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BackgroundSo far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. ObjectiveThis study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. MethodsAn online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. ResultsOf 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P

Background At present, the problem of regional imbalance and lack of fairness in the allocation of medical resources in China remains prominent. The report of the 20th National Congress of the Communist Party of China clearly stated that it is necessary to promote the expansion of high-quality medical resources and balanced regional layout. Objective To explore the specific path to improve the efficiency of medical resource allocation in China, and provide scientific reference for realizing the rational and high-efficient allocation of medical resources in China and promoting the equalization of basic public services. Methods The study was conducted from September 2022 to February 2023, and the data were derived from the 2021 China Statistical Yearbook and 2021 China Health Statistics Yearbook. The data envelopment analysis (DEA) method was used to measure the efficiency of medical resource allocation in 31 provinces of China in 2020, considering the number of healthcare institutions, health technicians, and beds as input indicators, the number of visits and admissions as output indicators. Fuzzy-set Qualitative Comparative Analysis (fsQCA) was used to explore the synergistic influence mechanism of internal and external factors on the efficiency of medical resource allocation from a group perspective, taking resource allocation efficiency as the outcome variable, the ratio of health technicians, number of beds per 1 000 population, average hospitalization days of discharged patients, gross domestic product (GDP) per capita, disposable income of the residents, the fiscal revenue decentralization, and ratio of the budgetary expenditures on healthcare as conditional variables, to analyze the conditional configuration of high or non-high level of healthcare resource allocation efficiency, and clarify the multiple paths of efficient and inefficient allocation of medical resources. Results In 2020, the overall level of medical resource allocation efficiency in 31 provinces of China is relatively high, with an average of 0.852, but there were large differences among provinces. The results of configuration analysis showed that the improvement of medical resource allocation efficiency is the result of multiple factors, there are three paths for efficient allocation of medical resources. Path 1: government-led driving path, taking Guangxi Zhuang Autonomous Region as a typical case; Path 2: internal and external coordination driving path, represented by Yunnan Province and Gansu Province; Path 3: balanced driving path, with Guangdong Province, Fujian Province and Hubei Province as representative cases. There are also three paths of non-high medical resource allocation efficiency. Path 1: government-restricted path; Path 2: economic-government dual restriction path, representative cases included Heilongjiang and Jilin Province; Path 3: internal and external constraints path, the typical cases were Shanxi Province and Tibet Autonomous Region. Conclusion The internal and external elements and synergies between elements jointly affect the allocation of medical resources in the process of benign interaction, it is necessary to optimize the internal and external environment, and effectively integrate the key resource elements to form a joint force to promote the rational allocation of regional medical resources.

BackgroundThe allocation of medical resources in China has been in an "inverted triangle" state for a long time. The unreasonable allocation of grass-roots medical resources is difficult to meet the increasingly diversified needs of medical services. The coupling and coordination between the allocation of grass-roots medical resources and economic development will affect the level of regional economic development and the service capacity of grass-roots medical institutions. At present, there is a lack of research on the current situation of their coordinated development and how their influencing factors work through combination.ObjectiveTo assess the level of coordinated development of primary care resource allocation and economy in China, and to determine the associated factors, providing a decision-making basis for further improving medical resource allocation and planning.MethodsThe research was carried out from November 2020 to April 2021. Data were collected from China Health Statistics Yearbook 2019 and China Statistical Yearbook 2019. fsQCA was implemented to assess the influence of the number of licensed (assistant) doctors, number of registered nurses, financial subsidy for part of salary, number of beds, number of primary care institutions, regional gross domestic product (GDP) , regional fiscal revenue, per capita disposable income, and per capita GDP (used as conditional variables) on the level of interconnected, coordinated development level of primary care resource allocation and economic level (the outcome variable) in 31 regions of China.ResultsIn 2018, only the mean level of interconnected, and coordinated development of primary care resource allocation and economy in eastern China (0.61) was within the range (0.6, 1.0] of coordinated development, and that in central China (0.50) was within the transitional harmony range (0.4, 0.6], while that in western China (0.38) was within the range of imbalanced and recessional development[0, 0.4]. The coordinated development of primary care resource allocation and economic level were found to be affected by many factors, and it may be facilitated by four configurations of its associated factors revealed by the configuration analysis: (1) number of beds * number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary* ~ per capita disposable income * ~ per capita GDP; (2) ~ number of beds * ~ number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * ~ financial subsidy for part of salary* regional GDP * ~ per capita disposable income * per capita GDP; (3) number of licensed (assistant) doctors * number of registered nurses * number of primary care institutions * financial subsidy for part of salary * regional GDP * regional fiscal revenue * per capita disposable income * per capita GDP; (4) ~ number of beds * ~ number of licensed (assistant) doctors * ~ number of registered nurses * ~ number of primary care institutions * financial subsidy for part of salary * regional GDP * regional financial income * per capita disposable income * per capita GDP (* for "and", ~ for "not") . And these four configurations could be classified into three types of paths: primary care resource allocation-driven type, primary care resource allocation and economic balance type, and economic development-driven type.ConclusionThe overall level of coordinated development of primary care resource allocation and economy in China was unsatisfactory, with obvious regional differences, which was mainly affected by the number of registered nurses, regional GDP, and regional fiscal revenue, but may be facilitated greatly by the above-mentioned four configurations of associated factors. Therefore, it is suggested that each region chooses one path to achieve high level of interconnected, and coordinated development of primary care resource allocation and economy according to their own resources and conditions, so as to promote the rational primary care resource allocation, and the coordinated development of medical resources and economic level, thereby improving the level of primary care services in China.

Objective To determine the prevalence of and factors associated with dispensing antibiotics without a prescription in online and community pharmacies in China. Methods We conducted a nationwide cross-sectional study of online and community pharmacies in 27 cities and counties in nine provinces in China (selected by multistage sampling) from July 2017 to December 2018. We assessed sale of antibiotics without a prescription and quality of pharmacy services through simulated clients who asked to buy specific antibiotics. We compared the prevalence of sales between online and community pharmacies, and between location and features of community pharmacies. Findings Of 220 online and 675 community pharmacies, 174 (79.1%) and 586 (86.8%) sold antibiotics without a valid prescription, respectively. About half of the online pharmacies had a notice on their website about the illegality of selling prescription-only medicines without a prescription while none of the community pharmacists had. More online pharmacies without this notice dispensed antibiotics without a valid prescription (P < 0.001). Antibiotics' sale without a prescription was significantly less prevalent in provincial capital cities (71.6%; 161/225) than prefectural -level cities (95.1%; 214/225) and counties (93.8%; 211/225; P < 0.001). Most pharmacy staff did not ask for important information from clients before dispensing the antibiotic or provide them with necessary information about the antibiotic. Conclusion Given the high proportion of sales of prescription-only medicines without a prescription, there is a need to strengthen enforcement of regulations, improve public education on antibiotics, train pharmacy staff and consolidate public involvement in antibiotic stewardship in retail pharmacies in China. Objectif Determiner la frequence a laquelle des antibiotiques sans ordonnance sont vendus dans les pharmacies communautaires et en ligne, ainsi que les facteurs qui y sont associes. Methodes Nous avons mene une etude transversale a l'echelle nationale aupres de pharmacies communautaires et en ligne, dans 27 villes et comtes de neuf provinces chinoises (selectionnees selon un echantillonnage a plusieurs degres), entre juillet 2017 et decembre 2018. Nous avons analyse la vente d'antibiotiques sans ordonnance et evalue la qualite des services pharmaceutiques en nous faisant passer pour des clients cherchant a acheter des antibiotiques specifiques. Enfin, nous avons compare la frequence de vente entre pharmacies en ligne et pharmacies communautaires, de meme que la localisation et les caracteristiques des pharmacies communautaires. Resultats Sur les 220 pharmacies en ligne et 675 pharmacies communautaires observees, 174 (79,1%) et 586 (86,8%) respectivement ont vendu des antibiotiques sans ordonnance valable. Pres de la moitie des pharmacies en ligne avaient publie un avertissement sur leur site precisant que la vente sans ordonnance de medicaments soumis a prescription etait illegale; en revanche, aucune pharmacie communautaire ne mentionnait cette information. Les pharmacies en ligne vendant des antibiotiques sans ordonnance valable etaient souvent celles qui n'avaient pas publie cet avertissement (P < 0,001). La vente d'antibiotiques sans ordonnance etait nettement moins frequente dans les capitales provinciales (71,6%; 161/225) que dans les villes de niveau prefectoral (95,1%; 214/225) et les comtes (93,8%; 211/225; P < 0,001). La plupart des pharmaciens ne posaient pas aux clients les questions de base avant de leur fournir l'antibiotique, ou ne leur communiquaient pas les renseignements necessaires a son propos. Conclusion Etant donne la forte proportion de vente sans ordonnance de medicaments soumis a prescription, il est imperatif de renforcer l'application de la reglementation, de mieux sensibiliser le public sur les antibiotiques, de former les pharmaciens et de promouvoir la participation de la population aux activites de gestion des antibiotiques dans les pharmacies de detail en Chine. Objetivo Determinar la prevalencia de la distribucion de los antibioticos sin receta en las farmacias en linea y comunitarias de China, asi como los factores relacionados con esa distribucion. Metodos Se realizo un estudio transversal a nivel nacional de las farmacias en linea y comunitarias en 27 ciudades y condados de 9 provincias de China (seleccionadas mediante un muestreo de etapas multiples) entre julio de 2017 y diciembre de 2018. Se evaluo la venta de antibioticos sin receta y la calidad de los servicios de las farmacias a traves de clientes falsos que solicitaban comprar antibioticos especificos. Se comparo la prevalencia de las ventas entre las farmacias en linea y las comunitarias, y entre la ubicacion y las caracteristicas de las farmacias comunitarias. Resultados De 220 farmacias en linea y 675 farmacias comunitarias, 174 (79,1 %) y 586 (86,8 %) vendieron antibioticos sin recetas validas, respectivamente. Alrededor de la mitad de las farmacias en linea tenian un aviso en su sitio web sobre la ilegalidad de la venta sin la receta de los medicamentos que solo se venden con receta, mientras que ninguna de las farmacias comunitarias lo tenia. Mas farmacias en linea sin este aviso suministraban antibioticos sin recetas validas (P < 0,001). La venta de los antibioticos sin receta fue significativamente menos frecuente en las capitales de provincia (71,6 %; 161/225) que en las ciudades con nivel prefectural (95,1 %; 214/225) y en los condados (93,8 %; 211/225; P < 0,001). La mayoria del personal de las farmacias no pedia informacion importante a los clientes antes de vender los antibioticos ni les proporcionaba la informacion necesaria sobre su uso. Conclusion Teniendo en cuenta el alto porcentaje de ventas sin la receta de los medicamentos sujetos a receta medica, es necesario reforzar la aplicacion de las regulaciones, mejorar la educacion publica sobre los antibioticos, capacitar al personal de las farmacias y consolidar la participacion publica en la administracion de los antibioticos en las farmacias minoristas de China. [phrase omitted], Introduction Antibiotic misuse and overuse and the antibiotic resistance these practices have caused are serious global public health problems. (1-4) Pharmacies are one of the main sources of antibiotics worldwide; [...]