Can digital finance mitigate trust issues for chronically ill patients because of relative deprivation of income?

Objective: The relative deprivation of income among chronically ill patients may create a perception of inequity in their access to quality healthcare, which may lead to a decline in patients' trust and further increases the burden of chronic diseases. Digital finance could be the antidote. To promote equity in healthcare delivery, this study explores the mitigating effect of digital finance by elucidating the relationship between relative deprivation of income and chronically ill patients' trust. Methods: Using data from the China Family Panel Study, a Poisson regression model was applied to assess the effect of relative deprivation of income on chronically ill patients' trust. A marginal effect analysis was used to verify the effect and a two-stage least squares method was used to test robustness. Results: Chronically ill patients' trust was at a medium level (5.98 ± 2.05). Relative deprivation of income significantly reduced patients' trust (ß=-0.056, p < 0.1). The digital finance had a positive effect on patients' trust (ß=0.035, p < 0.01) and alleviated the negative effect of relative deprivation of income on patients' trust (ß=0.105, p < 0.01). The instrumental variable estimation results confirmed the robustness of the benchmark regression results. Conclusions: The inequity resulting from relative deprivation of income undermines patients' trust. Digital finance has a long-term effect on alleviating perception of inequity among chronically ill patients. The government should promote the integration of digital finance and smart healthcare to enhance patients' trust and contribute to equality in healthcare delivery. Limitations include self-reported data and an insufficient correlation between selected indicators and healthcare services.

Catastrophic health expenditure of households with hypertension: a comparative study in China.

Objectives: The aim of this study was to understand the impact of multimorbidity on catastrophic health expenditures for people with hypertension. Methods: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, 8,342 adults were included in our analysis. Propensity score matching method was used to compare the risk of catastrophic health expenditures between the hypertension patients (treatment group) and those without any chronic disease (control group) in middle-aged and older adults. Patients with hypertension were also divided into two groups: only hypertension and multimorbidity. Results: Hypertension increased the likelihood of CHE by 11.3% in older adults. Further analysis showed that hypertension alone does not increase the risk of CHE, and the risk of CHE in hypertension patients with multimorbidity was 12.9% higher than those without chronic disease. Conclusion: Our study highlights the importance of healthy management of patients with only hypertension and preventing them from developing multimorbidity.

Quality of life among different types of Chinese lonely elderly: A social isolation based analysis.

This study aimed to understand the types and characteristics of lonely elderly from the perspective of social isolation and compare their differences in quality of life (QOL). A cross-sectional survey of 2148 lonely elderly in Shanxi province, China was conducted. The latent profile analysis was used to classify the lonely elderly and describe their characteristics. A hierarchical multilinear regression method was applied to evaluate their differences in QOL. The lonely elderly can be divided into two categories: Class-Ι, in low social isolation with a significant correlation between social isolation and loneliness (p < 0.05), and Class-ΙΙ, in high social isolation with no significant correlation between social isolation and loneliness (p > 0.05).QOL of Class-Ι was significantly higher than that of Class-ΙΙ. Class-ΙΙ was in a state of self-imposed isolation with poor QOL and should be the focus-group during practical intervention.

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model.

BACKGROUND: As China's aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters. METHODS: A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL. RESULTS: The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester's QOL (P < 0.05) (R2 = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (ß = 0.446, P < 0.001). Socio-economic status had an indirect effect (ß = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (ß = 0.115, P < 0.001) on QOL. CONCLUSION: Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.

Efficacy of the self-mutual-group model targeting quality of life improvement among empty-nest older adults in Taiyuan, China: an intervention study.

BACKGROUND: In China, more and more older people have encountered a situation called "empty nest." Meanwhile, the health status of empty-nest older adults is an increasing public health concern. This research aims to examine the effectiveness of Self-Mutual-Group (SMG) model in improving quality of life of the empty-nest older adults to provide a scientific evidence for improving their health. METHODS: A prospective intervention study was conducted among empty-nest older adults in Taiyuan, Shanxi. Multi-stage stratified random cluster sampling was employed to selected participants. A total of 396 empty nesters were enrolled as participants, of which 204 and 192 were in the intervention and control group, respectively. The intervention group received a seven-month SMG-based intervention. A participant's quality of life was measured at the baseline and seven months after using the Short Form 36-Item Health Survey (SF-36). RESULTS: No significant difference was found between the intervention and control groups in terms of participant characteristics at baseline (P > 0.05). After the intervention, participants' scores on Mental Component Summary (MCS), Physical Component Summary (PCS), role emotional (RE), vitality (VT), social function (SF), mental health (MH) and general health (GH) increased significantly in the intervention group. Additionally, these scores differed significantly from those in the control group (P < 0.05). CONCLUSION: This study showed that the SMG-based health management is effective in improving quality of life among empty-nest older adults after seven months. TRIAL REGISTRATION: Study on the 'SMG' Health Management Model Based on Community Organization Theory among empty-nest older adults ( ChiCTR1800015884 ). Registration date: 26-04-2018. Retrospectively registered.

The relationship between socioeconomic status and depression among the older adults: The mediating role of health promoting lifestyle.

BACKGROUND: Depression is the most frequent psychiatric disorder among the older adults, the purpose of this study is to explore the mediation effect of health promoting lifestyle on the relationship between Socioeconomic Status (SES) and depression, so as to provide practical reference for effectively preventing and alleviating depression of the older adults. METHODS: A multi-stage random sampling method was conducted in Shanxi Province. A total 8526 older adults were included in the analysis. Regression analysis was used to explore the relationship between the socioeconomic status, health promoting lifestyle and depression, and the mediation effect test process was used to verify the mediating mechanism of health promoting lifestyle on this relationship. RESULTS: 62.1% of the older adults had depression symptoms in this study, and there were significant differences in depression scores among the older adults with gender, age, residence, marital status, endowment pattern, self-care ability, exercise frequency, physical examination frequency, daily diet rules(P<0.05). The results of mediating effect analysis showed that health promoting lifestyle as mediation effect between social economic status and depression was established, and the mediating effect was accounted for (a*b/c) 63.1%. LIMITATIONS: Given the cross-sectional study, it is not possible to make causal inferences. CONCLUSIONS: There were different degrees of depression in the older adults. The lower the SES is, the higher the risk of depression is. This result once again confirms the social causation theory. Combined with the theory of health risk behavior, the study further confirmed the applicability of lifestyle mechanism in the intermediate mechanism of the relationship between SES and depression in the elderly. Thus, in addition to providing material support and financial assistance, helping the elderly develop a healthy lifestyle is also effective measure to improve their depression.

Social Engagement and Urban-Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients.

BACKGROUND: This study examines the effect of social engagement on urban-rural disparities in self-management behaviors (medication use, self-monitoring, physical activity, and tobacco and alcohol avoidance) among middle-aged and older Chinese patients with hypertension. METHODS: Data from 2011 to 2018 were extracted from the four latest waves of the China Health and Retirement Longitudinal Study. Chi-square tests and t-tests were performed to examine urban-rural gaps in self-management behaviors. Random-effects panel logit regression models were adopted to confirm the effect of social engagement on urban-rural disparity in self-management behaviors and to explore whether this effect has narrowed or widened with "bilateral flow" between urban and rural residents. A Fairlie decomposition technique was also used to calculate the extent to which social engagement reflects urban-rural disparities. RESULTS: There was significant urban-rural disparity in medication use and tobacco avoidance behaviors among the sampled patients. Medication use behavior (p < 0.001) among urban middle-aged and older patients was significantly better, whereas tobacco avoidance behavior (p < 0.05) was significantly lower compared with the rural population. Social engagement significantly enlarged the urban-rural gap in tobacco avoidance behavior (p < 0.01), but significantly narrowed the urban-rural gap in medication use behavior (p < 0.001). The Fairlie decomposition revealed that ~75.000% and 29.412% of the explained urban-rural gap in tobacco avoidance and medication use, respectively, could be attributed to social engagement. The negative effect of social engagement on urban-rural disparity in medication use increased when urban residents moved to rural areas (p < 0.05). CONCLUSIONS: The urban-rural disparities in self-management behaviors of middle-aged and older Chinese hypertensive patients were mainly manifested in medication use and tobacco avoidance behaviors. The gaps in these two behaviors partly changed with social engagement, while the migration of urban population to rural areas weakens the positive role of social engagement in narrowing the urban-rural gap in medication use behavior. The insights of this paper on social engagement and urban-rural disparity in self-management behaviors, and the effect of urban-rural migration thereof, deserve the attention of health policymakers and researchers.

A rapid response near-infrared ratiometric fluorescent probe for the real-time tracking of peroxynitrite for pathological diagnosis and therapeutic assessment in a rheumatoid arthritis model.

Peroxynitrite (ONOO-) is a potent bio-oxidant involved in many physiological and pathological processes; however, most of the pathological effects associated with ONOO-in vivo are still ambiguous. Herein, we designed and synthesized two near-infrared ratiometric fluorescent probes, Ratio-A and Ratio-B, for the detection and biological evaluation of ONOO-. The recognition unit diene in the probes could be specifically cleaved by ONOO- with a 94-fold enhancement in the ratiometric fluorescence signal. By imaging ONOO- in immune stimulated cells and acute inflammation mice model using Ratio-A, we investigated the fluctuations of ONOO- levels in a rheumatoid arthritis (RA) model of mice. Ratio-A could be applied for the effective imaging of RA and could rapidly evaluate the response of the RA treatment with methotrexate (MTX). Thus, Ratio-A can be considered as a promising tool for pathological diagnosis and the therapeutic assessment of a wide range of diseases including RA.

Moderating effect of social support on depression and health promoting lifestyle for Chinese empty nesters: A cross-sectional study.

BACKGROUND: Health promoting lifestyle (HPL) may be a facilitator for empty nesters' active aging against depression. Social support (SS) may improve their HPL. This study aimed to examine moderating effect of SS and its three sources of SS on relationship between depression and HPL among empty nesters. The compensating role of socioeconomic status (SES) for lack of SS was examined, too. METHODS: A cross-sectional survey of empty nesters (n = 1593) was conducted in six districts of Taiyuan, China, using a stratified random cluster sampling method. Hierarchical multiple linear regression analyses were performed to assess moderation models by SS and its three sources. RESULTS: The findings indicated that low depression (p < 0.001) and sufficient perceived SS (p < 0.001) could directly predict better HPL among empty nesters. The effect of SS on HPL declined with the raise of educational level (p < 0.001). Family support (ß = 0.083, p < 0.001), friends support (ß = 0.085, p < 0.001) and others support (ß = 0.098, p < 0.001) expressed significant negative buffer effects on depression and HPL individually. LIMITATIONS: There was a cross-sectional study that limited the moderating effect of SS on depression and HPL just for empty nesters in Taiyuan, China. The results cannot explain the causal relationships among the study variables. CONCLUSIONS: SS might be a protective factor of empty nesters' health in China. Three sources of SS all showed moderating effect on the relationship between depression and HPL among empty nesters, and should be integrated to achieve maximum utility. Friends support/ others support could play complement role for lack of family support. SES expressed partial compensatory for lack of SS.

Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model.

BACKGROUND: China has the world's largest elderly population and an increasing number of empty-nest elderly. The purpose of this study is to evaluate the effectiveness of the Self-Mutual-Group model on social support of the empty-nest elderly, thus providing reference for improving their quality of life. METHODS: A intervention study was conducted between October 2016 and May 2017 at six communities in Taiyuan, Shanxi Province, China. A total of 350 empty-nest elderly aged 60-88 years were randomly assigned in the intervention group (n = 167) with a 7-month SMG-based intervention or to a control group (n = 183) with no intervention. The social support of the participating elderly (n = 350) was assessed by the Social Support Rating Scale (SSRS) at the baseline and 7 months later, respectively. RESULTS: A 7-month follow-up showed an increasing mean scores of SSRS, objective support, subjective support and support utilization of the intervention group, and reached statistical significance (P < 0.05). CONCLUSIONS: The Self-Mutual-Group model was considered to be a positive intervention and was effective in increasing social support among the empty-nest elderly. Furthermore, future research should extend the intervention period and introduce multi-point measurement to better evaluate the intervention process and outcomes. TRIAL REGISTRATION: Study on the 'SMG' Health Management Model Based on Community Organization Theory among empty-nest elderly (ChiCTR1800015884).

Health promoting lifestyles and influencing factors among empty nesters and non-empty nesters in Taiyuan, China: a cross-sectional study.

BACKGROUND: In China, the problems of population aging and empty nesting have become important issues which will affect the social stability and economic development. The aim of this study was to explore the health promoting lifestyles and influencing factors among empty nesters and compare with non-empty nesters to find out their differences, so as to provide a scientific evidence for people to formulate health management strategies for elderly. METHODS: A cross-sectional survey which used a stratified random cluster sampling method, was conducted among 500 elders in six districts of Taiyuan, China, there were 288 empty nesters and 212 non-empty nesters. The general information and health- promoting lifestyles were investigated by using the self-made General Information Questionnaire and Health Promoting Lifestyle Scale(HPLP). Two-sample t-test and Chi-square test were used to compare the sociodemographic factors, HPLP scores of empty nesters to non-empty nesters; Multiple stepwise linear regression was performed to estimate influencing factors related to the HPLP of empty nesters and non-empty nesters. RESULTS: The current findings showed that there were differences between the empty nesters and non-empty nesters in gender, resident, marital status, education and income, self-care ability, source of income, relationship with spouse and social activities (P < 0.05). Empty nesters were mostly male, married, had a higher education level, self-care ability and income and lived in urban compared with non-empty nesters. The health promoting lifestyles of the elderly in this survey were in the medium level, the highest score for all dimensions in both groups was in nutrition, whereas health responsibility was executed worst. The HPLP and six subscales scores of the empty nesters were higher than non-empty nesters, there were significant differences in total score of HPLP, self-realization and health responsibility (P < 0.01). Multiple regression analysis showed that the main predictive factors for the empty nesters were education, self-care ability and resident, whereas the main predictive factors for the non-empty nesters were parents-child relationship, source of income and age; social activity was the common factor for two group. CONCLUSION: The health promoting lifestyles of the empty nesters was better than that of the non-empty nesters. Health responsibility, interpersonal relations and stress management were key dimensions to be improved. Except social activity, education, self-care ability and resident were the unique influencing factors of health-promoting lifestyles for empty nesters, while the parents-child relationship, income and age were unique factors for non-empty nesters. The main target of Intervention strategy for elderly health promoting lifestyles should be the enhance of health responsibility, interpersonal relations and stress management by improving social activities, parent-child relationship, education and income of elderly.