The Impact of Air Pollution Controls on Health and Health Inequity Among Middle-Aged and Older Chinese: Evidence From Panel Data.

Objectives: We evaluated the long-term effects of air pollution controls on health and health inequity among Chinese >45 years of age. Methods: Data were derived from the China Health Aging and Retirement Longitudinal Survey and the China National Environmental Monitoring Centre. Decreases in PM2.5 and PM10 were scaled to measure air quality controls. We used a quasi-experimental design to estimate the impact of air quality controls on self-reported health and health inequity. Health disparities were estimated using the concentration index and the horizontal index. Results: Air pollution controls significantly improved self-reported health by 20% (OR 1.20, 95% CI, 1.02-1.42). The poorest group had a 40% (OR 1.41, 95% CI, 0.96-2.08) higher probability of having excellent self-reported health after air pollution controls. A pro-rich health inequity was observed, and the horizontal index decreased after air pollution controls. Conclusion: Air pollution controls have a long-term positive effect on health and health equity. The poorest population are the main beneficiaries of air pollution controls, which suggests policymakers should make efforts to reduce health inequity in air pollution controls.

Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city.

BACKGROUND: Although countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care. METHODS: The dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care. RESULTS: We demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual's risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts. CONCLUSION: This study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.

Bibliometric analysis of kinship analysis from 1960 to 2023: global trends and development.

Kinship analysis is a crucial aspect of forensic genetics. This study analyzed 1,222 publications on kinship analysis from 1960 to 2023 using bibliometric analysis techniques, investigating the annual publication and citation patterns, most productive countries, organizations, authors and journals, most cited documents and co-occurrence of keywords. The initial publication in this field occurred in 1960. Since 2007, there has been a significant increase in publications, with over 30 published annually except for 2010. China had the most publications (n = 213, 17.43%), followed by the United States (n = 175, 14.32%) and Germany (n = 89, 7.28%). The United States also had the highest citation count. Sichuan University in China has the largest number of published articles. The University of Leipzig and the University of Cologne in Germany exhibit the highest total citation count and average citation, respectively. Budowle B was the most prolific author and Kayser M was the most cited author. In terms of publications, Forensic Science International- Genetics, Forensic Science International, and International Journal of Legal Medicine were the most prolific journals. Among them, Forensic Science International-Genetics boasted the highest h-index, citation count, and average citation rate. The most frequently cited publication was "Van Oven M, 2009, Hum Mutat", with a total of 1,361 citations. The most frequent co-occurrence keyword included "DNA", "Loci", "Paternity testing", "Population", "Markers", and "Identification", with recent interest focusing on "Kinship analysis", "SNP" and "Inference". The current research is centered around microhaplotypes, forensic genetic genealogy, and massively parallel sequencing. The field advanced with new DNA analysis methods, tools, and genetic markers. Collaborative research among nations, organizations, and authors benefits idea exchange, problem-solving efficiency, and high-quality results.

TLR2 Supports γδ T cell IL-17A Response to ocular surface commensals by Metabolic Reprogramming.

The ocular surface is a mucosal barrier tissue colonized by commensal microbes, which tune local immunity by eliciting IL-17 from conjunctival γδ T cells to prevent pathogenic infection. The commensal Corynebacterium mastitidis (C. mast) elicits protective IL-17 responses from conjunctival Vγ4 T cells through a combination of γδ TCR ligation and IL-1 signaling. Here, we identify Vγ6 T cells as a major C. mast-responsive subset in the conjunctiva and uncover its unique activation requirements. We demonstrate that Vγ6 cells require not only extrinsic (via dendritic cells) but also intrinsic TLR2 stimulation for optimal IL-17A response. Mechanistically, intrinsic TLR2 signaling was associated with epigenetic changes and enhanced expression of genes responsible for metabolic shift to fatty acid oxidation to support Il17a transcription. We identify one key transcription factor, IκBζ, which is upregulated by TLR2 stimulation and is essential for this program. Our study highlights the importance of intrinsic TLR2 signaling in driving metabolic reprogramming and production of IL-17A in microbiome-specific mucosal γδ T cells.

Brimonidine as a possible treatment for myopia.

BACKGROUND: Myopia is becoming a huge burden on the world's public health systems. The purpose of this study was to explore the effect of brimonidine in the treatment of form-deprivation myopia (FDM) and the relationship between intraocular pressure (IOP) and myopia development. METHODS: Monocular form deprivation myopia (FDM) was induced in three-week-old pigmented male guinea pigs. They were treated with 3 different methods of brimonidine administration (eye drops, and subconjunctival or intravitreal injections). Four different concentrations of brimonidine were tested for each method (2µg/µL, 4µg/µL, 20µg/µL, and 40µg/µL). All treatments continued for a period of 21 days. Tonometry, retinoscopy, and A-scan ultrasonography were used to monitor intraocular pressure, refractive error and axial length (AL), respectively. RESULTS: Treatment with subconjunctival brimonidine at 40µg/µL, and intravitreal brimonidine at 2µg/µL and 4µg/µL, inhibited the development of FDM. The myopic refraction, excessive axial length, and elevation of IOP were significantly decreased. Brimonidine in eye drops was ineffective. CONCLUSION: Brimonidine at appropriate doses significantly reduced the development of FD myopia in guinea pigs. The IOP may change with FD myopia.

What motivates individuals to share information with governments when adopting health technologies during the COVID-19 pandemic?

BACKGROUND: While digital governance has been adopted by governments around the world to assist in the management of the COVID-19 pandemic, the effectiveness of its implementation relies on the collection and use of personal information. This study examines the willingness of individuals to engage in information-sharing with governments when adopting health technologies during the COVID-19 pandemic. METHODS: Data were obtained from a cross-sectional survey of 4,800 individuals drawn from 16 cities in China in 2021. Tobit regression models were used to assess the impacts of an array of determinants on an individual's willingness to share information with governments when adopting health technologies. RESULTS: Individuals who perceived a higher level of helpfulness, risk, expectations from others, weariness toward privacy issues, and were sensitive to positive outcomes were more willing to share information with governments when adopting health technologies during the COVID-19 pandemic. Across all the subgroups, self-efficacy only reduced the willingness to share information with governments for individuals who spent more than seven hours per day online. The negative impacts of being sensitive to negative outcomes on the willingness to share information were only found among females and the less educated group. CONCLUSIONS: This study revealed the seemingly paradoxical behavior of individuals who perceived high risks of sharing information and a sense of fatigue toward privacy issues yet continued to be willing to share their information with their governments when adopting health technologies during the COVID-19 pandemic. This work highlighted significant differential motivations for sharing information with governments when using health technologies during a pandemic. Tailored policies that resonate with population sub-groups were suggested to be proposed to facilitate crisis management in future situations.

Association between cognitive function and dusty weather: a propensity score matching study.

BACKGROUND: With a rapidly aging global population, the health of older adults is a national priority for countries across the world. Dusty weather has been demonstrated to be a potential risk factor of cognitive function among the elderly population. However, there is a paucity of studies exploring the associations between dusty weather and cognitive function among the older in China. METHODS: Data on individual characteristics were obtained from the China Health and Retirement Longitudinal Survey (CHARLS) 2018, whereas data on air pollution were sourced from environmental monitoring stations in China. Cognitive function, including general cognitive function, episodic memory, and linguistic competence, was assessed by self- or informant-questionnaires. We used propensity score matching and linear regression to investigate the relationship between dusty weather and cognitive function. Sensitivity analyses were conducted to test the robustness of the results. RESULTS: This study included 8,604 participants older than 60 years old. After controlling air pollutant weather, dusty weather was demonstrated to be positively associated with a decline in cognitive function (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), 4.0, 95% confidence interval (CI): 3.11, 4.89; Mini-Mental State Exam (MMSE), 0.63, 95% CI: 0.34, 0.92). Results of sensitivity analysis showed that our research findings are robust. CONCLUSION: Older adults living in dusty weather regions suffered a higher level of cognitive impairment, and such adverse effects were more substantial among females compared with their male counterparts. Targeted health interventions to help older adults living in regions where dusty weather occurs frequently are suggested to be proposed.

To what extent do young chinese elites comply with COVID-19 prevention and control measures?

BACKGROUND: During the COVID-19 pandemic, it is vital for individuals to comply with the government's prevention and control measures. This study aims to explore determinants of college students' compliance behaviour during the COVID-19 pandemic. METHODS: This study conducted an online survey among 3,122 individuals aged 18 and above from March to November 2022 in China. Individuals' compliance behaviour was divided into protective behaviour (that includes wearing a mask, maintaining a physical distance, and getting vaccinated) and restrictive behaviour (that includes offering health codes and a nucleic acid test certificate). Individuals' compliance motivation was divided into calculated motivation (including the fear of being infected, the fear of being published, and previous experience of pandemic prevention) and normative motivation (including the sense of social responsibility and trust in government). We defined young people aged between 18 and 24 with a college degree as young elites, and constructed ordinary least squares linear regression to compare their compliance behaviour with young people without a college degree (young non-elites), and non-young people with a college degree (non-young elites). RESULTS: Almost three years after the outbreak of the pandemic, Chinese individuals retained a high degree of compliance with COVID-19 prevention and control policies, particularly with respect to the provision of health codes. Young elites were more compliant with getting vaccinated, wearing a mask, providing health codes and testing results than their counterparts. The sense of social responsibility and trust in government were the major drivers of young elites' compliance behaviour during the pandemic. Young elites who were male, had a rural "hukou", and were not a member of the China Communist Party were more compliant with COVID-19 prevention and control measures. CONCLUSION: This study found that young elites in China had high policy compliance during the COVID-19 pandemic. These young elites' compliance behaviour was driven by their sense of social responsibility and trust in government rather than the fear of being infected and the fear of being punished as a result of violating the regulations. We suggest that in the context of managing health crises, in stead of introducing punitive measures to enforce citizens to comply with the management measures, promoting citizens' sense of social responsibility and building a trusting relationship with citizens contrite to the enhancement of citizens' policy compliance.

The Effect of a Long-Term Care Insurance Program on Subjective Well-Being of Older Adults with a Disability: Quasi-Experimental Evidence from China.

China launched its long-term care insurance (LTCI) program for older adults in 2016. Although the scheme has shown some promising outcomes, little is known about whether it improves subjective well-being. This study explored this topic among older persons with a disability and identified the underlying mechanisms associated with the channel of this effect using data from a national survey. The LTCI program was shown to improve the subjective well-being among older persons with a disability and this effect increased over time. The LTCI program has great positive effect among women and those who lived alone compared to their counterparts. Mechanism analysis revealed that the main channel by which the LTCI program has positive effect occurred through the satisfaction of long-term care needs and improved self-reported health. This study suggests promising benefits of the LTCI program for older Chinese adults.

The Association Between Work Environment, Work Attitudes, and Turnover Intentions Among Geriatric Social Workers in China.

The psychological state of geriatric social workers affects the intention to leave and thus the quality of services provided to older adults. This study explored the relationship between the work environment, work attitudes, and turnover intentions of geriatric social workers. This study obtained an analytic sample comprising 999 geriatric social workers from the 2019 Longitudinal Study of Social Work in China. Multivariate regression techniques combined with a mediation analysis was performed to explore the relationships. The study results provided preliminary evidence on the complex associations between and among work environment, work attitudes, and turnover intentions of geriatric social workers in China. We demonstrated that perceived organizational support reduced the turnover intentions of geriatric social workers through increased collective psychological ownership and reduced burnout. Regular inter- and intra-agency communication between social workers and their supervisors and colleagues have important roles in reducing turnover by enhancing support and emotional commitment to organizations. Policy decision-makers are suggested to clearly define the roles and responsibilities of geriatric social works to release their administrative burdens, which may help to reduce their burnout level and improve the stability of the geriatric social work force.

A multi-case study of the vertically integrated health-care at county-level in rural China: towards holistic and dynamic governance.

Background: In contrast to the Grading Diagnosis and Treatment System (GDTS), Vertically Integrated Health-care at County-level (VIHC) is a strategic policy in rural China. This research intends to analyze the shift in governance paradigm with regard to the adjustment of the power structure and interest relationships among various participants, using the building of VIHC as a cut-in point. Methods: We carry out a multi-case study to investigate the paradigms of health governance when building VIHC in three different rural counties in China. Results: There were exchanges between government and other participants, vertical and horizontal collaborations among government divisions, and prompt responses to public requirements. County C's local administration, in particular, placed a strong emphasis on bureaucratic power and collaboration between various departments both within and outside of administrative boundaries. In contrast, County B's local administration emphasized the independence of healthcare practitioners and worked to win their support. In contrast to the previous two governments, County A encouraged social actors to participate and saw a little improvement in performance. Conclusion: In examining the health reform in rural China, this study paints a picture of the development of the health governance paradigm. In rural China, a comprehensive and dynamic governance paradigm was created through the integration of the health decision-making process, which was driven by the public's health needs, the operation mechanism, which featured both competition and cooperation, and the action logic of sharing responsibility.

Does the provision of informal care matter for caregivers' mental health? Evidence from China.

This paper investigates the causal effect of informal care on the mental health of caregivers and disentangles the mechanisms of such effect. Using 2011-2018 CHARLS data, the fixed effects and instrumental variable approaches was conducted to address fundamental endogeneity problems. This study found that there was no impact of informal caregiving on caregivers' mental health in general. However, the intensity of caregiving was shown to negatively impair mental health. The impact of informal caregiving varied by kinship, cultural context, and residential area. Participation in social and exercise activities and life satisfaction mediated the association between the provision of informal care and caregivers' mental health. Long-term care insurance and the provision of formal care substantially modified the negative impacts of informal caregiving.

Tensile Property and Corrosion Performance of Ag Microalloying of Al-Cu Alloys for Positive Electrode Current Collectors of Li-Ion Batteries.

The development of a current collector for Li-ion batteries is of great significance for improving the performance of Li-ion batteries. Tensile property and corrosion performance of the positive electrode current collectors are an indispensable prerequisite for the realization of high-performance Li-ion batteries. In our study, the effects of Ag alloying on the microscopic structure, electrical conductivity, tensile property and corrosion resistance of Al-xCu (x = 0.1-0.15%) alloy foils were investigated. Moderate Ag addition on the Al-Cu alloy could reduce the size of second phases and promote the formation of second phases. The tensile strength of the Al-0.1Cu-0.1Ag alloy was higher than that of the Al-0.1Cu alloy at both room and high temperatures. All of the alloy foils demonstrated high electrical conductivity around 58% ICAS. The corrosion potential and corrosion current density of the Al-0.1Cu alloy were demonstrated by Tafel polarization to be -873 mV and 37.12 µA/cm2, respectively. However, the Al-0.1Cu-0.1Ag alloy showed enhanced corrosion resistance after the Ag element was added to the Al-0.1Cu alloy, and the Al-0.1Cu-0.1Ag alloy had a greater positive corrosion potential of -721 mV and a lower corrosion current density of 1.52 µA/cm2, which suggests that the Ag element could significantly improve the corrosion resistance of the Al-Cu alloy.

A High-Accuracy and Energy-Efficient CORDIC Based Izhikevich Neuron With Error Suppression and Compensation.

Bio-inspired neuron models are the key building blocks of brain-like neural networks for brain-science exploration and neuromorphic engineering applications. The efficient hardware design of bio-inspired neuron models is one of the challenges to implement brain-like neural networks, as the balancing of model accuracy, energy consumption and hardware cost is very challenging. This paper proposes a high-accuracy and energy-efficient Fast-Convergence COordinate Rotation DIgital Computer (FC-CORDIC) based Izhikevich neuron design. For ensuring the model accuracy, an error propagation model of the Izhikevich neuron is presented for systematic error analysis and effective error reduction. Parameter-Tuning Error Compensation (PTEC) method and Bitwidth-Extension Error Suppression (BEES) method are proposed to reduce the error of Izhikevich neuron design effectively. In addition, by utilizing the FC-CORDIC instead of conventional CORDIC for square calculation in the Izhikevich model, the redundant CORDIC iterations are removed and therefore, both the accumulated errors and required computation are effectively reduced, which significantly improve the accuracy and energy efficiency. An optimized fixed-point design of FC-CORDIC is also proposed to save hardware overhead while ensuring the accuracy. FPGA implementation results exhibit that the proposed Izhikevich neuron design can achieve high accuracy and energy efficiency with an acceptable hardware overhead, among the state-of-the-art designs.

Study on the Influence of Low-Price Bid Winning and General Subcontracting Management on the Unsafe Behavior Intention of Construction Workers.

In recent years, there are many reasons for the frequent safety accidents in the construction field. The most controversial and typical one that firmly correlated with China's national condition is the low-price bid winning and the general subcontracting management, which probably have a great impact on the unsafe behavior intention of workers on the construction site. In order to figure out their internal relation, a quantitative statistical analysis of the unsafe behavior intentions of construction workers in the Beijing area was conducted through the on-site questionnaire considering three main variables, namely, general subcontract management, reasonable low-cost bid winning, and construction experiences. Meanwhile, the correlation, regression, and mediating effects of different influencing factors were analyzed through a regressive model to quantify the impact of each variable on the unsafe behavior intention of construction workers. The results showed that the influence of low-price bid winning on the unsafe behavior intention of on-site workers is faint. This is mainly because, in the case of labor buyer's market, the actual salary of workers is not relevant to whether the project is awarded at a low price. However, the general subcontracting management has a great impact on the unsafe behavior intention of on-site workers. At the same time, low-price bid winning also indirectly affects the strength of general subcontracting safety management, which has an indirect impact on the unsafe behavior intention of on-site workers. Generally, it is of greater significance to enhance the strength of the general subcontracting management and to formulate relevant regulations to guarantee the safety of construction workers.

Long-Term Oral Administration of Salidroside Alleviates Diabetic Retinopathy in db/db Mice.

Diabetic retinopathy (DR), a microvascular complication of diabetes mellitus, is the leading cause of vision loss in the working-age population worldwide. Unfortunately, current clinical treatments cannot completely prevent the occurrence and development of DR. Salidroside (Sal) is a medicinal supplement that has antioxidative and cytoprotective properties. This study aimed to investigate the therapeutic effect of Sal on DR. Briefly, Sal treatment was applied to wide-type mice and db/db mice (a widely used diabetic mice) at 25 mg/kg by oral gavage once daily from 8 weeks to 20 weeks. Mice's bodyweight, blood glucose, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were recorded and analyzed. Retinal trypsin digestion and evans blue dye assay were used to detect retinal microvessel changes and function. Retinal glutathione and malondialdehyde content measurements were applied to assess retinal oxidative stress. Full-length transcriptome analysis was performed to explore the underlying mechanisms of Sal protection. Our results found that Sal treatment could successfully relieve blood glucose and blood lipid abnormalities, and reduce retinal oxidative stress level in diabetic mice. Also, Sal treatment repaired the abnormal transcriptome caused by diabetes, alleviated the microvascular lesion of the fundus in diabetic mice, and protected retinal normal barrier function. This study enriches the indications of Sal in the treatment of diabetic diseases, providing practical research ideas for the comprehensive preventions and treatments of DR.

A cross-sectional study of implicit rationing of care in publicly funded nursing homes in Shanghai, China.

AIMS: To investigate the level of implicit care rationing and its association with training needs in nursing homes in Shanghai, China. BACKGROUND: Nursing homes in Shanghai are confronted with a lack of care resources. Implicit care rationing can emerge due to inadequate training of care workers. METHODS: A cross-sectional survey was conducted between 10 September and 17 November 2020. A total of 374 care workers from 16 randomly were selected nursing homes from each of the administrative districts participated the surveys. The Basel Extent of Rationing of Nursing Care-Nursing Home instrument and the training needs analysis were adopted to measure implicit care rationing and training needs, respectively. Multiple regression techniques were used to explore the factors associated with implicit care rationing. RESULTS: Activities related to social care, documentation and activation/rehabilitation (mean rating = 2.8, 1.89 and 1.93 respectively) were mostly likely to be rationed. Training needs of activities of daily living (ADL), activation/rehabilitation and documentation were significantly related to their implicit rationing (ß = 0.864, 0.21 and 0.166, respectively, p < .01). CONCLUSION: Training needs are crucial determinants of implicit care rationing. IMPLICATIONS FOR NURSING MANAGEMENT: Quality control systems are needed to ensure care comprehensiveness. The current training system should be re-designed according to results of training needs analysis.

Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China.

BACKGROUND: The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). METHODS: A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. RESULTS: Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. CONCLUSIONS: Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Can integrated care improve the efficiency of hospitals? Research based on 200 Hospitals in China.

BACKGROUND: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. METHODS: This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. RESULTS: The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. CONCLUSIONS: IC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency.

The impacts of pollution and its associated spatial spillover effects on ill-health in China.

While the adverse health effects of air pollution and its associated spatial spillovers have been extensively explored, there are a paucity of studies examining and comparing the effects of air pollution, water pollution, and their associated spatial spillover consequences for health. This study aims to evaluate and compare the impacts of water pollution, air pollution, and their associated spillover effects on ill-health. This study combined individual-level health data acquired from three waves of the China Health and Retirement Longitudinal Study (CHARLS) for 25,504 residents from 28 Chinese provinces with provincial-level pollution data for 2011, 2013 and 2015. We used Moran's I statistic to examine the existence and direction of the spatial spillover effects of pollution. The Spatial Durbin Model was then employed to assess the impacts of pollution and its associated spatial spillover effects on ill-health. A province's ill-health score increased by 6.649 for every 1 ton per capita per annum increase in the average amount of soot/dust discharged by its adjacent provinces. For every 1 ton per capita per annum increase in wastewater discharged, a province's ill-health score increased by 0.004. Targeted actions through the construction of cooperative action with adjacent provinces are suggested by our study to improve the efficiency of policy interventions.