Patient Trust in Physicians: Empirical Evidence from Shanghai, China.

BACKGROUND: Patient trust in physicians, which can be considered a collective good, is necessary for an effective health care system. However, there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide. This article aimed to assess patient trust in physicians through a quantitative study in Shanghai, China, and to provide appropriate suggestions for improving the trust in China. METHODS: The data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital, which are two tertiary public hospitals in Shanghai, were used in this study. Patient trust in physicians was the dependent variable. Furthermore, a 10-item scale was used to precisely describe the dependent variable. The demographic characteristics were independent variables of trust in physicians. Binomial logistic regression was employed to analyze the factors associated with the dependent variable, which was divided into two categories on the basis of the responses (1: Strongly agree or agree and 0: Strongly disagree, disagree, or neutral). RESULTS: This study found that 67% of patients trusted or strongly trusted physicians. The mean score of patient trust in physicians was 35.4 from a total score of 50. Furthermore, patient trust in physicians was significantly correlated with the age, education level, annual income, and health insurance coverage of the patients. CONCLUSIONS: Patient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician-patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.

Trend of non-communicable disease mortality for three common conditions in the elderly population from 2002 to 2010: A population-based study in China.

OBJECTIVE: There is a lack of data focusing on non-communicable disease (NCD) mortality in the Chinese elderly population over the past decade. METHODS: Using mortality data from the Chinese Health Statistics, we explored the crude and age-standardized mortality trend of three major NCDs in the Chinese population ≥65 years of age from 2002 to 2010, namely, malignant neoplasms, heart diseases, and cerebrovascular diseases. Subpopulations characterized as rural and urban residence, and by gender and age were examined separately. RESULTS: Mortality increased with age and was higher among males than among females across the three NCDs, with the gender difference being most remarkable for malignant neoplasms and least for heart diseases mortality. Condition-specific crude mortalities increased between 2002 and 2010, overall and in all the pre-specified subpopulations. After age-standardization, rising trends were observed for people ≥65 years old, and condition-specific mortalities generally increased in rural regions and decreased in urban regions, especially for cerebrovascular diseases. CONCLUSIONS: There were increasing trends for mortality due to malignant neoplasms, heart diseases, and cerebrovascular diseases in China between 2002 and 2010, which were largely driven by the population aging. Disparities existed by rural and urban residence, gender, and age.

Analysis of the status of Chinese clinical practice guidelines development.

BACKGROUND: The work of developing clinical practice guidelines began just a little more than ten years ago in China. Up to now, there have been few studies about them. OBJECTIVES: To review and analyze the status of Chinese clinical practice guidelines in 1997-2007. METHODS: All Chinese guidelines from 1997-2007 were collected, and made a regression analysis, and a citation analysis for evaluating the impact of guidelines. To analyze the developing quality, the most influential guidelines were evaluated with AGREE instrument, and each guideline was evaluated to check for any updating. In order to analyze the objective and target population, all guidelines were classified and counted separately according to disease/symptom center, and whether towards specialists or general practitioners. RESULTS: 143 guidelines were collected. An exponential function equation was established for the trend in the number of guidelines. The immediacy index in every year was very low while the average citation rate was not. Both the percentages of highly cited and never cited were high. For the evaluation with AGREE, only the average score of clarity and presentation was high (89.9%); the remaining were much lower. Editorial independence scored 0. Only 27 (18.9%) of 143 guidelines, were found to be evidence-based. Only a few had ever been updated, with an average updating interval of 5.2 years. Only 2.1% were symptom-centered, and only 4.2% were aimed at general practitioners. CONCLUSION: Much progress has been obtained for Chinese guidelines development. However, there were still defects, and greater efforts should be made in the future.

Health insurance and household income associated with mammography utilization among American women, 2000 - 2008.

BACKGROUND: National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women. METHODS: Data were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year. RESULTS: From 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006. CONCLUSIONS: Health insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.

Coverage and utilization of the health insurance among migrant workers in Shanghai, China.

BACKGROUND: According to the regulations of the Chinese and Shanghai governments, migrant workers employed in Shanghai should all be entitled to Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have the New Rural Cooperative Medical System (NRCMS). This study aimed to examine the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai. METHODS: Quantitative and qualitative research methods were employed in the study. A survey of 1020 migrant workers employed in Shanghai was conducted in 2010 with a structured questionnaire. Focus group discussions were held with respondents who were unable to maintain health insurance coverage through NRCMS or SMWHI. In-depth interviews were held with village heads and employers of the migrant workers, migrant workers who were hospitalized within the last year, and various individuals employed by the insurance agencies. RESULTS: The study found that 72.9% and 36.5% of migrant workers were covered by NRCMS or SMWHI, respectively, while 16.7% of them had no health insurance. The coverage by NRCMS among migrant workers correlated significantly with education level and workplace, while the coverage by SMWHI correlated significantly with the length of employment in Shanghai and workplace. The qualitative results confirmed that migrant workers were the main group who were not covered by NRCMS, and the coverage by SMWHI was completely dependent upon the employers of the migrant worker. The results also showed that health insurance utilization among migrant workers was strongly limited by hospital location. CONCLUSIONS: We observed that the status of health insurance among migrant workers was not accordant with theory, and that Chinese health insurance policy should be further reformed in order to realize full coverage and equal utilization of health insurance among migrant workers in China.

[Selection of sentinel sites for death surveillance, using cluster or unequal probability sampling].

UNLABELLED: To compare the sampling errors from cluster or unequal probability sampling designs and to adopt the unequal probability sampling method to be used for death surveillance. Taking 107 areas from the county level in Shaanxi province as the sampling frame, a set of samples are drawn by equal probability cluster sampling and unequal probability designs methodologies. Sampling error and effect of each design are estimated according to their complex sample plans. Both the sampling errors depend on the sampling plan and the errors of equal probability in stratified cluster sampling appears to be less than simple cluster sampling. The design effects of unequal probability stratified cluster sampling, such as piPS design, are slightly lower than those of equal probability stratified cluster sampling, but the unequal probability stratified cluster sampling can cover a wider scope of monitoring population. CONCLUSIONS: Results from the analysis of sampling data can not be conducted without consideration of the sampling plan when the sampling frame is finite and a given sampling plan and parameters, such as sampling proportion and population weights, are assigned in advance. Unequal probability cluster sampling designs seems to be more appropriate in selecting the national death surveillance sites since more available monitoring data can be obtained and having more weight in estimating the mortality for the whole province or the municipality to be selected.

[The association of stroke with high plasma low-density lipoprotein cholesterol level and metabolic syndrome in Chinese adults].

OBJECTIVE: To investigate the impact of high plasma LDL-C level with or without metabolic syndrome (MS) on the incidence of stroke in Chinese adults. METHODS: Totally 42 626 subjects (25-75 years old) from Chinese National Health and Nutrition Survey in 2002 were stratified four groups based on plasma LDL-C level:<2.00 mmol/L group, 2.00-2.50 mmol/L group, 2.51-3.31 mmol/L group, and >or=3.32 mmol/L group. The prevalence of MS (with 2005 International Diabetes Federation criteria) and stroke and the risk factors of stroke were compared among the four groups. RESULTS: (1) The prevalence of MS and stroke increased with rising of LDL-C level. The prevalence of MS in LDL-C>or=3.32 mmol/L group increased 2.5 times (7.9% vs 20.1%) as compared with that in LDL-C<2.00 mmol/L group and the prevalence of stroke increased 4.2 times (0.5% vs 2.1%), all P<0.01. (2) In subjects with similar LDL-C level, the prevalence of stroke was significantly higher in a subgroup with MS than that without (P<0.01). (3) After adjustment for age, sex and smoking, logistic regression analysis showed that both LDL-C level and MS were positively associated with the development of stroke; the odds ratio (OR) was 2.35 and 3.15 (P<0.0001), respectively. (4) Compared with the subgroup of LDL-C<2.00 mmol/L without MS, OR for stroke in the subgroups of LDL-C 2.00-2.50 mmol/L, 2.51-3.31 mmol/L, and >or=3.32 mmol/L without MS was 1.03, 1.89, and 2.08, whereas the OR for stroke in the subgroups with MS and similar level of LDL-C was 4.38, 5.23 and 6.15; this indicated that the risk of stroke in subjects with MS increased by 3-4 times compared with subjects without (P<0.0001). CONCLUSION: Both high LDL-C level and MS are independent risk factors of stroke, but the risk of stroke will be further increased in the presence of high LDL-C level plus MS. It is suggested that combined intervention therapy of LDL-C and MS will play an important role in the prevention of stroke.

[Assessment of capacity for logisty, public education, and training in public health emergency management in China].

OBJECTIVE: To assess the capacity for logistics, public education, and training in managing public health emergency in China at present. METHODS: Four provinces were selected using stratified sampling. All the municipalities of these 4 provinces were assessed using the 9th and 10th subscales (logistics, public education and training) of Preparedness and response capacity questionnaire for public health emergencies for provincial or municipal governments developed by the Center for Health Statistics and Information, Ministry of Health of China. RESULTS: Sixty of the 66 questionnaires (90.91%) were collected. Among the 60 investigated municipalities, 80% established a specific agency to take charge of emergency material storage, management and allocation, 65% developed standard for material storage, 35% developed standard of places for material storage, 25% built regulation for testing, maintaining, and updating the emergency materials regularly, 45% arranged budget for routine payment, 27% established standard of emergency fund, and 28% set up the procedure to initiate emergency fund. The average of standard score of subscale 9 was 43.33 (95% confidence interval, 35.65~51.01). 25% of the 60 municipalities conducted assessment for training in the past 2 years, 53% developed plan for emergency personnel training, 20% developed effectiveness assessment regulation of emergency personnel training, 80% assigned a specific agency to be responsible for public education, and 23% established regulation for public education. The average of standard score of subscale 10 was 47.43 (95% confidence interval, 40.69~54.17). CONCLUSION: Serious problems are found in logistics, public education, and training for public health emergency management in China. Measures should be taken immediately by the central and local government to improve these capacities.

[Do isolated hypertension and metabolic syndrome have equal risk of stroke in Chinese adults?].

OBJECTIVE: To analyze whether isolated hypertension and metabolic syndrome ( Based on the 2005 IDF criteria) have equal risk on stroke in Chinese adults. METHODS: 25194 subjects (25-75 years old) from Chinese National Health and Nutrition Survey in 2002 were divided into control group, isolated hypertension ( i-HTN) group, metabolic syndrome (MS) without hypertension ( non-HTN/MS) group , MS with hypertension (HTN/MS) group. The clinical features and risk for stroke ( using multiple logistic stepwise regression analysis) were compared among 4 groups. RESULTS: (1) The clinic features in the i-HTN group was non-central obesity, and its plasma glucose, triglyceride 9TG), high density lipoprotein cholesterol ( HDL-C) levels were normal . (2) The prevalence of stroke in control group , i-HTN group, non-HTN/MS group and HTN/MS group was 0.14%, 1.27%, 1.19% and 2.14%, respectively. (3) After adjustment for age, sex, smoking, low density lipoprotein cholesterol level, logistic regression analysis showed that the i-HTN group, non-HTN/MS group and HTN/MS group had higher risk of stroke compared with the controls, the odd ratio (OR) were 4.18, 8.00, 8.69 (P < 0.01), respectively. Compared with i-HTN group, OR in HTN/MS group was 2.05, while no difference was found between i-HTN group and non-HTN/MS group ( P>0.05). (4) Among different components of the MS, hypertension (OR 2.33), central obesity (OR 2.09), low HDL-C (OR 1.69), hyperglycemia (OR 1.66) except hypertriglyceridemia were all significantly related to stroke (P < 0.01). CONCLUSION: (1) MS and hypertension were an independent risk factor for the development of stroke in Chinese adults. (2) Though there was no clinical features of insulin resistance in i-HTN group, it was observed that the i-HTN and non-HTN/MS had equal contribution to stroke. The risk of stroke will be further increased if hypertension included in the MS.

[Development and testing of a preparedness and response capacity questionnaire in public health emergency for Chinese provincial and municipal governments].

OBJECTIVE: To develop a capacity questionnaire in public health emergency for Chinese local governments. METHODS: Literature reviews, conceptual modelling, stake-holder analysis, focus group, interview, and Delphi technique were employed together to develop the questionnaire. Classical test theory and case study were used to assess the reliability and validity. RESULTS: (1) A 2-dimension conceptual model was built. A preparedness and response capacity questionnaire in public health emergency with 10 dimensions and 204 items, was developed. (2) Reliability and validity results. Internal consistency: except for dimension 3 and 8, the Cronbach's alpha coefficient of other dimensions was higher than 0.60. The alpha coefficients of dimension 3 and dimension 8 were 0.59 and 0.39 respectively; Content validity: the questionnaire was recognized by the investigatees; Construct validity: the Spearman correlation coefficients among the 10 dimensions fluctuated around 0.50, ranging from 0.26 to 0.75 (P<0.05); Discrimination validity: comparisons of 10 dimensions among 4 provinces did not show statistical significance using One-way analysis of variance (P>0.05). Criterion-related validity: case study showed significant difference among the 10 dimensions in Beijing between February 2003 (before SARS event) and November 2005 (after SARS event). CONCLUSION: The preparedness and response capacity questionnaire in public health emergency is a reliable and valid tool, which can be used in all provinces and municipalities in China.

Identification of a detailed function list for public health emergency management using three qualitative methods.

BACKGROUND: At present, many administrators lack a theoretical guide to build management systems to cope with public health emergencies. This study developed a detailed function list for public health emergency management to help building the management systems scientifically. METHODS: The five steps in this study including literature review, semistructured interviews with experts, focus group, Delphi study and focus group were conducted to develop the detailed list of functions. RESULTS: An initial list of 25 functions with 188 items was formed through literature review. The list was reduced to 10 functions with 57 items by semistructured interviews with experts and focus group. Next, all these 57 items reached the consensus through one-round Delphi study. Some revisions of the consensus were done by the same focus group. CONCLUSION: The final 10 functions with 57 items could be used as a guide for most countries during their building of a public health emergency management system.

[Investigation into the capacity for risk identification, assessment, and mitigation in managing public health emergencies in China].

OBJECTIVE: To investigate the capacity for risk identification, assessment, and mitigation in public health emergency management in China. METHODS: Four provinces were randomly selected using stratified sampling. All the municipalities under these four provinces were assessed using the 3rd subscale (Risk Identification, Risk Assessment, and Risk Mitigation) of Preparedness and Response Capacity Questionnaire for Public Health Emergencies Used in Provincial or Municipal Governments, which was developed by the Center for Health Statistics and Information, Ministry of Health of the People's Republic of China. RESULTS: Sixty of 66 questionnaires (90.91%) were collected. Among 60 investigated municipalities, 35 (58%) identified the potential public health emergencies, 17 (28%) assessed the risks for the identified emergencies, and 5 (8%) conducted risk assessments for the locally accident-prone factories, mines, corporations, and big establishments, 6 (10%) identified the priorities in public health emergency management based on risk assessment, 6 (10%) developed special prevention strategies for main public health emergencies, 3 (5%) assessed the vulnerability of local residents to public health emergencies, and 34 (57%) assessed or were assessing the preparedness and response capacity for public health emergencies in the past 2 years. The mean of standard total score for risk identification, assessment, and mitigation was 24.05 (95% CI: 18.32, 29.77). CONCLUSION: Risk identification, assessment, and mitigation still require further improvement in China, and both the central and local authorities should implement more effective and efficient measures.

[A description on the Chinese national nutrition and health survey in 2002].

OBJECTIVE: To describe the status of nutrition and health related indices in the Chinese population. METHODS: A stratified multi-stage cluster sampling was used from 31 provinces, autonomous regions, and municipalities. The survey was done in 2002, including data gathered from questionnaires, interviews, physical examinations, measurement of biochemical indices, and dietary investigation. RESULTS: Cereals accounted for 48.5% of all the sources of energy in urban and 61.4% in rural populations. Daily mean percentages of calories for total fat were 35.0% in urban and 27.5% in rural areas. The prevalence rates of stunting and underweight were 14.3% and 7.8% respectively in young children under 5-year-old. The prevalence of vitamin A deficiency was 9.3% in Chinese children aged 3-12 years old. The total prevalence of anemia was 15.2% in general population of all ages. The prevalence of anemia in young adults was significantly higher in women than in men. The total prevalence rates of overweight and obesity were 17.6% and 5.6%, respectively. The prevalence rates of hypertension, diabetes, hypercholesteremia, hypertriglyceridemia, or low serum high density lipoprotein cholesterol were 18.8%, 2.6%, 2.9%, 11.9%, 7.4% respectively in Chinese adults aged 18 and over. The rates of awareness, treatment, and under control among hypertensives were 30.2%, 24.7%, and 25.0%, respectively. Significant regional and age differences were revealed in the dietary habit and the prevalence of various diseases. The prevalence of diseases associated with malnutrition were higher in rural than in urban areas. In contrast, the prevalence of conditions associated with overconsumption and inappropriate dietary patterns were higher in urban than in rural populations. CONCLUSION: Chinese people were currently suffering from both problems on nutrition related issues and burdens of diseases which were characterized in nutrient deficiencies and overconsumption, malnutrition and noncommunicable conditions associated with overconsumption and inappropriate diet. The difference of nutrition and health status between rural and urban people was also seen.

[Main problems existed in the providers and the demanders of rural health service in China].

Based on the results of three national health surveys and relevant statistical data, this article reviews the main problems existed in the providers and demanders of rural health service in China and tries to provide evidences for health decision-makers.

[Influence of smoking on the prevalence of chronic diseases among people with different income levels].

OBJECTIVE: To explore the influence of smoking on chronic diseases among people with various income levels in China. METHODS: Cross-sectional study on smoking behavior, chronic disease and income level was performed using database of the Second National Health Service Study (1998) provided by the Ministry of Health in China. RESULTS: Compared to never-smokers, smokers (including current smokers and former smokers) had a higher rate of having chronic diseases, after adjusted in age, income, educational level, employment status and type of jobs with corresponding countryside (OR = 1.185, 95% CI: 1.121 - 1.253 and town OR = 1.083, 95% CI: 1.010 - 1.161). Smoking had a more serious effect on having chronic illness in males from the countryside (former-smoker OR = 2.764, 95% CI: 2.471 - 3.092) than in town (former-smoker OR = 2.112, 95% CI: 1.844 - 2.419). Smokers at the lowest income level had a higher possibility of having chronic illness (town OR = 2.076, 95% CI: 1.551 - 2.780; countryside OR = 2.903, 95% CI: 2.248 - 3.749) than those at the highest income level (town OR = 1.785, 95% CI: 1.285 - 2.479 in the countryside OR = 2.466, 95% CI: 1.941 - 3.134). CONCLUSION: Smoking might cause more serious health problems to people at lower income level in China.