Defining indicators for the scoping stage of health impact assessment to evaluate tobacco control policy in the city of Beijing.

INTRODUCTION: Beijing initiated the nation's most comprehensive tobacco control program that adheres to the WHO Framework Convention on Tobacco Control. This study aimed to identify a set of indicators for the scoping of an Health Impact Assessment (HIA) to assess this policy. METHODS: This study used a modified Delphi process. It proposed a tobacco control health impact framework based on the Driving forces- Pressure- State- Exposure- Effect- Action model and the Determinants of Health Theory. After a review of current surveillance system and literature, a working group of 13 experts with multidisciplinary background was established to formulate indicator evaluation criteria and conduct indicator scoring. Each indicator was scored by experts according to four evaluation criteria chosen. Indicators that obtained a total score above 80% and with standard error less than 5 were selected as the final set of indicators. Kendall's coefficient of concordance was calculated. RESULTS: Twenty-three out of 36 indicators were selected. Smoking prevalence, mortality rate, hospital admission rate, tobacco consumption and hospital admission fees of smoking related diseases achieved more than 90% of total scores and ranked as the top five. Kendall's concordance coefficient was 0.218 for all indicators. For all model composition, Kendall's concordance coefficients were statistically significant. CONCLUSION: This study identified a set of twenty-three indicators for scoping of HIA of a comprehensive tobacco control policy in Beijing based on a tobacco control health impact conceptual framework. The set of indicators achieved high scores and statistically significant consistency and has great potential to promote the evaluation of tobacco control policy in a global city. Further study might use the set of indicators for HIA on tobacco control policy to analyze empirical data.

Assessment of preoperative anxiety and depression in patients with pulmonary ground-glass opacities: Risk factors and postoperative outcomes.

Objective: A large number of patients with pulmonary ground-glass opacities (GGOs) have anxiety and depression. However, the contributing factors and effects of anxiety and depression on postoperative outcomes are still unclear. Methods: Clinical data for patients undergoing surgical resection for pulmonary GGOs were collected. We prospectively evaluated levels and risk factors for anxiety and depression in patients with GGOs before surgery. The relationship between psychological disorders and postoperative morbidity was evaluated. Quality of life (QoL) was also assessed. Results: A total of 133 patients were enrolled. Prevalence rates of preoperative anxiety and depression were 26.3% (n = 35) and 18% (n = 24), respectively. Multivariate analysis revealed depression [odds ratio(OR) = 16.27, p < 0.001] and multiple GGOs (OR = 3.146, p = 0.033) to be risk factors for preoperative anxiety. Anxiety (OR = 52.166, p < 0.001), age > 60 (OR = 3.601, p = 0.036), and unemployment (OR = 8.248, p = 0.006) were identified as risk factors for preoperative depression. Preoperative anxiety and depression were associated with lower QoL and higher postoperative pain scores. Our results also revealed that the incidence of postoperative atrial fibrillation was higher in patients with than in those without anxiety. Conclusions: In patients with pulmonary GGOs, comprehensive psychological assessment and appropriate management are required before surgery to improve QoL and reduce postoperative morbidity.

Multiple streams approach to tobacco control policymaking in the capital city of the world's largest tobacco consuming country.

The aim of this study was to analyse the policymaking process of Beijing tobacco control regulations based on a multiple streams framework to provide a reference for other cities, at the national level and for the international community to promote the development of tobacco control policy. Twenty-one documents related to tobacco control in Beijing were collected, nine informants were interviewed and the interview data were analysed by a thematic framework method. It was found that indicators, feedback and a focus event in the problem stream drew the attention of policymakers and the society for tobacco control. In 2011, Ying Songnian, a representative of the Beijing Municipal People's Congress, put forward tobacco control legislation, which was just in time for the legislative reform of the Congress. The proposal was studied by the Congress, and a strategy of 'social co-governance' was founded. In the political stream, the government actively promoted tobacco control and social organizations extensively participated in it. In 2013, the General Office of the Central Committee of the Chinese Communist Party and the General Office of the State Council issued a notice on matters related to leading cadres taking the lead in banning smoking in public places, which opened a policy window for decision-makers who were hesitatant. The issue of tobacco control was successfully put on the policy agenda and contributed to the introduction of the Beijing Municipal Regulations on Smoking Control. Development of the factors in problem stream, policy stream and political stream promoted the setting up of the tobacco control policy agenda in Beijing. It is suggested that more cities should learn from the experience of Beijing, seize the opportunity of the ideological change of the ruling party, actively identify the problems, mobilize and advocate for representatives and introduce the concept of 'social co-governance' to promote tobacco control legislation.

The effect of prenatal education curriculum on mother's prenatal examination utilization, delivery mode and recovery status: a cross-sectional survey in China.

OBJECTIVES: To examine the participation, implementation, and effect of the prenatal education curriculum provided by hospitals in China, and to provide evidence for the improvement of prenatal education. METHODS: A cross-sectional survey was conducted in the hospitals in Hunan Province, China. Mothers aged 20-45 years who had given birth between 1 May 2011 and 1 May 2012 and not diagnosed with pregnancy-related complications were invited to participate in the study. A self-administered, structured questionnaire was used to examine the effect of prenatal education curriculum on prenatal examination utilization, delivery mode, and recovery status from delivery. RESULTS: Among the total 604 respondents, only 175 (29.1 %) surveyed mothers participated in prenatal education curriculum provided by hospitals during their latest delivery. These mothers had a higher rate of attending all the required prenatal examinations (57.9 vs. 48.3 %), and a higher rate of recovering very well and well (80 vs. 73.7 %) from the latest delivery, than those who did not participate in prenatal education curriculum (P < 0.05). However, there was no statistical difference in the delivery mode between mothers who participated and those who did not participate in the prenatal education curriculum provided by hospitals. CONCLUSIONS: Prenatal education is indispensable for the improvement of maternal and child health, and thus should be advocated. In China, a standard and convenient specification prenatal education curriculum provided by hospitals and their doctors is appropriated for providing prenatal education to pregnant women.

Lack of health risk awareness in low-income Chinese youth migrants: assessment and associated factors.

OBJECTIVE: To analyze and assess health risk awareness of youth migrants in China and the factors that influence it, and to provide evidence for making health promotion interventions and decreasing health risks among Chinese youth migrants. METHOD: This was a cross-sectional survey conducted in 2009 among rural-to-urban migrants aged 15-24 years in Tianjin and Xi'an, China. A total of 1,838 youth migrants were enrolled by the stratified cluster sampling method. An anonymous questionnaire was self-administered to investigate health risk awareness. The t test and χ(2) test were used to analyze differences between different groups. Logistic regression analysis was used to test the influence of various sociodemographic, living condition, and occupational factors. RESULTS: The smoking rate of men (66.8%) was higher than that of women (6.8%; P < 0.05), the rate of sexual intercourse in men was higher than in women (56.8 vs 27.7%; P < 0.05), and 75.7% of participants had written into medical care systems with 40.4% of them having undergone a physical examination during the last year. Only 438 of the participants (26% of 1,647) were considered to have a satisfactory level of health risk awareness [273 (32.4% of 958) from Tianjin and 165 (28.8% of 689) from Xi'an]. No significant difference was found between the youth migrant populations of the two cities. The percentage of youth migrants with a satisfactory level of health risk awareness who thought they had a good health status was higher than that with an unsatisfactory health risk awareness who thought they had a good health status (P < 0.05). Logistic regression analysis showed that gender, age, education, reading the newspaper, and occupation significantly influenced on health risk awareness. CONCLUSION: Youth migrants in China have a low health risk awareness. Combined and targeted health education interventions should be promoted to increase their health risk awareness.

[Effect of health education on farmers' intention of joining in the new rural cooperative medical system].

OBJECTIVE: To evaluate the impact of health education intervention on promoting rural residents to join new rural cooperative medical system (NCMS) and their intention of joining NCMS based on Health Belief Model in project areas in Henan and Jilin Provinces. METHODS: Quasi-experiment study was used to evaluate intervention impact. Following the evidence-based approach, according to needs assessment, a half-year health education intervention was implemented among farmers in the experimental counties in Henan and Jilin Provinces respectively. A questionnaire survey was conducted among farmers in intervention and control counties before and after intervention, and intervention impact was evaluated by comparing the indicators' changes in intervention and control counties. RESULTS: After health education intervention, the knowledge level of farmers in two intervention counties increased by 29.0% and 37.8% respectively, their scores of perceived threatens of health risk and perceived barriers of joining NCMS among the respondents were decreased. Meanwhile, their score of perceived benefit of joining NCMS were increased, and the rate of willingness to join NCMS increased remarkably in both intervention counties. CONCLUSION: Health education was effective and helpful in increasing farmer's knowledge, understanding and cognitive level of NCMS, and it should play an important role for the sustainable development of NCMS.

Assessment of gap junctional intercellular communication.

Gap junctions are important plasma membrane organelles through which most cells in normal tissues communicate with each other. They exist in two neighboring cells and each cell contributes half of the structure. One gap junction consists of two hexameric connexons that dock with each other to create a channel. Six of the basic subunits referred to as connexins form a connexon. Less than one hundred to several thousand gap junction channels cluster together in the plane of the membrane. The gap junction channels serve as a regulated conduit for the intercellular exchange of small molecules. Maintenance of the integrity of gap junctional intercellular communication (GJIC) is important and required for normal electrical coupling, homeostasis, and embryogenesis. Aberrations of gap junctions have been related to human diseases such as cancer, cardiac arrhythmia, Charcot-Marie-tooth disease, and visceroatrial heterotaxia syndrome. This unit describes methods for measuring gap junctional intercellular communication using primary mouse hepatocytes as a model. Focus is only on functional evaluation based on dye coupling. Other methods, such as intracellular calcium waves and dual patch clamp, have been used to measure gap junctional communication, but these are not described in this unit.