Increasing Burden of Osteoarthritis in China: Trends and Projections from the Global Burden of Disease Study 2019.

BACKGROUND This study aimed to evaluate the epidemiology of osteoarthritis in China in a comprehensive and reliable way, to project its future epidemiological patterns, and to mitigate its health hazards. MATERIAL AND METHODS Data were extracted and analyzed from the Global Burden of Diseases Study 2019. Trends in osteoarthritis epidemiology were explored using joinpoint regression analysis. Additionally, we analyzed dynamic trends using the sociodemographic index (SDI) of China. To assess and predict the epidemiology of osteoarthritis from 2020 to 2039, we used both the Bayesian age-period-cohort model and Nordpred model. RESULTS The number of prevalent cases, incident cases, and years lived with disability (YLDs) for osteoarthritis in China increased from 51.8, 4.6, and 1.8 million, respectively, in 1990, to 132.8, 10.7, and 4.7 million, respectively, in 2019, and the average annual percentage changes were 3.286, 2.938, and 3.324, respectively. The prevalence and YLDs peaked in the population aged over 90 years old, while the incidence peaked in the population aged around 50 years old. A significant positive correlation was found between osteoarthritis burden and SDI. Osteoarthritis burden is expected to continue to increase. In the population studied here, it was higher in women than in men, but this may invert by 2039. CONCLUSIONS The prevalence, incidence, and YLDs of osteoarthritis had significantly increased and may continue to increase during the next 2 decades. Prevention and treatment strategies should target women, middle-aged individuals, and the elderly.

Association Between Small Vessel Disease and Financial Capacity: A Study Based on Cognitively Normal Older Adults.

Background: Financial capacity is vital for the elderly, who possess a substantial share of global wealth but are vulnerable to financial fraud. Objective: We explored the link between small vessel disease (SVD) and financial capacity in cognitively unimpaired (CU) older adults via both cross-sectional and longitudinal analyses. Methods: 414 CU participants underwent MRI and completed the Financial Capacity Instrument-Short Form (FCI-SF). Subsequent longitudinal FCI-SF data were obtained from 104, 240, and 141 participants at one, two, and four years, respectively. SVD imaging markers, encompassing white matter hyperintensities (WMH), cerebral microbleeds (CMB), and lacune were evaluated. We used linear regression analyses to cross-sectionally explore the association between FCI-SF and SVD severity, and linear mixed models to assess how baseline SVD severity impacted longitudinal FCI-SF change. The false discovery rate method was used to adjust multiple comparisons. Results: Cross-sectional analysis revealed a significant association between baseline WMH and Bank Statement (BANK, ß=-0.194), as well as between lacune number and Financial Conceptual Knowledge (FC, ß= -0.171). These associations were stronger in APOE ɛ4 carriers, with ß= -0.282 for WMH and BANK, and ß= -0.366 for lacune number and FC. Longitudinally, higher baseline SVD total score was associated with severe FCI-SF total score decrease (ß= -0.335). Additionally, baseline WMH burden predicted future decreases in Single Checkbook/Register Task (SNG, ß= -0.137) and FC (ß= -0.052). Notably, the association between baseline WMH and SNG changes was amplified in APOE ɛ4 carriers (ß= -0.187). Conclusions: Severe SVD was associated with worse FCI-SF and could predict the decline of financial capacity in CU older adults.

RNA m6 A Methylation Suppresses Insect Juvenile Hormone Degradation to Minimize Fitness Costs in Response to A Pathogenic Attack.

Bioinsecticides and transgenic crops based on the bacterial pathogen Bacillus thuringiensis (Bt) can effectively control diverse agricultural insect pests, nevertheless, the evolution of resistance without obvious fitness costs has seriously eroded the sustainable use of these Bt products. Recently, it has been discovered that an increased titer of juvenile hormone (JH) favors an insect host (Plutella xylostella) to enhance fitness whilst resisting the Bt pathogen, however, the underlying regulatory mechanisms of the increased JH titer are obscure. Here, the involvement of N6 -methyladenosine (m6 A) RNA modification in modulating the availability of JH in this process is defined. Specifically, it is found that two m6 A methyltransferase subunit genes, PxMettl3 and PxMettl14, repress the expression of a key JH-degrading enzyme JH esterase (JHE) to induce an increased JH titer, mitigating the fitness costs associated with a robust defense against the Bt pathogen. This study identifies an as-yet uncharacterized m6 A-mediated epigenetic regulator of insect hormones for maintaining fitness during pathogen defense and unveils an emerging Bt resistance-related m6 A methylation atlas in insects, which further expands the functional landscape of m6 A modification and showcases the pivotal role of epigenetic regulation in host-pathogen interactions.

Assessing the quality of care for skin malignant melanoma on a global, regional, and national scale: a systematic analysis of the global burden of disease study from 1990 to 2019.

Malignant melanoma (MM) is a highly aggressive form of skin cancer with increasing global incidence rates, particularly in developed countries. Variations in the prevalence and quality of care provided to patients with melanoma exist across different regions and across different sex and age. Assessing the global burden of melanoma and evaluating the quality of care can provide valuable insights for developing targeted interventions in certain underperforming regions and improving patient outcomes. This study aimed to systematically analyze the Global Burden of Disease Study from 1990 to 2019 to assess the quality of care for skin malignant melanoma on a global scale. We conducted a comprehensive literature review and extracted data on melanoma incidence, mortality, and disability-adjusted life years (DALYs) from the Global Burden of Disease Study. We incorporated these variables using principal component analysis (PCA) to form an informative single variable of quality of care index (QCI) and analyzed its spatial-temporal variations as well as disparities across age, sex and socio-demographic index (SDI). The overall Quality of Care Index (QCI) for melanoma improved from 82.81 in 1990 to 91.29 in 2019. The QCI score showed a positive correlation with socioeconomic status across regions. Australia ranked highest in QCI (99.96), while Central African Republic, and Kiribati had the lowest scores. China and Saudi Arabia showed significant QCI improvement, while the QCI of the Democratic People's Republic of Korea, Zimbabwe, and Guam decreased from 1990 to 2019. The highest QCI scores were observed in the age groups of 20-39 years old (93.40-94.65). Gender disparities narrowed globally in these three decades, but lower Socio-demographic Index (SDI) regions showed increased gender inequities. Our findings highlighted the spatial-temporal variations in the quality of care of MM as well as its disparities across different SDI levels, age groups and sex. These findings offer valuable insights and guidance for implementing focused interventions and resource allocation to enhance the quality of care and overall outcomes for MM worldwide, especially for underperforming regions.

The Impact of Prescribing Monitoring Policy on Drug Use and Expenditures in China: A Multi-center Interrupted Time Series Study.

BACKGROUND: A prescribing monitoring policy (PMP) was implemented in November 2015 in Anhui province, China, the first province to pilot this policy to manage the use and costs of select drugs based on their large prescription volumes and/ or costs in hospitals. This study evaluated the impact of PMP on the use and expenditures of different drugs in three tertiary hospitals in Anhui. METHODS: We obtained monthly drug use and expenditures data from three tertiary hospitals in Anhui (November 2014 through September 2017). An interrupted time series (ITS) design was used to estimate changes in defined daily doses (DDDs per month) and drug expenditures (dollars per month) of policy-targeted and non-targeted drugs after PMP implementation. Drugs were grouped based on whether they were recommended (recommended drugs) by any clinical guidelines or not (non-recommended drugs), or if they were potentially over-used (proton pump inhibitors, PPIs). RESULTS: After PMP, DDDs and costs of the targeted PPIs (omeprazole) declined while use of non-targeted PPIs increased correspondingly with overall sustained declines in total PPIs. The policy impact on recommended drugs varied based on whether the targeted drugs have appropriate alternatives. The DDDs and costs of recommended drugs that have readily accessible appropriate alternatives (atorvastatin) declined, which offset increases in its alternative non-target drugs (rosuvastatin), while there was no significant change in those recommended drugs that did not have appropriate alternative drugs (clopidogrel and ticagrelor). Finally, the DDDs and costs of non-recommended drugs decreased significantly. CONCLUSION: PMP policy impact was not the same across different drug groups. PMP did help contain the use and costs of potentially over-used drugs and non-recommended drugs. PMP did not seem to reduce the use of first-line therapeutic drugs recommended by clinical treatment guidelines, especially those lacking alternatives; such drugs are unlikely appropriate candidates for PMP.

Building an ecological momentary assessment smartphone app for 4- to 10-year-old children: A pilot study.

OBJECTIVE: Ecological momentary assessment (EMA) minimizes recall burden and maximizes ecological validity and has emerged as a valuable tool to characterize individual differences, assess contextual associations, and document temporal associations. However, EMA has yet to be reliably utilized in young children, in part due to concerns about responder reliability and limited compliance. The present study addressed these concerns by building a developmentally appropriate EMA smartphone app and testing the app for feasibility and usability with young children ages 4-10 (N = 20; m age = 7.7, SD = 2.0). METHODS: To pilot test the app, children completed an 11-item survey about their mood and behavior twice a day for 14 days. Parents also completed brief surveys twice a day to allow for parent-child comparisons of responses. Finally, at the end of the two weeks, parents provided user feedback on the smartphone app. RESULTS: Results indicated a high response rate (nearly 90%) across child surveys and high agreement between parents and children ranging from 0.89-0.97. CONCLUSIONS: Overall, findings suggest that this developmentally appropriate EMA smartphone app is a reliable and valid tool for collecting in-the-moment data from young children outside of a laboratory setting.

The significance of endoscopic Kyoto classification of gastritis in the gastric cancer risk assessment: A systematic review and meta­analysis.

BACKGROUND: Kyoto Classification of Gastritis is a newly proposed gastric cancer risk assessment in recent years. It selects important gastroscopic manifestations that have been reported and calculates score values. Although it has been extensively employed in clinical practice, there is no thorough review or systematic summary of its usage. METHODS: We looked for works published before May 2022 on the correlation between the Kyoto Classification of Gastritis and gastric cancer (GC) risk in Web of Science, EMBASE, China National Knowledge Infrastructure, PubMed, Wanfang database, and other suitable sources. Statistical analysis was carried out using Stata 14.0 and RevMan 5.40. Two statistical methods were employed. RESULTS: Eight case-control studies involving 6927 patients (continuous variables group: 1961 patients; dichotomy variables group: 4966 patients) were included, and the meta-analysis results showed a significant association between Kyoto Classification of Gastritis and GC. A Kyoto classification score ≥ 4 might indicate a risk of GC (odds ratios 7.30; 95% confidence intervals [CI] 3.62-14.72; P < .00001. There was a significant difference between gastritis and GC scores (mean difference [MD] 0.86; 95% CI 0.73-0.99; P < .00001). Moreover, we found that intestinal metaplasia and atrophy highly affected the Kyoto Classification score (MD = 0.35, MD = 0.72 95% CI 0.20-0.50,0.56-0.88). However, there was considerable heterogeneity in both statistical analyses. We found the source of heterogeneity in the first analysis method but failed to find it in the second analysis method, which may be due to the small number of studies. CONCLUSIONS: The Kyoto Classification of gastritis score is crucial for detecting early stomach cancer. A score >4 suggests a significant risk for gastric cancer, with atrophy and intestinal metaplasia having the most impact. This score may be promoted at primary hospitals; however, because of the small number and quality of included studies, the results mentioned above need to be verified by randomized control trials with large samples and high-quality methods.

DMsan: A Multi-Criteria Decision Analysis Framework and Package to Characterize Contextualized Sustainability of Sanitation and Resource Recovery Technologies.

In resource-limited settings, conventional sanitation systems often fail to meet their goals-with system failures stemming from a mismatch among community needs, constraints, and deployed technologies. Although decision-making tools exist to help assess the appropriateness of conventional sanitation systems in a specific context, there is a lack of a holistic decision-making framework to guide sanitation research, development, and deployment (RD&D) of technologies. In this study, we introduce DMsan-an open-source multi-criteria decision analysis Python package that enables users to transparently compare sanitation and resource recovery alternatives and characterize the opportunity space for early-stage technologies. Informed by the methodological choices frequently used in literature, the core structure of DMsan includes five criteria (technical, resource recovery, economic, environmental, and social), 28 indicators, criteria weight scenarios, and indicator weight scenarios tailored to 250 countries/territories, all of which can be adapted by end-users. DMsan integrates with the open-source Python package QSDsan (quantitative sustainable design for sanitation and resource recovery systems) for system design and simulation to calculate quantitative economic (via techno-economic analysis), environmental (via life cycle assessment), and resource recovery indicators under uncertainty. Here, we illustrate the core capabilities of DMsan using an existing, conventional sanitation system and two proposed alternative systems for Bwaise, an informal settlement in Kampala, Uganda. The two example use cases are (i) use by implementation decision makers to enhance decision-making transparency and understand the robustness of sanitation choices given uncertain and/or varying stakeholder input and technology ability and (ii) use by technology developers seeking to identify and expand the opportunity space for their technologies. Through these examples, we demonstrate the utility of DMsan to evaluate sanitation and resource recovery systems tailored to individual contexts and increase transparency in technology evaluations, RD&D prioritization, and context-specific decision making.

Life cycle net energy assessment of sustainable H2 production and hydrogenation of chemicals in a coupled photoelectrochemical device.

Green hydrogen has been identified as a critical enabler in the global transition to sustainable energy and decarbonized society, but it is still not economically competitive compared to fossil-fuel-based hydrogen. To overcome this limitation, we propose to couple photoelectrochemical (PEC) water splitting with the hydrogenation of chemicals. Here, we evaluate the potential of co-producing hydrogen and methyl succinic acid (MSA) by coupling the hydrogenation of itaconic acid (IA) inside a PEC water splitting device. A negative net energy balance is predicted to be achieved when the device generates only hydrogen, but energy breakeven can already be achieved when a small ratio (~2%) of the generated hydrogen is used in situ for IA-to-MSA conversion. Moreover, the simulated coupled device produces MSA with much lower cumulative energy demand than conventional hydrogenation. Overall, the coupled hydrogenation concept offers an attractive approach to increase the viability of PEC water splitting while at the same time decarbonizing valuable chemical production.

Financial Viability and Environmental Sustainability of Fecal Sludge Treatment with Pyrolysis Omni Processors.

Omni Processors (OPs) are community-scale systems for non-sewered fecal sludge treatment. These systems have demonstrated their capacity to treat excreta from tens of thousands of people using thermal treatment processes (e.g., pyrolysis), but their relative sustainability is unclear. In this study, QSDsan (an open-source Python package) was used to characterize the financial viability and environmental implications of fecal sludge treatment via pyrolysis-based OP technology treating mixed and source-separated human excreta and to elucidate the key drivers of system sustainability. Overall, the daily per capita cost for the treatment of mixed excreta (pit latrines) via the OP was estimated to be 0.05 [0.03-0.08] USD·cap-1·d-1, while the treatment of source-separated excreta (from urine-diverting dry toilets) was estimated to have a per capita cost of 0.09 [0.08-0.14] USD·cap-1·d-1. Operation and maintenance of the OP is a critical driver of total per capita cost, whereas the contribution from capital cost of the OP is much lower because it is distributed over a relatively large number of users (i.e., 12,000 people) for the system lifetime (i.e., 20 yr). The total emissions from the source-separated scenario were estimated to be 11 [8.3-23] kg CO2 eq·cap-1·yr-1, compared to 49 [28-77] kg CO2 eq·cap-1·yr-1 for mixed excreta. Both scenarios fall below the estimates of greenhouse gas (GHG) emissions for anaerobic treatment of fecal sludge collected from pit latrines. Source-separation also creates opportunities for resource recovery to offset costs through nutrient recovery and carbon sequestration with biochar production. For example, when carbon is valued at 150 USD·Mg-1 of CO2, the per capita cost of sanitation can be further reduced by 44 and 40% for the source-separated and mixed excreta scenarios, respectively. Overall, our results demonstrate that pyrolysis-based OP technology can provide low-cost, low-GHG fecal sludge treatment while reducing global sanitation gaps.

Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study.

BACKGROUND: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. METHODS: A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. RESULTS: Mean follow-up of the 20 995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77-0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective. CONCLUSIONS: Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants.

Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review.

Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary-screening programs can be made universal or targeted just for the high-risk population.

Towards a Cost-Effective Implementation of Genomic Prediction Based on Low Coverage Whole Genome Sequencing in Dezhou Donkey.

Low-coverage whole genome sequencing is a low-cost genotyping technology. Combined with genotype imputation approaches, it is likely to become a critical component of cost-effective genomic selection programs in agricultural livestock. Here, we used the low-coverage sequence data of 617 Dezhou donkeys to investigate the performance of genotype imputation for low-coverage whole genome sequence data and genomic prediction based on the imputed genotype data. The specific aims were as follows: 1) to measure the accuracy of genotype imputation under different sequencing depths, sample sizes, minor allele frequency (MAF), and imputation pipelines and 2) to assess the accuracy of genomic prediction under different marker densities derived from the imputed sequence data, different strategies for constructing the genomic relationship matrixes, and single-vs. multi-trait models. We found that a high imputation accuracy (>0.95) can be achieved for sequence data with a sequencing depth as low as 1x and the number of sequenced individuals ≥400. For genomic prediction, the best performance was obtained by using a marker density of 410K and a G matrix constructed using expected marker dosages. Multi-trait genomic best linear unbiased prediction (GBLUP) performed better than single-trait GBLUP. Our study demonstrates that low-coverage whole genome sequencing would be a cost-effective approach for genomic prediction in Dezhou donkey.

Ethnic Stereotype Formation and Its Impact on Sojourner Adaptation: A Case of "Belt and Road" Chinese Migrant Workers in Montenegro.

Ethnic stereotypes are cognitive markers that are formed and modified because of intercultural contact with a new cultural group. There is now much empirical evidence that explicates how stereotypes of ethnic groups can impact individuals' acculturation experiences. However, what is unknown is how previously nonexistent ethnic beliefs are formed as a result of contact with the local culture. One hundred and seventy-four (N = 174) overseas Chinese construction workers were contacted through the Chinese Consulate in Montenegro and agreed to participate in the present study. The online questionnaire asked workers to describe Montenegrin majority members in terms of five characteristics. These traits formed the stereotype markers that were classified as positive, neutral, or negative. Sojourners also answered questions that measured perceived cultural distance, social exclusion, knowledge of Montenegrin culture, feelings of social exclusion, and their sociocultural adaptation. Results show that both positive and negative stereotypes are correlated with less social exclusion and better socio-cultural adaptation. Perceived cultural distance, knowledge of host culture and length of stay was mediated by stereotypes on adaptation outcomes. Interestingly longer sojourn did not lessen the type of stereotype, nor did it reduce cultural distance. Contribution to the stereotype literature and practical understanding of how Chinese sojourners see majority members will be discussed.

Protocol for the economic evaluation of the China Salt Substitute and Stroke Study (SSaSS).

INTRODUCTION: Cardiovascular diseases (CVDs) are the leading causes of death and disability worldwide. Reducing dietary salt consumption is a potentially cost-effective way to reduce blood pressure and the burden of CVD. To date, economic evidence has focused on sodium reduction in food industry or processed food with blood pressure as the primary outcome. This study protocol describes the planned within-trial economic evaluation of a low-sodium salt substitute intervention designed to reduce the risk of stroke in China. METHODS AND ANALYSES: The economic evaluation will be conducted alongside the Salt Substitute and Stroke Study: a 5-year large scale, cluster randomised controlled trial. The outcomes of interest are quality of life measured using the EuroQol-5-Dimensions and major adverse cardiovascular events. Costs will be estimated from a healthcare system perspective and will be sought from the routinely collected data available within the New Rural Cooperative Medical Scheme. Cost-effectiveness and cost-utility analyses will be conducted, resulting in the incremental cost-effectiveness ratio expressed as cost per cardiovascular event averted and cost per quality-adjusted life year gained, respectively. ETHICS AND DISSEMINATION: The trial received ethics approval from the University of Sydney Ethics Committee (2013/888) and Peking University Institutional Review Board (IRB00001052-13069). Informed consent was obtained from each study participant. Findings of the economic evaluation will be published in a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02092090).

Catastrophic health expenditure: a comparative study between hypertensive patients with and without complication in rural Shandong, China.

BACKGROUND: Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. METHODS: Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3457 hypertensive patients registered in the NCDs management system in the sampling villages, 3113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. RESULTS: The incidence of CHE and impoverishment is 13.6 and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% (Ρ = 0.000, OR = 2.29) and 47.3% (P = 0.000, OR = 3.60) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE (Ρ = 0.000). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups (Ρ <0.05). CONCLUSIONS: CHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication. More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.

Cost-effectiveness of CYP2C19 LOF-guided antiplatelet therapy in Chinese patients with acute coronary syndrome.

Aim: This study aimed to evaluate the cost-effectiveness of CYP2C19 loss-of-function(LOF) allele-guided antiplatelet therapy compared with the universal use of clopidogrel or ticagrelor among Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention. Methods: A two-part cost-effectiveness model comprising of a 1-year decision tree and a long-term Markov model was utilized to simulate outcomes of three treatment strategies: universal use of clopidogrel (75 mg daily) or universal use of ticagrelor 90 mg twice daily for all patients and CYP2C19 LOF-guided therapy (LOF allele carriers receiving ticagrelor, LOF allele noncarriers receiving clopidogrel). Model outcomes included quality-adjusted life years (QALYs) gained, direct medical costs and incremental cost-effectiveness ratios (ICERs). ICERs less than one-time gross domestic product per capita in China 59,660 yuan/QALY were considered cost-effective. Results: Base-case analysis showed 'universal ticagrelor use' was cost-effective for an ICER of 33,875 yuan per QALY gained compared with 'universal clopidogrel use' of which gained a 1.6932 QALYs at lowest life-long cost of 2450 yuan. CYP2C19 LOF-guided therapy had an effectiveness of 1.6975 QALYs at a cost of 2812 yuan, for an ICER of 84,118 yuan per QALY gained relative to 'universal clopidogrel use'. Sensitivity analysis demonstrated that base-case results were significantly affected by five factors: the risk ratio of 'non-fatal myocardial infarction', 'non-fatal stroke' and 'cardiovascular death' in ticagrelor versus clopidogrel and the annual costs of clopidogrel and ticagrelor. According to the results of Monte Carlo simulation, when willing to pay is about 32,000 yuan, patients willing to receive clopidogrel or ticagrelor are approximately equal. Conclusion: Optimal antiplatelet treatment is affected by lots of factors. The results of our study demonstrated that 'universal ticagrelor use' was cost-effective compared with 'universal clopidogrel use' for Chinese acute coronary syndrome patients with percutaneous coronary intervention.

Catastrophic health expenditure among type 2 diabetes mellitus patients: A province-wide study in Shandong, China.

AIMS/INTRODUCTION: Diabetes mellitus often causes high economic burden on the patients and their households. The present study aimed to assess the incidence and intensity of catastrophic health expenditure (CHE) relating to type 2 diabetes mellitus care, and to explore its determinants in China. MATERIALS AND METHODS: A total of 1,948 type 2 diabetes patients were included in the analysis. CHE for type 2 diabetes mellitus was defined as out-of-pocket payments for diabetes care that were ≥40% of the non-food expenditure of a household. The Chi-square-test was used to identify the factors associated with CHE. Multivariate logistic regression was used to assess the effects of explanatory analysis variables. RESULTS: The incidence of CHE for type 2 diabetes mellitus care was 13.8%. An association was observed between CHE incidence and household income level, and the poorest group was more likely to experience CHE as a result of diabetes mellitus care. The type 2 diabetes mellitus patients with complications were found to be more likely to experience CHE. Diabetes patients who experienced outpatient or inpatient services increased the likelihood of CHE, and those who experienced inpatient services were more likely to incur CHE. CONCLUSIONS: Type 2 diabetes mellitus has a significantly catastrophic effect on patients and their households in China. Early screening for type 2 diabetes mellitus patients among the high-risk groups and effective management of the detected cases should be priorities to reduce the overall healthcare expenditure for type 2 diabetes mellitus.

Rural-urban disparity in category II vaccination among children under five years of age: evidence from a survey in Shandong, China.

BACKGROUND: Compared with the Expanded Program on Immunization (EPI) vaccines, the coverage rate of the non-EPI vaccines is still low. The aim of this study is to explore the rural-urban disparity in category II vaccine and its determinants among children under 5 years old in China. METHODS: A cross-sectional study was conducted in 17 cities in Shandong province from August to October, 2013. A total of 1638 children were included in the analysis. Unadjusted and adjusted regression model were used to identify the rural-urban difference in vaccination of category II vaccine. Multivariate logistic regression models were employed to analyze the determinants associated with vaccination of category II vaccine in rural and urban areas respectively. RESULTS: The coverage rates of category II vaccine in rural and urban children were 81.5 and 69.4% respectively. Factors including age and satisfaction with vaccination services were associated with category II vaccination both in rural and urban children (Ρ < 0.05). It was also found that the households with four or less members are more likely to vaccinate category II vaccine in rural children. CONCLUSIONS: There was a big difference between rural and urban children in the use of category II vaccine. The government should strengthen financial support and regulation for the category II vaccine. The identified at-risk factors, including age, satisfaction with the vaccination services, and family size should be taken into account when designing targeted vaccination policies for rural and urban children.

Inequality trends of health workforce in different stages of medical system reform (1985-2011) in China.

INTRODUCTION: The aim of this study was to identify whether policies in different stages of medical system reform had been effective in decreasing inequalities and increasing the density of health workers in rural areas in China between 1985 and 2011. METHODS: With data from China Health Statistics Yearbooks from 2004 to 2012, we measured the Gini coefficient and the Theil L index across the urban and rural areas from 1985 to 2011 to investigate changes in inequalities in the distributions of health workers, doctors, and nurses by states, regions, and urban-rural stratum and account for the sources of inequalities. RESULTS: We found that the overall inequalities in the distribution of health workers decreased to the lowest in 2000, then increased gently until 2011. Nurses were the most unequally distributed between urban-rural districts among health workers. Most of the overall inequalities in the distribution of health workers across regions were due to inequalities within the rural-urban stratum. DISCUSSIONS AND CONCLUSIONS: Different policies and interventions in different stages would result in important changes in inequality in the distribution of the health workforce. It was also influenced by other system reforms, like the urbanization, education, and employment reforms in China. The results are useful for the Chinese government to decide how to narrow the gap of the health workforce and meet its citizens' health needs to the maximum extent.