Cultural capital, the digital divide, and the health of older adults: a moderated mediation effect test.

BACKGROUND: It is of great practical significance to study the intrinsic relationship between cultural capital, digital divide, cognitive ability, and health of older adults in the dual social context of population aging and the digital era. METHODS: We analyzed data from the 2020 China Family Panel Studies (CFPS) initiated by the China Center for Social Science Surveys at Peking University. Physical health, mental health, and memory health were set as indicators of older adults, and the relationship between cultural capital, digital divide, cognitive ability, and health of older adults was examined by hierarchical regression with moderated mediated effect methods. RESULTS: Improvement in the health of older adults is associated with an increase in the level of cultural capital; cultural capital may bridge the digital divide faced by older adults, which in turn promotes the improvement of the health of older adults; the higher the level of cognitive ability, the stronger the effect of cultural capital on the digital divide, and at the same time, the stronger the mediating effect of the digital divide; cultural capital has a more pronounced effect on the health of older male adults living in the city. CONCLUSIONS: The results of the study show that cultural capital can have a positive impact on the health of older adults, but there is urban-rural heterogeneity and gender heterogeneity, in which the digital divide plays a mediating role, and the enhancement of the cognitive ability of older adults will be conducive to the improvement of their health, so the health of older adults should be promoted by improving the level of their cultural capital and the ability of older adults to use digital technology, thus provide references for the protection of health of older adults.

Assessing the mediating role of motivation in the relationship between perceived management support and perceived job satisfaction among family doctors in Jiangsu province, China.

BACKGROUND: The study aimed to examine the influence of perceived management support on job satisfaction through the mediating role of motivation among family doctors in the Jiangsu province of China. METHODS: Six dimensions of motivation were employed as mediators in the association between perceived management support and job satisfaction in collecting data to analyze the hypothesized relationships in the present study. A total of 600 questionnaires were distributed to family doctors in Jiangsu province. Structural equation model (SEM) in the analysis of a moment structure (AMOS) version 26 software was used to estimate the path coefficients. RESULTS: Perceived management support has a significant positive relationship with job satisfaction. Motivation had a fully mediated relationship with the association between perceived management support and job satisfaction. CONCLUSIONS: The study's findings suggest motivation is important in enhancing family doctors' satisfaction and must not be underestimated. It, therefore, offers diverse recommendations for enhancing motivation among healthcare professionals.

Fluid shear stress promotes periodontal ligament cells proliferation via p38-AMOT-YAP.

Periodontal ligament (PDL) cells are a promising tool for periodontal regeneration therapy. Achieving a sufficient number of PDL cells is essential to PDL regeneration. In our study, appropriate flow shear stress (FSS, 1-6 dyn/cm2) promotes the proliferation of PDL cells. FSS remodels cytoskeleton and focal adhesion in a duration-dependent manner. FSS induces PDL cells to form the actin cap within 10 min, flattens the nuclei, and increases the nuclear pore size, which promotes nuclear translocation of Yes-associated protein (YAP). FSS activates p38, which plays a dual function in YAP regulation. p38 regulates the phosphorylation of Akt and cofilin, as well as induced F-actin polymerization to induce YAP activity. In addition, p38 inhibits pLATS and consecutively regulates angiomotin (AMOT) and YAP phosphorylation. AMOT competitively binds to F-actin and YAP to participate in FSS-mediated YAP nuclear translocation and cell proliferation. Taken collectively, our results provide mechanistic insights into the role of p38-AMOT-YAP in FSS-mediated PDL cells proliferation and indicate potential applications in dental regenerative medicine.

A multiplicative effect of Education and Wealth associated with HIV-related knowledge and attitudes among Ghanaian women.

BACKGROUND: Knowledge and attitudes regarding HIV play a crucial role in prevention and control efforts. Understanding the factors influencing HIV-related knowledge and attitudes is essential for formulating effective interventions and policies. This study aims to investigate the possibility of an interaction between education and wealth in influencing HIV-related knowledge and attitudes among women in Ghana. METHODS: Cross-sectional data from the Ghana Multiple Indicator Cluster Survey (MICS), a nationally representative sample, were analyzed. Statistical summaries were computed using place of residence, marital status, education level, wealth index quintile, use of insurance, functional difficulties, and exposure to modern media. Furthermore, a three-model Logistic regression analysis was conducted; Model 1 with main effects only, Model 2 with the interaction between education and wealth, and Model 3 with additional covariates. To account for the complexity of the survey data, the svyset command was executed in STATA. RESULTS: Although most interaction terms between wealth index quintiles and education levels did not show statistical significance, a few exceptions were observed. Notably, women with primary education in the second, middle, and fourth wealth quintiles, along with those with secondary education in the second wealth quintile, exhibited a negative significant association with HIV-related attitude level. However, no significant associations were found between other factors, including age, place of residence, marital status, and health insurance, and HIV-related attitude. The study also found significant associations between socioeconomic variables and HIV-related knowledge. There was a significant positive association between higher levels of education and HIV-related knowledge level. Women in wealthier quintiles had a significant positive association with HIV-related knowledge level. Factors such as place of residence and media exposure, including radio and television were also observed to be associated with HIV-related knowledge level. CONCLUSIONS: This study highlights the importance of socioeconomic status and media exposure in shaping HIV-related knowledge and attitudes among women in Ghana. Policy interventions should focus on reducing socioeconomic disparities, ensuring equitable access to education and healthcare services, and utilizing media platforms for effective HIV information dissemination.

Effects of incentive-based population policies on sustainability of China's recent maternity insurance system reform: a system dynamics simulation.

BACKGROUND: This paper seeks to assess the sustainability of the reformed maternity insurance system and the extent to which China's current maternity insurance system can support different levels of fertility incentives in the future. Our findings will serve as a reference for countries in a similar demographic predicament and those about to face it. METHODS: This study used a combination of qualitative and quantitative methods. In the qualitative assessment, we used a grounded theory model to generalize the factors influencing the sustainability of maternity insurance funds. For the quantitative analysis, we used a novel and comprehensive system dynamics model to visualize the status of the combined operation of maternity and health insurance. Data are mainly derived from the historical data of the Statistical Yearbook of Jiangsu Province and the National Bureau of Statistics of China. RESULTS: In the short term, fertility incentive payments can be set to motivate people to have children. It is therefore recommended that when the scope of the fertility incentive policy is limited to two children, and an average amount above RMB 10 000 could be set, it would be prudent to set the amount at a level not exceeding RMB 10 000 when the scope of the fertility incentive policy is for all newborns. In the long term, a system of incentives for childbirth should be built from education policy, house price regulation, tax relief and childcare services. CONCLUSION: Our research not only highlights the significance of improving the resilience of maternity insurance by combining maternity insurance and health insurance funds, but also suggests a way to economically incentivize beneficiaries to have children so as to mitigate the decline in China's birth rate and cope with the crisis of an ageing population.

An empirical analysis of the impact of income inequality and social capital on physical and mental health - take China's micro-database analysis as an example.

BACKGROUND: Income inequality is one of the important reflections of the unbalanced development of the world economy and can have adverse effects on physical and mental health. METHODS: This article used the 2018 China Family Panel Studies Database as an empirical analysis data source. The Kakwani index (KI) was used to measure income inequality, and social capital was broken into cognitive social capital and structural social capital. Our assessment was conducted by using STATA16 software for ordered logistic regression, verifying income inequality, social capital on correlation between physical and mental health firstly; then by gradual regression methods to verify intermediary effect, and demonstrate the social capital as an intermediary variable affecting physical and mental health as income inequality. RESULT: The income inequality has a significant negative effect on physical and mental health (ß = - 0.964, - 0.381; OR = 0.382, 0.758; P < 0.01), Social capital has a significant effect on physical and mental health (Cognitive SC(MH): ß = 0.146 and 0.104, OR = 1.157 and 1.110, P < 0.01; Cognitive SC(PH): ß = 0.046 and 0.069, OR = 1.047 and 1.071, P < 0.01; Structural SC(MH): ß = - 0.005, 0.025 and 0.015, OR = 0.995, 1.025 and 1.015, P > 0.1, P < 0.01 and P < 0.01; Structural SC(PH): ß = - 0.026, 0.009 and - 0.013, OR = 0.975, 1.009 and 0.987, P < 0.01, P > 0.1 and P < 0.01). Our analysis also showed that social capital (cognitive social capital and structural social capital) has an intermediary effect on physical and mental health due to income inequality. CONCLUSION: This study shows that income inequality can not only directly affect physical and mental health, but also through social capital intermediary utility indirectly affect physical and mental health, social capital has positive effects on physical and mental health. At the same time, income inequality and social capital's effects on physical and mental health exist regional differences, urban-rural differences, and gender differences. Therefore, in the development of special policies to support and take care of vulnerable groups, special attention needs to be paid to poor rural areas and female groups.

Can social capital play a role in contracting services of family doctors in China? Reflections based on an integrative review.

BACKGROUND: The family doctors' contract service problem is not about government management alone, but an interaction of a complex social environment. Consequently, the effect of contracted services of family doctors not only depends on policy incentives but also needs to win the participation, acknowledgement, and confidence of community residents. The purpose of this integrative review is to examine whether there is any significant evidence that social capital in the form of social networking groups and other forms of social groups have any positive impact on the acceptance and the effectiveness of family doctors' contractual services. METHOD: Research on qualitative, quantitative and hybrid methods published in peer-reviewed journals on the social capital role in the process of contract service of family doctors were eligible for inclusion. In view of the increasing attention paid to the contract service effect of family doctors during this period, a 10-year time scale was selected to ensure full coverage of relevant literature in the same period. In total, 809 articles were determined in the database retrieval results which were downloaded and transferred to the Mendeley reference application software. RESULTS: Twelve articles met the inclusion criteria for this integrative review and the quality of the included studies were assessed using the published criteria for the critical appraisal of quantitative and qualitative research methods. Majority of the articles assessed reported that there was evidence of a positive link between social support, especially a sense of belonging and the presence of regular family doctors. The influencing factors of patients' contract behavior of studies conducted in China were social interaction of social capital, acceptance of the first contact in the community, year of investigation, and exposure to the public. CONCLUSION: The study affirms previous studies that suggest that social resources have the propensity to improve relationship between patients and clients and between doctors and peers for the benefit of the patients and the stability of the overall healthcare system. Through the integration of various social resources family doctor systems accelerate the development of community construction. These social capital (social network groups) can guide residents to use family doctor services to maintain health. Social capital can also help residents have a regular and reliable family doctor.

An empirical study on the determinants of health care expenses in emerging economies.

BACKGROUND: Emerging countries continue to suffer gravely from insufficient healthcare funding, which adversely affects access to quality healthcare and ultimately the health status of citizens. By using panel data from the World Development Indicators, the study examined the determinants of health care expenditure among twenty-two (22) emerging countries from the year 2000 to 2018. METHODS: The study employed cross-section dependence and homogeneity tests to confirm cross-sectional dependence and to deal with homogeneity issues. The Quantile regression technique is employed to test for the relationship between private and public health care expenses and its determinants. The Pooled mean group causality test is used to examine the causal connections among the variables. RESULTS: The outcome of the quantile regression test revealed that economic growth and aging population could induce healthcare costs in emerging countries. However, the impact of industrialization, agricultural activities, and technological advancement on health expenses are found to be noticeably heterogeneous at the various quantile levels. Unidirectional causality was found between industrialization and public health expenses; whereas two-way causal influence was reveled amongst public health expenditure and GDP per capita; public health expenditure and agricultural activities. CONCLUSION: It is therefore suggested that effective and integrated strategies should be considered by industries and agricultural sectors to help reduce preventable diseases that will ultimately reduce healthcare costs among the emerging countries.

Reconstructing family doctors' psychological well-being and motivation for effective performance in China: the intervening role of psychological capital.

BACKGROUND: Family practice and family doctors are critical part of China's primary healthcare delivery in a constantly evolving society. As the first point of contact with the medical system, family practices require physically and psychologically sound and a well-motivated family doctors at all times. This is because an error can lead to loss of lives as gatekeepers of the medical system. Our study explored the extent to which positive psychological capital promotes higher performance among family doctors. METHODS: A questionnaire was used to collect data from family doctors in Shanghai, Nanjing, and Beijing. We applied a structural equation analysis to analyze the causal relationship among the variables. RESULTS: We found out that psychological well-being and job involvement significantly influences the performance of family doctors in China. The study also noted that psychological capital moderates the relationship between psychological well-being attainment, job involvement, and performance. CONCLUSIONS: Studies have shown that these pressures affect their well-being considerably. For this reason, a healthcare professional who experiences positive emotions affects the total behavior which culminates into performance.

Endangering China's environmental health security goals through negative environmental investor behaviours.

China sees the need to maximise its environmental health security as a major priority in its sustainable development agenda. This is at the heart of China's "ecological civilisation" and "beautiful China" dream. One of the objectives of this dream is to sensitize investors to invest in health and environmental stocks to support environmental health goals. However, both the Shanghai and the Shenzhen stock markets continue to witness contemporaneous movement (herding behaviour) by investors from environmental stock to perceived safer stocks and this is stifling the growth of the environmental health sector due to capital deprivation. Our paper evaluates the significance and potential effect of this herding trend among environmental stocks using a collection of sophisticated econometric models namely, the state-space model, enhanced state-space model, the cross-sectional SD (CSSD) and the cross-sectional absolute deviation (CSAD). The models are used to evaluate firm-level data collected from the 80 environmental stocks indexed by the KGRM MSCI China IMI Environment 10/40 Index. Three of the models confirm the presence of endemic negative (herding) investor behaviour among environmental stocks in China and this threatens the sustainability of environmental stock capital to promote China's environmental health goals. We have proposed measures to ameliorate the risks posed by such negative contemporaneous investor behaviours.

A high-risk luminal A dominant breast cancer subtype with increased mobility.

PURPOSE: Breast cancer is a heterogeneous disease, and although advances in molecular subtyping have been achieved in recent years, most subtyping strategies target individual genes independent of one another and primarily concentrate on proliferative markers. The contributions of biological processes and immune patterns have been neglected in breast cancer subtype stratification. METHODS: We performed a gene set variation analysis to simplify the information on biological processes using hallmark terms and to decompose immune cell data using the immune cell gene terms on 985 breast invasive ductal/lobular carcinoma RNAseq samples in the TCGA database. RESULTS: The samples were gathered into three clusters following implementation of the t-SNE and DBSCAN algorithms and were categorized as 'hallmark-tsne' subtypes. Here, we identified a high-risk luminal A dominant breast cancer subtype (C3) that displayed increased motility, cancer stem cell-like features, a higher expression of hormone/luminal-related genes, a lower expression of proliferation-related genes and immune dysfunction. With regard to immune dysfunction, we observed that the motility-increased C3 subtype exhibited high granulocyte colony stimulating factor (G-CSF) expression accompanied by neutrophil aggregation. Cancer cells that produce high levels of G-CSF can stimulate neutrophils to form neutrophil extracellular traps, which promote cancer cell migration. This finding sheds light on one potential explanation for why the C3 subtype correlates with poor prognosis. CONCLUSIONS: The hallmark-tsne subtypes confirmed again that even the luminal A subtype is heterogeneous and can be further subdivided. The biological processes and immune heterogeneity of breast cancer must be understood to facilitate the improvement of clinical treatments.

Learning to read in Chinese: Evidence for reciprocal relationships between word reading and oral language skills.

This study investigates the longitudinal predictors of the development of Chinese word reading skills and potential bidirectional relationships between Chinese word reading and oral language skills. We examine, in a 2-year longitudinal study, a wide range of theoretically important predictors (phonological awareness, tone awareness, morphological awareness, visual skills, rapid automatized naming, Pinyin knowledge, and vocabulary knowledge) of reading in 143 primary-school children living in mainland China. Initial levels of reading were predicted by vocabulary knowledge, phonological awareness, and visual discrimination skills. Only initial reading levels predicted growth in reading. Initial reading also predicted growth in vocabulary knowledge and morphological construction. This pattern demonstrates that the early stages of learning to read in Chinese places demands on semantic (vocabulary) and visual skills in addition to phonological skills. Furthermore, early levels of word reading predict the growth of vocabulary knowledge and morphological awareness suggesting that the development of these oral language skills is facilitated by learning to read.

Evaluation of health resource utilization efficiency in community health centers of Jiangsu Province, China.

BACKGROUND: While the demand for health services keep escalating at the grass roots or rural areas of China, a substantial portion of healthcare resources remain stagnant in the more developed cities and this has entrenched health inequity in many parts of China. At its conception, China's Deepen Medical Reform started in 2012 was intended to flush out possible disparities and promote a more equitable and efficient distribution of healthcare resources. Nearly half a decade of this reform, there are uncertainties as to whether the attainment of the objectives of the reform is in sight. METHODS: Using a hybrid of panel data analysis and an augmented data envelopment analysis (DEA), we model human resources, material, finance to determine their technical and scale efficiency to comprehensively evaluate the transverse and longitudinal allocation efficiency of community health resources in Jiangsu Province. RESULTS: We observed that the Deepen Medical Reform in China has led to an increase concern to ensure efficient allocation of community health resources by health policy makers in the province. This has led to greater efficiency in health resource allocation in Jiangsu in general but serious regional or municipal disparities still exist. Using the DEA model, we note that the output from the Community Health Centers does not commensurate with the substantial resources (human resources, materials, and financial) invested in them. We further observe that the case is worst in less-developed Northern parts of Jiangsu Province. CONCLUSIONS: The government of Jiangsu Province could improve the efficiency of health resource allocation by improving the community health service system, rationalizing the allocation of health personnel, optimizing the allocation of material resources, and enhancing the level of health of financial resource allocation.

Towards an equitable healthcare in China: evaluating the productive efficiency of community health centers in Jiangsu Province.

BACKGROUND: While the demand for the health service keeps escalating at the grass root or rural areas of China, a substantial portion of healthcare resources remains stagnant in the more developed cities and this has entrenched health inequity in many parts of China. At its conception, the Deepening Health Care Reform in 2012 China was intended to flush out these discrepancies and promote a more equitable and efficient distribution of health resources. Nearly half a decade of this reform, there are uncertainties as to whether the attainment of the objectives of the reform is in sight. METHODS: We divided Jiangsu Province into 3 zones according to the level of economic and social development i.e. developed, developing, and undeveloped areas. Using a hybrid of Panel data analysis and an augmented Data Envelopment Analysis (DEA), we model human resources, capital inputs of Community Health Centers to comprehensively determine the technical and scale efficiency of community health resources in 3 zones in Jiangsu Province. RESULTS: We sampled data and analysed efficiency and productivity growth of 75 Community Health Centers in 13 cities of Jiangsu Province from 2011 to 2015, which shows that a significant productive growth among Community Health Centers between 2011 and 2015. Mirroring the behavior of Community Health Centers, technological progress was the underlying force for the growth and the deterioration in efficiency change was found. This can be credited partly to the Deepening Health Care Reform measures aimed at improving technology availability in health centers in sub-urban areas. The regional summary of the DEA result shows that the stage of economic development and the efficiency performance of hospital did not necessarily go hand in hand among the 3 zones of Jiangsu. CONCLUSIONS: The government of China in general and Jiangsu province in particular could improve the efficiency of health resources allocation by improving the community health service system, rationalizing the allocation of health personnel, optimizing the allocation of material resources and enhancing the level of health of financial resources allocation.

A novel method for quantitative analysis of acetylacetone and ethyl acetoacetate by fluorine-19 nuclear magnetic spectroscopy.

A new method utilization of NMR spectra was developed for structural and quantitative analysis of enol forms of acetylacetone and ethyl acetoacetate. Acetylacetone and ethyl acetoacetate were determined by (19) F NMR upon derivatisation with р-fluorobenzoyl chloride. The base-catalyzed derivatives of acetylacetone and ethyl acetoacetate reaction with р-fluorobenzoyl chloride were analyzed by (1) H and (13) C NMR spectroscopies. E and Z configurations of acetylacetone and ethyl acetoacetate were separated and purified by thin layer chromatography. In addition, the ability of (19) F NMR for quantitative analysis of acetylacetone by integration of the appropriate signals of the derivatives were tested and compared. The results further testified the enol forms of acetylacetone and ethyl acetoacetate and the feasibility of (19) F NMR method. This method can be potentially used to characterize E and Z isomers and quantitatively analyze E/Z ratio of ß-diketone and ß-ketoester homologues. Copyright © 2015 John Wiley & Sons, Ltd.

Regional inequity in financing New Cooperative Medical Scheme in Jiangsu, China.

This study examined the regional inequity in the New Cooperative Medical Scheme (NCMS) financing in Jiangsu, China. Counties were classified into three categories according to socio-economic development level: South Jiangsu, Middle Jiangsu and North Jiangsu. Five counties (Changshu, Danyang, Gaoyou, Jiangyan and Ganyu) were selected on the basis of the following criteria: (i) NCMS had been implemented before 2005; (ii) county governments were willing and able to collaborate with the research team; and (iii) counties had different socio-economic development status representing the low, medium and high level of socio-economic development in Jiangsu. As shown in this study, local governments in Jiangsu took the major NCMS financing responsibilities (75.2% in 2009), and local governments (county and lower) subsidies ranged from 220 RMB per capita in South Jiangsu to 18 RMB per capita in North Jiangsu in 2009, with a larger contribution (73.3%) in South than that in Middle (40.0%) and North Jiangsu (18.0%). For achieving more equity in NCMS financing and carrying NCMS forward, we propose that provincial and municipal governments should increase their contribution to NCMS for balancing the regional inequity in subsidies from county and lower-level governments, and the risk pool of NCMS should be promoted to a higher level (e.g., provincial).

Perceived discrimination as a mediator between cultural identity and mental health symptoms among racial/ethnic minority adults in the United States: insights from the Health Information National Trends Survey 6.

Objective: This study examined the role of perceived discrimination as a mediator between cultural identity and mental health symptoms among adults from racial/ethnic minority groups in the United States. Methods: Data were gathered from the National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) 6, a nationally representative survey. The mediating role of perceived discrimination was investigated using structural equation modeling (SEM) analysis. Results: The study found significant associations between demographic and lifestyle factors and mental health symptoms. Non-Hispanic Blacks or African Americans and Hispanics were less likely than Non-Hispanic Whites to have mental health symptoms. Individuals between the ages of 35 and 49, 50 to 64, 65 to 74, and 75 and older had lower odds of mental health symptoms. Gender differences revealed that females had a higher risk of mental health issues than males. Socioeconomic factors, such as household income and employment status, played a significant role, with higher household income and employment status being associated with a decreased likelihood of mental health symptoms. The study emphasizes the role of perceived discrimination as a mediator, suggesting that it fully mediated the association between cultural identity and mental health symptoms. These findings highlight the significance of addressing discrimination experiences in fostering the mental health of adults from diverse backgrounds. Conclusion: The findings highlight the need to take racial, ethnic, and socioeconomic inequities, as well as cultural identity and prejudice, into account in mental health research and interventions. The identified risk and protective factors can guide interventions and policies to enhance this population's mental health.

Assessing the effect of health status on multidimensional poverty among older adults: the Chinese longitudinal healthy longevity survey.

Background: This study aimed to explore the association between health status (physical, mental, and self-rated health) and multidimensional poverty (subjective and objective poverty) in older adults. Method: A panel binary logit regression approach was applied to four waves of CLHLS data (2008, 2011, 2014, and 2018). In total,1,445 individuals were included after data cleaning. Results: The mean values and proportion of physical, mental, and self-rated health were 5.73 (87.42%), 0.93 (93.06%), and 3.46 (86.7%), respectively, and mean values and proportion of subjective and objective poverty were 0.19 (18.51%) and 0.21(21.4%). In addition, physical, mental, and self-rated health were all found to be associated with subjective poverty among older adults (r = -0.181, r = -0.630, r = -0.321, p < 0.05), that is, the better the physical, mental, and self-rated health, the lower the probability of subjective poverty. A comparable connection between self-rated health and objective poverty also exists (r = -0.157, p < 0.05). Furthermore, medical expenditure played a mediation role in the association between the health status and poverty of older adults. Conclusion: In order to effectively alleviate the poverty of older adults, strategies should be taken to improve the health level of older adults, especially the physical and mental health of high-aged older adults, and the self-rated health of middle-aged older adults. Furthermore, social security and pensions should be further developed to adequately reimburse medical expenditures.

Reciprocal Effects between Sleep Quality and Life Satisfaction in Older Adults: The Mediating Role of Health Status.

OBJECTIVES: to examine the causal relationship between sleep quality and life satisfaction and explore the mediating role of health status on the relationship between sleep quality and life satisfaction. METHODS: A total of 1856 older Chinese people participating in 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. A cross-lagged panel analysis (CLPA) combined with mediator analysis was utilized. RESULTS: The average sleep quality levels for the years 2011, 2014, and 2018 were 3.70, 3.63, and 3.47 out of 5, respectively. The corresponding average levels of health status were 3.47, 3.44, and 3.39 out of 5, and the average levels of life satisfaction were 3.75, 3.86, and 3.87 out of 5, respectively. In addition, sleep quality at prior assessment points was significantly associated with life quality at subsequent assessments, and vice versa. Also, health status partially mediated this prospective reciprocal relationship. CONCLUSIONS: There is a nonlinear decreased trend in sleep quality and health status, while there exists a nonlinear increased trend in life satisfaction for older adults from 2011 to 2018. Reciprocal positive effects between sleep quality and life satisfaction in older adults exist and are mediated by health status.

Tripartite Evolutionary Game and Simulation Analysis of Healthcare Fraud Supervision under the Government Reward and Punishment Mechanism.

This study aims to provide useful insights for the Chinese government in dealing with healthcare fraud by creating an evolutionary game model that involves hospitals, third-party entities, and the government based on the government reward and punishment mechanism. This paper analyzes the evolutionary stability of each participant's strategy choice, discusses the influence of each element on the tripartite strategy choice, and further analyzes the stability of the equilibrium point in the tripartite game system. The results show that (1) the government increasing fines on hospitals is conducive to compliant hospital operations, and the incentive mechanism has little effect on such operations; (2) the lack of an incentive mechanism for third parties results in false investigations by third parties; and (3) rewards from higher levels of government promote strict supervision by local governments, but that the high cost of supervision and rewards for hospitals inhibits the probability of strict supervision. Finally, Matlab 2020a is used for simulation analysis to provide a reference for the government to improve the supervision of healthcare fraud.