Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis.

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

Analysis of medical resources for allocation equity using traditional Chinese medicine resource as a model.

OBJECTIVES: This study is designed to analyse current allocation equity of medical resources in China for a better distribution of medical resources. METHODS: Descriptive statistical methods were used to analyse the overall allocation of Traditional Chinese medicine (TCM) resources between 2012 and 2018. Lorentz curve and Gini coefficient were used to quantitatively analyse the fairness of the allocation from the population and geography two dimensions. RESULTS: This study revealed an increase of TCM resources for the 6-year period, but the fair allocation of these resources was subjected to the methods used. The Gini coefficients were <0.3 based on population distribution but >0.5 basing on the geography allocation. CONCLUSION: Population based analysis for the equity of the TCM resource allocation is superior, more attention for health resource planning is needed to focus on geographical fairness in the future, especially for the less populated rural regions.

Equity analysis of Chinese physician allocation based on Gini coefficient and Theil index.

BACKGROUND: Unequal allocation of medical physician resource represents one of major problems in the current medical service management in China and many other countries. This study is designed to analyze the current distribution of physicians in 31 provincial administrative regions in China, to estimate the fairness of the distribution of physicians and provide a theoretical basis for the improvement of the allocation of physicians. METHODS: This study took physicians from 31 provincial administrative regions in China as the study objects, and the data were obtained from the China Health Statistics Yearbook 2019 and the official website of the National Bureau of Statistics of China. Calculation of the Gini coefficient (G) and the Theil index (T) were carried out by drawing the Lorenz curve. The fairness of present physician location in 31 provincial administrative regions in China was analyzed from the perspective of distribution by both population and service area. RESULTS: The Gini coefficients of medical physicians in China are 0.003 and 0.88 by population and by service area, respectively. This shows that the distribution of medical physicians is fair basing on population, and there is little difference in the number of physicians per 1000 population in different regions. However, the physician distribution basing on service area is highly unfair and shows a large gap in the number of physicians per square kilometer between different regions. In general, Beijing, Zhejiang, Shanghai, Jiangsu, Shandong, and Tianjin are higher than the overall level of 31 provincial administrative regions. In addition, the number of medical physicians in Zhejiang, Shandong, Beijing and Jiangsu is over-provisioned. CONCLUSION: Bridging the number of medical physicians in different regions is a key step to improve the equity of physicians' resource allocation. Thus, findings from this study emphasize the need to take more measures to reduce physician quality differences between regions, balance and coordinate medical resources. This will increase the access of all citizens to quality medical services.

An Observational Assessment of Park-based Physical Activity in Older Adults in Nanchang, China.

Objectives: Parks are more widely used by older adults in East Asia than in the United States. Parks are an important community asset for healthy aging; yet, little is known about park usage and features among older adults in China. Methods: The Community Park Audit Tool and the System for Observing Play and Recreation (SOPARC) were used to assess park features, PA levels and primary activities among 40,469 older adults in Nanchang, China. Results: None of the 8 parks observed had basketball courts or baseball fields and only one had a playground. Results indicated that about half of older adults were active in parks, with women, cooler temperatures, weekdays, and morning hours being related to higher levels of activity. Conclusions: Lessons from the construction of parks in China may be useful in increasing park use in older adults in western countries. Features such as exercise equipment, water features, and small exercise areas were common where western parks are often designed with features for teens and youth including basketball courts, baseball fields, and playgrounds.

The intentions, needs, advantages and barriers: a survey of twenty-nine countries participating in the "Belt and Road Initiative" health cooperation.

BACKGROUND: China launched the Belt and Road Initiative (BRI) aiming to develop a mutually-beneficial, sustainable trade model with partner countries. The processes of international health exchanges are key parts of how this model can be sustained into the future. This paper aims to contribute to broader understanding by exploring various intentions, needs, advantages and barriers of BRI countries and then define ways China can achieve better health cooperation. METHODS: In this study, a survey questionnaire was developed to investigate the perspectives of 60 international experts from 29 BRI countries. The survey was distributed and collected during the "Belt and Road High-level Meeting for Health Cooperation", held in Beijing in August 2017. The data were entered into EpiData 3.0 by two team members respectively and analyzed with SPSS22.0. RESULTS: Altogether 58 valid questionnaires were obtained. More than 93% of participants showed their willingness to be part of BRI health cooperation. Frist, three key areas were identified, which are broadly defined as BRI country "needs": (1) "Develop health industries"; (2) "Prevent and control infectious diseases"; and (3) "Provide health services". Second, three "advantages" of participating in BRI Health Cooperation were found: (1) "The establishment of a long-term partnership"; (2) "Quality investment and financing system"; and (3) "The convenience of cooperation". Third, two main cross-cultural "barriers" for cooperation were encountered: (1) "Cultural differences"; and (2) "Lack of communication platforms". CONCLUSION: In this study, we have identified priority fields that China can collaborate with BRI countries and show its leadership. It is suggested that successful health cooperation between China and other BRI countries should focus on maximizing present health-industry partnerships, investment and financing, as well as overcoming cultural and communication barriers.

Probabilistic health risk assessment of nitrosamines in drinking water of Shaoxing, Zhejiang, China.

Nitrosamines (NAms) are potent genotoxic and carcinogenic but widely detected in drinking water. This study aimed to investigate the occurrence of major types of NAms in drinking water in Shaoxing, China, and to conduct multi-pathway probabilistic cancer risk (CR) assessment to residents based on age-dependent adjustment Chinese exposure factors. Results showed that concentrations of NAms in water varied from not detected (ND) to dozens of nanograms per liter level. N-Nitrosodimethylamine (NDMA) was detected most frequently (93.06%), followed by N-nitrosodiethylamine (NDEA) (64.08%)-with the highest cancer risk among NAms. The CR of NAms came mainly through the oral exposure pathway. The 95th percentile of the total CR of five major NAms was 1.06 × 10-4, exceeding the maximum acceptable lifetime CR (1 × 10-4) recommended by US EPA. Exposure to NDEA contributed the highest to the total CR. The CR of the five NAms through ingestion was 2.5 times higher using the Chinese exposure factors than that of the Americans. The most important variables related to CRs were concentrations of NAms in drinking water, exposure duration, drinking water ingestion rate, and exposure time during bathing. Our findings suggest the urgent need to develop and enforce effective regulatory policies to control the contamination of NAms in drinking water in China. Graphical abstract.

Investigation on Task Shifting of HIV/AIDS Follow-Up Management Workers in New Launched Areas, China.

Background: This study aimed to understand attitudes of HIV/AIDS follow-up workers regarding task shifting, reveal the current conditions of this implementation, as well as to find out any challenges of early-stage implementation. Methods: Taking Jiangxi Province as an example, a cross-sectional survey with 102 health professionals in CDCs (Centers for Disease Control and Prevention) and 92 health care providers in primary health institutions was conducted from November 2016 to January 2017. This survey includes the demographic backgrounds of participants, their attitudes towards task shifting, and the main difficulties faced in their work, etc. Results: 60.8% of professionals and 77.2% of providers hold positive attitudes towards task shifting. Both health professionals and providers express their concerns about unclear and undefined funds distribution and lack of confidentiality of PLWHA (people living with HIV) in local primary health institutions. Conclusions: The majority of health workers hold positive attitudes towards task shifting. It also highlights some negative reactions in implementation, and reveals the main difficulties that constitute barriers to follow-up. Findings from this study may provide evidence for enhancing future implementation of task shifting.

Impact of the New Cooperative Medical Scheme on the Rural Residents' Hospitalization Medical Expenses: A Five-Year Survey Study for the Jiangxi Province in China.

This survey study was conducted to understand the effect of the New Cooperative Medical Scheme (NCMS) on farmers’ medical expenses through comparing the information from five investigations and to obtain a scientific basis for a more applicable NCMS. The survey was carried out through interviewing farmers in their homes. The multi-phase stratified cluster random sampling was adopted to select 3 counties from all 92 counties of the Jiangxi province, 9 townships from the 3 selected counties, 27 villages from the selected 9 townships, and 60 families from each village between 2006 and 2014, and a longitudinal comparative analysis was conducted. The numbers of households/overall sample for the five years were 1924/8082, 1879/8015, 1885/7506, 1890/7857, and 1896/7811, respectively. We collected family members’ social demographic characteristics, health resources, and peoples’ health and medical expenses and reimbursement of each family member. The adjusted hospitalization expenses per capita of township hospitals and county hospitals were totally on a rising trend. However, the costs of tertiary hospitals were on a decreasing tendency. In addition, the expenses for county hospitalization per admission were on an upward trend in general. Furthermore, the total hospitalization expenses and reimbursement per capita (the insurance paid out for the hospitalization expenses) were also all on an upward trend. The proportion of reimbursement also had a tendency of increasing from 24.41% in 2006 to 41.34% in 2014. The costs paid from farmers’ pockets were fluctuated, but in general all lower than the costs in 2006. Furthermore, the percentage of hospitalization expenses from farmers’ annual incomes gradually decreased each year from 56.38% in 2006 to 26.58% in 2014. NCMS program has had an obvious impact on the hospitalization expenses in the Jiangxi rural area. It reduced the hospitalization expenses of the tertiary hospitals significantly. In addition, the program has also encouraged farmers to get more health care. However, there are still some shortages associated with present construction of the NCMS. Hence, there is a need for local government to continue to take effective countermeasures to control the rising trend of hospitalization expense.

Mental Health Status and Associated Contributing Factors among Gay Men in China.

Chinese gay men are preferentially vulnerable to mental health problems because of deep-rooted, traditional social influence that overemphasizes heterosexual marriage, fertility, and filial piety. A cross-sectional survey was conducted from November to December 2017 using the Chinese version of the Symptom Checklist-90-R (SCL-90-R) to assess the status of, and factors associated with the mental health of Chinese gay men. Unadjusted associations between demographic factors and the total score of SCL-90-R were examined using t/F tests or person correlation analysis. The main factors that were most predictive of the aggregate score of SCL-90-R were identified by multiple linear regressions. A total of 367 gay men participated in this survey with an average score of SCL-90-R of 180.78 ± 79.58. The scores of seven dimensions (OCS, INTS, DEPR, ANX, HOS, PHOA, PARI) for Chinese gay men were found to be significantly higher than the national norm (all p < 0.001). Age (B = -1.088, SE = 0.478, p = 0.023), educational level (B = -14.053, SE = 5.270, p = 0.008), and degree of coming out publicly (B = -23.750, SE = 4.690, p < 0.001) were protective factors for participants' mental health status. A gay man who is the only child in his family was more likely to obtain a higher total score of SCL-90-R in China (B = 59.321, SE = 7.798, p < 0.001). Our study reveals the worrying mental health status of Chinese gay men. Shifts in familial, governmental, and societal normas are suggested to improve the current social acceptance towards sexual minority men, as well as to reduce detrimental health effects.

Government employees' perception of urban air pollution and willingness to pay for improved quality: a cross-sectional survey study in Nanchang, China.

To improve the public's awareness of urban air pollution and promote establishment of more efficient policy toward urban air pollution, we investigated the government employees' perceptions of current urban air pollution and their willingness to pay (WTP) taxes for improved quality in Nanchang, China. Stratified cluster sampling strategy was used to distribute 629 questionnaires, and 608 were completed anonymously, yielding a 96.7 % response rate. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were performed to assess the associations of perception of urban air quality and WTP versus demographic variables. We found low awareness of urban air pollution (34.5 %) as well as low WTP (44.9 %), especially among the middle aged people (age 30-39 and age 40-49). Our study shows that female employees have better awareness of urban air pollution but much less willingness to pay for air quality improvement. Majority of the government employees showed their support to the government for more effective policies toward environmental protection, indicating more enhanced public education and environmental protection campaigns to improve the public's awareness of air pollution and work with every citizen to improve air quality. This study also obtained baseline information useful to the local regional and even national government in developing nations in their attempt to control urban air pollution in future.

The Association between Family and Parental Factors and Obesity among Children in Nanchang, China.

BACKGROUND: With rapid economic development in China, traditional patterns of health behaviors are changing, concurrent with a rise in childhood obesity. While the home environment and parenting behaviors are modifiable factors that could be targeted for intervention, little is known about their relationship with children's health behaviors. Therefore, the purpose of this study was to investigate the relationship between obesity and home and parenting factors in Chinese children. METHODS: A cross-sectional survey was conducted in Nanchang, China in 2013 with caregivers (N = 470) of a child between the ages of 2 and 10 years. Regression analyses were conducted to determine risk factors for childhood obesity. RESULTS: Obesity prevalence (21.7%) did not differ by demographic variables. Eight physical activity, nutrition, and sedentary variables had significant relationships to obesity status. Logistic regression analysis revealed three significant predictors of obesity: the number of days the family eats meals together (odds ratio = 0.84, 95% CI 0.73-0.96) and parental home computer use time (odds ratio = 0.83, 95% CI 0.72-0.96) were related to lower levels of obesity, while parental television time (odds ratio = 1.25 95% CI 1.07-1.47) was related to higher levels of obesity. CONCLUSION: The prevalence of obesity among children is high in Nanchang. Family and environmental risk factors are significantly related to obesity.

Analysis of residents' willingness to pay to reduce air pollution to improve children's health in community and hospital settings in Shanghai, China.

BACKGROUND: Shanghai, along with many major cities in China, faces deterioration of air quality and increases in air pollution-related respiratory diseases (RDs) in children due to rapid industrialization and urbanization. The Contingent Valuation Method (CVM) was used to qualitatively and quantitatively measure the willingness to pay (WTP) for reducing children's RDs through air quality improvement. METHODS: Between April and May, 2014, 975 face-to-face interviews were collected from parents in a community-based and a hospital-setting in Shanghai. Multiple imputation and the Probit model were used to determine the relationship between the WTP and the related environmental factors, child health factors and the socio-economic status. RESULTS: Most respondents reported being willing to make a financial contribution to improve air quality in both the community (52.6%) and hospital (70.2%) samples. Those in the hospital setting were willing to pay significantly more ¥504 (USD$80.7) compared to the community sample ¥428 ($68.5) as expected. Reasons for those not being willing to pay included lack of disposable income and believing that responsibility of the air quality was a community issue. These did not differ by sample. Annual household income and education were related to WTP. CONCLUSION: This study indicated that parents in Shanghai would be willing to pay for improved air quality. Children's health can be the incentive for the citizens' participation and support in the air quality improvement, therefore, hospital settings may present unique places to improve education about air quality and enhance advocacy efforts. This study also suggested that future environmental policies be addressed more rigorously for targeted populations.

Insights from an observational assessment of park-based physical activity in Nanchang, China.

Internationally, parks have been shown to be an important community asset for physical activity (PA), but little is known about the relationship between park usage and physical activity in China. The purpose of this study was to determine the association between park user characteristics and PA in Nanchang, China. In June 2014, 75,678 people were observed in eight parks over 12 days using SOPARC, a validated systematic observation tool. A logistic regression analysis was used to determine the association between PA and park user characteristics. Most park users were older adults (53.5%) or adults (34.6%). Overall, 55% of park users engaged in moderate-to-vigorous physical activity (MVPA). Fewer women were observed in parks than men, but were 66% more likely to be engaged in MVPA than men. Park users were more likely to be observed in MVPA between 6-9 am and when the temperature was below 30 °C. Chinese park users were more active (55%) than US studies in Tampa (30%), Chicago (49%), and Los Angeles (34%). More research is necessary to identify features of parks that are associated with greater PA so that effective interventions can be developed to promote active park use in Chinese citizens.

Hepatitis C virus infection in patients with HIV-1: epidemiology, natural history and management.

Hepatitis C virus (HCV)-related liver diseases have contributed to increased morbidity and mortality in HIV-1-infected individuals in the era of effective antiretroviral therapy. HCV transmission patterns have changed among the HIV co-infected population during the last decade, with acute HCV infection emerging worldwide. HIV infection accelerates the progression of HCV-related liver diseases and consequently cirrhosis, liver failure, and hepatocellular carcinoma. However, the current standard treatment of HCV infection with pegylated interferon plus ribavirin results in only a limited viral response. Furthermore, cumbersome pill regimens, antiretroviral related hepatotoxicity, and drug interactions of HCV and HIV regimens complicate therapy strategies. Fortunately, in the near future, new direct-acting anti-HCV agents will widen therapeutic options for HCV/HIV co-infection. Liver transplantation is also gradually accepted as a therapeutic option for end stage liver disease of HCV/HIV co-infected patients.