Gender income differences among general practitioners with compulsory services in early career stage in underdeveloped areas: evidence from a prospective cohort study in China.

BACKGROUND: Gender equality and the gender income gap in medicine are long-standing global problems. Although gender-related differences have been widely studied in developed countries, they remain unclear in underdeveloped regions. In 2010, China initiated a national compulsory service program (CSP) to train qualified general practitioners in rural and remote areas. This study aimed to evaluate gender income differences for early career CSP and non-CSP (NCSP) graduates in underdeveloped areas. METHODS: A cohort study was conducted with 3620 CSP and NCSP graduates from four medical universities in Central and Western China. Baseline surveys and six follow-up surveys were conducted between 2015 and 2022. Incomes, including monthly mean income and proportion of performance-based income, were measured as the key outcome variables. Multivariate linear regression models were used to identify the gender income gap. RESULTS: NCSP graduates had higher average monthly incomes than CSP graduates. In the seventh year after graduation, the average monthly income for NCSP graduates was 7859 CNY while was 5379 CNY for CSP graduates. After controlling for demographic characteristics, the gender monthly income gap for CSP graduates was expanded from the fourth year (3.0%) to the sixth year (5.9%) after graduation, and that for NCSP graduates was expanded from the fifth year (11.9%) to the seventh year (16.3%) after graduation. Regarding performance-based income, it was 58.9% for NCSP graduates and 45.8% for CSP graduates in the seventh year after graduation. After controlling for performance-based income proportion, the gender income gap was reduced from 5.9 to 4.0% in the sixth year after graduation for CSP graduates, and from 16.3 to 14.4% for NCSP graduates in the seventh year after graduation. CONCLUSION: An extensive and ever-increasing gender income gap exists among young doctors in the early stages of their careers in underdeveloped areas of China. The high proportion of performance-based income among men is one of the main explanations for the observed difference. A more explicit compensation system must be established to enhance support for female health workers.

Changing inequity in health service utilization and financial burden among patients with hypertension in China: evidence from China Health and Retirement Longitudinal Study (CHARLS), 2011-2018.

BACKGROUND: China initiated a health system reform in 2009 to achieve Universal Health Coverage (UHC) by 2020. While the effectiveness of health-system reforms has been studied, equity in health-service utilization and financial burden remains underexplored. This study evaluated whether the health system reform has improved the equity in utilization and financial burden of health services among patients with hypertension in China. METHODS: We obtained data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. The main outcome variables were outpatient and inpatient service utilization rates and catastrophic health expenditure (CHE) for patients with hypertension. The Standardized Concentration Index (CI) was used to measure the changing equity in health service utilization and affordability. RESULTS: Outpatient service utilization was relatively equal among patients with varying socioeconomic statuses (SESs) (CI: 0.041 in 2011 and 0.064 in 2018). Inpatient service utilization inequity improved from CI 0.144 in 2011 to CI 0.066 in 2018. CHE incidence increased from 15.6% in 2011 to 24.2% in 2018. CI for CHE declined from -0.069 in 2011 to -0.012 in 2015 but increased to -0.063 in 2018. CONCLUSIONS: Health insurance expansion and poverty alleviation policies promoted equity in inpatient service utilization for hypertensive patients. However, the financial burden for the poor requires further attention through reimbursement policy adjustments for outpatient services in primary care settings.

Drug users' awareness of and willingness to use HIV non-occupational post-exposure prophylaxis (nPEP) services in China: a mixed methods study.

BACKGROUND: Drug users are regarded as a high-risk population for HIV infection. Non-occupational post-exposure prophylaxis (nPEP) is internationally regarded as an effective biomedical prevention against HIV but still a small-scale pilot project in China at present. The aim of this study was to understand drug users' awareness of and willingness to use nPEP service in China. METHODS: This mixed methods study consisting of a qualitative study and a cross-sectional survey was conducted in two cities of China from 2018 to 2019. The in-depth interviews were audio-taped, transcribed verbatim and analyzed using thematic framework analysis. Univariate and multivariate logistic regressions were used to examine factors associated with drug users' awareness of and willingness to use nPEP. RESULTS: There were 401 and 19 participants included in quantitative and qualitative study respectively. Among participants in quantitative study, 30.2% had heard of nPEP and 56.7% reported willingness to use nPEP in future HIV exposure. In multivariate analyses, nPEP awareness was associated with age, sex, education level, AIDS knowledge score and HIV risk perception. nPEP willingness was associated with AIDS knowledge score, HIV risk perception, alcohol use, monthly income and awareness of nPEP. The qualitative results showed the barriers to nPEP willingness included the fatigue after taking drugs, high cost and side effects of nPEP medication, long nPEP course, and fear of privacy disclosure. CONCLUSION: Drug users had low nPEP awareness and only about half participants reported willingness to use nPEP. It is essential to promote nPEP education campaigns among drug users, especially for elders, women and those with lower education level. Simultaneously, price regulation, side effect management, psychological support and privacy protection need to be managed well when nPEP is routinized.

Urban-rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults from 2011 to 2015: a repeated cross-sectional study.

BACKGROUND: China has experienced a continuing increase in hypertension prevalence over the past few decades, especially in rural areas. The paper aims to examine the variation of urban-rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults between 2011 and 2015. METHODS: Our team extracted data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of residents aged 45 years and older. In this study, we used the 2011 wave and the 2015 wave of CHARLS. We calculated crude rates and age-adjusted rates of hypertension prevalence, awareness, treatment, and control for the general, urban, and rural populations in each wave and performed chi-square tests to examine urban-rural disparities. We used logistic regression to further confirm these disparities by controlling confounding factors in each wave. We then used generalized estimating equation (GEE) to further examine whether urban-rural disparities changed between 2011 and 2015. RESULTS: We included 11,129 records in the 2011 wave and 8916 records in the 2015 wave in this study. The mean age was 59.0 years and 5359 (48.2%) participants were male in the 2011 wave. Age-adjusted hypertension prevalence, awareness, treatment, control, and control among treated in the total population were 38.5%, 70.6%, 59.2%, 27.4%, and 46.4% in 2015. Urban-rural disparities in the indicators mentioned above were 5.7%, 13.4%, 15.3%, 9.4% and 5.6% in 2011; which decreased to 4.8%, 2.7%, 5.2%, 4.9% and 3.8% in 2015. Urban-rural disparities in prevalence, awareness and treatment were statistically significant in 2011 but not significant in 2015 adjusted for confounding factors, yet control disparities were statistically significant in both waves. Finally, urban-rural disparities in awareness and treatment had narrowed from 2011 to 2015. CONCLUSIONS: Awareness, treatment, and control rates were sub-optimal among both urban and rural adults. Prevention and management of hypertension among both urban and rural adults should be further strengthened. Awareness and treatment increased more rapidly among rural adults, indicating some achievement had been made in enhancing the healthcare system in rural areas. More efforts are needed in attaining urban-rural equity of healthcare services.

Lightweight and Efficient Image Dehazing Network Guided by Transmission Estimation from Real-World Hazy Scenes.

In this paper, a transmission-guided lightweight neural network called TGL-Net is proposed for efficient image dehazing. Unlike most current dehazing methods that produce simulated transmission maps from depth data and haze-free images, in the proposed work, guided transmission maps are computed automatically using a filter-refined dark-channel-prior (F-DCP) method from real-world hazy images as a regularizer, which facilitates network training not only on synthetic data, but also on natural images. A double-error loss function that combines the errors of a transmission map with the errors of a dehazed image is used to guide network training. The method provides a feasible solution for introducing priors obtained from traditional non-learning-based image processing techniques as a guide for training deep neural networks. Extensive experimental results demonstrate that, in terms of several reference and non-reference evaluation criteria for real-world images, the proposed method can achieve state-of-the-art performance with a much smaller network size and with significant improvements in efficiency resulting from the training guidance.

Processable and Moldable Sodium-Metal Anodes.

Sodium-ion batteries are similar in concept and function to lithium-ion batteries, but their development and commercialization lag far behind. One obstacle is the lack of a standard reference electrode. Unlike Li foil reference electrodes, sodium is not easily processable or moldable and it deforms easily. Herein we fabricate a processable and moldable composite Na metal anode made from Na and reduced graphene oxide (r-GO). With only 4.5 % percent r-GO, the composite anodes had improved hardness, strength, and stability to corrosion compared to Na metal, and can be engineered to various shapes and sizes. The plating/stripping cycling of the composite anode was significantly extended in both ether and carbonate electrolytes giving less dendrite formation. We used the composite anode in both Na-O2 and Na-Na3 V2 (PO4 )3 full cells.

Removal of cobalt(II) ion from aqueous solution by chitosan-montmorillonite.

Montmorillonite (MMT) modified with chitosan (CTS, molecular weight=5×10(4)) was applied to remove heavy metal cations by using Co(2+) as a model ion. An increase in MMT interlayer distance observed from X-ray diffraction indicates the intercalation of CTS into MMT. Together with the results of scanning electron microscopy and Fourier transform infrared spectroscopy, it was concluded that the composite material of CTS and MMT (CTS-MMT) was prepared successfully. The mass ratio of CTS to MMT had a strong influence on the adsorption performance of CTS-MMT. The highest adsorption value of 150mg/g was obtained over the composite material with CTS to MMT mass ratio of 0.25, which is much higher than those reported in other studies. The adsorption isotherms and kinetic results indicated that Co(2+) was adsorbed over CTS-MMT in a multilayer model, and the chemical sorption of Co(2+) was determined to be the rate-limiting step.

Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China.

BACKGROUND: There is a paucity of evidence regarding the definition of the quality of primary health care (PHC) in China. This study aims to evaluate the PHC quality for chronic diseases in rural areas based on a modified conceptual framework tailored to the context of rural China. METHODS: This comprehensive study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, and health care workers providing care on hypertension or diabetes were involved. The modified PHC quality framework encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patient's preferences, and family-centeredness). Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. RESULTS: This study included 1355 patients, 333 health care providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for the PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, and 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients' preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. CONCLUSION: The PHC quality in rural China has shown strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.

Primary care team and its association with quality of care for people with multimorbidity: a systematic review.

BACKGROUND: Multimorbidity is posing an enormous burden to health systems, especially for primary healthcare system. While primary care teams (PCTs) are believed to have potentials to improve quality of primary health care (PHC), less is known about their impact on the quality of care for people with multimorbidity. We assessed the characteristics of PCTs and their impact on the quality of care for people with multimorbidity and the mechanisms.  METHODS: We searched PubMed, MEDLINE, EMBASE, ProQuest for published studies from January 2000 to October 2021 for studies in English. Following through PRISMA guidelines, two reviewers independently abstracted data and reconciled by consensus with a third reviewer. Titles, abstracts, and full texts were evaluated to identify relevant studies. Studies were categorized by types of interventions, the impact of interventions on outcome measures, and mechanisms of interventions.  RESULTS: Seventeen studies (13 RCT, 3 cohort studies, and 1 non-randomized trial) were identified. PCTs were summarized into three types-upward PCTs, downward PCTs and traditional PCTs according to the skill mix. The upward PCTs included primary care workers and specialists from upper-level hospitals, downward PCTs involving primary care workers and lay health workers, and traditional PCTs involving physicians and care managers. PCTs improved patients' mental and psychological health outcomes greatly, and also improved patients' perceptions towards care including satisfaction with care, sense of improvement, and patient-centeredness. PCTs also improved the process of care and changed providers' behaviors. However, PCTs showed mixed effects on clinical outcome measures. CONCLUSIONS: PCTs have improved mental and psychological health outcomes, the process of care, patients' care experiences, and satisfaction towards care for patients with multimorbidity. The effect of PCTs on clinical outcomes and changes in patient behaviors need to be further explored.

Microstructure Evolution and In Situ Resistivity Response of 2196 Al-Li Alloy during Aging Process.

The microstructure evolution of 2196 Al-Li alloy during aging was investigated by microhardness test, transmission electron microscope (TEM) analysis and in situ resistivity measurement. The results showed that the resistivity of the 2196 Al-Li alloy during aging rapidly decreased during the first few hours, and then gradually increased after reaching the minimum value, which is temperature-dependent. The microstructure of the alloy was dominated by the δ' phase after aging at 160 °C for 2 h while the T1 phase could hardly be seen until it had been aged for 16 h. As the aging time went on, significant ripening appeared for the δ' phase while typical growth could be observed for the T1 phase. The increase in the resistivity of the 2196 Al-Li alloy during aging was attributed to the stronger electron scattering capacity of the T1 precipitation and the coupling effect between the T1 and δ' phases.

Supporting and retaining competent primary care workforce in low-resource settings: lessons learned from a prospective cohort study.

OBJECTIVE: Assess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China's national compulsory services programme (CSP). DESIGN: Prospective cohort study. SETTING: Health facilities in middle and western rural areas in China, 2015-2022. PARTICIPANTS: Cohorts of CSP graduates from 2015 to 2019 in four major medical universities. MAIN OUTCOMES: Job performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year. RESULTS: 91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance-adequate medication increased job performance by 2.2 points (95% CI 0.7 to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8 to 4.8). Facility support was also positively associated with productivity-adequate medication increased outpatients seen per day by 20% (95% CI 0.1 to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0 to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9-2.3 times more likely to report adequate facility support. CONCLUSION: GPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.

Characterization of lithium zinc titanate doped with metal ions as anode materials for lithium ion batteries.

With the aim of improving the ionic and electronic conductivities of Li2ZnTi3O8 for high performance lithium ion battery applications, Li2Zn0.9M0.1Ti3O8 (M = Li+, Cu2+, Al3+, Ti4+, Nb5+, Mo6+) compounds are successfully fabricated using facile high temperature calcination at 800 °C. Physical characterization and lithium ion reversible storage demonstrate that Zn-site substitution by multivalent metal ions is beneficial for improving the migration rate of ions and electrons of Li2ZnTi3O8. X-ray diffraction analysis and scanning electron microscopy reveal that the crystal structure and microscopic morphology of bare Li2ZnTi3O8 do not change by introducing a small amount of foreign metal ions. As a result, Li2Zn0.9Nb0.1Ti3O8 retains a reversible capacity as high as 198 mA h g-1 at the end of the 500th cycle among all samples. Even when cycled at high temperatures, Li2Zn0.9Nb0.1Ti3O8 still maintains excellent reversible discharge capacities of 210 mA h g-1 and 196 mA h g-1 at 1000 mA g-1 for the 100th cycle at 50 °C and 60 °C, respectively. All the conclusions indicate that Li2Zn0.9Nb0.1Ti3O8 is a high-performance anode material for large-scale energy storage devices.

The stereo-microstructure of ZnO affects the lithium storage capacity of Li2ZnTi3O8 anode materials.

ZnO materials with multidimensional stereoscopic morphologies were synthesized via a one-step solvothermal process with water, ethanol and acetone as solvents. In this work, well-prepared ZnO was used as a Zn source for preparing pristine Li2ZnTi3O8 anode materials for the first time by a facile solid-state method. The resulting Li2ZnTi3O8 electrode material with rice-shaped ZnO as the zinc source (LZTO-E) possessed a smaller particle size and larger specific surface area, which were conducive to increase the electrochemical reaction area. Impressively, the LZTO-E electrode showed an excellent electrochemical performance with large discharge capacity (253.4 mA h g-1 at 100 mA g-1) and good cycling stability (175 mA h g-1, 133.4 mA h g-1, and 115.0 mA h g-1 at 1000 mA g-1, 2000 mA g-1, and 5000 mA g-1 after 500 cycles, respectively). This superior electrochemical performance of the as-synthesized Li2ZnTi3O8 was attributed to the specific microtopography of ZnO.