Risk factors for agitation in home-cared older adults with dementia: evidence from 640 elders in East China.

Background: Agitation is common among older adults with dementia, negatively affecting their quality of life and their caregivers'. Since home care remains the dominant approach for older adults, this study investigates the risk factors for agitation in older adults with dementia in China. Methods: We perform a cross-sectional study of home-cared older adults with dementia in Ningbo, China, using 2020 data. We use a self-made questionnaire to investigate the risks of agitated behavior and its related factors. We perform descriptive, univariate, and regression analyses. Findings: We address 640 older Chinese adults; 42.8% of the sample exhibits one or more agitated behaviors. We find that basic health issues, such as activities of daily living (ADL), family support issues, such as Zarit Burden Interview (ZBI) scale and Family APGAR Questionnaire (APGAR), and behavioral awareness issues, such as fall and scald, significantly influence the occurrence of agitation behaviors (p < 0.05). Older adults with severe ADL disorder (b = 6.835, ß = 0.196, p < 0.001), ZBI score of 67.00-88.0 (b = 10.212, ß = 0.248, p = 0.005), severe APGAR disorder (b = 3.699, ß = 0.100, p = 0.012) and a history of fall (b = 9.311, ß = 0.199, P = <0.001) or scald (b = 9.288, ß = 0.125, p = 0.002) are more likely to exhibit agitated behaviors. Interpretation: Agitated behavior in home-cared older adults with dementia are diverse and related to mental state, family support, and behavioral awareness issues. Caregivers, often family members, should be attentive to the needs of dementia patients and take active and effective measures to improve their quality of life. They should be aware of the causes and triggers of agitated behavior and take steps to reduce its occurrence.

Impact of non-regional lymph node metastases accurately revealed on 18F-PSMA-1007 PET/CT in the clinical management of metastatic hormone-sensitive prostate cancer.

BACKGROUND: Non-regional lymph node (NRLN) metastases has shown increasing importance in the prognosis evaluation and clinical management of primary metastatic hormone-sensitive prostate cancer (mHSPC). Hence, this study aimed to investigate the concordance rates between 18F-PSMA-1007 PET/CT and conventional imaging (CI) in revealing NRLN metastases, and explore the impact of NRLN metastases on the management of primary mHSPC. METHODS: The medical records of 224 patients with primary mHSPC were retrospectively reviewed, including 101 patients (45.1%) only received CI for TNM classification, 24 patients (10.7%) only received 18F-PSMA-1007 PET/CT, and 99 patients (44.2%) received both 18F-PSMA-1007 PET/CT and CI. Among patients who received 18F-PSMA-1007 PET/CT and CI before initial treatment, the concordance rates between 18F-PSMA-1007 PET/CT and CI were analyzed. The high-volume disease was defined as the presence of visceral metastases and/or ≥ 4 bone metastases (≥ 1 beyond the vertebral bodies or the pelvis) based on the findings of 18F-PSMA-1007 PET/CT and/or CI. The primary endpoint was progression-free survival (PFS), and Cox regression analyses were performed to explore independent predictors of PFS. RESULTS: A total of 99 patients (44.2%) received both 18F-PSMA-1007 PET/CT and CI, the concordance rate in revealing NRLN metastases between 18F-PSMA-1007 PET/CT and CI was only 61.62%, and Cohen's kappa coefficient was as low as 0.092. Moreover, 18F-PSMA-1007 PET/CT detected an additional 37 of 94 (39.4%) patients with positive NRLNs who were negative on CI. Cox regression revealed that androgen deprivation therapy (ADT), N1, high-volume, NRLN and visceral metastases were associated with worse PFS (all P < 0.05) in 224 patients. Furthermore, in patients with low-volume disease, the median PFS of patients with NRLN metastases was significantly shorter than that of patients without NRLN metastases (19.5 vs. 27.5 months, P = 0.01), while the difference between patients with low-volume plus NRLN metastases and high-volume disease was not significant (19.5 vs. 16.9 months, P = 0.55). Moreover, early docetaxel chemotherapy significantly prolonged the PFS of these patients compared with ADT alone (20.7 vs. 12.3 months, P = 0.008). CONCLUSION: NRLN metastases could be accurately revealed by 18F-PSMA-1007 PET/CT, which should be considered a high-volume feature, especially concomitant with bone metastases. Furthermore, patients with low-volume plus NRLN metastases may be suitable for more intensive treatment, such as early docetaxel chemotherapy.

Utilization and performance of long-term care system for older people with disabilities and dementia in Zhejiang Province, China.

Introduction: To explore changes in performance, weaknesses, and utilization of the long-term care (LTC) system for older people with disabilities and dementia (OPWDD) in Zhejiang Province, China, thereby providing a reference for decision-making amid a progressively aging population. Methods: A performance evaluation model of the LTC system for OPWDD was constructed using three dimensions: input, process, and outcome. Performance indicators and trends were calculated based on data collected from statistical yearbooks, documents, and work reports of the Bureau of Statistics and other government departments in Zhejiang Province, China, published in 2015-2021. Results: Significant improvements were observed in most LTC performance indicators for OPWDD, such as input, process, and outcome, with notable enhancements in fairness, accessibility, and affordability of LTC services. By 2021, there were 6.20 nursing and rehabilitation beds in medical institutions and 3.77 general practitioners per 1,000 people aged 65 and above, up 144.14% and 13.73%, respectively, from 2015. The rate of health management for older people was 70.91%, representing a 10.33% increase from 2015. The actual reimbursement ratio of hospitalization expenses covered by basic medical insurance for older people rose 7.05%, from 72.76% in 2015 to 77.89% in 2021. Social security satisfaction rose 12.4%, from 71.3% in 2015 to 83.7% in 2021. Certain indicators, however, showed no significant improvement and tended to decline, such as the number of beds at older care institutions and caregivers per 1,000 people aged 65 and over. Discussion: It is imperative to further balance the allocation of care resources, using a people-centered and integrated LTC system. The proportion of rehabilitation and nursing beds for older people should be consistently increased to effectively alleviate the shortage of care beds. Furthermore, a talent incentive policy should be improved to train caregivers and provide whole-person and whole-life course care based on OPWDD needs.

Fall risks and the related factors for the homebound older people with dementia: Evidence from East China.

Purpose: Falls are a major public health problem, especially for older people. This research aimed to provide a direct illustration of fall risks among the homebound older people with dementia in China, and to identify the risk factors associated with it. Methods: In 2020, a questionnaire-based field survey was used to assess 1,042 people aged over 60 years in Ningbo, Eastern China. The Morse Fall Risk Scale's result was employed as the dependent variable, while the basic health problems, living environment difficulties, social support problems, and behavioral awareness issues were utilized as the independent variables; subsequently, chi-squared tests and four multivariate ordinarily ordered logistic regression models were performed. Results: Overall, nine hundred and thirty-one older people with dementia were included in this study (the effective rate was 89.34%), with the majority of them having severe dementia (27.9%). Furthermore, 16.2% had fallen in the past 3 months, and 16.8% were at a high risk of falling. The risk factors for the older people's cognitive function included 80-90 years old, vascular dementia, marital status, and history of falls (P < 0.05); the kinds of chronic diseases, the activities of daily living, living environment, caregiver burden, caregiver knowledge, the Cohen Mansfield Agitation Inventory results, and the Clinical Dementia Rating were the protective factors for the risk of falls in them (P < 0.05). Conclusion: The risk of falling of the Chinese homebound older people with dementia was high. Their caregivers, such as relatives, need to pay attention to these risk factors and perform appropriate measures to prevent falls.

Development of a Psychometric Test: A Care Risk Scale for Homebound Older People With Dementia.

Background: Homebound older people with dementia (OPWD) face a series of care risks due to disease characteristics, care issues, and the family environment. However, China lacks a quantitative assessment tool for care risk. Thus, we attempted to develop a care risk scale for homebound OPWD. Methods: A care risk scale, with initially 18 items, was designed based on a systematic literature review, expert consultation, and a pilot study with 20 OPWD. The initial scale was validated among 1,045 homebound OPWD in Ningbo, China from November 1, 2020 to July 30, 2021. After removing three items that lacked discrimination power, the reliability and validity of the remaining 15 items was evaluated. Factor extraction was performed via principal axis factoring and Cattell's scree plot analysis, with the resulting factors then being subjected to a varimax rotation. Results: The final scale consisted of 15 items assessed on a 5-point Likert scale that loaded on to three different factors, including dementia symptoms (four items), family support (four items), and home environment (seven items). These three factors were found to explain 72.9% of the cumulative variance. The overall Cronbach's alpha for the final scale was 0.907. The correlation coefficients in the item-to-total analysis ranged from 0.511 to 0.662. Conclusion: The validation analysis indicated satisfactory reliability and validity of the 15-item scale for assessing care risk of homebound OPWD. This scale can help long-term care professionals and family caregivers identify care risks and help them take targeted measures to enhance safety of care for OPWD.

Perceived and unmet needs for health and social services among families coping with dementia in China: A descriptive study.

OBJECTIVES: To describe the perceived and unmet needs for health and social services and their relative importance among families coping with dementia in urban China. METHODS: We used data from a cross-sectional survey conducted between 2018 and 2019 in two cities in eastern China. Trained staff conducted structured interviews of family caregivers of people living with dementia at home to obtain individual characteristics as well as types of service needs of families coping with dementia. Service needs and utilization in 24 types of services across five domains (daily living, medical/nursing, rehabilitation, mental health, and other) were examined. Descriptive statistics were used to describe characteristics of the dyads and the ranking of services based on the percentage of respondents with perceived/unmet needs. RESULTS: A total of 170 (87.6%) family caregivers completed the interviews. The mean age of the care recipient was 77.2 years (range: 60-102) and 65.3% were female. The mean age of family caregivers was 58.4 years (range: 28-90), and 57.1% were female. The top five services used by the care recipients were: primary care, medication management, housekeeping, activities of daily living assistance, and adult day service. The five services with the most unmet needs were: legal assistance (42.7%), hospice care (44.7%), respiratory secretion management (expectoration) (57.6%), life enrichment activities (65.4%), and companion care (67.0%). Except for transportation and dressing/grooming, working and nonworking caregivers reported similar relative importance of service needs. CONCLUSIONS: The findings suggest that people living with dementia and their family require a wide range of services and supports to live in the community. Future research and policy efforts should target the unmet needs of families to improve dementia care in the community and promote aging-in-place.

Neoadjuvant chemotherapy with liposomal paclitaxel plus platinum for locally advanced esophageal squamous cell cancer: Results from a retrospective study.

BACKGROUND: This study analyzed the efficacy and safety of neoadjuvant chemotherapy with liposomal paclitaxel plus platinum in patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). METHODS: The data of patients with locally advanced resectable ESCC (staging cT2N + M0, cT3-4aNanyM0, IA-IVA) who received preoperative chemotherapy with liposomal paclitaxel plus platinum (cisplatin, nedaplatin or carboplatin) in HuanXing Cancer Hospital from July 2018 to October 2019 were collected. The primary endpoint of this study was R0 resection rate, and secondary endpoints were pathological complete response (pCR) rate, 1- and 2-year overall survival (OS) rate, 1-year and 18-month disease-free survival (DFS) rate, and safety. RESULTS: A total of 32 eligible patients were included in this study. All patients received neoadjuvant chemotherapy and surgery. The R0 resection rate was 93.8%, the pCR rate was 12.5%, and down-staging was achieved in 14 patients (47.8%). Median follow-up was 31.0 months (95% confidence interval [CI] 30.1-31.9 months). The 1- and 2-year OS rates were 96.9% and 78.1%, and the 1-year and 18-month DFS rates were 86.7% and 76.7%, respectively. The median DFS and OS were not reached. The incidence rate of neoadjuvant chemotherapy related grade 3-4 adverse events was 21.9%, including neutropenia (21.9%) and leukopenia (9.4%). CONCLUSIONS: The results of this study suggest that liposomal paclitaxel combined with platinum as neoadjuvant chemotherapy can provide satisfactory R0 resection rate and survival rate, and significant tumor down-staging effect for patients with locally advanced resectable ESCC, with safety profile.

Synergistic influence of education and marriage on the risk for cognition loss among the older people in China.

AIM: The study aimed to prove that both rationality and emotion are indispensable for older people to maintain their ability to live independently during the twilight of their lives. The resilience of older people to dementia were investigated by considering the interactions between educational levels and marriage status. DESIGN: A quantitative study was conducted using questionnaires. METHODS: Four sociodemographic variables (age, sex, educational level and marital status) were collected from 1,177 older Chinese participants, whose mini-mental state examination scores (MMSE scores) were measured. RESULTS: A lower educational level coupled with being widowed caused a greater risk for severe cognitive impairment (relative risk [RR] 1.48; 95% confidence interval [CI] 1.20-1.82; p < .001) for high-aged older participants (age range: ≥80) than for their low-aged counterparts (age range: ≥60 and <80). In contrast, a higher educational level coupled with being married levelled this age-related risk for cognitive loss (RR 0.91; 95% CI 0.65-1.27; p = .62).

Psychometric properties of long-term care needs questionnaire for older Chinese adults with dementia.

AIM: Long-term care needs are important for older adults with dementia in the West, but they have not received enough attention from China. This study evaluated the psychometric properties of a long-term care needs instrument for older Chinese adults with dementia. METHODS: A total of 1,212 older adults with dementia were recruited from five Chinese cities to complete a 30-item long-term care needs questionnaire. The reliability and validity of the questionnaire was evaluated using multiple assessments, including a content validity assessment, Cronbach's alpha, an item-to-total correlation test, and exploratory factor analysis. RESULTS: The questionnaire was divided into four sub-sections: life care services (eight items), basic and specialist care services (12 items), mental comfort psychological services (four items), and homecare support services (six items). Cronbach's alpha was .93 for the whole questionnaire and ranged from .83 to .92 for the four sub-questionnaires. The item-to-total correlation coefficients for the four sub-questionnaires were between .68 and .88, and the test-retest correlation coefficient was .88. CONCLUSION: Our results validated the reliability and validity of a questionnaire designed to measure the quality of long-term care services for older Chinese adults with dementia.

The Needs of Older Adults With Disabilities With Regard to Adaptation to Aging and Home Care: Questionnaire Study.

BACKGROUND: The home environment is an important means of support in home-based care services for older people. A home environment that facilitates healthy aging can help older adults maximize their self-care abilities and integrate and utilize care resources. However, some home environments fail to meet the needs of older adults with disabilities. OBJECTIVE: This paper aimed to study the needs of older adults with disabilities with respect to adaptation to aging, and to analyze the associations of individual factors and dysfunction with those needs. METHODS: A questionnaire survey was administered to 400 older adults with disabilities from 10 communities in Ningbo City, Zhejiang Province, China. The survey was conducted from August 2018 to February 2019. RESULTS: A total of 370 participants completed the survey. The proportion of participants with mild dysfunction was the highest (128/370, 34.59%), followed by those with extremely mild (107/370, 28.92%), moderate (72/370, 19.46%), and severe (63/370, 17.03%) dysfunction. The care needs of older adults with extremely mild and mild dysfunction pertained primarily to resting, a supportive environment, and transformation of indoor activity spaces. The care needs of older adults with moderate dysfunction pertained mainly to resting and renovation of bathing and toilet spaces. Factors influencing the needs of older adults with disabilities were dysfunction (P=.007), age (P=.006), monthly income (P=.005), and living conditions (P=.04). CONCLUSIONS: The needs of older adults with disabilities varied by the degree of dysfunction, and many factors influenced these needs in the community. These findings may provide a scientific basis for developing community-specific aging-related adaptation services for older adults with disabilities in the future.

Prevalence of Depressive Symptoms and Associated Factors among Internal Migrants with Tuberculosis: A Cross-Sectional Study in China.

There are hundreds of millions of internal migrants in China, and tuberculosis (TB) is an important health threat to them. However, the mental health problems of internal migrants with TB in China have been ignored. The present study aimed to determine the prevalence of depressive symptoms and its associated risk factors among internal migrants with TB in China. A cross-sectional survey was conducted between June 2018 and March 2019 in Shenzhen, southern China. Data were collected from 1,057 internal migrants with TB using a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Multinomial logistic regression analysis was used to identify risk factors for depressive symptoms. Of the 1,057 participants included in this study, 53.8% had depressive symptoms. Of these, 38.9% had mild, whereas 14.9% had moderate-to-severe depressive symptoms. Multinomial logistic regression analysis suggested that higher likelihoods of depressive symptoms were associated with female gender, lower education, family dysfunction, poor doctor-patient communication, and TB-related stigma. This study shows that the prevalence of depressive symptoms among internal migrants with TB is high in China. Targeting interventions and treatment of depressive symptoms among internal migrants with TB are needed.

The impact of the government health funding on prescribing behaviors in community health institutions in China.

Government health funding (GHF) is a cosmopolitan problem. It is especially conspicuous in China, where drug sales become a main source of medical institutions' incomes due to limited GHF. This is well known as China's "drug maintain medical institutions (DMMIs)" system which results directly in very high use of antibiotics, injections, and corticosteroids. However, few statistical data existed in China on the association between the GHF and the prevalence of inappropriate drug prescribing, despite widespread acknowledgment of its existence.A multistage sampling strategy was employed to select 442,100 prescriptions written between 2007 and 2011 by urban community health (CH) institutions and check the GHF in 36 key cities (districts) across China. This study examined the association between the GHF and the prevalence of inappropriate drug prescribing, which differs somewhat from previous studies.The data suggested that from 2007 to 2011, with the increase of GHF, prescribing behaviors (PB) gradually improved on the whole although doctors still prescribed a few more drugs than the recommendations from World Health Organization (WHO). This study found that there is significant negative association between GHF and main indicators of PB (correlation coefficients more than 0.5).The findings implied that government should further perfect the compensation mechanism to medical institutions for gradually weakening the compensation function of drug sales in medical institutions.

Gatekeeping and the utilization of community health services in Shenzhen, China: A cross-sectional study.

To assess the effects of the gatekeeper policy implemented in Shenzhen, China, in conjunction with a labor health insurance program, on channeling patients toward community health centers (CHCs).Eight thousand patients who visited 8 CHCs in Shenzhen were surveyed between May 1, 2013 and July 28, 2013. Half of the patients were subject to gatekeeper policy and the other half of them were not. Structured questionnaire was used to collect patients' choices of initial medical institution, use of CHCs and their satisfaction with health care. Bivariate and regression analyses were used to compare patient's choice, utilization, and satisfaction of CHCs.Compared with patients who were free to seek medical care at any place, patients with gatekeepers were 1.77 (95% CI 1.37-2.30) times more likely to choose CHCs first when seeking care. In the past year, the group with gatekeeper made 0.88 more visits to CHCs in the past year than the group without gatekeeper (P < .01), controlling for influencing factors. The 2 groups were equally satisfied with all satisfaction measures except for "waiting time," which was higher among patients without gatekeepers (P < .01).Our study indicates that, as repeatedly proven in other parts of the world, gatekeeping is effective in orienting patients toward primary care system. Along with increased efforts in rebuilding China's primary care network and expanding health insurance coverage, implementation of gatekeeper policy may help increase access to care, reduce inappropriate use of health resources, and strengthen primary care institutions.

Chinese Version of the EQ-5D Preference Weights: Applicability in a Chinese General Population.

OBJECTIVES: This study aimed to test the reliability, validity and sensitivity of Chinese version of the EQ-5D preference weights in Chinese general people, examine the differences between the China value set and the UK, Japan and Korea value sets, and provide methods for evaluating and comparing the EQ-5D value sets of different countries. METHODS: A random sample of 2984 community residents (15 years or older) were interviewed using a questionnaire including the EQ-5D scale. Level of agreement, convergent validity, known-groups validity and sensitivity of the EQ-5D China, United Kingdom (UK), Japan and Korea value sets were determined. RESULTS: The mean EQ-5D index scores were significantly (P<0.05) different among the UK (0.964), Japan (0.981), Korea (0.987), and China (0.985) weights. High level of agreement (intraclass correlations coefficients > 0.75) and convergent validity (Pearson's correlation coefficients > 0.95) were found between each paired schemes. The EQ-5D index scores discriminated equally well for the four versions between levels of 10 known-groups (P< 0.05). The effect size and the relative efficiency statistics showed that the China weights had better sensitivity. CONCLUSIONS: The China EQ-5D preference weights show equivalent psychometric properties with those from the UK, Japan and Korea weights while slightly more sensitive to known group differences than those from the Japan and Korea weights. Considering both psychometric and sociocultural issues, the China scheme should be a priority as an EQ-5D based measure of the health related quality of life in Chinese general population.

Patient Satisfaction with Community Health Service Centers as Gatekeepers and the Influencing Factors: A Cross-Sectional Study in Shenzhen, China.

PURPOSE: Shenzhen is the first pilot city in China implementing the gatekeeper policy, with community health service (CHS) centers as the gatekeepers. We aim to investigate patient satisfaction with this policy and its influencing factors in Shenzhen. METHODS: 3,848 patients visiting eight CHS centers in Shenzhen of China between May 1 and July 28, 2013 were recruited. We interviewed them using a structured questionnaire to investigate their satisfaction with the gatekeeper policy of CHS. Multivariable logistic regression models were used to identify influencing factors. RESULTS: Of the respondents, 28.17%, 47.27% and 24.56% were satisfied with, neutral to, and not satisfied with the gatekeeper policy respectively. Patient satisfaction with this policy was found to be associated with education level, familiarity with the policy, referral experience, satisfaction with convenience of seeing a doctor, satisfaction with waiting time, satisfaction with medical facility, satisfaction with general medical practitioners' professional skill, and proportion of expense reimbursed. CONCLUSIONS: Our investigation shows that patient satisfaction with the gatekeeper policy was low. To improve patient satisfaction, efforts should be made to increase the convenience of seeing a doctor in community, shorten waiting time, improve general medical practitioners' professional skill, and increase proportion of expense reimbursement.

Patients' Willingness on Community Health Centers as Gatekeepers and Associated Factors in Shenzhen, China: A Cross-sectional Study.

The gate-keeping function of primary healthcare facilities has not been fully implemented in China. This study was aiming at assessing the willingness on community health centers (CHCs) as gatekeepers among a sample of patients and investigating the influencing factors.A cross-sectional survey was conducted in 2013. A total of 7761 patients aged 18 to 90 years from 8 CHCs in Shenzhen (China) were interviewed using a structured questionnaire. Descriptive and multivariable logistic regression analyses were used to analyze the characteristics of patients, their willingness on the gatekeeper policy, and identify the associated factors.On willingness of patients to select CHCs as gatekeepers, 70.03% of respondents were willing, 18.95% were neutral, and 9.02% were unwilling. Multivariable analysis indicated that female patients (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.02-1.30); patients with health insurance (OR = 1.21, 95% CI: 1.07-1.36); patients who lives near CHC (OR = 1.89, 95% CI: 1.17-3.05); and patients who were more familiar with the gatekeeper policy (OR = 2.09, 95% CI: 1.85-2.36), had higher level of willingness on the policy. Conversely, reporting with good health status was independently associated with the decreased willingness on gatekeeper policy (OR = 0.69, 95% CI: 0.53-0.90).The findings indicated that patients' willingness on CHCs as gatekeepers is high. More priority measures, such as expanding medical insurance coverage of patients, strengthening the propaganda of gatekeeper policy, and increasing the access to community health service, are warranted to be taken. This will help to further improve the patients' willingness on CHCs as gatekeepers. It is thus feasible to implement the gatekeeper policy among patients in China.

The effect of essential medicines programme on rational use of medicines in China.

OBJECTIVE: Irrational use of medicines is a serious problem in China and has been the primary target of China's national essential medicines programme (NEMP). The aim of this study was to evaluate the effect of the NEMP on rational use of medicines in China. METHODS: A nationwide sample of 3 76 700 prescriptions written by primary care providers from 2007 to 2011 was obtained following a multistage sampling process. Six prescribing indicators were measured: average number of drugs prescribed per prescription, average expenditure per prescription, percentage of prescriptions with antibiotics, with injections, with two or more antibiotics and with corticosteroids. The pre-post with control study design and the difference-in-difference (DID) methodology were employed to evaluate the effect of NEMP. RESULTS: Prescriptions from primary care institutions with the NEMP implementation were better than those without NEMP implementation. Adjusting for the institution's sizes, ownership, economic geographic regions and the year of NEMP implementation, the DID estimator was statistically significant in all prescribing indicators except for the percentage of prescriptions with injection. The number of drugs per prescription decreased by 0.2 per prescription [95% confidence interval (CI): -0.3, -0.1] after the NEMP was implemented; the percentages of prescriptions with antibiotics, with corticosteroids and with two or more antibiotics decreased by 7% (95% CI: -10, -4), 1% (95% CI: -2, 0) and 2% (95% CI: -3, 0), respectively; and the average expenditure per prescription decreased by eight Renminbi Yuan (95% CI: -14, -2). The effect of NEMP on reducing irrational prescribing was greater in public institutions than in private institutions (P < 0.05). CONCLUSIONS: China's NEMP is effective in promoting rational use of medicines, and the effect is greater in public institutions than in private institutions. However, the irrational use is still high, pointing to the need for further reforms to tackle the underlying causes, such as clinical guidelines and patient education.

Depression and the risk of breast cancer: a meta-analysis of cohort studies.

BACKGROUND: Whether depression causes increased risk of the development of breast cancer has long been debated. We conducted an updated meta-analysis of cohort studies to assess the association between depression and risk of breast cancer. MATERIALS AND METHODS: Relevant literature was searched from Medline, Embase, Web of Science (up to April 2014) as well as manual searches of reference lists of selected publications. Cohort studies on the association between depression and breast cancer were included. Data abstraction and quality assessment were conducted independently by two authors. Random-effect model was used to compute the pooled risk estimate. Visual inspection of a funnel plot, Begg rank correlation test and Egger linear regression test were used to evaluate the publication bias. RESULTS: We identified eleven cohort studies (182,241 participants, 2,353 cases) with a follow-up duration ranging from 5 to 38 years. The pooled adjusted RR was 1.13(95% CI: 0.94 to 1.36; I2=67.2%, p=0.001). The association between the risk of breast cancer and depression was consistent across subgroups. Visual inspection of funnel plot and Begg's and Egger's tests indicated no evidence of publication bias. Regarding limitations, a one-time assessment of depression with no measure of duration weakens the test of hypothesis. In addition, 8 different scales were used for the measurement of depression, potentially adding to the multiple conceptual problems concerned with the definition of depression. CONCLUSIONS: Available epidemiological evidence is insufficient to support a positive association between depression and breast cancer.

Tea consumption and the risk of depression: a meta-analysis of observational studies.

OBJECTIVE: Whether tea consumption decreases the risk of depression remains controversial. We performed a meta-analysis of findings from observational studies to evaluate the association between tea consumption and depression risk. METHOD: Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from their inception through August 2014 for observational studies that had reported the association between tea consumption and depression risk. We used a fixed effects model when heterogeneity was negligible and a random effect model when heterogeneity was significant to calculate the summary relative risk estimates (RRs) and 95% confidence intervals (CIs). RESULTS: Eleven studies with 13 reports were eligible for inclusion in the meta-analysis (22,817 participants with 4,743 cases of depression). Compared to individuals with lower tea consumption, those with higher tea consumption had a pooled RR of depression risk at 0.69 (95% CI: 0.63-0.75). Eight reports were included in the dose-response analysis of tea consumption and depression risk (10,600 participants with 2,107 cases). There was a linear association between tea consumption and the risk of depression, with an increment of 3 cups/day in tea consumption associated with a decrease in the risk of depression of 37% (RR = 0.63, 95% CI: 0.55-0.71). CONCLUSION: Tea consumption is associated with a decreased risk of depression.

Shift work and diabetes mellitus: a meta-analysis of observational studies.

BACKGROUND: Observational studies suggest that shift work may be associated with diabetes mellitus (DM). However, the results are inconsistent. No systematic reviews have applied quantitative techniques to compute summary risk estimates. OBJECTIVES: To conduct a meta-analysis of observational studies assessing the association between shift work and the risk of DM. METHODS: Relevant studies were identified by a search of PubMed, Embase, Web of Science and ProQuest Dissertation and Theses databases to April 2014. We also reviewed reference lists from retrieved articles. We included observational studies that reported OR with 95% CIs for the association between shift work and the risk of DM. Two authors independently extracted data and assessed the study quality. RESULTS: Twelve studies with 28 independent reports involving 226 652 participants and 14 595 patients with DM were included. A pooled adjusted OR for the association between ever exposure to shift work and DM risk was 1.09 (95% CI 1.05 to 1.12; p=0.014; I(2)=40.9%). Subgroup analyses suggested a stronger association between shift work and DM for men (OR=1.37, 95% CI 1.20 to 1.56) than for women (OR=1.09, 95% CI 1.04 to 1.14) (p for interaction=0.01). All shift work schedules with the exception of mixed shifts and evening shifts were associated with a statistically higher risk of DM than normal daytime schedules, and the difference among those shift work schedules was significant (p for interaction=0.04). CONCLUSIONS: Shift work is associated with an increased risk of DM. The increase was significantly higher among men and the rotating shift group, which warrants further studies.