Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study.

OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

Association between physical activity energy expenditure and cardiometabolic risk factor clustering among Chinese adults in 2015.

To understand the association between cardiometabolic risk factor (CMRF) clustering and physical activity (PA) levels, we included 86520 Chinese adults aged 18-64 years having at least one CMRF (hypertension, diabetes, dyslipidemia, or obesity) from the China Chronic Disease and Nutrition Surveillance survey in 2015, a nationally and provincially representative investigation with a multistage clustering sampling design. Self-reported PA information was collected with the Global Physical Activity Questionnaire through face-to-face interviews. In view of the obesity epidemic in CMRF patients, PA energy expenditure (PAEE) per kilogram body weight was used, and was defined into four categories: (i) inactivity: 0 â€‹kJ/kg/day; (ii) low activity: 0-5 â€‹kJ/kg/day; (iii) moderate activity: 6-11 â€‹kJ/kg/day; and (iv) vigorous activity: ≥ 12 â€‹kJ/kg/day. The estimated weighted prevalence (95% confidence interval [CI]) of having 1, 2, 3, and 4 CMRFs was 60.57% (59.48%-61.67%), 28.10% (27.40%-28.79%), 9.82% (9.22%-15.42%) and 1.50% (1.37%-1.63%), respectively. The rate (95%CI) of inactivity, low activity, moderate activity, and vigorous activity was 34.52% (32.69%-36.35%), 22.22% (21.37%-23.37%), 15.98% (15.38%-16.58%) and 27.28% (26.02%-28.53%), respectively. For those having 2, 3 and 4 CMRFs (compared to those having 1 CMRF), the adjusted odds ratio (95%CI) for moderate activity and vigorous activity were 0.91 (0.85-0.98) and 0.92 (0.85-0.99), 0.87 (0.80-0.95) and 0.84 (0.77-0.92), and 0.77 (0.67-0.89) and 0.85 (0.72-1.00), respectively. In conclusion, CMRF clustering was a pandemic among Chinese adults in 2015 and was inversely associated with PA level. PAEE (in kJ/kg/day) may be introduced into PA management practice, especially for populations with high body weight.

Punishment cost affects third-parties' behavioral and neural responses to unfairness.

Third-party punishment plays a crucial role in fairness norm enforcement. The present study investigated how punishment cost would affect third-parties' behavioral and neural responses to unfairness using a modified Third-Party Dictator Game and functional magnetic resonance imaging (fMRI). Participants acted as third-parties and decided how many monetary units (MUs) to invest to punish norm violations in two punishment cost contexts. Participants' every MU investment reduced dictators' payoff by 6 MUs in the low punishment cost context and 3 MUs in the high one. Participants' invested MUs reflected the cost they would like to pay to punish dictators while dictators' reduced MUs represented the amount of punishment they received. Behavioral results showed participants' fairness ratings were not affected by punishment cost. However, punishment amount decreased in the high punishment cost context where participants invested more MUs and spent more time for decision-making. Neurally, left anterior insula (AI) and bilateral dorsolateral prefrontal cortex (dlPFC) showed stronger responses to unfair relative to fair allocations in both contexts. Moreover, dorsal anterior cingulate cortex (dACC) was more active during unfair allocations in the high punishment cost context than in the low one and the difference of dACC activity between these two conditions was positively correlated with the difference of reaction times. Overall, the present study demonstrated that punishment cost would not affect people's fairness perception but increase the conflicts between norm enforcement and self-interest. The decision for punishment was the outcome of integrating fairness and economic considerations.

Burden of cardiovascular disease from 1990 to 2017 in Henan Province, China.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading causes of death in China. Little is known about the CVD burden and risk factors in Henan Province, China. OBJECTIVE: To analyze the CVD burden and main risk factors between 1990 and 2017 in the Henan Province in China. METHODS: The methodological framework and analytical strategies adopted in the Global Burden of Disease Study 2017 were used. RESULTS: (1) Age-standardized mortality rate attributed to CVDs increased from 355.0 per 100,000 persons in 1990 to 364.1 per 100,000 persons in 2017 in Henan. (2) Age-standardized disability adjusted life years (DALYs) rate fell by 3.9% from 1990 to 2017. However, the number of DALYs attributed to CVDs increased by 75.9% from 4.2 million person-years in 1990 to 7.3 million person-years in 2017. (3) The age-standardized years lived with disability (YLDs) rate increased by 27.5% from 1990 to 2017. However, years of life lost (YLLs) rate decreased by 6.7% from 1990 to 2017. The contribution of YLLs to the DALYs decreased from 91.4% in 1990 to 89.2% in 2017. (4) Stroke (52.3%) and ischemic heart diseases (38.8%) accounted for 91.1% of total CVDs DALYs among adults in 2017. (5) Dietary factors such as high intake of sodium, alcohol use and low intake of fruits, high systolic blood pressure, and tobacco use were the top risk factors for CVDs, and the estimated population attributable fraction in 2017 was 69.4%, 56.7% and 25.2%, respectively. CONCLUSIONS: The absolute burden of CVDs in Henan is still high, although age-standardized DALYs declined between 1990 and 2017. The prevention and control of stroke and ischemic heart diseases should focus on a few modifiable risk factors which mainly contributed to the burden of CVDs, such as dietary factors, high systolic blood pressure, and tobacco use.

Analysis of factors influencing the frequency of primary care visits among diabetic patients in two provinces in China.

BACKGROUND: Community health services have played an important role in the prevention and control of diabetes in China. The aims of this study were to examine the frequency of visits to community clinics for diabetic care services, to assess factors correlated with infrequent primary care visits and to identify barriers to regular follow-up visits for urban and rural patients. METHODS: Between October 2014 and November 2014, data were collected from 17 communities in two cities and four townships located in Shandong and Jiangsu Provinces in China. A total of 1598 diabetic patients aged 18 years or older who were registered with a primary health station in local communities were selected by simple random sampling. Each participant was required to complete an interviewer-led questionnaire. Univariate and multivariate analyses were used to identify significant factors for infrequent visitor status using multivariable logistic regression analysis. RESULTS: After being clearly informed of the study protocol, 1508/1598 (94.4%) patients agreed to participate in this survey. Among the 1508 subjects (mean age 64.4 ± 10.6), 683 (45.3%) were classified as infrequent visitors. The following were significant factors determining infrequent visitor status: urban residence, lack of health insurance, per-capita household income< 20,000 (yuan), lack of telephone follow-up and lack of household visit. From the patients' perspectives, the reasons for infrequent visits among urban patients included drug scarcity and longer travel time to clinics. For rural patients, worries about medical expenses and drug scarcity were the most common barriers to clinic visits. CONCLUSION: Determinants of infrequent community visits in diabetes patients include urban residence, lower household income, lack of health insurance, lack of telephone follow-up and lack of household visit services. Strategies aimed at enhancing the utilization of community health care should be implemented in China.

Basal energy expenditure, resting energy expenditure and one metabolic equivalent (1 MET) values for young Chinese adults with different body weights.

BACKGROUND AND OBJECTIVES: Accurately assessing energy expenditure (EE) of people with different body weight is essential to facilitate weight management. The aim of this study was to measure basal energy expenditure (BEE), resting energy expenditure (REE) and to explore the true 1 MET value for young Chinese adults with different body weight. METHODS AND STUDY DESIGN: A total of 251 young Chinese adults were divided into three groups: the normal weight group, the overweight group and the obese group. Their BEE, REE and 1 MET values were measured by Cortex Metamax 3B (MM3B). Multiple linear regressions and correlation analysis were used to examine factors that influence EE in Chinese population. RESULTS: The mean measured BEE and REE of young Chinese adults with normal weight, overweight and obesity was 1429, 1609, 1778 kcal/day and 1522, 1712, 1885 kcal/day, respectively. The EE per kilogram body weight decreased with the increasing body weight. The mean oxygen consumption in the three group was 3.78, 3.47, 3.21 mL/kg/min respectively. There was no significant difference in BEE and REE after adjustment for fat-free mass (FFM). The significant influencing factors were body mass index (BMI) and sex in BEE, FFM and BMI in REE in Chinese population. CONCLUSIONS: BEE and REE were significantly different for different body weights while these differences disappeared after adjustment for FFM, and people with different body weights may have different 1 MET values. Further studies should be conducted to obtain more accurate daily energy requirement and 1MET value for specific Chinese populations.

[Investigation on knowledge, attitude and behavior of salt reduction in Chinese adults, 2010].

OBJECTIVE: To explore the knowledge, attitude and behavior of salt reduction among Chinese adults aged over 18 years old in 2010. METHODS: A total of 96 916 adults aged over 18 were recruited from 162 surveillance points in 2010, applying multi-stage stratified cluster random sampling method.Information about subjects salt reduction related knowledge, attitude and behavior were collected by face-to-face interview. After performing complex weighted analysis, the awareness, willingness and behavior rates were compared by different genders, age groups, urban, rural and different regions. RESULTS: The unweighted salt reduction rate of the awareness, willingness and behavior among Chinese adults were 63.0%, 84.5% and 44.5%. After being weighted, the awareness rate was 62.9%, the awareness rate difference was not significant between males (62.4%) and females (63.4%) (χ(2) = 1.66, P > 0.05), but the urban areas (77.1%) were significantly higher than the rural areas (56.3%) (χ(2) = 85.11, P < 0.01) . The difference among different ages was significant (χ(2) = 228.68, P < 0.01) with descending order in 18-44, 45-59 and ≥ 60 years old (67.8%, 59.8%, 50.1%, respectively). The difference among different regions was not significant (χ(2) = 9.82, P < 0.01) in eastern, central and western China (68.2%, 61.3%, 57.1%, respectively). After being weighted, the willingness rate was 83.8%, the willingness rate in females (85.8%) was significantly higher than that in males (81.9%) (χ(2) = 61.92, P < 0.01) , and the urban areas (87.1%) were significantly higher than the rural areas (82.3%) (χ(2) = 15.49, P < 0.01) . The difference among different ages was significant (χ(2) = 74.50, P < 0.01) with descending order in 18-44, 45-59 and ≥ 60 years old (85.3%, 83.1%, 79.6%, respectively). The difference was not significant (χ(2) = 0.58, P > 0.05) among eastern, central and western China (84.3%, 84.0%, 82.9%, respectively). After being weighted, the behavior rate of salt reduction was 42.2%, the behavior rate in females (45.6%) was significantly higher than that in males (38.8%) (χ(2) = 107.74, P < 0.01), and urban areas (56.5%) were significantly higher than the rural areas (35.6%) (χ(2) = 74.38, P < 0.01) . The difference was not significant (χ(2) = 4.19, P > 0.05) among 18-44, 45-59 and ≥ 60 years old(41.5%, 43.6%, 42.2%, respectively). The behavior rate of salt reduction difference in eastern China(47.8%) was significantly higher than that in central (38.9%) and western (38.0%) (χ(2) = 7.22, P < 0.05). CONCLUSIONS: The rate of willingness to reduce salt is higher, but the awareness rate and the behavior rate of salt reduction are not high, especially among the population who are from rural area, or who are from central and western China.

[Assessment of left ventricle volume filling curve with magnetic resonance imaging: a preliminary study].

OBJECTIVE: To conduct a preliminary study on the reliability of left ventricle volume filling curve through the commercial medical program Report-Card 4.0. METHODS: A total pf 22 normal volunteers underwent the examination. Images of standard 2-chamber view and short-axis view were acquired at end-expiration by electrocardiography-gated FIESTA CINE sequence. Then one experienced doctor manually contoured the endocardium during end-systole and end-diastole phases respectively, obtained the results of the volume of end-diastole (EDV) and end-systole (ESV), ejection fraction (EF), stroke volume (SV) and cardiac output (CO), processing time and mean processing time per phase. Papillary muscle was not included into left ventricle volume. Another two observers utilized LV ANALYSIS of Report-Card, generated the left ventricle volume filling curve and recorded the processing time and mean processing time per phase. From the curve, EDV, ESV, SV, EF, CO, peak ejecting rate (PER) and peak filling rate (PFR) were also acquired. One observer repeated the procedures a week later. RESULTS: The difference of results from two methods were insignificant (P > 0.05) and the correlation was excellent (EDV 0.963, ESV 0.944). Intra-observer and inter-observer variability for measurements (EDV, ESV) were assessed by Bland-Altman analysis and interclass correlation coefficient (0.985, 0.987, 0.959 and 0.957 respectively). The mean processing time (179 ± 51) s by means of manually contouring was significantly less than the mean processing time (331 ± 99) s through REPORT-CARD 4.0 (P < 0.001). However, the mean processing time per phase (17 ± 5) s by means of REPORT-CARD 4.0 was significantly less than the mean processing time per phase (89 ± 26) s through manually contouring (P < 0.001). CONCLUSION: The reliability of left ventricle volume filling curve generated through Report-Card is excellent. Left ventricle volume filling curve may be a reliable method of further studying the functions of left ventricle.

[Leisure-time physical activity and sedentary behaviors among Chinese adults in 2010].

OBJECTIVE: To understand the prevalence of participation in leisure-time physical activity, and sedentary behaviors among Chinese adults. METHODS: Data from Chinese Chronic Disease Surveillance (2010) was used. Among adults aged 18 years old and over, the information on frequency and duration of occupational activity, house chores, commuting and leisure time activity was collected by an interview with Global Physical Activity Questionnaire (GPAQ). The time spent on watching TV, reading, using computers or playing games after work was also surveyed. This present study only analyzed the percentage of participating in leisure time moderate or vigorous intensity physical activity at least 10 minutes three days per week and the time spent on TV, reading, using computer and playing games during after hours among Chinese adults of 98 649 subjects. RESULTS: 11.9% (95%CI: 10.5% - 13.3%) of all adults took part in leisure time moderate or vigorous intensity physical activity at least 10 minutes for three days per week, with-group the percentage highest among age-group 18 - 24 (15.6%, 95%CI: 10.5% - 13.3%) and lowest among age 25 - 34 (9.9%, 95%CI: 8.0% - 11.7%) and 75 years old and over (9.9%, 95%CI: 8.2% - 11.6%) (P < 0.01). The age related change showed a double-peak curve. The percentage was higher in male (13.1%, 95%CI: 11.6% - 14.6%) than in female (10.6%, 95%CI: 9.3% - 12.0%) (P < 0.01). Among the populations engaged in diverse occupations, the lowest percentage was detected among those in farming, forestry, husbandry and fishing (4.2%, 95%CI: 3.4% - 4.9%). Higher percentage was found among the residents lived in urban areas (19.9%, 95%CI: 17.4% - 22.5%) than in rural areas (8.2%, 95%CI: 6.7% - 9.8%) (P < 0.01), and higher in the east area (14.8%, 95%CI: 11.9% - 17.6%) compared to that in central (9.7%, 95%CI: 8.1% - 11.3%) or in west areas (10.3%, 95%CI: 8.4% - 12.3%) in China (P < 0.01). Furthermore, (2.7 ± 2.0) hours per day was spent in sedentary behaviors, such as watching TV, reading, using computers or playing games during after hours. Those aged 18 - 24 years-old spent most time (3.8 ± 2.6) hours per day in sedentary behaviors and the time reduced with age (P < 0.01). More time on Sedentary behaviors were taken by male (2.9 ± 2.1 hours per day) than by female ((2.6 ± 1.9) hours per day) (P < 0.01), with more hours spent in urban ((3.3 ± 2.2) hours per day) than that in rural ((2.5 ± 1.9) hours per day) (P < 0.01). No difference was detected among the residents lived in east ((2.9 ± 2.1) hours per day), central ((2.7 ± 2.0) hours per day) and west area ((2.6 ± 2.0) hours per day) (P > 0.05). CONCLUSION: The percentage of taking part in moderate and vigorous activity during leisure time was generally low. Average time spent in after hours sedentary behaviors was long.