Contextualizing the revised Patient Perception of Patient-Centeredness (PPPC-R) scale in primary healthcare settings: a validity and reliability evaluation study.

BACKGROUND: An English version of the Patient Perception of Patient-Centeredness (PPPC) scale was recently revised, and it is necessary to test this instrument in different primary care populations. AIM: This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. DESIGN: A mixed method was used in this study. The Delphi method was used to collect qualitative and quantitative data to address the content validity of the PPPC scale by calculating the Content Validity Index, Content Validity Ratio, the adjusted Kappa, and the Item Impact Score. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to assess the construct validity of the PPPC scale through a cross-sectional survey. The internal consistency was also assessed. SETTING/PARTICIPANTS: In the Delphi consultation, seven experts were consulted through a questionnaire sent by email. The cross-sectional survey interviewed 188 outpatients in Guangzhou city and 108 outpatients in Hohhot City from community health service centers or stations face-to-face. RESULTS: The 21 items in the scale were relevant to their component. The Item-level Content Validity Index for each item was higher than 0.79, and the average Scale-level content validity index was 0.97 in each evaluation round. The initial proposed 4-factor CFA model did not fit adequately. Still, we found a 3-factor solution based on our EFA model and the validation via the CFA model (model fit: [Formula: see text], P < 0.001, RMSEA = 0.044, CFI = 0.981; factor loadings: 0.553 to 0.888). Cronbach's α also indicated good internal consistency reliability: The overall Cronbach's α was 0.922, and the Cronbach's α for each factor was 0.851, 0.872, and 0.717, respectively. CONCLUSIONS: The Chinese version of the PPPC scale provides a valuable tool for evaluating patient-centered medical service quality.

Optimizing plant density and balancing NPK inputs in combination with innovative fertilizer product for sustainable maize production in North China Plain.

Excessive NPK inputs but low grain yield and high environmental impact are common issues in maize production in North China Plain (NCP). The objective of our study was to test whether a combined strategy of optimizing plant density, balancing NPK input, and innovating one-time fertilizer products could achieve a more sustainable maize production in NCP. Thus, a field experiment was conducted at Luanna County NCP with the treatments of unfertilized control (CK), farmer practice (FP, conventional plant density and NPK input), conventional one-time urea-based coated fertilizer (CF, optimized plant density and NPK input), and five newly designed innovative one-time NPK fertilizers of ammonium sulphate and urea synergy (IF, optimized plant density and NPK input), innovative fertilizer with various additives of urea inhibitors (IF + UI), double inhibitors (IF + DI), micro-organisms (IF + MI), and trace elements (IF + TE). The grain yield, N sustainability indicators (N use efficiency NUE, partial factor productivity of N PFPN, and N surplus), and cost-benefits analysis were examined over the maize growing season of 2020. Results had shown that on average the five innovative fertilizers (IF, IF + UI, IF + DI, IF + MI, and IF + TE) and CF that had optimized plant density and NPK input achieved 13.5%, 98.6%, 105.9%, 37.4% higher yield, PFPN, NUE, net-benefits as well as 207.1% lower N surplus compared with FP respectively. Notably, the innovative fertilizer with various effective additives (IF + UI, IF + DI, IF + MI, and IF + TE) which can be commonly found in the fertilizer market hadn't resulted in a significant improvement in yield and NUE rather a greater cost and lower net benefits in comparison to IF. In summary, our study highlighted the effectiveness of the combined strategy of optimized plant density, balancing NPK input, and innovative NPK fertiliser on sustainable maize production in NCP, however, the innovative fertilisers with effective additives should be properly selected for better economic benefits.

Emotional State of Chinese Healthcare Workers During COVID-19 Pandemic.

Objective: Anti-epidemic work against coronavirus disease (COVID) has become routine work in China. Our study was intended to investigate the emotional and psychological state of healthcare workers and look for the association between sociodemographic factors/profession-related condition and emotional state. Methods: A cross-sectional survey was conducted online among healthcare workers from various backgrounds. Symptoms of anxiety and depression were assessed by the Chinese versions of the seven-item Generalized Anxiety Disorder (GAD-7) and the nine-item Patient Health Questionnaire (PHQ-9), respectively. Supplementary questions (Supplementary Material) were recorded to describe the participants' information about workplace violence, profession, and attitude related to the COVID pandemic. Wherever suitable, independent t-test, and one-way ANOVA were performed to detect group differences of GAD-7 and PHQ-9 total scores after grouping by sociodemographic variables, respectively, such as age, gender, marital status, educational level, after-tax income, department category, job title, experience of workplace violence, and anti-epidemic participation. Multiple linear regression analyses (stepwise method) were utilized in order to look for the potential associated factors of GAD-7 and PHQ-9 total scores. Results: A total of 2,139 questionnaires with valid response were completed. Approximately 86.44% of participants had minimal symptoms of anxiety, 11.08% mild, 1.59% moderate, and 0.89% severe. Meanwhile, 81.34% had minimal symptoms of depression, 14.07% mild, 2.90% moderate, 1.17% moderately severe, and 0.51% severe. Student's t-test showed that participants with female gender, with experience of workplace violence scored higher on both GAD-7 and PHQ-9, and participants with experience of anti-epidemic front-line work during pandemic scored lower on both GAD-7 and PHQ-9. ANOVA showed that participants aging from 31 to 40, with higher educational level, with middle level of annual after-tax income, with department of internal medicine or surgery, or with middle level of job title scored higher on both GAD-7 and PHQ-9. Regression analyses showed that female gender, high job title, and the experience of workplace violence positively were associated with anxiety or depression. Doctoral education, department (other vs. psychiatry), job enthusiasm, and professional self-identity were negatively associated with anxiety or depression. Additionally, psychological support was negatively associated with depression. Conclusion: As the epidemic prevention and control against COVID-19 become normalized in China, emotional state of healthcare workers deserves extensive attention. Our study revealed that gender, educational level, department category, job title, the experience of workplace violence, job enthusiasm, and professional self-identity are the most important influencing factors of physician's anxiety and depression. Self-tailored psychological intervention should be based on the predisposing factors above to mentally prepare healthcare workers for this long-lasting battle against COVID-19.

A precision compost strategy aligning composts and application methods with target crops and growth environments can increase global food production.

Compost represents an important input for sustainable agriculture, but the use of diverse compost types causes uncertain outcomes. Here we performed a global meta-analysis with over 2,000 observations to determine whether a precision compost strategy (PCS) that aligns suitable composts and application methods with target crops and growth environments can advance sustainable food production. Eleven key predictors of compost (carbon-to-nutrient ratios, pH and salt content electric conductivity), management (nitrogen N supply) and biophysical settings (crop type, soil texture, soil organic carbon, pH, temperature and rainfall) determined 80% of the effect on crop yield, soil organic carbon and nitrous oxide emissions. The benefits of a PCS are more pronounced in drier and warmer climates and soils with acidic pH and sandy or clay texture, achieving up to 40% higher crop yield than conventional practices. Using a data-driven approach, we estimate that a global PCS can increase the production of major cereal crops by 96.3 Tg annually, which is 4% of current production. A global PCS has the technological potential to restore 19.5 Pg carbon in cropland topsoil (0-20 cm), equivalent to 26.5% of current topsoil soil organic carbon stocks. Together, this points to a central role of PCS in current and emerging agriculture.

Developing evidenced-based quality assessment checklist for real practice in primary health care using standardized patients: a systematic review.

BACKGROUND: The aim of this review was to explore the quality assessment checklists development methods in previous researches using standardized patients (SPs), as well as to propose an evidence-based checklist development procedure for quality assessment of common conditions in primary health care (PHC) settings. METHODS: We conducted a systematic review of studies that described checklist development method and extracted the methodology in terms of the developer, the basis and processes. Based on that, we formulated the development procedure according to the recommendations of the WHO Handbook for Guideline Development. RESULTS: We identified a total of 13 articles, and proposed the following five key steps: (I) forming a multidisciplinary team; (II) selecting and evaluating relevant references; (III) extracting medical information and forming the basic items; (IV) clinical expert consensus on the items; and (V) pre-testing the item pool and determining final items. DISCUSSION: SP has been proven to be an effective method to assess performance in practice. There are still some deficiencies in the developing of case-specific checklists using SPs. To ensure the validity and reliability of checklists, the development processes need to be more standardized and procedural.

Investigation on Household Medication-Taking Behavior and Affordability Among Patients Under Chronic Condition: A Survey Study in Gansu Province, China.

AIM: This study aimed to investigate the household medication-taking behavior and affordability of patients with chronic diseases in Gansu Province. As well as to propose suggestions to assist improvement of related policies. METHODS: A multistage stratified cluster sampling technique was used to select the research sites and households according to the WHO manual for the "Household Survey to Measure Access and Use of Medicines". The impact factors of medication-taking behavior were estimated using binary logistic regression models. Medication treatment affordability of hypertension patients was evaluated. RESULTS: A total of 1,080 completed questionnaires were collected, in which 690 families reported to have chronic patients in their home. The total number of chronic disease patients were 915. About 93% of the patient reported scheduled medicine intake. Approximately 86.60% of patients with chronic medical conditions were able to adhere to the physicians' prescriptions. Age, gender, and the number of household chronic disease patients were the main factors influencing whether the patients take medication. Respondents' self-reported monthly expenditure on household medicine accounted for 16.95% of their total monthly expenditure. The total cost of irbesartan and valsartan for hypertension treatment was two-fold higher than the minimum daily wage of the families. CONCLUSION: This study found that patients with chronic diseases have a high proportion of medication and medication compliance. However, family drug burden, especially for those living with hypertension are among the key challenges. Related policy needs to be revised to promote the affordability of medication under chronic conditions.

Towards the circular nitrogen economy - A global meta-analysis of composting technologies reveals much potential for mitigating nitrogen losses.

Composting is an important technology to treat biowastes and recycle nutrients, but incurs nitrogen (N) losses that lower the value of the final products and cause pollution. Technologies aimed at reducing N losses during composting have inconsistent outcomes. To deepen insight into mitigation options, we conducted a global meta-analysis based on 932 observations from 121 peer-reviewed published studies. Overall, N losses averaged 31.4% total N (TN), 17.2% NH3-N, and 1.4% N2O-N, with NH3-N accounting for 55% of TN losses. The primary drivers affecting N losses were composting method, type of biowaste, and duration of composting. N losses were significantly impacted by the carbon-to-nitrogen (C/N) ratio of the input materials (feedstock of nutrient dense biowastes and C-rich bulking agents), moisture content and pH. Our analysis revealed N-conserving optima with C/N ratios of 25-30, 60-65% moisture content and pH 6.5-7.0. In situ mitigation technologies that control feedstock and processing conditions reduced average N losses by 31.4% (TN), 35.4% (NH3-N) and 35.8% (N2O-N). Biochar and magnesium-phosphate salts emerged as the most effective N-conserving strategies, curbing losses of TN by 30.2 and 60.6%, NH3 by 52.6 and 69.4%, and N2O by 66.2 and 35.4% respectively. We conclude that existing technologies could preserve ~0.6 Tg of biowaste-N globally, which equates to 16% of the chemical N-fertilizer used in African croplands, or 39% of the annual global increases of 1.58 Tg fertilizer-N. However, the adoption of N-conserving technologies is constrained by a lack of knowledge of best practice, suitable infrastructure, policies and receptive markets. To realize an N-conserving composting industry that supports sustainable practices and the circular nitrogen economy, stakeholders have to act collectively. Benefits will include lowering direct and indirect greenhouse gas emissions associated with agriculture, and facilitating the recarbonization of soils.