantly predicted impaired sleep quality. Conclusions: Bedtime NeA is a stronger predictor of poorer health than non-bedtime NeA, and the deleterious influence of bedtime NeA on health seems to operate through poor sleep quality. Therefore, interventions to reduce bedtime NeA could potentially improve subsequent sleep quality, thereby protecting people to some extent from impaired health status. [ABSTRACT FROM AUTHOR]

External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of 'graduating' from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor–recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries. [ABSTRACT FROM AUTHOR]

The development of rural preschool education (RPE) is not only related to the healthy growth of rural preschool children, but also to social fairness and sustainable development. Therefore, the development of RPE not only involves the expansion of quantity, but also the improvement of its quality. At present, in China's RPE, the determination of value goals There are still many obstacles in terms of source supply, institutional mechanism construction, development mode selection, and external environment construction, which make the high-quality development of RPE lack good internal motivation and external support. In view of this situation, some researchers have begun to explore the high-quality and sustainable development of RPE differently. However, the high-quality development of RPE is a systematic reform project that needs to start from the present. From multiple perspectives such as reality and history, internal and external education, this paper examines the systematic and global nature of RPE reform and development. The development level evaluation of RPE is a MADM. In this paper, the generalized weighted Bonferroni mean (GWBM) decision operator and power average (PA) is designed to manage the MADM under single-valued neutrosophic sets (SVNSs). Then, the generalized single-valued neutrosophic number power WBM (GSVNNPWBM) decision operator is constructed and the MADM model are constructed based on GSVNNPWBM decision operator. Finally, a decision example for development level evaluation of RPE and some useful comparative studies were constructed to verify the GSVNNPWBM decision operator. [ABSTRACT FROM AUTHOR]

Nitrate pollution in groundwater is a global environmental problem that poses risks to human health. We investigate the health risks of nitrate in rural drinking groundwater in Rucun Township and surrounding areas of Wutai County, and provide a basis for healthy drinking water. By using statistical analysis software (SPSS19) and hydrogeochemical analysis software (AqQA), a qualitative and quantitative evaluation of nitrate health risks was conducted among populations of different ages and genders through water sample collection, chemical analysis, and construction of a human health risk model (HHRA). Through research, it was found that the average concentration of nitrate in the study area is 43.99 mg/L. Groundwater is severely polluted by NO3-, and nitrate pollution areas are mainly concentrated in the main human activity areas, especially in the main agricultural production areas. The Quaternary loess layer, as a permeable layer, cannot prevent groundwater from being polluted by NO3-. Through evaluation, it is believed that there is a health risk of nitrate pollution in rural drinking groundwater in Rucun Township and surrounding areas. Health risk level: infants.children.adult females.adult males. The discovery and evaluation results can provide a basis for the prevention and control of nitrate pollution in groundwater. [ABSTRACT FROM AUTHOR]

Fine particulate matter (PM2.5) has health effects that may depend on its sources and chemical composition. In this study, characteristics of PM2.5 chemical composition and health risk assessment from Songyuan, China, were investigated during day and night in indoor and outdoor from February 4 to 19, 2021. Relative high concentrations of PM2.5 were obtained in indoor environment than outdoor, with 503.95 ± 209.62 μg/m3 during the day and 357.52 ± 232.81 μg/m3 at night for the indoor environment. Relatively high total carbon, organic carbons, elemental carbons, polycyclic aromatic hydrocarbons (PAHs), and oxygenated polycyclic aromatic hydrocarbons (OPAHs) were obtained in indoor environment. However, the average concentrations of PAHs were higher during night (73.57 ± 43.09 ng/m3) in indoor and OPAHs during day (6.027 ± 2.960 ng/m3) in outdoor. They had different I/O distributions of these compounds during day and night. Indeno(1,2,3-cd) pyrene was the dominant PAHs, and benzanthrone was the dominant OPAHs; this is different with the previous studies. The high indoor/outdoor ratios showed the indoor coal and biomass burning greatly affect the indoor pollutants. Average ILCR health risk assessment for PAHs was all higher than 10−6 for different age gender, suggesting there has potential cancer risk existed for populations living in the rural coal and biomass burning area Songyuan, China. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the impact of the increased prevalence of sanitary toilets in rural areas on the health of rural residents, and whether the popularity thereof has a positive externality. This study investigates whether the broader use of sanitary toilets has had a positive effect on the health of people who do not have access to them. Methods: Data from the China Family Panel Studies from 2012 to 2014 and a two-way fixed effect model were used to investigate the relationship between the prevalence of village sanitary toilets and the health of rural residents of all ages. Results: The results showed that: (1) the increase in the prevalence of sanitary toilets in villages is conducive to improving the health level of rural residents; (2) the widespread adoption of sanitary toilets in rural areas has improved the health of not only residents with access to these toilets but also residents without access; (3) the health of children is more sensitive to improvements in sanitary conditions of toilets; and (4) there are significant regional differences in the impact of the popularity of sanitary toilets on the health of rural residents. Conclusions: This study found that the popularity of sanitary toilets has externalities, improving not only the health of residents who use them but also the health of other residents. This study enriches the literature in the field of health effects of sanitation improvement, while providing a reference for developing countries to further enhance the living environment in rural areas. In the future, the popularization of sanitary toilets should be vigorously promoted to reduce the incidence of diseases. [ABSTRACT FROM AUTHOR]

Parabens and alkylphenols pose serious hazards to human health, yet there are few studies on their exposure profiles and health risks in rural Chinese populations. In this study, 804 participants were selected from the Henan Rural Cohort in mid-eastern China. The plasma levels of parabens (methylparaben, ethylparaben, propylparaben, butylparaben (BuP)) and alkylphenols (4-tert-butylphenol (4-t-BP), 4-tert-octylphenol (4-t-OP)) were analyzed via liquid chromatography–tandem mass spectrometry. Linear regression models were used to investigate factors that may influence pollutant exposure levels. The correlation between contaminants was assessed using Spearman's correlation. The human contaminant intake was estimated using the estimated daily intake (EDI). The health risk was assessed using the hazard quotient (HQ). The detection frequency of four parabens and two alkylphenols exceeded 75%, with median concentrations of 0.444, 0.067, 0.078, 0.053, 8.810, and 6.401 ng/mL, respectively. Significant correlations were observed between parabens, as well as between 4-t-BP and 4-t-OP. Regarding gender, paraben concentrations were higher in women than in men, except for BuP. The EDI for pollutants except 4-t-OP was lower than their respective tolerable/acceptable daily intake. In total, 85.70% of participants had 4-t-OP HQ > 1. A widespread exposure to parabens and alkylphenols among the rural population was found. The high health risks of alkylphenol exposure indicate that alkylphenols should be used with caution. [ABSTRACT FROM AUTHOR]

High-quality teaching staff is one of the key factors in the advancement of Chinese compulsory education. The purpose of this article is to pinpoint issues with teacher recruitment, retention, and training in rural areas, such as unbalanced employment mobility, unreasonable composition of staff, and impeded teacher professional development. Recommendations on improving rural school staffing are also made in the dimensions of government policies, in-service training, and social support. [ABSTRACT FROM AUTHOR]

Using data from three waves of the China Health and Retirement Longitudinal Study, this study identifies a causal effect of the distance adult children reside from their parents on the mental health of the rural elderly. We use panel correlated random effect methods with instrumental variables to address potential confounding effects of reverse causality and unobserved omitted variables. We find that the impact of the distance adult children live from their parents on parental mental health exhibits an inverted 'U-shaped' pattern that first increases (good) and then slowly decreases (poor). 80 kilometers is a threshold of residence distance for the mental health of the rural elderly. Further analysis finds that the effect of the residence distance on the mental health of rural elderly has statistically significant differences by gender of the elderly. [ABSTRACT FROM AUTHOR]

Environmental pollution, especially agricultural carbon emissions (ACE), has led to public health problems to rural areas in China and accompanied by a heavy medical economic burden. However, most studies on carbon dioxide emissions and healthcare expenditures focused on the industrial sector, and the effect of ACE was overlooked. Therefore, studying the effect of ACE on rural residents' healthcare expenditures (NHCE) is not only conducive to accelerating the low-carbon transformation of agriculture but also has important implications for reducing healthcare expenditures. In addition, the effect of ACE on NHCE in different areas might be complex and nonlinear due to differences in years of schooling (EDU) leading to different awareness of environmental protection and health among farmers. Therefore, this paper used the Bayesian quantile regression (BQR) model and the panel threshold model to explore the effect of ACE on NHCE in different areas, based on the panel data of 31 provinces in China from 2007 to 2019. The results showed that ACE and NHCE experienced similar spatial distribution from 2007 to 2019. The BQR estimation results found that ACE had a significant positive effect on NHCE at different quantile levels during the sample period, public health concern, and thereby increasing the medical and economic burden of rural households. Meanwhile, ACE had a positive effect on NHCE with a significant single threshold effect from EDU. Specifically, farmers gradually realize the harm of environmental pollution to health with the continuous improvement of education level, and then ACE aggravated the improvement of NHCE after exceeding the threshold. EDU was more essential for farmers in contiguous poverty (CP) areas than in relatively developed (RD) areas and played an important role between ACE and NHCE. Furthermore, demographic structure, economic development, and public services were also positive driving factors for NHCE. The results of analysis provide a valuable reference for understanding the factors influencing NHCE and enable formulation of ACE emission reduction policies according to local conditions. [ABSTRACT FROM AUTHOR]

The digital divide between urban and rural adolescents is widening. Many existing studies have found an association between internet use and adolescent mental health, but few use longitudinal data to focus on rural adolescents. We aimed to identify the causal relationships between internet use time and mental health in Chinese rural adolescents. Using a sample of 3694 participants (aged 10–19) from the 2018–2020 China Family Panel Survey (CFPS). Fixed effects model, mediating effect model and instrumental variables method was used to evaluate the causal relationships between internet use time and mental health. We find that more time spent on the internet has a significant negative effect on participants' mental health. This negative impact is stronger in female and senior students groups. Mediating effects analysis suggests that more time spent on the internet increase risk of mental health problems by reducing sleep duration and parent-adolescent communication. Further analysis find that online learning and online shopping is associated with higher depression scores, while online entertainment with lower depression scores. The data do not investigate the specific time spent on internet activities (e.g., learning, shopping, and entertainment), and the long-term impacts of internet use time and mental health have not been tested. Internet use time has a significant negative impact on mental health by crowding out sleep duration and parent-adolescent communication. The results provide an empirical reference for the prevention and intervention of mental disorders in adolescents. • Few studies use longitudinal data to focus on internet use time and mental health of Chinese rural adolescents. • More time spent on the internet increases risk of mental health problems • Sleep duration and parent-adolescent communication play a significant mediating role. • Online learning and online shopping is associated with higher depression scores. [ABSTRACT FROM AUTHOR]

The realization of common prosperity is an essential requirement of socialism and an important feature of modernization with Chinese characteristics. New infrastructure development is a new engine for general and balanced economic growth in the digital economy era and plays an important role in achieving high-quality and inclusive economic growth. This study innovatively incorporated new infrastructure development into the theoretical analysis framework of common prosperity. Based on the data of 30 provincial-level samples from 2011 to 2020 and using the entropy weight method and coupled coordination model, this paper measured the level index of new infrastructure development and that of common prosperity. On this basis, the paper empirically examined the influence mechanism of new infrastructure development on common prosperity, the process of marketization, and the moderating role of rural human capital investment. The results showed that, overall, new infrastructure development significantly promoted common prosperity. Regionally, the new infrastructure development promoted the common prosperity of China' s southern region but had an obvious inhibitory effect on its northern region. Although new infrastructure was divided into different categories, fusion infrastructure, innovation infrastructure, and information infrastructure all promoted common prosperity to different degrees, but in terms of impact coefficient, fusion infrastructure, information infrastructure, and innovation infrastructure all declined in turn, as a matter of fact. The marketization process, rural health, education and training, and the migration of human capital investments all contributed to strengthening the role of new infrastructure development in promoting common prosperity. This study not only helps to clarify the theoretical correlation between new infrastructure development and common prosperity and enrich the sustainable or inclusive assessment framework of new infrastructure development from the perspective of common prosperity, but also helps to coordinate the goals and tasks of new infrastructure development and common prosperity for governments at all levels and relevant departments in practice and provides empirical evidence and policy implications. [ABSTRACT FROM AUTHOR]

Ubuntu generally means humanity. It is an African philosophy and a principle that is being promoted by the international bodies of social work. Like other Western knowledge, its capacity for indigenisation should be a shared interest nowadays. This article assesses the utilisation of Ubuntu for a rural development programme in China. It illustrates Ubuntu's unique perspectives about traditional values and human relationships for promoting a holistic understanding of professional practice. The implications encourage further discoveries of various potential uses of Ubuntu in respective localities for developing a polythetic community of international social work. [ABSTRACT FROM AUTHOR]

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Background: Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Methods: Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Findings: Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Conclusion: Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population for the turnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect. [ABSTRACT FROM AUTHOR]

Older people in rural China enjoy the right to health under Chinese law. However, the problems of economic difficulties, the unbalanced allocation of medical resources between urban and rural areas and the weakening of the traditional function of the family as a provider of old-age care in reality make the elderly in rural areas face a higher risk of health problems. The law is an important tool to mitigate these problems. Although China has made great efforts to legally guarantee the right to health of the rural elderly, it has not yet fully implemented the requirements of Article 12 of the International Covenant on Economic, Social and Cultural Rights, Article 14 of the Madrid Political Declaration and International Plan of Action on Ageing. China needs to further improve the relevant legislation to provide adequate legal support for the exercise of the right to health of the elderly in rural areas. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the recent prevalence and the distributions of morphological subtypes of anaemia in the rural population. Design: Anaemia was defined according to the WHO and the Chinese criteria, and the morphological subtypes of anaemia were classified based on the erythrocyte parameters. The age-standardised prevalence was calculated according to the data of the Population Census 2010 in China. Setting: A cross-sectional study in Henan Province. Participants: 33 585 subjects aged 18–79 years old. Results: The standardised prevalence of anaemia across the WHO and the Chinese definitions was 13·63 % and 5·45 %, respectively. Regardless of which criteria was used, the standardised prevalence of anaemia was higher among women than among men and that increased with age in men, while markedly decreased after menopause in women. There were shifts in morphological patterns of anaemia using the WHO and the Chinese criteria that the standardised prevalence of microcytic anaemia was 3·74 % and 2·97 %, normocytic anaemia was 9·20 % and 2·34 %, and macrocytic anaemia was 0·75 % and 0·14 %, respectively. Besides, there were differences in the influencing factors of anaemia according to different criteria or gender. However, age, education level and renal damage were consistently significantly associated with anaemia in all participants. Conclusions: Anaemia may still be a serious health problem in rural China. It is necessary to reformulate prevention and management strategies to reduce the disease burden of anaemia. [ABSTRACT FROM AUTHOR]

With the development of digital technology, digital health tools connect individuals with vast health resources and empower individuals to participate in health management. In this paper, based on the KAP theoretical model and the theory of comprehensive human development, we combine the framework of China's health literacy system to construct a health literacy index system for rural physical education teachers. Based on the digital empowerment concept, digital technologies such as big data, mobile internet and artificial intelligence are used to empower physical education teachers so that physical education teachers in rural areas promote health literacy and teaching ability. Finally, through the results of promoting health literacy competence of physical education teachers in the tested rural areas under digital empowerment, we learned that the chain mediated effect value of digital health empowerment on physical education teachers' health literacy effect was 0.715, accounting for 35.82% of the total effect, and the mediated effect enhanced the total effect by 23.12%. It shows that digital health empowerment effectively enhances rural physical education teachers' and students' health literacy competence and promotes the overall development of student's physical and mental health with an important guiding role. [ABSTRACT FROM AUTHOR]

Evaluating the efficiency of health resource allocations is critical to improving China's rural three-level health service network. This was a prospective panel data study. Based on panel data of the medical and health resources of 31 provinces within rural China, collected from 2003 to 2020, this study uses a three-stage Data Envelopment Analysis–Malmquist index to analyze the evolution of efficiency and productivity. The efficiency and productivity of county and county-level medical and health institutions rank highest, followed by township hospitals, whereas village clinics are shown to be in great need of improvement. A decline in technical advancement appears as a crucial factor exacerbating loss of factor productivity. Policy makers should further optimize the efficiency of medical resource allocation and promote the coordinated development of rural health in China. [ABSTRACT FROM AUTHOR]

Local historical experience in public health emergencies has been perceived to largely affect COVID-19's social influence. Specifically, individuals' personal experience in public health emergencies would likely have an impact on their reactions to the next similar event. Herein, we combined life course and risk analysis frameworks to explore how individuals' experiences influence current risk perception and protective behaviors. We collected 1000 questionnaires of random network samples in six Chinese provinces of different risk levels from 29 April to 8 May 2020, and used the propensity score matching (PSM) model and multivariable linear regression to process the data. We categorized individual public emergency experience into three patterns: (1) having ever witnessed a public health emergency, (2) having ever experienced a public health emergency, and (3) currently experiencing a public health emergency. The study indicates that individuals' experiences had significant positive effects on protective behaviors against COVID-19. The average effects of the three patterns on behaviors were 0.371 (p < 0.001), 0.898 (p < 0.001) and 0.319 (p < 0.05), respectively. The study also shows that for those experiencing any one pattern, the effect of risk perception on protective behaviors appeared null in the early stage of the pandemic. We propose the potential interactive mechanism of risk factors in the life course at the individual level. Academically, this study develops the risk theory of perception and behavior and expands the application of the life course approach in the public health arena. Practically, our research indicates that public health emergency experiences are valuable for responding to a future pandemic and normalizing prevention policies. [ABSTRACT FROM AUTHOR]

The relationship between the weight-adjusted waist index (WWI) and newly diagnosed type 2 diabetes (T2D) remains uncertain. This study intended to explore the association between the WWI and the incidence of newly diagnosed T2D among participants in rural areas of China. In the Northeast China Rural Cardiovascular Health Study, 9205 non-diabetic individuals (mean age 53 ± 10, 53.1% women) without T2D were included at baseline during 2012–2013. They were followed up from 2015 to 2017. WWI was calculated as waist circumference (cm) divided by the square root of weight (kg). We used multivariate logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the probability of new diagnoses across three WWI categories. A total of 358 participants had been diagnosed with T2D during a median follow-up of 4.6 years. After adjusting for potential confounders, compared with the lowest WWI category (<9.79 cm/√kg in men; <10.06 in women), men with WWI 10.06–10.72 and ≥10.37 cm/√kg showed OR (95%CI) for T2D 1.200 (0.816, 1.767) and 1.604 (1.088, 2.364), respectively, while women with WWI 10.06–10.72 and ≥10.37 cm/√kg showed ORs (95%CIs) for T2D 1.191 (0.703, 2.018) and 1.604 (1.088, 2.364), respectively. The ORs were generally consistent on subgroup analysis by gender, age, body mass index, and current smoking and drinking status. Increasing WWI was significantly associated with a higher incidence of newly diagnosed T2D among rural Chinese adults. Our findings help clarify the harmful effect of increasing WWI on newly diagnosed T2D and provide evidence for formulating healthcare policy in rural China. [ABSTRACT FROM AUTHOR]

Introduction: With the rapid development of China’s “gig economy,” the on-call work model has grown increasingly prevalent in China and has attracted a large number of rural migrant workers with its low employment threshold. However, this irregular employment mode may negatively impact the mental health of workers. Methods: This paper uses an ordinal logistic regression model to study the relationship between Chinese rural migrant workers’ on-call work and their depression. Results: The results showed that after controlling for relevant variables, the odds ratio of depressive mood among rural migrant workers engaged in on-call work was 1.22 (95% CI 1.04–1.43) compared with rural migrant workers who did not need to be on call. In further heterogeneity research, we found that on-call work is more likely to aggravate the depression risk of rural migrant workers who are highly dependent on the internet and have low-wage incomes. Discussion: This research suggests that appropriate measures should be taken to mitigate the negative impact of on-call work on the mental health of rural migrant workers, and more attention needs to be paid to the mental health of lower salaried and gig workers. This paper provides a valuable sample of Chinese rural migrant workers for theoretical research on the relationship between on-call work and mental health and confirms the relationship between the two. These results contribute new ideas to the theory and practice of psychological crisis intervention aimed at Chinese rural migrant workers. [ABSTRACT FROM AUTHOR]

Background: Parental migration is an important factor affecting left-behind children's health. However, few studies have addressed the effect of parental migration on children's vision health in China. To fill the gap, this study aimed to assess the impact of parental migration on left-behind children's vision health and to explore the possible mechanisms of the effect. Methods: Data were obtained from the baseline survey of the China Education Panel Survey (CEPS), which included over 10,000 junior high school students. This study used myopia, the most common vision problem among junior high school students, and tried to analyze whether myopia was corrected with eyeglasses as indicator variables of vision health. The impact of parental migration on vision health was assessed using an instrumental variables approach. Results: The results show that parental migration reduced the likelihood of myopia in left-behind children and decreased the possibility of myopic left-behind children being corrected. This result passed a series of robustness tests. The mechanism analysis indicated that compared to non-left-behind children, left-behind children spent more time on outdoor activities and less time on after-school classes, reducing their risk of being myopic. Further, because left-behind children live apart from their parents, their myopia problem is more difficult for parents to notice, and left-behind children are less likely to inform their parents of their myopia than non-left-behind children actively. This helps to explain why left-behind children have a lower correction rate with eyeglasses. Conclusions: Our findings suggest that parental migration, while not increasing the prevalence of myopia in left-behind children, has led to inequity in myopic left-behind children's correction. Given the severe consequences of uncorrected myopia, action is required to enhance the correction rate of myopic left-behind children. [ABSTRACT FROM AUTHOR]

With rapid urbanization and industrialization, a large number of rural residents have migrated to urban areas for work, increasing the proportion of migration in rural villages. Previous studies have typically examined the direct effect of parental migration, while we provide the first evidence for the spillover effects of village migration on the health outcomes of non-left-behind children. The results from an instrumental variable analysis show a sizable adverse effect of exposure to village migration on the health outcomes of non-left-behind children. We examine the role of unhealthy peers, poor parental health behaviours, poor village healthcare infrastructure, and unbalanced human capital structure at the village level. [ABSTRACT FROM AUTHOR]

Background: How to promote the health (especially mental health) growth of left-behind children has become a hot social issue. Physical exercise is usually considered as a positive role in improving the physical and mental health of children, which can be considered to be integrated into the living environment of left-behind children. Objective: To discuss the changes of left-behind children in psychological health before and after the exercise-based intervention, thus providing a practical approach to improve the psychological growth of this disadvantaged group. Methods: An exercise-based social intervention experiment was designed and conducted in a township middle school in China, and 200 left-behind children with relatively low psychological health participated in the experiment. Results: Physical exercise had positive effects on rural left-behind children's sense of hope, self-esteem, self-efficiency, and self-concept, and it seems that the positive effects are durative due to the optimization of living environment. There was no significant difference in the psychological promotion effect of different programs (football and table tennis) on left-behind children. Hope, self-esteem, and self-efficiency significantly mediated the relationship between physical exercise and self-concept of left-behind children. Conclusion: Physical exercise contributes to promoting the development of rural left-behind children's positive psychology such as hope, self-esteem, self-efficiency, and thus relieving the negative psychology caused by longterm parental-child separation and improving self-concept. [ABSTRACT FROM AUTHOR]

In 2009, China launched a new round of healthcare reform to provide households with secure, efficient, convenient, equitable and affordable healthcare services. Healthcare reform is underpinned by three critical pillars: the health workforce, funding, and infrastructure, with reform of the health workforce being particularly significant. This study analyses the disparities in regional distribution and the inequity of healthcare workforce allocation across hospitals and primary health centers in China over twelve years. Retrospective longitudinal data from the National Health Statistics Yearbook 2011–2022 and National Statistical Yearbook in China from 2011 to 2022 were collected for analysis. The focus was on hospitals and primary health centers, explicitly examining their health technician and nursing workforce. The research utilized four key indicators of the healthcare workforce to evaluate the distribution of health resources between hospitals and primary health centers. Furthermore, the Gini coefficient and Theil index were employed to assess the inequality in allocating the health workforce. Between 2010 and 2021, there was a nationwide increase in the ratio of health workers per 1000 population in hospitals and primary health centers. It is noted that rural districts had higher ratios than urban districts in terms of the number of health technicians and nurses per 1000 population, whether in hospitals or primary health centers; western districts had higher ratios than eastern and central districts did. In the same year, at different levels of medical institutions, the Theil indices of health technicians and nurses in hospitals were lower than those in primary health centers in terms of both demographic and geographical dimensions. Regarding the allocation of the health workforce by population, the Gini coefficient remained below 0.3, while for geographical allocation, it exceeded 0.4. This study analyzed the temporal trends and inequality of health-resource allocation at the hospital and primary health center levels in China, noting trends of improvements in the quantity and inequality in health workforce allocation from 2010 to 2021, suggesting the success of the government's efforts to advance healthcare reform since 2009. The allocation of health workforce based on population exhibits greater fairness compared to geographical distribution. [ABSTRACT FROM AUTHOR]

Background: Achieving healthy ageing has become the only way for China to alleviate the pressure of ageing, especially in rural areas. However, the factors affecting the health of rural older adults are numerous and complex. It is important to identify the critical factors that affecting the health of older adults in rural areas and provide decision-making support for targeted health interventions.Methods: To overcome some limitations of existing works, an extended probabilistic linguistic fuzzy cognitive map model is proposed in this paper as a useful tool for modeling the cause-effect relationship between factors. The proposed model integrates the advantages of probabilistic linguistic term sets and fuzzy cognitive maps. In the end, to rank and identify the critical factors affecting the health, a novel similarity measure based on Euclidean distance and Z-mapping function is proposed.Results: The proposed model can effectively deal with the uncertainty of experts and reflect different opinions of groups well. In terms of representing uncertainty and ambiguity, the proposed method outperforms other models in modeling complex systems. In the real-world case analysis, we find that education is the most important factor affecting the health of rural older adults, followed by previous occupational experiences, psychology, and physical exercise, among other things. Intergenerational relationship has become another important factor affecting the health of rural older adults in China as the development of Chinese society.Conclusions: From a macro perspective, social economic status, living environment, lifestyle, and health management, are the variables that have the greatest impact on the health of rural older adults. As a result, providing more precise health interventions with the characteristics of factors influencing health is a crucial guarantee for preserving and improving the health of rural older adults in China. [ABSTRACT FROM AUTHOR]

Background: China has a shortage of physicians and nurses in primary care and rural health. This study explores factors that influence the choices of medical and nursing students in China to select a career in primary care, or in rural health. Methods: A total of 3826 medical students and 1771 nursing students were surveyed in China. Data were analysed using descriptive statistics, Chi-squared tests, and logistic regression models. Results: The majority of medical and nursing students were willing to practice primary care (55% and 59%, respectively). Yet, only 16% and 5% of medical and nursing students, respectively, desired to work in a village or small city. The most common reasons cited to not practice primary care is the lack of opportunities for clinical skills improvement, academic and personal development, and networking. Medical students who were living in a rural residence between ages 1 and 15 years were more likely to report a willingness to work in a rural location (OR: 2.18, 95% CI: 1.33–3.58) or in primary care (OR: 1.72, 95% CI: 1.31–2.25). Conclusion: More efforts are needed to understand how preferences among medical and nursing students influence their career choices and change in choices over time. Understanding the concerns of students can help to tailor interventions in healthcare education and training to increase student satisfaction with their career choice and enrolment counts in medical and nursing fields. There is scant literature available to highlight the factors that influence China's medical and nursing workforce from the student perspective. This study highlights a number of implications and opportunities for improvement for medical and nursing recruitment and education in China. To address the challenges that make it difficult to choose primary care and rural health as first-choice career paths, more efforts are needed to better understand these barriers from the medical and nursing students' points of view. [ABSTRACT FROM AUTHOR]

Large input and high loss of chemical fertilizer are the major causes of agricultural non-point source pollution in China. Employing fertilizer loss and micro-health data, this paper analyzes the effects of chemical fertilizer loss on the health of rural elderly and the medical cost in China. Results of the difference-in-differences (DID) method indicate that one kg/ha increase in fertilizer loss alters a key medical disability index (Activities of Daily Living) by 0.0147 (0.2 percent changes) and the number of diseases by 0.0057 for rural residents of 65 and older. This is equivalent to CNY 316 million (USD 45 million) at national medical cost. Furthermore, the age of onset is younger in regions with higher fertilizer loss. One kg/ha increase of fertilizer loss advances the age of onset by 0.267 year, which will cause long-term effect on public health. Our results are robust to a variety of robustness checks. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the relationship between communication skills, health service quality, and patient trust in primary health services. Method: This study was conducted in village clinics in rural China. A simple random sampling method was used to select volunteer village clinics and patients. In total, 574 participants from 25 village clinics were selected with the help of local health officers and village doctors. The response rate was 90%. Statistical analyses (hierarchical linear regression analysis and a structural equation model) were performed to analyze the data. Results: Patient trust in doctors in rural primary health was influenced by patient perceptions of doctors' communication skills and health service quality. However, health service quality fully mediated the relationship between doctors' communication skills and patient trust in village clinics. In other words, doctors' communication skills indirectly influence patients' trust in doctors. Conclusions: This study found a link between doctors' communication skills and patient trust. The findings suggest that health managers and doctors should attach great value to communication skills and health service quality in promoting the rural doctor-patient relationship. Moreover, the relationship between doctors and patients should be considered when reforming the primary health system. [ABSTRACT FROM AUTHOR]

Background: Among rural Chinese patients with non-communicable diseases (NCDs), low socioeconomic status increases the risk of developing NCDs and associated financial burdens in paying for medicines and treatments. Despite the chronic disease medicine reimbursement policy of the local government in Nantong City, China, various barriers prevent patients from registering for and benefitting from the policy. This study aims to develop a behavior science-based intervention program for promoting the adoption of the policy and to evaluate the effectiveness of the program compared with usual practices.Methods: Barriers and opportunities affecting stakeholders in adopting the policy were identified through contextual research and summarized through behavior mapping. The intervention is designed to target these barriers and opportunities through behavior science theories and will be evaluated through a 6-month cluster randomized controlled trial in Tongzhou District, Nantong, China. A total of 30 villages from two townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual practices). Village doctors in the intervention arm (1) receive systematic training on policy details, registration procedures, and intervention protocol, (2) promote the policy and encourage registration, (3) follow up with patients in the first, third, and sixth months after the intervention, and (4) receive financial incentives based on performance. The primary outcome is policy registration rate and the secondary outcomes include the number of patients registering for the policy, medical costs saved, frequency of village doctor visits, and health measures such as blood pressure and glucose levels.Discussion: This study is one of very few that aims to promote adoption of NCDs outpatient medication reimbursement policies, and the first study to evaluate the impact of these policies on patients' financial and physical wellbeing in China. The simple, feasible, and scalable intervention is designed based on the theories of behavior science and is applicable to similar low-income regions nationwide where outpatient medical costs remain a financial burden for patients.Trial Registration: ClinicalTrials.gov NCT04731194 , registered on 29 January 2021; Chinese Clinical Trial Registry ChiCTR2100042152 , registered on 14 January 14 2021. [ABSTRACT FROM AUTHOR]

People' s well-being is the top priority in China. Improving rural residents' well-being is the key path and an important issue for China to promote rural revitalization and achieve common prosperity. Unlike most previous studies which analyzed the impact of measured environmental pollution on rural residents' well-being, this study used the data of the China Labor Dynamics Survey (CLDS) in 2018 to empirically analyze the impact of perceived environmental pollution on rural residents' well-being and further discussed its underlying mechanism. The results showed that: ① Perceived environmental pollution significantly reduced rural residents' well-being. Furthermore, compared with air pollution and noise pollution, perceived soil pollution and water pollution had a greater negative impact on rural residents' well-being. The benchmark results remained robust after using the propensity score matching, inverse probability weighting, and inverse probability weighted regression adjustment method to correct the selection bias, and the instrumental variable method to control the potential endogenous bias. ② Heterogeneity estimation results showed that perceived environmental pollution had a more significant negative impact on the well-being of rural residents with high education, low income, or living in central and western China. ③ Further mechanism analysis results showed that rural residents' physical health, mental health, and farming time had significant mediating effects on the impact of perceived environmental pollution on rural residents' well-being, where the mediating effects of rural residents' physical health, mental health, and farming time were 19.1%, 11.7%, and 5.4%, respectively. Based on the research conclusions, this study proposes that the government should continue to increase investment in rural environmental pollution control, especially in rural soil pollution and water pollution control, to further expand the positive impact of environmental pollution governance on rural residents' well-being. In addition, the government should also pay attention to rural environmental pollution control in central and western China and among low-income rural residents to narrow the 'well-being gap' caused by environmental pollution among lowincome rural residents and those living in the central and western regions. [ABSTRACT FROM AUTHOR]

Many multi-story residential buildings have been built in villages to improve the living quality of rural residents in China. Therefore, village morphology has dramatically changed compared to the past. Since northern China continues to suffer from environmental problems, improving village ventilation by optimizing village morphology is essential for creating a good rural environment. In this study, 17 morphology models were categorized based on 383 actual villages in Tianjin. In addition, the ventilation capacity of courtyards and streets and residents' health risks of different morphology cases were analyzed. For the northwest wind direction, the ventilation capacity of the courtyards in the northern part of the village can be improved when there are multi-story residences in the north or west of the village. Accordingly, in the southeast wind direction, multi-story buildings in the south or east of the village can improve the courtyard ventilation in the southern part of the village. In addition, multi-story buildings in the west or east of the village can form ventilation corridors in the northwest or southeast wind direction. The morphologies without multi-story buildings in the west or east of the village were recommended to be applied in the village planning in Tianjin due to good ventilation capacity and low exposure risks. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major risk factor for cardiovascular disease (CVD), with a high prevalence in rural northeastern China. This study assesses the cardiovascular risk associated with different blood pressure patterns: systolic dominant, diastolic dominant, and parallel elevation., Methods: We analyzed data from the Northeast Rural Cardiovascular Health Study (NCRCHS), which included 8,189 participants aged 35 and above. Baseline surveys from 2012 to 2013 and follow-ups in 2015 and 2018 provided a median follow-up of 4.66 years. Participants were categorized into ten subgroups based on systolic and diastolic blood pressure elevations. Kaplan-Meier curves and Cox regression models were used to examine CVD incidence and cardiovascular risk across these groups., Results: The incidence of CVD varied significantly among hypertension categories. Patients with grade 1 hypertension had no significant increase in cardiovascular risk at nearly 5 years. Notably, parallel elevations in systolic and diastolic pressures posed the highest cardiovascular risk, while a predominant rise in diastolic pressure alone did not significantly increase risk. This highlights the importance of analyzing blood pressure comprehensively for cardiovascular risk stratification and suggests rethinking treatment strategies for diastolic dominant hypertension., Conclusions: Our findings call for a nuanced approach to cardiovascular risk assessment in hypertension, taking into account distinct patterns of systolic and diastolic blood pressure. The study supports personalized treatment interventions and reinforces current hypertension treatment guidelines. We advocate for prioritizing non-pharmacological management in grade 1 hypertension and further clinical evaluation of treatment thresholds for diastolic dominant hypertension., Competing Interests: Declarations Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024. The Author(s).)

This study aims to summarize the influence of different definitions of unintentional burns on the prevalence and risk factors in rural children. A total of 3548 children living in rural areas were recruited from 12 schools, and questionnaires were used to collect self-reported burn data and related influencing factors in the past 12 months. Burn incidence and risk factors were compared based on two operational burn definitions ("1996 Definition of Burn-related Injury, 1996-DBI" and "2011 Definition of Burn-related Injury, 2011-DBI"). Based on the 1996-DBI, the unintentional burn prevalence was 5.92% (95% confidence interval [95% CI] 5.14-6.70%), which was higher than the 2.23% ([95% CI] 1.74-2.71%) that was calculated using the 2011-DBI (χ 2  = 61.90, P < 0.001). The unintentional burn rate ratios ranged from 0.20- to 0.53. Children who were separated from one or both parents accounted for more than half (50.39%) of the sample, and this status was a common risk factor for burns according to the two operational injury definitions. Different operational definitions have significant effects on the reported burn incidence and risk factors., (© 2024. The Author(s).)