Associations between digital literacy, health literacy, and digital health behaviors among rural residents: evidence from Zhejiang, China.

OBJECTIVE: Within the digital society, the limited proficiency in digital health behaviors among rural residents has emerged as a significant factor intensifying health disparities between urban and rural areas. Addressing this issue, enhancing the digital literacy and health literacy of rural residents stands out as a crucial strategy. This study aims to investigate the relationship between digital literacy, health literacy, and the digital health behaviors of rural residents. METHODS: Initially, we developed measurement instruments aimed at assessing the levels of digital literacy and health literacy among rural residents. Subsequently, leveraging micro survey data, we conducted assessments on the digital literacy and health literacy of 968 residents in five administrative villages in Zhejiang Province, China. Building upon this foundation, we employed Probit and Poisson models to empirically scrutinize the influence of digital literacy, health literacy, and their interaction on the manifestation of digital health behaviors within the rural population. This analysis was conducted from a dual perspective, evaluating the participation of digital health behaviors among rural residents and the diversity to which they participate in such behaviors. RESULTS: Digital literacy exhibited a notably positive influence on both the participation and diversity of digital health behaviors among rural residents. While health literacy did not emerge as a predictor for the occurrence of digital health behavior, it exerted a substantial positive impact on the diversity of digital health behaviors in the rural population. There were significant interaction effects between digital literacy and health literacy concerning the participation and diversity of digital health behaviors among rural residents. These findings remained robust even after implementing the instrumental variable method to address endogeneity issues. Furthermore, the outcomes of robust analysis and heterogeneity analysis further fortify the steadfastness of the aforementioned conclusions. CONCLUSION: The findings suggest that policymakers should implement targeted measures aimed at enhancing digital literacy and health literacy among rural residents. This approach is crucial for improving rural residents' access to digital health services, thereby mitigating urban-rural health inequality.

Examining coordination and equilibrium: an analysis of supply index and spatial evolution characteristics for older adult services in Zhejiang Province.

Objective: This study aims to analyze the spatial distribution and dynamic evolution of older adult service supply in Zhejiang Province from 2010 to 2019. Additionally, this research seeks to propose an optimized resource allocation strategy for older adult care services, promoting regional fairness and coordinated development. Methods: To evaluate the older adult service supply capacity, this research first constructed an evaluation index system based on the Chinese modernization development pattern. Then, an empirical analysis was carried out using a combination of the entropy-TOPSIS method, kernel density estimation, Markov chain analysis, Dagum Gini coefficient, and panel regression model. Results: The results show an overall upward trend in the supply and service capacity of older adult care in the whole province. However, the spatial distribution of older adult service supply capacity in Zhejiang Province still exhibits a gradient effect, even in the most recent year of 2019. Furthermore, the supply capacity of older adult services shifted to a higher level in the whole province, and regions with high supply capacity had a positive spillover effect on adjacent regions. The overall difference in the older adult service supply capacity of the province showed a decreasing trend. The level of economic development, urbanization rate, transportation capacity, the level of opening up, and the proportion of employees in the tertiary industry had a significant impact on the supply capacity and spatial difference of older adult services. Conclusion: From the findings, this study puts forth countermeasures and suggestions to optimize the spatial distribution of older adult care services. This includes giving full play to the regional spatial linkage effect, promoting new-type urbanization construction, upgrading the transportation network, and expanding the opening up of the industrial structure. By implementing these measures, a more equitable and coordinated older adult services system can be developed in Zhejiang Province.

The impact of COVID-19 on cultural industries: An empirical research based on stock market returns.

The COVID-19 virus has challenged the development of the cultural industries seriously, so far, however few studies have used empirical methods to analyze the impact of the pandemic on the overall cultural industries. Based on the panel data of listed companies, this paper explores the impact of COVID-19 on cultural industries from the perspective of stock market returns. The empirical results show that the pandemic has a significant negative impact on the stock market returns of cultural industries, but the degrees of impact on various creative sub-sectors are significantly different. The findings also indicate that digitalization can effectively reduce the negative impact of COVID-19 on cultural companies, and the epidemic has bigger negative impacts on small and newly-established cultural companies. Moreover, we find that the stock market returns of cultural industries have an inverted U-shaped relationship with the daily growth in total confirmed cases and in total cases of death caused by COVID-19, indicating that the negative marginal impact of COVID-19 on the cultural industries increases firstly and then gradually decreases. Finally, implications for companies and governments are presented respectively based on the findings.

Real-world cost-effectiveness associated with infliximab maintenance therapy for moderate to severe Crohn's disease in China.

BACKGROUND: Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease (MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy (IMT) for MS-CD relative to conventional maintenance therapy remained unclarified. AIM: To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer. METHODS: A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy (CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs. RESULTS: Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications (odds ratio: 0.527, P = 0.010), higher utility value for quality of life (coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management (coefficient -0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers ¥55260 to gain one quality-adjusted life year (QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita (GDPPC)] was 86.4%. CONCLUSION: IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.

Novel radiographic parameters for the assessment of total body sagittal alignment in adult spinal deformity patients.

OBJECTIVE: In this study, the authors' goal was to develop and validate novel radiographic parameters that better describe total body sagittal alignment (TBSA). METHODS: One hundred sixty-six consecutive operative spinal deformity patients were evaluated using full-body stereoradiographic imaging. Seven TBSA parameters were measured and then correlated to 6 commonly used spinopelvic measurements. TBSA measures consisted of 4 distance measures relating the cranial center of mass (CCOM) to the sacrum, hips, knees, and ankles, and 3 angular measures relating the CCOM to the hips, knees, and ankles. Furthermore, each TBSA parameter was correlated to patient-reported outcome (PRO) scores using the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22) instruments. Thirty patients were randomly selected for inter- and intraobserver reliability testing of the TBSA parameters using intraclass correlation coefficients (ICCs). RESULTS: All TBSA radiographic parameters demonstrated strong linear correlation with the currently accepted primary measure of sagittal balance, the C7 sagittal vertical axis (r = 0.55-0.96, p < 0.001). Moreover, 5 of 7 TBSA measures correlated strongly with ODI and SRS-22 total scores (r = 0.42-0.51, p < 0.001). Inter- and intraobserver reliability for all TBSA measures was good to excellent (interrater ICC = 0.70-0.98, intrarater ICC = 0.77-1.0). CONCLUSIONS: In spine deformity patients, novel TBSA radiographic parameters correlated well with PROs and with currently utilized spinal sagittal measurements. Inter- and intrarater reliability was high for these novel parameters. This is the first study to propose a reliable method for measuring head-to-toe global spinal alignment.

Wastewater analysis reveals spatial pattern in consumption of anti-diabetes drug metformin in China.

Metformin has been widely used as an oral drug for the treatment of diabetes mellitus. However, its consumption can be influenced by many economic and social factors. In this study, we investigated the spatial consumption pattern of metformin in China through wastewater-based epidemiology (WBE) approach. Influent wastewater samples were collected from 21 wastewater treatment plants (WWTPs) in 19 cities of the northeast China. A method using solid-phase extraction combined with N-Methyl-bis (trifluoroacetamide) derivatization for GC-MS detection was applied for metformin analysis. In 21 days, metformin showed high stability in wastewater at 24 °C and -20 °C. The mean concentrations of metformin in all WWTPs ranged from 2.42 µg L-1 to 53.6 µg L-1. The consumption of metformin was 0.66-15.6 mg d-1 capita-1 with the mean value of 5.54 ±â€¯4.28 mg d-1 capita-1. The prevalence of metformin ranged from 0.09% to 2.10% with an average of 0.74%. Both the consumption and prevalence of metformin displays significant spatial variations in northeast China. A statistical correlation analysis indicated that the consumption of metformin increases with the decrease of per capita disposable income of urban residents. To further predict the use of metformin in China, we developed a regress model and depicted a consumption map. The annual consumption of urban residents in Chinese provinces range from 1085-63,828 kg yr-1 with mean value of 25,347 kg yr-1, which would provide a certain reference value for public health care and diabetes control.