Economic evaluations of electronic health interventions for people with age-related cognitive impairment and their caregivers: A systematic review.

OBJECTS: Dementia has physical, social and economic impacts, causing considerable distress for people with age-related cognitive impairment (PWACI) and their caregivers. Electronic health (e-health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e-health interventions will facilitate the decision making and implementation of integrating e-health into routine health services. The present review aimed to appraise economic evidence related to e-health interventions for PWACI and their caregivers. METHODS: We systematically searched multiple cross-disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive-analytical narrative method was used to analyze the review findings. RESULTS: Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi-experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost-effectiveness analysis, five cost-consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e-health multicomponent interventions can reduce the cost of health service utilization in short term (10-104 weeks). CONCLUSIONS: Few studies calculated the incremental cost-effectiveness ratio to evaluate the cost-effectiveness of e-health interventions. Preliminary evidence indicates that e-health interventions can reduce the cost of health service utilization in the short term, but the cost-effectiveness of e-health interventions hasn't been identified. More robust evidence is needed to clarify the value of e-health interventions for PWACI and their caregivers.

[Analysis on status quo of outcomes and measurement instruments of randomized controlled trials of acupuncture for post-stroke dysphagia].

OBJECTIVE: To analyze the report status of outcomes and measurement instruments of randomized controlled trials (RCTs) of acupuncture for post-stroke dysphagia, so as to provide a basis for designing clinical trials and developing the core outcome set in acupuncture for post-stroke dysphagia. METHODS: RCTs of acupuncture for post-stroke dysphagia were searched in databases i.e. CNKI, SinoMed, Wanfang, PubMed, EMbase, Web of Science and clinical trial registries i.e. ClinicalTrials.gov and Chinese Clinical Trial Registry (ChiCTR), from January 1st, 2012 to October 30th, 2021. By literature screening and data extraction, outcomes and measurement instruments were summarized and analyzed. RESULTS: A total of 172 trials (including 165 RCTs and 7 ongoing trials registrations) were included, involving 91 outcomes. The outcomes could be classified into 7 domains according to functional attributes, namely clinical manifestation, physical and chemical examination, quality of life, TCM symptoms/syndromes, long-term prognosis, safety assessment and economic evaluation. It was found that there were various measurements instruments with large differences, inconsistent measurement time point and without discriminatively reporting primary or secondary outcomes. CONCLUSION: The status quo of outcomes and measurement instruments of RCTs of acupuncture for post-stroke dysphagia is not conducive to the summary and comparison of each trial's results. Thus, it is suggested to develop a core outcome set for acupuncture for post-stroke dysphagia to improve the normative and research quality of their clinical trial design.

Policies of voluntary services involved in public health emergencies in China: Evolution, evaluation, and expectation.

Background: Public health emergencies have an immense effect on social stability, economic development, and human life. Volunteers played an indispensable role in health monitoring, assistance with daily life, and social network repairing. However, few policies analysis concentrated on the voluntary services involved in public health emergencies. Objectives: This study aims to analyze and summarize the advantages and flaws of the policy documents relating to voluntary services involved in public health emergencies, and put forward the enlightenment on policymaking and optimization. Methods: A three-dimensional analysis framework of "Policy instruments-Participants of voluntary services-Stages of voluntary services" was designed. Policy documents at the national level were retrieved from the official websites of the State Council of the People's Republic of China and its departments as well as the PKULAW Database. NVivo software was applied to analyze the contents of the included policy documents. Gephi software was adopted to conduct a visualized atlas analysis of the cooperative network among policymaking departments. Results: A total of 77 policy documents were included, and most were published in 2020 (n = 40). The Ministry of Civil Affairs (n = 19) and the National Health Commission (n = 18) issued more documents than the other departments. They cooperated more extensively with other departments. In policy documents, supply-side policy instruments were utilized the most (65.4%), followed by demand-side (23.9%). Voluntary organizations in the form of ambiguous sense were most mentioned as service participants (n = 73). In the stages of service delivery, service content mainly involved the prevention and control of public health emergencies (27, 18.9%) and psychological counseling (26, 18.2%). Conclusion: Time distribution of policy documents featured "incubation period-outbreak and continuous evolution period-elimination recovery period." Joint issuing became the dominant form. The internal structure of policy instruments was unbalanced with different priorities, and the overall structure is expected to be optimized to promote voluntary organization management, reinforce external resources, and close the gap between policymaking and policy implementation. Volunteers' competence and voluntary organizations' system needs to be improved, and the contents of voluntary services should be enriched for the preparedness for future public health emergency.

Unmet needs of activities of daily living among a community-based sample of disabled elderly people in Eastern China: a cross-sectional study.

BACKGROUND: China has the largest population of partially or completely disabled elderly people in the world. Although the disabled elderly people try to remain independent in their lives, many still need assistance from others. Failure to obtain sufficient assistance creates a situation of unmet need. Unmet needs of activities of daily living (ADL) for disabled elderly people pose significant risks for hospitalization and mortality and cause an increased economic burden on families and society. This study aimed to identify the prevalence and risk factors of unmet needs among the disabled elderly in China to guide government toward corrective action. METHODS: A total of 303 older adults from 15 communities in Nanjing, China were recruited. The Barthel Index (BI) and Functional Activities Questionnaire (FAQ) were used to screen disabled elderly people from the communities. These disabled elderly participants were then investigated in terms of their unmet ADL needs, using an unmet needs assessment form, which had been adapted from the BI and FAQ. Additionally, the Zarit Burden Interview and Family Caregiver Task Inventory were used to survey the main caregivers. Finally, univariate analysis was first used to filter out candidate impact factors, and then, binary logistic regression analysis was used to adjust for cofounders and determine reliable risk factors. RESULTS: A total of 93.1% of the disabled elderly people in our study reported at least one unmet need. The prevalence of unmet needs for different ADL tasks ranged from 4.6 to 77.2%. The unmet needs with the highest percentages were using vehicles (77.2%), using stairs (73.1%), working on a hobby (72.1%), social interaction (62.6%) and ambulating (60.1%). The factors influencing unmet needs were related to the degree of disability in instrumental activities of daily living (IADL) (OR = 1.079, p ≤ 0.01), the relationship with caregivers (OR = 1.429, p ≤ 0.05) and the monthly income of caregivers (OR = 0.679, p ≤ 0.05). CONCLUSION: Disabled elderly people living in communities had a high percentage of unmet needs for activities of daily life that required going outside the bedroom and involved spiritual aspects. Unmet needs increased with worsening disability status in IADL, more distanced relationships with caregivers and lower incomes of caregivers. Both government and caregivers should take more action to prevent or reduce unmet needs among the elderly.

Homogeneity study of proton and carbon ion scanning beams using combinations of different spot sizes and grid sizes.

PURPOSE: Different scanning ion beam delivery systems have different delivery accuracies, and the resulting delivery errors will affect field homogeneity. This study was performed to determine an appropriate combination of spot size (FWHM) and spot grid size (GS), which can provide homogenous dose distributions for both proton and carbon ion scanning beam radiotherapy. The combination of the two parameters is represented by a combination factor named n, which is the quotient of FWHM divided by GS. METHODS: Delivery uncertainties of our beam delivery system were analyzed using log files from the treatment of 28 patients. Square fields for different n values were simulated with and without considering the delivery uncertainties, and the homogeneity of these square fields was analyzed. All spots were located on a rectilinear grid with equal spacing in the x and y directions. In addition to the simulations, we performed experimental measurements using both protons and carbon ions. We selected six energy levels for both proton and carbon ions. For each energy level, we created six square field plans with different n values (1, 1.5, 2, 2.5, 3, 3.5). These plans were delivered and the field homogeneity was determined using a film measurement. RESULTS: The simulations demonstrated that under ideal condition (i.e., the delivery system has no delivery errors), the homogeneity is within 3% when n ≥ 1.1. When delivery uncertainties were included in the simulation, the homogeneity is within 3% when n ≥ 2.3. For film measurements, homogeneity under 3% was achieved when n ≥ 2.5. CONCLUSION: A practical method to determine the appropriate combination of spot size and grid size is here presented. Considering the uncertainties of the beam delivery system, an n value of 2.5 is good enough to meet the lateral homogeneity requests in our center. The methods used here can be easily repeated in other particle therapy centers.

Rural households' attitude and economic strategies toward the conversion of cropland to forest and grassland program (CCFG): a case study in Qira, China.

The Conversion of Cropland to Forest and Grassland Program (CCFG), which was initiated by the Chinese government in 1999, is a cropland retirement program with integrated objectives for ecological preservation and local development. The purpose of this article was to study the influencing factors of attitude and economic strategies in rural households toward the CCFG. Rural households' knowledge, attitude and economic strategies toward the CCFG were investigated through a questionnaire survey in Qira, China. Influencing factors of attitude and strategies of households were analyzed using a logit model technique. The analysis indicated that household's income level, environmental knowledge of the program, and program implementation were significant influencing factors in a household's attitude toward the CCFG, while major influencing factors of household strategies were their regional background and availability of income generation sources. Meaningful association was not found between attitude and strategy choices. Rich households had more strategy choices, while poor households were usually confined to low input strategies with uncertain income. To sustain their livelihood, the poor need extra assistances in marketing, loan granting, employment training, information, and technical services.

[Assessment on PCBs wastes treatment technologies including incineration, cement kiln and secure landfill].

Analytic hierarchy process and a specialist investigation were applied to value the three PCBs treatment technologies qualitatively and quantitatively, in which the environmental, technological, social and economic factors were considered. The most important factor is thought to be environmental impact. Incineration is proved to be the most suitable technology in this period according to the research. For the high concentration of PCBs pollutants, or the low concentration of PCBs pollutants with good economic performance and large quantity of waste, incineration is considered the best. For the low concentration of PCBs pollutants in the area with bad economic performance and with little quantity of waste, cement kiln and landfill are thought to be suitable. It is also suggested that pollutants be treated at the nearest place. What's more, the measures to improve the three technologies are discussed and the policy comments on PCBs treatment are presented.

[Assessment of PCB pollution in spatial distribution and analysis of the PCB sources in sediments in China].

An assessment of the current state of pollution from polychlorinated biphenyls (PCBs) and PCBs spatial character in sediments are represented. The sources of PCBs and relative factors are also analyzed. Songhua River and Dalian Bay in Northeast, Baoding in Hebei Province, Ya-er Lake in Wuhan City, Pearl River and Taiwan Province in Southeast of China have relatively high level of PCBs, while most other regions have lower average concentrations of PCBs. Serious pollution of PCBs is found in some locations, most of which are harbors, industrial areas, the places where improper disposal of and leakage from PCB containers taken place Point source pollution is the common pattern of contamination, influenced primarily by local geographic, economic, management and historical factors, with Pearl River/Estuary as an example.

Persistent organic pollutants control strategy in China.

The development of Persistent Organic Pollutants (POPs) control policy in China in the context of international concerns on POPs was reviewed. The aspects of the Chinese POPs control strategies were analyzed, and compared with those of developed counterparts (e.g. U.S., E.U., Japan). Currently, while the legal framework on POPs management, which complies with international guidelines has been established, it should be improved in the areas of special POPs management, risk assessment, the precautionary principle, life-cycle management and technical support capacity. The analysis of Chinese POPs policy and suggestions for strengthening the science-based decision making capacity are not only useful for Chinese decision-makers, but also a case study for developing world and make a great contribution for the global elimination of POPs to make a toxic-free future.

A spatial temporal assessment of pollution from PCBs in China.

This research represents an assessment of the current state of pollution from polychlorinated biphenyls (PCBs) in China. Various environmental media including sediment, water, organism and soil were analyzed and the spatial character of PCB pollution in each environmental medium was determined. On a national basis, PCB levels in all environmental media were relatively low, with little evidence of major contamination in China's main regions and rivers. However, there were some locations with high PCB concentrations. Sediments in Pearl River (83.1 ng/g) and its estuary (58.9 ng/g), Dalian Bay (58.1 ng/g) and Songhua River (36.8 ng/g) had relatively high level of PCBs. There were also some areas, which were mainly the industrial pollution sites or PCB equipment storage locations, remained seriously polluted with the highest PCB residue level of 150,000 ng/g. In addition, Minjiang Estuary (985.2 ng/g) and Taihu Lake (631 ng/g) had high levels of water pollution, while Pearl Estuary (635.7 ng/g) and Jiaozhou Bay (273.3 ng/g) had relatively high PCB levels in organisms. PCB pollution in soil was limited to a few special pollution areas with the highest PCB level of 4.5448 x 10(6) ng/g. Point source pollution was the common pattern of contamination, influenced primarily by local geographic, economic and historical factors. Analysis of PCB concentrations from the 1980s to 1990s shows an increasing trend, possibly due to the improper disposal of and leakage from PCB containers, chemical transfers, and the general rise of industrial pollution.