The willingness and influencing factors to choose institutional elder care among rural elderly: an empirical analysis based on the survey data of Shandong Province.

BACKGROUND: The ageing of the population has become an escalating problem in China, which has led to an increasing demand for healthcare throughout society. The care services of elderly institutions, as a more mature way of aging, can alleviate various social problems brought about by ageing to a certain extent. The aim of this paper is to explore the degree of acceptance of institutional care by rural elderly people in Shandong Province and the factors that influence whether rural elderly people accept institutional care services. METHODOLOGY: Based on the theory of planned behavior, an analytical framework was constructed for the willingness of rural elderly people to receive nursing services from elderly care institutions. Using survey data from 192 rural elderly people in Shandong Province, descriptive statistics, binary logistic regression, and horizontal comparative analysis methods were used to analyze the willingness of rural elderly people to provide for the elderly and its influencing factors. RESULT: Only 17.71% of respondents expressed willingness to receive services from elderly care institutions. Among them, education level, trust in elderly care institutions, and support from adult children have a significant positive impact on whether rural elderly people receive nursing services from elderly care institutions; The number of children, the level of understanding of elderly care institutions, neighbors' choices of elderly care methods, and their ability to contribute to the family have a significant negative impact on whether rural elderly people receive nursing services from elderly care institutions. There are significant differences in the willingness and influencing factors of rural elderly people to provide for the elderly among different regions. CONCLUSION: The non-acceptance of institutional care by rural older people is a general phenomenon rather than a sample characteristic, thus justifying the supplementary status of institutional care services. The pension intention of the rural elderly in Shandong Province is obviously affected by personal will factors, and the influencing factors are various. The traditional concept of old-age care in Shandong province has a strong path-dependent effect on the choice of the rural elderly. There is heterogeneity in the willingness and influencing factors of the rural elderly in different regions and countries. Based on this, this paper puts forward the following suggestions: strengthen the spiritual and cultural construction of residents; The government should pay attention to the correct guidance of public opinion; And increase pension subsidies. It is hoped that reduce the burden of national elderly care through these suggestions.

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.

A whole genome scan reveals distinct features of selection in Zhaotong cattle of Yunnan province.

Over the years, indigenous cattle have not only played an essential role in securing primary food sources but have also been utilized for labor by humans, making them invaluable genetic resources. The Zhaotong cattle, a native Chinese breed from the Yunnan province, possess excellent meat quality and resistance to heat and humidity. Here we used whole genome sequencing data of 104 animals to delve into the population structure, genomic diversity and potential positive selection signals in Zhaotong cattle. The findings of this study demonstrate that the genetic composition of Zhaotong cattle was primarily derived from Chinese indicine cattle and East Asian cattle. The nucleotide diversity of Zhaotong cattle was only lower than that of Chinese indicine cattle, which was much higher than that of other taurine cattle. Genome-wide selection scans detected a series of positive candidate regions containing multiple key genes related to bone development and metabolism (CA10, GABRG3, GLDN and NOTUM), meat quality traits (ALG8, LINGO2, MYO5B, PRKG1 and GABRB1), immune response (ADA2, BMF, LEF1 and PAK6) and heat resistance (EIF2AK4 and LEF1). In summary, this study supplies essential genetic insights into the genome diversity within Zhaotong cattle and provides a foundational framework for comprehending the genetic basis of indigenous cattle breeds.

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.

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.

Synthesis and Biological Activities of Novel Pyrazole Carboxamides Containing an Aryloxypyridyl Ethylamine Module.

Pyrazole carboxamide is widely utilized in agricultural crop protection. In this research, we synthesized two classes of compounds, namely, pyrazole-5-carboxamide (4a) and pyrazole-4-carboxamide (4b), which are distinguished by the inclusion of the N-1-(6-aryloxypyridin-3-yl) ethylamine skeleton. This design was inspired by the frequent occurrence of diaryl ether modules in pesticide molecules. The bioassay results revealed that some compounds 4a exhibit higher insecticidal activity (IA) than 4b, while some compounds 4b display stronger fungicidal activity compared to 4a. This suggests that pyrazolyl plays a crucial role in determining the selectivity of these compounds toward different biological species. Notably, compound 4a-14 not only retains the potent activity of tolfenpyrad, the exact lead compound of 4a, against Lepidoptera pest Plutella xylostella and Thysanoptera pest Frankliniella occidentalis but also shows excellent IA against pests with piercing-sucking mouthparts, such as Aphis craccivora Koch and Nilaparvata lugens. This research has important implications for the control of pests with piercing-sucking mouthparts and the development of new insecticides and fungicides. The findings highlight the potential of inhibitory complex I as an effective control target for these pests, particularly those that have developed resistance to traditional insecticides. Additionally, it sheds light on the binding mode of 4b-11 and complex II, which serves as a negative reference for the design of SDHI fungicides. The study emphasizes the significance of pyrazolyl in determining selectivity in biological species and identifies avenues for future research in enhancing the biological activity of amino modules. The discovery of (S)-4a-14 not only presents a promising candidate compound for pesticide development but also provides valuable insights into the inhibitory effect of a respiratory chain complex on piercing-sucking insect pests. These findings have important implications in both theory and practice, offering new directions for pest control strategies and pesticide and fungicide development.

On the momentum toward vaccine self-sufficiency in the BRICS: an integrative review of the role of pharmaceutical entrepreneurship and innovation.

Background: With the perspicuous effect of COVID-19 on vaccine demand, academic and business interest in vaccine production in the BRICS nations (Brazil, the Russian Federation, India, China, and South Africa) has reached a crescendo. Aware of a "dark" past when the BRICS depended heavily on vaccines and pharmaceuticals from other parts of the world, academic curiosity on how the BRICS countries have leveraged vaccine self-sufficiency and become the hub of global vaccine production and supply is justifiable, especially in times of ineffable pandemics. Methods: The articles were searched from November 2020 to December 2022. Within this period, an electronic search of 13 reputable healthcare and public databases was conducted. The initial searches from the designated databases yielded a total of 3,928 articles. Then, duplicated studies were removed through a two-step process, articles without titles and abstracts were excluded, and the remaining 898 articles that met the qualification assessment criteria were evaluated for article quality. Results: The main entrepreneurial innovations that have quickened the pace of vaccine self-sufficiency in the BRICS include investment in artificial intelligence (AI), Big Data Analytics, and Blockchain technologies. These help to speed up the drug delivery process by enhancing patient identification or optimizing potential drug candidates for clinical trials and production. Conclusion: Over the past 20 years, the BRICS nations have achieved major strides in vaccine development, regulation, and production. The creation of the BRICS Vaccine Research and Development (R&D) Center will have a significant impact on vaccine cost and accessibility given the anticipated development of stronger research capability, production, and distribution technology, as well as stronger standardization to improve vaccine production quality in the near future. It is anticipated that the BRICS' contributions to vaccine development will alter the global vaccination market and hasten the availability of vaccinations in developing nations. The challenge is turning these hopes into concrete plans of action and outcomes.

Detection of colonization capacity of probiotic Bifidobacterium breve CCFM1025 in the human gut.

Aim: To detect the gut colonization capacity of Bifidobacterium breve CCFM1025 with clinical antidepressant-like effects. Materials & methods: A unique gene sequence of B. breve CCFM1025 was discovered based on the genome analysis of 104 B. breve strains and a strain-specific primer (1025T5) was designed. In vitro and in vivo samples were used to validate the specificity and quantitative capability of this primer in the PCR system. Results: Quantitative PCR using strain-specific primers enabled absolute quantification of CCFM1025 in fecal samples within 104-1010 cells/g (R2 >0.99). CCFM1025 remained highly detectable in volunteer feces 14 days after cessation of administration, demonstrating its favorable colonization characteristics. Conclusion: CCFM1025 can colonize the healthy human gut.

Role demands and turnover intention among Covid-19 frontline nurses: The mediating and moderating roles of compassion fatigue and spiritual leadership.

The working conditions created by the Covid-19 pandemic have been proven to amplify frontline nurses' desire to leave their profession in recent years; thus, exploring new causing variables is vital. This cross-sectional study examined role demands' direct and indirect effects on turnover intention through compassion fatigue and tested the various dimensions of spiritual leadership as moderators on the relationship between compassion fatigue and turnover intention. A total of 527 valid responses were collected from frontline nurses working in designated hospitals across Zhejiang province in China using a survey questionnaire. The outcomes from the hierarchical regression analysis indicated that role demands positively and significantly impacted turnover intention and compassion fatigue. Besides, compassion fatigue significantly and positively affected turnover intention and mediated its relationship with role demands. However, vision and altruistic love moderated the relationship between compassion fatigue and turnover intention, which was not true for the dimension hope/faith. This study's findings are a steppingstone for medical firms' managers and policymakers in demonstrating the likelihood of frontline nurses developing turnover thoughts arising from ambiguous and conflicting roles and the emotional strain from patients' burdens. Furthermore, an exemplary implementation of spiritual leadership could help enhance nurses' sense of calling and membership, essential in embracing the organization's vision and achieving its goals.

Social Capital and the Realization of Mutual Assistance for the Elderly in Rural Areas-Based on the Intermediary Role of Psychological Capital.

BACKGROUND: Mutual assistance for the elderly is a new pension model that has been widely valued and discussed in China, especially in rural areas. The social and psychological capital owned by the elderly in rural areas promotes their participation and affects the realization of mutual assistance for the elderly. Based on this, this paper proposes the following hypotheses: H1: Bonding social capital positively affects the realization of mutual assistance for the elderly in rural areas; H2: bridging social capital positively affects the realization of mutual assistance for the elderly in rural areas; H3: linking social capital positively affects the realization of mutual assistance for the elderly in rural areas; and H4: psychological capital plays an intermediary role in the process of social capital influencing the realization of mutual assistance for the elderly in rural areas. The empirical research is carried out around these hypotheses. METHODS: In this paper, the 2019 China General Survey of Social Conditions (CSS) database was used as the data source for empirical analysis. Social capital can be divided into bonding social capital, bridging social capital, and linking social capital, while psychological capital can be divided into four dimensions: self-efficacy, optimism, hope, and resilience. Our evaluation was performed using LOGIT regression analysis with STATA16 software. First, the correlation of social capital to the realization of mutual assistance for the elderly in rural areas was verified. Next, the mediation effect was verified using the KHB regression method, and the influence of psychological capital as an intermediary variable on the realization of mutual assistance for the elderly in rural areas was demonstrated. RESULTS: Social capital had a significant positive effect on mutual assistance for the elderly in rural areas. Psychological capital played an intermediary role in the relationship between the three types of social capital and rural mutual assistance for the elderly. Among the four dimensions of psychological capital, self-efficacy, optimism, and tenacity played a partial mediating role in the relationship between social capital and mutual assistance for the elderly in rural areas, while the mediating role of hope was not significant. CONCLUSIONS: (1) All three types of social capital have a significant promoting effect on the realization of mutual assistance for the elderly in rural areas, among which bridging social capital has the most significant effect. (2) Psychological capital plays a partial mediating role in the three kinds of social capital's influence on the realization of mutual assistance for the elderly in rural areas, and the intermediary role is the strongest in the effect of linking social capital on the realization of mutual assistance for the elderly in rural areas, but the overall effect is not high. (3) Among the four dimensions of psychological capital, self-efficacy, optimism, and tenacity all have certain intermediary effects, but the intermediary effect of hope is not significant. (4) There are significant gender and regional differences in the impact of social capital and psychological capital on the realization of mutual assistance for the elderly in rural areas.

An Emerging Market: The Impact of User Selection on the Decision-Making Behavior of Mobile Medical Businesses in China.

Background: User selection is an important guarantee for the sustainable development of mobile medical businesses. Under the background of increasingly fierce competition, the decision-making behavior of mobile medical businesses will directly affect the choice of the behavior of users. Methods: The study constructs the decision-making behavior model of mobile medical business based on the user choice and adds the role of people in government. It uses the game method to explore the relationship between the government, mobile medical business, and users. Finally, it makes an example analysis. Empirical research is conducted to demonstrate the influence of different parameter changes on the results. Results: The results show that in the absence of government intervention, users' choice of filtering information will create a bad environment for mobile medical businesses, and further will be reduced, and the expected utility of businesses will not be affected causing a reduction in expected utility of companies. Similarly, government regulations can effectively improve the mobile medical environment and enhance the expected utility of mobile medical companies. Conclusion: The government needs to formulate relevant laws and regulations to ensure the orderly operation of the mobile medical market and strengthen government supervision. It is necessary to conduct publicity and education to protect the fundamental interests of users and businesses.

A Study on Epidemic Information Screening, Prevention and Control of Public Opinion Based on Health and Medical Big Data: A Case Study of COVID-19.

The outbreak of the coronavirus disease 2019 (COVID-19) represents an alert for epidemic prevention and control in public health. Offline anti-epidemic work is the main battlefield of epidemic prevention and control. However, online epidemic information prevention and control cannot be ignored. The aim of this study was to identify reliable information sources and false epidemic information, as well as early warnings of public opinion about epidemic information that may affect social stability and endanger the people's lives and property. Based on the analysis of health and medical big data, epidemic information screening and public opinion prevention and control research were decomposed into two modules. Eight characteristics were extracted from the four levels of coarse granularity, fine granularity, emotional tendency, and publisher behavior, and another regulatory feature was added, to build a false epidemic information identification model. Five early warning indicators of public opinion were selected from the macro level and the micro level to construct the early warning model of public opinion about epidemic information. Finally, an empirical analysis on COVID-19 information was conducted using big data analysis technology.

A study on the impact and buffer path of the internet use gap on population health: Latent category analysis and mediating effect analysis.

Background: The development of Internet information technology will generate an Internet use gap, which will have certain adverse effects on health, but internet information dependence can alleviate these negative effects. Objective: This article is to demonstrate the negative impact of the internet use gap on population health in developing countries and to propose improvement paths. Methods: This article used the 2018 China Family Tracking Survey database (N = 11086). The research first used Latent class analysis (LCA) to identify potential categories of users with different Internet usage situations, then used the Bolck, Croon, and Hagenaars (BCH) method to perform latent class modeling with a continuous distal outcome, and finally built an intermediary model about Internet information dependence based on the model constraint function in Mplus software. Results: (1) The Internet users can be divided into light-life users (C1: N = 1,061, 9.57%), all-around users (N = 1,980, 17.86%(C2: N = 1,980, 17.86%), functional users (C3: N = 1,239, 11.18%), and pure-life users (C4: N = 6,806, 61.39%). (2) We examined individual characteristics, social characteristics and different living habits, and health differences between the latent classes. For example, there are certain structural differences on the effect of different categories of Internet use on health (C1: M = 3.089, SE = 0.040; C2: M = 3.151, SE = 0.037; C3: M = 3.070, SE = 0.035; C4: M = 2.948, SE = 0.016; P < 0.001). (3) The Internet use gap can affect health through the indirect path of Internet information dependence, and some of the mediation effects are significant. When the functional user group (C3) was taken as the reference group, the mediating effect values of light-life users (C1) and all-around users (C4) on health were -0.050 (SE = 0.18, Est./SE = -3.264, P = 0.001) and -0.080 (SE = 0.010, Est./SE = -8.412, P = 0.000) through Internet information dependence, respectively. However, the effect of categories on health was not significant after adding indirect paths. Conclusion: The Internet use gap has a significant effect on health, and Internet information dependence plays an intermediary role in this effect path. The study proposes that attention should be paid to the diversified development of Internet use, the positive guiding function of Internet information channels should be made good use of, and the countermeasures and suggestions of marginalized groups in the digital age should also be paid attention to and protected.

Media attention and Vaccine Hesitancy: Examining the mediating effects of Fear of COVID-19 and the moderating role of Trust in leadership.

Vaccination has emerged as the most cost-effective public health strategy for maintaining population health, with various social and economic benefits. These vaccines, however, cannot be effective without widespread acceptance. The present study examines the effect of media attention on COVID-19 vaccine hesitancy by incorporating fear of COVID-19 as a mediator, whereas trust in leadership served as a moderator. An analytical cross-sectional study is performed among rural folks in the Wassa Amenfi Central of Ghana. Using a questionnaire survey, we were able to collect 3079 valid responses. The Smart PLS was used to estimate the relationship among the variables. The results revealed that media attention had a significant influence on vaccine hesitancy. Furthermore, the results showed that fear of COVID-19 played a significant mediating role in the relationship between media and vaccine hesitancy. However, trust in leadership had an insignificant moderating relationship on the fear of COVID-19 and vaccine hesitancy. The study suggests that the health management team can reduce vaccine hesitancy if they focus on lessening the negative impact of media and other antecedents like fear on trust in leadership.

Towards an Integrated Healthcare System: Evolutionary Game Analysis on Competition and Cooperation Between Urban and Rural Medical Institutions in China.

Background: The game of interest is the root cause of the non-cooperative competition between urban and rural medical and health institutions. The study investigates competition and cooperation among urban and rural medical institutions using the evolutionary game analysis. Methods: With the evolutionary game model, analysis of the stable evolutionary strategies between the urban and rural medical and health facilities is carried out. A numerical simulation is performed to demonstrate the influence of various values. Results: The result shows that the cooperation mechanism between urban and rural medical Institutions is relevant to the efficiency of rural medical institutions, government supervision, reward, and punishment mechanism. Conclusions: Suggestions for utilizing the government's macro regulation and control capabilities, resolving conflicts of interest between urban and rural medical and health institutions is recommended. In addition, the study again advocates mobilizing the internal power of medical institutions' cooperation to promote collaboration between urban and rural medical and health institutions.

COVID-19: The effects of perceived organizational justice, job engagement, and perceived job alternatives on turnover intention among frontline nurses.

Nurses' turnover intention has become a concern for medical institutions because nurses are more needed than ever under the prevalence of COVID-19. This research sought to investigate the effects of the four dimensions of organizational justice on COVID-19 frontline nurses' turnover intention through the mediating role of job engagement. We also tested the extent to which perceived job alternatives could moderate the relationship between job engagement and turnover intention. This descriptive cross-sectional study used an online survey to collect data from 650 frontline nurses working in appointed hospitals in Jiangsu province, China. Hierarchical regression was used to analyze the hypothesized relationships. Findings revealed that all organizational justice components significantly influenced job engagement and turnover intention. Job engagement also significantly affected nurses' turnover intention and mediated the relationships between organizational justice components and turnover intention. Besides, perceived job alternatives moderated the relationships between job engagement and turnover intention. The implications of this study include demonstrating that healthcare authorities should respect human rights through effective organizational justice as this approach could encourage nurses to appreciate their job and be more devoted to staying and achieving their institutional duties, especially under challenging circumstances.