Validation study of the Chinese version of the Community Integration Questionnaire-Revised for individuals with spinal cord injury in Mainland China.

OBJECTIVE: To validate the Chinese version of the Community Integration Questionnaire-Revised (CIQ-R-C) for individuals with spinal cord injury. DESIGN: Cross-sectional study. SETTING: Shanghai Sunshine Rehabilitation Center. PARTICIPANTS: 317 adults with spinal cord injury in a rehabilitation center in Mainland China. INTERVENTIONS: Not applicable. METHODS: The CIQ-R-C (including an additional e-shopping item), global QoL, Zung Self-Rating Anxiety/Depression Scale (SAS/SDS), and Multidimensional Scale of Perceived Social Support (MSPSS) were administered. Reliability and validity analyses were conducted. RESULTS: Good item-domain correlations were found for 15 of the 16-item original CIQ-R, except for item 10 (leisure alone or with others). Exploratory Factor Analysis supported a construct of the CIQ-R-C (excluding item 10) as made of four domains (CFI = 0.94; RMSEA = 0.06): home, social engagement, digital social networking, and traditional social networking. Good internal consistency and test-retest reliability were observed in the total and the home subscale of the CIQ-R-C. Satisfactory construct validity was shown by the correlation analysis among the CIQ-R-C Scale, SAS/SDS, global QoL, and MSPSS. CONCLUSION: The CIQ-R-C Scale is valid and reliable, and can be used to assess community integration of individuals with spinal cord injury in China.

The Prevalence of and Factors Associated With Anxiety and Depression Among Working-Age Adults in Mainland China at the Early Remission Stage of the Coronavirus 2019 Pandemic.

Background: The Coronavirus 2019 (COVID-19) outbreak has led to a considerable proportion of adverse psychological symptoms in different subpopulations. This study aimed to investigate the status of anxiety and depression and their associated factors in the adult, working-age population in Mainland China at the early remission stage of the COVID-19 pandemic. Methods: An online study was conducted among 1,863 participants in 29 provinces in Mainland China from March 23 to 31, 2020. Their mental health was evaluated by the generalized anxiety disorder scale (GAD-7) and the patient health questionnaire (PHQ-9). Descriptive analysis, Chi-square, and multiple logistic regressions were applied. Results: About 44.5% of the participants had anxiety, 49.2% had depression, and 37.9% showed a combination of depression and anxiety. Around 83.7% of the participants claimed that the pandemic had a negative impact on their medical needs, which was the primary predictor of mental health, the degree of impact being positively related to the prevalence of anxiety and depression. More chronic diseases, moderate to bad self-rated health, severe perceived infection risk, and younger age group were the common risk factors for anxiety and depression. Having no children, unemployment, and a college-level educational background were associated with higher anxiety prevalence, whereas unmarried participants were correlated with higher depression prevalence. Conclusion: The working-age population showed a relatively high risk of anxiety and depression in Mainland China at the early remission stage of the pandemic. To improve medical services capacity for routine and delayed medical service needs should be a part of policy-makers' priority agenda during this period of crisis.

Preliminary validation study of the WHO quality of life (WHOQOL) scales for people with spinal cord injury in Mainland China.

OBJECTIVE: To validate the WHOQOL Scales (WHOQOL-BREF and WHOQOL-DIS module) for people with spinal cord injury in Mainland China. DESIGN: Cross-sectional study. SETTING: Shanghai Sunshine Rehabilitation Center. PARTICIPANTS: 249 adults with SCI who were admitted to a rehabilitation training program between 2017 and 2019. INTERVENTIONS: Not applicable. METHODS: Questionnaires about personal and injury characteristics, the WHOQOL Scales, global QOL, Zung Self-Rating Anxiety/Depression Scale (SAS/SDS), and Community Integration Questionnaire (CIQ) were administrated. Floor and ceiling effects, reliability, and validity analyses were tested. RESULTS: The 8 domains of the WHOQOL Scales showed no floor or ceiling effects. Cronbach alpha values of the WHOQOL-BREF and the WHOQOL-DIS were 0.93 and 0.78, respectively. Test-retest reliability was good for the WHOQOL Scales. Satisfactory criterion-related validity was shown by the correlation analysis among the WHOQOL Scales, SAS/SDS, CIQ, and global QOL. Good item-domain correlations (>0.50) were found for 38 items of the 39-item WHOQOL Scales, excepting the "impact of disability" (0.48) of the WHOQOL-DIS. Confirmatory Factor Analysis (CFA) supported a construct of the WHOQOL-DIS as made of four domains: autonomy, social inclusion, social activities, and discrimination. CFI and RMSEA values were 0.91 and 0.07, respectively, for the four-domain structure WHOQOL-DIS, with a higher-order factor. WHOQOL-BREF domains and WHOQOL-DIS scores showed the predicted pattern among a priori known groups. CONCLUSION: The WHOQOL Scales are valid and reliable, and they can be used to measure QOL in people with SCI in China. We suggest the WHOQOL-DIS be analyzed as one general item constituting a single 12-item domain.

Parents' attitudes as mediators between knowledge and behaviours in unintentional injuries at home of children aged 0-3 in Shanghai, Eastern China: a cross-sectional study.

OBJECTIVE: Parental behaviours are important in preventing unintentional injury at home among young children. Previous research showed an inconsistent relationship between knowledge and behaviours, indicating that the mechanisms may vary for different behaviours. This study aimed to examine the mediating roles of different attitudes in the mechanism of knowledge acting on different behaviours. DESIGN: Cross-sectional study. SETTING: Eastern China. PARTICIPANTS: Participants were recruited using stratified community-based sampling. A total of 488 parents of children aged 0-3 years participated in the study and 476 (97.5%) valid questionnaires were recovered. PRIMARY OUTCOME MEASURES: Parents' knowledge, attitudes (including injury attribution, preventability and responsibility) and behaviours (including supervision behaviours, risky behaviours and providing a safe home environment). RESULTS: The results of mediation analysis showed that the mediator variables were different for different behaviours and that all associations were positive. Parents' knowledge (ß 0.19, 95% CI 0.13 to 0.24) and attitude of injury attribution (ß 0.37, 95% CI 0.21 to 0.46) were directly associated with risky behaviours. Attitude of preventability was directly associated with parents' supervision behaviour (ß 0.27, 95% CI 0.14 to 0.40). Parents' attitude of preventability mediated the positive association between knowledge, attitudes of injury attribution and responsibility, and supervision behaviours, as well as providing a safe home environment. In addition, the occurrence of child injuries at home was directly associated with home environment (ß -0.41, 95% CI -0.82 to -0.01). CONCLUSIONS: The current findings confirm that attitudes play varying mediating roles between knowledge and different behaviours. An important recommendation is that parents' attitudes, especially towards preventability and responsibility, need to be considered when health providers develop health education programmes targeted at improving parental supervision behaviours and providing a safe home environment.

Status and Factors Associated with Healthcare Choices among Older Adults and Children in an Urbanized County: A Cross-Sectional Study in Kunshan, China.

As important unit for regional health planning, urbanized counties are facing challenges because of internal migrants and aging. This study took urbanized counties in China as cases and two key populations as objects to understand different populations' intentions of choosing corresponding health service resources and to provide support for resource allocation. A cross-sectional study was conducted in Kunshan, a highly urbanized county in China, in 2016, among older adults aged 60 or over and children aged 0-6. Multinomial logistics models were used to identify the factors associated with healthcare choices. In this study, we found that income, distance of the tertiary provider, and migrant status were not associated with choices of tertiary healthcare outside county for children, while parents' education level was. The responsiveness of the tertiary provider inside the county was lower than primary and secondary providers inside the county, while respondents were dissatisfied with the medical technology and medical facility for the tertiary inside the county compared to those of the tertiary provider outside the county. Significant differences existed in terms of the perception of different categories of institutions. To conclude, local governments should particularly seek to strengthen pediatric primary health services and improve the responsiveness of healthcare facilities to treat geriatric and pediatric diseases, which also bring significance to the developing countries in the process of urbanization.

Quality of life of adults with chronic spinal cord injury in mainland china: A cross-sectional study.

OBJECTIVE: To evaluate the quality of life of patients with chronic spinal cord injury in mainland China. DESIGN: Cross-sectional study. SUBJECTS: A total of 247 adults ≥ 1 year post-SCI in mainland China. METHODS: The WHOQOL-BREF and WHOQOL-DIS module were used to assess quality of life. Anxiety/depression was measured using the Zung Self-Rating Anxiety/Depression Scale. Quality of life was compared with that of reference populations from China, Korea, etc. Multivariate linear regression was conducted to determine the factors that might be associated with quality of life. RESULTS: The means of the 4 domains of the WHOQOL-BREF varied from 11.5 to 13.0. The mean of the 12-item WHOQOL-DIS module was 38.7. The quality of life of the participants as measured by the WHOQOL-BREF was 1.1-4.7 points lower than that of the global reference population, while quality of life as measured by the WHOQOL-DIS module was 1.2 points lower than that of the Korean data. Anxiety and depression were negative factors associated with quality of life (p < 0.05). Better community integration was a positive factor for physical quality of life and quality of life as measured by the WHOQOL-DIS module (p <0.01). CONCLUSION: The quality of life of adults with chronic spinal cord injury in mainland China was lower compared with reference populations. Duration of spinal cord injury, sex, community integration, anxiety, and depression were related to quality of life.

Effects of a rehabilitation program for individuals with chronic spinal cord injury in Shanghai, China.

BACKGROUND: Specialized Institution-Based Rehabilitation (SIBR) is the cornerstone of care and treatment for individuals with spinal cord injury, but most people with chronic spinal cord injury (CSCI) living in China have no SIBR experience after acute care hospital discharge. In 2009, an SIBR facility was set up in Shanghai (China) to fill this important gap in care. The purpose of the study was to evaluate the effectiveness of an integrated rehabilitation training program among individuals with CSCI living in Shanghai. METHODS: A within-subject pre-posttest design was used to evaluate the SIBR. The sample included 455 individuals ≥1 year post-SCI, who were older than 18 years of age and were enrolled in a rehabilitation center in Shanghai, China, between 2013 and 2019. The data included individuals' sociodemographic and injury characteristics, and twenty-three indicators were used as outcome measurements to evaluate basic life skills and their applications in family and social life. Multivariate linear regression was conducted to determine which factors might have influenced the effectiveness of the SIBR. RESULTS: All basic life skills and their applications in family and social life were improved, but with variations across socio-demographics. Female individuals with CSCI had better outcomes in basic life skills than did males. In terms of basic life skills and their applications in family and social life, individuals with a low level (thoracic or lumbosacral) of injury achieved more significant functional gains than those with a higher level (cervical). The baseline score was also a relevant factor in functional outcome. CONCLUSIONS: Even for individuals with a long SCI history, SIBR training can improve basic life skills and the applications of those skills in family and social life settings.

The effects of two periods of rehabilitation for people with spinal cord injury from Shanghai, China.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate the effects of two periods of rehabilitation among people with spinal cord injury (SCI). SETTING: Shanghai Sunshine Rehabilitation Center (SSRC), China. METHODS: A total of 130 people with SCI who received two periods of rehabilitation participated in the study. Outcome measures included basic life skills (15 items) and their applications in family and social life (8 items). Six factors were identified from the 23 items by factor analysis: self-care and transfer skills; basic life skills application in social life; cognition and emotion; basic life skills application in family life; walking and climbing stairs; and wheelchair skills. Standardized scores ranging from 0 to 100 were used to show the rehabilitation outcome in a histogram. RESULTS: Median scores for self-care and transfer skills, wheelchair skills, cognition and emotion, and their applications in family and social life improved significantly (7-80%, p < 0.01) over the first rehabilitation period, while no improvement was observed in walking and climbing stairs. Five factors showed a significant sustained effect (p < 0.01) upon admission to the second rehabilitation period, except walking and climbing stairs. By enrolling in the second period of rehabilitation, participants acquired significant additional improvement (5-43%, p < 0.01) in rehabilitation outcomes, except in cognition and emotion, walking and climbing stairs. CONCLUSIONS: Two periods of rehabilitation were efficacious at increasing the abilities of basic life skills and their applications in family and social life. The potential benefits of continuous rehabilitation merit further research.

Family-based intervention for patients with type 2 diabetes via WeChat in China: protocol for a randomized controlled trial.

BACKGROUND: China has the largest number of cases of diabetes with a high rate of uncontrolled blood sugar. Many studies show that family members' involvement is related to better glycemic control. However, there is a significant problem with low participation of family members. The widespread use of WeChat provides an opportunity for family members to support their diabetic loved ones in their type 2 diabetes self-management practices. The main aim of this study is to examine the effectiveness of a family-based intervention via WeChat. METHODS: A parallel, two-group, randomized controlled trial will be conducted in the central urban area of Jiading district in Shanghai, China. A total of 222 type 2 diabetics will be randomly divided into an intervention group or a control group using a 1:1 ratio. Patients in the intervention group will receive the usual care, and their family will get education in diabetes control and the importance of family support by subscribing to the WeChat public account. Both the patients and the family members will be followed up at 12 months after the intervention commences. Data collection is scheduled at baseline, 6-months, and 12-months. DISCUSSION: Family involvement based on WeChat may generate ongoing support for type 2 diabetic patients and improve these patients' health outcomes. A successful outcome of this study may also provide inspiration for other efforts to provide health education via WeChat. TRIAL REGISTRATION: ChiCTR1900020736 . Registered 15 January 2019.

Impact evaluation of the routine hepatitis B vaccination program of infants in China.

BACKGROUND: To evaluate the impact of the routine hepatitis B vaccination program of infants in China. METHODS: The incidence of new hepatitis B infection and coverage with three doses of the vaccines by age groups and provinces were derived from the National Network Direct Report System of Infectious Disease during 2004-10. Chi square test and Pearson correlation analysis were used to analyze differences in incidence according to vaccination coverage and the relationship between the coverage with three doses and the incidence in different provinces. RESULTS: The incidence of new infection was 8.96/100 000 among children with complete coverage (0-15 years old), which was significantly lower than that with partial or no coverage. Among 0-9-year-old children in 2010, the incidence of new infection was 6.36/100 000, which was significantly lower than 2004. Considering the impact of vaccination on cumulative incidence among 0-5-year-old children, a 2.2-fold greater incidence of new infection was observed in provinces with the lowest to the highest vaccination rate. CONCLUSION: The impact of the routine hepatitis B vaccination program of infants in China has become more apparent over time. Program implementation and regional disequilibrium should be payed attention to as well as the expanded program.

Does exam-targeted training help village doctors pass the certified (assistant) physician exam and improve their practical skills? A cross-sectional analysis of village doctors' perspectives in Changzhou in Eastern China.

BACKGROUND: Quality of health care needs to be improved in rural China. The Chinese government, based on the 1999 Law on Physicians, started implementing the Rural Doctor Practice Regulation in 2004 to increase the percentage of certified physicians among village doctors. Special exam-targeted training for rural doctors therefore was launched as a national initiative. This study examined these rural doctors' perceptions of whether that training helps them pass the exam and whether it improves their skills. METHODS: Three counties were selected from the 4 counties in Changzhou City in eastern China, and 844 village doctors were surveyed by a questionnaire in July 2012. Chi-square test and Fisher exact test were used to identify differences of attitudes about the exam and training between the rural doctors and certified (assistant) doctors. Longitudinal annual statistics (1980-2014) of village doctors were further analyzed. RESULTS: Eight hundred and forty-four village doctors were asked to participate, and 837 (99.17%) responded. Only 14.93% of the respondents had received physician (assistant) certification. Only 49.45% of the village doctors thought that the areas tested by the certification exam were closely related to the healthcare needs of rural populations. The majority (86.19%) felt that the training program was "very helpful" or "helpful" for preparing for the exam. More than half the village doctors (61.46%) attended the "weekly school". The village doctors considered the most effective method of learning was "continuous training (40.36%)" . The majority of the rural doctors (89.91%) said they would be willing to participate in the training and 96.87% stated that they could afford to pay up to 2000 yuan for it. CONCLUSIONS: The majority of village doctors in Changzhou City perceived that neither the certification exam nor the training for it are closely related to the actual healthcare needs of rural residents. Policies and programs should focus on providing exam-preparation training for selected rural doctors, reducing training expenditures, and utilizing web-based methods. The training focused on rural practice should be provided to all village doctors, even certified physicians. The government should also adjust the local licensing requirements to attract and recruit new village doctors.

Epidemiological study of Spinal Cord Injury individuals from halfway houses in Shanghai, China.

OBJECTIVE: To describe the characteristics of spinal cord injury (SCI) individuals in Shanghai and examine their treatment and rehabilitation for traumatic and complete SCI individuals. DESIGN: Community-based secondary data analyses. SETTING: Shanghai, China. METHODS: We analyzed gender, age at injury, complications, disturbances of function, treatment, etiology, and severity of injury of SCI individuals that enrolled in "halfway houses", government-supported community co-op centers. Bivariate statistical analyses were conducted to examine the factors associated with complete and traumatic SCI. RESULTS: We analyzed 808 SCI individuals who participated in halfway houses in Shanghai during 2009-2015. The male-to-female ratio was 2.1:1. The proportion of middle or elder age groups at injury (age 46 to 60 and age 61 or over) showed a rising trend from 1970 to 2015. The leading causes of SCIs in Shanghai were traumatic injuries (58%), followed by disease (29.5%). The proportion of traumatic injuries decreased over time, while the proportion of non-traumatic injuries rose significantly. A majority of traumatic injury individuals were aged between 16-45. CONCLUSION: The middle or elder age groups at injury among SCI individuals increased continuously from 1970 to 2015. The principal causes of injury in Shanghai were traumatic injuries and disease-related injuries. Men had a higher prevalence of traumatic SCI in Shanghai. Preventive measures should focus on male and middle-aged adults. As a fast-aging society in Shanghai, more effective prevention, medical care, and rehabilitation schemes should be implemented for aging SCI individuals.

ASSESSMENT OF UNIVERSAL NEWBORN HEARING SCREENING AND INTERVENTION IN SHANGHAI, CHINA.

OBJECTIVES: The aim of this study was to evaluate the universal newborn hearing screening (UNHS) and intervention program in Shanghai, China. METHODS: This study included the quantitative analyses of the UNHS-Shanghai database in 2002-12 and qualitative assessment of the program. The Otoacoustic Emissions and the Automated Auditory Brainstem Evoked Responses tests were conducted in screening. The costs and benefits were calculated based on the number of participants in each stage. The short-term and long-term periods were defined as from birth to 15 years of age or to death (82-year-olds), respectively. Sensitivity analyses were conducted. RESULTS: A total 1,574,380 newborns were included, representing 93.6 percent of all eligible babies in Shanghai during the study period. The prevalence of newborn hearing loss was 1.66‰. The short-term/long-term program costs were ¥488.5 million (US$75.52 million)/¥1.08 billion (US$167.12 million), and the short-term/long-term program benefit was ¥980.1 million (US$151.53 million)/¥8.13 billion (US$1.26 billion). The program benefit was greater than its cost if the proportion of hearing-loss children enrolled in regular schools was no less than 41.4 percent of all hearing impaired children, as well as if the wage growth rate ranged from 3 percent to 8 percent. Qualitative results also suggested that stakeholders strongly supported this program. CONCLUSIONS: The universal newborn hearing screening and intervention program in Shanghai is justified in terms of the resource input in the long run, although there is still room for further improvement with respect to educational rehabilitation and a better infrastructure system.

Universal neonatal hearing screening program in Shanghai, China: An inter-regional and international comparison.

OBJECTIVE: By comparing the Universal Neonatal Hearing Screening (UNHS) program as implemented in Shanghai and other regions in China and countries around the world, this study makes an assessment of the Shanghai model and summarizes the experiences implementing the UNHS program, so as to provide a valuable reference for other countries or regions to carry out UNHS more effectively. Since Shanghai is one of the most developed regions in China, we also examined the relationship between economic development and the UNHS starting year and coverage rate. METHODS: The study conducted a systematic review of published studies in Chinese and English on the program status of neonatal hearing screening to compare and analyze the implementation of the UNHS program in 20 cities or provinces in China and 24 regions or countries around the world. The literature search in Chinese was conducted in the three most authoritative publication databases, CNKI (China National Knowledge Infrastructure), WANFANGDATA, and CQVIP (http://www.cqvip.com/). We searched all publications in those databases with the keywords "neonatal hearing screening" (in Chinese) between 2005 and 2014. English literature was searched using the same keywords (in English). The publication database included Medline and Web of Science, and the search time period was 2000-2014. RESULTS: Shanghai was one of the first regions in China to implement UNHS, and its coverage rate was among the top regions by international comparison. The starting time of the UNHS program had no relationship with the Gross Domestic Product (GDP) per capita in the same year. Economic level serves as a threshold for carrying out UNHS but is not a linear contributor to the exact starting time of such a program. The screening coverage rate generally showed a rising trend with the increasing GDP per capita in China, but it had no relationship with the area's GDP per capita in selected regions and countries around the world. The system design of UNHS is the key factor influencing screening coverage. Policy makers, program administrators, and cost-sharing structures are important factors that influence the coverage rates of UNHS. CONCLUSION: When to carry out a UNHS program is determined by the willingness and preference of the local government, which is influenced by the area's social, political and cultural conditions. Mandatory hearing screening and minimal-cost to no-cost intervention are two pillars for a good coverage rate of UNHS. In terms of system design, decision-making, implementation, funding and the concrete implementation plan are all important factors affecting the implementation of the UNHS.

Effects of China's New Rural Cooperative Medical Scheme on reducing medical impoverishment in rural Yanbian: An alternative approach.

BACKGROUD: This study aimed to measure the poverty head count ratio and poverty gap of rural Yanbian in order to examine whether China's New Rural Cooperative Medical Scheme has alleviated its medical impoverishment and to compare the results of this alternative approach with those of a World Bank approach. METHODS: This cross-sectional study was based on a stratified random sample survey of 1,987 households and 6,135 individuals conducted in 2008 across eight counties in Yanbian Korean Autonomous Prefecture, Jilin province, China. A new approach was developed to define and identify medical impoverishment. The poverty head count ratio, relative poverty gap, and average poverty gap were used to measure medical impoverishment. Changes in medical impoverishment after the reimbursement under the New Rural Cooperative Medical Scheme were also examined. RESULTS: The government-run New Rural Cooperative Medical Scheme reduced the number of medically impoverished households by 24.6 %, as well as the relative and average gaps by 37.3 % and 38.9 %, respectively. CONCLUSIONS: China's New Rural Cooperative Medical Scheme has certain positive but limited effects on alleviating medical impoverishment in rural Yanbian regardless of how medical impoverishment is defined and measured. More governmental and private-sector efforts should therefore be encouraged to further improve the system in terms of financing, operation, and reimbursement policy.

An evaluation of China's new rural cooperative medical system: achievements and inadequacies from policy goals.

BACKGROUND: Although much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. The purpose of this study is to examine to what extent the policy goals of NRCMS have been achieved. METHODS: Using multistage sampling processes, two rounds of cross-sectional household surveys including 9787 and 7921 rural households were conducted in Eastern China in year 2000 and year 2008, respectively. A pre- and post-implementation comparison was used to evaluate the achievement of policy goals in three measures: impoverishment from major health hazards, household financial risk from medical expenses, and rural income inequity. Intention surveys were also applied to find out potential obstacles in the implementation of NRCMS. RESULTS: The rate of re-impoverishment from health hazard was reduced from 2.69 % ex ante to 2.12 % ex post, a decrease of 21.13 %. The severity of impoverishment fell from a previous 4.66 % to 3.02 %, a decline of 35.18 %. Economic risk of medical treatment population relative to the whole population fell from 2.62 ex ante to 2.03 ex post, a 22.52 % reduction. As indication of effect on improving income equity, the Gini coefficient fell from 0.4629 to 0.4541. The effects of NRCMS were significantly better than those of RCMS. Despite the preliminary achievements, our intention survey of key respondents identified that technical difficulties in actuarial funding and more sustainable reimbursement schedules has become the most challenging barriers in achieving the goals of NRCMS, while raising the insurance premium on NRCMS was no longer as big a barrier. CONCLUSIONS: With NRCMS, China has established a medical security system to reduce the financial burden of healthcare on rural residents. NRCMS has achieved some positive though limited effects; but technical difficulties in the implementation of NRCMS have become barriers to achieve the pre-set policy goals. Efforts should be made to improve the capacity building in the design of the reimbursement schemes for the implementers of NRCMS, such as identifying medical impoverishment, calculating actuarial funding levels for the risk pooling.

Factors impacting the use of antenatal care and hospital child delivery services: a case study of rural residents in the Enshi Autonomous Prefecture, Hubei Province, China.

This study was undertaken to understand the factors that impact whether rural women obtain antenatal care (ANC) and choose to use hospital delivery services in central and western China. We chose to conduct field research with the rural residents in Hubei Province through a combination of random sampling and purposive sampling methods. A mixed method approach was taken to analyze the factors impacting the use of ANC and hospital delivery services from the perspective of the villagers. Our results indicate that the quality of the available ANC services is poor. In particular, women who have special circumstances and unplanned pregnancies or who become pregnant prior to marriage are confronted with inadequate ANC and hospital child delivery services. The factors that impact whether women use or not use ANC and hospital delivery services and that cause women to choose hospital or home delivery can be understood at three levels: macro, middle, and micro. We strongly suggest that the policies and projects that promote maternal healthcare in rural areas be sustained with an added focus on including women with special circumstances. Village doctors can be enlisted to regularly visit pregnant women at home and to provide extra explanation about the ANC services available and the purpose of maternal healthcare. These findings and suggestions can be used by local health providers and decision-makers to improve the quality of ANC and hospital delivery services.

Understanding the shortage of village doctors in China and solutions under the policy of basic public health service equalization: evidence from Changzhou.

As the most important public health service providers in rural China, village doctors are facing a new challenge of heavier workload resulting from the recent policy of public health service equalization. Studies on the shortage of village doctors, mainly based on the national statistics, have so far been very broad. This study conducted detailed field surveys to identify specific factors of and potential solutions to the shortage in village doctors. Eight hundred forty-four village doctors and 995 health decision makers and providers were surveyed through a questionnaire, and some of them were surveyed by in-depth face-to-face interviews and focus group interviews. Opinions on the shortage in village doctors and the potentially effective approaches to addressing the problem were sought. Some village doctors (51.3%) were at least 50 years old. Some village doctors (92.3%) did not want their children to become a village doctor, and the main reasons were "low salary" and "lack of social security". Village doctors felt that it was difficult to provide all the required public health services. Local residents indicated that they established good relationships with village doctors. Some health decision makers and providers (74.0%) thought that they needed more village doctors. The shortage in village doctors presents a major obstacle toward the realization of China's policy of public health service equalization. The aging of current village doctors exacerbates the problem. Policies and programs are needed to retain the current and attract new village doctors into the workforce. Separate measures are also needed to address disparities in socioeconomic circumstance from village to village.

The impact of the major causes of death on life expectancy in China: a 60-year longitudinal study.

BACKGROUND: In the 12th Five-Year Plan, the Chinese government set the goal of increasing life expectancy by one year. The purpose of this study is to examine the impact of major causes of death on the life expectancy of the Chinese people between 1950 and 2010 and predict changing trends to identify major issues requiring future attention. METHODS: A continuous database organised by population and death data on diseases by age group between 1950 and 2010 were created from A Province in Eastern China. The diseases were classified into four categories by the International Classification of Diseases-10 (ICD-10): infectious and parasitic diseases, chronic diseases, accidental injuries, and maternal diseases. Potential gains in life expectancy (PGLEs) were applied to reflect the impact on life expectancy caused by deaths from various diseases, by using the cause-eliminated life table. RESULTS: The PGLEs of infectious and parasitic diseases decreased from 15.59 years in 1950, to 0.07 year in 2010, and have remained low since 2000. However, the PGLEs of chronic diseases increased from 8.70 years in 1950, to 13.36 years in 2010, and indicated an increasing future trend. The two opposite trends exhibited a 'scissors-like difference'. The proportion of accidental injuries and maternal diseases in the death spectrum was low. The PGLEs of accidental injuries decreased from 2.95 years in 1950, to 0.86 year in 2010, maintaining a low level, while the PGLEs of maternal diseases dropped from 0.56 to 0.002 year during the same period, approaching zero. CONCLUSIONS: The findings of this study provide useful information, which could contribute to a more effective allocation of public health programmes. In recent years, chronic diseases and accidental injuries have emerged as major factors influencing life expectancy. Primary and secondary prevention actions, such as public education, modification of behaviours, and introduction of safety measures should be emphasised in efforts to promote life expectancy. The morbidity and mortality rates of infectious, parasitic, and maternal diseases should be maintained at low levels.

Acquired immunodeficiency syndrome/human immunodeficiency virus knowledge, attitudes, and practices, and use of healthcare services among rural migrants: a cross-sectional study in China.

BACKGROUND: Today's rapid growth of migrant populations has been a major contributor to the human immunodeficiency virus (HIV) epidemic. However, relatively few studies have focused on HIV/acquired immunodeficiency syndrome (AIDS)-related knowledge, attitudes, and practice among rural-to-urban migrants in China. This cross-sectional study was to assess HIV/AIDS-related knowledge and perceptions, including knowledge about reducing high-risk sex. METHODS: Two-phase stratified cluster sampling was applied and 2,753 rural migrants participated in this study. An anonymous self-administered questionnaire was conducted in Guangdong and Sichuan provinces in 2007. Descriptive analysis was used to present the essential characteristics of the respondents. Chi-square test and multiple logistic regression models were performed to examine the associations between identified demographic factors and high-risk sex, sexually transmitted disease (STD) symptoms, and access to HIV screening services among the seven types of workers. RESULTS: 58.6% of participants were knowledgeable about HIV/AIDS transmission, but approximately 90% had a negative attitude towards the AIDS patients, and that 6.2% had engaged in high-risk sex in the past 12 months. Logistic regression analysis revealed sex, marital status, income, migration and work experience to be associated with high-risk sex. Among the 13.9% of workers who reported having STD symptoms, risk factors that were identified included female gender, high monthly income, being married, daily laborer or entertainment worker, frequent migration, and length of work experience. Only 3% of migrant workers received voluntary free HIV screening, which was positively associated with monthly income and workplace. CONCLUSIONS: HIV/AIDS knowledge, attitudes, and practices among rural migrants in China remain a thorny health issue, and use of healthcare services needs to be improved. Low levels of education and knowledge regarding HIV/AIDS among housekeepers and migrant day laborers result in this population likely being engaged in high-risk sex. Government programs should pay more attention to public education, health promotion and intervention for the control of the HIV/AIDS epidemic in China.