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ObjectiveTo evaluate the current status of hypertension prevention and control management operation mechanisms in Chinese mainland, explore the impact of their improvement on hypertension prevention and control effects, and provide a reference for enhancing hypertension prevention and control management. MethodsPolicy documents related to hypertension prevention and control from January 1 2000 to December 31, 2018 in 31 provinces (municipalities and autonomous regions) in Chinese mainland were collected. The current status of hypertension prevention and control management operation mechanisms in Chinese mainland was systematically evaluated according to the appropriate public health system evaluation model and standard. A logistic regression model was used to analyze the impact of the improvement of management operation mechanisms on hypertension prevention and control effects. ResultsIn 2018, the appropriateness of hypertension prevention and control management operation mechanisms in Chinese mainland was 43.68%, with an increase of 21.64% compared to 2000, but there was still a gap of 48.61% from the appropriate standard. Among them, the appropriateness of coordination and incentive mechanisms was the lowest (14.03%), and the appropriateness of planning and evaluation mechanisms was the highest (63.04%). In terms of specific positioning, the coverage of medium and long-term plans (100.00%) and the completeness of content and form (94.45%) were relatively high, while the feasibility of management mechanisms was only 9.76%. The results of logistic regression analysis showed that the improvement of management operation mechanisms helped control blood pressure in hypertensive patients (OR = 1.012, P = 0.007) and maintain the stability of patients’ blood pressure (OR = 1.010, P = 0.029). Conclusion From 2000 to 2018, the construction of hypertension prevention and control management mechanisms in Chinese mainland tended to be improved, effectively promoting the improvement of hypertension prevention and control management levels. However, it is still necessary to further establish and improve coordination and incentive mechanisms and clarify the division of departmental responsibilities.

Abstract Background There is a dearth of research combining geographical big data on medical resource allocation and growth with various statistical data. Given the recent achievements of China in economic development and healthcare, this study takes China as an example to investigate the dynamic geographical distribution patterns of medical resources, utilizing data on healthcare resources from 290 cities in China, as well as economic and population-related data. The study aims to examine the correlation between economic growth and spatial distribution of medical resources, with the ultimate goal of providing evidence for promoting global health equity. Methods The data used in this study was sourced from the China City Statistical Yearbook from 2001 to 2020. Two indicators were employed to measure medical resources: the number of doctors per million population and the number of hospital and clinic beds per million population. We employed dynamic convergence model and fixed-effects model to examine the correlation between economic growth and the spatial distribution of medical resources. Ordinary least squares (OLS) were used to estimate the β values of the samples. Results The average GDP for all city samples across all years was 36,019.31 ± 32,029.36, with an average of 2016.31 ± 1104.16 doctors per million people, and an average of 5986.2 ± 6801.67 hospital beds per million people. In the eastern cities, the average GDP for all city samples was 47,672.71 ± 37,850.77, with an average of 2264.58 ± 1288.89 doctors per million people, and an average of 3998.92 ± 1896.49 hospital beds per million people. Cities with initially low medical resources experienced faster growth (all β |βi|, i = 1, 2, 3, …, 9, all β doc: |βi|, i = 3, 4, 5, …, 10, P

ObjectiveTo analyze the change in service capacity against major epidemics before and after coronavirus disease 2019 (COVID-19) in China for the promotion of the capacity. MethodsVia systematic search on the official websites and the law documents website of Peking University (PKULAW), we collected totally 1 756 policy documents relevant to major epidemic prevention and control issued during 2002 – 2020 by government departments and professional public health institutions in 31 provincial-level administrative divisions of China. Contents about the coverage and assessability of service capacity of major epidemic prevention and control were extracted from the documents and indexes for evaluating national and regional coverage and assessability were calculated based on the extracted contents. Paired signed-rank test was used to analyze changes in the indexes before and during COVID-19 epidemic. ResultsThe coverage of major epidemic prevention and control services has reached 100% in the Chinese mainland in 2019. In comparison to those in 2019 before the emergence of COVID-19 epidemic, the national assessability indexes (%) for service capability of major epidemic prevention and control of pre-, ongoing- and post-stage increased in 2020 by 29.78% (65.59% vs. 50.54%) , 17.54% (72.04% vs. 61.29% ) and 4.34% (38.71% vs. 37.10%). the assessment index for service capability of major epidemic prevention and control of pre-stage increased from 78.79% to 89.39% for eastern region and that of ongoing-stage increased from 65.00% to 76.67% for western region (both P < 0.05); but there was no significant increase in regional assessment index for service capability of major epidemic prevention and control of post-stage. The national assessment index for service capacity of major epidemic prevention and control of whole process increased significantly from 66.00% in 2019 to 73.78% in 2020 after the emergence of COVID-19 epidemic (P < 0.001). ConclusionThe overall service capacity of major epidemic prevention and control has improved after the emergence of COVID-19 epidemic in the Chinese Mainland but the service capacity needs to be improved in central and western regions; in addition, the post-event assessment on the service capacity should be concerned for the promotion of the service capacity.

ObjectiveTo analyze changes in the coverage of incentive measures for promoting major epidemic prevention and control in documents published by governmental and professional departments in the Chinese Mainland before and after coronavirus disease 2019 (COVID-19) epidemic of 2020.MethodsThrough systematically searching websites of government departments and professional institutions in 31 provincial-level administrative divisions (PLADs) of the mainland of China, we retrieved totally 3 864 documents (including laws, regulations, standards, rules, proposals, plans, and guidelines) relevant to major epidemic prevention and control published from 2000 through 2020. The paragraphs related to incentive and disciplinary measures for promoting the containment of major epidemic were extracted to calculate region- and institution-specific coverage of the measures in the retrieved documents. Wilcoxon paired rank sum test was adopted to evaluate differences in the coverage of the established measures before and after COVID-19 epidemic of 2020 among various economic regions and administrative/professional institutions. ResultsThe average coverage of disciplinary measures for the retrieved documents increased from 74.19% before 2020 to 76.34% in 2020, with a significant increase of 2.90% (P < 0.05); while, the average coverage incentive measures was 22.85% for the documents published in 2020, significantly increased in comparison with no incentive measure presented in all the documents published before 2020 (P < 0.001). Compared to those before 2020, the national average combined coverage of incentive and disciplinary measures increased significantly by 11.83%, 30.77%, 42.11%, and 89.66% in 2020, for the documents published by administrative departments, public health institutions, health care institutions, and primary health care institutions, respectively; the national average coverage increased from 37.10% before 2020 to 49.60% in 2020 for the documents published by all the institutions, with an increment of 33.70%; and for the documents published by all the institutions in the PLADs of eastern, central and western region, the coverage increased significantly by 47.47%, 27.54% and 25.00% (all P < 0.05). ConclusionAfter COVID-19 epidemic of 2020, the coverage of incentive and disciplinary measures for promoting major epidemic prevention and control increased significantly in the documents published by governmental and professional departments in the mainland of China and the increase was much higher for the coverage of incentive measures.

ObjectiveTo evaluate the capacity for hypertension prevention and control and to identify strengths, shortcomings and key control points of the capacity-building in 31 provincial-level administrative divisions (PLADs) in China.MethodsPolicy documents, information reports, and research literature on hypertension prevention and control in 31 PLADs of China published from January 1995 through December 2019 were systemically collected via searching relevant websites and statistical yearbooks for evaluating on hypertension prevention and control capacity across the 31 PLADs according to the standards for appropriate public health system. Normative gap analysis was used to explore strengths and shortcomings of the capacity-building and multiple linear regression and sensitivity analysis were used to clarify key control points of the capacity-building. ResultsThe average index for the appropriateness of hypertension prevention and control capacity-building was 47.10% among 31 PLADs of China in 2019, and the average annual increasing rate of the capacity-building was 18.75% from 2000 to 2019, showing a significant upward trend (Z = 6.067, P < 0.001). The strengths of hypertension prevention and control capacity-building for the PLADs include more complete organizational structure established, comprehensive coverage of medium- and long-term plans, and sound management and monitoring mechanisms; while the shortcomings are insufficient allocation of human and financial resources and low implementation of multi-dimensional management mechanisms such as management and coordination, medium- and long-term goals and evaluation criteria. The identified key control points for the five aspects in hypertension prevention and control capacity-building are effective motivation of personnel for resource allocation, the coordination for organizational framework, the coverage of incentive measures for management mechanism, practicable assessment criteria for management process evaluation, and the balance between supply and demand of medical service for service offering, with the estimated increment of 23.14%, 66.40%, 15.77%, 23.43% and 7.06%, respectively, in the indexes for the appropriateness of the capacity-building under the conditions of the five key control points being well managed. ConclusionThe capacity for hypertension prevention and control has been improved continuously in 31 PLADs of China during 2000 – 2019 but several aspects in hypertension prevention and control capacity-building still need to be improved for the promotion of the capacity-building.

ObjectiveTo examine current situation and influencing factors of disability among urban and rural elderly residents in Tai'an municipality, and to provide evidence for promoting healthy aging in the population. Methods Face-to-face interviews were conducted among 3 896 elderly residents ( ≥ 60 years) recruited with multistage random cluster sampling in 6 prefectures/counties/districts of Tai′an municipality, Shandong province during July – August 2020. The Physical Self-Maintenance Scale (PSMS) for activities of daily living (ADL) assessment, Pittsburgh Sleep Quality Index (PSQI) for sleep status evaluation, and a self-designed general questionnaire were adopted in the survey for analyzing ADL and its associates of the elderly. Results Of the 3 864 elderly averagely aged 68.89 ± 5.98 years, 4.8% were assessed as having disabilities (with a PSMS score of higher than 6), with a significantly higher disability ratio among the rural elderly than that among the urban elderly (5.5% vs. 3.5%, χ2 = 8.040; P < 0.05). The results of multivariate logistic regression analysis revealed following significant influencing factors of disability: (1) risk factors for urban elderly: aged ≥ 80 years (odds ratio [OR] = 7.058), poor self-rated health (OR = 3.237), and poor sleep quality (OR = 6.288); (2) protective factors for urban elderly: participating in the basic medical insurance for urban employees (OR = 0.146) or the basic medical insurance for urban and rural residents (OR = 0.180); (3) risk factors for rural elderly: aged 70 – 79 years (OR = 2.116) or ≥ 80 years (OR = 7.270), fair self-rated health (OR = 2.256) or poor self-rated health (OR = 4.368), suffering from chronic diseases (OR = 3.290), falling history in the previous year (OR = 2.151); and (4) protective factors for rural elderly: participating in physical exercise (OR = 0.568). ConclusionThe prevalence of disability was higher among rural elderly residents than that among urban elderly residents and the prevalence was influenced by age and self-rated health for both rural and urban elderly in Tai′an municipality.

BackgroundWellbeing of healthcare workers is crucial for the effective functioning of primary health systems. This study aimed to examine the association between occupational stress and subclinical depression among primary healthcare workers, and to establish the foundation for future preventive strategies.MethodsA cross-sectional study was conducted in Tai’an City, Shandong Province, China. Data were collected from 832 medical staff in primary health institutions using a structured self-administered questionnaire. The participants completed the Challenge and Hindrance-Related Self-Reported Stress (C-HSS) Scale and Patient Health Questionnaire-9. Multivariable logistic regression analysis was conducted to explore the relationship between occupational stress and subclinical depression among primary healthcare workers.ResultsThe prevalence of subclinical depression among primary healthcare workers was 11.66%. Participants with subclinical depression have a significant higher level of occupational stress (including challenge-stress and hindrance-stress). Regression analysis result indicated that higher level of occupational stress was significantly associated with more severe subclinical depression, and the risk of subclinical depression remained after adjusting other covariates (OR = 4.57, 95%CI, 3.14–6.63). The association between challenge-stress and subclinical depression was not statistically significant when controlling for hindrance-stress. Subgroup analysis showed that male healthcare workers who perceived higher level of challenge stress were more likely to develop subclinical depression than female healthcare workers.ConclusionThe level of subclinical depression among Chinese primary healthcare workers was high, and occupational stress especially hindrance stress may contribute to subclinical depression. Findings were also robust in subgroup analysis after adjusting for other covariates. These findings emphasize the importance of occupational stress psychosocial interventions to decrease the risk of developing depression among the primary healthcare workers.

Abstract Background Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension. Methods Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The “KHB-method” was used to perform mediation analysis. Results Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78–7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control. Conclusions Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.

BackgroundSleep quality is considered to be associated with cognitive function for older adults, but little is known about whether living with others can buffer mild cognitive impairment in older adults with poor sleep quality. The objective of this study was to examine the role of living arrangements in sleep quality and cognitive function among older adults aged 65 and over.Methods2,859 older adults over 65 years old were selected by using multi-stage stratified sampling method. Cognitive function and sleep quality were measured using Mini-Mental State Examination (MMSE) and Pittsburgh Sleep Quality Index (PSQI). Binary logistic regression was performed to examine the relationship between sleep quality and mild cognitive impairment, and the interaction effects of sleep quality and living arrangements on mild cognitive impairment stratified by gender.ResultsPoor sleep quality was associated with mild cognitive impairment among men and women regardless of living arrangements. The significantly protective role of living with others in reducing the incidence of mild cognitive impairment was found in men with poor sleep quality, but not in women.ConclusionTargeted support for older adults with poor sleep quality may be effective in preventing mild cognitive impairment, and gender differences should be taken into account when promoting cohabitations.

BackgroundDepressive status of medical personnel worldwide and especially in China is an important public health and social problem. There is a strong relationship between education and depression, but no studies have studied grouping healthcare workers (HCWs) with different educational degree to discuss whether there are differences in the factors that affect depression. This study aims to examine the role of job satisfaction and sleep quality in the relationship between work stress and depression among Chinese HCWs, and teste whether the mediation models are differed by the differences of educational degree.MethodsPatient Health Questionnaire-9 (PHQ-9) scale was used to test depression. Work stress was assessed using the Challenge-blocking stress scale (CBSS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). HCWs’ satisfaction with their current work was assessed using the Job Satisfaction Index (JSI). The representative sample of HCWs was chosen using a multi-stage stratified cluster random sampling procedure and 844 HCWs were utilized to the statistical analysis of the study.ResultsIn the overall sample, sleep quality could mediate the relationship between work stress and depression in healthcare workers (p

BackgroundThe migrant elderly following children (MEFC) are a vulnerable group that emerged during fast urbanization in China. The MEFC faced physical and psychological discomfort upon their arrival in the inflow city, particularly those who came from rural areas.ObjectiveThis study aimed to explore the relationship between oral health status, loneliness, and sleep quality among the MEFC in China and to clarify the disparities in the above mentioned relationship by migration type.MethodsIn 2021, a cross-sectional survey was conducted in Weifang, Shandong Province, using multistage cluster random sampling to collect data from the MEFC aged 60 years and over. In total, 613 respondents [525 rural-to-urban (RTU) and 88 urban-to-urban (UTU)] were included in the final database. The chi-square test, t-test, and structural equation modeling (SEM) were used to investigate the relationship between oral health status, loneliness, and sleep quality among the RTU and UTU MEFC.ResultsTotal scores [mean ± standard deviation (SD)] for oral health status, loneliness, and sleep quality were 54.95 ± 6.47, 8.58 ± 3.03, and 4.47 ± 3.60, respectively. SEM revealed that, among the RTU and UTU MEFC, oral health status was positively and significantly related to sleep quality; however, the correlation was slightly stronger in the UTU MEFC. In both groups, there was a significant negative correlation between oral health status and loneliness, which was stronger in the UTU MEFC. In the RTU MEFC, a significant negative correlation between loneliness and sleep quality was observed, and in the UTU MEFC, no significant association between loneliness and sleep quality was observed.ConclusionThe sleep quality among the MEFC in this study was higher compared to previous studies. Oral health status was negatively correlated with loneliness and positively associated with sleep quality, whereas loneliness was negatively correlated with sleep quality. These three associations differed significantly between the UTU and RTU MEFC. The government, society, and families should take measures to improve oral health and reduce loneliness among the MEFC to improve their sleep quality.

BackgroundSince 1987, the Chinese government has promoted public mental health by continuously implementing mental health related policies. This research attempts to reveal the distribution and characteristics of mental health related policies. In addition, it can help stakeholders evaluate whether the environment for policy implementation has improved and identify key points in the development of the overall mental health system.MethodsWe used a bibliometric approach to analyze the evolution of mental health related policies in China from 1987 to 2020. A total of 239 mental health related policies were collected from Beida Fabao and official Internet websites of governmental departments. Co-wording, social networks, and citation analysis were applied to explore the evolutionary features of such policies.ResultsThe evolution of policy development showed that the number of mental health related policies in China has been increasing and their content has been enriched. Over time, mental health related policies not only gradually expanded its focus on common mental disorders, but also included an increasing number of keywords related to service provision, organization and administration. However, most policies were implemented independently by separate agencies and the number of policies jointly implemented by different agencies only accounted for 32.64% of all the policies implemented. The Ministry of Health (MOH) is at the core of the collaborative network associated with implementing mental health related policies in China.ConclusionThe environment associated with the implementation of mental health related policies in China is gradually improving. However, cross-sector collaboration among different agencies needs to be strengthened and financial support for related resources needs more attention. A clear division of responsibilities among various agencies and a sustainable financing mechanism are essential to the development and implementation of mental health related policies.

BackgroundLiving arrangements and social support have an impact on depression among older adults. However, the underlying mechanism between those variables remains unknown. This study aims to investigate the mediating role of social support in the relationship between living arrangements and depression among older adults.Materials and methodsMulti-stage stratified sampling method was used to select 3,859 older adults from Taian City, Shandong Province, China, for cross-sectional investigation. Living arrangements were measured by a question. Social support and depression were measured using the Multidimensional Scale of Perceived Social Support and Patient Health Questionnaire-9. Multiple linear regression models were used to assess the relationship between living arrangements and depression and the possible influence of social support on the relationship between living arrangements and depression.ResultsStatistics showed that 15.08% of older adults lived alone. After controlling for covariates, living arrangements (ß = 0.45, t = 2.87, P < 0.01) and social support (ß =−0.08, t =−16.93, P < 0.001) were significantly associated with depression. The linear regression model showed that social support mediated the relationship between living arrangements and depression, and the mediating effect accounted for 18.20% of the total effect.ConclusionThis study revealed that living arrangements played an essential role in indirectly predicting depression in older adults through social support. This provided evidence for how to reduce depression in older adults.

BackgroundThe World Health Organization has proposed an initiative to “end tuberculosis (TB).” Unfortunately, TB continues to endanger the health of people worldwide. We investigated the impact of public health services (PHS) in China on TB incidence. In this way, we provided policy ideas for preventing the TB epidemic.MethodsWe used the “New Public Management Theory” to develop two indicators to quantify policy documents: multisector participation (MP) and the Assessable Public Health Service Coverage Rate (ASCR). The panel data from 31 provinces in Chinese mainland were collected from 2005 to 2019 based on 1,129 policy documents and the China Statistical Yearbook. A fixed-effect model was used to determine the impact of MP and the ASCR on TB incidence.ResultsFrom 2005 to 2019, the average MP increased from 89.25 to 97.70%, and the average ASCR increased from 53.97 to 78.40% in Chinese mainland. However, the development of ASCR between regions was not balanced, and the average level in the western region was lower than that in the eastern coastal provinces. With an increase in MP and the ASCR, the TB incidence had been decreasing gradually in recent years. The panel analysis results showed that MP (β = −0.76, p < 0.05). and ASCR (β = −0.40, p < 0.01) had a negative effect on TB incidence, respectively. Even if the control variables were added, the negative effects of MP (β = −0.86, p < 0.05) and ASCR (β = −0.35, p < 0.01) were still statistically significant.ConclusionsPromoting the participation of multiple departments, as well as emphasizing the quality of PHS delivery, are important ways to alleviate the TB epidemic. The settings of evaluation indices for PHS provision should be strengthened in the future.

BackgroundThe associations between parental parenting styles and adolescents' development and health problems were also identified in a series of studies. However, the interactive impact of mother's and father's parenting style was less reported, which was implied in previous studies. In this study, we aim to analyze the associations between parental parenting style disparities and mental health among medical college students.MethodA cross-sectional study was conducted among medical college students in Shandong province, China, and 2,598 medical college students with parents were analyzed in this study. Items in a short form of Egna Minnen av Barndoms Uppfostran (EMBU) were used to calculate the parental parenting style disparities. Mental health was evaluated by the Kessler 10 scale.ResultsThe results of linear regressions showed that parental nurture reject disparities (RDs, β = 0.50, p < 0.001), parental emotional warmth disparities (WDs, β = 0.33, p < 0.001), parental overprotective disparities (ODs, β = 0.25, p < 0.001), and total disparities in parenting styles (TDs, β = 0.15, p < 0.001) were associated with mental health among medical college students, respectively. The other associated factors were age, ethnicity, chronic disease, above average family economic status, and good parental relationship.ConclusionOur findings supported the positive association between parental parenting style disparities and mental health problems. Further studies can test the mechanism and intervention of the findings about the importance of parental parenting style consistence on mental health.

ObjectiveFew are known on how and to what extent residents and healthcare providers have different preferences for family doctor contract service (FDCS). This study aimed to elicit and compare the residents' and healthcare providers' preferences for FDCS through a discrete choice experiment (DCE).MethodsResidents and healthcare providers recruited for the DCE were asked to choose repeatedly between two hypothetical service plans, which differed in six attributes: cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team. We use mixed logit regression models to determine preferences for potential attributes.ResultsA total of 2,159 residents and 729 healthcare providers completed valid DCE questionnaires. The mixed logit model results suggested that cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team all had a significant impact on residents' and healthcare providers' preference. The level of healthcare team was the most important characteristic of FDCS to both residents and healthcare providers, followed by types of service. They have different preferences on the cost and way of service delivery.ConclusionsThis study provides new evidence on how and to what extent residents and healthcare providers have different preferences for FDCS by determining their perception of various service attributes. These findings suggested that the optimal design and improvement of FDCS plans should consider not only residents but also healthcare providers' preferences to maximize contract service uptake.

Abstract Background Suicide is a global public health problem which has significant negative influence on individuals, families and the society. The aim of this study is to investigate the prevalence of suicidal ideation and related factors among elderly people in rural China, and further examine the gender differences of suicidal ideation. Methods Data were collected from the 2017 Survey of the Shandong Elderly Family Health Service, which was conducted by Shandong University. A total of 5514 elderly aged 60 and above from rural Shandong were included in this study. Binary logistic regression model was performed to examine the gender difference towards suicidal ideation, and to identify the influencing factors of suicidal ideation by gender among elderly. Results 7.7% rural elderly reported suicidal ideation in the past 12 months in Shandong, China. The prevalence of suicidal ideation among females was significantly higher than that among males (P

Abstract Background This study aims to assess the association between body mass index (BMI) and health-related quality of life (HRQOL), and to further explore gender differences in BMI-HRQOL association among adults. Methods We used data from the fifth Health Service Survey of Shandong Province, which was part of China’s National Health Service Survey (NHSS), a total of 27,257 adults aged 18 and over were interviewed. The HRQOL was measured using the EuroQOL-5 Dimensions (EQ-5D) instrument. One-way ANOVA and Post hoc tests were used to compare EQ-5D utility values and visual analogue scale (VAS) scores between BMI categories. Tobit regression models were used to identify the association between BMI and HRQOL for male and female separately after controlling for influential confounders, and to assess gender differences on the relationship between BMI and HRQOL. Results The prevalence of underweight in men and women were 3.2 and 5.3%, respectively, while the prevalence of overweight/obesity in men and women were 35.7 and 34.6%, respectively. Men had higher EQ-5D utility values and VAS scores than women. The mean EQ-5D utility value and VAS score was highest in obese men and normal-weight women, respectively. After controlling potential confounders, being underweight was significantly and negatively associated with lower HRQOL among adults. The relationship between obesity and gender was that in women obesity was negatively and significantly associated with HRQOL, whereas in men this association was positive but not statistically significant. Results of gender by BMI interaction in regression model showed that this difference between men and women in this respect was significant. Conclusions The association between BMI and HRQOL differed by gender and the so-called “obesity-HRQOL paradox” phenomenon was verified in male adults. Gender difference should be considered when implementing targeted weight control programs and appropriate interventions to improve HRQOL.

Abstract Backgrounds Suicidal ideation is an important public health issue due to devastating mortality. In the meantime, interpersonal trust was found to be negatively associated with mental disorder and physical health. Although there is increasing evidence that interpersonal trust is a significant predictor of suicidal ideation, evidence of this association is still lacking in the developing world. The aim of this study was to test the association between interpersonal trust and suicidal ideation among older adults in China. Methods Using a multi-stage stratified sampling strategy, 7070 older adults aged 60 and above from Shandong Province, China were recruited in this study. Socio-demographic characteristics, health status, family relationship, psychological distress, interpersonal trust and suicidal ideation in the last 12 months were obtained through face to face interviews. The association between interpersonal trust and suicidal ideation was assessed using multiple logistic regression models adjusting for socio-demographic characteristics, health status, family relationship and psychological distress. Results 7.1% of participants reported suicidal ideation in the past 12 months, which was related to gender, resident area, marital status, educational level, self-rated economic, chronic disease, self-rated health status and family relationship within 1 month, psychological distress and interpersonal trust. After adjusting for sociodemographic factors, health status, family relationship and psychological distress, interpersonal mistrust was associated with two times odds of suicidal ideation when compared to interpersonal trust Conclusions The interpersonal trust was associated with suicidal ideation among elderly in Shandong, China. Intervention approaches regarding inducing and promoting interpersonal trust should be developed to prevent suicide.

Abstract Background In 2009, China unveiled an ambitious national health care reform program, with the goal of providing equitable and affordable basic health care for everyone. This study was intended to partially fill the knowledge gap in understanding of the demand-side impact on health care utilization and affordability among older people in Zhejiang and Gansu provinces of China. Methods We used two waves of data from the pilot survey of CHARLS implemented in 2008 and 2012. Chi-square tests and t tests were performed to examine whether out-of-pocket (OOP) and pharmaceutical spending (PS), as a share of total health expenditures (THEs), have significantly changed following the health reform. Two-part model was employed to confirm these changes after controlling for confounding variables. All analyses were weighted and clustered the standard errors. Results After controlling for confounding variables, older people in 2012 were 2.1 and 6.8% more likely to use outpatient and inpatient care than they did in 2008, respectively. Among those who have at least one outpatient visit, declines of OOP-to- THEs and PS-to-THEs percentage significantly reduced 0.998 (p

Background: Substantial evidence indicated that absolute income is directly associated with health. Few studies have, however, examined if relative income may be equally associated with health. This study aimed to investigate the association between absolute income/relative deprivation (RD) and self-rated health (SRH). We also investigated whether the urban-rural difference was existing in these associations.Methods: Using cross-sectional data of 7,070 participants in the Shandong Family Health Service Survey of older people, this study applied binary logistic model and semi-parametric model to estimate the effect of absolute income and relative deprivation on SRH of older people. The Kakwani Index was used as a measure of relative deprivation at the individual level.Results: Absolute income has a significant positive effect on the SRH among both urban and rural older people. When considered RD as a variable, both absolute income and RD have negative significant effects on SRH among all older people. In addition, the negative effect of RD on rural elderly is more pronounced than that of urban older populations. Semi-parametric regression results show that there was a complex non-linear relationship between income and SRH. Psychological distress substantially attenuated the association between relative deprivation and SRH.Conclusions: Relative deprivation is negatively associated with self-rated health in both urban and rural older people after controlling the absolute income. RD may partly explain the association between income inequality and worse health status. Compared with the urban elderly, the effect of income-based relative deprivation on SRH was more pronounced among the rural elderly, and more care should be given to the lower income and rural older populations.

Background: The psychology of university and college students is immature, they are thus more likely to suffer from depression due to the COVID-19 pandemic. The present study aims to investigate the self-reported depression status of Chinese university and college students and explore its influencing factors.Methods: We conducted a network-based online survey, and a total of 17,876 participants completed the questionnaire. Depression was measured by the Self-Rating Depression Scale (SDS). Univariate analysis and multivariate logistic analysis were performed to explore the influencing factors of self-reported depression symptoms.Results: The proportion of self-reported depression symptoms, mild self-reported depression symptoms, and moderate to severe (M/S) self-reported depression symptoms was 65.2, 53.7, and 11.5%, respectively. The mean score of self-reported depression was 54.8 ± 9.0. Female, personality type of partial introversion, junior college educational level, “moderate” or “high” self-perceived risk of infection, “moderately” or “highly” impacted by the outbreak, and being eager to go back to school were risk factors for M/S self-reported depression symptoms (p < 0.05). While, “moderate” or “high” concern about the outbreak, “moderate” or “high” satisfaction with pandemic prevention and control measures, and having health literacy on communicable diseases were protective factors for M/S self-reported depression symptoms (p < 0.05).Conclusion: The status of self-reported depression symptoms among university and college students was severer than expected, and the influencing factors were multifaceted. Government and school administrators should strengthen the dissemination of knowledge on disease prevention and control. Moreover, much attention should be paid to female and junior college students.

Objectives Whether the association between obesity-related anthropometric indices and multimorbidity differs by age among Chinese older adults (aged 65+) is unclear. We aimed to investigate the association between body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with multimorbidity among the young-old (aged 65–79) and old-old (aged 80+) adults.Design Cross-sectional population-based study.Setting Shandong province on the eastern coast of China.Participants 5493 subjects aged 65 years or above.Measurements Details on sociodemographics, lifestyle characteristics and chronic conditions were collected using a structured questionnaire. The respondents were assessed with anthropometric measurements including height, weight, WC, hip circumference.Results The overall prevalence of multimorbidity in older adults (aged 65+) was 35.2%. The BMI-obesity, WC-obesity and WHR-obesity rates were 7.4%, 57.5% and 80.4%, respectively. In the young-old adults (aged 65–79), the likelihood of multimorbidity was more than two times higher among the BMI-obese than the BMI-normal population (OR 2.08, 95% CI 1.66 to 2.60). Similar but less strong associations were found for the WC-obese and WHR-obese young-old population (OR 1.60, 95% CI 1.42 to 1.81; OR 1.31, 95% CI 1.10 to 1.56, respectively). For the old-old group (aged 80+), the BMI-obese, WC-obese and WHR-obese had a higher likelihood of having multimorbidity compared with the normal weight category (OR 2.10, 95% CI 0.96 to 4.57; OR 1.75, 95% CI 1.21 to 2.54; OR 2.15, 95% CI 1.18 to 3.93, respectively).Conclusion BMI-obesity, WC-obesity and WHR-obesity were associated with a greater risk of multimorbidity, and the associations were different between the young-old and the old-old adults. These age differences need to be considered in assessing healthy body weight in old age. These findings may be vital for public health surveillance, prevention and management strategies for multimorbidity in older adults.

Abstract Background The purpose of this study was to measure the level of job satisfaction of certified physicians in rural primary health care facilities (PHCFs) in Shandong Province in order to ascertain the key factors affecting their satisfaction and to provide effective information for policy decisions. Methods This cross-sectional study was conducted among certified physicians in PHCFs in rural Shandong from June to August 2016. An anonymous questionnaire was completed by 495 participants (valid response rate: 91.6%). Data were analyzed using an exploratory factor analysis (EFA), one-way analysis of variance (ANOVA), and multiple linear regression. Results The participants consisted of 310 (62.6%) males and 185 (37.4%) females. The overall mean score for job satisfaction among respondents was 3.41 (standard deviation (SD) 0.68), which indicated that certified physicians were partially satisfied with their jobs. Results also indicated that factors for the highest level of satisfaction among certified physicians were the internal environment and job description. Moreover, physicians were more satisfied with competency behaviours and organizational management than with working conditions and job rewards. In contrast, physicians were dissatisfied with the external environment to an extent. Overall job satisfaction decreased with more years of service. Older physicians were less satisfied with their jobs than younger ones. Physicians with a higher level of education or senior professional title were less satisfied with their jobs than those with a lower level of education or junior professional tilte. Organizational management and the external environment were the most important factors influencing job satisfaction. Conclusion Certified physicians working in PHCFs in rural Shandong had a slightly higher level of overall job satisfaciton than usual. After recent healthcare reforms, the job satisfaction of primary health care physicians in Shandong has changed little in comparison to that of physicians in other provinces in China. More attention should be paid to the impacts of these variables (age, educational background, technical title, monthly salary, form of employment, and years of service) on job satisfaction. Numerous recommendations may be considered to enhance organizational management and the external environment. The Government should enhace the formulation, implementation, and evaluation of policies to ensure that physicians continue to enjoy working in PHCFs. In short, the Government should pay more attention to protecting the legitimate rights and interests of primary care physicians when devising medical reforms.

Abstract Background Blood pressure measurement is the first step in preventing and controlling hypertension. The objective of this study is to examine the rural–urban difference towards blood pressure measurement among elderly with hypertension. Methods A total of 2007 elderly (65+) were selected from the fifth Health Service Survey of Shandong Province in 2013. A standardized questionnaire was used to investigate the demographic characters, socioeconomic status, self-rated health, and blood pressure related index. Three logistic regression models were used to examine the difference in blood pressure measurement between rural and urban elderly. Unadjusted and adjusted logistic regression models were used to explore the associated factors of blood pressure measurement in both rural areas and urban areas. Results The prevalence of weekly blood pressure measurement in urban elderly was higher than that in rural elderly (63.9% vs 34.3%). The rural elderly had an odds ratio (OR) for weekly blood pressure measurement of 0.467 (95%CI = 0.380–0.575) compared with urban elderly. Binary logistic regression analysis showed that medication frequency and accepting health care professionals’ guidance were common associated factors of blood pressure measurement among both rural and urban elderly; personal income was unique associated factor of blood pressure measurement among rural elderly; marital status, education level, self-rated health, and blood pressure level currently were unique associated factors of blood pressure measurement among urban elderly. Conclusions There is a big difference in blood pressure measurement between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, should be made to reduce such a gap.

Abstracts Objective To have a basic and comprehensive understanding about the prevalence, risk factors and disease management situation of hypertension among floating population in China. Method We used “(hypertension or hypertensive or chronic disease) and (floating population or migrant worker)” as the key words, to search in the China academic literature database (CNKI), Wan Fang database, PubMed and Web of Science for relevant literature and extracted the data about the prevalence of hypertension, relevant risk factors and disease management of floating population in China from 1990 to 2016. Result The 23 related studies that entered into final analysis were all articles in Chinese. The prevalence of hypertension in floating population is lower than that in both general population and local residents. The prevalence of hypertension in male floating population is higher than that in females. In addition, the prevalence of hypertension also increases with age growing. As for the risk factors of hypertension, the rate of drinking in floating population is higher than that in general population and local residents, while the rates of overweight and obesity in floating population are lower than that in general population in China. Finally, the rates of awareness, treatment and control of hypertension are also lower in floating population. Conclusion The major problem of floating population is focused on their unhealthy lifestyle (drinking) and deficient disease management. Therefore, we should increase the fund and facility support for public health service system so as to improve their service delivery ability, and enforce the education and unhealthy lifestyle intervention to improve their health awareness and compliance to disease management.

Abstract Background Compared with the Expanded Program on Immunization (EPI) vaccines, the coverage rate of the non-EPI vaccines is still low. The aim of this study is to explore the rural-urban disparity in category II vaccine and its determinants among children under 5 years old in China. Methods A cross-sectional study was conducted in 17 cities in Shandong province from August to October, 2013. A total of 1638 children were included in the analysis. Unadjusted and adjusted regression model were used to identify the rural-urban difference in vaccination of category II vaccine. Multivariate logistic regression models were employed to analyze the determinants associated with vaccination of category II vaccine in rural and urban areas respectively. Results The coverage rates of category II vaccine in rural and urban children were 81.5 and 69.4% respectively. Factors including age and satisfaction with vaccination services were associated with category II vaccination both in rural and urban children (Ρ

Abstract Background Government health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China’s healthcare reform. The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services. Methods Data from China’s National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile’s percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles. Results In urban populations, the CI value of GHS for primary care was negative. (− 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = − 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (− 0.4991,-0.1851 and − 0.1651; − 0.482, − 0.247and − 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich. Conclusions The inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Abstract Background Despite economic growth and improved health outcomes over the past few decades, China still experiences striking urban-rural health inequalities. Urban and rural residents distinguished by the hukou system may experience profound disparities because of institutional effect. The aim of this study is to estimate trends in urban-rural disparities in self-care, outpatient care, and inpatient care utilization from a perspective of the hukou system. Methods Data were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in self-care, outpatient care, and inpatient care utilization. Multinomial logistic regression was employed to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011 once known determinants of utilization are taken into account according to Andersen/Aday’s Health Behaviour Model. Results The urban-rural disparities were evident after controlling for confounding variables: urban adults were 3.24 (p

After the publication of our article [1] we have been made aware of a number of mislabelling and reporting errors, which were introduced in the preparation of the manuscript. The conclusions are not affected by these errors and thus remain unchanged.

Objective Identifying the spatial patterns of childhood overweight/obesity (OW/OB) can help to guide resource allocation for preventive intervention in China. This study aims to estimate rates of childhood OW/OB across counties within Shandong Province, using geographic techniques to identify sex-specific spatial patterns of childhood OW/OB as well as the presence of spatial clusters.Design Cross-sectional study.Setting Shandong Province in China.Participants and methods Data on 6 216 076 children and adolescents aged 7–18 years from the Primary and Secondary Schoolchildren Physical Examination Database for Shandong Province were used in this study. Spatial patterns of sex-specific prevalence of childhood OW/OB were mapped. Global autocorrelation statistic (Moran’s I) and the Local Indicator of Spatial Association (LISA) were applied to assess the degree of spatial autocorrelation.Results The overall prevalence of childhood OW/OB in Shandong province were 15.05% and 9.23%, respectively. Maps of the sex-specific prevalence of OW/OB demonstrate a marked geographical variation of childhood OW/OB in different regions. Prevalence of childhood OW/OB had a significant positive spatial autocorrelation among both boys and girls. LISA analysis identified significant clusters (or ‘hot spots’) of childhood OW/OB in the eastern coastal region, central region and southwestern region.Conclusions The prevalence of childhood OW/OB is highly spatially clustered. Geographically focused appropriate intervention should be introduced in current childhood OW/OB prevention and control strategy.

Abstract Background Rotavirus infection causes considerable disease burden of acute gastroenteritis (AGE) hospitalization and death among children less than 5 years in China. Although two rotavirus vaccines (Rotarix and RotaTeq) have been licensed in more than 100 countries in the world, the Lanzhou Lamb rotavirus vaccine (LLR) is the only vaccine licensed in China. This study aims to forecast the potential impacts of the two international vaccines compared to domestic LLR. Methods An economic evaluation was performed using a Markov simulation model. We compared costs at the societal aspect and health impacts with and without a vaccination program by LLR, Rotarix or RotaTeq. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from literature review. The model incorporated the impact of vaccination on reduction of incidence of rotavirus infection and severity of AGE indicated by hospitalization, inpatient visits and deaths. Outcomes are presented in terms of quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio (ICER) compared to status quo. Results In a hypothetical cohort of 100,000 infants, the two international vaccines showed very good cost-effectiveness, with ICER of Rotateq and Rotarix shifting from LLR of $1715.11/QALY and $2105.66/QALY, respectively. Rotateq and Rotarix had significantly decreased incidence compared to LLR, particularly among infants aged 6 months to 2 years. Conclusions RotaTeq is expected to introduce in the national routine immunization program to reduce disease burden of rotavirus infection with universal coverage.

As a common ocular complication for diabetic patients, diabetic retinopathy has become an important public health problem in the world. Early diagnosis and early treatment with the help of fundus imaging technology is an effective control method. In this paper, a robust inverse diffusion equation combining a self-similarity filtering is presented to detect and evaluate diabetic retinopathy using retinal image enhancement. A flux corrected transport technique is used to control diffusion flux adaptively, which eliminates overshoots inherent in the Laplacian operation. Feature preserving denoising by the self-similarity filtering ensures a robust enhancement of noisy and blurry retinal images. Experimental results demonstrate that this algorithm can enhance important details of retinal image data effectively, affording an opportunity for better medical interpretation and subsequent processing.

This study aimed to determine the prevalence of psychological distress among elderly people in rural China. Moreover, the mediating effect of social support on the association between functional disability and psychological distress and whether this effect varies with age would be examined. A total of 741 elderly people aged 60-89 years from a rural area of Shandong Province, China participated in a cross-sectional survey. Their psychological distress, perceived social support, enacted social support, and functional disability were assessed through questionnaires. A total of 217 (29.3%) rural elderly people had psychological distress. The functional disability of people ≥75 years old had smaller total effects (0.18) on their psychological distress than in people

BACKGROUND: In 2009, the Chinese Ministry of Health recommended scale-up of routine neonatal hearing screening - previously performed primarily only in select urban hospitals - throughout the entire country. METHODS: A decision analytical model for a simulated population of all live births in china was developed to compare the costs and health effects of five mutually exclusive interventions: 1) universal screening using Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR); 2) universal OAE; 3) targeted OAE and AABR; 4) targeted OAE; and 5) no screening. Disability-Adjusted Life Years (DALYs) were calculated for health effects. RESULTS AND DISCUSSION: Based on the cost-effectiveness and potential health outcomes, the optimal path for scale-up would be to start with targeted OAE and then expand to universal OAE and universal OAE plus AABR. Accessibility of screening, diagnosis, and intervention services significantly affect decision of the options. CONCLUSION: In conclusion, to achieve cost-effectiveness and best health outcomes of the NHS program, the accessibility of screening, diagnosis, and intervention services should be expanded to reach a larger population. The results are thus expected to be of particular benefit in terms of the 'rolling out' of the national plan.

Adherence to TB treatment is the most important requirement for efficient TB control. Migrant TB patients' "migratory" nature affects the adherence negatively, which presents an important barrier for National TB Control Program in China. Therefore, TB control among migrants is of high importance.The aim of this study is to describe adherence to TB treatment among migrant TB patients and to identify factors associated with adherence. A total of 12 counties/districts of Shandong Province, China were selected as study sites. 314 confirmed smear positive TB patients were enrolled between August 2(nd) 2008 and October 17(th) 2008, 16% of whom were non-adherent to TB therapy. Risk factors for non-adherence were: the divorced or bereft of spouse, patients not receiving TB-related health education before chemotherapy, weak incentives for treatment adherence, and self supervision on treatment. Based on the risk factors identified, measures are recommended such as implementing health education for all migrant patients before chemotherapy and encouraging primary care workers to supervise patients.