Search

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.

ObjectiveTo examine the variation in clearly documented assignment of departmental responsibilities for major epidemic prevention and control in the Chinese mainland before and after the outbreak of COVID-19. MethodsOfficial policy documents related to major epidemic prevention and control issued by administrative agencies of 31 provincial level administrative divisions from 2000 through 2020 were systematically retrieved online from websites of the agencies. The extracted information on the coverage, clarification and assessability of the assigned departmental responsibilities for major epidemic prevention and control were analyzed; T-test and paired rank sum test were adopted in statistical analysis. ResultsBased on relevant information extracted from the 3 864 policy documents retrieved, the nationwide average proportion of the departments with officially assigned responsibility versus all departments at provincial level increased significantly from 80.93% (18.61/23.00) in 2019 to 89.62% (20.61/23.00) in 2020 (P < 0.05); the average proportion of the departments with the assessable responsibility versus all departments with the assigned responsibility increased from 26.16% (4.81/18.61) to 30.93% (6.39/20.61) and the average proportion of the departments with the specified responsibility versus all departments with the assigned responsibility also increased significantly from 44.00% to 54.58%; but the average proportion of the departments with clearly specified responsibility was not significantly improved. In 2020, the nationwide average proportion of the provincial departments with officially assigned responsibility increased significantly to 87.10% and 20.97% for the professional departments and the key support departments (P < 0.05), while the proportion for other support departments was not significantly different from that in 2000. ConclusionThe degree of clearly documented assignment of departmental responsibilities for major epidemic prevention and control in China has been significantly improved after the outbreak of COVID-19 epidemic but the assessability of the assigned departmental responsibilities need to be improved.

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.

ObjectivesChina has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.MethodsAn interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.ResultsAfter the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p

Benefiting from the growth of the bandwidth, Terahertz (THz) communication can support the new application with explosive requirements of the ultra-high-speed rates for future 6G wireless systems. In order to compensate for the path loss of high frequency, massive Multiple-Input Multiple-Output (MIMO) can be utilized for high array gains by beamforming. However, the existing THz communication with massive MIMO has remarkably high energy consumption because a large number of analog phase shifters should be used to realize the analog beamforming. To solve this problem, a Reconfigurable Intelligent Surface (RIS) based hybrid precoding architecture for THz communication is developed in this paper, where the energy-hungry phased array is replaced by the energy-efficient RIS to realize the analog beamforming of the hybrid precoding. Then, based on the proposed RIS-based architecture, a sum-rate maximization problem for hybrid precoding is investigated. Since the phase shifts implemented by RIS in practice are often discrete, this sum-rate maximization problem with a non-convex constraint is challenging. Next, the sum-rate maximization problem is reformulated as a parallel Deep Neural Network (DNN) based classification problem, which can be solved by the proposed low-complexity Deep Learning based Multiple Discrete Classification (DL-MDC) hybrid precoding scheme. Finally, we provide numerous simulation results to show that the proposed DL-MDC scheme works well both in the theoretical Saleh-Valenzuela channel model and practical 3GPP channel model. Compared with existing iterative search algorithms, the proposed DL-MDC scheme significantly reduces the runtime with a negligible performance loss.

Cell-free (CF) network is a favorable technique against inter-cell interferences to improve the network capacity. However, to further improve the network capacity, a large number of base stations (BSs) are required to be deployed with high cost and power consumption. To tackle this problem, an energy-efficient technique called reconfigurable intelligent surface (RIS)-aided CF network has been recently proposed. By replacing some of the required power-hungry BSs with low-power RISs, the energy efficiency of CF network can be enhanced with guaranteed performance. To achieve this goal, in this paper, we first formulate a joint active and passive beamforming problem to maximize the energy efficiency of RIS-aided CF networks. Then, we propose an alternate optimization algorithm to solve this problem. Specifically, we decompose the original energy efficiency maximization problem into multiple subproblems and solve them alternatively. Particularly, we adopt the zero-forcing (ZF) beamforming scheme to optimize the active beamforming at BSs, while the sequential programming (SP) method is adopted to realize the passive beamforming at RISs. Moreover, a realistic energy-consumption model for wideband RIS-aided CF networks is provided, and the effectiveness of the proposed scheme is evaluated by simulations. Finally, simulation results verify that, the proposed scheme is able to achieve a higher energy efficiency than the existing benchmark solution.

Telehealth is an effective combination of medical service and intelligent technology. It can improve the problem of remote access to medical care. However, an imbalance in the allocation of health resources still occurs. People spend more time and money to access higher-quality services, which results in inequitable access to primary health care (PHC). At the same time, patients’ usage of telehealth services is limited by the equipment and their own knowledge, and the PHC service suffers from low usage efficiency and lack of service supply. Therefore, improving PHC accessibility is crucial to narrowing the global health care coverage gap and maintaining health equity. In recent years, China has explored several new approaches to improve PHC accessibility. One such approach is the capsule clinic, an emerging institution that represents an upgraded version of the internet hospital. In coordination with the United Nations, the Yinzhou district of Ningbo city in Zhejiang, China, has been testing this new model since 2020. As of October 2022, the number of applications in Ningbo was 15, and the number of users reached 12,219. Unlike internet hospitals, the entire process—from diagnosis to prescription services—can be completed at the capsule clinic. The 24-hour telehealth service could also solve transportation problems and save time for users. Big data analysis can accurately identify regional populations’ PHC service needs and improve efficiency in health resource allocation. The user-friendly, low-cost, and easily accessible telehealth model is of great significance. Installation of capsule clinics would improve PHC accessibility and resolve the uneven distribution of health resources to promote health equity.

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.

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.

Abstract. Background. Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities. Methods. Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC. Results. By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = −0.831, −0.833, and −0.909, and P

Abstract In this paper, we consider the reconfigurable intelligent surface (RIS)‐aided MIMO systems to realize a high quality link between the base station (BS) and the users via a RIS. To achieve this goal, the active beamforming at the BS and the passive beamforming at the RIS should be jointly optimized. However, most of the existing joint optimization schemes that maximize the sum‐rate have high computational complexity due to the complex derivative calculations and matrix inversion. To this end, a biologically inspired particle swarm optimization (PSO) algorithm is exploited to solve the non‐convex sum‐rate optimization problem with low‐complexity. Simulation results show that the proposed scheme provides a better trade‐off between performance and complexity than existing solutions for RIS‐aided MIMO systems.

Abstract Background The public health workforce (PHW) is a key component of a country’s public health system. Since the outbreak of SARS (severe acute respiratory syndrome) in 2003, the scale of PHW in China has been continuously expanding, but policymakers and researchers still focus on the distribution of public health personnel, especially the regional inequality in such distribution. We aimed to identify the root cause of PHW inequality by decomposing different geographical units in China. Methods This study was based on data from a nationwide survey, which included 2712 county-level data. The distribution of the PHW in geographical units was evaluated by the Gini coefficient and Theil T index, and inequalities at regional, provincial, and municipal levels were decomposed to identify the root causes of inequalities in the PHW. Additionally, the contextual factors affecting the distribution of the PHW were determined through regression analysis. Results The overall inequality results show that health professional and field epidemiological investigators faced worse inequality than the staff. In particular, field epidemiological investigators had a Gini coefficient close to 0.4. Step decomposition showed that within-region inequalities accounted for 98.5% or more of overall inter-county inequality in the distribution of all PHW categories; provincial decomposition showed that at least 74% of inequality is still distributed within provinces; the overall contribution of within-municipal inequality and between-municipal inequality was basically the same. Further, the contextual factor that influenced between-municipality and within-municipality inequality for all three categories of PHWs was the agency building area per employee. Per capita GDP had a similar effect, except for between-municipality inequality of professionals and within-municipality inequality of field epidemiological investigators. Conclusions The successive decomposition showed that inequality is mainly concentrated in counties at the within-province and within-municipal levels. This study clearly suggests that the government, especially the municipal government at the provincial level, should increase financial investment in Centers for Disease Control and Prevention (CDCs) with worse resource allocation in their jurisdiction through various ways of compensation and incentives, enhance their infrastructure, and improve the salary of personnel in these institutions, to attract more public health professionals to these institutions.

Millimeter-wave (mmWave) massive multiple-input multiple-output (MIMO) has already been considered as a promising solution to meet the requirement of the higher data rate for the future Internet of Things (IoTs). Hybrid precoding is an effective solution for the mmWave massive MIMO systems to significantly decrease the number of radio frequency (RF) chains without an apparent sum-rate loss. However, the current literature on hybrid precoding considers either the high-resolution (HR) phase shifters (PSs) with high power consumption or the impractical narrowband mmWave channel model. To this end, in this paper, we investigate an energy-efficient hybrid precoding scheme using one-bit PSs for practical frequency-selective wideband mmWave massive MIMO systems. Specifically, we provide the energy consumption analysis to reveal the fact that the energy consumed by the one-bit PSs is much lower than that by the HR-PSs, and the array gain loss incurred by using one-bit PSs is minimal. Moreover, motivated by the cross-entropy optimization (CEO) algorithm evolved for machine learning, we propose the CEO-based hybrid precoding scheme to maximize the achievable sum-rate of the considered system. In the CEO-based hybrid precoding, we update the probability distributions of the elements in the hybrid precoder to minimize the cross-entropy between the two probability distributions so that we can generate the final solution close to the optimal one. Furthermore, we extend the proposed CEO-based hybrid precoding scheme from the case with one-bit PSs to the general case with HR-PSs to show that our solution can also be applied in other scenarios. The performance evaluation demonstrates that our proposed scheme can obtain near-optimal sum-rate and considerably higher energy efficiency than some existing solutions.

BackgroundIncreasing coffee intake was inversely associated with risk of type 2 diabetes in Western countries. However, in China where coffee consumption and diabetes population has been growing fast in recent years, studies on the impact of coffee intakes on the onset of type 2 diabetes are lacking. This study attempts to determine the associations between coffee consumption and type 2 diabetes in Chinese adults.MethodsThis longitudinal study analyzed 10447 adults who had participated in at least two rounds of the China Health and Nutrition Survey (CHNS), which is a survey database of multistage, random cluster process during 1993-2011. Coffee consumption and type 2 diabetes incidence were measured in the survey. Body mass index (BMI), age, sex, place of residence, waves, education level, smoking, drinking alcohol and tea drinking frequency were adjusted as covariate. We used longitudinal fixed effects regression models to assess changes within person.ResultsAfter adjusting confounding factors, lower risk of diabetes is observed among Chinese adults who drink coffee occasionally (Adjusted Odds Ratio (AOR) = 0.13, 95% CI = 0.05, 0.34) and drink almost every day (AOR = 0.61, 95% CI = 0.45, 0.83), compared with those who do not or hardly drink. In the subgroup analysis, among women aged 45-59 who drink coffee one to three times a week (AOR = 0.21, 95% CI = 0.08, 0.52) and men over 60 who drink coffee almost every day (AOR = 0.19, 95% CI = 0.07, 0.53), protective effects were found. For young men aged 19-29, drinking coffee almost every day showed a risk effect (AOR = 20.21, 95% CI = 5.96-68.57).ConclusionsCoffee drinking habit is an independent protective factor for adult on type 2 diabetes in China. And it varies among people with different ages and genders. The rapid growth of coffee consumption in China in recent years may help reduce the risk of type 2 diabetes, but at the same time, the risk of type 2 diabetes in adolescents needs attention.

Abstract Background Public health emergencies have challenged the public health emergency management systems (PHEMSs) of many countries critically and frequently since this century. As the world’s most populated country and the second biggest economy in the world, China used to have a fragile PHEMS; however, the government took forceful actions to build PHEMS after the 2003 SARS outbreak. After more than one decade’s efforts, we tried to assess the improvements and problems of China’s PHEMS between 2002 and 2012. Methods We conducted two rounds of national surveys and collected the data of the year 2002 and 2012, including all 32 provincial, 139 municipal, and 489 county CDCs. The municipal and county CDCs were selected by systematic random sampling. Twenty-one indicators of four stages (preparation, readiness, response and recovery) from the National Assessment Criteria for CDC Performance were chosen to assess the ten-year trends. Results At the preparation stage, organization, mechanisms, workforce, and stockpile across all levels and regions were significantly improved after one decade’s efforts. At the readiness stage, the capability for formulating an emergency plan was also significantly improved during the same period. At the response stage, internet-based direct reporting was 98.8%, and coping scores were nearly full points of ten in 2012. At the recovery stage, the capabilities were generally lower than expected. Conclusions Due to forceful leadership, sounder regulations, and intensive resources, China’s PHEMS has been improved at the preparation, readiness, and response stages; however, the recovery stage was still weak and could not meet the requirements of crisis management and preventive governance. In addition, CDCs in the Western region and counties lagged behind in performance on most indicators. Future priorities should include developing the recovery stage, establishing a closed feedback loop, and strengthening the capabilities of CDCs in Western region and counties.

Regional regulatory policies (RPs) are a major factor in the prevention and control of chronic diseases (PCCDs) through the implementation of various measures. This study aimed to explore the impacts of RPs on PCCDs, with a focus on the mediating roles of community service. The soundness of the regulatory mechanism (SORM) was used to measure the soundness of RPs based on 1095 policy documents (updated as of 2015). Coverage provided by community service institutions (CSIs) and community health centres (CHCs) was used to represent community service coverage derived from the China Statistical Yearbook (2015), while the number of chronic diseases (NCDs) was used to measure the effects of PCCDs based on data taken from the 2015 China Health and Retirement Longitudinal Study survey. To assess the relationship between SORM, NCDs and community service, a negative binomial regression model and mediation analysis with bootstrapping were conducted. Results revealed that there was a negative correlation between SORM and NCDs. CSIs had a major effect on the relationship between RPs and PCCDs, while CHCs had a partial mediating effect. RPs can effectively prevent and control chronic diseases. Increased effort should also be aimed at strengthening the roles of CSIs and CHCs.

Influenza vaccination coverage was low among healthcare workers (HCWs) in China. In October 2018, the National Health Commission of China began to require all hospitals to provide free influenza vaccination for HCWs to increase vaccine uptake, and no study on vaccine coverage among HCWs at the national level after the announcement of new policy. This evaluation aims to investigate self-reported influenza vaccination coverage among HCWs and factors that may affect vaccine receipt during the 2018/2019 influenza season. We delivered an opt-in internet panel survey among registered HCWs of DXY forum (the biggest online forum for HCWs in China). The survey was self-administered using a standard questionnaire to collect information on demographics, occupational characteristics, policy implementation, influenza vaccination and influence factors. We conducted multivariate logistic regression analysis to assess factors associated with receipt of influenza vaccine. The response rate of this online survey was 3.6%. The seasonal influenza vaccine coverage reported among HCWs surveyed during the 2018/2019 season was 11.6% (472/4078). Only 19.0% (774/4078) of HCWs surveyed reported free policy in their workplace. Combing free policy and workplace requirement proved to be effective to improve influenza vaccination coverage in HCWs (PR = 6.90, 95% CI: 6.03−7.65). The influenza vaccination coverage among surveyed HCWs in China was low during the 2018/2019 season. To increase future vaccination uptake, we recommend a multi-faceted strategy that include free policy, workplace requirement and promotion, on-site vaccination, and monitoring.

The objective of this study was to validate the reliability and validity of the safety attitudes questionnaire (SAQ) in Heilongjiang province, northern China.The SAQ was distributed to 27 public hospitals in five cities across Heilongjiang province. The Cronbach's α, item-dimension and dimension-dimension correlations were calculated. Descriptive analyses and confirmatory factor analysis were also performed.The recovery rate of the questionnaire was 84.45%. The validity and reliability measures of the SAQ were acceptable. The goodness-of-fit index from the confirmatory factor analysis showed a reasonable model fit (CFI = 0.93, GFI = 0.91, RMSEA = 0.05). The Cronbach's α value for the scale was 0.91 and ranged from 0.66 to 0.91 for each of the scales. The SAQ showed good internal consistency reliability.The SAQ had satisfactory psychometric properties and could be a useful tool to measure safety attitudes in public hospitals in Heilongjiang province in China.

To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction.China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area.A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests.The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494).Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

Given limited health sources, how to make DRGs (Diagnosis Related Groups) more feasible is a big question in developing countries. This study contributes to the debate on how to bridge the pay-for-service and DRGs during the transitional period of payment reform.From 2008 to 2012, 20740 patients with cirrhosis or duodenal ulcer disease were chosen as sample. Using multiple linear regression analysis, the interrelationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay (LOS), region and economic level of the hospitals were examined.The main findings were 1) length of stay (LOS) and the economic level of treatment location had a statistically significant impact on patients with cirrhosis or duodenal ulcer disease. Meanwhile gender is not a significant factor for both of them. 2) Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases.Based on picking out common diseases and their key factors, Simplification of the DRGs setting process will greatly increase the efficiency of implementing DRGs in the developing world.

Abstract Background The purpose of this study was to evaluate the prognostic value of cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) patients. Methods A retrospective analysis was performed on CN involvement using medical records of 178 consecutive patients with histologically diagnosed, non-disseminated NPC. Results In 178 NPC patients with CN palsy, the 5-year survival rates were as follows: overall survival (OS), 61.0%; disease-specific survival (DSS), 69.6%; local relapse-free survival (LRFS), 75.2%; distant metastasis-free survival (DMFS), 73.4%; and disease-free survival (DFS), 55.3%. Significant differences were observed in the 5-year OS rates between patients with single and multiple CN palsy (69.8% vs. 54.3%; P = 0.033) and the OS rates between patients with different pretreatment durations (68.7% vs. 43.3%, P = 0.007). However, no significant differences were observed in OS, DSS, LRFS and DFS rates between patients with upper and lower CN palsy (P = 0.581, P = 0.792, P = 0.729 and P = 0.212, respectively). The results showed that recovery duration was an independent prognostic factor for OS (HR = 2.485; P Conclusions Recovery duration is an independent prognostic factor for NPC patients with CN palsy and is related to recurrence, which leads to poor survival. Recovery duration requires close surveillance and different treatment regimens.

Abstract Background CD8+ effector cells often have an antitumor function in patients with cancer. However, CD8+Foxp3+ regulatory T cells (Tcregs) and interleukin (IL)-17-producing CD8+ T cells (Tc17 cells) also derive from the CD8+ T cell lineage. Their role in the antitumor response remains largely unknown. In the present study, we aimed to investigate the distribution, characterization, and generation of CD8+ Tcregs and Tc17 cells in NPC patients. Methods Peripheral blood and tumor biopsy tissues from 21 newly diagnosed patients with nasopharyngeal carcinoma (NPC) were collected, along with peripheral blood from 21 healthy donors. The biological characteristics of Tcregs and Tc17 cells from blood and tumor tissues were examined by intracellular staining, tetramer staining and fluorescence-activated cell sorting (FACS) analysis. The suppressive function of Tcregs was investigated using a proliferation assay that involved co-culture of sorted CD8+CD25+ T cells with naïve CD4+ T cells in vitro. Results We observed an increased prevalence of Tcregs and Tc17 cells among tumor-infiltrating lymphocytes (TILs) and different distribution among peripheral blood mononuclear cells (PBMCs) in NPC patients. Cytokine profiles showed that the Tcregs expressed a high level of IL-10 and low level of transforming growth factor β, whereas Tc17 cells expressed a high level of tumor necrosis factor α. Interestingly, both subsets expressed a high level of interferon γ in TILs, and the Tcregs suppressed naïve CD4+ T cell proliferation by a cell contact-dependent mechanism in vitro. Moreover, we demonstrated the existence of Epstein-Barr virus latent membrane protein (LMP) 1 and LMP2 antigen-specific Tcregs in NPC. Conclusions Our data provide new insights into the composition and function of CD8+ T-cell subsets in NPC, which may have an important influence on NPC immunotherapy.

Abstract Background Increasing amounts of evidence indicate that tumor infiltrating lymphocytes (TIL) are correlated with the prognosis of cancer patients. This study focuses on the association between the densities of tumor infiltrating cytotoxic T lymphocytes (CTL), activated CTL, regulatory T lymphocytes (Treg) and Th17 lymphocytes, and the prognosis and clinicopathological features of nasopharyngeal carcinoma (NPC) patients. Results Double immunohistochemical staining was performed in 106 biopsy specimens from newly diagnosed NPC patients. Prognostic values of infiltrating lymphocyte densities were evaluated by Kaplan-Meier analysis and Cox regression. The density of CD8+ TIL was positively correlated with lymph node metastasis, while the density of Foxp3+ TIL was negatively associated with T stage (P < 0.05). For survival evaluation, the density of Foxp3+ TIL or Foxp3+ TIL combined with GrB+ TIL together was associated with better overall survival (OS) and progression-free survival (PFS) (P < 0.01) in all patients and in the patients with late-stage diseases (Stages III and IV, P < 0.01). Meanwhile a low density of CD8+TIL or high ratio of FOXP3+TIL to CD8+TIL was correlated with better PFS in early stage patients (Stages I and II, P < 0.05). No significant association was found between IL-17+ TIL and clinicopathological characteristic or survival of NPC patients. Conclusions Our study identifies for the first time the tumor infiltrating Foxp3+ TIL as an independent favorable factor in the prognosis of NPC patients, especially for the patients with late-stage diseases.

Loading individual oocytes is a critical step for injecting RNA, expressing heterologous proteins, performing electrophysiological measurements, and so on. However, existing methods remain a challenge for automatically loading multiple single oocytes into different locations. Herein, a novel microfluidic chip on a robotic manipulator (chip‐on‐robot) with feedback control for flexible manipulation of multiple oocytes within a large spatial range is proposed. The manipulator automatically controls the microfluidic chip to reach different locations based on imaging feedback. The microfluidic chip then utilizes the hydrodynamic focusing effect of the main channel to separate oocytes for individual loading or reloading under capacitive sensor feedback. The separation distance reaches approximately 16 times the oocyte diameter. Moreover, capacitive signal feedback on the number of oocytes for flow direction control ensures the separation of all oocytes. For close‐loop control of the loading/reloading process, image‐based oocyte detection is combined using deep learning to calculate the target position of the oocyte. Finally, an automatic sequence is achieved to load multiple single oocytes into a well chip by using the chip‐on‐robot. As a demonstration, the oocytes are reloaded into a specified location based on the conditions. The proposed chip‐on‐robot with feedback control has significant advantages in the micromanipulation of oocytes. [ABSTRACT FROM AUTHOR]