Evaluating China's primary healthcare services' efficiency and spatial correlation: a three-stage DEA-Malmquist model.

Introduction: Enhancing the efficiency of primary healthcare services is essential for a populous and developing nation like China. This study offers a systematic analysis of the efficiency and spatial distribution of primary healthcare services in China. It elucidates the fundamental landscape and regional variances in efficiency, thereby furnishing a scientific foundation for enhancing service efficiency and fostering coordinated regional development. Methods: Employs a three-stage DEA-Malmquist model to assess the efficiency of primary healthcare services across 31 provincial units in mainland China from 2012 to 2020. Additionally, it examines the spatial correlation of efficiency distribution using the Moran Index. Results: The efficiency of primary healthcare services in China is generally suboptimal with a noticeable declining trend, highlighting significant potential for improvement in both pure technical efficiency and scale efficiency. There is a pronounced efficiency gap among provinces, yet a positive spatial correlation is evident. Regionally, efficiency ranks in the order of East > Central > West. Factors such as GDP per capita and population density positively influence efficiency enhancements, while urbanization levels and government health expenditures appear to have a detrimental impact. Discussion: The application of the three-stage DEA-Malmquist model and the Moran Index not only expands the methodological framework for researching primary healthcare service efficiency but also provides scientifically valuable insights for enhancing the efficiency of primary healthcare services in China and other developing nations.

Temporal trends of breast cancer burden in the Western Pacific Region from 1990 to 2044: Implications from the Global Burden of Disease Study 2019.

INTRODUCTION: Breast cancer (BC) is a malignant disease that occurs worldwide and poses serious health burden. OBJECTIVES: To assess the prevalence of BC burden in the Western Pacific region (WPR) from 1990 to 2019, and to predict trends from 2020 to 2044. To analyze the driving factors and put forward the region-oriented improvement. METHODS: Based on the Global Burden of Disease Study 2019, BC cases, deaths, disability-adjusted life years (DALYs) cases, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALYs rate in WPR from 1990 to 2019 was obtained and analysed. Age-period-cohort (APC) model was used to analyze age, period, and cohort effects in BC, and Bayesian APC (BAPC) was used to predict trends over the next 25 years. RESULTS: In conclusion, BC incidence and deaths in the WPR have increased rapidly over the past 30 years and are expected to continue to increase between 2020 and 2044. Among behavioral and metabolic factors, high body-mass index was the main risk factor for BC mortality in middle-income countries, whereas alcohol use was the main risk factor in Japan. Age is a key factor in the development of BC, with 40 years being the critical point. Incidence trends coincide with the course of economic development. CONCLUSIONS: The BC burden remains an essential public health issue in the WPR and will increase substantially in the future. More efforts should be made in middle-income countries to prompt the health behavior and minimize the burden of BC because these nations accounts for the majority of BC burden in the WPR.

Spatial effects of public health laboratory emergency testing institutions under COVID-19 in China.

BACKGROUND: The transmission of 2019 novel coronavirus (COVID-19) has caused global panic in the past three years. Countries have learned an important lesson in the practice of responding to COVID-19 pandemic: timely and accurate diagnosis is critical. As an important technology of virus diagnosis, nucleic acid testing (NAT) is also widely used in the identification of other infectious diseases. However, geographic factors often constrain the provision of public health services such as NAT services, and the spatial nature of their resource allocation is a significant problem. METHODS: We used OLS, OLS-SAR, GWR, GWR-SAR, MGWR, and MGWR-SAR models to identify the determinants of spatial difference and spatial heterogeneity affecting NAT institutions in China. RESULTS: Firstly, we identify that the distribution of NAT institutions in China shows a clear spatial agglomeration, with an overall trend of increasing distribution from west to east. There is significant spatial heterogeneity in Chinese NAT institutions. Secondly, the MGWR-SAR model results show that city level, population density, number of tertiary hospitals and number of public health emergency outbreaks are important factors influencing the spatial heterogeneity of NAT institutions in China. CONCLUSIONS: Therefore, the government should allocate health resources rationally, optimise the spatial layout of testing facilities, and improve the ability to respond to public health emergencies. Meanwhile, third-party testing facilities need to focus on their role in the public health emergency response system as a market force to alleviate the inequitable allocation of health resources between regions. By taking these measures to prepare adequately for possible future public health emergencies.

Determining the spatial non-stationarity underlying social and natural environment in thyroid cancer in China.

BACKGROUND: Light at night (LAN) is a physiological environmental factor related to thyroid cancer (TC). The spatial relationship between the number of TC incident cases, LAN, air pollution and other macro social factors and stationarity needs to be further examined to provide evidence for regional control of TC. METHODS: Spatial econometrics methods for spatial nonstationarity were used to explore the impacts of LAN, air pollutants, economic factors, and population size on the number of TC incident cases in 182 Chinese prefecture-level cities and the local coefficients were further tested for nonstationarity. Temporally weighted regression (TWR), geographically weighted regression (GWR), and geographically and temporally weighted regression (GTWR) were compared in this study for model selection. RESULTS: Based on the ordinary least squares (OLS), LAN, air pollutants, and urbanization all significantly affected the number of TC incident cases. GWR had the best goodness of fit, and the coefficients of all the variables passed the nonstationarity test. The strong positive impact of LAN was mainly concentrated in North China, air pollutants in Central China and neighboring regions, and urbanization in the eastern coast of China. CONCLUSIONS: The locational factors of the prefecture-level city influence the spatial pattern of the number of TC incident cases. Governments should pay attention to this influence, adhere to the Health in All Policies principle, and formulate region-specific policies based on regional characteristics, which this study provides updated evidence for.

The optimal balance of controlled and spontaneous processing in insight problem solving: fMRI evidence from Chinese idiom guessing.

Cognitive control is a key factor in insight generation. However, the neurocognitive mechanisms underlying the generation of insight for different cognitive control remain poorly understood. This study developed a parametric fMRI design, wherein hints for solving Chinese idiom riddles were gradually provided in a stepwise manner (from the first hint, H1, to the final hint, H4). By classifying the step-specific items solved in different hint-uncovering steps/conditions, we could identify insightful responses for different levels of spontaneous or controlled processing. At the behavioral level, the number of insightful problem solving trials reached the maximum at a intermediate level of the cognitively controlled processing and the spontaneously idea generating in H3, while the bilateral insular cortex and thalamus showed the robust engagement, implying the function of these regions in making the optimal balance between external hint processing and internal generated ideas. In addition, we identified brain areas, including the dorsolateral prefrontal cortex (dlPFC), angular gyrus (AG), dorsal anterior cingulate cortex (dACC), and precuneus (PreC), whose activities were parametrically increased with the levels of controlled (from H1 to H4) insightful processing which were increasingly produced by the sequentially revealed hints. Further representational similarity analysis (RSA) found that spontaneous processing in insight featured greater within-condition representational variabilities in widely distributed regions in the executive, salience, and default networks. Altogether, the present study provided new evidence for the relationship between the process of cognitive control and that of spontaneous idea generation in insight problem solving and demystified the function of the insula and thalamus as an interactive interface for the optimal balance of these two processes.

Regional grey matter volume in the posterior cingulate cortex predicts positive risk-taking: A moderation model.

Positive risk-taking is a crucial element of individual creativity and social development. However, little is known regarding the relation between individual neural differences and positive risk-taking. In addition, critical thinking (CT) and gender have been proven to be two important individual-specific factors associated with risk-taking behaviour, and different levels of CT and gender may have diverse effects on the relationship between brain structure and positive risk-taking. The present study examined the relationship between positive risk-taking and regional grey matter volume (rGMV) in 292 healthy participants. The results showed that positive risk-taking was significantly positively associated with the rGMV of the posterior cingulate cortex (PCC). In addition, this study investigated individual differences in critical thinking and found that it moderated the relationship between rGMV and positive risk-taking. Individuals with lower CT had a stronger association between rGMV and positive risk-taking. Further analysis showed that for males, a greater rGMV was significantly linked to higher positive risk-taking tendency. These findings suggest that PCC evaluates risk and serves as a behavioural adaptation hub for positive risk-taking. This study thereby contributes to the literature on individual differences in brain structure and risk-taking by elucidating the moderating effects of CT and gender in healthy adults.

Spatial effects of air pollution on the economic burden of disease: implications of health and environment crisis in a post-COVID-19 world.

BACKGROUND: Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty. METHODS: The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified. RESULTS: First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors. CONCLUSION: The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.

Government drivers of breast cancer prevention: A spatiotemporal analysis based on the association between breast cancer and macro factors.

Background: Currently, breast cancer (BC) is ranked among the top malignant tumors in the world, and has attracted widespread attention. Compared with the traditional analysis on biological determinants of BC, this study focused on macro factors, including light at night (LAN), PM2.5, per capita consumption expenditure, economic density, population density, and number of medical beds, to provide targets for the government to implement BC interventions. Methods: A total of 182 prefecture-level cities in China from 2013 to 2016 were selected as the sample of the study. The geographically and temporally weighted regression (GTWR) model was adopted to describe the spatiotemporal correlation between the scale of BC and macro factors. Results: The results showed that the GTWR model can better reveal the spatiotemporal variation. In the temporal dimension, the fluctuations of the regression coefficients of each variable were significant. In the spatial dimension, the positive impacts of LAN, per capita consumption expenditure, population density and number of medical beds gradually increased from west to east, and the positive coefficient of PM2.5 gradually increased from north to south. The negative impact of economic density gradually increased from west to east. Conclusion: The fact that the degree of effect of each variable fluctuates over time reminds the government to pay continuous attention to BC prevention. The spatial heterogeneity features also urge the government to focus on different macro indicators in eastern and western China or southern and northern China. In other words, our research helps drive the government to center on key regions and take targeted measures to curb the rapid growth of BC.

Time tracking and multidimensional influencing factors analysis on female breast cancer mortality: Evidence from urban and rural China between 1994 to 2019.

Background: There are huge differences in female breast cancer mortality between urban and rural China. In order to better prevent breast cancer equally in urban and rural areas, it is critical to trace the root causes of past inequities and predict how future differences will change. Moreover, carcinogenic factors from micro-individual to macro-environment also need to be analyzed in detail. However, there is no systematic research covering these two aspects in the current literature. Methods: Breast cancer mortality data in urban and rural China from 1994 to 2019 are collected, which from China Health Statistical Yearbook. The Age-Period-Cohort model is used to examine the effects of different age groups, periods, and birth cohorts on breast cancer mortality. Nordpred project is used to predict breast cancer mortality from 2020 to 2039. Results: The age effect gradually increases and changes from negative to positive at the age of 40-44. The period effect fluctuates very little and shows the largest difference between urban and rural areas in 2019. The birth cohort effect gradually decreases with urban-rural effects alternating between strong and weak. In the predicted results, the urban-rural mortality gap becomes first narrow and then wide and shows a trend of younger death. Conclusions: From the perspective of a temporal system, the changing trend of breast cancer mortality is highly consistent with the history of social and economic structural changes in China. From the perspective of the theory of social determinants of health, individuals, families, institutions and governments need to participate in the prevention of breast cancer.

Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local.

BACKGROUND: The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population characteristics, ignoring the differences in regional characteristics. Thus, our study aimed to explore the impact of various influencing factors on the ICHE from a spatiotemporal perspective. METHODS: We used data from the China Health and Retirement Longitudinal Study (waves 1 to 4), to conduct a retrospective cohort study across 28 provinces, from 2011 to 2018. We measured regional incidences of catastrophic health expenditure using methods recommended by the World Health Organization. Ordinary least squares (OLS) and geographical and temporal weighted regression (GTWR) were used as the global and local estimation models, respectively. The Fortheringham method was used to test the spatiotemporal non-stationarity. RESULTS: National ICHE showed a gradual increase from 2011 to 2015, but suddenly decreased from 2015 to 2018, also showing the spatial heterogeneity. And the southwest area and Hebei showed persistently high ICHE (Qinghai even reached the highest value of 27.5% in 2015). Out-of-pocket payment, gross domestic product, PM2.5, ageing, incidence of non-communicable diseases and disabilities, number of nurses, and health insurance coverage in the global estimation passed the significance test, and the GTWR model showed a better model fit (0.769) than the OLS model (0.388). Furthermore, except for health insurance coverage, all seven variables had spatiotemporal non-stationarity among their impacts on ICHE. CONCLUSION: In this longitudinal study, we found spatiotemporal non-stationarity among the variable relationships, supporting regional governments' adoption of regional-target policies. First, after the completion of universal health insurance coverage, the spatiotemporal non-stationarity of the prevalence of non-communicable diseases and disability and ageing should be the focus of the next phase of health insurance design, where improvements to compensation coverage and benefit packages are possible policy instruments. Second, the governance and causes of catastrophic health expenditure need to be laid out from a macro perspective rather than only from the individual/household perspective, especially for the potential impact of economic development, air pollution and nursing resources.

A Longitudinal Investigation of the Causal Relationship Between Wellbeing and Perceived Discrimination Among Migrant Children in China: The Mediating Role of Self-Esteem and the Moderating Role of School Type.

Background: A large rural labor force has been attracted to urban areas with the acceleration of urbanization in China. This significant change in environment for migrant children from rural to urban may lead to psychological problems, such as decreased subjective wellbeing (WB) and increased perceived discrimination (PD). However, previous studies have focused on the influence of PD on WB by using a cross-sectional design, ignoring the causality and intrinsic mechanisms between WB and PD. The current study investigates the causal association and internal relations between migrant children's PD and WB. Methods: A total of 466 (222 females, 47.64%) migrant children (M age = 11.78, SD = 1.80) were recruited from Beijing in China. The participants filled in the questionnaire twice, with an interval of 1 year, including a basic information questionnaire, wellbeing index scale, perceived discrimination questionnaire, and self-esteem scale. Results: Overall, cross-lagged regression analysis revealed that WB (T1) had a predictive effect on PD (T2) but that PD (T1) had no predictive effect on WB (T2). Mediation results indicated that self-esteem (SE) (T1) mediated the relation between WB (T1) and PD (T2). Moderated mediation results further proved that the link between WB (T1) on SE (T1) and the indirect effect between WB (T1) and PD (T2) were more robust for migrant children who attended public school than those in the migrant children's school. Conclusion: These findings implied that a decrease in WB may increase the perception of subjective discrimination and that SE could be an intrinsic factor between migrant children's WB and PD, especially in public schools. Therefore, educators and parents should also pay attention to mental health problems to improve the wellbeing and self-esteem of migrant children.

Self-determination in Physical Exercise Predicts Creative Personality of College Students: The Moderating Role of Positive Affect.

Although previous studies indicated that intrinsic motivation and positive affect were important for creativity and proved the benefits of physical exercise for creativity, little is known about underlying this relationship between self-determination in physical exercise and creative personality among college students. Based on prior studies and theoretical models, the current study investigated the relationship between self-determination in physical exercise and creativity and the moderating role of positive affect in the relationship between self-determination in physical exercise and creative personality. This model was analyzed with 1,201 Chinese college students (Mean age = 20.10 years, SD = 0.93). Participants filled out the physical exercise self-determination scale, the Williams creativity assessment packet, and the satisfaction with life scale. The results indicated that self-determination in physical exercise was significantly positively correlated with the creative personality of college students, including risk-taking, curiosity, challenge, and imagination. Moreover, self-determination in physical exercise could significantly positively predict the creative personality of college students. Moderation analysis further showed that the relationship between self-determination in physical exercise and creative personality was robust for college students with low levels of positive affect. These findings suggest the importance of cultivating students' creative ability through improving exercise autonomy, especially for those college students with a low level of positive affect.

The superposition effects of air pollution on government health expenditure in China- spatial evidence from GeoDetector.

BACKGROUND: As the fifth-largest global mortality risk factor, air pollution has caused nearly one-tenth of the world's deaths, with a death toll of 5 million. 21% of China's disease burden was related to environmental pollution, which is 8% higher than the US. Air pollution will increase the demand and utilisation of Chinese residents' health services, thereby placing a greater economic burden on the government. This study reveals the spatial impact of socioeconomic, health, policy and population factors combined with environmental factors on government health expenditure. METHODS: Spearman's correlation coefficient and GeoDetector were used to identify the determinants of government health expenditure. The GeoDetector consist of four detectors: factor detection, interaction detection, risk detection, and ecological detection. One hundred sixty-nine prefecture-level cities in China are studied. The data sources are the 2017 data from China's Economic and Social Big Data Research Platform and WorldPOP gridded population datasets. RESULTS: It is found that industrial sulfur dioxide attributed to government health expenditure, whose q value (explanatory power of X to Y) is 0.5283. The interaction between air pollution factors and other factors will increase the impact on government health expenditure, the interaction value (explanatory power of × 1âˆ©× 2 to Y) of GDP and industrial sulfur dioxide the largest, whose values is 0.9593. There are 96 simple high-risk areas in these 169 areas, but there are still high-risk areas affected by multiple factors. CONCLUSION: First, multiple factors influence the spatial heterogeneity of government health expenditure. Second, health and socio-economic factors are still the dominant factors leading to increased government health expenditure. Third, air pollution does have an important impact on government health expenditure. As a catalytic factor, combining with other factors, it will strengthen their impact on government health expenditure. Finally, an integrated approach should be adopted to synergisticly governance the high-risk areas with multi-risk factors.

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China.

OBJECTIVE: Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to. METHODS: The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE. RESULTS: The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents' Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30-3.24) and 2.16 times (95% CI 1.81-2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them. CONCLUSIONS: Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.

Spatial Pattern and Spatial Heterogeneity of Chinese Elite Hospitals: A Country-Level Analysis.

Elite hospitals represent the highest level of Chinese hospitals in medical service and management, medical quality and safety, technical level and efficiency, which are also one of the important indicators reflecting high-quality medical resources in the region, and their spatial allocation is directly related to the fairness of health resource allocation. We explored the allocation pattern of high-quality resources and its influencing factors in the development of China's health system using geographic weighted regression (GWR), Multi-scale Geographically Weighted Regression (MGWR), GWR and MGWR with Spatial Autocorrelation(GWR-SAR and MGWR-SAR), spatial lag model (SLM), and spatial error model (SEM). The results of OLS regression showed that city level, number of medical colleges, urbanization rate, permanent population and GDP per capita were its significant variables. And spatial auto-correlation of elite hospitals in China is of great significance. Further, its spatial agglomeration phenomenon was confirmed through SLM and SEM. Among them, the city level is the most important factor affecting the spatial allocation of elite hospitals in China. Its action intensity shows a solid and weak mosaic trend in the Middle East, relatively concentrated in some areas with medium intensity and concentrated in the West China. Obviously, China's elite hospitals are unevenly distributed and have evident spatial heterogeneity. Therefore, we suggest that we should pay attention to the spatial governance of high-quality medical resources, attract medical elites in the region, increase investment in medical education in the scarce areas of elite hospitals and develop tele-medicine service.

Linking temporal-parietal junction to internet addiction tendency: Moderating effect of critical thinking.

BACKGROUNDS AND AIMS: Internet addiction (IA) is a common internet-related addictive behavior. An enormous amount of previous research on IA disorders (IADs) have paid attention to the neural basis of abnormalities, while few studies have elucidated the neural distinctions of IA tendency in general population. METHODS: The current study examined the neural basis of IA tendency combining with voxel-based morphometry (VBM) from the average student body (N = 244). RESULTS: As the results presented, the gray matter density (GMD) of the left temporal-parietal junction (TPJ) was positively correlated with Internet Addiction Test (IAT) score. Further analysis revealed that critical thinking moderated the path between GMD in the TPJ and IA tendency. Specifically, the correlation between GMD in the TPJ and IA tendency was weaker for those with a higher critical thinking disposition. DISCUSSION AND CONCLUSION: Higher critical thinking show a hindering effect in susceptibility to IA based on the neural basis of temporal-parietal junction differences.

Ten-Year Poverty Alleviation Effect of the Medical Insurance System on Families With Members Who Have a Non-communicable Disease: Evidence From Heilongjiang Province in China.

Aims: Non-communicable diseases (NCD) drag the NCD patients' families to the abyss of poverty. Medical insurance due to weak control over medical expenses and low benefits levels, may have actually contributed to a higher burden of out-of-pocket payments. By making a multi-dimensional calculation on catastrophic health expenditure (CHE) in Heilongjiang Province over 10 years, it is significant to find the weak links in the implementation of medical insurance to achieve poverty alleviation. Methods: A logistic regression was undertaken to predict the determinants of catastrophic health expenditure. Results: The average CHE of households dropped from 18.9% in 2003 to 14.9% in 2013. 33.2% of the households with three or more NCD members suffered CHE in 2013, which was 7.2 times higher than the households without it (4.6%). The uninsured households with cardiovascular disease had CHE of 12.0%, which were nearly 10% points lower than insured households (20.4-22.4%). For Medical Insurance for Urban Employees Scheme enrolled households, the increasing number of NCD members raised the risk of impoverishment from 3.4 to 20.0% in 2003, and from 0.3 to 3.1% in 2008. Households with hospital in-patient members were at higher risk of CHE (OR: 3.10-3.56). Conclusions: Healthcare needs and utilization are one of the most significant determinants of CHE. Households with NCD and in-patient members are most vulnerable groups of falling into a poverty trap. The targeting of the NCD groups, the poorest groups, uninsured groups need to be primary considerations in prioritizing services that are contained in medical insurance and poverty alleviation.

Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics.

BACKGROUND: The vulnerability of cardiovascular disease (CVD) patients' health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance. METHODS: Data from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of "China Health and Retirement Longitudinal Study" (CHARLS). The recommended method of the "World Health Organization" (WHO) was adopted to calculate "catastrophic health expenditure" (CHE), "impoverishment by medical expenses" (IME), and applied the treatment-effect model to analyze the determinants of CHE. RESULTS: The incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS. CONCLUSIONS: Elderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.

The development of brain functional connectome during text reading.

Reading is an important skill for human beings to obtain information, whose acquisition is a major learning task for children. Especially, compared with single word reading, text reading requires an integration of multiple cognitive processes, which makes its underlying neural developmental mechanism not only extremely complicated but also remained poorly understood. Employing the graph theory analysis method, the present study explored the development of brain in the context of story reading from the perspective of connectomics. Forty-two primary school students and thirty-two adults read the stories in the functional magnetic resonance imaging (fMRI) experiment. We found that compared with children, adults had increased connectivity strength, nodal degree, and modular interactions for vision-related and semantics-related brain regions while decreased connectivity strength, nodal degree, and modular interactions for phonology-related brain regions. Brain-behavior association analysis suggested that the transmission to vision-related brain circuits would enhance the reading performance in adults, whereas phonology-related brain circuits played important roles in children's reading before they develop into fluent readers. Collectivity, we highlight a shift from reliance on phonology-related networks to semantics-related and vision-related networks with age for text reading, which provides insights into the underlying neural signature of developmental cognitive mechanisms.

Relationship between self-defeating humor and the Gray matter volume in the orbital frontal cortex: the moderating effect of divergent thinking.

The self-defeating humor style is characterized by the excessive use of self-mockery, fawning over others and ineffective denial of negative emotions. The differences in brain structures responsible for self-defeating humor and the role of divergent thinking (DT) in this relationship have not been directly investigated in a large sample. Using voxel-based morphometry (VBM), we identified the association between regional gray matter volume (GMV) and self-defeating humor (assessed by the Humor Style Questionnaire) in 284 participants. Then, the role of DT (assessed by the Torrance Tests of Creative Thinking, TTCT) in the relationship between humor and the related brain regions was examined in the participants (N = 280). The results showed that self-defeating humor was significantly positively associated with the regional GMV in the left orbital frontal cortex (OFC) and that DT had a moderating effect on this relationship. Among the individuals with higher DT, a strong positive correlation was observed between self-defeating humor and the OFC, but among individuals with lower DT, this correlation was weaker. These results reveal that the interaction between brain structures and DT plays an important role in humor, thus providing new evidence enhancing our understanding of the mechanism of humor.