Understanding the impact of chronic diseases on COVID-19 vaccine hesitancy using propensity score matching: Internet-based cross-sectional study.

AIMS AND OBJECTIVES: To investigate whether chronic diseases are associated with higher COVID-19 vaccine hesitancy and explore factors that influence COVID-19 vaccine hesitancy in patients with chronic diseases. BACKGROUND: Vaccine hesitancy has been acknowledged as one of the greatest hazards to public health. However, little information is available about COVID-19 vaccine hesitancy among patients with chronic diseases who may be more susceptible to COVID-19 infection, severe disease or death. METHODS: From 6 to 9 August 2021, we performed an internet-based cross-sectional survey with 22,954 participants (14.78% participants with chronic diseases). Propensity score matching with 1:1 nearest neighbourhood was used to reduce confounding factors between patients with chronic diseases and the general population. Using a multivariable logistic regression model, the factors impacting COVID-19 vaccine hesitancy were identified among patients with chronic diseases. RESULTS: Both before and after propensity score matching, patients with chronic diseases had higher COVID-19 vaccine hesitancy than the general population. In addition, self-reported poor health, multiple chronic diseases, lower sociodemographic backgrounds and lower trust in nurses and doctors were associated with COVID-19 vaccine hesitancy among patients with chronic diseases. CONCLUSIONS: Patients with chronic diseases were more hesitant about the COVID-19 vaccine. Nurses should focus on patients with chronic diseases with poor health conditions, low socioeconomic backgrounds and low trust in the healthcare system. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses are recommended to not only pay more attention to the health status and sociodemographic characteristics of patients with chronic diseases but also build trust between nurses and patients by improving service levels and professional capabilities in clinical practice. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in setting the research question, the outcome measures, or the design or implementation of the study. However, all participants were invited to complete the digital informed consent and questionnaires.

Inflammatory response in lungs and extrapulmonary sites detected by [18F] fluorodeoxyglucose PET/CT in convalescing COVID-19 patients tested negative for coronavirus.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in an ongoing global pandemic of coronavirus disease 2019 (COVID-19). The challenges associated with imaging infected patients have resulted, to date, in a paucity of metabolic imaging studies of patients with severe COVID-19 infection. Furthermore, it remains unclear if any abnormal metabolic events are taking place in patients who have recovered from COVID-19. PURPOSE: To use [18F] fluorodeoxyglucose ([18F] FDG) positron emission tomography/computed tomography (PET/CT) to measure metabolic activity in inflamed organs of patients convalescing post severe COVID-19 infection. MATERIALS AND METHODS: A prospective study was performed in seven convalescing patients who were recovering from severe COVID-19 infection in February 2020. Prior to [18F] FDG PET/CT, all patients had received two consecutive negative results of real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acid. Clinical intake including symptoms, treatment, laboratory test results, and follow-up was performed. The PET/CT images of COVID-19 patients were compared to a control group of patients that were matched for age and sex. RESULTS: Residual pulmonary lesions were present in all patients and maximum standard uptake value (SUVmax), average standard uptake value (SUVavg), maximum CT intensity (CTmax), and average CT intensity (CTavg) were all significantly greater than in the control group (p < 0.01 for all). In addition, SUVmax and SUVavg were significantly greater in the mediastinal lymph node and liver, and SUVmax was significantly greater in the spleen, of COVID-19 patients compared with controls (p < 0.05 for all). For the spleen, SUVmax (r2 = 0.863, p = 0.003) and SUVavg (r2 = 0.797, p = 0.007) were significantly correlated with blood lymphocyte count, and which was below the normal range in five of the seven (71.4%) patients convalescing post severe COVID-19 infection. CONCLUSION: [18F] FDG PET/CT quantitative analysis has shown that significant inflammation remained in lungs, mediastinal lymph nodes, spleen, and liver after two consecutive negative RT-PCR tests in patients convalescing post severe COVID-19 infection.

Prioritizing the perceived equity of the residents to construct an equitable health care system: evidence from a national cross-sectional study in China.

BACKGROUND: Building an equitable health care system involves both the promotion of social justice in health and people's subjective perception of the promotion. This study aimed to analyze the overall status and associated factors of the perceived equity of the Chinese health care system, and then to offer policy recommendations for health care reform. METHODS: Information on the perceived equity score (scale 0 to 10) of 10,243 valid cases in total were derived from the data set of Chinese Social Survey 2015. Univariate analysis methods were applied to present respondents' overall perceived equity of the Chinese health care system. Multivariate linear regression method was used to explore the associated factors of the perceived equity and examine their independent effect. RESULTS: The respondents gave positive but relatively low marks (6.7 ± 2.6, 95% CI: = 6.64~6.74) of the equity of the Chinese health care system. Younger respondents reported a higher score of perceived equity than their elder counterparts (ß = - 0.132, 95% CI: - 0.203~ - 0.062, P < 0.001). Respondents with lower education level were significantly more likely to consider the Chinese health care system equitable (ß = - 0.104, 95% CI: - 0.153~ - 0.056, P < 0.001). Respondents satisfied with the Social Health Insurance reimbursement ratio tended to score the system higher in the survey (ß = 0.044, 95% CI: 0.024~0.063, P < 0.001). Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (ß = - 0.268, 95% CI: - 0.338~ - 0.199, P < 0.001). Meanwhile, rural respondents reported higher scores of the perceived equity than urban respondents did (ß = 0.348, 95% CI: 0.237~0.458, P < 0.001). Respondents from regions with adequate GPs scored the system higher in this survey (ß = 0.087, 95% CI: 0.008~0.165, P < 0.001). The present study found no influence of gender, economic status, Social Health Insurance coverage, or satisfaction with the latest treatment on perceived equity. CONCLUSIONS: Eliminating the sense of inequity among a range of populations should be prioritized in health care reform. A national-level investigation system to rate residents' perceived equity was necessary for global health care reform.

Improving the performance of social health insurance system through increasing outpatient expenditure reimbursement ratio: a quasi-experimental evaluation study from rural China.

BACKGROUND: China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance. METHODS: Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes. RESULTS: One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (- 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (- 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (- 44.0%) yuan and 192.3 (- 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (- 36.7%) yuan and 201.9 (- 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (- 7.9 mmHg, P > 0.05). CONCLUSION: For China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.

Seasonal association between ambient ozone and mortality in Zhengzhou, China.

Different seasonal health effects of ambient ozone (O3) have been reported in previous studies. This might be due to inappropriate adjustment of temperature in different seasons. We used daily data on non-accidental mortality and ambient air pollution in Zhengzhou from January 19, 2013 to June 30, 2015. Season-stratified analyses using generalized additive models were conducted to evaluate the seasonal associations with adjustment of temperature with different lagged days (lag0-1 for warm season, lag0-14 for cold season). We recorded a total of 70,443 non-accidental deaths in Zhengzhou during the study period. Significant associations were observed between ambient O3 and mortality in cold season. Every 10-µg/m3 increment of 24-h O3 of 1-day lagged time was associated with a 1.38% (95% CI 0.60, 2.16%) increase in all cause mortality, 1.35% (95% CI 0.41, 2.30%) increase in cardiovascular mortality, and 1.78% (95% CI 0.43, 3.14%) increase in respiratory mortality. Similar associations were observed when using daily 1- and 8-h maximum concentrations of O3. No significant association was found during warm season. This study suggests a more pronounced ozone-mortality association in cold season in Zhengzhou, and we suggest that different lagged temperatures should be considered when examining the seasonal health effects of ambient ozone.

Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study.

BACKGROUND: COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult. OBJECTIVE: This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations. METHODS: The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models. RESULTS: Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy. CONCLUSIONS: The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy.

The pattern from the first three rounds of vaccination: declining vaccination rates.

Introduction: Vaccination rates for the COVID-19 vaccine have recently been stagnant worldwide. We aim to analyze the potential patterns of vaccination development from the first three doses to reveal the possible trends of the next round of vaccination and further explore the factors influencing vaccination in the selected populations. Methods: On July 2022, a stratified multistage random sampling method in the survey was conducted to select 6,781 people from 4 provinces China, who were above the age of 18 years. Participants were divided into two groups based on whether they had a chronic disease. The data were run through Cochran-Armitage trend test and multivariable regression analyses. Results: A total of 957 participants with chronic disease and 5,454 participants without chronic disease were included in this survey. Vaccination rates for the first, second and booster doses in chronic disease population were93.70% (95% CI: 92.19-95.27%), 91.12% (95%CI: 94.43-95.59%), and 83.18% (95%CI: 80.80-85.55%) respectively. By contrast, the first, second and booster vaccination rates for the general population were 98.02% (95% CI: 97.65-98.39%), 95.01% (95% CI: 94.43-95.59%) and 85.06% (95% CI: 84.11-86.00%) respectively. The widening gap in vaccination rates was observed as the number of vaccinations increases. Higher self-efficacy was a significant factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education level, middle level physical activity and higher public prevention measures play a positive role in vaccination among the general population, while alcohol consumption acts as a significant positive factor in the chronic disease population (p < 0.05). Conclusion: As the number of vaccinations increases, the trend of decreasing vaccination rate is becoming more pronounced. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and the fatigue associated with the prolonged outbreak hamper vaccination. Measures need to be found to counter this downward trend such as improving the self-efficacy of the population.

How urban versus rural residency relates to COVID-19 vaccine hesitancy: A large-scale national Chinese study.

RATIONALE: Although urban-rural residency has been shown to influence individual COVID-19 vaccine hesitancy, the differences between urban and rural China have yet to be uncovered. OBJECTIVE: This study aims to assess the current prevalence and factors associated with COVID-19 vaccine hesitancy in urban and rural areas and explore whether the rural versus urban residency is associated with COVID-19 vaccine hesitancy. METHODS: A national, cross-sectional, online survey among Chinese urban and rural adults (≥18 years old) was conducted from 6th to August 9, 2021. A questionnaire was used to collect data on sociodemographic factors, perceptions of the COVID-19 pandemic and vaccination status. A multivariable logistic regression model was used to identify the factors that influence COVID-19 vaccine hesitancy. Propensity score matching (PSM) analysis was performed to explore the association between urban versus rural residency and COVID-19 vaccine hesitancy. RESULTS: In total, 29,925 participants (80.56% urban participants) were recruited. Urban participants had a higher COVID-19 vaccine hesitancy than their rural counterparts (9.39% vs. 4.26%). After adjusting for potential confounders, we found that COVID-19 vaccine hesitancy among females was lower than that in males in both urban (aOR = 0.78, 95% CI [0.69-0.88]) and rural areas (aOR = 0.54, 95% CI [0.39-0.75]). The lack of trust towards vaccine producers was found to be associated with vaccine hesitancy among the urban participants (aOR = 2.76, 95% CI [2.22-3.43]). The rural floating population had a lower COVID-19 vaccine hesitancy than the rural permanent residents (aOR = 0.58, 95% CI [0.42-0.80]). PSM analysis revealed a 2.38% difference in COVID-19 vaccine hesitancy between urban and rural participants. CONCLUSIONS: Urban participants were more hesitant to receive the COVID-19 vaccine than rural participants. Priority should be placed on boosting confidence in the healthcare system to reduce COVID-19 vaccine hesitancy among urban residents. Furthermore, we advocate for extra incentives and vaccination education for rural permanent residents.

The Psychological Experience of COVID-19 Vaccination and Its Impact on the Willingness to Receive Booster Vaccines among the Chinese Population: Evidence from a National Cross-Sectional Study.

The purpose of this study was to assess the psychological experience of COVID-19 basic vaccination, the willingness to receive booster vaccines, and to determine their relationships among Chinese people. Between 6 August 2021 and 9 August 2021, a research firm performed a national cross-sectional online survey among Chinese individuals (aged over 18), using the snowball sampling approach, with 26,755 participants. Factor analysis and binary logistic regression were used to evaluate the existing associations. The overall COVID-19 vaccination psychological experience score of the participants was 25.83 (25.78~25.89; scores ranged from 7-35). A total of 93.83% (95%CI = 93.54~94.12) of respondents indicated a willingness to receive booster vaccines. After classifying psychological experiences associated with COVID-19 vaccination into positive and negative experiences and adjusting for confounding factors, for the former, the willingness to receive booster vaccines for participants with the highest scores of 13-15 was 3.933 times higher (OR = 3.933, 95%CI = 3.176~4.871) than participants who obtained scores of 3-9, and for the latter, the willingness to receive booster vaccines for participants with the highest scores of 19-20 was 8.871 times higher (OR = 8.871, 95%CI = 6.240~12.612) than participants who obtained scores of 4-13. Our study suggests that a good psychological experience with vaccination is positively associated with an increased willingness to receive booster vaccines.

Guardians' willingness to vaccinate their teenagers against COVID-19 in China: A national cross-sectional survey.

OBJECTIVE: To investigate Chinese guardians' willingness to vaccinate teenagers (WVT) against COVID-19, we conducted a national wide survey in 31 provinces in mainland China. METHODS: We involved 16133 guardians from 31 provinces in Chinese Mainland from August 6th to 9th, 2021. The question "Are you willing to vaccinate teenagers of COVID-19 vaccine?" was designed to capture WVT. Odds ratios (OR) with 95% Confidence Intervals (CI) for potential factors of WVT were estimated using multiple logistic regression models. RESULTS: In total, 13327 (82.61%) of the respondents expressed positive WVT, 12.90% of the respondents were uncertain but inclined to vaccinate their teenagers. Meanwhile, 3.89% of the respondents were uncertain and inclined to reject, and 0.60% of the respondents rejected the vaccines. After adjusting for potential confounders, the married, total family income last year, reject to Categoly1 vaccines, access information about the COVID-19 vaccines from community workers, low COVID-19 vaccine conspiracy, guardian's vaccination behavior, and the importance of vaccinating teenagers were all independent factors that affected the guardians' likely to accept. Further, the current study found that lower trust in doctors and vaccine developers was associated with negative WVT. The reasons for negative WVT included teenagers' young age and guardians' worries on the safety and effectiveness of COVID-19 vaccines. CONCLUSION: This large-scale study assessed Chinese guardians' WVT against COVID-19, as well as its potential influencing factors, which is useful for international and national decision-makers.

The association between lifestyle and COVID-19 vaccine hesitancy in China: A large-scale cross-sectional survey.

OBJECTIVE: To assess the association between lifestyle and COVID-19 vaccine hesitancy among Chinese adults and provide recommendations for increasing vaccination rates. METHODS: From August 6, 2021 to August 9, 2021, we recruited 29,925 participants from 31 Chinese provinces via an online questionnaire. We designed a question to assess COVID-19 vaccine hesitancy and used 16 items to assess lifestyle by calculating lifestyle scores. Odds ratios (OR) with 95 % confidence intervals (CI) were used to estimate the association by using binary logistic regression models. RESULTS: The overall prevalence of COVID-19 vaccine hesitancy was 8.40 % (95 % CI: 8.09-8.72), and the median lifestyle score was 65.00 (interquartile range: 59.00-71.00). After adjusting for potential confounders, the COVID-19 vaccine hesitancy rate decreased significantly with an increase in lifestyle score (P for Trend <0.001). Low COVID-19 vaccine hesitancy rate was associated with lifestyle factors including adequate sleep, never smoking, intermittent drinking, good relationships, working and studying, using hand sanitizer, wearing masks, less gathering activities, and keeping social distance (P < 0.05). CONCLUSION: Our findings indicate that high lifestyle score is associated with low vaccine hesitancy rate among Chinese. The government should view the smokers (or the drinkers) as the key to further boosting the vaccination rate. In addition, the publicity and education about wearing masks and keeping social distance should be prioritized.

COVID-19 Vaccination Acceptance Among Chinese Population and Its Implications for the Pandemic: A National Cross-Sectional Study.

Objective: To examine the COVID-19 vaccination rate among a representative sample of adults from 31 provinces on the Chinese mainland and identify its influencing factors. Methods: We gathered sociodemographic information, data on people's awareness and behavior regarding COVID-19 and the COVID-19 vaccine, the accessibility of COVID-19 vaccination services, community environmental factors influencing people's awareness and behavior regarding the vaccination, information about people's skepticism on COVID-19 vaccine, and information about people's trust in doctors as well as vaccine developers through an online nationwide cross-sectional survey among Chinese adults (18 years and older). The odds ratios (OR) and 95% confidence intervals (CI) for the statistical associations were estimated using logistic regression models. Results: A total of 29,925 participants (51.4% females and 48.6% males) responded. 89.4% of the participants had already received a COVID-19 vaccination. After adjusting for demographic characteristics, awareness of COVID-19 pandemic/ COVID-19 vaccine, community environmental factors, awareness and behavior of general vaccinations, we discovered that having no religious affiliation, having the same occupational status as a result of coronavirus epidemic, being a non-smoker, always engaging in physical activity, having a lower social status, perceiving COVID-19 to be easily curable, and having easier access to vaccination are all associated with high vaccination rate (all P <0.05). Conclusions: 31 provinces in mainland China currently have a relatively high rate of COVID-19 vaccination. To further increase the rate of COVID-19 vaccination, we must remove barriers associated with the community context and improve access to COVID-19 vaccine services. In addition, taking proactive and effective measures to address the reasons for non-vaccination with COVID-19 will aid in epidemic prevention and control.

Association between lifestyle and COVID-19 vaccination: A national cross-sectional study.

Objective: To assess lifestyles, COVID-19 vaccination coverage rates, and the relationships between lifestyles and COVID-19 vaccination among Chinese population. Methods: We collected data on sociodemographics, perception of the COVID-19 pandemic, lifestyles, and self-reported COVID-19 vaccination via an online survey in China. The chi-square goodness-of-fit test was used to monitor sample saturation throughout the formal online survey. The binary logistic regression analyses were conducted to examine the association between COVID-19 vaccination rate and lifestyle score. We assigned values to 12 lifestyles ranging from positive to negative, with positive lifestyles receiving a higher score and negative lifestyles receiving a lower score, ranging from 1 to 5. For each participant, the total lifestyle scored from 12 to 56. Restricted cubic spline (RCS) was used to visualize the trends and correlations between lifestyle score and COVID-19 vaccination coverage. Propensity score matching (PSM) was used to explore the association between specific lifestyles and COVID-19 vaccination. Results: A total of 29,925 participants (51.4% females) responded. The lifestyle score of the sample was 44.60 ± 6.13 (scoring range: 12-56). COVID-19 vaccination rate was found to be 89.4% (89.1-89.8%). Female participants reported a higher vaccination rate than male participants (91.5 vs. 87.1%). Compared to Q1, COVID-19 vaccination coverage rates increased with lifestyle total scores [OR Q2 = 1.901 (1.718-2.103), P < 0.001; OR Q3 = 2.373 (2.099-2.684), P < 0.001; and OR Q4 = 3.765 (3.209-4.417), P < 0.001]. After applying PSM, it was determined that all the 12 specific healthy lifestyles analyzed, including maintaining a healthy body weight, a healthy diet, regular physical exercises, adequate sleep, regular physical examination, and others, were found to be positive factors for COVID-19 vaccination. Conclusion: The majority of mainland Chinese lived a healthy lifestyle throughout the COVID-19 pandemic, and the rate of COVID-19 vaccination was high. Specific healthy lifestyles contributed to COVID-19 vaccination coverage rates significantly. According to the study's findings, global efforts to achieve herd immunity should be prioritized by continually promoting healthy lifestyles and improving public perception of COVID-19 vaccines.

Multimorbidity in Hospitalized Patients Admitted to General Practice Departments and Its Implications for the General Practice Healthcare System: A Four-Year Longitudinal Study in China.

Objective: China and many developing countries has placed high expectations on the general practice healthcare system in terms of lowering medical costs and improving the health status of the multimorbid population in recent years. However, the prevalence of multimorbidity among inpatients attending the general practice department of hospitals and its policy implications are largely unknown. The current study aimed to analyze the prevalence of comorbidities among inpatients attending the general practice department of the tertiary Grade-A Hospitals in China, and put forward evidence-based policy recommendations. Methods: Between December 2016 and November 2020, 351 registered general practitioners from 27 tertiary hospitals were selected, and their direct admissions were evaluated. The rate and composition ratio were used for descriptive analysis of the clinical and epidemiological characteristics of multimorbidity. A backward stepwise algorithm was used to explore independent variables. The absence of multicollinearity and plausible interactions among variables were tested to ensure the robustness of the logistic regression model. The pyramid diagram was used to show the link between gender and the involved human body system in multimorbidity. Results: Multimorbidity was present in 93.1% of the 64, 395 patients who were admitted directly. Multimorbidity was significantly more prevalent in patients aged 45-59 years (OR=3.018, 95% CI=1.945-4.683), 60-74 years (OR = 4.349, 95% CI = 2.574-7.349), ≥75 years (OR = 7.804, 95% CI = 3.665-16.616), and those with body mass index (BMI) ≥ 28 kg/m2 (OR = 3.770, 95% CI = 1.453-9.785). The circulatory system was found to be the most commonly involved human body system in multimorbidity, accounting for 79.2% (95% CI = 78.8-79.5%) of all cases. Significant gender inequity was further observed in the involved human body system in multimorbidity. Conclusion: Multimorbidity is likely common among the inpatients attending the general practice department of hospitals in China and many developing countries, with significant gender inequity in the involved human body systems. Effective countermeasures include establishing a GP-PCIC multimorbidity prevention and control model and enhancing the multimorbidity of elderly and obese patients at both the clinical and healthy lifestyle levels. The diagnosis and treatment capabilities of GPs on the circulatory, endocrine, metabolic, digestive, and respiratory systems should be prioritized.

COVID-19 Vaccine Hesitancy Among Chinese Population: A Large-Scale National Study.

Globally, vaccine hesitancy is a growing public health problem. It is detrimental to the consolidation of immunization program achievements and elimination of vaccine-targeted diseases. The objective of this study was to estimate the prevalence of COVID-19 vaccine hesitancy in China and explore its contributing factors. A national cross-sectional online survey among Chinese adults (≥18 years old) was conducted between August 6, 2021 and August 9 via a market research company. We collected sociodemographic information; lifestyle behavior; quality of life; the knowledge, awareness, and behavior of COVID-19; the knowledge, awareness, and behavior of COVID-19 vaccine; willingness of COVID-19 vaccination; accessibility of COVID-19 vaccination services; skepticism about COVID-19 and COVID-19 vaccine; doctor and vaccine developer scale; and so on. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the associations by using logistic regression models. A total of 29,925 residents (48.64% men) were enrolled in our study with mean age of 30.99 years. We found an overall prevalence of COVID-19 vaccine hesitancy at 8.40% (95% CI, 8.09-8.72) in primary vaccination and 8.39% (95% CI, 8.07-8.70) in booster vaccination. In addition, after adjusting for potential confounders, we found that women, higher educational level, married residents, higher score of health condition, never smoked, increased washing hands, increased wearing mask, increased social distance, lower level of vaccine conspiracy beliefs, disease risks outweigh vaccine risk, higher level of convenient vaccination, and higher level of trust in doctor and developer were more willing to vaccinate than all others (all p < 0.05). Age, sex, educational level, marital status, chronic disease condition, smoking, healthy behaviors, the curability of COVID-19, the channel of accessing information of COVID-19 vaccine, endorsement of vaccine conspiracy beliefs, weigh risks of vaccination against risks of the disease, making a positive influence on the health of others around you, and lower trust in healthcare system may affect the variation of willingness to take a COVID-19 vaccine (all p < 0.05). The prevalence of COVID-19 vaccine hesitancy was modest in China, even with the slight resulting cascade of changing vaccination rates between the primary and booster vaccination. Urgent action to address vaccine hesitancy is needed in building trust in medical personnel and vaccine producers, promoting the convenience of vaccination services, and spreading reliable information of COVID-19 vaccination via the Internet and other media.

Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. OBJECTIVE: The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. METHODS: Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. RESULTS: Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. CONCLUSIONS: Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.

Effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery.

BACKGROUND: To investigate the effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery METHODS: A total of 120 patients with lung cancer were randomly allocated into three groups: general anesthesia group (GAL group), thoracic paravertebral nerve block (TPVB) combined with general anesthesia (TPL group), and TPVB (with paravertebral dexmedetomidine) combined with general anesthesia group (TDL group); 120 patients with esophageal cancer were randomly allocated into three groups: general anesthesia group (GAE group), TPVB combined with general anesthesia group (TPE group), and thoracic epidural block combined with general anesthesia group (TEE group). Lung injury and immune function were evaluated. Hemodynamic changes, early recovery in post-anesthesia care unit, pain, 6-min walking test (6MWT), drug consumption, and life quality were also observed. The duration in the PACU of patients was retrospectively analyzed. The effect of dexmedetomidine on lung injury was established in vitro. RESULTS: The lung injury, including injury scores, apoptosis, and inflammation, were decreased in the TDL group compared with the GAL group and TPL group. The ratio of CD4+ /CD8+ cells at the end of surgery was higher in the TPE group than in the GAE group. More stable hemodynamic was found in TPL group and TPE group. Acute pain was alleviated and the 6MWT was enhanced by TPVB with or without dexmedetomidine. Anesthetic consumption was decreased by thoracic nerve block. CONCLUSIONS: Thoracic nerve block, especially TPVB with or without paravertebral dexmedetomidine, can enhance recovery after thoracic surgery. Protection against independent lung injury and cellular immune dysfunction may be a potential mechanism.