Long-term mental health cost of the Great Chinese Famine.

The Great Chinese Famine (1959-1961) claimed tens of millions of lives. This study aims to causally examine the long-term mental health cost it imposed on those who survived. To estimate the nationwide total mental health cost, we use a novel dataset to measure the famine intensity of every prefecture-level region, match it to a nationally representative survey, and then identify the long-term effects of the famine on the depression of rural residents then in the early years of their lives. Difference-in-differences estimates reveal that a one-standard-deviation rise in the experienced famine intensity increased a standard measure of depression by about 0.039 and 0.064 if the individual experienced the famine at ages 0-2 and 3-5, respectively. This translates into roughly 7.99 million cases of severe depressive symptoms caused by the famine, which is likely an undercount. Examining the mechanisms behind the large effects, we find that important roles were played by starvation experience and childhood maltreatment, as well as the primary mediators including other health outcomes, economic status, and social relationship. Our findings shed light on how large-scale food security failures impact the mental well-being of the survivors.

Case-Control Trials on Risk Factors for Pancreatic Cancer: A Systematic Review and Meta-Analysis.

Background: The single risk factors of pancreatic cancer (PC) has been extensively studied. We aimed to synthesize results from such studies to identify and estimate multiple independent risk factors of PC. Methods: Articles published up to Feb 28, 2020 in English or Chinese reporting risk factors of PC were reviewed. The fixed-effects model with 95% confidence interval (CI) were used to calculate the pooled Odds Ratio (OR). Data were analyzed using RevMan 5.3. Results: PC was significantly associated with smoking (OR: 1.76, 95% CI: 1.61-1.92, P < 0.00001, I2 = 6%), diabetes (OR: 2.69, 95% CI: 2.52-2.88, P < 0.00001, I2 = 0%), family history of PC (OR: 2.58, 95% CI: 2.13-3.11, P < 0.00001, I2 = 0%), and chronic pancreatitis (OR: 5.84, 95% CI: 3.63-9.41, P < 0.00001, I2 = 0%). Conclusion: Smoking, diabetes, family history of PC, and chronic pancreatitis were independent risk factors for PC. These independent risk factors have an important role in identifying high-risk groups, which is of great significance to reduce the incidence of PC and improve the quality of life and prognosis of patients.

Internet Use and Better-Informed Divorce in China.

China has witnessed a rapid expansion in Internet penetration in recent years, with profound impacts on people's family life and marital relationships. This paper aims to examine the causal effects and functionary of information access through Internet on marital stability. This paper identifies a robust association between Internet use and increasing divorce rates in China by using nationally representative, individual-level survey data and province-level aggregate data. Various regression techniques and specifications demonstrated the statistical and economic significance of the association. Given the ever-expanding role of the Internet and the serious consequences of divorce on families and society, it is imperative that we study the underlying mechanisms as the first step toward socially responsible policymaking. Our analysis revealed a significant mediating effect of the self-reported importance of Internet information acquisition, the frequency of chatting with online friends, the frequency of meeting with online friends, and the intensity of Internet use. These findings are consistent with the theory that the increase in divorce decisions is due to better information access and is, therefore, rational and that policies such as a mandatory cooling-off period for divorce may lower societal welfare. We also conducted a series of heterogeneity analyses that showed, among other findings, that the Internet effect is stronger for women.

Heterogeneous effects of retirement on the biomedical risk factors for cardiovascular and metabolic diseases: New evidence based on the physical examination database in Shanghai, China.

Retirement has a heterogeneous impact depending on gender and occupation. This study aimed to analyze and evaluate the heterogeneity and potential mechanism of retirement on the biomedical risk factors for cardiovascular and metabolic diseases. Physical examination data from 2017 to 2020 were extracted from a hospital database in Shanghai. The fluctuation tendency of biomedical risk factor indicators for cardiovascular and metabolic diseases was evaluated by gender and occupation shortly after retirement using fuzzy regression discontinuity design and was analyzed for internal mechanism. Retirement had a significantly negative influence on body weight (ß = -3.943), body mass index (ß = -2.152), and diastolic blood pressure (ß = -5.180) in women working in public institutions or state-owned enterprises, but a positive influence on their blood glucose level (ß = 0.696). Retirement had a significantly positive effect on high-density lipoprotein in men (ß = 0.138), particularly those employed in private enterprises (ß = 0.339). The internal influencing mechanism of retirement showed that the health attention effect after retirement among women in government or public institutions on diastolic blood pressure reduction was better than that before retirement. The body weight, body mass index, and diastolic blood pressure of women in public institutions or state-owned enterprises were reduced at retirement; however, they were exposed to higher risks of elevated blood glucose level. Conversely, high-density lipoprotein level, which is protective against cardiovascular disease, was increased in men at retirement. Retirement has a heterogeneous effect on cardiovascular and metabolic health among people of different genders or occupational experiences. Retirees with low health awareness should be targeted for behavioral interventions and monitored conscientiously by health providers during retirement adaptation.

Do VIP medical services damage efficiency? New evidence of medical institutions' total factor productivity using Chinese panel data.

This study examines the causal impact of very important person (VIP) medical services on hospital total factor productivity in Deyang, a prefectural-level city in western China, spanning the years 2015-2020. This aims to offer empirical evidence and policy recommendations for the implementation of VIP practices in the medical field. A secondary unbalanced panel dataset of 416 observations was collected from the annual reports of the Health Commission and 92 eligible medical institutions were included. This study utilized a two-stage strategy. First, the Global Malmquist index was used to calculate the total factor productivity and its decomposition terms for hospitals from 2015 to 2020. In the second stage, two-way fixed effects models and Tobit models were used to identify the relationship between VIP medical services and hospital efficiency; instrumental variables were used to solve potential endogeneity problems in the model. The results showed that VIP medical services had a significantly negative impact on medical institutions' efficiency. The technological advances and pure technical efficiency related to VIP medical care may help explain these negative impacts, which were heterogeneous across groups divided by the nature of the hospital and the outside environment. It is imperative to prioritize the standardized provision of VIP medical services for medical institutions, optimize management and service process, enhance the training of clinical and scientific research capabilities of medical personnel, and scientifically allocate resources for both VIP and general medical services. This will help mitigate health inequality while improving the overall quality of medical services.

Do public employment services affect the self-rated health of migrant workers in China?

Migrant workers greatly contributing to China's industrialization and urbanization are confronted with increasing health risks. This study empirically investigates the effects of public employment services on the self-rated health of migrant workers in Shanghai China, by using data from the National Bureau of Statistics from 2015 to 2020. The estimation results under the Ordered Probit model illustrate that public employment services significantly improve the self-rated health of migrant workers, and vocational training, job development and other related services show an apparently positive correlation with the self-rated health. The marginal effect analysis reveals that public employment services obviously reduce the probability of health satisfaction as "average", "relatively satisfied" and "relatively dissatisfied", which translate into a significant increase in the probability of "very satisfied". The mechanism analysis verifies that public employment services enhance the self-rated health by increasing the proportion of medical insurance and injury insurance of migrant workers. The results are still reliable by adopting the methods of subsample regression, Propensity Score Matching and variable substitution to conduct robustness checks. This study further enriches the literature on public employment services and the health status of migrant workers, and provides policy implications on improving the health status of migrant workers and the public employment service system of China under the impact of the COVID-19 pandemic.

Influencing mechanisms of lifestyle and dietary factors on chronic diseases among community residents: updated evidence in Shanghai, China.

OBJECTIVES: This study aimed to determine the risk factors for chronic diseases and to identify the potential influencing mechanisms from the perspectives of lifestyle and dietary factors. The findings could provide updated and innovative evidence for the prevention and control of chronic diseases. DESIGN: A cross-sectional study. SETTING: Shanghai, China. PARTICIPANTS: 1005 adults from Yangpu district of Shanghai participated in the study, and responded to questions on dietary habits, lifestyle and health status. RESULTS: Residents suffering from chronic diseases accounted for about 34·99 % of the respondents. Logistic regression analysis showed that age, diet quality, amount of exercise and tea drinking were related to chronic diseases. Age > 60 and overeating (Diet Balance Index total score > 0) had negative additive interaction on the occurrence of chronic disease, while overexercise (Physical Activity Index > 17·1) and tea drinking had negative multiplicative interaction and negative additive interaction on the occurrence of chronic disease. Diet quality, physical activity and tea drinking were incomplete mediators of the relationship between types of medical insurance residents participating in and chronic diseases. CONCLUSIONS: The residents in Yangpu District of Shanghai have a high prevalence of chronic diseases. Strengthening access of residents to health education and interventions to prevent chronic diseases and cultivating healthy eating and exercise habits of residents are crucial. The nutritional environment of the elderly population should be considered, and the reimbursement level of different types of medical insurance should be designed reasonably to improve the accessibility of medical and health services and reduce the risk of chronic diseases.

What determines urban resilience against COVID-19: City size or governance capacity?

This study analyzed the effects of urban governance and city size on COVID-19 prevention and control measures. Based on real-time data in 276 prefecture-level Chinese cities, we used the ordinary least squares plus robust standard error strategy. It was found that: (1) despite the non-significant effect of city size, urban governance capacity was an important factor affecting the prevention and control of the COVID-19 pandemic; urban governance capacity was particularly significant in the late control of the pandemic, but not significant in the early prevention; for every unit increase of urban governance capacity, the number of recovered COVID-19 cases per capita increased by 2.4%. Moreover, (2) the influence mechanism of anti-pandemic measures in cities could be divided into the workforce, financial, and material effects, and their contribution rates were 26.15%, 32.55%, and 37.20%, respectively; namely, the effective/timely assistance from Chinese central government regarding the workforce, financial, and material resources in key pandemic areas and nationwide played a major role in pandemic control. Additionally, (3) cities with a high level of smart city construction were more capable of enhancing the pandemic prevention and control effect, indicating that smart city construction is conducive to enhanced coping with public crises.

Perceptions Among Medical Staff in Community Health Centres of Coping Capacity Regarding Infectious Disease Epidemics: A Cross-Sectional Study in Shanghai, China.

BACKGROUND: With the increasing risk of infectious disease outbreaks around the world, the role of community health centres (CHCs) in the prevention and control of epidemics has become increasingly prominent. This study aimed to examine the capacities, vulnerabilities, and obstacles related to coping with infectious disease epidemics in Chinese CHCs. METHODS: A cross-sectional study was conducted in Shanghai CHCs. Stratified random sampling was used to select 48 CHCs, and 2460 medical staff members responded to questionnaire surveys. ANOVA and multivariate analysis were used to evaluate the current situation and main obstacles regarding CHC medical staff members' perceptions of their capacity to cope with infectious disease epidemics. RESULTS: The scores for regulation awareness (mean= 3.64, SD= 0.02) and detection/reporting ability (mean= 3.66, SD= 0.02) were lower than the score for the ability to handle an epidemic (mean= 3.79, SD= 0.02). After controlling for covariates, working in a traditional Chinese medicine (ß= -0.63, P= 0.002) or medical technology department (ß= -0.60, P= 0.002), not having participated in emergency exercises (ß= -0.78, P< 0.001), and not having participated in emergency training (ß= -0.59, P= 0.01) were associated with lower scores on all three domains. Those with senior professional titles reported relatively high levels of ability to handle an epidemic (ß= 0.21, P= 0.01). Female workers reported relatively low regulation awareness (ß= -0.11, P= 0.02) and detection/reporting ability (ß= -0.11, P= 0.01). CONCLUSION: The three emergency response abilities of CHC medical workers differed based on the medical worker's sex, department, and title, indicating the need for targeted scientific emergency exercises and training for infectious disease outbreaks. Moreover, there is a need to improve the relevant policies and equipment.

Internet use and individuals' environmental quality evaluation: Evidence from China.

Identifying factors that influence the public's environmental quality perception is conducive to environmental protection and risk management. By employing data from the Chinese Social Survey (CGSS) and the ordinary least squares (OLS) method, the present study aims to explore the associations between Internet use and Chinese residents' environmental quality evaluation. The results show that, compared with non-netizens, netizens have a higher negative evaluation of environmental quality, which supports the negativity bias theory, namely, that netizens pay more attention to negative news related to environmental pollution on the Internet. Further study suggests that the impact of Internet use on environmental quality evaluation is heterogeneous across different categories of environmental issues and populations: Internet use has greater effects on risk perception of environmental issues that are closely related to residents' lives. In addition, Internet use has a greater negative impact on environmental quality evaluation for older people and rural residents. Finally, this paper utilizes a substitution variable method, propensity score matching (PSM) and quantile regression to conduct the robustness check.

Association of Internet Use with Attitudes Toward Food Safety in China: A Cross-Sectional Study.

A growing body of research has shown that people's attitudes toward food safety is affected by their availability and accessibility to food risk information. In the digital era, the Internet has become the most important channel for information acquisition. However, empirical evidence related to the impact of Internet use on people's attitudes towards food safety is inadequate. In this study, by employing the Chinese Social Survey for 2013 and 2015, we have investigated the current situation of food safety perceptions and evaluations among Chinese residents and the association between Internet use and individuals' food safety evaluations. Empirical results indicate that there is a significant negative correlation between Internet use and people's food safety evaluation in China. Furthermore, heterogeneity analysis shows that Internet use has a stronger negative correlation with food safety evaluation for those lacking rational judgment regarding Internet information. Specifically, the negative correlation between Internet use and food safety evaluations is more obvious among rural residents, young people, and less educated residents. Finally, propensity score matching (PSM) is applied to conduct a robustness check. This paper provides new evidence for studies on the relationship between Internet use and an individuals' food safety cognition, as well as additional policy enlightenment for food safety risk management in the digital age.