Anaiysis on the strategy of promoting COVID-19 vaccination for the elderly in China / 上海预防医学

ObjectiveCOVID-19 vaccination is critical for pandemic control， especially in the elderly. Compared with developed countries， the rate of full vaccination and booster vaccination for the elderly in China is low， making it urgent to accelerate the process of vaccination for the elderly in China. MethodsThis study summarizes the policy experiences of the United Kingdom， the United States， Singapore， and South Korea by sorting relevant literature and government websites， analyzes the current performance and reasons for COVID-19 vaccination among the elderly in China， and explores strategic suggestions for improving COVID-19 vaccination in the elderly in terms of vaccination priority groups， service provision， and vaccination intention. ResultsIt is important to vaccination rate for the elderly in China by focusing on the priority vaccination population， establishing a permanent mechanism based on the family doctor system， and increasing the willingness to vaccinate. ConclusionContinued reinforcement of COVID-19 vaccination for the elderly is needed， and the existing vaccination model is overwhelming. We should establish a permanent mechanism based on the family doctor system to transfer from a mobilization model to a regular vaccination model.

Role of non-coding RNA on immune cells in tumor microenvironment of hepatocellular carcinoma / 临床肝胆病杂志

Hepatocellular carcinoma (HCC) is a common malignant tumor of the liver characterized by a high incidence rate, rapid progression, and poor prognosis. In recent years, it has been found that non-coding RNA (ncRNA) participates in the regulation of tumor immunity in tumor microenvironment (TME) and in turn affects the biological behavior of HCC. This article briefly describes the regulatory effect of ncRNA on immune cells in TME and introduces the potential value of ncRNA in the diagnosis and treatment of HCC, in order to provide potential diagnostic and treatment strategies for HCC.

Global spatiotemporal trends and determinants of COVID-19 vaccine acceptance on Twitter: a multilingual deep learning study in 135 countries and territories

BackgroundCOVID-19 vaccination has faced a range of challenges from supply-side barriers such as insufficient vaccine supply and negative information environment and demand-side barriers centring on public acceptance and confidence in vaccines. This study assessed global spatiotemporal trends in demand- and supply-side barriers to vaccine uptake using COVID-19-related social media data and explored the country-level determinants of vaccine acceptance. MethodsWe accessed a total of 13,093,406 tweets sent between November 2020 and March 2022 about the COVID-19 vaccine in 90 languages from 135 countries using Meltwater(R) (a social listening platform). Based on 8,125 manually-annotated tweets, we fine-tuned multilingual deep learning models to automatically annotate all 13,093,406 tweets. We present spatial and temporal trends in four key spheres: (1) COVID-19 vaccine acceptance; (2) confidence in COVID-19 vaccines; (3) the online information environment regarding the COVID-19 vaccine; and (4) perceived supply-side barriers to COVID-19 vaccination. Using univariate and multilevel regressions, we evaluated the association between COVID-19 vaccine acceptance on Twitter(R) and (1) country-level characteristics regarding governance, pandemic preparedness, trust, culture, social development, and population demographics; (2) country-level COVID-19 vaccine coverage; and (3) Google(R) search trends on adverse vaccine events. FindingsCOVID-19 vaccine acceptance was high among Twitter(R) users in Southeast Asian, Eastern Mediterranean, and Western Pacific countries, including India, Indonesia, and Pakistan. In contrast, acceptance was relatively low in high-income nations like South Korea, Japan, and the Netherlands. Spatial variations were correlated with country-level governance, pandemic preparedness, public trust, culture, social development, and demographic determinants. At the country level, vaccine acceptance sentiments expressed on Twitter(R) predicted higher vaccine coverage. We noted the declining trend of COVID-19 vaccine acceptance among global Twitter(R) users since March 2021, which was associated with increased searches for adverse vaccine events. Interpretation In future pandemics, new vaccines may face the potential low-level and declining trend in acceptance, like COVID-19 vaccines, and early responses are needed. Social media mining represents a promising surveillance approach to monitor vaccine acceptance and can be validated against real-world vaccine uptake data. FundingNational Natural Science Foundation of China.

Monitoring global trends in Covid-19 vaccination intention and confidence: a social media-based deep learning study

BackgroundThis study developed deep learning models to monitor global intention and confidence of Covid-19 vaccination in real time. MethodsWe collected 6.73 million English tweets regarding Covid-19 vaccination globally from January 2020 to February 2021. Fine-tuned Transformer-based deep learning models were used to classify tweets in real time as they relate to Covid-19 vaccination intention and confidence. Temporal and spatial trends were performed to map the global prevalence of Covid-19 vaccination intention and confidence, and public engagement on social media was analyzed. FindingsGlobally, the proportion of tweets indicating intent to accept Covid-19 vaccination declined from 64.49% on March to 39.54% on September 2020, and then began to recover, reaching 52.56% in early 2021. This recovery in vaccine acceptance was largely driven by the US and European region, whereas other regions experienced the declining trends in 2020. Intent to accept and confidence of Covid-19 vaccination were relatively high in South-East Asia, Eastern Mediterranean, and Western Pacific regions, but low in American, European, and African regions. 12.71% tweets expressed misinformation or rumors in South Korea, 14.04% expressed distrust in government in the US, and 16.16% expressed Covid-19 vaccine being unsafe in Greece, ranking first globally. Negative tweets, especially misinformation or rumors, were more engaged by twitters with fewer followers than positive tweets. InterpretationThis global real-time surveillance study highlights the importance of deep learning based social media monitoring to detect emerging trends of Covid-19 vaccination intention and confidence to inform timely interventions. FundingNational Natural Science Foundation of China. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWith COVID-19 vaccine rollout, each country should investigate its vaccination intention in local contexts to ensure massive vaccination. We searched PubMed for all articles/preprints until April 9, 2021 with the keywords "("Covid-19 vaccines"[Mesh] OR Covid-19 vaccin*[TI]) AND (confidence[TI] OR hesitancy[TI] OR acceptance[TI] OR intention[TI])". We identified more than 100 studies, most of which are country-level cross-sectional surveys, and the largest global survey of Covid-19 vaccine acceptance only covered 32 countries to date. However, how Covid-19 vaccination intention changes over time remain unknown, and many countries are not covered in previous surveys yet. A few studies assessed public sentiments towards Covid-19 vaccination using social media data, but only targeting limited geographical areas. There is a lack of real-time surveillance, and no study to date has globally monitored Covid-19 vaccination intention in real time. Added value of this studyTo our knowledge, this is the largest global monitoring study of Covid-19 vaccination intention and confidence with social media data in over 100 countries from the beginning of the pandemic to February 2021. This study developed deep learning models by fine-tuning a Bidirectional Encoder Representation from Transformer (BERT)-based model with 8000 manually-classified tweets, which can be used to monitor Covid-19 vaccination beliefs using social media data in real time. It achieves temporal and spatial analyses of the evolving beliefs to Covid-19 vaccines across the world, and also an insight for many countries not yet covered in previous surveys. This study highlights that the intention to accept Covid-19 vaccination have experienced a declining trend since the beginning of the pandemic in all world regions, with some regions recovering recently, though not to their original levels. This recovery was largely driven by the US and European region (EUR), whereas other regions experienced the declining trends in 2020. Intention to accept and confidence of Covid-19 vaccination were relatively high in South-East Asia region (SEAR), Eastern Mediterranean region (EMR), and Western Pacific region (WPR), but low in American region (AMR), EUR, and African region (AFR). Many AFR countries worried more about vaccine effectiveness, while EUR, AMR, and WPR concerned more about vaccine safety (the most concerns with 16.16% in Greece). Online misinformation or rumors were widespread in AMR, EUR, and South Korea (12.71%, ranks first globally), and distrust in government was more prevalent in AMR (14.04% in the US, ranks first globally). Our findings can be used as a reference point for survey data on a single country in the future, and inform timely and specific interventions for each country to address Covid-19 vaccine hesitancy. Implications of all the available evidenceThis global real-time surveillance study highlights the importance of deep learning based social media monitoring as a quick and effective method for detecting emerging trends of Covid-19 vaccination intention and confidence to inform timely interventions, especially in settings with limited sources and urgent timelines. Future research should build multilingual deep learning models and monitor Covid-19 vaccination intention and confidence in real time with data from multiple social media platforms.

Health seeking behaviors of patients with acute respiratory infections during the outbreak of novel coronavirus disease 2019 in Wuhan, China

We conducted two surveys to evaluate the health-seeking behaviors of individuals with acute respiratory infections (ARI) during the COVID-19 outbreak in Wuhan, China. Among 351 participants reporting ARI (10.3%, 351/3,411), 36.5% sought medical assistance. Children were more likely to seek medical assistance than other age groups (66.1% vs. 28.0%-35.1%).

Assessment of public attention, risk perception, emotional and behavioural responses to the COVID-19 outbreak: social media surveillance in China

BackgroundUsing social media surveillance data, this study aimed to assess public attention, risk perception, emotion, and behavioural response to the COVID-19 outbreak in real time. MethodsWe collected data from most popular social medias: Sina Weibo, Baidu search engine, and Ali e-commerce marketplace, from 1 Dec 2019 to 15 Feb 2020. Weibo post counts and Baidu searches were used to generate indices assessing public attention. Public intention and actual adoption of recommended protection measures or panic buying triggered by rumours and misinformation were measured by Baidu and Ali indices. Qualitative Weibo posts were analysed by the Linguistic Inquiry and Word Count text analysis programme to assess public emotion responses to epidemiological events, governments announcements, and control measures. FindingsWe identified two missed windows of opportunity for early epidemic control of the COVID-19 outbreak, one in Dec 2019 and the other between 31 Dec and 19 Jan, when public attention was very low despite the emerging outbreak. Delayed release of information ignited negative public emotions. The public responded quickly to government announcements and adopted recommended behaviours according to issued guidelines. We found rumours and misinformation regarding remedies and cures led to panic buying during the outbreak, and timely clarification of rumours effectively reduced irrational behaviour. InterpretationSocial media surveillance can enable timely assessments of public reaction to risk communication and epidemic control measures, and the immediate clarification of rumours. This should be fully incorporated into epidemic preparedness and response systems. FundingNational Natural Science Foundation of China.

Public Exposure to Live Animals, Behavioural Change, and Support in Containment Measures in response to COVID-19 Outbreak: a population-based cross sectional survey in China

BackgroundIn response to the COVID-19 outbreak, we aimed to investigate behavioural change on exposure to live animals before and during the outbreak, and public support and confidence for governmental containment measures. MethodsA population-based cross-sectional telephone survey via random dialing was conducted in Wuhan (the epicentre) and Shanghai (an affected city with imported cases) between 1 and 10 February, 2020. 510 residents in Wuhan and 501 residents in Shanghai were randomly sampled. Differences of outcome measures were compared before and during the outbreak, and between two cities. FindingsProportion of respondents visiting wet markets at usual was 23.3% (119/510) in Wuhan and 20.4% (102/501) in Shanghai. During the outbreak, it decreased to 3.1% (16) in Wuhan (p<0{middle dot}001), and 4.4% (22) in Shanghai (p<0{middle dot}001). Proportion of those consuming wild animal products declined from 10.2% (52) to 0.6% (3) in Wuhan (p<0{middle dot}001), and from 5.2% (26) to 0.8% (4) in Shanghai (p<0{middle dot}001). 79.0% (403) of respondents in Wuhan and 66.9% (335) of respondents in Shanghai supported permanent closure of wet markets (P<0.001). 95% and 92% of respondents supported banning wild animal trade and quarantining Wuhan, and 75% were confident towards containment measures. Females and the more educated were more supportive for the above containment measures. InterpretationThe public responded quickly to the outbreak, and reduced exposure to live animals, especially in Wuhan. With high public support in containment measures, better regulation of wet markets and healthy diets should be promoted. FundingNational Science Fund for Distinguished Young Scholars, H2020 MOOD project. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSOn February 19, 2020, we searched PubMed for papers published after January 1, 2020, containing the following terms: "2019 nCoV" or "COVID-19". We identified 179 studies, most of which are research on clinical and epidemiological characteristics of COVID-19. To date there is no primary research to quantify public behavioural response and support in containment measures in response to the outbreak. Only four commentaries mentioned the influence of the outbreak on mental health. One commentary introduced the habit of consuming wild animal products in China. Another commentary briefly introduced isolation, quarantine, social distancing and community containment as public health measures in the outbreak. The Chinese government has introduced a series of strict containment measures, and societal acceptability of these measure is important for effective and sustained response. Evidence is urgently needed to help policy makers understand public response to the outbreak and support for the containment measures, but no evidence available to date. Added value of this studyWe conducted a population-based cross-sectional telephone survey via random digital dialing in Wuhan (the epicentre) and Shanghai (an affected city with imported cases) between 1 and 10 February, 2020. To date, this is the only few analyses on behavioural response to the outbreak and societal acceptability of governmental containment measures, which has been listed as the current priority of China CDC. We provide an assessment of behavioural change on exposure to live animals during the outbreak, by comparison before and during the outbreak, and between two cities with diverse exposure intensities to COVID-19. We also provide evidence on public support in governmental containment measures, including strict regulation on wet markets to reduce animal-to-human transmission and city quarantine to reduce human transmission. Implications of all the available evidenceWe found that wild animal consumption was more prevalent in Wuhan (10.2%) than in Shanghai (5.2%). The public responded quickly to the outbreak, and significantly reduced exposure to live animals and stopped wild animal consumption, especially in Wuhan. They were very supportive of governmental containment measures. With high public support, wet markets should be better regulated, and healthy diets, including changing the traditional habit of eating wild animal products, should be promoted. This can inform policy makers in China and other countries to implement and adjust containment strategies in response to the outbreak in the future.

Psychological responses, behavioral changes and public perceptions during the early phase of the COVID-19 outbreak in China: a population based cross-sectional survey

ObjectiveTo investigate psychological and behavioral responses to the threat of SARS-CoV-2 infections and their associations with public perceptions in China DesignCross sectional population-based telephone survey via random digital dialing between 1 and 10 February, 2020 SettingWuhan (the epicentre and quarantined city), and Shanghai (a typical major city with close transportation link with Wuhan) ParticipantsRandom sample of 510 residents in Wuhan and 501 residents in Shanghai aged above 18 Main outcome measuresAnxiety (measured by the 7-item generalized anxiety disorder [GAD-7] scale), recommended and avoidance behaviors (engaged in all six behaviors such as increasing surface cleaning and reducing going out). ResultsThe prevalence rates of moderate or severe anxiety (score [≥]10 on GAD-7) were 32.7% (n=167) among Wuhan participants and 20.4% (n=102) among Shanghai participants. 78.6% (n=401) of Wuhan participants and 63.9% (n=320) of Shanghai participants had carried out all six precautionary behaviors. For both measures, Wuhan participants were more responsive to the outbreak (p<0.001). Controlling for personal characteristics, logistic regression results suggested that risks of moderate or severe anxiety were positively associated with perceived susceptibility (odds ratio 1.6, 95% confidence interval 1.3-1.8) and severity of the disease (1.6, 1.4-1.9) and confusion about information reliability (1.6, 1.5-1.9). Having confidence in taking measures to protect oneself against the disease was associated with a lower risk (0.6, 0.5-0.7). The strongest predictor of behavioral change was perceived severity (1.2, 1.1-1.4), followed by confusion about information reliability (1.1, 1.0-1.3). ConclusionsPsychological and behavioral responses to COVID-19 have been dramatic during the rising phase of the outbreak. Our results support efforts for timely dissemination of accurate and reliable information to address the high anxiety level.

Reference significance of the teaching model of flipped classroom combined with group learning in the course of biostatistics in Duke University / 中华医学教育探索杂志

This article summarizes the experience in the teaching model of flipped classroom combined with group learning in the course of biostatistics in Duke University and discusses the application of this teaching model in universities and colleges in China.The study results show that this teaching model introduces group learning in flipped classroom to develop continuous peer-assisted learning.Meanwhile,this teaching model follows the process of knowledge internalization and designs four successive steps of individual readiness assessment,team readiness assessment,mini-lectures,and application activity,in order to strengthen the understanding and practical application of key points.This teaching model also establishes a transparent mechanism for individual and curriculum evaluation and feedback collection to find and solve the issues in this course.These teaching experiences provide a good reference for the application of flipped classroom in large-class teaching in China.

Research on the governance tools of international NGOs participating in global health / 中国卫生政策研究

Non-governmental organizations ( NGOs) are playing an increasingly significant role in global health governance. This study selected ten key NGOs that play an important role in global health affairs and summarized the tools employed by NGOs participating in global health governance, including nine dimensions:“Generating informa-tion and evidence/intelligence”, “Cooperation ( Partnerships )”, “Participation”, “Consultation”, “Transparen-cy”,“Organizational adequacy/system design”, “Formulating policy / strategic direction”, “Responsibility” and“Regulation”. Four types of NGOs including Operational, Supportive, Advocacy and Integrated ones presented com-monness and their priorities in the selection of tools to participate in global health governance. Meanwhile, China should strive to nurture local NGOs, which should pay attention to“Transparency”,“Participation” and“Cooperation ( Partnerships)”.

Government orientation and cooperation with NGOs in global health sector：Example of WHO, US and UK / 中国卫生政策研究

NGOs play an important role in global health governance, and have become the key partners of World Health Organization ( WHO) , European and American governments. The goal of the sustainable development of the United Nations also proposes to strengthen NGOs as global health governance partners. Taking WHO, the Unit-ed States and Britain as case examples, this study reviewed the NGOs positioning and cooperation in their global health strategies. The results found that these entities explicitly define the roles of NGOs and strengthen cooperation in their global health strategies to expand their influence in the field of global health. Results also found that WHO, US and UK have given NGOs a clear positioning, that is, they have strengthened the mutual cooperation ( partner-ships) in the same way of expanding their influence in the field of global health for China’s global health strategy de-velopment referred to those NGOs. Therefore, China should incorporate NGOs into the global health strategy, estab-lish NGOs management and cooperation mechanism and define their roles and make it an important complement to global health. China should also strictly select international NGOs to cooperate with and strive to nurture and support Chinese NGOs to participate in global health programs set by the Government, formulate the cooperation list and neg-ative list for NGOs, and at the same time strengthen the supervision and audit to avoid possible risks of NGOs.

Experience and references from typical international foundations in global health project man-agement / 中国卫生政策研究

The International Foundations have invested large sums of funds to participate in global health gov-ernance and greatly contributed to the promotion of global health. The foundations have extensive experience in the management of global health projects. Based on the nature of the foundation and its structure in the government, this paper compares the management methods of project management, project selection, project planning, project imple-mentation, project follow-up, project evaluation and project completion in two stages of the Gates Foundation and Global Fund. It summarizes the project management features, provided references for China participating in global health governance.

International experience and reference on NGOs and global health / 中国卫生政策研究

The international Non-governmental Organizations ( NGOs) have been playing an important role in the field of global health, which also represents a channel for countries' international experience. This research fo-cuses on the role of NGOs in global health, their governance tools, global health program management experience, and current status of development for Chinese NGOs. In light of international experiences, we suggest the Chinese government to support a few top NGOs to engage intensely in global health, build management and cooperation mechanism with NGO which will be considered as important complemertary role. The Chinese government shonld implement “major support and comprehensive improvement” strategy.

Study on the roles of NGOs in global health / 中国卫生政策研究

The global health system is undergoing dramatic reforms, which would further bring about signifi-cant changes in key global health stakeholders. As a key actor and decision maker in global health system, NGO owns extensive experiences in global health governance and can provide a systematic experience for China’s participa-tion in global health decision-making as a reference model. This paper aimed at studying the roles of NGOs in the field of global health, the roles which can be summarized in four aspects of advocacy, implementation, support, and community mobilization. In addition, NGOs also developed some potential risks and unexpected impacts on global health governance. As represented by some typical examples, there occurred conflicts of interests between some NGOs and the local governments. A number of local health systems suffered from a considerable brain drain of health personnel to NGOs, especially the health officials and technical staff, which weakened the country’s health workforce and system. The financing model driven by external donors could weaken the influences and capacity of local govern-ments on health planning. As a key member involved in global health, we that suggested China and Chinese NGOs should strategically and rationally borrow their experiences and try to avoid these risks.

Analysis on the development strategy of the Chinese Global Health NGOs / 中国卫生政策研究

The international NGOs have been playing an important role in global health governance, and also represent a channel for countries to exert international influence. However, the Chinese NGOs are not actively in-volved in global health so far. This purpose of this paper is to analyze and show the picture of the social and political context of NGOs in China, to learn from the experience of emerging global health-related NGOs through describing their development, provides a strategy for China to support NGO participation in the global health governance, and to put forward recommendation on how to develop China’s global health NGOs based on experiences from international counterparts. The results of this paper found that China has a better international environment, which is a beneficial opportunity for the country to engage in global health governance. Domestic social NGOs are developing progressive-ly, while they are still being harnessed by political safety considerations, for example being affiliated to public admin-istrative system and policy orientation development. However, this would possibly not obstruct health-related NGOs for its minimal political relevance as it is oriented at professionalism, i. e. specialization, public service attributes and relevance to public governance. Therefore, health-related NGOs can have more support from governments since their number is relatively small, with less foundation ( they are undeveloped) and less participation in international cooper-ation ( they lack international involvement) . International experience indicates that supports from governmental enti-ties represent a backbone of the emerging institutions in the participation into the global health programs. The author suggests that the Chinese government should establish a specific global health development strategy of “prioritizing and improving the whole” and setting up the global development strategy in the county. The government should attach more importance to the government-owned and affiliated and private-capital-supported (social elites) NGOs, guide and subsidize them to the international stage, to engage intensely in global health.

Does health insurance impact on the hospital seeking behavior among floating population?Evi-dence from the 2014 National Floating Population Dynamic Monitoring Survey / 中国卫生政策研究

Objectives:To analyze the influencing factors and status of hospital seeking behavior among floating population by focusing on the function of health insurance , and provide evidence to comprehensively promote tiered health care system in China .Methods:Using data from 2014 National Floating Population Dynamic Monitoring Survey , multivariate logistic regressions were applied to analyze the influencing factors of hospital seeking behavior for inpatient care .Chi-square tests were used to analyze the different proportion of having basic medical insurance reimbursement and reasons for not having it for different hierarchical inpatient care , and T test were used to analyze the ratio of basic medical insurance reimbursement for hospital costs .Results:The proportion of hospitalization at the county level and below was 56.4%among floating population , the proportion of inflow patients being 51.5%and the rest of the hospital population being counted at a proportion of 37.9%, lower than the corresponding proportion of 72.6%among local res-idents derived from the Fifth National Health Services Survey , but this ratio was 78.9%among registered population . The multivariate logistic regression results indicated that demographic , socio-economic and flow characteristics , hospital location and reasons for hospitalization have significantly affected the migrant inpatients facilities , but health insurance did not significantly influence the hospital seeking behaviors among floating population .Conclusions:The proportion of hospitalization at the county level and below was low among migrants and this proportion presented great regional differ -ences;and medical insurance didn't play a guiding role in the diversion of the internal floating population .

Effects of basic health insurance ecdemic settlement policy on health services utilization / 中国卫生政策研究

Objective:To study the effects of basic medical insurance ecdemic settlement policy on health services utilization.Methods:Based on data from China Health and Retirement Longitudinal Survey conducted in 2011 and 2013, a multivariate logistic regression analysis was used to compare the effect of basic health insurance registering site on health services utilization before and after the implementation of basic medical insurance ecdemic settlement policy .Results:Af-ter the basic medical insurance ecdemic settlement policy was carried out , health services utilization was improved .Con-clusions:The basic medical insurance ecdemic settlement policy can effectively improve the portability of health insur-ances, reducing the crowd remote medical disorders of off-site medical services to improve health care accessibility .

Utilization and equity of preventive care in China from 1991 to 2011 / 中国卫生政策研究

Objective:To analyze the influential factors, trend and equity of preventive care utilization in China from 1991 to 2011. Methods:Using China Health and Nutrition Survey ( CHNS) , logistic regression was applied to explore influential factors, study time trend of preventive care utilization, and examine its equity by Concentration In-dex. Results: Total preventive care services and physical examination utilization significantly increased. Significant inequity still exit in terms of general physical examination and blood text, however, disappeared with respect to blood pressure screening and gynecological examination. Main influential factors of preventive care utilization includes in-come, gender, education and insurance, etc. Conclusion:Preventive care utilization had significantly grown with de-creasing inequalities, but inequity still exit, particularly for general physical examination and blood test.

"Changes of the usage of""motivation"" and related concepts within Chinese literature of human resources for health" / 中国卫生政策研究

After introduction into Chinese academy, and in the application in health care domain, the usage ofmotivation and related concepts has been changed. The changes were partly due to pragmatic utility, and caused confusion in the application of motivation theory in Chinese human resource for health. Both English and Chinese lit-erature was reviewed and systematic literature review was applied. We analyzed the different definitions of motiva-tion in English, and how they were used and understand in Chinese academia in history. Motivation was divided into three Chinese concepts, representing the process of motivation, inner driver of motivation and psychological state of being motivated. The other usage changes include willful exchange ofincentive andmotivation;motivationbeing used more as a means to motivate than a motivational process;the result of motivation as an aroused psychologi-cal state not seriously defined. Systematic literature review revealed the distribution of various motivation topics in Chinese literature and supported the abovementioned arguments. These changes of usage could cause barriers to re-search of human resource for health in China. It is recommended that usage ofmotivation should be clarified in ac-ademia in China and the process of motivation rather than motivation as a managerial means deserves more attention.

Provision capacity research of primary healthcare services in rural China / 中华医院管理杂志

Objective Studying the status quo and constraints for rural healthcare service in grassroot rural healthcare units,for policy recommendations.Methods Using data from the fourth healthcare service investigation,by means of quantitative interview and qualitative interview,for an investigative interview of 348 township hospitals and 251 village clinics in 31 provinces in China.Results Deployment percentage of primary heahhcare services at township hospitals level is 49.1% (28.0/57),and that for village clinics is 60.6%(5.4/9).Conclusions The key to upgrading rural healthcare service system at grassroots level is to deploy better diagnostic equipments,upgrade the diagnostic competence of grassroots healthcare personnel and build a continuous service system for primary healthcare service.