Mpox patients' experience from infection to treatment and implications for prevention and control: A multicenter qualitative study in China.

Monkeypox (mpox), a viral zoonotic disease, is spreading worldwide. However, evidence that informs prevention and control strategies in the Asia Pacific Region is very limited. Our study aims to investigate the experiences of mpox patients from infection to treatment to provide scientific basis for the prevention and control. A multicenter qualitative design was used. A total of 15 mpox patients were recruited between July 6 and July 25, 2023, from six cities in China. Semistructured interviews were conducted by telephone and analyzed using the thematic analysis. The interview was divided into two sections: patients' experiences (prediagnosis experience, treatment-seeking experience, and quarantine experience) and advice. Prediagnosis experience was summarized into three themes: symptoms, possible routes of infection, and knowledge of mpox. Treatment-seeking experience was summarized into three themes: time of visit to hospital, diagnostic difficulties, and attitude toward diagnosis. Quarantine experience was summarized into three themes: body and mind reactions, reluctance to self-disclose infection status, and factors facilitating recovery. Themes identified from patients' advice were as follows: (1) Increase in testing channels and methods, (2) Development and introduction of vaccines, (3) Adjustment of quarantine program, (4) Improvement of treatment measures, and (5) Improvement of publicity and education. To effectively curb the mpox epidemic, structured measures are urgently needed to address the mpox-related stigma and discrimination. Targeted health education should be provided to MSM, focusing on the prevention, detection, and treatment services. Hospitals should enhance the training of clinicians in key departments including infectious disease and dermatology, to improve diagnostic capability and sensitivity. Furthermore, given the absence of specific antiviral medications, supervised home quarantine may be a good option.

Efforts made, challenges faced, and recommendations provided by stakeholders involved in mpox prevention and control in China: a qualitative study.

OBJECTIVES: Mpox continues to spread in China, and stakeholders' experiences may help inform prevention and control strategies. STUDY DESIGN: Qualitative study. METHODS: A qualitative study across 14 Chinese cities recruited stakeholders from Centers for Disease Control and Prevention (CDCs), community-based organizations (CBOs), and hospitals involved in curbing mpox. Semi-structured interviews were conducted by telephone and analyzed using Colaizzi's phenomenological method. RESULTS: 15 CBOs workers, 14 CDCs staff, and 13 healthcare workers were recruited. Three theme categories were identified: "Efforts to curb mpox epidemic", including CDCs' epidemic management and health education, hospitals' diagnosis, treatment, and care, CBOs' counseling, publicity, and referrals. "Challenges to curb mpox epidemic", including negative impacts of hospital-based quarantine, lack of specific antiviral drugs, gay identity disclosure concerns, psychological problems, contact tracing difficulties, and inadequate communication and collaboration. "Recommendations for curbing mpox epidemic", including prioritizing supervised home-based quarantine, incorporating HIV-related indicators into hospital quarantine criteria, reducing the cost of hospital quarantine, accelerating the development of vaccines and drugs, enhancing patient privacy protection, psychological training for stakeholders, establishing a task force that comprises personnel who are experienced in contact tracing and strengthening communication and collaboration. CONCLUSIONS: Effective control of mpox spread requires strengthening collaboration with CBOs and community healthcare centers (CHCs) and working out a flexible and contextualized mechanism. It also needs to reinforce patient privacy protection and integrate stigma reduction into strategies. Additionally, it is important to include HIV-related indicators in the quarantine evaluation and provide psychological training for stakeholders to help them manage their mental health and improve counseling skills.

Policy interplay among social health insurance system, pension system, delayed retirement initiative and implications for the self-rated health status of older workers.

Delayed retirement initiative proposed in China attaches greater importance to the sustainability of pension systems and the labour shortage, but less to the health status of older people. The existing social health insurance and pension system are not well established to match this initiative. This study investigates the policy mix of delayed retirement, employment-based social health insurance, social pension participation for health status of older people. Results of the data from the China Health and Retirement Longitudinal Study (CHARLS-2018) show that late retirement could benefit health status among older adults. Moreover, such effect of late retirement appears more salient for those uninsured by employment-based social health insurance and those still in the pension contribution phase upon reaching the statutory retirement age. Hence, in countries with inadequate health insurance and pension systems, such as China, delayed retirement may serve as an important alternative to social security for the health of older people.

Barriers and Facilitators to, and Experience of, Voluntary Medical Male Circumcision Among Men Who Have Sex with Men in China: A Mixed-Methods Study.

Voluntary medical male circumcision (VMMC) may be incorporated into HIV prevention services for men who have sex with men (MSM). We conducted a mixed-methods study to elucidate barriers and facilitators to, and experience of, VMMC among MSM. Participants were MSM aged 18 years and older who were enrolled in an ongoing multicenter randomized controlled trial (RCT) to evaluate VMMC to prevent HIV among MSM in China. RCT participants completed a questionnaire before and after VMMC to assess perceptions of and complications after the procedure. A subset of RCT participants were selected for in-depth interviews. Interviewees answered open-ended questions about barriers and facilitators to and experience of undergoing VMMC. Six-step thematic analysis incorporating inductive and deductive approaches was used to interpret interview responses. A total of 457 MSM completed the pre-VMMC survey, 115 circumcised MSM completed post-VMMC surveys, and 30 MSM completed an interview. Main barriers to VMMC uptake were concerns about pain, length of wound healing, cost, lack of knowledge about or misconceptions of VMMC, and stigma related to surgery. Facilitators to VMMC could be categorized as internal factors (foreskin) and external factors (motivation and follow-up care). Interestingly, the VMMC experiences of others could be transformed from a barrier into a facilitator to VMMC in some circumstances. After VMMC participants transitioned from a negative state of pain, remorse, difficulty sleeping, and discomfort to a positive state of symptom alleviation and personal hygiene improvement. Optimizing facilitators and addressing barriers may encourage VMMC among MSM. Joint efforts should be made by relevant stakeholders to improve the awareness and uptake of VMMC among MSM.

The Sonic hedgehog pathway inhibitor GDC0449 induces autophagic death in human Medulloblastoma Daoy cells.

Medulloblastoma (MB) is a frequently occurring malignant brain tumor in children, and many of these tumors are identified by the abnormal activation of the Sonic Hedgehog (SHH) pathway. Although the Shh inhibitor GDC0449 initially shows some effectiveness in certain tumors, they eventually recur due to drug resistance mechanisms, highlighting the need for new treatment options. In this study, we explore whether GDC0449 induces autophagy in the human MB cell lines. To investigate the ultrastructural pathology changes of GDC0449-treated Daoy and D283 cells, we employed Transmission Electron Microscopy (TEM) technology to identify the expression of autophagic vacuoles. Our results indicate that GDC0449 only increases autophagy in Daoy cells by increasing the LC3-II/LC3-I ratio and autophagosome formation.We also analyzed Beclin1, LC3, Bax, and Cleaved-caspase3 protein and mRNA expression levels of autophagic and apoptotic markers using fluorescence confocal microscopy, RT-PCR, and Western blot. We found that cell autophagy and apoptosis increased in a dose-dependent manner with GDC0449 treatment. Additionally, we observed increased mammalian target of rapamycin (mTOR) phosphorylation and decreased protein kinase B (AKT/PKB), Ribosomal Protein S6, eIF4E-binding protein (4EBP1) phosphorylation in GDC0449-treated Daoy cells. It was observed that inhibiting autophagy using Beclin1 siRNA significantly blocked the apoptosis-inducing effects of GDC0449, suggesting that GDC0449 mediates its apoptotic effects by inducing autophagy.Our data suggests that GDC0449 inhibits the growth of human MB Daoy cells by autophagy-mediated apoptosis. The mechanism of GDC0449-induced autophagy in Daoy cells may be related to the inhibition of the PI3K/AKT/mTOR signaling pathway.

Issues of Elder Care among Migrant Workers in Contemporary Rural China: Filial Piety Redefined from a Foucauldian Perspective.

This article reports on research that explored rural migrant workers' experiences of returning to their hometown to provide care for elderly parents diagnosed with cancer. The authors used a culturally integrated approach to Foucauldian discourse analysis to consider how 24 participants narrated their experiences of care in China. The discourse of care demonstrated a strong commitment to filial piety despite their unique care challenges, and this commitment was bolstered by discourses that emphasized how much parents had sacrificed, as well as by a persistent forgetting of experiences or background details that suggested any lack of parental sacrifice in recent Chinese history. Policy implications related to enhancing filial care are discussed.

Social work research ethics in China: A scoping review of research involving human subjects during COVID-19.

As the first review to systematically explore the scope and application of Chinese social work research ethics, this study incorporated web-crawling technology in the scoping review process and identified 18 eligible studies from 1168 publications from January 2020 to July 2021. Findings suggest that social work scholars are aware of research ethics when conducting human subjects research in the Chinese population. Yet, many failed to fully demonstrate practical considerations of internationally accepted ethical principles (e.g. respect for persons). We discuss education on research ethics, new challenges of the digital age, and considerations of Chinese culture in developing ethical protocols for social work research in China.

Development of a Three-Stage Strength-Based Meaning Intervention to Promote Mental Health Among Individuals with Physical Disabilities in Disadvantaged Communities: A Randomized Controlled Trial.

A three-stage strength-based meaning intervention (SMI) was developed in the present study, and its utility in facilitating the mental health of individuals with physical disabilities in low-income communities was tested. A randomized controlled and single-blind trial was adopted. A total of 50 qualified participants (mean age = 42.12, standard deviation = 8.68; 48% males; 26 for the intervention group, 24 for the control group) completed the pre-intervention test, post-intervention test, and three-month follow-up test. No significant difference was observed between the two groups at pre-intervention assessment . After intervention, the results in terms of strength knowledge, strength use, sense of meaning in life and mental health showed a significant improvement in the intervention group, with the changes maintained over three months except mental health. The differences in mental health between the post-intervention test and the three-month follow-up test were not significant in the intervention group. The results imply that the SMI model is a promising approach in promoting the mental health of individuals with physical disabilities in low-income communities as it promotes improved knowledge and use of strength and sense of meaning in life.

Socioeconomic disadvantages and vulnerability to the pandemic among children and youth: A macro-level investigation of American counties.

This study intends to reveal the underlying structural inequity in vulnerability to infection of the novel coronavirus disease pandemic among children and youth. Using multi-source data from New York Times novel coronavirus disease tracking project and County Health Rankings & Roadmap Program, this study shows that children and youth in socioeconomically disadvantaged status are faced with disproportionate risk of infection in this pandemic. On the county level, socioeconomic disadvantages (i.e., single parent family, low birthweight, severe housing problems) contribute to the confirmed cases and death cases of the novel coronavirus disease. Policymakers should pay more attention to this vulnerable group to implement more targeted and effective epidemic prevention and control.

Spirituality-Integrated Interventions for Caregivers of Patients with Terminal Illness: A Systematic Review of Quantitative Outcomes.

This systematic review of published quantitative research was conducted to explore the effects of spirituality-integrated interventions for informal caregivers of terminally ill patients. Multiple databases were searched for articles published between January 2004 and November 2019. Twelve randomized controlled trials were identified. Methodological quality was assessed using the revised Cochrane Collaboration's tool for assessing risk of bias. Studies were notably diverse in terms of spiritual background, intervention design, technology used, and outcomes measures. Spirituality-integrated interventions were found to show positive outcomes for caregivers. However, methodological flaws negatively affected the quality of most studies, warranting further and rigorous research into the topic.

Chinese Migrant Workers' Care Experiences: A Model of the Mediating Roles of Filial Piety.

Filial piety is a highly relevant cultural mechanism that mediates the impacts of caregiving experiences on Chinese adult children, worldwide but perhaps especially in rural China. We undertook qualitative research with 24 migrant workers who were caring for an elderly parent diagnosed with terminal cancer. Research aims included building a comprehensive explanatory theoretical model for filial piety's mediating role in caregivers' lived experiences. We undertook a culturally sensitive Foucauldian discourse analysis of data, which showed that filial piety can not only function as a positive resource but also (mainly) translate to a requirement for secrecy, including about an ill parent's prognosis and the need for support for caregivers. The findings challenge the extent of this secrecy and the burdens it places on caregivers. Policy makers should take account of the importance of filial piety and its mediating role both as a resource and hindrance to providing support to caregivers.

Sexual attitudes and utilization of sexual and reproductive health services among older women in southern China: a qualitative study.

Objective: Sexual health plays a vital role in healthy aging. However, little is known about the sexual attitudes of and the utilization of sexual and reproductive health services by older women in China. This article is based on a qualitative study of older Chinese women in suburban areas to examine their attitudes toward sexuality and their utilization of sexual and reproductive health services. Methods: Face-to-face semi-structured interviews were conducted with older women (ages 50 to 74) from suburbs of southern China. Participants were purposively sampled on a convenience basis and recruited when they were visiting community health facilities between June and December 2021. Inclusion criteria were older women aged 50 years and older who had sexual experience. A topic guide was used that focused on sexual activity, sexual attitudes, the utilization of sexual and reproductive health services, and the factors that influence these. Interviews were audio recorded and transcribed verbatim. We coded the data inductively and conducted a thematic analysis. Results: Twenty-six Chinese women participated in the study. These older women had varying attitudes regarding sexual activity and its significance for older adults. The gender norms they held concerning sexual desire deemed that men had higher sexual desire than women. Most asymptomatic women did not actively seek sexual and reproductive health services. In most cases, women only sought professional services when they started to have sexual and reproductive health problems. Factors influencing the uptake of sexual and reproductive health services by older women were cost (affordability), availability, distance (accessibility), and conservative cultural norms towards sexuality. Conclusion: The attitudes of older women towards sexual activity are diverse. While some view sexual activity as common and essential for maintaining a sense of well-being in older age, others may hold different perspectives, considering it less significant. The utilization of sexual and reproductive health services by older Chinese women, except for when they were having a specific health issue, was low. Sexual health messages and services tailored for older women are needed.

Influence of grandchildren on COVID-19 vaccination uptake among older adults in China: a parallel-group, cluster-randomized controlled trial.

The uptake of COVID-19 booster vaccination among older adults in China is suboptimal. Here, we report the results of a parallel-group cluster-randomized controlled trial evaluating the efficacy of promoting COVID-19 booster vaccination among grandparents (≥60 years) through a health education intervention delivered to their grandchildren (aged ≥16 years) in a Chinese cohort (Chinese Clinical Trial Registry: ChiCTR2200063240 ). The primary outcome was the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents' attitude and intention to get a COVID-19 booster dose. A total of 202 college students were randomized 1:1 to either the intervention arm of web-based health education and 14 daily reminders (n = 188 grandparents) or control arm (n = 187 grandparents) and reported their grandparents' COVID-19 booster vaccination status at baseline and 21 days. Grandparents in the intervention arm were more likely to receive COVID-19 booster vaccination compared to control cohort (intervention, 30.6%; control, 16.9%; risk ratio = 2.00 (95% CI, 1.09 to 3.66)). Grandparents in the intervention arm also had greater attitude change (ß = 0.28 (95% CI, 0.04 to 0.52)) and intention change (ß = 0.32 (95% CI, 0.12 to 0.52)) to receive a COVID-19 booster dose. Our results show that an educational intervention targeting college students increased COVID-19 booster vaccination uptake among grandparents in China.

A qualitative meta-synthesis of the caregiving experiences of adult children providing care for cancer patients in China: Implications for multidisciplinary healthcare teams.

Qualitative meta-synthesis is a coherent approach to answering an overarching research question by synthesising past qualitative studies so as to create new meanings from their results. We conducted a qualitative meta-synthesis to systematically evaluate and integrate the caregiving experiences of adult children providing care for an elderly parent with cancer. The search was conducted in the databases Web of Science, PubMed, Embase, MEDLINE, Cochrane Library, Grew Literature in the Health Sciences, CNKI, WanFang Data, VIP, SINOMED and China Academic Journals as well as Chinese grey literature databases (China Academic Conference Literature Database/, National Science and Technology Library) from inception to June 9, 2021. Thirteen studies were included in the final synthesis. The caregiver experiences they describe are synthesised into three primary themes: care needs, care burden and care gains, with numerous secondary themes. Besides our findings that seem to align with those from studies focused on other cultures, we have highlighted three main discoveries from the synthesis that stand out in the Chinese context: (1) many sub-themes related to specific caregiving skills; (2) a strong expectation for health professionals to improve their communication skills with family caregivers; (3) the negative and positive influences of filial piety in caregiving experiences. Our findings can help multidisciplinary healthcare teams in China support adult children as caregivers in their emphasis on improving caregiver education and training, ways of making the most of potential care gains, and ways of easing care burdens.

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries.

Background: The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods: The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Results: Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients' needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation: Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.

Balancing instrumental rationality with value rationality: towards avoiding the pitfalls of the productivist ageing policy in the EU and the UK.

The current dominant approach to active ageing policy in the EU and the UK is the productivist approach. Drawing on Weber's concepts of instrumental rationality and value rationality, this article argues that this approach is principally informed by instrumental rationality and thus has the potential to instrumentalize older persons, to become an oppressive ideological narrative, and to ignore the unique developmental meanings in late life. To avoid these pitfalls, the article proposes balancing instrumental rationality with value rationality. The balancing can occur in three dimensions. First, the value of internally oriented activities for late life should be recognized. Second, the value of participatory policy development needs to be upheld. Third, the value of meaning-in-life for the well-being and growth of older adults should be validated.

Study protocol for a network meta-analysis of digital-technology-based psychotherapies for PTSD in adults.

INTRODUCTION: Studies on various types of digital-technology-based psychotherapies (DTPs) have indicated that they are effective for post-traumatic stress disorder (PTSD) symptom relief among adults. The intervention efficacy or effectiveness hierarchy, however, is still not clear. Therefore, we propose to conduct a network meta-analysis to assess the relative effectiveness of various types of DTPs. We aim to establish the differential effectiveness of these therapies in terms of symptom reduction and provide high-quality evidence for treating PTSD. METHODS AND ANALYSES: We will search Embase, CINAHL, MEDLINE, HealthSTAR, the Cochrane Library, PsycINFO, PubMed, the Chinese Biomedical Literature Database, clinical trials (eg, ClinicalTrials.gov) and other academic platforms for relevant studies, mainly in English and Chinese (as we plan to conduct a trial on PTSD patients in Wuhan, China, based on the results of this network meta-analysis), from inception to October 2020. Randomised controlled trials (RCTs) and meta-analyses investigating the effectiveness of any DTPs for PTSD patients for any controlled condition will be included. The number of intervention sessions and the research duration are unlimited; the effects for different durations will be tested via sensitivity analysis. For this project, the primary measure of outcome will be PTSD symptoms at the end of treatment using raw scores for one widely used PTSD scale, PCL-5. Secondary outcome measures will include (1) dropout rate; (2) effectiveness at longest follow-up, but not more than 12 months and (3) patients' functional recovery ratio (such as the return-to-work ratio or percentage of sick leave). Bayesian network meta-analysis will be conducted for all relative outcome measures. We will perform subgroup analysis and sensitivity analysis to see whether the results are influenced by study characteristics. The Grading of Recommendations, Assessments, Development, and Evaluation framework will be adopted to evaluate the quality of evidence contributing to network estimates of the primary outcome. ETHICS AND DISSEMINATION: The researchers of the primary trials already have had ethical approval for the data used in our study. We will present the results of this meta-analysis at academic conferences and publish them in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42020173253.

OA2†Chinese migrant peasant workers and the contradictory demands of filial piety in neo-liberal chinese society: a case study of filial end-of-life care in langzhong city.

BACKGROUND: Many scholars claim that recent changes to Chinese society since economic reform have challenged longstanding forms of informal social care, such as filial piety. For instance there is a societal tension at work in contemporary Chinese society today. On the one hand decreasing co-residence in multi-generational households caused by rural-urban migration, population ageing, the fall in fertility and 'One-Child Policy', and women's increasing participation in the labour market, emphasises an individualised, wage earning centred society. On the other hand, the Chinese government has sought to enforce a form of institutionalised filial piety through policies that legally require younger generations fulfil the full responsibility of care as there is no institutionalised equivalent of the welfare state to provide e.g. home help or personal care to the elderly whose relatives live and work at some distance. This places many younger generations in the contradiction of having to comply with neo-liberal labour market demands while also fulfilling state enforced filial piety. AIM: This research is to look at how Chinese migrant worker experience perceived filial responsibilities in relation to End-of-Life care for parents diagnosed with cancer in the current Chinese context. METHOD: My PhD, based on interviews with migrant peasant workers caught in this dilemma by the demands of having a terminally ill parent, examines how Chinese migrant peasant workers negotiate and conduct their filial practices. RESULTS: The preliminary analysis of the interviews suggests that 'Filial Piety' is getting reconstructed in multifaceted ways as they negotiate the care dilemmas they face. The way they engage with the concept of filial piety enables and constrains how they can think about and practically organise their parents' care. CONCLUSION: The result would shed a light on evaluation of and suggestions for governmental policy-makings, such as the newly implemented Parent-Visiting law in China, in terms of better reinforcing familial value and equipping end-of-life care, as well as taking into account of the specificity of peasant migrant workers' socio-economic status quo.