Effect of no eyeglasses sales on the quality of eye care: an experimental evidence from China.

BACKGROUND: Eye examinations and eyeglasses acquisition are typically integrated into a cohesive procedure in China. We conducted a randomized controlled trial using incognito standardized patient (SP) approach to evaluate the impact of separating eyeglasses sales on the accuracy of final prescription. METHODS: 52 SPs were trained to provide standardized responses during eye examinations, and undergoing refraction by a senior ophthalmologist at a national-level clinical center. SPs subsequently received eye examinations at 226 private optical shops and public hospitals in Shaanxi, northwestern China. The visits were randomly assigned to either control group, where SPs would typically purchase eyeglasses after refraction, or treatment group, where SPs made an advance declaration not to purchase eyeglasses prior to refraction. The dioptric difference between the final prescriptions provided by local refractionists and expert in the better-seeing eye was determined using the Vector Diopteric Distance method, and the completeness of exams was assessed against national standards. Multiple regressions were conducted to estimate the impact of no eyeglasses sales on the accuracy of the final prescription of local refractionists, as well as the completeness of examinations. RESULTS: Among 226 eye exams (73 in public hospitals, 153 in private optical shops), 133 (58.8%) were randomized to control group and 93 (41.2%) to no eyeglasses sales group. The inaccuracy rate of final prescriptions provided by local refractionists (≥ 1.0 D, experts' final prescription as the reference) was 25.6% in control group, while 36.6% in no-sale group (P = 0.077). The likelihood of providing inaccurate final prescriptions was significantly higher in no-sale group compared to control group (OR = 1.607; 95% CI: 1.030 to 2.508; P = 0.037). This was particularly evident in private optical shops (OR = 2.433; 95% CI: 1.386 to 4.309; P = 0.002). In terms of process quality, the no-sale group performed significantly less subjective refraction (OR = 0.488; 95% CI: 0.253 to 0.940; P = 0.032) and less testing SP's own eyeglasses (OR = 0.424; 95% CI: 0.201 to 0.897; P = 0.025). The duration of eye exams was 3.917 min shorter (95% CI: -6.798 to -1.036; P = 0.008) in no-sale group. CONCLUSIONS: Separating eyeglasses sales from optical care could lead to worse quality of eye care. Policy makers should carefully consider the role of economic incentives in healthcare reform.

Beyond mothers: the crucial role of family caregivers' knowledge on exclusive breastfeeding in rural western China.

BACKGROUND: The exclusive breastfeeding rate in China remains significantly low. Numerous studies have identified the impact of maternal characteristics on exclusive breastfeeding; however, the correlation between primary family caregivers' characteristics, such as health and nutrition knowledge, and exclusive breastfeeding still lacks clarity. The aim of this study is to investigate the association between the health and nutrition knowledge of primary family caregivers and exclusive breastfeeding in rural China. METHODS: In 2019, a cross-sectional study was conducted in two prefectures within the Qinba Mountains area, located in the southern region of Shaanxi province. Data on knowledge of health and nutrition, breastfeeding practices, breastfeeding family support, breastfeeding self-efficacy, and conflict frequency were collected via structured questionnaires from 372 caregiver-infant pairs. Infant feeding practices were assessed based on the caregivers' recall of the previous day (within the 24 h before the interview). The mother was interviewed first, followed by a brief questionnaire for the primary family caregiver, both conducted individually to minimize disruptions from other family members. Univariate and multivariate regression analyses were conducted to explore the correlation between knowledge of mothers and primary family caregivers and exclusive breastfeeding. RESULTS: The exclusive breastfeeding rate for six-month-old infants in the sample was 15.7%. On average, mothers scored 4.6 (SD 1.4) for health and nutrition knowledge, while primary family caregivers scored 3.6 (SD 1.4). Both maternal (OR 1.48; 95% CI 1.16, 1.88) and primary family caregiver's (OR 1.34; 95% CI 1.05, 1.70) health and nutrition knowledge were significantly associated with exclusive breastfeeding. A positive correlation (OR 1.98; 95% CI 1.40, 2.80) existed between the average health and nutrition knowledge of the mother and primary family caregiver and exclusive breastfeeding. The primary family caregiver's health and nutrition knowledge was positively correlated with the practical family support perceived by the mother (OR 1.23; 95% CI 1.02, 1.49) and breastfeeding self-efficacy of the mother (ß = 1.40; 95% CI 0.29, 2.50). CONCLUSIONS: The characteristics of the primary family caregiver play a large role in exclusive breastfeeding. To promote exclusive breastfeeding, interventions should address the needs of the whole family instead of just mothers.

Unraveling controversies over civic honesty measurement: An extended field replication in China.

Cohn et al. (2019) conducted a wallet drop experiment in 40 countries to measure "civic honesty around the globe," which has received worldwide attention but also sparked controversies over using the email response rate as the sole metric of civic honesty. Relying on the lone measurement may overlook cultural differences in behaviors that demonstrate civic honesty. To investigate this issue, we conducted an extended replication study in China, utilizing email response and wallet recovery to assess civic honesty. We found a significantly higher level of civic honesty in China, as measured by the wallet recovery rate, than reported in the original study, while email response rates remained similar. To resolve the divergent results, we introduce a cultural dimension, individualism versus collectivism, to study civic honesty across diverse cultures. We hypothesize that cultural differences in individualism and collectivism could influence how individuals prioritize actions when handling a lost wallet, such as contacting the wallet owner or safeguarding the wallet. In reanalyzing Cohn et al.'s data, we found that email response rates were inversely related to collectivism indices at the country level. However, our replication study in China demonstrated that the likelihood of wallet recovery was positively correlated with collectivism indicators at the provincial level. Consequently, relying solely on email response rates to gauge civic honesty in cross-country comparisons may neglect the vital individualism versus collectivism dimension. Our study not only helps reconcile the controversy surrounding Cohn et al.'s influential field experiment but also furnishes a fresh cultural perspective to evaluate civic honesty.

The compliance of free folic acid supplements among pregnant women in rural areas of Northwestern China: The role of related knowledge.

Background: High prevalence of neural tube defects remains one of the major threats to newborns in rural China. Folic acid supplementation before and during early pregnancy can effectively reduce the risk of neural tube defects. Despite the efforts of the free folic acid mass distribution, the actual usage of folic acid supplements was still suboptimal among rural pregnant women in China. The objective of this study is to investigate if and how knowledge can influence the picking up and intake of the free folic acid supplements distributed by the government. Methods: We collected survey data from 821 pregnant women in rural areas of Shaanxi, China, in March and December of 2021. Face-to-face interviews and questionnaire surveys were conducted with every participant. Univariate and multivariate logistic regression analyses were performed to test the relationship between knowledge and dependent variables. Results: Our study found that there were 76.4% of pregnant women would pick up folic acid supplements distributed by the government and only 44.5% of women would use folic acid before current pregnancy. Awareness of folic acid policy both affects the picking up (OR: 6.708, 95% CI: 4.672-9.632) and periconceptional intake (OR: 1.912, 95% CI:1.326-2.758) of folic acid supplements. Knowledge of health and nutrition in pregnancy showed no significant relationship with the picking up and periconceptional intake of folic acid supplements but was positively associated with the intake duration (Coefficient: 9.278, 95% CI: 2.966-15.591). Conclusion: Despite the relatively high level of picking up, the actual folic acid usage was not ideal among pregnant women in rural areas of China. Folic acid policy awareness was positively associated with the picking up and intake of folic acid before and during conception. Knowledge of health and nutrition about pregnancy was related to a longer duration of folic acid intake but had no impact on the picking up rate and periconceptional intake of folic acid supplements.

Exclusive breastfeeding in rural Western China: does father's co-residence matter?

BACKGROUND: China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father's co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father's co-residence and breastfeeding family support as well as maternal decision-making power. METHODS: A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding. RESULTS: The exclusive breastfeeding (0-6 months) rate was 16% in rural western China. Fathers' co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227-0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (ß =0.109, P = 0.105; ß =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (ß = - 0.196, P = 0.007). CONCLUSIONS: Fathers' co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father's education to help them better involvement and show more respect to mothers' decisions.

Using incognito standardised patients to evaluate quality of eye care in China.

BACKGROUND/AIMS: Few studies have objectively examined the quality of eye care in China. We assessed refractive care using the incognito standardised patient (SP) approach, a gold standard for evaluating clinical practice. METHODS: A total of 52 SPs were trained to provide standardised responses during eye examinations, and underwent automated and non-cycloplegic, subjective refraction by a senior ophthalmologist from Zhongshan Ophthalmologic Center, a national-level clinical and research centre. SPs subsequently received subjective refraction and eye exams at a randomly selected sample of 40 public hospitals and 93 private optical shops in Shaanxi, Northwestern China. Difference between expert and local refraction in the better-seeing eye was calculated by the vector diopteric method, and completeness of exams assessed against national standards. SP and provider demographic information and provider clinical experience were recorded. RESULTS: SPs (n=52, mean (range) age, 25.7 (22-31) years, 28.8% male) underwent 133 eye exams (mean total duration 15.0±11.7 min) by 133 local refractionists (24-60 years, 30.3% male). Only 93 (69.9%), 121 (91.0%) and 104 (78.2%) of local refractionists assessed vision, automated and subjective refraction, respectively. The median inaccuracy was -0.25 diopters (D), while 25.6% of results differed by an absolute value of ≥1.0 D and 6.0% by ≥2.0 D. Predictors of inaccurate refraction included spectacle power <-6.0 D (OR=2.66; 95% CI, 1.27 to 5.56), service at a public (vs private) hospital (OR=2.01; 95% CI, 1.11 to 3.63) and provider male sex (OR=2.03; 95% CI, 1.11 to 3.69). CONCLUSION: Inaccurate refractions are common in Northwestern China, particularly in public facilities. Important assessments, including subjective refraction, are frequently omitted.

Regularity of Clinical Visits and Medication Adherence of Patients with Hypertension or Diabetes in Rural Yunnan Province of China.

Chronic diseases can be controlled through effective self-management. The purpose of this study is to explore the regularity of clinical visits and medication adherence of patients with hypertension or diabetes (PWHD), and its association with the first experience with care and individual factors in rural Southwestern China. This cross-sectional study was carried out in Yunnan province in 2018 and recruited 292 PWHD and 122 village clinics from 122 villages in 10 counties. Participants were interviewed using a structured questionnaire. Results show around 39% of hypertensive and 25% of diabetic patients neither visited physicians nor took medicine regularly during the preceding three months of the interview date. The regression results further indicated that individual characteristics of the PWHD, including patient age, health status, and economic level, as well as their first experience with care, were significantly associated with their regular healthcare behavior. In addition to providing medical services, on average each sample village clinic, with around two physicians, simultaneously managed 180 hypertensive and 45 diabetic patients. This study revealed the need for further reforms in terms of improving self-management and thus recommends an increase in the quantity and the quality of human resources in the primary healthcare realm in rural China.

Associations between Maternal and Infant Illness and the Risk of Postpartum Depression in Rural China: A Cross-Sectional Observational Study.

This study explored how maternal and infant illness correlated with the risk of postpartum depression in the Chinese Qinba Mountains region. In total, 131 villages comprising 435 families with infants (≤6 months old) were randomly sampled. We collected data on maternal and infant illnesses and maternal health knowledge level. The Depression, Anxiety, and Stress Scale-21 was used to measure the risk of postpartum depression. We used descriptive statistics and multivariate logistic regression for the analysis. Infant overall health status was a risk factor for postpartum depression (odds ratio (OR) = 1.90, 95% Confidence Interval (95% CI) = 1.10~3.28), whereas maternal overall health status was not correlated with postpartum depression (OR = 1.36, 95% CI = 0.55~3.39). For specific illnesses, infants experiencing over two common illnesses in the past two weeks (OR = 1.98, 95% CI = 1.13~3.45) and mothers experiencing over two common pains within two weeks after delivery (OR = 1.77, 95% CI = 1.02~3.08) were risk factors for postpartum depression, whereas infants with mild and severe stunted growth, maternal C-section, and postpartum body mass index (normal or overweight) were not correlated with it (all p > 0.050). Maternal health knowledge was an important moderator of maternal and infant illnesses on the risk of postpartum depression. In conclusion, maternal and infant illness were essential factors for the risk of postpartum depression in a poor rural region in western China, which may be mainly affected by the feeling of uncertainty of illness. Improved maternal and infant health and enhanced maternal health knowledge might alleviate the risk of postpartum depression.

What Can Children Learn from a Free Trial of Eyeglasses Use? Evidence from a Cluster­Randomized Controlled Trial in Rural China.

Free trial is a widely used business strategy that takes advantage of information asymmetry. However, evidence on what we can learn and how rapidly we can learn from a free trial of health care is limited. This study evaluates the effect of a free trial of eyeglasses on children's 8 items of perception related to eyeglasses use. An evaluation was conducted alongside a cluster-randomized controlled trial involved 832 myopic children from northwest rural China. A total of 428 myopic children from 42 schools were randomized to receive free eyeglasses, and 404 myopic children from 42 schools were randomized as control group. We find that the perceived costs and benefits of eyeglasses use and the perceived timing of wearing eyeglasses at the appropriate time can be learned from a free trial of eyeglasses. Compared with the control group in the long run, 5.6 percentage points more children in treatment group agreed that wearing eyeglasses was attractive, 16.5 percentage points more children agreed that wearing eyeglasses is helpful to academic performance, and 7.9 percentage points more children agreed that children with vision problems should wear eyeglasses. Due to the effects of a free product and the time to learning from experience, the magnitude of the impact of a free trial changed over time. We also find that the indirect experience, such as a vision protection course, cannot change children' perceptions about the cost or benefits of eyeglasses use. The findings imply that children can learn significantly from the experience of a free trial of eyeglasses. A free trial is an effective strategy to solve the information asymmetry problem for health care. The first pair of eyeglasses of children can be one-off subsidized to trigger demand for eyeglasses use.

[Association between the introducing time of complementary food and growth of infants and young children in poor rural areas in Shaanxi Province].

OBJECTIVE: To study the introducing time of complementary food in poor rural areas and its association with the growth of infants and young children. METHODS: In total of 1802 infants and young children aged 6-12 months from 11 poverty counties in southern Shaanxi Province were selected by stratified random cluster sampling. These infants were surveyed four times, and once every 6 months. Data on complementary feeding for children were collected through the questionnaires. Cognitive development was measured by BSID. Body weight and length for them were measured using standard gauges to generate height for age Z score( HAZ), weight for age Z score( WAZ) and weight for height Z score( WHZ). The analysis of variance was used to identify the association between the introducing time of complementary food and growth of children. RESULTS: at baseline, only 32. 93% of children were introduced complementary food at the age of 6 months. This study indicated that the introducing time of complementary food was significantly associated with the cognitive development in the longer run. The third and fourth survey showed that children with introducing complementary food after 6 months of age( mental development index were 81. 24 and78. 40 respectively) had significantly lower cognitive development ability( F = 11. 86, P<0. 05; F = 4. 24, P< 0. 05). There were no long-term significant correlation between the introducing time of complementary food and WAZ, HAZ and WHZ. CONCLUSION: There are still lots of children that were not feeding reasonably in poor rural China. The introducing time of complementary food is related to growth of infants and young children.

Correlation analysis between adolescent cognitive ability and health risk behaviors / 中国学校卫生

Objective@#To explore the status of adolescents’ health risk behaviors, relationship between cognitive ability and health risk behaviors, and provide an empirical reference for reducing the occurrence and early prevention of health risk behaviors among adolescents.@*Methods@#Samples were extracted by hierarchical, multi-stage, probability and scale proportional (PPS) methods. There were 112 schools randomly selected from 28 county-level regions(county, district, city), and 19 487 students were investigated by baseline survey, a follow-up study was conducted among 8 636 students during 2014-2015. Descriptive statistical methods of using 2 test and t test, and logistic multivariate regression analysis were used to analyze the relationship between cognitive abilities and healthy risk behaviors.@*Results@#The reported rate of a healthy risk behavior was 20.77%, and the incidence of more than one type of health risk behavior was 16.03%. The student’s cognitive ability standardized score was(0.33±0.82). The average score of cognitive ability of adolescents with healthy risk behavior was 0.14, which was lower than the average score of cognitive ability of adolescents without healthy risk behaviors(0.43). Boys, having rural household registeration, non-residential schools, and parents with low education levels adolescents were more likely to be involved in health behavior risks. There was a significant correlation between adolescent cognitive ability and healthy risk behavior(OR=0.67, P<0.01).@*Conclusion@#The current status of adolescent health risk behaviors is worrying. The cognitive ability has a significant impact on health risk behaviors. It is recommended to use the cognitive ability of adolescents as a starting point to prevent and reduce the occurrence of adolescent health risk behaviors.

The Quality of Tuberculosis Care in Urban Migrant Clinics in China.

Large and increasing numbers of rural-to-urban migrants provided new challenges for tuberculosis control in large cities in China and increased the need for high quality tuberculosis care delivered by clinics in urban migrant communities. Based on a household survey in migrant communities, we selected and separated clinics into those that mainly serve migrants and those that mainly serve local residents. Using standardized patients, this study provided an objective comparison of the quality of tuberculosis care delivered by both types of clinics and examined factors related to quality care. Only 27% (95% confidence interval (CI) 14⁻46) of cases were correctly managed in migrant clinics, which is significantly worse than it in local clinics (50%, 95% CI 28⁻72). Clinicians with a base salary were 41 percentage points more likely to demonstrate better case management. Furthermore, clinicians with upper secondary or higher education level charged 20 RMB lower out of pocket fees than less-educated clinicians. In conclusion, the quality of tuberculosis care accessed by migrants was very poor and policies to improve the quality should be prioritized in current health reforms. Providing a base salary was a possible way to improve quality of care and increasing the education attainment of urban community clinicians might reduce the heavy barrier of medical expenses for migrants.

Medical waste management in three areas of rural China.

OBJECTIVE: The purpose of this paper is to describe current practices of medical waste management, including its generation, investments, collection, storage, segregation, and disposal, and to explore the level of support from upper tiers of the government and health care system for medical waste management in rural China. METHODS: The authors draw on a dataset comprised of 209 randomly selected rural township health centers (THCs) in 21 counties in three provinces of China: Anhui, Shaanxi and Sichuan. Surveys were administered to health center administrators in sample THCs in June 2015. RESULTS: The results show that the generation rate of medical waste was about 0.18 kg/bed, 0.15 kg/patient, or 0.13 kg/person per day on average. Such per capita levels are significant given China's large rural population. Although investments of medical waste facilities and personnel in THCs have improved, results show that compliance with national regulations is low. For example, less than half of hazardous medical waste was packed in sealed containers or containers labeled with bio-hazard markings. None of the THCs segregated correctly according to the categories required by formal Chinese regulations. Many THCs reported improper disposal methods of medical waste. Our results also indicate low levels of staff training and low rates of centralized disposal in rural THCs. CONCLUSIONS: Medical waste is a serious environmental issue that is rising on the agenda of policymakers. While a large share of THCs has invested in medical waste facilities and personnel, it appears that actual compliance remains low. Using evidence of low rates of training and centralized disposal, we surmise that a lack of support from upper tiers of management is one contributing factor. Given these findings, we recommend that China's policymakers should enhance support from upper tiers and improve monitoring as well as incentives in order to improve medical waste management.