Association between sleep quality and living environment among Chinese older persons: a cross-sectional study.

Sleep quality significantly affects the quality of life of older persons. Therefore, this study explored the relationship between sleep quality and living environment of older persons in China to provide a theoretical basis for therapies to alleviate sleep disorders in older persons. A total of 6211 subjects > 60 years of age in Anhui Province, China, were evaluated using the Pittsburgh Sleep Quality Index and a self-reported questionnaire. Multivariate logistic regression analysis revealed that living alone (OR = 1.26, 95% CI 1.09-1.46) and living in a rural area (OR = 1.19, 95% CI 1.06-1.34) were significantly associated with a high incidence of sleep disorders in older persons. Living near a park or foot paths suitable for exercise or walking was significantly associated with a lower incidence of sleep disorders in older persons (OR = 0.87, 95% CI 0.77-0.96). Individual factors such as female sex (OR = 1.30, 95% CI 1.14-1.48) and depression (OR = 2.80, 95% CI 2.47-3.19) were also associated with sleep quality in older persons. These data indicate a correlation exists between living environment and sleep quality.

Impact of work-family support on job burnout among primary health workers and the mediating role of career identity: A cross-sectional study.

Objective: In China, medical workers in the primary sector shoulder the task of providing people with the basic medical and public health services, and are the "gatekeepers" of the public health. This study aims to analyze the current situation of job burnout among primary health workers of China, and shed light on the effect of work-family support and career identity on job burnout among them and their relationships. This may provide a new perspective for primary health care institutions and health administrative departments so as to formulate policies to "attract, retain and stabilize" primary health workers. Methods: A multi-stage sampling method was adopted to select 8,135 primary health workers from 320 primary health care institutions in a province of central China. A descriptive statistical analysis, univariate analysis, Pearson correlation analysis, and mediation effect analysis were applied to analyze the effects of work-family support and career identity on job burnout among primary health workers as well as the mediating role of career identity. Results: Among 8,135 primary health workers, 4,911 (60.4%) participants had mild to moderate levels of job burnout, 181 (2.2%) participants had severe job burnout, and the burnout detection rate is 62.6%. Work-family support was negatively correlated with job burnout (r = -0.46, p < 0.01) and positively correlated with career identity (r = 0.42, p < 0.01). Work-family support (ß = -0.346, p < 0.01) and career identity (ß = -0.574, p < 0.01) were negative predictors of job burnout respectively. In addition, career identity had a mediating effect between work-family support and job burnout, with the mediating effect contributing 33.7% to the overall effect. Conclusions: The findings of this study demonstrate that work-family support is a protective factor against job burnout in primary health workers and reveal that career identity is a critical mediating mechanism linking work-family support to burnout. We propose to reduce job burnout by strengthening work-family support (especially work support), enhancing career identity, increasing the number of primary health workers and reducing the workload of existing incumbents, which can provide important practical implications for the future prevention and intervention programs.

Factors influencing self-care behaviours of patients with type 2 diabetes in China based on the health belief model: a cross-sectional study.

OBJECTIVES: The study aimed to explore the status and predictors of self-care behaviours in patients with type 2 diabetes in China based on the health belief model. DESIGN: The cross-sectional study included 1140 patients aged ≥36 years with type 2 diabetes who had established health records in community health service institutions. A questionnaire was designed based on the health belief model, which mainly included perceived susceptibility, severity, benefits, barriers, effectiveness, sociodemographic characteristics and self-care behaviours. SETTING: Using a multistage sampling method, 36 villages and communities were randomly selected in China. PARTICIPANTS: A total of 1260 patients with type 2 diabetes were contacted, but 118 refused to participate in the study. Of the 1142 participants, two were subsequently excluded, and the final number of participants included in the study was 1140 (90.5% response rate). RESULTS: The average score of health beliefs was 0.71 (SD=0.08). The logistic regression analysis showed that sex, region, perceived severity, perceived barriers and perceived benefits were related to self-care behaviours. CONCLUSIONS: Perceived severity, benefits and barriers were key factors affecting self-care behaviours in patients with type 2 diabetes; health education for patients should be strengthened to improve the self-care level of patients with diabetes.

Experiences and Challenges of Implementing Universal Health Coverage With China's National Basic Public Health Service Program: Literature Review, Regression Analysis, and Insider Interviews.

BACKGROUND: Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China's National Basic Public Health Service Program (the Program) is highly consistent with this direction. OBJECTIVE: The aim of this study was to analyze the key experience and challenges of the Program so as to present China's approach to UHC, help other countries understand and learn from China's experience, and promote UHC across the world. METHODS: A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders. RESULTS: The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively. CONCLUSIONS: The Program has made a significant contribution to China's efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes.

Overexpression of lncRNA IRAIN restrains the progression and Temozolomide resistance of glioma via repressing IGF-1R-PI3K-NF-κB signaling pathway.

BACKGROUND: Increasing studies have found that long noncoding RNAs (lncRNAs) contribute to regulating tumor progression. This study explores the expression characteristics, effects, and related mechanisms of lncRNA IGF1R antisense imprinted non-protein coding RNA (IRAIN) in glioma. METHODS: Quantitative real-time PCR (qRT-PCR) was implemented to testify the IRAIN profile in glioma tissues and paracancerous tissues, and the link between the IRAIN level and the clinicopathological indicators of glioma was analyzed. IRAIN overexpression and knockdown cell models were constructed in glioma cells. Cell proliferation was verified by the colony formation experiment, while flow cytometry was implemented to monitor apoptosis. Transwell assay was performed to examine cell invasion and migration. Western blot (WB) was adopted to compare the profiles of the apoptosis-related proteins (Bax, Bcl2, and Caspase3) and IGF-1R-PI3K-NF-κB pathway. RESULTS: IRAIN was down-regulated in glioma tissues (compared with adjacent normal tissues), and the low IRAIN expression was significantly linked with the larger tumor volume and higher pathological stages. Functionally, overexpressing IRAIN abated glioma cell proliferation, invasion, and migration, promoted apoptosis, and attenuated IGF-1R-PI3K-NF-κB expression and temozolomide (TMZ) resistance, which was also confirmed in the xenograft tumor experiment. The WB result showed that overexpressing IRAIN inactivated the IGF-1R-PI3K-NF-κB pathway. Additionally, the IGF-1R knockdown model was established in U251 cells. Si-IGF-1R induced cell proliferation inhibition, promoted cell death, and reduced cell migration and TMZ resistance, whereas Si-IGF-1R+IRAIN group showed no additional effects on glioma cells compared with the Si-IGF-1R group. CONCLUSION: IRAIN repressed glioma development and TMZ resistance by inactivating the IGF-1R-PI3K-NF-κB axis.

The development and reform of public health in China from 1949 to 2019.

BACKGROUND: Public health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China. METHODS: The study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents. RESULTS: This study identified four key stages that public health experienced in China: the initial stage centering on prevention, the stage of deviation with more attention to treatment but little to prevention, the recovery stage after SARS(Severe Acute Respiratory Syndromes) Crisis, and the new stage to an equitable and people-centered system. In the latest stage, the National Basic Public Health Service Program (NBPHSP) is implemented to respond the threat of noncommunicable diseases (NCDs) and has achieved some initial results, while there are still many challenges including service quality, poor integration among service items and IT system, lack of quality professionals and insufficient intersectoral endeavor. DISCUSSION: There are unique Chinese wisdom and remarkable achievements as well as twists and turns on the development of China's public health. Prevention-first, flexible structure of the system, multi-agency collaboration and mass mobilization and society participation are the main experience of public health in early stage. Despite twists and turns since 1980s, public health system in China shows substantial resilience which may be from the government's continuous commitment to social development and people's livelihoods and its flexible governance. In 2010s, in order to achieve the well-off society, Chinese government pays unprecedented attention to health sector, which bring a new wave of opportunities to public health such as remaining the NBPHSP for priority. The evolution and reform of China's public health is based on its national condition, accumulates rich experience but also faces many common worldwide challenges. Getting this development and reform right is important to China's social and economic development in future, and China's experience in public health may provide many lessons for other countries. CONCLUSION: Public health in China needs to focus on prevention, strengthen multi-agency coordination mechanism, improve the quality of public health services in the future.

E-learning for grass-roots emergency public health personnel: Preliminary lessons from a national program in China.

In China, grass-roots emergency public health personnel have relatively limited emergency response capabilities and they are constantly required to update their professional knowledge and skills due to recurring and new public health emergencies. However, professional training, a principal solution to this problem, is inadequate because of limitations in manpower and financial resources at grass-roots public health agencies. In order to provide a cost-effective and easily expandable way for grass-roots personnel to acquire knowledge and skills, the National Health Planning Commission of China developed an emergency response information platform and provided trial access to this platform in Anhui and Heilongjiang provinces in China. E-learning was one of the modules of the platform and this paper has focused on an e-learning pilot program. Results indicated that e-learning had satisfactorily improved the knowledge and ability of grass-roots emergency public health personnel, and the program provided an opportunity to gain experience in e-course design and implementing e-learning. Issues such as the lack of personalized e-courses and the difficulty of evaluating the effectiveness of e-learning are topics for further study.

Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China.

BACKGROUND: Improving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China's healthcare sector reform in China. OBJECTIVES: This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution. METHODS: Benefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews. RESULTS: High-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and -0.0273 [95% CI, -0.1702 to 0.1156] in 2007). CONCLUSIONS: Our study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.