Prevalence and effect factors of dementia among the community elderly in Chongqing, China.

BACKGROUND: China is an ageing society, with around 150 million people aged 60 years or older. The prevalence of dementia will increase by more than 100% in the coming 20 years. This study aimed to investigate the prevalence and effects of dementia among the community elderly in Chongqing, China. METHODS: Cluster sampling was adopted. A sample of elderly individuals aged 60 years and older was extracted as research subjects from three counties within Chongqing, China. One-on-one interviews were conducted through a general information questionnaire, and the Mini-Mental State Examination, Instrumental Activity of Daily Living Scale, and Geriatric Depression Scale were administered. The investigated data were tested by χ2 , and the effect factors of dementia were analyzed by multiple logistic regression analysis. Statistical significance was set at P < 0.05. RESULTS: We distributed 1850 questionnaire, and the response rate was 100%. However, only 1781 questionnaires were able to be used in the study. Of the 1781 elderly respondents, 186 (10.44%) presented with dementia. Our findings revealed that differences in regions, age, marital status, education level, occupation, tobacco consumption, alcohol consumption, freshwater fish consumption, exercise, intensive labour, mah-jong- and chess-playing habits, media consumption (i.e. watching TV, listening to the radio, or reading the newspaper), body mass index, hypertension, coronary heart disease, and depression were statistically significant in the prevalence of dementia (P < 0.05). CONCLUSIONS: According to multiple logistic regression analyses, living in a rural area, older age, being single, obesity, hypertension, coronary heart disease, and depression are risk factors for dementia. In contrast, cessation of smoking, freshwater fish consumption, moderate or frequent exercise, intensive labour, daily housework, outdoor activities, media consumption, and social activities are protective factors against dementia among community elderly in Chongqing, China.

The equity of China's emergency medical services from 2010-2014.

BACKGROUND: With the depth development of health care system reform in China, emergency medical services (EMS) is confronted with challenges as well as opportunities. This study aimed to analyze the equity of China's EMS needs, utilization, and resources distribution, and put forward proposal to improve the equity. METHOD: Three emergency needs indicators (mortality rate of cardiovascular and cerebrovascular diseases, harm, and digestive system disease), two utilization indicators (emergency outpatient visits and rate of utilization) and one resource allocation indicator (number of EMS facilities) were collected after the review of the China Statistical Yearbook and the National Disease Surveillance System. Next, EMS related indicators were compared among 31 provinces from the eastern, central, and western regions of the country. Concentration Index (CI) were used to measure the equity of EMS needs and utilization among the western, central, and eastern regions. The Gini coefficient of demographic and geographic distribution of facilities represented the equity of resource allocation. RESULT: During 2010-2014, the CI of cardiovascular and cerebrovascular disease mortality changed from positive to negative, which indicates that the concentrated trend transferred from richer regions to the poorer area. Injury mortality (CI: range from - 0.1241to -0.1504) and digestive disease mortality (CI: range from - 0.1921 to - 0.2279) consistently concentrated in the poorer region, and the inequity among regions became more obviously year-by-year. The utilization of EMS (CI: range from 0.1074 to 0.0824) showed an improvement; however, the inequity reduced gradually. The EMS facilities distribution by population (Gini coefficient: range from 0.0922 to 0.1200) showed high equitability but the EMS facilities distribution by geography (Gini coefficient: range from 0.0922 to 0.1200) suggested a huge gap between regions because the Gini coefficients were greater than 0.5 in the past 5 years. CONCLUSION: There are some inequities of needs, utilization, and resource allocation in the China EMS. The government needs to stick to the principle of increasing investment in poorer regions, perfecting ambulance configuration and improving health workers' professional skills to improve the equity and quality of EMS.