A mixed acid treatment for the prevention of Ulva prolifera attachment to Neopyropia aquaculture rafts: Laboratory experimentation.

The sessile green macroalgae in the Neopyropia aquaculture areas of the Subei Shoal are a confirmed source of green tides in the Southern Yellow Sea (SYS) of China. The green tides have a significant impact on local economic development (tourism, aquaculture, etc.) and ecological stability. In order to develop an effective method for eliminating the green macroalgae attached to Neopyropia aquaculture rafts, this study investigated the effects of mixed acid solutions (0.0475 % hydrochloric acid [HCl] and pH 2.0 citric acid) on cell damage, chlorophyll composition, phycobiliprotein content, and the photosynthetic fluorescence characteristics of Ulva prolifera and Neopyropia yezoensis. The chlorophyll contents of U. prolifera and N. yezoensis were significantly affected by the mixed acid solutions. After treatment with a mixed acid solution (4:3 volume ratio of HCl to citric acid) for 5 s, the photosynthetic pigment content of U. prolifera was significantly different from that of normal U. prolifera. However, photosynthetic pigment content in the treated N. yezoensis increased significantly. In addition, mixed acid solution treatment had a significant effect on the Fv/Fm of U. prolifera and N. yezoensis. After mixed acid treatment (4:3 HCl to citric acid), U. prolifera completely died, but the Fv/Fm of N. yezoensis was restored after 3 d. Therefore, a mixed acid solution comprising 0.0475 % HCl and pH 2.0 citric acid (at a volume ratio of 4:3) can be used as an agent for the removal of green macroalgae from Neopyropia aquaculture areas.

Monitoring and ecological risk assessment of contaminants in freshwater bodies by bioindicators in China: a proposed framework.

Bioindicators can provide pollution information with longer temporal duration and larger spatial scale. It is an ideal strategy for long-term monitoring of bioaccumulative contaminants. Bioindicator monitoring has been widely used; however, there were seldom detailed studies about bioindicator methodology in literature. The present study proposed a bioindicator framework suitable for the local conditions of China, including selection of bioindicator species, evaluation of impact factors, and derivation of threshold values using per- and polyfluoroalkyl substances (PFASs) as an example. The criteria that proper bioindicator species should meet and the procedure how the bioindicator species is selected were proposed, under which crucian carp (Carassius auratus) was selected as the local bioindicator for studied PFASs. Several factors which may affect accumulation of contaminants in bioindicators were suggested to produce reliable and comparable results. Derivation method of bioindicator thresholds for ecological risk assessment of aquatic ecosystems was firstly developed. The long-term and short-term ecological thresholds of perfluorooctanesulfonate using crucian carp as bioindicator are 3.329 and 1.402 µg/g wet weight respectively. Using the long-term thresholds derived from chronic toxicity data and the accumulative concentrations of contaminants obtained by bioindicator results, the bioindicator monitoring can be used for long-term ecological risk surveillance. The threshold derivation method can extend the application of bioindicator monitoring from the occurrence study to ecological risk surveillance, which is especially important for China who has made progresses on regular contaminant control and starts to be concerned about the ecological risks of the emerging contaminants. The framework can be used to create national and regional long-term freshwater bioindicator monitoring programs, with the purposes of ecological risk assessment, occurrence and temporal trend study, pollution source identification, international convention fulfillment, retrospective study, etc. The bioindicator framework will benefit the aquatic environmental safety and the hazardous chemical management in China.

The Association between Health Workforce and Health Outcomes: A Cross-Country Econometric Study.

This study investigates the strength and significance of the associations of health workforce with multiple health outcomes and COVID-19 excess deaths across countries, using the latest WHO dataset. Multiple log-linear regression analyses, counterfactual scenarios analyses, and Pearson correlation analyses were performed. The average density of health workforce and the average levels of health outcomes were strongly associated with country income level. A higher density of the health workforce, especially the aggregate density of skilled health workers and density of nursing and midwifery personnel, was significantly associated with better levels of several health outcomes, including maternal mortality ratio, under-five mortality rate, infant mortality rate, and neonatal mortality rate, and was significantly correlated with a lower level of COVID-19 excess deaths per 100 K people, though not robust to weighting by population. The low density of the health workforce, especially in relatively low-income countries, can be a major barrier to improving these health outcomes and achieving health-related SDGs; however, improving the density of the health workforce alone is far from enough to achieve these goals. Our study suggests that investment in health workforce should be an integral part of strategies to achieve health-related SDGs, and achieving non-health SDGs related to poverty alleviation and expansion of female education are complementary to achieving both sets of goals, especially for those low- and middle-income countries. In light of the strains on the health workforce during the current COVID-19 pandemic, more attention should be paid to health workforce to strengthen health system resilience and long-term improvement in health outcomes. Supplementary Information: The online version contains supplementary material available at 10.1007/s11205-022-02910-z.

Spatial Disparities in Access to Healthcare Professionals in Sichuan: Evidence from County-Level Data.

As a southwestern province of China, Sichuan is confronted with geographical disparities in access to healthcare professionals because of its complex terrain, uneven population distribution and huge economic gaps between regions. With 10-year data, this study aims to explore the county-level spatial disparities in access to different types of healthcare professionals (licensed doctors, registered nurses, pharmacists, technologists and interns) in Sichuan using temporal and spatial analysis methods. The time-series results showed that the quantity of all types of healthcare professionals increased, especially the registered nurses, while huge spatial disparities exist in the distribution of healthcare professionals in Sichuan. The local Moran's I calculations showed that high-high clusters (significantly high healthcare professional quantity in a group of counties) were detected in Chengdu (capital of Sichuan) and relatively rich areas, while low-low clusters (significantly low healthcare professional quantity in a group of counties) were usually found near the mountain areas, namely, Tsinling Mountains and Hengduan Mountains. The findings may deserve considerations in making region-oriented policies in educating and attracting more healthcare professionals to the disadvantaged areas.

Detecting the priority areas for health workforce allocation with LISA functions: an empirical analysis for China.

BACKGROUND: Health workforce misdistribution leads to severe inequity and low-efficiency in health services in the developing countries. Targeting at China, this research aims to reveal, visualize and compare the geographical distribution patterns of different subtypes of urban and rural health workforce and identify the priority regions for health workforce planning and allocation policies designing. METHODS: The health workforce density (workforce-to-population ratio) is adopted to represent the accessibility to health workforce in each geographical unit. Besides a descriptive geography of health workforce as a whole, the local indicators of spatial association (LISA) are used to explore the spatial clusters of different subtypes of health workforce, which are visualized by geographical tools. RESULTS: Results reveal that regional disparities and spatial clusters exist in China's health workforce distribution, with different types of workforce exhibiting relatively different spatial distribution characteristics. Besides, huge urban-rural disparities are found in the distribution of health workforce in China. Unexpectedly but intriguingly, most of the high-high and high-low cluster area of urban health workforce are concentrated in the western China (Xinjiang, Xizang etc.), indicating the relative abundant stock of urban health workforce in these units, while the low-low and low-high cluster area of different types of urban health workforce are mainly distributed in middle China. Regarding the rural health workforce, there is an obvious and similar low-low and low-high clustering pattern in western provinces (Sichuan, Yunnan) for the licensed doctors, pharmacists, technologists, which play a critical role in health services delivery. CONCLUSIONS: Different types of health workforce displayed distinct spatial distribution patterns, while the misdistribution of rural health workforce imposed more challenges to the Chinese health sector due to its poorer stock and more disadvantaged positions of backward regions (i.e., low-low and low-high cluster area). Subtype-specific and region-oriented health workforce planning and allocation policies are suggested to be made, aiming at the urban and rural health workforce respectively, by prioritizing the identified low-low and low-high cluster areas.

Attitude towards working in rural areas: a cross-sectional survey of rural-oriented tuition-waived medical students in Shaanxi, China.

BACKGROUND: Attracting and recruiting health workers to work in rural areas is still a great challenge in China. The rural-oriented tuition-waived medical education (RTME) programme has been initiated and implemented in China since 2010. This study aimed to examine the attitudes of rural-oriented tuition-waived medical students (RTMSs) in Shaanxi towards working in rural areas and the related influencing factors. METHODS: A cross-sectional survey was conducted in 2015 among 232 RTMSs in two medical universities from the first group of students enrolled in the RTME programme in Shaanxi. Descriptive and analytical statistics were used for the data analyses. RESULTS: Of the 230 valid responses, 92.6% expressed their intentions of breaking the contract for working in rural township hospitals for 6 years after their graduation under the RTME programme. After the contract expired, only 1.3% intended to remain in the rural areas, 66.5% had no intention of remaining, and 32.2% were unsure. The factors related to a positive attitude among the RTMSs towards working in rural areas (no intention of breaking the contract) included being female, having a mother educated at the level of primary school or below, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the policy. The factors related to a positive attitude of the RTMSs towards remaining in rural areas included being female, having a rural origin, having no regular family monthly income, having a father whose occupation was farmer, having a mother educated at the level of postsecondary or above, having the RTMSs be the final arbiter of the policy choice, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the educational scheme. CONCLUSIONS: Related policy makers and health workforce managers may benefit from the findings of this study. Appropriate strategies should be implemented to stimulate the RTMSs' intrinsic motivation and improve their willingness to work in rural areas and to better achieve the objectives of RTME policy. Meanwhile, measures to increase the retention of RTMSs should also be advanced.

Association between rural clinical clerkship and medical students' intentions to choose rural medical work after graduation: A cross-sectional study in western China.

BACKGROUND: A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students' participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. METHODS: Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson's chi-squared tests and binary logistic regression analyses were performed for data analyses. RESULTS: Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students' intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05-1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48-2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background. CONCLUSIONS: Rural clinical clerkship is likely to increase the odds of having intentions to work in rural medical institutions after graduation among medical students in western China, especially for those with an urban background. Related policy makers could consider developing compulsory rural clerkship programs and implement them among medical students to increase early rural exposure.

Equity of health service utilization of urban residents: data from a western Chinese city.

BACKGROUND: Getting medical treatment is still difficult and expensive in western China. Improving the equity of basic health services is one of the tasks of the new healthcare reform in China. This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors. METHODS: In August 2011, a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling. Based on the survey data, we calculated a concentration index of health service utilization for different income residents and a difference index of different ages. We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model. RESULTS: The two-week morbidity rate of sampled residents was 19.43%, the morbidity rate of chronic diseases was 21.68%, and the required hospitalization rate after medical diagnosis was 11.36%. Among out-patient service utilization, the two-week out-patient rate, number of two-week out-patients, and out-patient expense had good parallel and vertical equity, while out-patient compensation expense had poor parallel and vertical equity. The inpatient service utilization, hospitalization rate, number of inpatients, days stayed in the hospital, and inpatient expense had good parallel equity, while inpatient compensation expense had poor parallel equity. While the hospitalization rate and number of inpatients had vertical equity, the days stayed in hospital, inpatient expense, and inpatient compensation expense had vertical inequity. CONCLUSIONS: Urban residents' health was at a low level and there was not good health service utilization. There existed rather poor equity of out-patient compensation expense. The equity of inpatient service utilization was quite poor. Income difference and the type of medical insurance had great effects on the equity of health service utilization.

Pharmaceuticals and personal care products (PPCPs): a review on environmental contamination in China.

Pharmaceuticals and personal care products (PPCPs) which contain diverse organic groups, such as antibiotics, hormones, antimicrobial agents, synthetic musks, etc., have raised significant concerns in recently years for their persistent input and potential threat to ecological environment and human health. China is a large country with high production and consumption of PPCPs for its economic development and population growth in recent years. This may result in PPCP contamination in different environmental media of China. This review summarizes the current contamination status of different environment media, including sewage, surface water, sludge, sediments, soil, and wild animals, in China by PPCPs. The human body burden and adverse effects derived from PPCPs are also evaluated. Based on this review, it has been concluded that more contamination information of aquatic environment and wildlife as well as human body burden of PPCPs in different areas of China is urgent. Studies about their environmental behavior and control technologies need to be conducted, and acute and chronic toxicities of different PPCP groups should be investigated for assessing their potential ecological and health risks.