Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai.

The purpose of this study was to analyze the health status and unmet healthcare needs, and the impact of related factors, of unwell migrants in Shanghai. A total of 10,938 respondents, including 934 migrants and 10,004 non-migrants, were interviewed in Shanghai's Sixth Health Service Survey. Descriptive statistics were utilized to present the prevalence of health status and unmet healthcare needs. Binary logistic regression analysis was performed to explore the relationships between predisposing factors, enabling factors, need factors, and health-related behavior and unmet healthcare needs in the Anderson health service utilization model. This study indicated the percentages of migrants having a fair or poor self-evaluated health status (21.09%) and suffering from chronic diseases (72.91%) were lower than those of non-migrants (28.34% and 88.64%, respectively). Migrants had higher percentages of unmet hospitalization needs (88.87%), unmet outpatient care needs (44.43%), and self-medication (23.98%) than those of non-migrants (86.24%, 37.95%, 17.97%, respectively). Migrants enrolled in Urban Employee Basic Medical Insurance were more likely to utilize hospitalization services (OR = 1.457) than those enrolled in other health insurances or uninsured. Need factors had impacts on unwell migrants' unmet healthcare needs. Other factors, including age and health behavior, were also found to significantly affect unwell migrants' unmet health service needs. Specific gaps continue to exist between unwell migrants and non-migrants regarding the accessibility of local health services. Flexible policies, such as enhancing the health awareness of migrants and eliminating obstacles for migrants to access medical services, should be implemented to provide convenient and affordable healthcare services to unwell migrants.

The ecology of medical care in Shanghai.

BACKGROUND: To better understand the distribution and consumption patterns of resources in different ethnic groups and at different levels of economic development, this paper chose to describe the healthcare seeking behavior in Shanghai. METHODS: The data are from the Sixth Health Service Survey of Shanghai, which encompasses 23,198 permanent residents. Descriptive analyses were conducted to estimate the number of patients who reported health-related symptoms and healthcare-seeking behaviors per 1,000 residents. Logistic regression analyses were conducted to examine differences in reporting health-related symptoms and healthcare-seeking behaviors by age, gender and area of residence. RESULTS: This paper have mapped the ecology of healthcare in Shanghai in 2018. Of 1000 individuals considered during a 1-month period, 444 reported sickness, 433 received treatment, 288 went to medical institutions, 195 went to primary medical institutions, 86 took a self-healing approach, 26 received TCM services, 7 were hospitalized, and 3 underwent surgery. CONCLUSIONS: Age is a risk factor leading to disease, medical treatment, self-medication, medical institution visits, TCM service, hospitalization and surgery. But age is a protective factor in the use of primary health care services. By gender, the number of people receiving medical services was similar, but women were statistically more likely to have surgery. As the income level increased, the number of patients and people receiving medical services showed a decreasing trend. Compared with the local population, the probability of non-local people visiting medical institutions was lower and statistically significant. Compared with the people who had health insurance, fewer uninsured people reported sickness and utilized healthcare services.

Comparing Regional Distribution Equity among Doctors in China before and after the 2009 Medical Reform Policy: A Data Analysis from 2002 to 2017.

BACKGROUND: Although China began implementing medical reforms in 2009 aimed at fair allocation of the regional distribution of doctors, little is known of their impact. This study analyzed the geographic distribution of doctors from 2002 to 2017. METHODS: This study calculated the Gini coefficient and Theil index among doctors in the eastern, central, and western regions (Category 1) of China, and in urban and rural areas (Category 2). The statistical significance of fairness changes was analyzed using the Mann-Whitney U test. RESULTS: The annual growth rates of the number of doctors for the periods from 2002 to 2009 and 2010 to 2017 were 2.38% and 4.44%. The Gini coefficients among Category 1 were lower than those in Category 2, and statistically decreased after the medical reforms (P < 0.01) but continued to increase in Category 2 (P = 0.463). In 2017, the Theil decomposition result of Category 1 was 74.33% for the between-group, and in Category 2, it was 95.22% for the within-group. CONCLUSIONS: The fairness among the regional distribution of doctors in Category 1 is now at a high level and is better than that before the reforms. While the fairness in Category 2 is worse than that before the reforms, it causes moderate inequality and is continually decreasing. Overall unfairness was found to be derived from the between-group.

Residue behaviors and risk assessment of flonicamid and its metabolites in the cabbage field ecosystem.

Flonicamid, a novel selective systemic pesticide, can effectively control a broad range of insect pests. However, the dissipation behaviors and the terminal residues of flonicamid and its metabolites in some crops and soils remain unclear. Herein, an easy, sensitive and reliable method using a modified QuEChERS extraction coupled with LC-MS/MS for the simultaneous analysis of flonicamid and its metabolites in cabbage and soil was developed. Based on this method, the dissipation behaviors of flonicamid and its metabolites as well as their persistence in cabbage and soil during harvest were investigated. Flonicamid degraded rapidly, and the half-lives of flonicamid only and total residues (the sum of flonicamid and its metabolites) were 1.49-4.59 and 1.97-4.99 days in cabbage, and 2.12-7.97 and 2.04-7.62 days in soil, respectively. When 50% flonicamid WG was sprayed once or twice at the recommended dose and 1.5-fold the recommended dose, the highest residues of total flonicamid in cabbage and soil from different pre-harvest intervals (3, 7 and 14 days) were 0.070 and 0.054 mg kg-1, respectively. The risk quotient (RQ) of flonicamid based on the consumption data from China was below 16.84%, indicating that the use of flonicamid is non-hazardous to humans. These results could not only guide the safe and responsible use of flonicamid in agriculture but also help the Chinese government establish the maximum residue level (MRL) for flonicamid in cabbage.

Residue behavior and risk assessment of thifluzamide in the maize field ecosystem.

In the present work, the dissipation kinetics and final residue levels of thifluzamide in the maize field ecosystem were investigated. Using a modified quick, easy, cheap, effective, rugged, and safe (QuEChERS) extraction combined with liquid chromatography-tandem mass spectrometric detection (LC-MS/MS), a rapid, sensitive, efficient, and reliable method for extraction and quantitative analysis of thifluzamide residues in maize grain, maize plant, and soil was developed. Satisfactory recoveries of 78.7-97.0% were achieved with relative standard deviations (RSDs) in the range of 1.6 to 8.2%. The limits of detection (LODs) and the limit of quantification (LOQ) were 0.002-0.005 and 0.010 mg kg-1, respectively. The dissipation kinetics of thifluzamide in maize plant was well fitted by the first-order kinetic model with short half-lives of 0.19-0.22 days, while thifluzamide degraded slowly in soil with half-lives of 4.56-15.85 days. The final residues in maize grain, maize plant, and soil samples collected at the milk stage and the physiological maturity stage were no more than 0.010, 0.807, and 0.278 mg kg-1, respectively. Given that no maximum residue limit (MRL) for thifluzamide in maize has been established, the safety of this fungicide application was estimated by a dietary risk assessment. The hazard quotient was 0.03%, which was substantially less than 1, indicating that the long-term risk induced by the thifluzamide application on maize at the recommended dose is negligible. These results help governments to develop regulations for the safe use of thifluzamide.

Raman microscopic applications in the biopharmaceutical industry: in situ identification of foreign particulates inside glass containers with aqueous formulated solutions.

Particle identification is an important analytical procedure for quality control and assurance in the biopharmaceutical industry. Rapid and reliable identification of micro-particles helps in evaluating the nature of particle contamination and its consequences on the product quality regulated by internal and external standards. Raman microscopy is one of the microspectroscopic techniques that can be used to identify micro-particles with the advantage of in situ detection. In this paper we demonstrate that a visible laser Raman microscope was particularly useful to identify micro-particles that were inside glass containers such as glass syringes, vials, and test tubes, which are commonly used as containers for aqueous formulated drugs. The examples include the identifications of a droplet-like particle inside a pre-filled glass syringe, a fibrous particle inside a glass test tube, and a white particle inside a glass vial; all of these examples usually demand challenging or time-consuming sample manipulation for other techniques. The Raman microscopic technique was shown to be able to solve these challenging micro-particle identifications due to its ability to carry out detection in situ. Particularly in the example of micro-droplet identification, the Raman microscopic technique was the only choice for a fast and successful particle detection. For all three identifications, Raman in situ detection has significantly accelerated particle analysis and avoided potential sample secondary contamination or losses owing to none or minimal sample manipulation.

Stereochemical determination and bioactivity assessment of (S)-(+)-curcuphenol dimers isolated from the marine sponge Didiscus aceratus and synthesized through laccase biocatalysis.

Electrospray ionization mass spectrometry-guided isolation of extracts from Didiscus aceratus led to the discovery of several new derivatives of the bioactive bisabolene-type sponge metabolite (S)-(+)-curcuphenol (1). The compounds obtained by this method included a mixture of known (2) and new (3) dihydroxylated analogs as well as a novel family of dimeric derivatives, dicurcuphenols A-E (4-8), and dicurcuphenol ether F (9). Dimers 4-9 were also subsequently obtained through a hemisynthetic method in which 1 was incubated with the enzyme laccase. Atropisomeric dimers 5 and 6 were subjected to vibrational circular dichroism analysis thereby establishing their absolute biaryl axial chirality as P and M, respectively. In contrast to 1, metabolites 2-9 exhibited weak or no cytotoxic or lipoxygenase inhibitory effects.