The Health Cost of Organizational Citizenship Behavior: Does Health-Promoting Leadership Matter?

Previous research has mainly focused on the positive effects of organizational citizenship behavior (OCB). This study questions the positive impact of OCB, arguing that there is a health cost of OCB. Based on the conservation of resource theory, this study expects that OCB triggers citizenship fatigue, which, in turn, negatively affects employees' health and results in health complaints. This study also seeks to find a moderator (health-promoting leadership) that could mitigate the negative effects of citizenship fatigue (caused by engaging in OCB) on health complaints. To test our predictions, we collected three-wave data from 207 leader-subordinate dyads. The results of regression analyses show that OCB is positively related to employees' health complaints, which is mediated by citizenship fatigue. Health-promoting leadership weakens the positive relationship between citizenship fatigue and health complaints, thus negatively moderating the indirect relationship between OCB and health complaints via citizenship fatigue. This study provides theoretical and practical implications for future research directions.

The impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China.

BACKGROUND: Since 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making. METHODS: The Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018. RESULTS: The reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures. CONCLUSION: We conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).

A new framework to address challenges in quantitative benefit-risk assessment for medical products.

In recent years, there has been a proliferation of regulatory and industry-wide initiatives on structured benefit-risk (BR) assessment. Examples of structured BR frameworks include the PrOACT-URL (Problem formulation, Objectives, Alternatives, Consequences, Trade-Offs, Uncertainties, Risk Attitude and Linked Decisions) from European Medicines Agency Work Package 3, multiple U.S. Food and Drug Administration guidance documents on benefit-risk assessment for medical devices, and U.S. Food and Drug Administration implementation plans for benefit-risk assessment in drug regulatory decision-making. In June 2016, the ICH Expert Working Group finalized the Common Technical Document (CTD) Section 2.5.6 on Benefit-Risk Evaluations. As a result of these efforts, the uptake and utilization of structured benefit-risk (BR) assessments has been increasing. However, the aforementioned BR frameworks are mostly qualitative in nature, and the utility of quantitative BR approaches has not been systemically explored, creating uncertainty about settings in which quantitative BR assessment (qBRA) could be optimally applied. In this paper, we will provide an overview of the current qBRA methods, discuss challenges of qBRA, and describe a structural qBRA framework. The performance of the described qBRA framework will be evaluated by simulations based on a case study.

[Influence of Land Use Change on Ecosystem Service Value Based on GEE in the Beijing-Tianjin-Hebei Region from 1998 to 2018].

In sustainable development assessment of the Beijing-Tianjin-Hebei region, the ability to dynamically estimate the value of ecosystem services is of great significance. This study considers the Beijing-Tianjin-Hebei region as the research area, based on the google earth engine (GEE); the classification and decision tree (CART) classification algorithm was adopted to supervise and classify the Landsat Thematic Mapper/Operational Land Imager (TM/OLI) images in the study area in 1998, 2003, 2008, 2013, and 2018, and land use types in these five periods were obtained. Quantitative analysis of the dynamic changes of land use in the Beijing-Tianjin-Hebei region from 1998 to 2018 was carried out. Then, the ecosystem service value (ESV) equivalent estimation method was used to quantitatively estimate the ESV in the Beijing-Tianjin-Hebei region and combine it with a 15 km×15 km scale grid to detect its temporal and spatial dynamics. The main results were as follows. ① From 1998 to 2018, the area of construction land (increased by 16.67%) and grassland (reduced by 13.73%) in the six land use types in the Beijing-Tianjin-Hebei region was the largest, and the change in the proportion of water bodies (0.2%) was the smallest. ② The total value of ESV in the Beijing-Tianjin-Hebei region experienced a short-term increase from 1998 to 2003 (an increase of 91.97×108 yuan), and continued to decrease from 2003 to 2018 (a decrease of 239.07×108 yuan), mainly related to the expansion of construction land area in the other three time periods excluding 1998 and 2003. Among the six land use types, the forest provides the highest value of ecosystem services, and the construction land and unused land provide the lowest value of ecosystem services. ③ The ESV time-space analysis based on the 15 km×15 km scale grid showed that the ESV medium area in the Beijing-Tianjin-Hebei region gradually decreased from 1998 to 2018, the ESV lower area and the higher area gradually increased, and the ESV lower-area growth rate was higher than for the higher area. ④ The revised value of the Beijing-Tianjin-Hebei region (sensitivity coefficient range 0-0.83) has good significance and reliability. In future economic development, the Beijing-Tianjin-Hebei region should rationally optimize the land use pattern and strengthen the protection of forest land, grassland, water bodies and cultivated land.

Electronic Health Record Driven Prediction for Gestational Diabetes Mellitus in Early Pregnancy.

Gestational diabetes mellitus (GDM) is conventionally confirmed with oral glucose tolerance test (OGTT) in 24 to 28 weeks of gestation, but it is still uncertain whether it can be predicted with secondary use of electronic health records (EHRs) in early pregnancy. To this purpose, the cost-sensitive hybrid model (CSHM) and five conventional machine learning methods are used to construct the predictive models, capturing the future risks of GDM in the temporally aggregated EHRs. The experimental data sources from a nested case-control study cohort, containing 33,935 gestational women in West China Second Hospital. After data cleaning, 4,378 cases and 50 attributes are stored and collected for the data set. Through selecting the most feasible method, the cost parameter of CSHM is adapted to deal with imbalance of the dataset. In the experiment, 3940 samples are used for training and the rest 438 samples for testing. Although the accuracy of positive samples is barely acceptable (62.16%), the results suggest that the vast majority (98.4%) of those predicted positive instances are real positives. To our knowledge, this is the first study to apply machine learning models with EHRs to predict GDM, which will facilitate personalized medicine in maternal health management in the future.

Psychosocial therapy for Parkinson's-related dementia: study protocol for the INVEST randomised controlled trial.

INTRODUCTION: Parkinson's disease (PD) with mild cognitive impairment (MCI-PD) or dementia (PDD) and dementia with Lewy bodies (DLB) are characterised by motor and 'non-motor' symptoms which impact on quality of life. Treatment options are generally limited to pharmacological approaches. We developed a psychosocial intervention to improve cognition, quality of life and companion burden for people with MCI-PD, PDD or DLB. Here, we describe the protocol for a single-blind randomised controlled trial to assess feasibility, acceptability and tolerability of the intervention and to evaluate treatment implementation. The interaction among the intervention and selected outcome measures and the efficacy of this intervention in improving cognition for people with MCI-PD, PDD or DLB will also be explored. METHODS AND ANALYSIS: Dyads will be randomised into two treatment arms to receive either 'treatment as usual' (TAU) or cognitive stimulation therapy specifically adapted for Parkinson's-related dementias (CST-PD), involving 30 min sessions delivered at home by the study companion three times per week over 10 weeks. A mixed-methods approach will be used to collect data on the operational aspects of the trial and treatment implementation. This will involve diary keeping, telephone follow-ups, dyad checklists and researcher ratings. Analysis will include descriptive statistics summarising recruitment, acceptability and tolerance of the intervention, and treatment implementation. To pilot an outcome measure of efficacy, we will undertake an inferential analysis to test our hypothesis that compared with TAU, CST-PD improves cognition. Qualitative approaches using thematic analysis will also be applied. Our findings will inform a larger definitive trial. ETHICS AND DISSEMINATION: Ethical opinion was granted (REC reference: 15/YH/0531). Findings will be published in peer-reviewed journals and at conferences. We will prepare reports for dissemination by organisations involved with PD and dementia. TRIAL REGISTRATION NUMBER: ISRCTN (ISRCTN11455062).

Optimizing Peri-URban Ecosystems (PURE) to re-couple urban-rural symbiosis.

Globally, rapid urbanization, along with economic development, is dramatically changing the balance of biogeochemical cycles, impacting upon ecosystem services and impinging on United Nation global sustainability goals (inter alia: sustainable cities and communities; responsible consumption and production; good health and well-being; clean water and sanitation, and; to protect and conserve life on land and below water). A key feature of the urban ecosystems is that nutrient stocks, carbon (C), nitrogen (N) and phosphorus (P), are being enriched. Furthermore, urban ecosystems are highly engineered, biogeochemical cycling of nutrients within urban ecosystems is spatially segregated, and nutrients exported (e.g. in food) from rural/peri-urban areas are not being returned to support primary production in these environments. To redress these imbalances we propose the concept of the Peri-URban Ecosystem (PURE). Through the merging of conceptual approaches that relate to Critical Zone science and the dynamics of successional climax PURE serves at the symbiotic interface between rural/natural and urban ecosystems and allow re-coupling of resource flows. PURE provides a framework for tackling the most pressing of societal challenges and supporting global sustainability goals.

Security and cost comparison of INR self-testing and conventional hospital INR testing in patients with mechanical heart valve replacement.

BACKGROUND: International normalized ratio (INR) self-testing can improve the management of anticoagulation therapy with warfarin for the patients following mechanical heart valve replacement. Several reviews and studies have demonstrated self-management as an option to improve patient's outcome considerably after mechanical heart valve replacement. We sought to analyze the security, economy and discuss the prospect of self-testing of anticoagulation therapy in patients following mechanical heart valve replacement in China, and evaluate the accuracy and stability of CoaguChek XS portable INR-testing device. METHODS: This was a prospective self-controlled clinical study conducted with 526 patients receiving oral warfarin anticoagulation therapy after mechanical heart valve replacement in the period of Mar.1, 2012 - Nov.1, 2012 in Cardiovascular Surgery Department of West China Hospital of Sichuan University. The same patient performed INR testing with CoaguChek XS portable coagulometer (group1) and central lab (group 2) in parallel. The follow-up time was 6 months. Meanwhile, a questionnaire was handed out to survey the expenses required for the re-examination visits to the hospital, time, and anticoagulation complications. RESULTS: No severe anticoagulation complications occurred in all the patients. No significant difference of the INR results were observed between group 1 and group 2, they showed significant relevance, r = 0.953(p < 0.05). Compared with the conventional method of INR testing in hospital, the portable coagulometer is convenient, quick and less traumatic. Self-testing of anticoagulation therapy reduced the cost and the time required for re-examination. CONCLUSIONS: Results of CoaguChek XS monitor are precise and have a good consistency and stability as compared with traditional laboratory testing. For the patients receiving anticoagulation therapy after mechanical heart valve replacement, the self-testing of anticoagulation therapy with portable coagulometer is a safe choice, and it has a promising future application in China.

The association between low socioeconomic status with high physical limitations and low illness self-perception in patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study.

OBJECTIVE: To examine the association between socioeconomic status (SES) and delay to a pediatric rheumatology clinic, disease severity, and illness perception in patients with juvenile idiopathic arthritis in England. METHODS: Using the Index of Multiple Deprivation, 923 consecutive children from the Childhood Arthritis Prospective Study were assigned to SES groups: high-SES (19.1%), middle-SES (44.5%), or low-SES (36.4%). At baseline, disease activity was assessed, and the Childhood Health Assessment Questionnaire (C-HAQ), the Illness Perception Questionnaire, and the Child Health Questionnaire, version Parent Form 50, were completed. Linear median regression analyses or zero-inflated negative binominal (ZINB) regression analyses were used. RESULTS: Delay to first pediatric rheumatology consultation was the same between the 3 SES groups. Although disease activity scores assessed by the pediatric rheumatologist did not differ between the 3 SES groups, persons in the low-SES group recorded higher C-HAQ scores compared to the high-SES group (zero-inflated part of ZINB odds ratio 0.28 [95% confidence interval (95% CI) 0.14, 0.55], count part of ZINB ß 0.26 [95% CI 0.05, 0.48]). Parents with low SES also reported more often that their children's school work or activities with friends had been limited. Furthermore, the low-SES group had a worse perception about the consequences of the disease and the effect of treatment than those in the high-SES group. CONCLUSION: Patients from a low-SES background report more problems with daily activities and have a lower perception of the consequences of the disease than patients from a high-SES background, warranting special attention from a multidisciplinary team.

Study on method for assessment of the physical structure integrity in Chagan lake in China based on remote sensing.

This paper, taking Chagan lake as the study area, uses and improves MWR V1.0 (Rivers (Lake) Health Assessment Indicators, Standards and Methods V1.0) relating to the theory and method of physical structure integrity assessment. A 500 m × 1000 m grid on the lakeshore zone is a basic evaluation unit, and then a lakeshore physical structural integrity evaluation system using remote sensing (RS) and geographic information system (GIS) technology is established, which contains a target layer, criterion layer and indicator layer. The criterion layer consists of lakeshore condition, shoreline development rate and lake atrophy rate, and the index layer is composed of slope, vegetation cover rate and water level change rate, and another eight indicators. The results showed that for the 23 monitoring points in Chagan lake and the 15 monitoring points in Xinmiao lake, the evaluation results based on RS were 0.60-0.74 and 0.35-0.52, respectively, and the field evaluation results were 0.64-0.77 and 0.35-0.55, respectively. The evaluation results of the two methods consistently indicated that the physical structure of the lakeshore of Chagan lake was healthy and the Xinmiao's lakeshore was sub-health. On this basis, a piecewise evaluation method of physical structure integrity based on the division of the nature reserve function was proposed in this paper.

Health Assessment Questionnaire disability progression in early rheumatoid arthritis: systematic review and analysis of two inception cohorts.

OBJECTIVE: The Health Assessment Questionnaire is widely used for patients with inflammatory polyarthritis (IP) and its subset, rheumatoid arthritis (RA). In this study, we evaluated the progression of HAQ scores in RA (i) by systematically reviewing the published literature on the methods used to assess changes in functional disability over time and (ii) to study in detail HAQ progression in two large prospective observational studies from the UK. METHODS: Data from two large inception cohorts, ERAS and NOAR, were studied to determine trajectories of HAQ progression over time by applying latent class growth models (LCGMs) to each dataset separately. Age, sex, baseline DAS28, symptom duration, rheumatoid factor, fulfilment of the 1987 ACR criteria and socio-economic status (SES) were included as potential predictors of HAQ trajectory subgroup membership. RESULTS: The literature search identified 49 studies showing that HAQ progression has mainly been based on average changes in the total study population. In the HAQ progression study, a LCGM with four HAQ trajectory subgroups was selected as providing the best fit in both cohorts. In both the cohorts, older age, female sex, longer symptom duration, fulfilment of the 1987 ACR criteria, higher DAS28 and lower SES were associated with increased likelihood of membership of subgroups with worse HAQ progression. CONCLUSION: Four distinct HAQ trajectory subgroups were derived from the ERAS and NOAR cohorts. The fact that the subgroups identified were nearly identical supports their validity. Identifying distinct groups of patients who are at risk of poor functional outcome may help to target therapy to those who are most likely to benefit.

Rapid screening and quantification of sulfonate derivatives in white peony root by UHPLC-MS-MS.

A rapid ultra-high-performance liquid chromatographic-tandem mass spectrometric (UHPLC-MS-MS) method has been developed for rapid screening and quantitative analysis of sulfonate derivatives (SDs) in commercial white peony root. Separation was performed on an Agilent Zorbax Eclipse Plus-C18 column by gradient elution with acetonitrile-0.1% (v/v) formic acid as the mobile phase. In-source fragmentation was used to generate the characteristic fragment ion at m/z 259 and to screen for nine SDs. Detection of these SDs was further performed in multiple reaction monitoring (MRM) mode to improve sensitivity and to quantify the two SDs paeoniflorin sulfonate and benzoylpaeoniflorin sulfonate. The method was validated for specificity, linearity, limits of detection and quantification, precision, accuracy, and matrix effects. Nine commercial white peony root samples were examined by use of this method, which revealed great variety in the paeoniflorin sulfonate and benzoylpaeoniflorin sulfonate content.

Sex assessment using measurements of the first lumbar vertebra.

Sex determination is a vital part of the medico-legal system but can be difficult in cases where the integrity of the body has been compromised. The purpose of this study was to develop a technique for sex assessment from measurements of the first lumber vertebrate. Twenty-nine linear measurements and five ratios were collected from 113 Chinese adult males and 97 Chinese adult females using digital three-dimensional anthropometry methods. By using discriminant analysis, we found that 23 linear measurements and two ratios identified sexual dimorphism (P<0.01), with predictive accuracy ranging from 57.1% to 86.6%. Using a stepwise method of discriminant function analysis, we found three dimensions predicted sex with 88.6% accuracy: (a) upper end-plate width (EPWu), (b) left pedicle height (PHl), and (c) middle end-plate depth (EPDm). This study shows that a single first lumber vertebra can be used for this purpose, and that the discriminant equation will help forensic determination of sex in the Chinese population.

Analyzing hospital length of stay: mean or median regression?

BACKGROUND: Length of stay (LOS) is an important measure of hospital activity and health care utilization, but its empirical distribution is often positively skewed. OBJECTIVE: This study reviews the mean and median regression approaches for analyzing LOS, which have implications for service planning, resource allocation, and bed utilization. METHODS: The two approaches are applied to analyze hospital discharge data on cesarean delivery. Both models adjust for patient and health-related characteristics, and for the dependency of LOS outcomes nested within hospitals. The estimation methods are also compared in a simulation study. RESULTS: For the empirical application, the mean regression results are somewhat sensitive to the magnitude of trimming chosen. The identified factors from median regression, namely number of diagnoses, number of procedures, and payment classification, are robust to high-LOS outliers. The simulation experiment shows that median regression can outperform mean regression even when the response variable is moderately positively skewed. CONCLUSION: Median regression appears to be a suitable alternative to analyze the clustered and positively skewed LOS, without transforming and trimming the data arbitrarily.