Evaluating the Quality of Home Care in China Using the Home Care Quality Assessment Tool.

INTRODUCTION: This study aimed to evaluate the quality of home care in China using the Home Care Quality Assessment Tool (HCQuAT). METHOD: We recruited 38 home health agencies in Shanghai, China, which included 18 in urban areas, 11 in suburban areas, and nine in rural areas. Data on quality of home care from each agency were collected by trained staff using the HCQuAT. RESULTS: On average, these home health agencies scored 74.28/100.00 (SD = 6.80) on the HCQuAT, with an excellence rate of 39.5% and a failing rate of 23.7%. The mean scores on the structure quality module, process quality module, and outcome quality module were 71.2 ± 21.8, 86.6 ± 9.2, and 44.1 ± 37.5, respectively. Significant differences existed across geographic locations (p = .018). DISCUSSION: Significant variations were identified in the quality of home care across quality modules and geographic locations. Outcome quality and quality in rural areas were lower than those for their counterparts.

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions.

BACKGROUND: Pain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). AIMS: Examine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. DESIGN: Analysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. SETTINGS/PARTICIPANTS: 6,153 patients ≥65 years receiving care from a nonprofit HH agency in 2017. METHODS: Study outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. RESULTS: Patients with ADRD (n = 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] = 1.35, p = .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. CONCLUSIONS: HH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.

The development of ecological environment in China based on the system dynamics method from the society, economy and environment perspective.

The harmonious development in society, economy and environment are crucial to regional sustained boom. However, the society, economy and environment are not respectively independent, but both mutually promotes one which, or restrict mutually complex to have the long-enduring overall process. The present study is an attempt to investigate the relationship and interaction of society, economy and environment in China based on the data from 2004 to 2013. The principal component analysis (PCA) model was employed to identify the main factors effecting the society, economy and environment subsystems, and SD (system dynamics) method used to carry out dynamic assessment for future state of sustainability from society, economy and environment perspective with future indicator values. Sustainable development in China was divided in the study into three phase from 2004 to 2013 based competitive values of these three subsystems. According to the results of PCA model, China is in third phase, and the economy growth is faster than the environment development, while the social development still maintained a steady and rapid growth, implying that the next step for sustainable development in China should focus on society development, especially the environment development.

Multilocus estimation of divergence times and ancestral effective population sizes of Oryza species and implications for the rapid diversification of the genus.

· Despite substantial investigations into Oryza phylogeny and evolution, reliable estimates of the divergence times and ancestral effective population sizes of major lineages in Oryza are challenging. · We sampled sequences of 106 single-copy nuclear genes from all six diploid genomes of Oryza to investigate the divergence times through extensive relaxed molecular clock analyses and estimated the ancestral effective population sizes using maximum likelihood and Bayesian methods. · We estimated that Oryza originated in the middle Miocene (c. 13-15 million years ago; Ma) and obtained an explicit time frame for two rapid diversifications in this genus. The first diversification involving the extant F-/G-genomes and possibly the extinct H-/J-/K-genomes occurred in the middle Miocene immediately after (within < 1 Myr) the origin of Oryza. The second giving rise to the A-/B-/C-genomes happened c. 5-6 Ma. We found that ancestral effective population sizes were much larger than those of extant species in Oryza. · We suggest that the climate fluctuations during the period from the middle Miocene to Pliocene may have contributed to the two rapid diversifications of Oryza species. Such information helps better understand the evolutionary history of Oryza and provides further insights into the pattern and mechanism of diversification in plants in general.