How surface acting affects turnover intention among family doctors in rural China: the mediating role of emotional exhaustion and the moderating role of occupational commitment.

BACKGROUND: Family doctors in rural China are the main force for primary health care, but the workforce has not been well stabilized in recent years. Surface acting is an emotional labor strategy with a disparity between inner feelings and emotional displays, provoking negative effects such as emotional exhaustion, occupational commitment reduction, and, consequently, increasing turnover rate. With the Conservation of Resources theory, this study explores how the surface acting of rural family doctors affects turnover intention through emotional exhaustion and investigates what role occupational commitment plays in this relationship. METHODS: With a valid response rate of 93.89%, 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach's Alpha and confirmatory factor analysis (CFA) were used to estimate reliability and construct validity, respectively. The PROCESS macro in SPSS was performed to analyze the mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention. RESULTS: Reliability and validity indicated that the measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (ß = 0.481, 95% CI [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95% CI [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (ß = - 0.065, 95% CI [- 0.111, - 0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: - 0.035). CONCLUSIONS: Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. Policymakers should pay more attention to the effects of emotional labor and emotional resource depletion on the stability of rural health human resources.

Cross-sectional study of factors affecting the receipt of mental health education in older migrants in China.

BACKGROUND: Population migration in China has increasingly included middle-aged and older populations. Relatedly, the lack of mental health education among China's older migrants is still an important but neglected problem. This study aimed to understand the current situation of mental health education received by the older migrant population in China and to explore related influencing factors. METHODS: This cross-sectional study included 5729 older migrants who participated in the 2017 China Migrants Dynamic Survey. The independent variables included four components: demographic and socioeconomic characteristics, migration factors, public health service utilization, and social integration factors. Data were analyzed using the chi-square test for single factors and a binary logistic regression model for multiple factors. RESULTS: A total of 1749 older migrants received mental health education, for a receipt rate of 30.53%. Regression analysis showed that older migrant individuals who had an average monthly household income > 3000 CNY, self-rated their health as healthy, had chronic diseases, had heard of National Basic Public Health Services, had established health records, received ≥2 types of health education were willing to integrate into the local population, and were highly involved in the community were more likely to receive mental health education. Older migrants who were ≥ 70 years old, had an elementary school education or below, had difficulties in the local community, had migrated ≥11 years prior, moved for their offspring, and moved across provinces were less likely to receive mental health education. CONCLUSIONS: The older migrant population does not receive sufficient mental health education. Mental health interventions should be tailored to the characteristics of older migrants to increase their mental health literacy and meet their psychological needs.

Evaluation and countermeasures of contracted services of Chinese family doctors from demanders' point of view - a case study of a city.

BACKGROUND: The "gatekeepers" for residents' health are their family doctors. The implementation of contracted services provided by family doctors is conducive to promoting hierarchical diagnosis and treatment and achieving the objective of providing residents comprehensive and full-cycle health services. Since its implementation in 2016, the contract service system for Chinese family doctors has yielded a number of results while also highlighting a number of issues that require further investigation. Consequently, the purpose of this study is to assess the impact of family doctors' contracted services in a Chinese city from the perspective of demanders (i.e., contracted residents), identify the weak links, and then propose optimization strategies. METHODS: In this study, a city in Shandong Province, China was selected as the sample city. In January 2020, 1098 contracted residents (including 40.5% men and 59.5% women) from 18 primary medical institutions (including township health centers and community health centers) were selected for on-site investigation. Take the PCAT-AS(Adult Short) scale revised in Chinese as the research tool to understand the medical experience of contracted residents in primary medical institutions, and interview some family doctors and residents to obtain more in-depth information. RESULTS: Among the four core dimensions of PCAT-AS, the score of Continuous was the highest (3.44 ± 0.58); The score of Coordinated was the lowest (3.08 ± 0.66); Among the three derived dimensions, the score of Family-centeredness was the highest (3.33 ± 0.65); The score of Culturally-competent was the lowest (2.93 ± 0.77). The types of contracting institutions, residents' age, marital status, occupation, and whether chronic diseases are confirmed are the influencing factors of PCAT scores. CONCLUSION: The family doctors' contracted services in the city has achieved certain results. At the same time, there are still some problems, such as difficult access to outpatient services during non-working hours, incomplete service items, an imperfect referral system, and inadequate utilization of traditional Chinese medicine services, it is recommended that the government continue to enhance and increase its investment in relevant policies and funds. Primary medical institutions should improve the compensation mechanism for family doctors and increase their work enthusiasm, improve and effectively implement the two-way referral system, gradually form an orderly hierarchical pattern of medical treatment, provide diversified health services in accordance with their own service capacity and the actual needs of residents, and improve the utilization rate of traditional Chinese medicine services in primary medical institutions.

Trend and equity of general practitioners' allocation in China based on the data from 2012-2017.

BACKGROUND: General practitioners are the gatekeepers of the health of the residents. This study aims to evaluate the trend and equity of general practitioners' allocation from 2012 to 2017 in China and provide a reference for regional health planning and rational distribution of general practitioners. METHODS: We extracted the data of general practitioners from 22 provinces, 5 autonomous regions, and 4 municipalities of mainland China. The population and geographical area were taken from the China Statistical Yearbook. The general practitioners' data were taken from the China Health Statistical Yearbook. Lorenz curve, Gini coefficient, and agglomeration degree were used to analyze the data. RESULTS: The number of general practitioners was 252,717 in 2017, which equates to 1.82 per 10,000 residents, and accounts for 7.45% of the total number of practicing (assistant) doctors. From 2012 to 2017, the population-based Gini coefficient for general practitioners reduced from 0.31 to 0.24, while the geographical area-based Gini coefficient remained unchanged at 0.73. The agglomeration degree based on population increased from 0.72 to 0.73 in the western region including Tibet (0.403) and Shaanxi (0.513). Moreover, in the eastern region the agglomeration degree reduced from 1.477 to 1.329. In the middle region it rose from 0.646 to 0.802. The agglomeration degree based on the geographical area in the western region increased from 0.270 to 0.277 while the values in Tibet, Qinghai, Xinjiang were less than 0.1. In the eastern region, it reduced from 1.447 to 1.329. It increased from 1.149 to 1.423 in the middle region. CONCLUSIONS: The number of general practitioners has increased significantly in China. It has a fair allocation based on population. However, the equity based on geographical area is low and uneven in different regions with large regional differences. In the western region, there is an allocation shortage with respect to population and geographical area. Concerned departments should establish and improve the incentive and performance appraisal mechanisms of general practitioners. The Internet + should be used to empower their service capacity and efficiency. The educational input should be increased for the western region and government should encourage the eastern region to support the western region.

Effect of healthcare system reforms on job satisfaction among village clinic doctors in China.

BACKGROUND: Village clinic doctors (VCDs) are part of the health service force in rural China. VCDs' job satisfaction (JS) is important to the stability of the three-tiered health service system. Since 2009, the Chinese government launched a new health care system reform (NHCSR) which affected VCDs significantly. This study aimed to analysing the effect of NHCSR on JS among VCDs. METHODS: All the data came from three surveys in Shandong Province conducted in 2012, 2015 and 2018. In 2012, an originally designed questionnaire was used to conduct a baseline survey of 405 VCDs from 27 townships in nine counties. In 2015 and 2018, 519 and 223 VCDs in the same counties were surveyed with the same questionnaire. Descriptive analysis and ANOVA were used to analyse the level and changes in VCDs' JS. RESULTS: The mean scores of VCDs' total JS were 2.664 ± 1.069, 3.121 ± 0.931 and 2.676 ± 1.044 in 2012, 2015 and 2018, respectively, with a significant difference (F = 28.732, P < 0.001). The mean scores of the medical practice environment and the job itself showed a continuous downward trend. The trends of the mean scores for job reward, internal work environment and organizational management were consistent with the trend for total JS. CONCLUSION: The NHCSR had a partly negative impact on VCDs' JS. Policy-makers should pay more attention to VCDs' job reward and medical practice environment. With the implementation of new reform policies, VCDs' JS should be the subject of more systematic and detailed research.

COVID-19 Information Dissemination Using the WeChat Communication Index: Retrospective Analysis Study.

BACKGROUND: The COVID-19 outbreak has tremendously impacted the world. The number of confirmed cases has continued to increase, causing damage to society and the economy worldwide. The public pays close attention to information on the pandemic and learns about the disease through various media outlets. The dissemination of comprehensive and accurate COVID-19 information that the public needs helps to educate people so they can take preventive measures. OBJECTIVE: This study aimed to examine the dissemination of COVID-19 information by analyzing the information released by the official WeChat account of the People's Daily during the pandemic. The most-read COVID-19 information in China was summarized, and the factors that influence information dissemination were studied to understand the characteristics that affect its dissemination. Moreover, this was conducted in order to identify how to effectively disseminate COVID-19 information and to provide suggestions on how to manage public opinion and information governance during a pandemic. METHODS: This was a retrospective study based on a WeChat official account. We collected all COVID-19-related information, starting with the first report about COVID-19 from the People's Daily and ending with the last piece of information about lifting the first-level emergency response in 34 Chinese provinces. A descriptive analysis was then conducted on this information, as well as on Qingbo Big Data's dissemination index. Multiple linear regression was utilized to study the factors that affected information dissemination based on various characteristics and the dissemination index. RESULTS: From January 19 to May 2, 2020, the People's Daily released 1984 pieces of information; 1621 were related to COVID-19, which mainly included headline news items, items with emotional content, and issues related to the pandemic's development. By analyzing the dissemination index, seven information dissemination peaks were discerned. Among the three dimensions of COVID-19 information-media salience, content, and format-eight factors affected the spread of COVID-19 information. CONCLUSIONS: Different types of pandemic-related information have varying dissemination power. To effectively disseminate information and prevent the spread of COVID-19, we should identify the factors that affect this dissemination. We should then disseminate the types of information the public is most concerned about, use information to educate people to improve their health literacy, and improve public opinion and information governance.

Job burnout and its influencing factors among village doctors during the COVID-19 pandemic: a cross-sectional study.

Objective: The aim of this study is to understand the job burnout of village doctors during the COVID-19 epidemic and its influencing factors, and to provide a reference for effectively alleviating the job burnout of village doctors. Methods: A cross-sectional survey was conducted among village doctors in S province in December 2021. The survey included a general information questionnaire and the CMBI Burnout Scale. Epidata was used for dual input, and descriptive analysis, t-test, chi-square test, and binary Logistic regression for statistical analysis were used. Results: A total of 993 village doctors participated in the survey. Most of them were male village doctors (62.84%), with an average age of 46.57 (SD = 7.50). Village doctors believed that the impact of the epidemic on work was serious, with a score of 3.87 ± 0.91. The economic support was small, with a score of 2.31 ± 0.99. The development space was low, with a score of 2.62 ± 0.98. The overall incidence of burnout was 53.47%. In the burnout group, 54.05% were mild, 33.14% were moderate, and 12.81% were severe. The high degree of difficulty in using WeChat (OR = 1.436, 95%CI: 1.229-1.679), high work pressure (OR = 1.857, 95%CI: 1.409-2.449), high risk of practice (OR = 1.138, 95%CI: 1.004-1.289), less economic support (OR = 0.825, 95%CI: 0.684-0.995), less technical support (OR = 0.696, 95%CI: 0.565-0.858), and poor emotional support (OR = 0.632, 95%CI: 0.513-0.780) were more likely to have job burnout. Conclusion: Burnout is a common phenomenon among village doctors during the COVID-19 pandemic, which needs to be prevented and alleviated by various measures.

Sedentary Behavior and Risk of Depression in Older Adults: A Systematic Meta-Analysis.

Background: The elderly represents the population group with the highest rate of sedentary behavior. Sedentary behavior has an adverse impact on the elderly, which might be related to depression. Methods: We queried PubMed, EMBASE, Web of Science, and MEDLINE to collect literature data. The odds ratio (OR) and corresponding 95% confidence interval (CI) were adopted for the pooled measurements. Sub-group analyses were conducted through stratified meta-analyses based on study design, depression indicator, adjustment for physical activity, sedentary behavior indicator, and type. Sensitivity analyses were performed to test the robustness of the results, and publication bias was assessed through a funnel plot. Results: Seven cross-sectional studies and five cohort studies were included in our meta-analysis. The overall pooled OR was 1.38 (95%CI: 1.16-1.65; P < 0.01), which indicated that sedentary behavior was positively associated with depression in older adults. Sub-group analysis showed that different study designs, depression indicators, sedentary behavior indicators, adjustment for physical activity, sedentary behavior indicator, and type produced different results. In the cross-sectional studies (OR = 1.45, 95%CI: 1.15-1.84), CES-D scale (OR = 1.54, 95%CI: 1.13-2.10), self-reported (OR = 1.39, 95%CI: 1.04-1.87), watching TV (OR = 1.75, 95%CI: 1.02-3.02), and not adjusted for physical activity (OR = 1.37, 95%CI: 1.14-1.65) groups, there was a strong correlation between sedentary behavior and depression in the elderly. Conclusion: Sedentary behavior is associated with depression in the elderly. As a preventive strategy, we should consider reducing their sedentary time and appropriately increasing physical activity.

COVID-19 prevention and control effect of non-pharmaceutical interventions-fuzzy-sets qualitative comparative analysis based on 69 countries in the world.

Introduction: Coronavirus disease 2019 occurred unexpectedly in late December 2019, it was difficult to immediately develop an effective vaccine or propose targeted medical interventions in the early stages of the outbreak. At this point, non-pharmaceutical interventions (NPIs) are essential components of the public health response to COVID-19. How to combine different NPIs in the early stages of an outbreak to control the spread of epidemics and ensure that the policy combination does not incur high socio-economic costs became the focus of this study. Methods: We mainly used the fuzzy set qualitative comparative analysis to assess the impact of different combinations of NPIs on the effectiveness of control in the COVID-19 pandemic early stage, using open datasets containing case numbers, country populations and policy responses. Results: We showed that the configuration of high morbidity results includes one, which is the combination of non-strict face covering, social isolation and travel restrictions. The configuration of non-high morbidity results includes three, one is strict mask wearing measures, which alone constitute sufficient conditions for interpreting the results; the second is strict testing and contact tracing, social isolation; the third is strict testing and contact tracing, travel restriction. The results of the robustness test showed that the number, components and consistency of the configurations have not changed after changing the minimum case frequency, which proved that the analysis results are reliable. Conclusion: In the early stages of the epidemic, the causes of high morbidity are not symmetrical with the causes of non-high morbidity. Strict face covering is the most basic measure required to prevent and control epidemics, and the combination of non-strict face covering and containment is the most important factor leading to poor prevention and control, and the combination of strict containment and proactive pursuit is the way to achieve superior prevention and control, timely and proactive containment strategies have better prevention and control, and should mobilize the public to cooperate.

The relationship between Internet use and loneliness of middle-aged and older adult people: the moderating effect of residence.

Objectives: The proportion of middle-aged and older adult people exposed to the Internet continues to grow. Internet use may have an impact on the mental health of the older adult, especially loneliness. This study analyzed the relationship between Internet use and presence of loneliness. Methods: A total of 550 person aged 45 years and above were randomly selected from a province in eastern China at the end of 2022. The outcome variable was presence of loneliness, as measured by self-report. Descriptive analysis, chi-square test and binary logistic analysis were used to analyze the data. Results: 58.3% of respondents use the Internet. Internet use could reduce the possible of reported loneliness in middle-aged and older adult people (OR = 0.652, 95%CI: 0.465, 0.940), and residence played a moderating role in the relationship between them. Middle-aged and older adults who used the Internet for 1-3 h (OR = 0.464, 95%CI: 0.275, 0.784) and 3-5 h (OR = 0.484, 95%CI: 0.247, 0.946) were less likely to felt lonely than those who used the Internet for less than 1 h per day. In addition, middle-aged and older adult people using the Internet to contact relatives and friends (OR = 0.488, 95%CI:0.292, 0.818), read the news (OR = 0.485, 95%CI:0.277, 0.848), assets management (OR = 0.297, 95%CI:0.109, 0.818) were less likely to report loneliness, while those who made online payment (OR = 3.101, 95%CI:1.413, 6.807) were more likely to report loneliness. Conclusion: There is a significant negative correlation between Internet use and presence of loneliness, but different Internet duration and content have different effects on loneliness in middle-aged and older adult people. We should pay attention to the impact of Internet use on loneliness in middle-aged and older adult people.

Comparative analysis of village doctors' relative deprivation: based on two cross-sectional surveys.

BACKGROUND: Village doctors are the main health service providers in China's rural areas. Compared with other rural groups, they will have a sense of relative deprivation, which has an impact on their practice mentality and job stability. This study aims to analyze the changes and causes of relative deprivation among village doctors, so as to improve the stability of them. METHODS: The data were collected from two surveys conducted in Shandong Province in 2015 and 2021. In 2015, 322 village doctors were surveyed and 307 questionnaires were collected, with a recovery rate of 95.3%. In 2021, 394 village doctors were surveyed and 366 questionnaires were collected, with a recovery rate of 92.9%. Descriptive and univariate analysis were used to compare the changes before and after the survey. RESULTS: The scores of vertical deprivation of village doctors increased from 2.77 ± 0.81 in 2015 to 3.04 ± 0.83 in 2021, with a statistically significant difference (P < 0.001). The reference group selected by village doctors changed from village teachers to ordinary villagers. Compared to village teachers, the horizontal deprivation score of village doctors increased from 3.47 ± 0.87 to 3.97 ± 0.77, with a statistically significant difference (P < 0.001). Compared to villagers, only the professional reputation deprivation score increased, from 2.38 ± 0.93 to 2.68 ± 0.76, with a statistically significant difference (P < 0.05). CONCLUSIONS: As time goes by, village doctors fail to reach the expected level in terms of economic income, social status, professional reputation and living standards, resulting in a sense of relative deprivation. This may have a negative impact on village doctors' work motivation and behavior, and will fail to guarantee the sustainability of the team. We should pay attention to this unbalanced mentality of village doctors.

The status of emotional labour and its influence on job burnout among village doctors during the COVID-19 pandemic in China: a cross-sectional study.

BACKGROUND: Village doctors in China are not only the gatekeepers of rural residents' health but also the net bottom of the medical security system. However, emotional labour is increasingly threatening the stability of the rural primary medical system. In addition, the ongoing coronavirus disease 2019 (COVID-19) pandemic has further exposed the vulnerability of human resources in China's rural health system. This study aims to evaluate the current situation of emotional labour among village doctors and explore the impact of emotional labour on job burnout during the COVID-19 pandemic in China. METHODS: A cross-sectional survey was conducted in December 2021 in Shandong Province. We used structured questionnaires to collect data, including sociodemographic characteristics, emotional labour, and job burnout. Data were analysed by t test, analysis of variance (ANOVA), Pearson correlation analysis, and hierarchical multiple linear regression. RESULTS: A total of 1,093 village doctors from Shandong Province participated in the study. More than half of the participants were male (62.40%) and were between 41 and 50 years old (53.43%). The total mean score of emotional labour was 3.17 ± 0.67, of which the surface acting (SA) score was 2.28 ± 0.90, and the deep acting (DA) score was 3.91 ± 0.93. There were significant differences in SA according to gender and work content (P < 0.05) and in DA according to gender, age, education level, and work content (P < 0.05). Pearson correlation analysis showed that SA was positively correlated with job burnout (P < 0.001), and DA was negatively correlated with job burnout (P < 0.001). Hierarchical multiple linear regression analysis revealed that 29% of the variance in job burnout is attributable to SA (ß = 0.530, P < 0.001) and DA (ß = -0.154, P < 0.001). CONCLUSION: Village doctors in Shandong Province performed moderate levels of emotional labour during the COVID-19 pandemic. SA had a significant positive effect on job burnout, while DA had a significant negative effect on job burnout among village doctors. Administrators should enhance training on emotional labour for village doctors to play a positive role in alleviating their job burnout.

How does the turnover intention of village clinic doctors change after China's new health care system reform? A comparison based on three surveys in a province in eastern China.

Objectives: This study aims to analyze the changes in village clinic doctors' turnover intention following the new health care system reform (NHCSR). Methods: All the data were obtained from three surveys conducted in 2012, 2015, and 2018 in a province in eastern China. Descriptive analysis and analysis of variance (ANOVA) were used to analyze the changes in village clinic doctors' turnover intention. Results: The mean scores of village clinic doctors' turnover intention were 2.87 ± 1.07, 2.76 ± 1.12, and 2.99 ± 1.14 in 2012, 2015, and 2018, respectively, with a significant difference (F = 3.60, P = 0.03). During the 3 years, the turnover intention scores of village clinic doctors who were male, aged 40 years and below, secondary technical school graduates, had the qualifications to practice as village clinic doctors, and were under village-township integrated management first decreased and then increased. The turnover intention scores of village clinic doctors with medical practitioner qualifications increased; however, the scores, decreased for those without village-township integrated management. Conclusion: The turnover intention of village clinic doctors has increased, and the possible reasons for this phenomenon include changes in the demographic characteristics of village clinic doctors and policy factors. The government should pay more attention to the problems that village clinic doctors consider of urgent concern, such as the treatment of income and pension insurance, and provide greater career development and training opportunities for village clinic doctors to maintain their motivation and stability.

Association of individual resilience with organizational resilience, perceived social support, and job performance among healthcare professionals in township health centers of China during the COVID-19 pandemic.

Background: Primary healthcare professionals were overworked and psychologically overwhelmed during the COVID-19 pandemic. Resilience is an important shield for individuals to cope with psychological stress and improve performance in crises. This study aims to explore the association of individual resilience with organizational resilience, perceived social support and job performance among healthcare professionals in township health centers of China during the COVID-19 pandemic. Methods: Data from 1,266 questionnaires were collected through a cross-sectional survey conducted in December 2021 in Shandong Province, China. Descriptive analysis of individual resilience, organizational resilience, perceived social support, and job performance was conducted. Pearson correlation analysis was used to examine the correlations among these variables, and structural equation modeling was performed to verify the relationships between these variables. Results: The score of individual resilience was 101.67 ± 14.29, ranging from 24 to 120. Organizational resilience (ß = 0.409, p < 0.01) and perceived social support (ß = 0.410, p < 0.01) had significant direct effects on individual resilience. Individual resilience (ß = 0.709, p < 0.01) had a significant direct effect on job performance. Organizational resilience (ß = 0.290, p < 0.01) and perceived social support (ß = 0.291, p < 0.01) had significant indirect effects on job performance. Conclusion: During the COVID-19 pandemic, the individual resilience of healthcare professionals in township health centers was at a moderate level. Organizational resilience and perceived social support positively affected individual resilience, and individual resilience positively affected job performance. Furthermore, individual resilience mediated the effect of organizational resilience and perceived social support on job performance. It is recommended that multiple stakeholders work together to improve the individual resilience of primary healthcare professionals.

Prevalence and Factors Associated With Burnout of Frontline Healthcare Workers in Fighting Against the COVID-19 Pandemic: Evidence From China.

OBJECTIVES: The sudden outbreak of the novel coronavirus disease (COVID-19) plunged healthcare workers (HCWs) into warfare. This study aimed to determine the prevalence of burnout and the factors associated with it among frontline HCWs fighting COVID-19. METHODS: A cross-sectional survey was conducted among frontline HCWs fighting against the COVID-19 in Wuhan, Harbin, and Shenzhen during the period from February 18 to March 4. Finally, HCWs were recruited using cluster sampling, 1,163 HCWs were included in the final analysis. Burnout was measured using a 22-item Maslach Burnout Inventory scale (MBI scale). RESULTS: Of the participants, 48.6% suffered from burnout, and 21.8% showed a high degree of burnout. Doctors (b = 3.954, P = 0.011) and nurses (b = 3.067, P = 0.042) showed higher emotional exhaustion (EE) than administrators. Participants who worked continuously for more than 8 h a day (b = 3.392, P = 0.000), those who were unable to eat three regular daily meals (b = 2.225, P = 0.008), whose daily water intake was no more than 800 ml (b = 3.007, P = 0.000), who slept for no more than 6 h (b = 1.609, P = 0.036), and who were infected or had colleagues who were infected with COVID-19 (b = 4.182, P = 0.000) experienced much higher levels of EE, while those who could adhere to infection control procedures (b = -5.992, P = 0.000), who were satisfied with their hospital's infection control measures(b = -3.709, P = 0.001), and who could receive sufficient psychological crisis intervention (b = -1.588, P = 0.039) reported lower levels of EE. CONCLUSION: The study reveals that burnout is prevalent among frontline HCWs and that the known factors associated with burnout, such as workload, and the factors directly associated with COVID-19, such as having insufficient protection, can affect burnout symptoms in frontline HCWs. Synergized and comprehensive interventions should be targeted at reducing its occurrence among frontline HCWs fighting COVID-19.

Impact of isolated dissolved organic fractions from seawater on biofouling in reverse osmosis (RO) desalination process.

The biofouling potential of three isolated dissolved organic fractions from seawater according to their molecular weights (MWs), namely, fractions of biopolymers (F.BP, MW > 1000 Da), humic substances and building blocks (F.HS&BB, MW 350-1000 Da), and low molecular weight compounds (F.LMW, MW < 350 Da) were characterized by assimilable organic carbon (AOC) content. The AOC/DOC ratio was in the order of F.LMW (∼35%) > F.BP (∼19%) > F.HS&BB (∼8%); AOC/DOC of seawater was ∼20%; organic compositions of seawater were BP ∼6%, HS&BB ∼52% and LMW ∼42%; LMW accounted for >70% of AOC in seawater. Their impact on SWRO biofouling in term of flux decline rate was in the order of F. LMW (∼30%) > F.BP (∼20%) > F.HS&BB (<10%). Despite being the major organic compound in seawater, HS&BB showed marginal effect on biofouling. The role of indigenous BP was less critical owing to its relatively low concentration. LMW, which was the major AOC contributor, played a significant role in biofouling by promoting microbial growth that contributed to the build-up of soluble microbial products and exopolymeric substances (i.e., in particular BP). Therefore, seawater pretreatment shall focus on the removal of AOC (i.e., LMW) rather than the removal of biopolymer.

Fouling behavior of isolated dissolved organic fractions from seawater in reverse osmosis (RO) desalination process.

Organic fouling is still elusive in seawater reverse osmosis (SWRO) desalination process. Classifying organics in seawater will provide an in-depth understanding of the important fraction on RO fouling. In this study, dissolved organic matter (DOM) in seawater was fractionated and concentrated by membrane technique into three major fractions (i.e., biopolymer fraction, humic substance with building block fraction, and low molecular weight fraction) by their molecular weight (MW) according to the definitions in liquid chromatography with organic carbon detection (LC-OCD) method. Overall recovery of >80% was attained. The isolated organic fractions were compared with common model foulants such as sodium alginate (SA), bovine serum albumin (BSA), and humic acid (HA), in terms of chemical analyses using fluorescence-excitation emission matrix (FEEM) and LC-OCD, as well as their fouling potentials. SWRO fouling experiments were carried out and fouling mechanism was investigated by atomic force microscopy (AFM) method and extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory. Results showed that initial fouling (i.e., foulant-membrane interaction) was the main driver in SWRO organic fouling with biopolymer fraction as the major contributor followed by low molecular weight fraction. In addition, divalent ions was found to enhance the RO fouling by increasing the adhesion and cohesion forces between foulant-membrane and foulant-foulant.

Incidence, mortality and trends of drowning among children aged 0-14 years in China, 1990-2019 / 中国学校卫生

Objective@#To understand the incidence and mortality of drowning and secular trend among children aged 0-14 from 1990 to 2019 in China, so as to provide reference for drowning intervention among children in China.@*Methods@#Based on data of drowning incidence and death in 0-14 years old children in China in 1990-2019 years Global Burden of Disease (GBD 2019) database, the standardized rate was calculated by the world standard population, and the trend of incidence rate and mortality rate was fitted by Joinpoint regression model respectively.@*Results@#From 1990 to 2019, the overall incidence of drowning among children aged 0-14 years in China decreased from 37.17/100 000 to 12.54/100 000, a relative decrease of 66.26%; the standardized incidence rate decreased from 21.78/100 000 to 14.98/100 000, a relative decrease of 31.22%. The incidence rate and standardized incidence rate of drowning in children showed an increasing after decreasing trend, with decreasing mortality and standardized mortality rate. Joinpoint regression showed that the incidence rate of standardized AAPC for child drowning was -1.3, -2.5 for males and 0 for females. The overall standardized mortality rate of drowning was -3.9, male was -3.6, female was about -4.5 , the trend changes were statistically significant ( P <0.05). The incidence rate and mortality rate of male were higher than that of female, and there was significant difference between male and female groups ( P <0.05).@*Conclusion@#Significant progress has been made in child drowning prevention and control, with substantial decreasing in the incidence rate of child drowning. However, considering recent slight increase in drowning incidence, effective measures should be developmed including risk factors, vulnerable population to further control the incidence and mortality of child drowning.

Study on HPV vaccine hesitation and associated factors among female college students in Weifang / 中国学校卫生

Objective@#To investigate HPV vaccine hesitation and associated factors among female college students in Weifang, and to provide a suggestions for improving the coverage rate of HPV vaccine among female college students.@*Methods@#The questionnaire of HPV vaccine hesitancy of female college students was designed. By adopting the stratified sampling method, the survey was conducted among female students at one medical university and three nonmedical universities in Weifang. Chi-square test and Logistic regression were used to analyze the influencing factors of vaccine hesitation.@*Results@#Female college students who had high risk perception toward vaccine (OR=4.15, 95%CI=1.55-11.10) and those who were angry about the sideeffects of the vaccine (OR=3.63, 95%CI=1.95-6.75) were hesitate to vaccinate against HPV. Female college students who believed long protection period of HPV vaccine (OR=0.08, 95%CI=0.04-0.17), that women had a high probability of cervical cancer (OR=0.44, 95%CI=0.21-0.90) and that the knowledge of HPV vaccine scored >6 (OR=0.31, 95%CI=0.15-0.67) were more likely to receive HPV vaccine.@*Conclusion@#High risk perception of vaccines and anger at vaccine adverse reactions are important factors affecting HPV vaccines for female college students. Our findings call for strategic role of the state, school-based health education as well as medical professional guidance in lowering HPV vaccination hesitation among fenale college sutdents.

Pneumonia mortality in children aged 0-14 years in China during 2005 to 2019 / 中国学校卫生

Objective@#To understand pneumonia mortality in children aged 0-14 years in China in recent 15 years, and to provide reference for child pneumonia prevention and treatment.@*Methods@#Based on the death data from China Statistical Yearbook 2005-2019, pneumonia mortality in urban and rural children aged 0-14 was extracted and the standardized mortality was calculated, and the trend of mortality was fitted by Joinpoint regression model.@*Results@#The crude mortality rate of child pneumonia in urban and rural areas showed an increasing trend, while the standardized mortality rate showed a fluctuating downward trend. Joinpoint regression showed that the mortality rate of pneumonia in urban and rural children showed a monotonous downward trend, and there was no turning point. The overall APC of pneumonia mortality of urban children was -3.4, that of boys and girls were both -3.5. Trend for annual changes in urban areas were found significant among total sample and boys (both P <0.05). The overall APC of pneumonia mortality in rural children was -7.8, that of boys and girls were -7.1 and -7.8, respectively. Trend for annual changes in rural areas were found significant among total sample and boys(both P <0.05). There was no significant differences in the trend of mortality between urban and rural groups.@*Conclusion@#During 2005 to 2019, child pneumonia mortality in urban and rural areas in China shows a downward trend, which is relatively balanced in urban and rural areas. Further strengthened pediatric pneumonia treatment and management are expected to reduce the pneumonia mortality.