Prescription medication use among patients with type 2 diabetes in the United States: 1999-2020.

AIMS: We aimed to examine trends in overall prescription medication use among patients with type 2 diabetes in the United States to provide insights for patient care. MATERIALS AND METHODS: We used nationally representative data from the National Health and Nutrition Examination Survey from 1999 to 2020 and included adult patients with type 2 diabetes. We examined the use of prescription drugs, overall and by drug class, polypharmacy (use of ≥5 medications), and number of medications attributed to specific classes. RESULTS: In the period 2015-2020, the mean patient age was 59.6 (51.0-70.0) years, with 46.8% (43.6-49.9) being female and 57.8% (52.8-62.8) being non-Hispanic White. Among 9489 adults with type 2 diabetes, the prevalence of polypharmacy was high and increased from 35.1% (31.6-38.6) in 1999-2002 to 47.2% (43.7-50.7) in 2003-2006, and further to 51.1% (48.3-53.9) in 2015-2020 (p for trend <0.001). Increasing trends of polypharmacy were found across all population subgroups and across the majority of therapeutic classes. Use of non-cardiometabolic medications was common. Among them, the most common were antidepressants (19.8%), proton pump inhibitors (19.0%) and analgesics (16.2%). Among patients with polypharmacy, approximately 40% of medication use was attributed to non-cardiometabolic medications. CONCLUSIONS: Prescription medication burden and complexity increased substantially among patients with type 2 diabetes, with more than 50% of patients with polypharmacy. Attention should be paid to this escalating medication use and regimen complexity, which requires multidisciplinary and coordinated care.

Risk prediction algorithms for prolonged postoperative ileus: A systematic review.

AIM: Prolonged postoperative ileus (PPOI) is common and is associated with a significant healthcare burden. Previous studies have attempted to predict PPOI clinically using risk prediction algorithms. The aim of this work was to systematically review and compare risk prediction algorithms for PPOI following colorectal surgery. METHOD: A systematic literature search was conducted using MEDLINE, Embase, Web of Science and CINAHL Plus. Studies that developed and/or validated a risk prediction algorithm for PPOI in adults following colorectal surgery were included. Data were collected on study design, population and operative characteristics, the definition of PPOI used and risk prediction algorithm design and performance. Quality appraisal was assessed using the PROBAST tool. RESULTS: Eleven studies with 87 549 participants were included in our review. Most were retrospective, single-centre analyses (6/11, 55%) and rates of PPOI varied from 10% to 28%. The most commonly used variables were sex (8/11, 73%), age (6/11, 55%) and surgical approach (5/11, 45%). Area under the curve ranged from 0.68-0.78, and only three models were validated. However, there was significant variation in the definition of PPOI used. No study reported sensitivity, specificity or positive/negative predictive values. CONCLUSION: Currently available risk prediction algorithms for PPOI appear to discriminate moderately well, although there is a lack of validation data. Future studies should aim to use a standardized definition of PPOI, comprehensively report model performance and validate their findings using internal and external methodologies.

Theoretical investigations of weakly- and strongly-coupled multi-core fibers for the applications of optical submarine communications under power and fiber count limits.

The practical cable design for optical submarine communications has a limited fiber pair count due to the mechanical considerations of cable weight and size. Consequently, multi-core fibers (MCFs) could exhibit higher capacity than conventional single-mode fibers (SMFs) thanks to space division multiplexing (SDM). That is because the power supply to a submarine cable is fed by the voltage difference between shores. Under the power-limited condition, SDM improves the cable capacity by using more paths which outperforms the SMF link whose capacity approximately complies with a logarithmic relationship to optical power. At the same time, fiber nonlinearity can be alleviated by the reduced power density of transmitted light in MCFs, due to the increased spatial diversity and mode coupling among coupled cores. In this work, we theoretically investigate the potentials of MCFs including weakly-coupled multicore fiber (WC-MCF) and strongly-coupled multicore fiber (SC-MCF) as the propagation media for submarine communications across the Atlantic and the Pacific. To fairly compare the performances of SMFs- and MCFs-based submarine cables, the Gaussian noise (GN) model for SDM links is employed to optimize the systematic settings including spatial multiplicity and single span length. Then, we develop an SDM and wavelength division multiplexing (WDM) fiber transmission model based on coupled nonlinear Schrodinger equations (CNSE) to investigate the optical filed coupling effect in MCFs-based cables. The developed transmission model has been self-examined by measuring the inter-core crosstalk (IC-XT) and spatial mode dispersion (SMD), referring to the set values. As indicated by the theoretical analysis, the WC-MCFs cable exhibits a larger capacity than the SMFs cable, when the fiber pair count is limited below 32. Moreover, the SC-MCFs cable outperforms the WC-MCFs cable thanks to the reduced fiber nonlinearity due to the random mode coupling and the assistance of multiple-input and multiple-output digital signal processing (MIMO-DSP). At last, the marginal influences of IC-XT, SMD, and insertion loss of Fan-in and Fan-out couplers are also analyzed for the MCFs cable.

Demonstration of an 800G CDM-SDM coherent PON utilizing weakly coupled multicore fibers with CDM tributary manipulation.

In this Letter, we present an experimental demonstration of downstream signaling in a 16 × 50 Gbit/s coherent passive optical network (CPON) using the code and space division multiplexing (CDM-SDM) approach. We realize optical SDM through the utilization of a 4-core weakly coupled multicore fiber (WC-MCF), enhancing the total available optical launch power at the optical line terminal (OLT). This enhancement significantly improves the power budget for CPONs that connect with a large number of optical network units (ONUs). At the second stage of the CPON, four CDM-assigned ONUs are connected to individual cores of the WC-MCF, thereby supporting the connectivity of up to 16 ONUs. Through experiments, we have noted substantial disparities in the downstream signaling performance among individual CDM-assigned ONUs, particularly as the capacity is increased to 800 Gbit/s. To address this issue, we have employed an innovative approach by leveraging space-time coding techniques to manipulate the CDM tributaries, to achieve a balanced reception performance for all ONUs within the CPON. We believe that the proposed CDM-SDM CPON scheme, complemented by the advanced DSP flow chart, holds significant promise for future PON systems characterized by substantial capacity and extensive connectivity.

Ex-ante moral hazard and health insurance: Evidence from China's urban residence basic medical insurance scheme.

This study examines whether implementing Urban Residents Medical Insurance Scheme decreased an individual's risky lifestyle behavior before illness, termed ex-ante moral hazard. Ex-ante moral hazard is predicted by the classical economic theory suggesting that health insurance coverage reduces an individual's incentive to take preventive efforts to remain healthy. Studies have provided mixed evidence for this prediction. China's 2006 nationwide social experiment of implementing the Urban Residents Basic Medical Insurance Scheme offers an excellent opportunity for examining the effect of the transition from uninsured to insured on an individual's health behaviors. We exploit the longitudinal dimension of a representative survey data for 2007-2010 and employ the instrumental variable technique, thereby addressing the issue of self-selection into voluntary health insurance schemes. The results do not provide evidence for and contrast the prediction of the ex-ante moral hazard. Significant differences exist between insured and uninsured groups with respect to smoking, drinking habits, and being overweight. People with insurance care more about their health than people without insurance do. The main results still hold if we use alternative estimation methods and other robustness tests.

Oral dextrose gel to prevent hypoglycaemia in at-risk neonates.

BACKGROUND: Neonatal hypoglycaemia is a common condition that can be associated with brain injury. Current practice usually includes early identification of at-risk infants (e.g. infants of diabetic mothers; preterm, small- or large-for-gestational-age infants), and prophylactic measures are advised. However, these measures often involve use of formula milk or admission to the neonatal unit. Dextrose gel is non-invasive, inexpensive and effective for treatment of neonatal hypoglycaemia. Prophylactic dextrose gel can reduce the incidence of neonatal hypoglycaemia, thus potentially reducing separation of mother and baby and supporting breastfeeding, as well as preventing brain injury. This is an update of a previous Cochrane Review published in 2021. OBJECTIVES: To assess the effectiveness and safety of oral dextrose gel in preventing hypoglycaemia before first hospital discharge and reducing long-term neurodevelopmental impairment in newborn infants at risk of hypoglycaemia. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and Epistemonikos in April 2023. We also searched clinical trials databases and the reference lists of retrieved articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no intervention, or other therapies for the prevention of neonatal hypoglycaemia. We included newborn infants at risk of hypoglycaemia, including infants of mothers with diabetes (all types), high or low birthweight, and born preterm (< 37 weeks), age from birth to 24 hours, who had not yet been diagnosed with hypoglycaemia. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias. We contacted investigators to obtain additional information. We used fixed-effect meta-analyses. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included two studies conducted in high-income countries comparing oral dextrose gel versus placebo in 2548 infants at risk of neonatal hypoglycaemia. Both of these studies were included in the previous version of this review, but new follow-up data were available for both. We judged these two studies to be at low risk of bias in 13/14 domains, and that the evidence for most outcomes was of moderate certainty. Meta-analysis of the two studies showed that oral dextrose gel reduces the risk of hypoglycaemia (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95; risk difference (RD) -0.06, 95% CI -0.10 to -0.02; 2548 infants; high-certainty evidence). Evidence from two studies showed that there may be little to no difference in the risk of major neurological disability at two years of age after oral dextrose gel (RR 1.00, 95% CI 0.59 to 1.68; 1554 children; low-certainty evidence). Meta-analysis of the two studies showed that oral dextrose gel probably reduces the risk of receipt of treatment for hypoglycaemia during initial hospital stay (RR 0.89, 95% CI 0.79 to 1.00; 2548 infants; moderate-certainty evidence) but probably makes little or no difference to the risk of receipt of intravenous treatment for hypoglycaemia (RR 1.01, 0.68 to 1.49; 2548 infants; moderate-certainty evidence). Oral dextrose gel may have little or no effect on the risk of separation from the mother for treatment of hypoglycaemia (RR 1.12, 95% CI 0.81 to 1.55; two studies, 2548 infants; low-certainty evidence). There is probably little or no difference in the risk of adverse effects in infants who receive oral dextrose gel compared to placebo gel (RR 1.22, 95% CI 0.64 to 2.33; two studies, 2510 infants; moderate-certainty evidence), but there are no studies comparing oral dextrose with other comparators such as no intervention or other therapies. No data were available on exclusive breastfeeding after discharge. AUTHORS' CONCLUSIONS: Prophylactic oral dextrose gel reduces the risk of neonatal hypoglycaemia in at-risk infants and probably reduces the risk of treatment for hypoglycaemia without adverse effects. It may make little to no difference to the risk of major neurological disability at two years, but the confidence intervals include the possibility of substantial benefit or harm. Evidence at six to seven years is limited to a single small study. In view of its limited short-term benefits, prophylactic oral dextrose gel should not be incorporated into routine practice until additional information is available about the balance of risks and harms for later neurological disability. Additional large follow-up studies at two years of age or older are required. Future research should also be undertaken in other high-income countries, low- and middle-income countries, preterm infants, using other dextrose gel preparations, and using comparators other than placebo gel. There are three studies awaiting classification and one ongoing study which may alter the conclusions of the review when published.

Cost-effectiveness of folic acid therapy for primary prevention of stroke in patients with hypertension.

BACKGROUND: For hypertensive patients without a history of stroke or myocardial infarction (MI), the China Stroke Primary Prevention Trial (CSPPT) demonstrated that treatment with enalapril-folic acid reduced the risk of primary stroke compared with enalapril alone. Whether folic acid therapy is an affordable and beneficial treatment strategy for the primary prevention of stroke in hypertensive patients from the Chinese healthcare sector perspective has not been thoroughly explored. METHODS: We performed a cost-effectiveness analysis alongside the CSPPT, which randomized 20,702 hypertensive patients. A patient-level microsimulation model based on the 4.5-year period of in-trial data was used to estimate costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for enalapril-folic acid vs. enalapril over a lifetime horizon from the payer perspective. RESULTS: During the in-trial follow-up period, patients receiving enalapril-folic acid gained an average of 0.016 QALYs related primarily to reductions in stroke, and the incremental cost was $706.03 (4553.92 RMB). Over a lifetime horizon, enalapril-folic acid treatment was projected to increase quality-adjusted life years by 0.06 QALYs or 0.03 life-year relative to enalapril alone at an incremental cost of $1633.84 (10,538.27 RMB), resulting in an ICER for enalapril-folic acid compared with enalapril alone of $26,066.13 (168,126.54 RMB) per QALY gained and $61,770.73 (398,421.21 RMB) per life-year gained, respectively. A probabilistic sensitivity analysis demonstrated that enalapril-folic acid compared with enalapril would be economically attractive in 74.5% of simulations at a threshold of $37,663 (242,9281 RMB) per QALY (3x current Chinese per capita GDP). Several high-risk subgroups had highly favorable ICERs < $12,554 (80,976 RMB) per QALY (1x GDP). CONCLUSIONS: For both in-trial and over a lifetime, it appears that enalapril-folic acid is a clinically and economically attractive medication compared with enalapril alone. Adding folic acid to enalapril may be a cost-effective strategy for the prevention of primary stroke in hypertensive patients from the Chinese health system perspective.

Low-latency and efficient retiming and equalizing scheme for a 112-Gbps bandwidth-limited optical PAM-4 system.

The bandwidth limitation of optoelectronic devices is a key constraint for realizing higher capacity short-reach optical communication systems. In this work, we show that the performance of the timing recovery algorithm will significantly impact the performance of bandwidth-limited optical PAM-4 signals. To address this problem, we introduce a moving average filter (MAF) into the Gardner retiming loop to realize ultra-stable retiming without any pilot symbols. It enables a significantly reduced timing jitter, especially for bandwidth-limited conditions. Based on simulations, we show that the proposed retiming scheme will give a stable sampling phase, which is beneficial to the performance of the decision feedback equalizer. Compared to the system based on the traditional Gardner timing synchronization algorithm, the 2-dB power budget gain is realized. The proposed method improves the equalization performance of short-reach optical communication systems where complexity and processing latency are important concerns.

Optimizations and investigations for transfer learning of iteratively pruned neural network equalizers for data center networking.

In this work, for the first time to the best of our knowledge, we introduce the iterative pruning technique into the transfer learning (TL) of neural network equalizers (NNE) deployed in optical links with different length. For the purpose of time saving during the training period of NNE, TL migrates the NNE parameters which have been already trained on the source link to the newly-routed link (the target link), which has been proved to outperform the training initialized with the random state. Based on simulations, we proved that iterative pruning technique could further enhance the convergence speed during TL between the source and target links. Moreover, we quantitatively investigate the marginal effects of pruned threshold and pruned span on the convergence performance in various transmission distance scenarios. In addition, we observed a trade-off between performance stability and complexity of NNE, which requires to be optimized compromisingly by choosing an appropriate equalizer scale.

Complex-valued decision feedback equalizer for optical IMDD signals with adaptive manipulations in time and amplitude domains.

In this work, we innovatively equalize optical intensity-modulated and directly detected (IMDD) four-level pulse amplitude modulation (PAM-4) signals using a complex-valued decision feedback equalizer (CDFE). Through mapping adjacent symbols of PAM-4 signals onto the complex domain, the influence of strongest inter-symbol interference (ISI) can be alleviated during the decision process in a decision feedback equalizer (DFE), effectively combating burst-error propagation when signals are noisy. Moreover, signal-adaptive manipulations of DFE parameters in both the time and the amplitude domain are performed by using an ultra-stable timing recovery and level-adaptive decision. Performance evaluations are made on vertical cavity surface emitting laser (VCSEL) modulated and multimode fiber (MMF) transmitted 100-Gbit/s optical PAM-4 signals. Based on experimental results of the short-reach optical communication, the proposed DFE outperforms the traditional DFE with a 0.5-dB system power budget gain at the 7% overhead (OH) forward error correction (FEC) bit error rate (BER) threshold.

Improving the spectral efficiency of visible light communications by a super-Nyquist multi-band CAP modulation.

In this Letter, we propose a flexible bandwidth compression scheme for visible light communication (VLC) systems employing multi-band carrierless amplitude and phase (CAP) modulation. The scheme combines a narrow filtering for every subband at the transmitter and an N-symbol look-up-table (LUT) based maximum likelihood sequence estimation (MLSE) at the receiver. The N-symbol LUT is generated by recording pattern-dependent distortions induced by inter-symbol-interference (ISI), inter-band-interference (IBI), and the other channel effects upon the transmitted signal. The idea is experimentally demonstrated on a 1 m free space optical transmission platform. The results show that the proposed scheme can improve the subband overlap tolerance up to 42% in subband overlapping scenarios, that is, 3 bit/s/Hz, which is the highest spectral efficiency (SE) among the experimented schemes.

Rural population's preferences matter: a value set for the EQ-5D-3L health states for China's rural population.

PURPOSE: To develop an EQ-5D-3L social value set based on Chinese rural population's preferences using the time trade-off (TTO) method, and to compare the differences in preferences on health states between China urban and rural population. METHODS: Between Sep 2013 and Nov 2013, a total of 1201 participants were recruited from rural areas of five Chinese cities (Beijing, Chengdu, Guiyang, Nanjing, and Shenyang) using a quota sampling method. Each respondent valued 13 health states using the TTO, and a total of 97 EQ-5D-3L health states were directly valued for estimating the value set. Various models with different specifications were explored at both aggregate and individual levels. The final model was determined by a set of predefined selection criteria. FINDINGS: An ordinary least square model at the aggregate level included 10 dummy variables for specifying the level 2 and 3 for each dimension and an N3 term presenting any dimension on level 3 was selected as the final model. The final model provides a value set ranges from - 0.218 to 0.859. The predicted utility values were highly correlated with but consistently lower than that of the published Chinese EQ-5D-3L value set (for urban population). CONCLUSION: The availability of the China rural value set provides a set of social preferences weights for researchers and policy decision-makers for use in China rural area.

Oral dextrose gel for the treatment of hypoglycaemia in newborn infants.

BACKGROUND: Neonatal hypoglycaemia, a common condition, can be associated with brain injury. It is frequently managed by providing infants with an alternative source of glucose, often given enterally with milk-feeding or intravenously with dextrose solution, which may decrease breastfeeding success. Intravenous dextrose also often requires that mother and baby are cared for in separate environments. Oral dextrose gel is simple and inexpensive, and can be administered directly to the buccal mucosa for rapid correction of hypoglycaemia, in association with continued breastfeeding and maternal care. This is an update of a previous review published in 2016. OBJECTIVES: To assess the effectiveness of oral dextrose gel in correcting hypoglycaemia in newborn infants from birth to discharge home and reducing long-term neurodevelopmental impairment. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase from database inception to October 2021.  We also searched international clinical trials networks, the reference lists of included trials, and relevant systematic reviews identified in the search.  SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no treatment, or other therapies for the treatment of neonatal hypoglycaemia in newborn infants from birth to discharge home. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study quality and extracted data; they did not assess publications for which they were study authors. We contacted investigators to obtain additional information. We used fixed-effect models and the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included two studies conducted in high-income countries, involving 312 late preterm and at-risk term infants and comparing oral dextrose gel (40% concentration) to placebo gel. One study was at low risk of bias, and the other (an abstract) was at unclear to high risk of bias. Oral dextrose gel compared with placebo gel probably increases correction of hypoglycaemic events (rate ratio 1.08, 95% confidence interval (CI) 0.98 to 1.20; rate difference 66 more per 1000, 95% CI 17 fewer to 166 more; 1 study; 237 infants; moderate-certainty evidence), and may result in a slight reduction in the risk of major neurological disability at age two years or older, but the evidence is uncertain (risk ratio (RR) 0.46, 95% CI 0.09 to 2.47; risk difference (RD) 24 fewer per 1000, 95% CI 41 fewer to 66 more; 1 study, 185 children; low-certainty evidence). The evidence is very uncertain about the effect of oral dextrose gel compared with placebo gel or no gel on the need for intravenous treatment for hypoglycaemia (RR 0.78, 95% CI 0.46 to 1.32; RD 37 fewer per 1000, 95% CI 91 fewer to 54 more; 2 studies, 312 infants; very low-certainty evidence). Investigators in one study of 237 infants reported no adverse events (e.g. choking or vomiting at the time of administration) in the oral dextrose gel or placebo gel group (low-certainty evidence).  Oral dextrose gel compared with placebo gel probably reduces the incidence of separation from the mother for treatment of hypoglycaemia (RR 0.54, 95% CI 0.31 to 0.93; RD 116 fewer per 1000, 95% CI 174 fewer to 18 fewer; 1 study, 237 infants; moderate-certainty evidence), and increases the likelihood of exclusive breastfeeding after discharge (RR 1.10, 95% CI 1.01 to 1.18; RD 87 more per 1000, 95% CI 9 more to 157 more; 1 study, 237 infants; moderate-certainty evidence).   AUTHORS' CONCLUSIONS: Oral dextrose gel (specifically 40% dextrose concentration) used to treat hypoglycaemia in newborn infants (specifically at-risk late preterm and term infants) probably increases correction of hypoglycaemic events, and may result in a slight reduction in the risk of major neurological disability at age two years or older. Oral dextrose gel treatment probably reduces the incidence of separation from the mother for treatment and increases the likelihood of exclusive breastfeeding after discharge. No adverse events have been reported. Oral dextrose gel is probably an effective and safe first-line treatment for infants with neonatal hypoglycaemia in high-income settings.  More evidence is needed about the effects of oral dextrose gel treatment on later neurological disability and the need for other treatments for hypoglycaemia. Future studies should be conducted in low-and middle-income settings, in extremely and moderately preterm infants, and compare oral dextrose gel with other therapies such as intravenous dextrose. There are two ongoing studies that may alter the conclusions of this review when published.

Effectiveness of a mobile-based HIV prevention intervention for the rural and low-income population involving incentive policy to doctors in Liangshan, China: a randomized controlled trial protocol.

BACKGROUND: The HIV/AIDS epidemic is a concerning problem in many parts of the world, especially in rural and poor areas. Due to health service inequality and public stigma towards the disease, it is difficult to conduct face-to-face interventions. The widespread use of mobile phones and social media applications thus provide a feasible and acceptable approach for HIV prevention and education delivery in this population. The study aims to develop a generalizable, effective, acceptable, and convenient mobile-based information intervention model to improve HIV-related knowledge, attitudes, practices, and health outcomes in poverty-stricken areas in China and measure the impact of incentive policies on the work of village doctors in Liangshan, China. METHODS: A randomized controlled trial design is used to evaluate the effectiveness of an 18-month mobile-based HIV prevention intervention, collaborating with local village doctors and consisting of group-based knowledge dissemination and individualized communication on WeChat and the Chinese Version of TikTok in Liangshan, China. Each village is defined as a cluster managed by a village doctor with 20 adults possessing mobile phones randomly selected from different families as participants, totaling 200 villages. Clusters are randomized (1:1:1) to the Control without mobile-based knowledge dissemination, Intervention A with standardized compensation to the village doctors, or Intervention B with performance-based compensation to the village doctors. The intervention groups will receive biweekly messages containing HIV-related educational modules. Data will be collected at baseline and 6-, 12-, and 18-month periods for outcome measurements. The primary outcomes of the study are HIV-related knowledge improvement and the effectiveness of village doctor targeted incentive policies. The secondary outcomes include secondary knowledge transmission, behavioral changes, health outcomes, social factors, and study design's acceptability and reproducibility. These outcomes will be explored via various qualitative and quantitative means. DISCUSSION: The findings will provide insights into the effectiveness, generalizability, and challenges of the mobile-based HIV prevention intervention for the population living in rural communities with low education levels and will guide the development of similar models in other low-income and culturally isolated regions. TRIAL REGISTRATION: ClinicalTrial.gov: NCT05015062 ; Registered on June 6, 2022.

Medical disputes and patient satisfaction in China: How does hospital management matter?

OBJECTIVE: Satisfaction with healthcare may be captured by surveys of patients and staff, or in extreme cases, the number and severity of medical disputes. This study tries to investigate the relationship between satisfaction and hospital management as well as the role of good management in preventing medical disputes ex ante. METHOD: We investigate this relationship using information on management practices collected from 510 hospitals in mainland China using the World Management Survey questionnaire and combined with medical malpractice litigation data and patient/staff satisfaction surveys. Multiple regression models were used to analyse the relationship between hospital management scores and medical litigation outcomes as well as patient and staff satisfaction during 2014-2016. RESULTS: An increase of one standard deviation in the management score was related to 13.1% (p < 0.10) lower incidence of medical disputes, 12.4% (p < 0.05) fewer medical litigations, and 51.3% (p < 0.10) less compensation. Better management quality of hospitals was associated with higher inpatient satisfaction (p < 0.05) and staff well-being (p < 0.01). CONCLUSION: Improving hospital management could reduce hospital costs generated by lawsuits, reduce potential harm to patients, and improve patient and staff satisfaction, thus leading to a better patient-physician relationship.

Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey.

BACKGROUND: Partial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic. METHODS: The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities. RESULTS: Most participants reported their health status as "very good" (39.0%) or "excellent" (42.3%). CCI of SRH and mental health were - 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%), p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health). CONCLUSIONS: Per capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.

Healthcare utilization at retirement in China.

Previous studies, mostly analyzing data from high-income economies, present mixed evidence on the relationship between retirement and healthcare utilization. This study leverages administrative data for over 80,000 urban Chinese workers to explore the effect of retirement on outpatient and inpatient care utilization using a fuzzy regression discontinuity design. The analyses of medical claims from a large city in China complement and extend the current literature by providing evidence of potential mechanisms underlying increased short-run utilization. In this relatively well-insured population, annual total healthcare expenditures significantly increase primarily because of more intensive use of outpatient care at retirement, especially at the right tail of the distribution of outpatient visits. This increase in outpatient care appears to stem from a decline in the patient cost-sharing rate and the reduced opportunity cost of time upon retirement, interacting with supplier-induced demand, not from any sudden impact on health. We do not find evidence of change in inpatient care at retirement. The results hold for both females and males, and are robust to a number of sensitivity analyses.

Oral dextrose gel to prevent hypoglycaemia in at-risk neonates.

BACKGROUND: Neonatal hypoglycaemia is a common condition that can be associated with brain injury. Current practice usually includes early identification of at-risk infants (e.g. infants of diabetic mothers; preterm, small- or large-for-gestational-age infants), and prophylactic measures are advised. However, these measures usually involve use of formula milk or admission to the neonatal unit. Dextrose gel is non-invasive, inexpensive and effective for treatment of neonatal hypoglycaemia. Prophylactic dextrose gel can reduce the incidence of neonatal hypoglycaemia, thus potentially reducing separation of mother and baby and supporting breastfeeding, as well as preventing brain injury.  This is an update of a previous Cochrane Review published in 2017.  OBJECTIVES: To assess the effectiveness and safety of oral dextrose gel given to newborn infants at risk of hypoglycaemia in preventing hypoglycaemia and reducing long-term neurodevelopmental impairment. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 10) in the Cochrane Library; and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) on 19 October 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no intervention, or other therapies for the prevention of neonatal hypoglycaemia. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. We contacted investigators to obtain additional information. We used fixed-effect meta-analyses. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included two studies conducted in high-income countries comparing oral dextrose gel versus placebo in 2548 infants at risk of neonatal hypoglycaemia. Of these, one study was included in the previous version of this review. We judged these two studies to be at low risk of bias, and that the evidence for most outcomes was of moderate certainty. Meta-analysis of the two studies showed that oral dextrose gel reduces the risk of hypoglycaemia (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95; risk difference (RD) -0.06, 95% CI -0.10 to -0.02; 2548 infants; high certainty evidence). One study reported that oral dextrose gel probably reduces the risk of major neurological disability at two years' corrected age (RR 0.21, 95% CI 0.05 to 0.78; RD -0.05, 95% CI -0.09 to 0.00; 360 infants; moderate certainty evidence). Meta-analysis of the two studies showed that oral dextrose gel probably reduces the risk of receipt of treatment for hypoglycaemia during initial hospital stay (RR 0.89, 95% CI 0.79 to 1.00; 2548 infants; moderate certainty evidence) but makes little or no difference to the risk of receipt of intravenous treatment for hypoglycaemia (RR 1.01, 0.68 to 1.49; 2548 infants; moderate certainty evidence). Oral dextrose gel may have little or no effect on the risk of separation from the mother for treatment of hypoglycaemia (RR 1.12, 95% CI 0.81 to 1.55; two studies, 2548 infants; low certainty evidence). There is probably little or no difference in the risk of adverse events in infants who receive oral dextrose gel compared to placebo gel (RR 1.22, 95% CI 0.64 to 2.33; two studies, 2510 infants; moderate certainty evidence), but there are no studies comparing oral dextrose with other comparators such as no treatment, standard care or other therapies. No data were available on exclusive breastfeeding after discharge. AUTHORS' CONCLUSIONS: Oral dextrose gel reduces the risk of neonatal hypoglycaemia in at-risk infants and probably reduces the risk of major neurological disability at two years of age or greater without increasing the risk of adverse events compared to placebo gel. Additional large follow-up studies at two years of age or older are required. Future research should also be undertaken in low- and middle-income countries, preterm infants, using other dextrose gel preparations, and using comparators other than placebo gel. There are three studies awaiting classification and one ongoing study which may alter the conclusions of the review when published.

Association between household fuel use and sleep quality in the oldest-old: Evidence from a propensity-score matched case-control study in Hainan, China.

STUDY OBJECTIVES: Emerging evidence has documented that poor sleep quality associated with adverse effects with physical, psychological and neurological disorders, which impeded healthy aging. There is limited knowledge regarding the association of household air pollution (HAP) from solid fuel use with sleep quality, particularly among the population at advanced ages. The aim of this study is to investigate this association in oldest-old (≥80 years) populations. METHODS: China Hainan Centenarian Cohort Study was conducted in the 18 cities and counties of Hainan Province from 2015 to 2017. A total of 1725 individuals aged 80 years and older were included in the study. We used the Pittsburgh sleep quality index (PSQI) to measure individuals' sleep quality with a score of PSQI >8 indicating poor sleep quality. Solid fuel users were defined as those who primarily use coal, biomass charcoal, wood or straw for cooking in their daily life. The propensity score matching (PSM) was adopted and logistic regressions were performed based on the matched sample to estimate the association between the two factors. We adjusted for a wide range of covariates, including demographic, socioeconomic, health-related, and environmental factors. RESULTS: After matching, a total of 1616 participants (mean [SD] age, 94.5 [9.5] years; 72.5% women) were included in the final analysis. About 50.9% of the participants used solid fuel for cooking. The average global PSQI score was 8.26 (SD = 3.3), 49.0% of them were detected as poor sleep quality with a global PSQI score >8. We found significantly higher risk of having poor sleep quality among those who were currently solid fuel users than among clean fuel users, with an odds ratio (OR) of 1.43 (95% CI: 1.14-1.80), adjusting for a wide range of confounders. The associations were more pronounced in those who did not use any ventilation (compared to those who used either mechanical or natural cooking ventilation; 1.79 [1.30-2.47] vs. 1.27 [1.01-1.53], P for interaction = 0.016) and in those who were frequent cooking at home (compared to those who never cooked; 1.65 [1.21-2.26] vs. 1.18 [0.93-1.40], P for interaction = 0.025). CONCLUSIONS: Exposure to HAP from solid fuel combustion increases the risk of poor sleep quality at oldest-old ages. Our findings point to the need of reducing HAP from polluted fuel combustion and implementing cooking ventilation as a public health priority for healthy aging initiatives.

The association between iodine intake and semen quality among fertile men in China.

BACKGROUND: Iodine intake is essential in the production of thyroid hormone but very few foods are rich in it. Iodine deficiency or excess iodine level may both lead to thyroid disorders, which further affects human fertility function. The objective of this study is to investigate the relationship between iodine intake and seminal parameters among fertile men in China. METHODS: A total of 1098 couples were recruited by trained physicians at different family planning service stations in 2015. Semen and iodine samples were obtained from male respondents. A questionnaire survey inquired about demographic information from couples. The main outcome variables of semen quality were semen volume, semen concentration, semen motility, and sperm count, and time to pregnancy. Urinary iodine concentration (UIC) was used to measure iodine levels for male respondents. Ordinary least squared regressions and logistic regressions were performed to estimate the association between iodine intake level and semen quality parameters. RESULTS: Male respondents with deficient or excess iodine levels had a 5% higher semen volume relative to those with optimal iodine intake (p < 0.1). Suboptimal iodine intake was negatively associated with semen concentration and semen counts (p < 0.01). Longer time of pregnancy was observed in iodine deficiency and excess group than those in the optimal group (p < 0.01). CONCLUSION: In general, iodine deficiency and excess were both associated with decreasing semen quality parameters in male respondents.