Relationship between outpatients' sociodemographic and belief characteristics and their healthcare-seeking behavioral decision-making: Evidence from Jiaxing city, China.

BACKGROUND: China established the Tiered-network Healthcare Delivery System (THDS) in 2015 to address the disproportionate number of patients attending tertiary hospitals relative to primary- or secondary-care institutions. Although the reported number of outpatients visiting tertiary hospitals is slowly decreasing, numerous patients choose to visit them regardless of their disease's severity. To effectively implement the THDS, this article explored the relationship between patients' sociodemographic and belief characteristics and their healthcare-seeking behavioral decision-making in China. METHODS: Data obtained through questionnaires were analyzed using decision tree and logistic regression models to explore outpatients' characteristics and medical decision-making using comprehensive feature data. Moreover, further statistical analyses were conducted on the outpatient data obtained from the regional population health platform in Jiaxing, China. RESULTS: The decision tree model revealed that whether outpatients have medical insurance is the primary factor guiding their healthcare-seeking behaviors, with those without medical insurance more likely to choose primary or secondary hospitals to treat minor diseases. For those with medical insurance, profession is the main factor, with industrial workers more inclined to choose primary or secondary hospitals for minor diseases. The logistic regression analyses revealed that outpatients without insurance and who were not freelancers or individual owners were more likely to choose primary or secondary hospitals for minor diseases. Further statistical analysis of the data from the Jiaxing population health platform showed that, for minor or general diseases, outpatients without medical insurance and employed as farmers tended to choose primary and secondary hospitals over tertiary hospitals. CONCLUSION: The three analyses yielded consistent results: in China, medical insurance and patients' profession are the most important factors guiding outpatients' healthcare-seeking behaviors. Accordingly, we propose that the government should focus on economic reforms to increase outpatients' visits to primary and secondary hospitals and diagnosis-related groups' payment of medical insurance to decrease the admittance of patients with minor diseases in large tertiary hospitals. Meanwhile, the government should correct patients' belief prejudice about selecting hospitals through corresponding publicity.

A systematic review of self-neglect and its risk factors among community-dwelling older adults.

OBJECTIVES: To systematically review published evidence on self-neglect (SN) and its risk factors among community-dwelling older adults. METHOD: A comprehensive literature search was conducted in PubMed, Embase, CINAHL Plus, PsycINFO, and Scopus for studies that were published in English from inception to 8 April 2020. Grey database was also included to ensure a thorough search. The study quality was assessed by two reviewers independently using the Newcastle-Ottawa Scale or the checklist suggested by the Agency for Healthcare Research and Quality. RESULTS: A total of 19 studies was included in this review. Various tools were used to assess SN among the available studies. The prevalence rates of SN among community-dwelling older adults ranged from 18.4% to 29.1%. The risk factors of SN identified by these studies involved sociodemographic characteristics (male gender, older age, low economic status, ethnicity, lower educational level, marital status, and lower number of children), health-related characteristics (cognitive impairment, lower level of physical function, nutritional status, higher number of medical comorbidities, and pain), psychological characteristics (depression), and social context characteristics (living alone, lower social networks and social engagement, lower neighborhood cohesion, and neighborhood disorder). CONCLUSION: SN is a common and under-recognized phenomenon among community-dwelling older adults. Our review provides healthcare professionals with an insight into SN and its risk factors. More studies are required to test the potency of each independent risk factor to deepen our understanding of this particular phenomenon.

Predictors of self-neglect among community-dwelling older adults living alone in China.

Little is known about the prevalence of self-neglect and its predictors among community-dwelling older adults living alone in China. The present study was conducted among 181 older adults living alone in Nanjing, China. Self-neglect was assessed using a self-neglect screening scale. Participants' sociodemographic data, social network, functional ability, cognitive function, and depression level were also collected through a set of questionnaires. The prevalence of self-neglect among this group of older adults was 23.2%, which is comparative to their counterparts in Korea and in the United States. Only depression (ß = 0.361, p < 0.001) and monthly income (ß = -0.159, p = 0.025) were identified as significant predictors of self-neglect, accounting for 27.1% of the variance. Understanding self-neglect and its predictive factors is essential to provide culturally relevant and tailored interventions to enhance the confidence and self-care abilities of older adults to maintain their health and well-being.

Pharmacokinetics and Safety Assessment of l-Tetrahydropalmatine in Cocaine Users: A Randomized, Double-Blind, Placebo-Controlled Study.

Cocaine use disorder (CUD) remains a significant public health challenge. l-Tetrahydropalmatine (l-THP), a well-tolerated and nonaddictive compound, shows promise for the management of CUD. Its pharmacologic profile includes blockade at dopamine and other monoamine receptors and attenuation of cocaine self-administration, reinstatement, and rewarding properties in rats. This study evaluated the safety of l-THP in human cocaine users and its influence on the safety and pharmacokinetics (PK) of cocaine. Twenty-four cocaine-using adult men were randomized to receive l-THP (30 mg twice a day orally) or placebo double-blind for 4 days, with an intranasal cocaine (40 mg) challenge on the fourth day. Safety and tolerability were evaluated using vital signs, ECG, clinical laboratory tests, and standardized self-report instruments. Peripheral venous blood was collected periodically and later assayed for l-THP and cocaine using highly sensitive and specific ultraperformance liquid chromatography-fluorescence detection (UPLC-FLD) methods. Twenty subjects completed the study, of whom 19 provided complete PK data. The short 3.5-day course of l-THP was safe and well tolerated and did not affect cocaine's PK or its acute cardiovascular effects. The cocaine AUC0→∞ was 211.5 and 261.4 h·ng/mL, and the Cmax was 83.3 and 104.5 ng/mL for the l-THP and placebo groups, respectively. In addition there were no significant differences in the number of side effects reported in each group (l-THP group 22 [48%], placebo group 24 [52%]) or vital signs including, heart rate, blood pressure, complete blood count, or ECG. These findings suggest that oral THP has promise for further development as a treatment for CUD.

Population Pharmacokinetic and Covariate Analysis of Apatinib, an Oral Tyrosine Kinase Inhibitor, in Healthy Volunteers and Patients with Solid Tumors.

BACKGROUND AND OBJECTIVES: Apatinib is an oral tyrosine kinase inhibitor approved in China for the treatment of patients with advanced metastatic gastric cancer. The approved dosing schedule is 850 mg once daily. The objective of this study was to develop a population pharmacokinetic (popPK) model of apatinib and determine factors that affect its pharmacokinetics. METHODS: A popPK model for apatinib was developed using data from 106 individuals, including healthy volunteers and patients with malignant solid tumors. The potential influence of demographic, patient, and laboratory characteristics on oral apatinib pharmacokinetics were investigated in a covariate analysis. The extent of the impact of significant covariates on the exposure of apatinib was evaluated using simulations. RESULTS: The final popPK model was a two-compartment model with mixed first- and zero-order absorption and first-order elimination. The population estimates of apparent clearance (CL/F) and apparent volume at steady-state were 57.8 L/h and 112.5 L, respectively. The non-linear dose proportionality in apatinib relative bioavailability was characterized by a sigmoidal maximum effect (E max) equation wherein the midpoint dose for the decrease in bioavailability was 766 mg. Patients with advanced gastric cancer exhibited lower bioavailability. Cancer patients in general had lower CL/F than healthy volunteers. Simulation results indicated that apatinib exposure in various population groups were impacted by disease and laboratory characteristics. CONCLUSIONS: The increase in apatinib exposure was less than proportional to dose. The pharmacokinetics of apatinib in gastric cancer patients were significantly different from those in patients with other cancer types. Dosing of apatinib in various cancer subpopulations may require adjustments to optimize efficacy and benefits to patients.

Information needs of patients with heart failure: Health professionals' perspectives.

This study aimed to understand information needs of patients with heart failure from the perspectives of health professionals. The exploratory qualitative study was conducted in 2011. Face-to-face interviews were performed to collect data from 24 health professionals. Data were evaluated through content analysis. Information identified by health professionals as essential for patients' learning included risk factors and symptom management, prognosis, medication and lifestyle adjustment. Factors related to both patients and health professionals were recognized as barriers to information acquisition. Moreover, health professionals provided several recommendations for improving the health condition of patients. Information needs identified by health professionals, as well as actual needs expressed by patients, can be incorporated in health education. The effectiveness of educating patients can be improved by addressing needs perceived by both patients and health professionals.