Low-cost and sensitive chemiluminescence detection of phthalates in environment by signal sensing of carbon-based materials from PVC/coal gangue dechlorination.

BACKGROUND: The detection of plasticizers in the environment is important to prevent environmental risks and people's health hazards. Improving recycling efficiency of waste PVC still faced challenges. RESULTS: In this work, it was found that solid products from waste PVC/coal gangue dechlorination in subcritical water (dPVC) had strong catalysis activity for luminol-H2O2 chemiluminescence (CL) reaction. Phthalates, common plasticizers, could bond and adsorb on dPVC, which greatly inhibited the luminol-H2O2-dPVC CL reaction. Based on this, a low-cost CL analysis was constructed for the detection of phthalates combinations (PACs) and di-(2-ethylhexyl) phthalate (DEHP) in the environment. The detection limit for PACs and DEHP was 0.048 ng/L and 0.13 ng/L, respectively. Compared with HPLC standard method, the dPVC CL analysis had accuracy and reliability for the detection of phthalates in actual environmental samples. Besides, the results of life cycle assessment (LCA) revealed that dPVC for CL sensing materials had significantly small global warming potential (GWP). SIGNIFICANCE: The use of dPVC for CL sensing not only improved the recycling efficiency of PVC, but also reduced carbon emissions of obtaining CL sensing materials.

Assessment of prolonged proteasome inhibition through ixazomib-based oral regimen on newly diagnosed and first-relapsed multiple myeloma: A real-world Chinese cohort study.

OBJECTIVE: To evaluate the effectiveness, safety, and convenience of in-class transition (iCT) from intravenous bortezomib-based induction to ixazomib-based oral regimens. METHODS: This retrospective real-world study was conducted in 16 Chinese hospitals between October 2017 and April 2023 and analyzed newly diagnosed (NDMM) and first-line relapsed multiple myeloma (FRMM) patients who attained at least a partial response from bortezomib-based induction therapy, followed by an ixazomib-based oral regimen for 2 year or until disease progression or intolerable toxicity. RESULTS: The study enrolled 199 patients, median age: 63 years old, male 55.4%, 53% as high risk (HR), and 47% as standard risk. Cytogenetic risk stratification by metaphase fluorescence in situ hybridization (M-FISH), based on the Mayo Clinic risk stratification system. The median duration of total PI therapy was 11 months, with ixazomib-based treatment spanning 6 months. At the 20-month median follow-up, 53% of patients remained on therapy. The 24-month PFS rate was 84.3% from the initiation of bortezomib-based induction and 83.4% from the start of ixazomib-based treatment. Overall response rate (ORR) was 100% post-bortezomib induction and 90% following 6 cycles of the ixazomib-based regimen. Based on the Sankey diagrams, 89.51% of patients maintained or improved their disease response after 2 cycles of iCT, 6 cycles (90.14%), and 12 cycles (80%). The HR level of Mayo was found to be a significant independent factor in a worse remission (hazard ratio (HR) 2.55; p = 0.033). Ixazomib's safety profile aligned with previous clinical trial data, with 49% of patients experiencing at least one AE of any grade. The most common AEs included peripheral neuropathy, nausea and vomiting, diarrhea, thrombocytopenia, and granulocytopenia. CONCLUSION: In the real-world Chinese MM population, NDMM and FRMM patients responded favorably to PI-based continuous therapy, demonstrating substantial response rates. The ixazomib-based iCT allows for sustained PI-based treatment, offering promising efficacy and tolerable AEs.

Simultaneous assessment of stress hyperglycemia ratio and glycemic variability to predict mortality in patients with coronary artery disease: a retrospective cohort study from the MIMIC-IV database.

BACKGROUND: Stress hyperglycemia and glycemic variability (GV) can reflect dramatic increases and acute fluctuations in blood glucose, which are associated with adverse cardiovascular events. This study aimed to explore whether the combined assessment of the stress hyperglycemia ratio (SHR) and GV provides additional information for prognostic prediction in patients with coronary artery disease (CAD) hospitalized in the intensive care unit (ICU). METHODS: Patients diagnosed with CAD from the Medical Information Mart for Intensive Care-IV database (version 2.2) between 2008 and 2019 were retrospectively included in the analysis. The primary endpoint was 1-year mortality, and the secondary endpoint was in-hospital mortality. Levels of SHR and GV were stratified into tertiles, with the highest tertile classified as high and the lower two tertiles classified as low. The associations of SHR, GV, and their combination with mortality were determined by logistic and Cox regression analyses. RESULTS: A total of 2789 patients were included, with a mean age of 69.6 years, and 30.1% were female. Overall, 138 (4.9%) patients died in the hospital, and 404 (14.5%) patients died at 1 year. The combination of SHR and GV was superior to SHR (in-hospital mortality: 0.710 vs. 0.689, p = 0.012; 1-year mortality: 0.644 vs. 0.615, p = 0.007) and GV (in-hospital mortality: 0.710 vs. 0.632, p = 0.004; 1-year mortality: 0.644 vs. 0.603, p < 0.001) alone for predicting mortality in the receiver operating characteristic analysis. In addition, nondiabetic patients with high SHR levels and high GV were associated with the greatest risk of both in-hospital mortality (odds ratio [OR] = 10.831, 95% confidence interval [CI] 4.494-26.105) and 1-year mortality (hazard ratio [HR] = 5.830, 95% CI 3.175-10.702). However, in the diabetic population, the highest risk of in-hospital mortality (OR = 4.221, 95% CI 1.542-11.558) and 1-year mortality (HR = 2.013, 95% CI 1.224-3.311) was observed in patients with high SHR levels but low GV. CONCLUSIONS: The simultaneous evaluation of SHR and GV provides more information for risk stratification and prognostic prediction than SHR and GV alone, contributing to developing individualized strategies for glucose management in patients with CAD admitted to the ICU.

The spatial linkage mechanism: medical level, public health security, and economic climate from 19 OECD EU countries.

Introduction: The global spread of the COVID-19 has brought about global changes, especially in terms of economic growth. Therefore, it has become a global issue to explore the impact of public health security on the economy. Methods: Employing a dynamic spatial Durbin model, this study analyzes the spatial linkage mechanism of medical level, public health security, and economic climate in 19 countries as well as investigates the relationship between economic climate and COVID-19 by the panel data of 19 OECD European Union countries from March 2020 to September 2022. Results: Results show that an improvement in the medical level can reduce the negative impact of public health security on the economy. Specifically, there is a significant spatial spillover effect. The degree of economic prosperity hurts the reproduction rate of COVID-19. Discussion: Policymakers should consider both the severity of the public health security issues and the economic level when developing prevention and control policies. Given this, corresponding suggestions provide theoretical support for formulating policies to reduce the economic impact of public health security issues.

Tinnitus assessment: Chinese version of the Tinnitus Primary Function Questionnaire.

Objective: The aim of this study is to evaluate the Chinese Version of the Tinnitus Primary Function Questionnaire (TPFQ). Methods: One hundred and sixteen patients who had been suffering from tinnitus for over 3 months were included in this study. Those tinnitus patients were administered the TPFQ, the Tinnitus Handicap Inventory (THI), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI). Additionally, the magnitude estimate of tinnitus loudness, pure tone audiogram, and tinnitus matching was obtained. The factor structure was measured using the Kaiser-Meyer-Olkin test. The internal consistency was examined using Cronbach's α coefficient. The relationships between the TPFQ scores and other measurements were compared using Spearman's rank correlation coefficient. Results: The Cronbach's α of the 20-item version of TPFQ was 0.94, and that of the 12-item version of TPFQ was 0.92. Both the 20- and 12-item versions of TPFQ were significantly correlated with magnitude estimation of tinnitus loudness, THI, PSQI, BDI, and BAI. The average pure tone hearing threshold was significantly correlated with the hearing subscale. Conclusion: The 20- and 12-item Chinese versions of TPFQ are reliable and valid measures of tinnitus. The TPFQ can be applied to the assessment and management of tinnitus among the Chinese-speaking population.

Environmental Effects of China's Export Trade to the Countries along Belt and Road: An Empirical Evidence Based on Inter-Provincial Panel Data.

There is a close inherent connection between manufacturing exports and environmental pollution. With the continuous growth of China's export trade to the countries along Belt and Road, the resulting environmental problems have also received much attention. This paper first analyzes the environmental impact mechanism of China's export trade to the countries along Belt and Road. Then based on the dynamic panel data of 30 provinces in China from 2013 to 2019, we use the SYS-GMM method to make an empirical test from national and regional perspectives and analyze the environmental effects of China's export trade to the countries along Belt and Road. The results show that the environmental effects of export trade are significantly heterogeneous in different regions. In general, export trade has a significant positive scale effect on CO2 emissions; the negative effect of environmental regulation on CO2 emissions can effectively offset the positive effect caused by the growth of output in the capital-intensive sector, and the composition effect is generally negative; the technical effect of China's export trade to the countries along Belt and Road mainly depends on the technological-independent innovation, which is caused by the domestic investment in science and technology, so the overall technical effects are negative. Therefore, China should optimize the structure of export trade, promote technological innovation, and cultivate green advantage industries by increasing investment in scientific research and development; implement a gradient environmental regulation policy; and improve the quality and level of foreign direct investment.

[Analysis of Heavy Metal Sources in Groundwater and Assessment of Health Risks: An Example from the Southwest Sub-basin of the Shiqi River].

In order to explore the sources of pollution and health risk profile of heavy metal elements in groundwater, 41 sets of representative groundwater samples from the southwest sub-basin of the Shiqi River were examined for 10 heavy metal elements (As, Cr, Cd, Al, Cu, Zn, Ni, Co, Mn, and Hg), and correlation analysis and principal component analysis were used to resolve the possible sources of heavy metal contamination in groundwater in the study area. The concentration characteristics and health risk levels of the 10 heavy metals were assessed using the single-factor contamination index (Pi), the Nemerow comprehensive contamination index (PN), and the health risk model. The results showed that:① the average values of heavy metal elements of the groundwater in the study area all met the limit of the class Ⅲ water standard in the quality standard for groundwater (GB/T 14848-2017); only the maximum value of Al was exceeded, followed by a large variation in the concentrations of Al, Mn, and Cr. The heavy metal element with the largest average contribution was Al (65.74%). ② The results of the single-factor contamination index evaluation showed that only the heavy metal element Al exceeded the cleaning level, and the results of the Nemerow comprehensive contamination index evaluation showed that the study area was basically at low pollution levels, and the quality of groundwater was good. ③ The results of the multivariate statistical analysis showed that Zn, Co, and Mn were from mixed sources consisting of geological formation and domestic waste; Al, As, and Cu were from agricultural sources; Cd, Cr, and Ni were from industrial sources; and Hg came from long-range atmospheric transport. ④ The health risk values for all heavy metals in the study area were within acceptable limits, with higher health risk values for children than for adults from the drinking water route, lower health risk values than in adults from the dermal route, and higher health risk values for heavy metals from the drinking water route than those from the dermal route, indicating that the drinking water route was the main route of exposure to heavy metals.

Short-term and long-term effects of Sanming healthcare system reform on drug-related expenditures for rural patients with cancer in public hospitals: an interrupted time series analysis using segmented regression model in China.

OBJECTIVES: To assess the effects of 'Sanming model' on drug-related expenditures. DESIGN: Interrupted time series analysis with two time points was conducted to analyse the effects of 'Sanming model' using segmented regression model. SETTING: Two hundred and eighty public hospitals in Fujian province in China. PARTICIPANTS: A total of 777 171 inpatients and 792 743 outpatients with cancer who participated in New Rural Cooperative Medical Scheme (NRCMS) were included. INTERVENTIONS: 'Sanming model' was issued by Sanming government in February 2013 and spread to other cities in Fujian province in January 2015. PRIMARY OUTCOME MEASURES: Four drug-related expenditure variables. RESULTS: Among inpatients, total drug expenditures and drug expenditures covered by NRCMS dropped instantly after the reform in all hospitals. Although there was insignificant change during the short-term reform period, the total drug expenditures and drug expenditures covered by NRCMS decreased at the rate of ¥20.3 (p=0.0099) and ¥18.8 (p=0.0341) per capita month-to-month during the long-term reform period in Sanming hospitals, respectively. Among outpatients, total drug expenditures and drug expenditures covered by NRCMS decreased at the rate of ¥20.8 (p=0.0335) and ¥18.4 (p=0.0242) per capita month-to-month during the short-term reform period in Sanming hospitals, respectively. However, the downward trend did not continue into the long term. The significant decreases in trend of drug expenditures uncovered by NRCMS were only observed after the reform in provincial hospitals. The ratio of drug expenditures to inpatient (outpatient) expenditures decreased after the reform in all hospitals. CONCLUSIONS: 'Sanming model' had long-term effect in reducing total drug expenditures, drug ratio and drug expenditures covered by NRCMS for rural inpatients with cancer and only short-term positive effect for outpatients. However, there was limited effect of 'Sanming model' on drug expenditures uncovered by NRCMS. 'Sanming model' still needs to accumulate experiences and improves the reform measures dynamically.

A Soil Moisture Prediction Model, Based on Depth and Water Balance Equation: A Case Study of the Xilingol League Grassland.

Soil moisture plays an important role in ecology, hydrology, agriculture and climate change. This study proposes a soil moisture prediction model, based on the depth and water balance equation, which integrates the water balance equation with the seasonal ARIMA model, and introduces the depth parameter to consider the soil moisture at different depths. The experimental results showed that the model proposed in this study was able to provide a higher prediction accuracy for the soil moisture at 40 cm, 100 cm and 200 cm depths, compared to the seasonal ARIMA model. Different models were used for different depths. In this study, the seasonal ARIMA model was used at 10 cm, and the proposed model was used at 40 cm, 100 cm and 200 cm, from which more accurate prediction values could be obtained. The fluctuation of the predicted data has a certain seasonal trend, but the regularity decreases with the increasing depth until the soil moisture is almost independent of the external influence at a 200 cm depth. The accurate prediction of the soil moisture can contribute to the scientific management of the grasslands, thus promoting ecological stability and the sustainable development of the grasslands while rationalizing land use.

Determinants of Willingness to Use PrEP Among Gay and Bisexual Men in China Before Implementation: A Structural Equation Modeling Assessment.

With the recent endorsement of PrEP by the Chinese government, research is urgently needed to better understand factors impacting PrEP uptake among gay, bisexual, and other men who have sex with men (GBMSM) in China. This study examined willingness to use PrEP for HIV prevention among GBMSM in China through structural equation modeling. We examined the relationship among PrEP-related attitudes, subjective norms, PrEP-related knowledge and beliefs about medicines and willingness to use PrEP. The analysis showed a good fit between the data and both the measurement model (RMSEA = 0.060) and structural model (RMSEA = 0.054). Knowledge, attitudes, and subjective norms were significantly related to intention to use PrEP, whereas the effect of general beliefs about medicines was insignificant. These effect mechanisms point to the importance of designing interventions to support PrEP uptake that target knowledge, enhance positive attitudes about PrEP within social networks, and build positive social norms around PrEP among sexually active GBMSM.

Comprehensive geriatric assessment in newly diagnosed older myeloma patients: a multicentre, prospective, non-interventional study.

BACKGROUND: Multiple myeloma is a disease of the older people, whose prognoses are highly heterogeneous. The International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based on age, functional status and comorbidities to discriminate between fit and frail patients. Given the multidimensional nature of frailty and the relatively recent exploration of frailty in the field of MM, reaching a consensus on the measurement of frailty in MM patients remains challenging. OBJECTIVE: We sought to assess the feasibility of performing a comprehensive GA (CGA) in older MM patients in a real-world and multicentre setting and to evaluate their baseline CGA profiles. RESULTS: We studied 349 older patients with newly diagnosed MM (age range, 65-86 years). Our results showed that a CGA is feasible for older MM patients. Using the IMWG-GA criteria, we identified significantly more frail patients in our cohort comparing to in the IMWG cohort (43% vs 30%, P = 0.002). In the IMWG-GA 'fit' group, risk of malnutrition, depression and cognitive impairment remains. The median follow-up time was 26 months (range 1-38). The median overall survival (OS) was 34.7 months, and the estimated 3-year OS rate was 50%. A high MNA-SF score (MNA-SF ≥ 12), low GDS score (GDS ≤ 5) and high CCI score (CCI ≥ 2) can be used to predict the OS of older patients with newly diagnosed MM. This study is registered at www.clinicaltrials.gov (NCT03122327). CONCLUSIONS: Our study justifies the need for a CGA in older patients with newly diagnosed MM.

Feeding sites promoting wildlife-related tourism might highly expose the endangered Yunnan snub-nosed monkey (Rhinopithecus bieti) to parasite transmission.

An increasing number of studies have found that the implementation of feeding sites for wildlife-related tourism can affect animal health, behaviour and reproduction. Feeding sites can favour high densities, home range overlap, greater sedentary behaviour and increased interspecific contacts, all of which might promote parasite transmission. In the Yunnan snub-nosed monkey (Rhinopithecus bieti), human interventions via provisioning monkeys at specific feeding sites have led to the sub-structuring of a group into genetically differentiated sub-groups. The fed subgroup is located near human hamlets and interacts with domesticated animals. Using high-throughput sequencing, we investigated Entamoeba species diversity in a local host assemblage strongly influenced by provisioning for wildlife-related tourism. We identified 13 Entamoeba species or lineages in faeces of Yunnan snub-nosed monkeys, humans and domesticated animals (including pigs, cattle, and domestic chicken). In Yunnan snub-nosed monkeys, Entamoeba prevalence and OTU richness were higher in the fed than in the wild subgroup. Entamoeba polecki was found in monkeys, pigs and humans, suggesting that this parasite might circulates between the wild and domestic components of this local social-ecological system. The highest proportion of faeces positive for Entamoeba in monkeys geographically coincided with the presence of livestock and humans. These elements suggest that feeding sites might indirectly play a role on parasite transmission in the Yunnan snub-nosed monkey. The implementation of such sites should carefully consider the risk of creating hotspots of disease transmission, which should be prevented by maintaining a buffer zone between monkeys and livestock/humans. Regular screenings for pathogens in fed subgroup are necessary to monitor transmission risk in order to balance the economic development of human communities dependent on wildlife-related tourism, and the conservation of the endangered Yunnan snub-nosed monkey.

Energy market uncertainty and the impact on the crude oil prices.

Our paper proposes a novel measure of global energy market uncertainty and studies its impact on oil prices. The current literature primarily relies on a single or small number of observable variables, or general macroeconomic uncertainty (JLN) and economic policy uncertainty (EPU) indices to reflect energy market uncertainty. Using a Factor Augmented Vector Autoregression model (FAVAR), we construct time-varying global energy market uncertainty in a data-rich environment. Our estimates show variations from JLN and EPU proxies. The results reveal that real oil prices respond strongly to our proposed aggregate energy market uncertainty shocks. We also find heterogeneous responses to different types and magnitudes of uncertainty shocks. The real price of oil is affected the most under unexpected strong demand for alternative energy sources scenario.

Bioavailability Assessment of Heavy Metals Using Various Multi-Element Extractants in an Indigenous Zinc Smelting Contaminated Site, Southwestern China.

Despite recent studies have investigated the strong influences of smelting activities on heavy metal contamination in the soil environment, little studies have been conducted on the current information about the potential environmental risks posed by toxic heavy metals in smelting contaminated sites. In the present study, a combination of the bioavailability, speciation, and release kinetics of toxic heavy metals in the indigenous zinc smelting contaminated soil were reliably used as an effective tool to support site risk assessment. The bioavailability results revealed that the bioavailable metal concentrations were intrinsically dependent on the types of chemical extractants. Interestingly, 0.02 mol/L EDTA + 0.5 mol/L CH3COONH4 was found to be the best extractant, which extracted 30.21% of Cu, 31.54% of Mn, 2.39% of Ni and 28.89% of Zn, respectively. The sequential extraction results suggested that Cd, Pb, and Zn were the most mobile elements, which would pose the potential risks to the environment. The correlation of metal bioavailability with their fractionation implied that the exchangeable metal fractions were easily extracted by CaCl2 and Mehlich 1, while the carbonate and organic bound metal fractions could be extracted by EDTA and DTPA with stronger chelating ability. Moreover, the kinetic modeling results suggested that the chemical desorption mechanism might be the major factor controlling heavy metal release. These results could provide some valuable references for the risk assessment and management of heavy metals in the smelting contaminated sites.

The best of both worlds? The economic effects of a hybrid fee-for-service and prospective payment reimbursement system.

Countries seeking to move away from a purely fee-for-service (FFS) system may consider a hybrid approach whereby only some procedures are paid by FFS while others are paid prospectively. Yet little evidence exists whether such a hybrid payment system contains overall costs without adverse influences on health outcomes. In 2003, Japan experienced a reform from FFS to a hybrid payment system in which only some inpatient procedures were paid prospectively. We exploit this reform to test how such a hybrid system affects overall costs and health outcomes. Briefly, we find that healthcare providers responded opportunistically to the reform, moving some procedures out of the bundled inpatient setting to FFS services, leading to no reduction in cost. There was some evidence of a moderate deterioration in health outcomes, in terms of a decline in the probability of symptoms being cured at discharge. In sum, our results suggest that in some cases, a hybrid payment system can be non-superior to either FFS or prospective payment system.

Association between compliance with quality indicators and hospitalisation expenses in patients with heart failure: a retrospective study using quantile regression model in China.

OBJECTIVE: To explore the association between compliance with quality indicators and hospitalisation expenses in patients with heart failure. DESIGN: Generalised linear model and quantile regression model were used to examine the association between compliance with five quality indicators and hospitalisation expenses. SETTING: Grade A hospital in Fujian Province, China. PARTICIPANTS: Data on 2568 heart failure admissions between 2010 and 2015 were analysed. RESULTS: The median (IQR) of hospitalisation expenses of 2568 patients was ¥10.9 (¥6.9-¥31.6) thousand. The rates of compliance with five quality indicators were 90.3% for evaluation of left ventricular function, 43.8% for diuretics, 62.0% for ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB), 67.4% for beta-blockers, and 58.9% for aldosterone receptor antagonists. After adjustment for gender, age, residence, method of payment, number of diseases before admission, number of diseases at admission, number of emergency treatments during hospital stay and length of stay, patients who received evaluation for left ventricular function, diuretics, or ACEI or ARB had lower hospitalisation expenses, and patients who received beta-blockers had higher hospitalisation expenses, compared with their counterparts in generalised linear models. Differences in hospitalisation expenses between compliance and non-compliance with quality indicators became larger across quantile levels of hospitalisation expenses, and were found to be statistically significant when quantile level exceeded 0.80 (¥39.7 thousand) in quantile regression models. CONCLUSIONS: The quality of care for patients with heart failure was below the target level. There was a negative relationship between compliance with quality indicators and hospitalisation expenses at the extreme quantile of expenses. More attention should be given to patients who may experience extreme expenses, and effective measures should be taken to improve the quality of care they receive.

Quantitative assessment of environmental exposure of delivery men in Wuhan.

The take out industry is rapidly developing in China, but the environmental exposure of delivery men is neglected. "Ele.Me," an online food ordering platform, is one of the two largest catering online-to-offline platforms in China. From January 2018 to April 2018, data from 16,528 take out shops in Wuhan were crawled by using Python. The data included store name, average delivery time, delivery price, region, and store type. With the use of Baidu map's API batch reverse address resolution, the map locations of the take out shops were identified. Network service area was utilized to obtain the activity space of delivery men along the Wuhan traffic road network. Combined with the data on sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), PM2.5, PM10, and noise provided by the Wuhan Environmental Protection Bureau, the spatial interpolation, regional analysis, superposition analysis, and other geographic information system spatial analysis methods were used to study the air and noise pollution within the activity space of delivery men in various take out shops. Results revealed the unbalanced environment faced by Wuhan delivery men. The exposure to NO2, CO, and PM2.5 was mainly concentrated in the central city, whereas the exposure to SO2, O3, and PM10 was mainly noted far from the city. Noise pollution was mainly observed in the districts of Hannan, Caidian, and Dongxihu; and the most serious pollution was recorded in Shamao Street. The weighted comprehensive pollution index model was used to calculate the contribution weight of each evaluation factor to obtain the results of environmental exposure to air pollution. The influence of noise was further considered to obtain the consequences of comprehensive environmental exposure to pollution. The highly polluted regions were those in the central part of the city. Pollution was mainly concentrated in the third loop, whereas Zhucheng Street in the Xinzhou District provided the best environment. The results of this study can serve as a reference for the physical health risk assessment of delivery men.

Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016.

BACKGROUND: New Rural Cooperative Medical Scheme (NRCMS) was developed to improve the health security for rural residents. This study aimed to assess the trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor from 2007 to 2016 under the effect of NRCMS. METHODS: The data from medical records of 1,306,895 patients with malignant tumor who had NRCMS in 2932 hospitals was collected. The relative differences [95% confidence intervals (CIs)] between coastland and inland in four medical expense indicators were calculated using generalized linear models to assess the trend of disparity over time. RESULTS: In total, there were 769,484 (58.88%) coastland patients and 537,411 (41.12%) inland patients. Male and patients aged older than 44 years accounted for 56.87 and 80% of 1,306,895 patients, respectively. After adjusting for gender, age, tumor site and hospital level, coastland patients had higher hospitalization expenses which were all medical expenses incurred during the hospitalization, lower reimbursement ratio and ratio of out-of-pocket expenses to disposable income than inland patients in most years. The surgery expenses of coastland patients were lower than those of inland patients in 2016. The relative differences (95% CIs) between coastland and inland in medical expense indicators were moving closer to 1.0 from 2007 to 2010 among patients without surgery, implying that the disparity between two areas significantly narrowed. The range of change was similar between two areas from 2011 to 2016 whether among patients without or with surgery, implying that the disparity did not significantly change. The disparity between coastland and inland depended on the household income situation. For low-income patients, the differences between two areas in medical expense indicators were not statistically significance in most cases and the disparity between two areas did not significantly change over time. CONCLUSIONS: Under the effect of NRCMS, the medical expenditure burden of rural inpatients reduced but suffering from malignant tumor was still catastrophic. As a whole, the inland patients had heavier medical expenditure burden than coastland patients. Because of economic factors and medical assistance policies, the medical expenditure burden was similar between coastland and inland low-income patients.

Do gay and bisexual men who conceal their same-sex behavior prefer different kinds of health services? Findings across four cities to inform client-centered HIV prevention in China.

BACKGROUND: In China, addressing disparities in the HIV epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention. In an effort to advance MSM-friendly HIV services within China, and informed by community-based partnerships, we tested whether MSM who have ever versus never disclosed their same-sex behavior to healthcare providers (HCP) differ in sociodemographic and behavioral characteristics as well as the qualities of sexual health services each group would prefer to access. METHODS: We conducted a cross-sectional survey among HIV-negative MSM who went to MSM-focused voluntary counseling and testing clinics in four cities in China. The survey was anonymous and collected information on sociodemographic characteristics, testing behaviors, sexual-health related behavior, and sexual health service model preferences. RESULTS: Of 357 respondents, 68.1% participants had ever disclosed same-sex behavior to HCPs when seeking advice for sexual health. Younger age (aOR = 1.04; 95% CI: 1.01-1.08), and worry of HIV acquisition (aOR = 1.39; 95% CI: 1.05-1.84) were associated with higher odds of past disclosure. The availability of comprehensive sexual health services was one of the most valued characteristics of the ideal sexual health clinic. Those who ever disclosed and never disclosed differed significantly in their ranking of the importance of three out of ten dimensions: sexual health counseling services available (M = 3.99 vs. M = 3.65, p = .002), gay identity support available (M = 3.91 vs. M = 3.62, p = .016) and clinic collaborates with a gay CBO (M = 3.81 vs. M = 3.56, p = .036). CONCLUSIONS: Our hypothesis that MSM who had disclosed versus never disclosed same-sex behavior would differ in the value they placed on different dimensions of sexual health service was partially borne out. As health authorities in China decide on implementation models for pre-exposure prophylaxis (PrEP) delivery and specifically within which institutions to integrate PrEP services, the preferences of target populations should be considered to develop comprehensive, patient-centric and LGBT-friendly services.

Disease-related stressors of caregiving burden among different types of family caregivers of persons with schizophrenia in rural China.

BACKGROUND: Little is known about the impacts of schizophrenia on different types of caregiving burden. AIM: This study aims to examine how the severity of schizophrenia, social functioning and aggressive behavior are associated with caregiving burden across different kinship types. METHOD: The analytic sample included 300 dyads of persons with schizophrenia and their family caregivers in Xinjin, Chengdu, China. The 10th edition of the International Classification of Diseases (ICD-10) was utilized to identify the patients, whose symptom severity, social functioning and aggressive behavior were measured. Caregiving burden was estimated using the Burden Scale for Family Caregivers-short (BSFC-s). RESULTS: A higher level of burden was significantly associated with female caregivers, larger family size, lower income, worse symptoms, poorer functional status and more aggressive behaviors. Parent caregivers showed greater burden if the patients had better functioning of social interest and concern or more aggression toward property. Mother caregivers showed greater burden than fathers. Spouses tended to perceive greater burden if the patients had better marital functioning, poorer occupational functioning or more aggressive behaviors toward property. Patients attacking others or a father with schizophrenia was related to a higher burden of child caregivers. A heavier burden of other relatives was correlated with patients' more verbal aggression and self-harm. CONCLUSION: This study shows the distinct impacts of disease-related factors on the caregiving burden across different kinship types. Our findings have implications for health-care professionals and practitioners in terms of developing more targeted family-based or individualized intervention to ameliorate burden according to kinship types and deal with behavioral and functional problems in schizophrenia.