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Abstract Background Preventive treatment of tuberculosis infection (TBI) is considered a crucial strategy to prevent and control tuberculosis (TB). However, the acceptance and completion rates of preventive therapy for TBI are still far from optimistic. Evidence is mounting that TB knowledge and stigma may have a substantial effect on acceptance of TBI treatment. This study aimed to explore the effect of stigma on the relationship between the level of TB knowledge and acceptance of TBI treatment. Methods 7017 general population were included in the study. We adjusted for the covariates at the individual. Stepwise logistic regression was used to examine the moderating role of TB stigma and also explore the association between TB knowledge and acceptance of TBI treatment. Results The acceptance rate of TBI treatment among the respondents was 84.38% (n = 5921). Among respondents, a significant positive correlation between acceptance of TBI treatment and TB knowledge (OR = 1.096,95%CI = 1.073,1.118). Additionally, the association between TB knowledge and acceptance of TBI treatment was found to be moderated by TB stigma. In other words, TB stigma was found to weaken the impact of TB knowledge on acceptance of TBI treatment (OR = 0.994,95%CI = 0.991,0.996). Conclusion The findings of the study indicated that having a high level of awareness about TB can enhance the general population’s acceptability of TBI treatment. TB stigma moderated this association; it weakened the relationship between TB knowledge and individuals’ willingness to accept TBI treatment. To mitigate TB stigma and enhance the intention of individuals with TBI to accept preventive therapy, it is imperative to enhance TB-related health education.

In the post-pandemic era, the resumption of visa-free group travel services between China and Russia has led to frequent population movements, posing a substantial risk of infectious disease transmission in the border regions of the two countries. Tuberculosis (TB) is currently the second leading cause of death from infectious diseases worldwide, and both China and Russia are high-TB-burden countries. This creates specific challenges for TB prevention and control in the border areas. There is an urgent need to deeply explore weaknesses in the TB epidemic prevention and control efforts along the China-Russia border. Strategies such as the development of intelligent border ports, enhancement of international exchange and cooperation, improvement of the public health collaborative governance capacity of both countries, optimization of health resource allocation in port areas, and strengthening the awareness of customs quarantine personnel and border residents regarding TB prevention and control, must be constructed. These strategies aim to comprehensively promote the joint construction of a human health and wellness community by China and neighboring countries.

Abstract Background Poor nurse-patient relationship poses an obstacle to care delivery, jeopardizing patient experience and patient care outcomes. Measuring nurse-patient relationship is challenging given its multi-dimensional nature and a lack of well-established scales. Purpose This study aimed to develop a multi-dimensional scale measuring nurse-patient relationship in China. Methods A preliminary scale was constructed based on the existing literature and Delphi consultations with 12 nursing experts. The face validity of the scale was tested through a survey of 45 clinical nurses. This was followed by a validation study on 620 clinical nurses. Cronbach’s α, content validity and known-group validity of the scale were assessed. The study sample was further divided into two for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), respectively, to assess the construct validity of the scale. Results The Nurse-Patient Relationship Scale (NPRS) containing 23 items was developed and validated, measuring five dimensions: nursing behavior, nurse understanding and respect for patient, patient misunderstanding and mistrust in nurse, communication with patient, and interaction with patient. The Cronbach’s α of the NPRS ranged from 0.725 to 0.932, indicating high internal consistency. The CFA showed excellent fitness of data into the five-factor structure: χ2/df = 2.431, GFI = 0.933, TLI = 0.923, CFI = 0.939, IFI = 0.923, RMSEA = 0.070. Good content and construct validity are demonstrated through expert consensus and psychometric tests. Conclusion The NPRS is a valid tool measuring nurse-patient relationship in China.

Background: The goal of our research was to determine the effects of plant-based dietary patterns on sleep health among older adults and to examine the parallel mediated effects of anxiety and depression. Methods: This investigation utilized data obtained from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) and contained 6853 participants. Logistic regression and the restricted cubic splines (RCSs) model were employed to examine how plant-based dietary patterns affect sleep health. Additionally, Amos 26.0 was used to construct a structural equation model to examine the parallel mediated effects of anxiety and depression. Results: A higher plant-based diet index (PDI) was connected to higher odds of better sleep quality (OR = 1.209, 95% CI: 1.039–1.407) and sleep duration (OR = 1.241, 95% CI: 1.072–1.437). Conversely, an elevated unhealthy plant-based diet index (uPDI) was correlated with a lower likelihood of sleep quality (OR = 0.678, 95% CI: 0.574–0.800) and sleep duration (OR = 0.762, 95% CI: 0.647–0.896). The RCSs regression further identified a significant dose–response relationship. Mediation analysis confirmed that anxiety and depression partially mediate the relationship between plant-based diets and sleep health. Conclusions: Our study exhibited significant correlations between plant-based diets and sleep health in the elderly. Depression and anxiety were determined as parallel mediators between plant-based diets and sleep health. Controlling early dietary patterns and affective disorder could help improve sleep quality in older adults.

The recycling of key components in waste lithium-ion batteries (LIBs) is an important route to make up for the shortage of battery materials. Metal separation and purification is an important step. It is of great significance to propose an efficient and green separation technology. In this paper, an electrochemical precipitation method was applied to metal separation from spent LiNi0.5Mn1.5O4 cathode material. The Li and metal elements were effective separated and the precipitates were then used as precursor to synthesize high-performance R–O3-NaNFM cathode material for sodium-ion batteries. The R–O3-NaNFM exhibits excellent electrochemical cycling stability. The capacity retains 71.3 mAh g−1 after a long-term cycling of 200 times at 1 C. This method offers a referable strategy of the recycling for the waste cathode material in spent LIBs.

The visceral adiposity index (VAI) and handgrip strength (HGS) are identified as important objectives for the prevention of illness. Nevertheless, there is limited understanding regarding the impact of the VAI and HGS on cardiometabolic multimorbidity (CMM). We aimed to ascertain the impact of the VAI and HGS on CMM among middle-aged and older people. Data spanning from 2011 to 2020 were derived from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7909 individuals aged 45 years and older were included. Cox proportional hazard regression was utilized to examine the correlation among the VAI, HGS, and CMM. Throughout the 10-year follow-up, we determined that both the VAI (HR = 1.330; 95%CI = 1.179–1.500) and HGS (HR = 0.745, 95%CI = 0.645–0.861) exhibited significant associations with CMM risk. Individuals exposed to both a high VAI and low HGS were found to have higher hazards of CMM (HR = 1.377, 95%CI = 1.120–1.694) in contrast to participants exposed to one or none of these conditions. The older (HR = 1.414; 95%CI = 1.053–1.899) and male (HR = 1.586; 95%CI = 1.114–2.256) groups are more likely to experience CMM risk. Our findings suggest that both the VAI and HGS have significant effects on CMM risk. Appropriate interventions focused on vulnerable groups are recommended to prevent the incidence of CMM.

ObjectiveTo establish an index system with three dimensions of health capacity, right and risk and multidimensional indexes for the measurement of household health poverty. MethodsAn indicator system for evaluating health poverty was preliminary established through reviewing 225 relevant studies published in Chinese or English from 1983 till 2023. Delphi qualitative interview and two rounds of consultation were conducted among 10 senior experts working in regions with higher prevalence of health poverty or better implementation of healthy poverty alleviation to screen the identified indicators. The weights of the selected indicators were calculated using hierarchical analysis and a set of multidimensional health poverty indexes was constructed using the key performance indicator method and the Alkire-Foster method. ResultsFor the two rounds of expert consultation, the positive coefficient was 100% and the authority coefficients were 0.8145 and 0.8667; the coordination coefficients of the experts′ opinions on the second/third level indicators were 0.342/0.233 and 0.487/0.353 for the first and second round of consultation, respectively (all P < 0.05), indicating a good coordination between the expert opinions. According to the results of the expert consultations and qualitative interviews, a health poverty evaluation index system was constructed; the index system includes 3 primary, 11 secondary, 39 tertiary indicators covering the three dimensions (health right, capability and risk) for health poverty measurement; in addition, 10 specific indicators were screened out from all the indicators for the measurement of multidimensional health poverty using key performance indicator method and double threshold method based on Alkire-Foster model. ConclusionThe study establishes the index system and multidimensional indexes for household-based measurement on health poverty and multidimensional health poverty and the index system could provide a reference to the promotion of healthy poverty alleviation in China.

BackgroundNurses during COVID-19 who face significant stress and high infection risk are prone to fatigue, affecting their health and quality of patient care. A cross- sectional study of 270 nurses who went to epidemic area to support anti-epidemic was carried out via online survey during the COVID-19 pandemic on November 2021.MethodsA web-based cross-sectional survey of 270 nurses in China who traveled to Heihe City in Heilongjiang Province to combat the novel coronavirus epidemic. The researchers collected information on sociodemographic variables, anxiety, transition shock, professionalism, collaboration, hours of work per day, and fatigue. Regression and fuzzy-set Quality Comparative Analysis (fsQCA) evaluated the factors’ impact on the nurses’ fatigue.ResultsRegression analysis showed that the psychological variables significant for fatigue, transition shock (β = 0.687, p

Abstract Tongue squamous cell carcinoma is highly malignant and has a poor prognosis. In this study, we aimed to combine whole-genome sequencing, whole-genome methylation, and whole-transcriptome analyses to understand the molecular mechanisms of tongue squamous cell carcinoma better. Oral tongue squamous cell carcinoma and adjacent normal tissues from five patients with tongue squamous cell carcinoma were included as five paired samples. After multi-omics sequencing, differentially methylated intervals, methylated loop sites, methylated promoters, and transcripts were screened for variation in all paired samples. Correlations were analyzed to determine biological processes in tongue squamous cell carcinoma. We found five mutated methylation promoters that were significantly associated with mRNA and lncRNA expression levels. Functional annotation of these transcripts revealed their involvement in triggering the mitogen-activated protein kinase cascade, which is associated with cancer progression and the development of drug resistance during treatment. The prognostic signature models constructed based on WDR81 and HNRNPH1 and combined clinical phenotype–gene prognostic signature models showed high predictive efficacy and can be applied to predict patient prognostic risk in clinical settings. We identified biological processes in tongue squamous cell carcinoma that are initiated by mutations in the methylation promoter and are associated with the expression levels of specific mRNAs and lncRNAs. Collectively, changes in transcript levels affect the prognosis of tongue squamous cell carcinoma patients.

Abstract Background Local environmental factors are associated with health and healthcare-seeking behaviors. However, there is a paucity in the literature documenting the link between air pollution and healthcare-seeking behaviors. This study aimed to address the gap in the literature through a cross-sectional study of domestic migrants in China. Methods Data were extracted from the 2017 China Migrants Dynamic Survey (n = 10,051) and linked to the official air pollution indicators measured by particulate matter (PM2.5 and PM10) and air quality index (AQI) in the residential municipalities (n = 310) of the study participants over the survey period. Probit regression models were established to determine the association between air pollution and refraining from visiting health facilities after adjustment for variations in the predisposing, enabling and needs factors. Thermal inversion intensity was adopted as an instrumental variable to overcome potential endogeneity. Results One unit (µg/m3) increase in monthly average PM2.5 was associated with 1.8% increase in the probability of refraining from visiting health facilities. The direction and significance of the link remained unchanged when PM2.5 was replaced by AQI or PM10. Higher probability of refraining from visiting health facilities was also associated with overwork (β = 0.066, p = 0.041) and good self-related health (β = 0.171, p = 0.006); whereas, lower probability of refraining from visiting health facilities was associated with short-distance (inter-county) migration (β=-0.085, p = 0.048), exposure to health education (β=-0.142, p

Abstract Objective China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3 and 14.4% of the total poverty-stricken population, respectively. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. In this study, we analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty. Method Data were extracted from the Fifth National Health Service Survey in China in 2013 through a multi-stage, stratified, and random sampling method, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants. Results The poverty and impoverishment rate in China were 16.2 and 6.3% respectively. The poverty rate in western region was much higher than that of central and eastern regions. The rate of impoverishment by medical expense (IME) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. The New Cooperative Medical Scheme (NCMS) was associated with the highest rate (9.1%) of IME cases. The top three diseases associated with IME were malignant tumor, congenital heart disease, and mental disease. Households with non-communicable disease members or hospitalized members had a higher risk on IME. NCMS-enrolled, poorer households were more likely to suffer from IME. Conclusion The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of IME. A combined strategy to precise target multiple vulnerabilities of poor population would be more effective.

Abstract Background Growing prevalence of multidrug-resistant/Rifampicin-resistant tuberculosis (MDR/RR-TB; resistance to Isoniazid and Rifampicin/Isolated resistance to Rifampicin) is putting in jeopardy the WHO End TB strategy. This study aimed to identify factors contributing to the high prevalence of MDR/RR-TB in Khabarovsk krai region of Russia. Methods A cross-sectional retrospective study was conducted, analyzing clinical, demographic, and drug susceptibility testing data on 1440 patients. As a source of raw data, the national electronic TB surveillance system was used. Anonymous data was collected on every patient diagnosed with TB in all healthcare facilities of the region from January 2018 to December 2019. Only patients with proven excretion of m. tuberculosis were included in the study. Factors associated with MDR/RR-TB were identified through logistic regression analysis, in conjunction with in-depth interviews with eight patients, five healthcare managers and five doctors. Findings 2661 patients were identified with TB, 1440 were incorporated in the study based on inclusion criteria. Of these, 618 (42.9%) were identified with MDR/RR-TB. Patients with a history of imprisonment were 16.53 times (95% CI 5.37 to 50.88,) more likely to have MDR/RR-TB, whereas re-treatment patients were 2.82 times (95% CI 2.16 to 3.66) more likely to have MDR/RR-TB. Other influencing factors included presence of disability (AOR is 2.32, 95% CI 1.38 to 3.89), cavitary disease (AOR is 1.76, 95% CI 1.37 to 2.25), and retirement status (AOR 0.65, 95% CI 0.43 to 0.98, p = 0.042). Poor patient knowledge and understanding of the disease, progressive weariness of prolonged TB treatment, and inability hospitalize infectious patients without their consent were perceived by the interviewees as major influencing factors. Conclusions Incarceration and treatment history, regardless of outcome, were identified as major factors influencing MDR/RR-TB prevalence. It is essential for the TB care system to eliminate legal loopholes, which deprive doctors of means to enforce quarantine procedures and epidemiological surveillance on infected patients, former and current inmates. Increasing people’s awareness of TB, early detection and appropriate treatment of patients with TB are needed for successfully combating MDR/RR-TB.

ObjectiveOver the past decade, scarlet fever has caused a relatively high economic burden in various regions of China. Non-pharmaceutical interventions (NPIs) are necessary because of the absence of vaccines and specific drugs. This study aimed to characterize the demographics of patients with scarlet fever, describe its spatiotemporal distribution, and explore the impact of NPIs on the disease in the era of coronavirus disease 2019 (COVID-19) in China.MethodsUsing monthly scarlet fever data from January 2011 to December 2019, seasonal autoregressive integrated moving average (SARIMA), advanced innovation state-space modeling framework that combines Box-Cox transformations, Fourier series with time-varying coefficients, and autoregressive moving average error correction method (TBATS) models were developed to select the best model for comparing between the expected and actual incidence of scarlet fever in 2020. Interrupted time series analysis (ITSA) was used to explore whether NPIs have an effect on scarlet fever incidence, while the intervention effects of specific NPIs were explored using correlation analysis and ridge regression methods.ResultsFrom 2011 to 2017, the total number of scarlet fever cases was 400,691, with children aged 0–9 years being the main group affected. There were two annual incidence peaks (May to June and November to December). According to the best prediction model TBATS (0.002, {0, 0}, 0.801, {}), the number of scarlet fever cases was 72,148 and dual seasonality was no longer prominent. ITSA showed a significant effect of NPIs of a reduction in the number of scarlet fever episodes (β2 = −61526, P < 0.005), and the effect of canceling public events (c3) was the most significant (P = 0.0447).ConclusionsThe incidence of scarlet fever during COVID-19 was lower than expected, and the total incidence decreased by 80.74% in 2020. The results of this study indicate that strict NPIs may be of potential benefit in preventing scarlet fever occurrence, especially that related to public event cancellation. However, it is still important that vaccines and drugs are available in the future.

Background: Irritable bowel syndrome (IBS) reduces patients’ quality of life and causes great burdens due to its unclear pathogenesis and criteria for diagnosis. This study aimed to explore the differences in prevalence and the influencing factors for IBS and its subtypes.Methods: The UK Biobank surveyed 174,771 adult participants who completed the Digestive Health Questionnaire (DHQ) through emails and websites. DHQ included the Rome III criteria, IBS symptom severity score, and Patient Health Questionnaire 12 Somatic Symptom score. The UK Biobank also asked regarding previous IBS diagnosis, diagnosis for post-infectious IBS (PI-IBS), and environmental exposures and associated conditions (including anxiety or depression, based on treatment sought or offered). Pearson’s Chi-squared test or Wilcoxon’s rank-sum test was used for potential associations. Binary logic regression based on sex stratification was used to examine associations between selected factors and IBS and its subtypes.Results: This study included 31,918 participants who met the Rome III criteria for IBS. The pooled prevalence of IBS in the UK Biobank was 18.3%, with mixed IBS as the predominant subtype (59.0%), followed by diarrhea-predominant IBS (25.1%), constipation-predominant IBS (14.7%), and untyped IBS (1.1%). IBS was significantly associated with somatization (male: OR = 5.326, 95% CI = 4.863–5.832; female: OR = 4.738, 95% CI = 4.498–4.992) and coeliac disease (male: OR = 4.107, 95% CI = 3.132–5.385; female: OR = 3.783, 95% CI = 3.310–4.323). Differences in antibiotics and mental status were presented among subtypes and sex. Furthermore, 1,787 individuals were diagnosed with PI-IBS in the group of patients with IBS. The prevalence of PI-IBS in IBS was 16.6% in the UK Biobank, and it was characterized by diarrhea, fever, bloody diarrhea, and vomiting.Conclusion: Somatization and coeliac disease are primary risk factors for IBS. Distinguishing differential risk factors is critical for the precise diagnosis and treatment of IBS subtypes, particularly sex-specific differences in mental health status. General practitioners should focus on the treatment according to IBS subtypes.

The dimensional crossover induces varieties of quantum phenomena. In this paper, we demonstrate the quantum critical dynamics under dimensional crossover involving many-body phase transitions by continuously suppressing correlations and tunnelings along one direction of bulk materials, which provides a smooth connection from higher dimensions to lower ones based on the intrinsic correlations rather than geometry tailoring. By measuring the nonadiabatic excitations, the critical scaling laws in both three and two dimensions are observed and are consistent with predictions. In addition, we find scaling behaviors for intermediate regimes with noninteger dimensions. This study provides insights to extend the descriptions of critical exponents into more general or complex scenarios.

BackgroundThe Chinese health system has long been committed to eliminating inequalities in health services utilization. However, few studies have analyzed or measured these inequalities in economically underdeveloped regions in China.MethodsA total of 6,627 respondents from 3,000 households in Heilongjiang Province were extracted from the Sixth National Health Services Survey. We measured horizontal inequity in both 2-week outpatient rate and annual inpatient rate, and then identified the factors contributing to inequality.ResultsThe horizontal inequity indices of the 2-week outpatient and annual impatient rates in Heilongjiang Province were 0.0586 and 0.1276, respectively. Household income, health status, place of residence, basic medical insurance, and commercial health insurance were found to be the main factors affecting inequality in health services utilization. The contributions of household income to these two indices were 184.03 and 253.47%, respectively. Health status factors, including suffering from chronic disease, limitations in daily activities, and poor self-rated health, played positive roles in reducing inequality in these two indices. The contributions of place of residence to these two indices were 27.21 and −28.45%, respectively. Urban Employee Basic Medical Insurance made a pro-rich contribution to these two indices: 56.25 and 81.48%, respectively. Urban and Rural Resident Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Scheme, and other basic medical insurance made a pro-poor contribution to these two indices: −73.51 and −54.87%, respectively. Commercial health insurance made a pro-rich contribution to these two indices: 20.79 and 7.40%, respectively. Meanwhile, critical illness insurance made a slightly pro-poor contribution to these two indices: −4.60 and −0.90%, respectively.ConclusionsThe findings showed that the “equal treatment in equal need” principle was not met in the health services utilization context in Heilongjiang Province. To address this issue, the government could make policy changes to protect low-income populations from underused health services, and work to improve basic medical insurance, critical illness insurance, and social security systems.

BackgroundDepression is one of the greatest public health problems worldwide. The potential benefit of social participation (SP) on mental health has been widely acknowledged. Nevertheless, a few studies have used propensity score matching (PSM) to reduce the influence of data bias and confounding variables. This study explored the effect of social participation on depression among middle-aged and older Chinese persons through a PSM method, considering the frequency, type, and quantity of SP. Effects were compared among different age groups, genders, and places of residence.MethodsThe datasets were obtained from the 2018 wave of the China Health and Retirement Longitudinal Study. A total of 9,404 respondents aged 45 and above were included in the study. PSM and ordinary least squares methods were used to estimate the effect of social participation on depression.ResultsPSM estimation results showed that SP had a significantly positive effect on decreasing depression scores (p < 0.001) by 0.875–0.898 compared with persons without SP. All types of SP had a significantly positive effect (p < 0.001), and participating in community activities had the largest effect (β = −1.549 to −1.788, p < 0.001). Higher frequency of participation and more types of SP promoted lower depression scores; subgroup analyses revealed that the promotion effect was significantly greater among women, those aged ≥75 years, and those living in urban areas.ConclusionPSM indicated that SP could alleviate the depression of middle-aged and older Chinese persons. Targeted measures should be adopted to promote SP and thereby improve mental health and promote healthy and active aging.

Catalytic graphitization opens a route to prepare graphitic carbon under fairly mild conditions. Biomass has been identified as a potentially attractive precursor for graphitic carbon materials. In this work, corn starch was used as carbon source to prepare hollow graphitic carbon microspheres by pyrolysis after mixing impregnation with nitrate salts, and the surface of these carbon microspheres is covered with controllable pores structure. Under optimal synthesis conditions, the prepared carbon microspheres show a uniform pore size distribution and high degree of graphitization. When tested as electrode materials for supercapacitor with organic electrolyte, the electrode exhibited a superior specific capacitance of 144.8 F g−1 at a current density of 0.1 A g−1, as well as large power density and a capacitance retention rate of 93.5% after 1,000 cycles in galvanostatic charge/discharge test at 1.0 A g−1. The synthesis extends use of the renewable nature resources and sheds light on developing new routes to design graphitic carbon microspheres.

Abstract Objective This study examined the relationship between sociodemographic characteristics and maternal health use from a policy perspective. It aimed to provide an overview of maternal health in Heilongjiang’s rural provinces and its implications on rural areas in countries with low and middle income gross domestic products. Design, setting, and participants This cross-sectional study used data from the Fifth Health Service Survey of Heilongjiang Province. Participants included 481 mothers who delivered a baby after August 15, 2008. Trained investigators collected data on their family and sociodemographic characteristics, antenatal care, delivery at specialised obstetric institutions (e.g. hospitals, clinics, other medical institutions), and postnatal care services. Results The number of women with more than five antenatal care visits and the delivery rate at specialised obstetric institutions were high. Approximately 50% of the participants had three or more postnatal care visits. Maternal healthcare use among women less than 20 years old and those with natural deliveries were higher. There were fewer antenatal care visits among women who had been pregnant once or twice before. Conclusions Delivery rates at specialised obstetric institutions and the number of antenatal care visits were higher than the World Health Organization requirements, while the frequency of postnatal care visits were better than most countries. This study identified several demographic characteristics that influenced maternal health service use. Policymakers should consider these findings when developing maternal health policies that protect women’s interests and expand free services. Additional resources should be given to increase the postnatal care capacity and quality of maternal healthcare.

Abstract Background We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods A national representative sample from the China Health and Retirement Longitudinal Study (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME. Conclusions The original poverty-promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance.

Abstract Background China’s fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. Methods Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. Results The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents’ better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (− 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. Conclusion The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.

ObjectivesThe sudden outbreak of the novel coronavirus disease (COVID-19) plunged healthcare workers (HCWs) into warfare. This study aimed to determine the prevalence of burnout and the factors associated with it among frontline HCWs fighting COVID-19.MethodsA cross-sectional survey was conducted among frontline HCWs fighting against the COVID-19 in Wuhan, Harbin, and Shenzhen during the period from February 18 to March 4. Finally, HCWs were recruited using cluster sampling, 1,163 HCWs were included in the final analysis. Burnout was measured using a 22-item Maslach Burnout Inventory scale (MBI scale).ResultsOf the participants, 48.6% suffered from burnout, and 21.8% showed a high degree of burnout. Doctors (b = 3.954, P = 0.011) and nurses (b = 3.067, P = 0.042) showed higher emotional exhaustion (EE) than administrators. Participants who worked continuously for more than 8 h a day (b = 3.392, P = 0.000), those who were unable to eat three regular daily meals (b = 2.225, P = 0.008), whose daily water intake was no more than 800 ml (b = 3.007, P = 0.000), who slept for no more than 6 h (b = 1.609, P = 0.036), and who were infected or had colleagues who were infected with COVID-19 (b = 4.182, P = 0.000) experienced much higher levels of EE, while those who could adhere to infection control procedures (b = −5.992, P = 0.000), who were satisfied with their hospital’s infection control measures(b = −3.709, P = 0.001), and who could receive sufficient psychological crisis intervention (b = −1.588, P = 0.039) reported lower levels of EE.ConclusionThe study reveals that burnout is prevalent among frontline HCWs and that the known factors associated with burnout, such as workload, and the factors directly associated with COVID-19, such as having insufficient protection, can affect burnout symptoms in frontline HCWs. Synergized and comprehensive interventions should be targeted at reducing its occurrence among frontline HCWs fighting COVID-19.

Harmonious eco-environment and socioeconomic development is challenged by the difficulty of achieving sustainable development goals in rural areas in developing regions. Moreover, the exploratory strategy of the Ecological County Strategy and management practices of ecological restoration in these regions have not attracted sufficient academic attention. This study uses Meixian County as a case study. We use modified ecological footprint to characterize the ecological environment system of counties, and establish an evaluation index system that reflects the characteristics of counties’ socioeconomic development system. Based on the analysis of the dynamic characteristics of the per capita ecological footprint of Meixian, the grey correlation degree model and coupling degree model were used to analyze the key factors and the degree of coordination between the eco-environment and socioeconomy. The results show that the per capita ecological footprint of Meixian decreased from 0.5884 ha/cap to 0.4797 ha/cap from 2011 to 2016, the quality of the eco-environment has improved. The results of the grey correlation degree show that the ecological footprints of agricultural inputs and agricultural pollutants are important factors that restrict socioeconomic development. The local financial revenue (0.6898), per capita kiwifruit income (0.6842), and the coverage rate of pension insurance (0.7098) and medical insurance (0.6668) all have considerable effects on improving the eco-environment. The results of the coupling coordination degree show that the average annual growth rate of the coupling coordination between the eco-environment system and the economic system is 7.84%, which is in a coordinated or higher state. The average annual growth rate of the coupling coordination between the eco-environment and the social system is 15.25%, and the coordination level rose from imbalanced to highly coordinated state. This study confirms the positive role of the Ecological County Strategy in promoting the coordinated development of counties, and provides beneficial experience for counties in developing regions to improve the coordination between eco-environment and socioeconomy on the basis of ecological carrying capacity.

Abstract Background Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China’s health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. Methods A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. Results Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. Conclusions The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.

Abstract Background Hostility can result in negative outcomes in people living with HIV/AIDS (PLWHA); however, previous research on this topic is far from adequate. To contribute to existing knowledge on this aspect of PLWHA, the current study examined the prevalence of hostility and its potential influencing factors among PLWHA. Methods A cross-sectional questionnaire survey was undertaken on 218 HIV patients in Heilongjiang Province of China between March and August in 2013. A multiple logistic regression analysis was performed to identify factors associated with hostility. Results The prevalence of hostility was 17.0% among the participants. The three most alarming types of hostility included desiring to kill the person who infected them, blaming the infection on the society, and abandoning themselves to despair. A multiple logistic regression model identified that depression (OR = 3.845, 95% CI = 1.309–9.229), perceived stigma (OR = 3.281, 95% CI = 1.109–7.711), and fear of dying (OR = 2.710, 95% CI = 1.068–6.881) were the risk factors for hostility, while higher levels of trust-in-doctor (OR = 0.176, 95% CI = 0.060–0.517) and per capita household income (OR = 0.344, 95% CI = 0.119–0.991) were protective factors. Conclusions Our findings highlight the prominent influence of psychological, healthcare, and social factors on hostility among PLWHA. Interventions specifically targeted to reduce hostility should be provided, including incorporating psychological service into HIV management guidelines, enhancing PLWHA’s trust-in-doctor, establishing comprehensive services for PLWHA, reducing the social stigma against PLWHA, and paying more attention to PLWHA with financial problems. These interventions may improve the management and control of HIV/AIDS.

Low- and middle-income countries (LMICs) suffered the most from nutritional deficiencies (NDs). Although decades of efforts have reduced it, little is known about the changing trajectory of ND burden in LMICs. By extracting data of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we calculated indicators of incidence and disability-adjusted life years (DALYs) to measure the burden of NDs and its main subcategories in LMICs, including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, dietary iron deficiency, and other nutritional deficiencies by sex, age and spatial patterns. In LMICs, ND incidence still increased in the age group 15+ born before 2005, especially in males. The effort of reducing the DALYs of NDs has generated a strong decline in per age group. In the main subcategories of NDs, protein-energy malnutrition incidence in males age 45+ born before 1970 still increased. Despite vitamin A deficiency incidence and dietary iron deficiency, DALYs strongly experienced decreases over three decades while still remaining at the heaviest level in 2019, especially in females and children under 5 years. The top largest tendency estimates occurred in Mali’ females and Bhutan’ males. Zimbabwe was the only country with increased DALYs rate tendency in both sexes.

Abstract Background International reports indicating that around 10–50% of health care staff are exposed to violence every year; in certain settings, this rate might reach over 85%. Evidence has shown that people who experience psychological violence are seven times as likely to be victims of physical violence. Although there have been numerous studies on WPV in general hospitals, there is no consensus regarding the current status of psychological violence directed at health care workers in township hospitals in China. The purpose of this study was to estimate the prevalence and the risk factors of psychological violence in Chinese township hospitals. Methods A retrospective cross-sectional survey of township hospitals general practitioners and general nurses was conducted in Heilongjiang Province, China.Descriptive analyses and binary logistic regression analysis were used to estimated the prevalence and the risk factors of psychological violence. Results Regardless of whether the assessment period was the past 12 months, past 36 months, or during their entire career,GPs and nurses reported that verbal abuse was the most common type of psychological violence (28.05, 30.28, 38.69 and 40.45%, 43.86, 54.02%).The main perpetrator was patients’ relatives. Most participants responded to violence with “pretend nothing happened”, 55.63% of GPs and 62.64% of nurses reported that the perpetrator received no punishment. Around 47.62% of respondents reported that their workplace had no procedures for reporting violence. When workplaces did have a reporting system, 57.73% knew how to use them. Only 36.98% had training in managing aggression and violence. General nurses, individuals 35 years or younger, those with higher professional titles and who work in shifts are at greater risk of psychological violence. Conclusions Our results indicate a high prevalence of psychological violence in Chinese township hospitals, which can no longer be ignored. Effective measures should be taken to prevent and respond to workplace violence(WPV), especially psychological violence. Trial registration (Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

Objectives Assessing medical students’ attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform. Methods A cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students’ attitudes. The medical students’ demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category. Results A total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for ‘Caring’ (including patients’ preferences into the decision-making process) than for ‘Sharing’ (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P

The pneumonic plague, which spread across Northeast China during the winter of 1910 and spring of 1911, caused numerous deaths and brought about severe social turmoil. After compulsory quarantine and other epidemic prevention measures were enforced by Dr Wu Lien-teh, the epidemic was brought to an end within 4 months. This article reviews the ways in which the plague was dealt with from a historical perspective, based on factors such as clinical manifestations, duration of illness, case fatality rate, degree of transmissibility, poverty, inadequate healthcare infrastructure, and the region's recent strife-filled history. Similarities were sought between the pneumonic plague in Northeast China in the twentieth century and the Ebola virus outbreak that is currently ravaging Africa, and an effort made to summarize the ways in which specific measures were applied successfully to fight the earlier epidemic. Our efforts highlight valuable experiences that are of potential benefit in helping to fight the current rampant Ebola epidemic in West Africa.

The study's objectives were to: 1) use social support theory to examine factors influencing healthcare workers' opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention.

The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals.A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%).A total of 106 of the 840 (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients' relatives (62.3%), followed by the patient (22.6%); 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60) resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%). Most respondents (62.8%) did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting) with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats) was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc.).Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue.