Understanding financial risk protection in China's health system: a descriptive analysis using data from multiple national household surveys.

BACKGROUND: Providing financial risk protection is one of the fundamental goals of health systems. Catastrophic health expenditure (CHE) and medical impoverishment (MI) are two common indicators in evaluating financial risk protection in health. As China continues its health system reform to provide accessible and affordable health care, it is important to have a clear understanding of China's progress in financial risk protection. However, past research showed discrepancies in the incidence of CHE and MI. In this article, using data from four national household surveys, we analyzed levels and characteristics of CHE and MI in China under different definitions. METHODS: We used multiple conventional thresholds for CHE and MI to comprehensively describe the levels of financial risk protection in China. We used data from four national household surveys to measure the incidence of CHE and MI, and their inequalities by urban/rural status and by income quartiles. The Probit regression model was used to explore influencing factors of CHE and MI. RESULTS: We found that the incidences of CHE and MI were largely consistent across four national household surveys, despite different sampling methods and questionnaire designs. At the 40% nonfood expenditure threshold, the incidence of CHE in China was 14.95%-17.73% across four surveys during the period of 2016-2017. Meanwhile, at the 1.9 US dollars poverty line, the incidence of MI was 2.01%-5.63%. Moreover, rural residents, lower-income subgroups, and smaller households were faced with higher financial risks from healthcare expenditures. Although positive progress in financial risk protection has been achieved in recent years, China has disproportionately high incidences of CHE and MI, compared to other countries. CONCLUSION: China has large margins for improvements in risk financial protection, with large inequalities across subgroups. Providing better financial protection for low-income groups in rural areas is the key to improve financial protection in China.

Association between solid fuel use and nonfatal cardiovascular disease among middle-aged and older adults: Findings from The China Health and Retirement Longitudinal Study (CHARLS).

BACKGROUND: Few studies have been conducted on the association between domestic solid fuel combustion and incident nonfatal cardiovascular disease (CVD). We assessed the prospective association between domestic fuel type and incident nonfatal CVD among Chinese adults aged ≥45 years. METHODS: This was a prospective cohort study using data from the China Longitudinal Study of Health and Retirement (CHARLS) that recruited 8803 participants ≥45 years in 2013. Household fuel types were assessed based on self-reports, including solid fuel (coal, crop residue, or wood fuel) and clean fuel (central heating, solar power, natural gas, liquefied petroleum gas, electricity, or marsh gas). Nonfatal CVD was defined as self-reported physician-diagnosed nonfatal CVD. We established Cox proportional hazard regression models with age as the time scale and strata by sex to evaluate the hazard ratios (HRs) and 95 % confidence intervals (95 % CIs). RESULTS: After a median follow-up of five years, 970 (11.02 %) nonfatal CVD cases were documented, including 423 (9.96 %) in males and 547 (12.01 %) in females. Participants with exposure to solid fuel for cooking and clean fuel for heating [HR (95 % CI):2.01 (1.36-2.96)], solid fuel for heating and clean fuel for cooking [HR (95 % CI):1.45 (1.06-1.99)], and solid fuel for both heating and cooking [HR (95 % CI):1.43 (1.07-1.92)] had an elevated nonfatal CVD risk compared to users of cleaner fuel for both cooking and heating. Those whom self-reported switching from solid fuels to cleaner fuels for cooking had significantly decreased nonfatal CVD risk [HR (95 % CI):0.76 (0.58-0.99)] than participants who did not switch to cleaner fuels. CONCLUSIONS: Exposure to domestic solid fuel burning for cooking or heating is associated with an elevated nonfatal CVD risk. Notably, switching cooking fuels from solid to cleaner fuels is related to a reduced risk of nonfatal CVD.

Gallium ions incorporated silk fibroin hydrogel with antibacterial efficacy for promoting healing of Pseudomonas aeruginosa-infected wound.

The continual resistance to antibiotics and the generation of a series of bacterial infections has emerged as a global concern, which requires appropriate measures and therapeutics to address such a menace. Herein, we report on Silk fibroin (SF) hydrogel with good biocompatibility and biodegradability fabricated through the crosslinking of the SF of different concentrations with Gallium nitrate (Ga (NO3)3) against Pseudomonas aeruginosa. However, the SF: Ga = 500: 1 (w/w) (SF/Ga) demonstrated a good bactericidal and wound healing effect as a result of the moderate and prolonged release of the Ga3+ following the gradual degradation of the hydrogel. The Ga3+, known for its innovative nature acted as a crosslinked agent and a therapeutic agent employing the "Trojan horse" strategy to effectively deal with the bacteria. Also, the Ga3+, which is positively charged neutralizes the negative potential value of the SF particles to reduce the charge and further induce the ß-sheet formation in the protein structure, a characteristic of gelation in SF. The morphology showed a fabricated homogenous structure with greater storage modulus- G' with low loss modulus- G'' modulus demonstrating the mechanical performance and the ability of the SF/Ga hydrogel to hold their shape, at the same time allowing for the gradual release of Ga3+. A demonstration of biocompatibility, biodegradability, bactericidal effect and wound healing in in vitro and in vivo present the SF/Ga hydrogel as an appropriate platform for therapeutic and for antibacterial wound dressing.

Association of handgrip strength with all-cause mortality: a nationally longitudinal cohort study in China.

OBJECTIVES: Handgrip strength is considered a vital and reliable measure of comprehensive physical assessments, whereas the association of handgrip strength with overall mortality risk among Chinese adults was less studied. We prospectively investigated the association between handgrip strength and all-cause mortality among Chinese middle-aged and older people based on data from the China Health and Retirement Longitudinal Study (CHARLS).3 DESIGN: Longitudinal cohort study. METHODS: Grip strength was assessed for both hands by a dynamometer. Odds ratios (ORs)4 and 95 % confidence intervals (CIs)5 were estimated applying logistic regression models with adjustments for age, body mass index, ethnicity, education level, annual household income, marital status, drinking, smoking, physical activity, and medical insurance among men and women. Deaths were ascertained by each follow-up survey in which the household member who lived with the participants were inquired. RESULTS: Over an average follow-up period of approximately 8 years among the screened 11,618 participants ≥45 years old, 1290 deaths were documented. The age range was 45-93 for men and 45-96 for women. Greater handgrip strength was associated with a lower overall mortality risk, with adjusted ORs (comparing with extreme tertiles) of 0.47 (95 % CI: 0.35-0.64; P-trend<0.001) in men and 0.51 (95 % CI: 0.24-1.08; P-trend = 0.059) in women. Such inverse association seemed stronger among younger men (OR = 0.29, 95 % CI: 0.18-0.45), compared with the older men (OR = 0.49, 95 % CI: 0.33-0.73; P-interaction = 0.023). CONCLUSIONS: Handgrip strength was inversely associated with all-cause mortality risk, especially among the younger men. Further investigations are warranted to elucidate the underlying mechanism.