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BackgroundEffective treatment of hypertension requires careful self-management. With the ongoing development of mobile technologies and the scarcity of health care resources, mobile health (mHealth)–based self-management has become a useful treatment for hypertension, and its effectiveness has been assessed in many trials. However, there is a paucity of comprehensive summaries of the studies using both qualitative and quantitative methods. ObjectiveThis systematic review aimed to measure the effectiveness of mHealth in improving the self-management of hypertension for adults. The outcome measures were blood pressure (BP), BP control, medication adherence, self-management behavior, and costs. MethodsA systematic search was conducted using 5 electronic databases. The snowballing method was used to scan the reference lists of relevant studies. Only peer-reviewed randomized controlled trials (RCTs) published between January 2010 and September 2019 were included. Data extraction and quality assessment were performed by 3 researchers independently, adhering to the validation guideline and checklist. Both a meta-analysis and a narrative synthesis were carried out. ResultsA total of 24 studies with 8933 participants were included. Of these, 23 studies reported the clinical outcome of BP, 12 of these provided systolic blood pressure (SBP) and diastolic blood pressure (DBP) data, and 16 articles focused on change in self-management behavior and medication adherence. All 24 studies were included in the narrative synthesis. According to the meta-analysis, a greater reduction in both SBP and DBP was observed in the mHealth intervention groups compared with control groups, −3.78 mm Hg (P

Educational aspirations are an important predictor of academic outcomes. While there has been considerable research on educational aspirations in the West, there has been little research in East Asia, and the investigation of factors influencing adolescent aspirations has been neglected, particularly in rural areas. Drawing on ecological systems theory and social cognitive career theory, this study investigated the associations between educational aspirations and factors at the individual, peer, and family levels among rural Chinese adolescents. A total of 606 students (M[subscript age] = 14.85 years; 50% boys) from a rural town in Central China completed questionnaires assessing their educational aspirations, individual factors (academic performance, academic self-perception, academic self-regulation, attitudes toward teachers, and goal valuation), and contextual factors (family socioeconomic status, parent and peer relationship quality, and parental and close friends' aspirations). Individual factors and aspirations of others had significant direct effects on adolescents' educational aspirations, while parent and peer attachments were significantly related to educational aspirations via individual factors. Family socioeconomic status was not significantly related to adolescents' educational aspirations. The findings highlight the importance of individual factors as mechanisms explaining the link between contextual factors and rural Chinese adolescents' educational aspirations. Our results suggest that interventions can be designed to increase and maintain the aspirations of rural Chinese youth by targeting multiple domains of influence.

Converging lines of inquiry from across the social and biological sciences target the adult sex ratio (ASR; the proportion of males in the adult population) as a fundamental population-level determinant of behavior. The ASR, which indicates the relative number of potential mates to competitors in a population, frames the selective arena for competition, mate choice, and social interactions. Here we review a growing literature, focusing on methodological developments that sharpen knowledge of the demographic variables underlying ASR variation, experiments that enhance understanding of the consequences of ASR imbalance across societies, and phylogenetic analyses that provide novel insights into social evolution. We additionally highlight areas where research advances are expected to make accelerating contributions across the social sciences, evolutionary biology, and biodiversity conservation.

Objective To measure sales of antibiotics without a prescription in pharmacies in China in 2017 and 2021, before and during the coronavirus disease 2019 (COVID-19) pandemic, and determine the factors associated with such sales. Methods We conducted cross-sectional surveys using the simulated patient method in retail pharmacies in 13 provinces in eastern, central and western China in 2017 and 2021. At the pharmacies, the simulated patients (trained medical students) reported that they had mild respiratory tract symptoms and asked for treatment, using a three-stage process: (i) request some treatment; (ii) request antibiotics; (iii) request specific antibiotics. We used multivariable logistic regression analysis to determine factors associated with sale of antibiotics without a prescription. Findings Of the pharmacies visited in 2017, 83.6% (925/1106) sold antibiotics without a prescription; this figure was 78.3% (853/1090) in 2021 (P-value: 0.002). After excluding pharmacies prohibited from selling antibiotics because of COVID-19, this difference was not significant (83.6% versus 80.9%; 853/1054; P-value: 0.11). Factors significantly associated with selling antibiotics without a prescription in both 2017 and 2019 were: location in central and western China compared with eastern China; being in a township or village compared with in a city; and presence of a counter where antibiotics were dispensed. Conclusion Although laws became stricter between 2017 and 2021, antibiotic sales without a prescription were still common in pharmacies across China. Existing regulations need to be more strictly enforced, and pharmacy staff and the public should be made more aware of the risks of antibiotic misuse and dangers of antimicrobial resistance. Objectif Mesurer les ventes d'antibiotiques sans ordonnance dans les pharmacies de Chine en 2017 et 2021, avant et pendant la pandemie de maladie a coronavirus 2019 (COVID-19), et determiner les facteurs associes a ces ventes. Methodes Nous avons mene des enquetes transversales a l'aide de la technique des patients simules dans des pharmacies de detail situees dans 13 provinces de Chine orientale, centrale et occidentale en 2017 et 2021. Dans ces pharmacies, les patients simules (des etudiants en medecine formes a cet effet) ont evoque des symptomes legers au niveau des voies respiratoires et sollicite un traitement selon un processus en trois etapes: (i) demande de traitement; (ii) demande d'antibiotiques; (ii) demande d'antibiotiques specifiques. Nous avons ensuite utilise une analyse multivariee de regression logistique afin d'identifier les facteurs lies a la vente d'antibiotiques sans ordonnance. Resultats Sur l'ensemble des pharmacies examinees en 2017, 83,6% (925/1106) ont vendu des antibiotiques sans ordonnance, contre 78,3% (853/1090) en 2021 (valeur-p: 0,002). Apres avoir exclu les pharmacies n'ayant pas le droit d'en vendre a cause de la COVID-19, cette difference s'est revelee negligeable (83,6% contre 80,9%; 853/1054; valeur-p: 0,11). Les principaux facteurs associes a la vente d'antibiotiques sans ordonnance, tant en 2017 qu'en 2019, etaient: le fait d'etre en Chine centrale et occidentale plutot qu'en Chine orientale; le fait d'etre une commune ou un village plutot qu'une ville; et enfin, le fait qu'il y ait ou non un comptoir oU se procurer des antibiotiques. Conclusion Bien que les lois soient devenues plus strictes entre 2017 et 2021, la vente d'antibiotiques sans ordonnance est restee monnaie courante partout en Chine. La reglementation en vigueur doit etre appliquee plus severement; en outre, le personnel des pharmacies et le grand public doivent etre mieux sensibilises aux risques lies a un usage inapproprie des antibiotiques et aux dangers que represente la resistance aux antimicrobiens. Objetivo Medir las ventas de antibioticos sin receta en farmacias de China en 2017 y 2021, antes y durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19), y determinar los factores asociados a estas ventas. Metodos Se realizaron encuestas transversales utilizando el metodo del paciente simulado en farmacias minoristas de 13 provincias de China oriental, central y occidental en 2017 y 2021. En las farmacias, los pacientes simulados (estudiantes de medicina entrenados) informaron que tenian sintomas leves del tracto respiratorio y solicitaron tratamiento, mediante un proceso de tres etapas: (i) solicitar algun tratamiento; (ii) solicitar antibioticos; (ii) solicitar antibioticos especificos. Se utilizo un analisis de regresion logistica multivariable para determinar los factores asociados a la venta de antibioticos sin receta. Resultados De las farmacias visitadas en 2017, el 83,6% (925/1106) vendian antibioticos sin receta; esta cifra fue del 78,3% (853/1090) en 2021 (valor de p: 0,002). Una vez excluidas las farmacias que tenian prohibida la venta de antibioticos debido a la COVID-19, esta diferencia no fue significativa (83,6% frente a 80,9%; 853/1054; valor de p: 0,11). Los factores que se asociaron significativamente con la venta de antibioticos sin receta tanto en 2017 como en 2019 fueron: la ubicacion en el centro y occidente de China en comparacion con el oriente del pais; estar en un municipio o pueblo en comparacion con estar en una ciudad; y la presencia de un mostrador donde se dispensaban antibioticos. Conclusion Aunque las leyes se hicieron mas estrictas entre 2017 y 2021, la venta de antibioticos sin receta seguia siendo habitual en las farmacias de toda China. Es necesario aplicar mas estrictamente la normativa vigente, y concienciar al personal de las farmacias y al publico en general sobre los riesgos del uso indebido de antibioticos y los peligros de la resistencia a los antimicrobianos., Introduction Antimicrobial resistance is one of the most serious threats to the health of the world's population. [1,2] In 2019, antimicrobial resistance was associated with 4.95 million deaths globally. [3] [...]

Objective To compare differences in current status of sexual health-related knowledge, attitude and behavior and influencing factors of sexual behavior between international and domestic students in Chinese colleges and universities for providing references and evidences to promote education on sexual health in the students. Methods With a self-designed questionnaire, we conducted an online anonymous survey from September through November, 2019. The respondents of the survey were 6 665 Chinese students recruited using stratified cluster sampling in 9 colleges/universities in eastern, central and western China and 1 403 international students sampled conveniently in 96 universities across China. Statistical analyses on collected data were performed with SPSS 21.0 software. Results Valid information were collected from 5 989 Chinese and 1 004 international students. The score for sexual knowledge of the international students was significantly lower than that of Chinese students (5.11 ± 2.20 vs. 5.31 ± 2.17, t = 2.751; P < 0.01). Significantly higher proportion of international students reported positive attitude towards one night stands than that of Chinese students (25.10% vs. 14.59%, χ2 = 73.04; P < 0.01); but significantly higher proportion of Chinese students reported positive attitude towards homosexuality than that of international students (53.35% vs. 43.23%, χ2 = 73.83; P < 0.01). More international students than Chinese students reported ever having sexual behaviors (20.42% vs. 18.88%) and for the students ever having sexual behaviors, the proportion of with multiple sexual partners was significantly higher among international students than among Chinese students (58.05% vs. 35.46%, χ2 = 27.26; P < 0.01). Significantly more international students than Chinese students reported first sexual behaviors at the age of less than 18 years (30.73% vs. 15.12%, χ2 = 29.28; P < 0.01). The results of logistic regression analysis showed that the international students of male gender, being seniors, with a high level of living consumption, without religious belief, and with bisexual orientation were more likely to have sexual behavior (all P < 0.01); while, the Chinese students of male gender, being seniors, majoring in liberal arts, with a high level of living consumption, and with homosexual or bisexual orientation were more likely to have sexual behavior (P < 0.01 for all). Conclusion There are disparities in sexual health-related knowledge, attitude and behavior between international students and domestic students of colleges/universities in China, suggesting that targeted education on sexual health should be promoted among student groups of different gender and culture background.

Background Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused. Objectives To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China. Methods A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically. Results Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system. Conclusion The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care. [ABSTRACT FROM AUTHOR]

Programmes based on social emotional learning (SEL) have been effective in reducing psychosocial difficulties in a number of countries. In Mainland China, there has been no empirical research on the prevention of children's psychosocial difficulties using the SEL approach. This study aimed to assess whether an adapted version of the SEL programme can reduce psychosocial difficulties of primary school children in rural China. The intervention consisted of 16 weekly 90‐min class sessions, conducted among 206 children aged 8–12 years (with 290 controls) in a poor rural area of Central China. Self‐report questionnaires were administered at baseline, post‐intervention and 5‐month follow‐up. The results suggested that the programme (1) can reduce children's total difficulties (measured using the Strength and Difficulties Questionnaire) at post‐intervention (d = −0.18) and 5‐month follow‐up (d = −0.19), (2) was more effective among children experiencing verbal abuse (d = −0.21) or physical abuse (d = −0.24) from caregivers and (3) was popular among more than 90% of the participants. The programme is cheap, easy to implement and can be delivered in school hours. Therefore, it has clear potential for replicability and sustainability. [ABSTRACT FROM AUTHOR]