Temporal changes in factors associated with COVID-19 vaccine hesitancy among Chinese adults: Repeated nationally representative survey.

Background: COVID-19 vaccine hesitancy has been cited as one of the main obstacles impacting vaccine coverage. However, factors that affect hesitancy may change over time. Understanding these evolving concerns and adapting strategies accordingly are crucial for effectively addressing vaccine hesitancy effectively and promoting public health. We aimed to explore the temporal changes in factors associated with COVID-19 VH during the COVID-19 pandemic and assess the dynamic evolution of VH. Methods: In August 2022 and February 2023, repeated online surveys were undertaken to collect information from 5378 adults across four regions of China. Multiple linear regression models assessed the influencing factors of COVID-19 VH. The association between protective motive theory (PMT) (perceived severity, susceptibility, benefits, barriers, and self-efficacy) and VH was evaluated by structural equation modeling (SEM). Results: Repeated measures showed that 573 (10.7%) and 1598 (29.7%) of the 5378 participants reported COVID-19 VH in the baseline and follow-up surveys, respectively. Educational levels, chronic disease, history of allergy, COVID-19 infection, and trust in medical staff and vaccine developers were positively associated with COVID-19 VH (P＜0.05). The application of SEM revealed that perceived severity, susceptibility, vaccination barriers, and self-efficacy in the PMT directly impacted on VH (P＜0.05). In addition, severity, susceptibility, benefits, and barriers had a significant direct effect on self-efficacy as ß = 0.113, ß = 0.070, ß = 0.722, ß = -0.516 respectively with P < 0.001. Conclusion: The prevalence of COVID-19 VH was relatively low in the baseline survey and much higher in the follow-up survey, with a significant increase in hesitancy rates among mainland Chinese residents. Acknowledging the substantial impact on the shaping of COVID-19 VH, one must consider factors including perceived severity, susceptibility, vaccination barriers, and self-efficacy.

The association of individual cognition and social environment of smoking with autonomy over tobacco: A survey from rural China.

INTRODUCTION: This study explores the association of individual cognition and social environment of smoking with autonomy over tobacco, providing evidence and insights to help smokers effectively prevent and reduce tobacco dependence. METHODS: Data were collected from 1389 participants, aged ≥15 years, by face-to-face interviews from June 2018 to November 2019 in central China. We assessed autonomy over tobacco using the Autonomy Over Smoking Scale (AUTOS), including Withdrawal Symptoms (WS), Psychological Dependence (PD) and Cue-induced Cravings (CC), and examined factors of individual cognition and social environment, as well as covariates, including demographic characteristics, health status, and smoking behavior. RESULTS: AUTOS total score was 16.92 ± 9.05, WS score was the lowest (4.40 ± 3.36) in the three subscales, and CC score was the highest (6.88 ± 3.2). After adjustment, WS score of having a greater awareness of smoking hazards to one's own health was lower than those who had no awareness (ß=0.14; 95% CI: -0.31-0.00), and the total score of AUTOS, the score of PD and CC for those who thought smoking was 'more helpful (high)' to interpersonal communication were higher than 'not helpful (not at all)' (ß=0.14; 95% CI: 0.01-0.28 with ß=0.16; 95% CI: 0.02-0.29; and ß=0.14; 95% CI: 0.00-0.28; respectively). Having a greater difficulty in smoking cessation was associated with higher AUTOS total and subscale scores (p<0.001). Notably, none of the social-environmental factors included had a significant association with AUTOS scores. CONCLUSIONS: Interventions targeting individual cognitive factors of tobacco dependence seem to be more effective in smoking cessation. Future research may explore the influence of family and workplace among social environmental factors, which may reveal the effect of a binding force.

Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study.

BACKGROUND: COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult. OBJECTIVE: This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations. METHODS: The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models. RESULTS: Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy. CONCLUSIONS: The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy.

Work-family conflict and anxiety among nurses of the maternal and child health institutions: the mediating role of job satisfaction.

Introduction: Over the past decades, anxiety has garnered significant attention from nursing population. Investigations have centered on the correlation between work-family conflict (WFC) and anxiety as well as the link between job satisfaction and anxiety among nurses. However, the role of job satisfaction plays in the relationship between work-family conflict and anxiety remains relatively unexplored. Methods: In April 2021, a cross-sectional survey was conducted among nurses (N = 3,770) working at the maternal and child health institutions in Henan province, China. Multiple linear regression model was used to explore the factors associated with anxiety. Model 4 in Hayes's PROCESS macro and Bootstrap method was performed to examine the mediating role of job satisfaction in the relationship between work-family conflict and anxiety. Results: The median (interquartile range) anxiety score was 5.00 (6.00). Work-family conflict was shown to be significantly correlated to job satisfaction (r = -0.517, p < 0.001) and anxiety (r = 0.457, p < 0.01). There was a strong negative correlation between job satisfaction and anxiety (r = -0.379, p < 0.01). The study also found that nurses aged 31-40 years, those with a junior college education (p = 0.001), those with an undergraduate or above education (p < 0.001), those who reported experiencing work-family conflict (p < 0.001), and those with lower job satisfaction (p < 0.001) were more likely to experience anxiety. Additionally, job satisfaction partially (a*b = 20.90%) mediated the relationship between work-family conflict and anxiety. Conclusion: The association between work-family conflict and anxiety among nurses in maternity and child health institutions was moderated by job satisfaction. Therefore, it is critical to enhance working conditions, minimize work-family conflict, and promoting job satisfaction among nurses may help to mitigate the negative effects of work-family conflict on anxiety.

The mediating role of resilience on the association between family satisfaction and lower levels of depression and anxiety among Chinese adolescents.

PURPOSE: This study aimed to explore the association between family satisfaction, resilience, and anxiety and depression among adolescents, and the mediating role of resilience in these relationships. METHODS: A cross-sectional study was conducted among grade 8 to 9 students from 4 secondary schools in Hong Kong. A total of 1,146 participants completed the survey. RESULTS: Respectively 45.8% and 58.0% of students scored above the cut-off for mild anxiety and mild depression. Results from linear regression analyses showed that family satisfaction was positively associated with resilience, and both family satisfaction and resilience were and negatively associated with anxiety and depression. The mediating effects of resilience on the relationship between family satisfaction and anxiety/ depression (26.3% and 31.1% effects accounted for, respectively) were significant. CONCLUSIONS: Both family satisfaction and resilience have important influence on adolescent mental health. Interventions that seek to promote positive family relationships and resilience of adolescents may be effective in preventing and reducing anxiety and depression symptoms among adolescents.

The pattern from the first three rounds of vaccination: declining vaccination rates.

Introduction: Vaccination rates for the COVID-19 vaccine have recently been stagnant worldwide. We aim to analyze the potential patterns of vaccination development from the first three doses to reveal the possible trends of the next round of vaccination and further explore the factors influencing vaccination in the selected populations. Methods: On July 2022, a stratified multistage random sampling method in the survey was conducted to select 6,781 people from 4 provinces China, who were above the age of 18 years. Participants were divided into two groups based on whether they had a chronic disease. The data were run through Cochran-Armitage trend test and multivariable regression analyses. Results: A total of 957 participants with chronic disease and 5,454 participants without chronic disease were included in this survey. Vaccination rates for the first, second and booster doses in chronic disease population were93.70% (95% CI: 92.19-95.27%), 91.12% (95%CI: 94.43-95.59%), and 83.18% (95%CI: 80.80-85.55%) respectively. By contrast, the first, second and booster vaccination rates for the general population were 98.02% (95% CI: 97.65-98.39%), 95.01% (95% CI: 94.43-95.59%) and 85.06% (95% CI: 84.11-86.00%) respectively. The widening gap in vaccination rates was observed as the number of vaccinations increases. Higher self-efficacy was a significant factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education level, middle level physical activity and higher public prevention measures play a positive role in vaccination among the general population, while alcohol consumption acts as a significant positive factor in the chronic disease population (p < 0.05). Conclusion: As the number of vaccinations increases, the trend of decreasing vaccination rate is becoming more pronounced. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and the fatigue associated with the prolonged outbreak hamper vaccination. Measures need to be found to counter this downward trend such as improving the self-efficacy of the population.

Association between lifestyle and COVID-19 vaccination: A national cross-sectional study.

Objective: To assess lifestyles, COVID-19 vaccination coverage rates, and the relationships between lifestyles and COVID-19 vaccination among Chinese population. Methods: We collected data on sociodemographics, perception of the COVID-19 pandemic, lifestyles, and self-reported COVID-19 vaccination via an online survey in China. The chi-square goodness-of-fit test was used to monitor sample saturation throughout the formal online survey. The binary logistic regression analyses were conducted to examine the association between COVID-19 vaccination rate and lifestyle score. We assigned values to 12 lifestyles ranging from positive to negative, with positive lifestyles receiving a higher score and negative lifestyles receiving a lower score, ranging from 1 to 5. For each participant, the total lifestyle scored from 12 to 56. Restricted cubic spline (RCS) was used to visualize the trends and correlations between lifestyle score and COVID-19 vaccination coverage. Propensity score matching (PSM) was used to explore the association between specific lifestyles and COVID-19 vaccination. Results: A total of 29,925 participants (51.4% females) responded. The lifestyle score of the sample was 44.60 ± 6.13 (scoring range: 12-56). COVID-19 vaccination rate was found to be 89.4% (89.1-89.8%). Female participants reported a higher vaccination rate than male participants (91.5 vs. 87.1%). Compared to Q1, COVID-19 vaccination coverage rates increased with lifestyle total scores [OR Q2 = 1.901 (1.718-2.103), P < 0.001; OR Q3 = 2.373 (2.099-2.684), P < 0.001; and OR Q4 = 3.765 (3.209-4.417), P < 0.001]. After applying PSM, it was determined that all the 12 specific healthy lifestyles analyzed, including maintaining a healthy body weight, a healthy diet, regular physical exercises, adequate sleep, regular physical examination, and others, were found to be positive factors for COVID-19 vaccination. Conclusion: The majority of mainland Chinese lived a healthy lifestyle throughout the COVID-19 pandemic, and the rate of COVID-19 vaccination was high. Specific healthy lifestyles contributed to COVID-19 vaccination coverage rates significantly. According to the study's findings, global efforts to achieve herd immunity should be prioritized by continually promoting healthy lifestyles and improving public perception of COVID-19 vaccines.

Association of Hospital Characteristics and Previous Hospitalization-Related Experiences with Patients' Perceptions of Hospital Care in China.

Patients' perceptions of healthcare vary over time and by setting, and previous studies have rarely focused on these factors. We aimed to measure patients' perceptions of hospital care in China and to examine how patients' perceptions of hospital care vary by hospital characteristics (differences in setting) and previous hospitalization-related experiences (changes with time). We conducted a national cross-sectional survey of 7267 inpatients between July 2014 and April 2015 in China. Hospital characteristics measured were hospital technical level, hospital type, teaching status, and the ratio of doctors/nurses to ward beds. Previous hospitalization-related experiences measured were current admission length, number of previous admissions, and hospital selection (hospital advertisements or personal recommendations). Patients' perceptions of hospital care included perceptions of doctors, nurses, and hospital organization. Scores were highest for perceptions of nurses, followed by perceptions of doctors, and hospital organization. Of the five hospital characteristics rated, the technical level was most strongly associated with patient perceptions of healthcare. The effect of hospital admission length and frequency of hospitalization on patients' perceptions was represented by a √-shaped dose-response curve (scores were initially high, then decreased, then rebounded to higher than the initial scores). Patients who selected a hospital with hospital advertisements gave lower scores than those without hospital advertisements, and patients who selected a hospital with personal recommendations gave higher scores than those without If the observed √-shaped dose-response curves indicate a causal relationship between patients' perceptions and hospital admission length or frequency of hospitalization, this may help to guide the timing of patient satisfaction assessments. The negative association between patient perception and advertising, and the positive association with personal recommendations (word-of-mouth) and hospital technical level, could provide important information for clinicians and hospital administrators.

The Psychological Experience of COVID-19 Vaccination and Its Impact on the Willingness to Receive Booster Vaccines among the Chinese Population: Evidence from a National Cross-Sectional Study.

The purpose of this study was to assess the psychological experience of COVID-19 basic vaccination, the willingness to receive booster vaccines, and to determine their relationships among Chinese people. Between 6 August 2021 and 9 August 2021, a research firm performed a national cross-sectional online survey among Chinese individuals (aged over 18), using the snowball sampling approach, with 26,755 participants. Factor analysis and binary logistic regression were used to evaluate the existing associations. The overall COVID-19 vaccination psychological experience score of the participants was 25.83 (25.78~25.89; scores ranged from 7-35). A total of 93.83% (95%CI = 93.54~94.12) of respondents indicated a willingness to receive booster vaccines. After classifying psychological experiences associated with COVID-19 vaccination into positive and negative experiences and adjusting for confounding factors, for the former, the willingness to receive booster vaccines for participants with the highest scores of 13-15 was 3.933 times higher (OR = 3.933, 95%CI = 3.176~4.871) than participants who obtained scores of 3-9, and for the latter, the willingness to receive booster vaccines for participants with the highest scores of 19-20 was 8.871 times higher (OR = 8.871, 95%CI = 6.240~12.612) than participants who obtained scores of 4-13. Our study suggests that a good psychological experience with vaccination is positively associated with an increased willingness to receive booster vaccines.

Impact of Tobacco Smoking on Health Care Utilization and Medical Costs in Chronic Obstructive Pulmonary Disease, Coronary Heart Disease and Diabetes.

OBJECTIVE: To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases (NCDs). METHODS: Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China. Logistic regressions and linear models were used to assess the relationship between tobacco smoking, health care utilization and medical costs. RESULTS: Totally, 1020 patients with chronic obstructive pulmonary disease (COPD), 3144 patients with coronary heart disease (CHD), and 1405 patients with diabetes were included in the analysis. Among patients with COPD, current smokers (ß: 0.030, 95% CI: -0.032-0.092) and former smokers (ß: 0.072, 95% CI: 0.014-0.131) had 3.0% and 7.2% higher total medical costs than never smokers. Medical costs of patients who had smoked for 21-40 years (ß: 0.028, 95% CI:-0.038-0.094) and ≥41 years (ß: 0.053, 95% CI: -0.004ß0.110) were higher than those of never smokers. Patients who smoked ≥21 cigarettes (ß: 0.145, 95% CI: 0.051-0.239) per day had more inpatient visits than never smokers. The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD; however, there were no significant associations in people with diabetes. CONCLUSION: This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD, CHD, and diabetes. Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.

COVID-19 Vaccination Acceptance Among Chinese Population and Its Implications for the Pandemic: A National Cross-Sectional Study.

Objective: To examine the COVID-19 vaccination rate among a representative sample of adults from 31 provinces on the Chinese mainland and identify its influencing factors. Methods: We gathered sociodemographic information, data on people's awareness and behavior regarding COVID-19 and the COVID-19 vaccine, the accessibility of COVID-19 vaccination services, community environmental factors influencing people's awareness and behavior regarding the vaccination, information about people's skepticism on COVID-19 vaccine, and information about people's trust in doctors as well as vaccine developers through an online nationwide cross-sectional survey among Chinese adults (18 years and older). The odds ratios (OR) and 95% confidence intervals (CI) for the statistical associations were estimated using logistic regression models. Results: A total of 29,925 participants (51.4% females and 48.6% males) responded. 89.4% of the participants had already received a COVID-19 vaccination. After adjusting for demographic characteristics, awareness of COVID-19 pandemic/ COVID-19 vaccine, community environmental factors, awareness and behavior of general vaccinations, we discovered that having no religious affiliation, having the same occupational status as a result of coronavirus epidemic, being a non-smoker, always engaging in physical activity, having a lower social status, perceiving COVID-19 to be easily curable, and having easier access to vaccination are all associated with high vaccination rate (all P <0.05). Conclusions: 31 provinces in mainland China currently have a relatively high rate of COVID-19 vaccination. To further increase the rate of COVID-19 vaccination, we must remove barriers associated with the community context and improve access to COVID-19 vaccine services. In addition, taking proactive and effective measures to address the reasons for non-vaccination with COVID-19 will aid in epidemic prevention and control.

Association of off-the-job training with work performance and work-family conflict among physicians: a cross-sectional study in China.

OBJECTIVES: To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work-family conflict in physicians. DESIGN, SETTING AND PARTICIPANTS: We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians. EXPOSURE: Participants were categorised into four groups: none, DT only, OS only and DT and OS. PRIMARY OUTCOME MEASURES: Work performance was assessed by work engagement, career attrition and patient-centred care. Work-family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family. RESULTS: A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work-family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care. CONCLUSIONS: Physicians with DT and OS experiences are more likely to have better work performance and less work-family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.

The overall plant-based diet index during pregnancy and risk of gestational diabetes mellitus: a prospective cohort study in China.

The high overall plant-based diet index (PDI) is considered to protect against type 2 diabetes in the general population. However, whether the PDI affects gestational diabetes mellitus (GDM) risk among pregnant women is still unclear. We evaluated the association between PDI and GDM risk based on a Chinese large prospective cohort - the Tongji Maternal and Child Health Cohort. Dietary data were collected at 13-28 weeks of pregnancy by a validated semi-quantitative FFQ. The PDI was obtained by assigning plant food groups positive scores while assigning animal food groups reverse scores. GDM was diagnosed by a 75 g 2-h oral glucose tolerance test at 24-28 weeks of gestation. Logistic regression models were fitted to estimate OR of GDM, with associated 95 % CI, comparing women in different PDI quartiles. Among the total 2099 participants, 169 (8·1 %) were diagnosed with GDM. The PDI ranged from 21·0 to 52·0 with a median of 36·0 (interquartile range (IQR) 33·0-39·0). After adjusting for social-demographic characteristics and lifestyle factors etc., the participants with the highest quartile of PDI were associated with 57 % reduced odds of GDM compared with women in the lowest quartile of PDI (adjusted OR 0·43; 95 % CI 0·24, 0·77; Pfor trend = 0·005). An IQR increment in PDI was associated with 29 % decreased odds of GDM (adjusted OR 0·71; 95 % CI 0·56, 0·90). Findings suggest that adopting a plant-based diet during pregnancy could reduce GDM risk among Chinese women, which may be valuable for dietary counselling during pregnancy.

The Associations of Ambient Fine Particulate Matter Exposure During Pregnancy With Blood Glucose Levels and Gestational Diabetes Mellitus Risk: A Prospective Cohort Study in Wuhan, China.

Investigators in previous studies have drawn inconsistent conclusions regarding the relationship between relatively low exposure to fine particulate matter (particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5)) and risk of gestational diabetes mellitus (GDM), while the association between high PM2.5 exposure and GDM risk has not been well studied. We investigated the association of high PM2.5 exposure during pregnancy with blood glucose levels and GDM risk in Chinese women. The present study was conducted from August 2013 to May 2016 among 3,967 pregnant women in the Tongji Maternal and Child Health Cohort in Wuhan, China. PM2.5 exposure during pregnancy for each participant was estimated by means of land-use regression models. An interquartile-range increase in PM2.5 exposure (33.84 µg/m3 for trimester 1 and 33.23 µg/m3 for trimester 2) was associated with 36% (95% confidence interval (CI): 1.15, 1.61) and 23% (95% CI: 1.01, 1.50) increased odds of GDM during trimester 1 and trimester 2, respectively. An interquartile-range increment of PM2.5 exposure during trimester 1 increased 1-hour and 2-hour blood glucose levels by 1.40% (95% CI: 0.42, 2.37) and 1.82% (95% CI: 0.98, 2.66), respectively. The same increment of PM2.5 exposure during trimester 2 increased fasting glucose level by 0.85% (95% CI: 0.41, 1.29). Our findings suggest that high PM2.5 exposure during pregnancy increases blood glucose levels and GDM risk in Chinese women.

Association between sleep-wake habits and use of health care services of middle-aged and elderly adults in China.

OBJECTIVE: To examine the relationship between sleep-wake habits and the use of health care services. RESULTS: The proportions of the participants who were "early to bed" and "late to bed" were 48.7% and 51.3%, respectively. In the full sample, compared with those who were early to bed and early to rise, participants who went to bed late were more likely to report physician visits (late to bed and early to rise: OR = 1.13, 95% CI: 1.08-1.19, late to bed and late to rise: OR = 1.27, 95% CI: 1.18-1.38, respectively). We found no significant association between sleep-wake habits and the number of hospitalization. CONCLUSIONS: Those middle-aged and elderly people who stayed up late and got up late are more likely to visit the doctors than those who went to bed early and got up early. METHODS: We obtained data from a cohort study of retired employees in China, and 36,601 (95.59%) involved in the present study. The participants were allocated into 4 sleep-wake habits groups: Early-bed/Early-rise, Early-bed/Late-rise, Late-bed/Early-rise, and Late-bed/Late-rise. We explored the association between sleep-wake habits with the number of physician visits and hospitalizations.

Effects of organisational and patient factors on doctors' burnout: a national survey in China.

OBJECTIVES: To measure the burnout of doctors affiliated with western medicine (WM) and traditional Chinese medicine (TCM) hospitals and to evaluate its relationships with organisational and patient factors. DESIGN: A national cross-sectional study in China. SETTING: By convenience sampling, this study was conducted in 64 general hospitals from six provinces and Beijing between July 2014 and April 2015. There were a total of 2576 eligible participants, including 1766 WM doctors and 810 TCM doctors in this study. PRIMARY OUTCOME MEASURES: Burnout symptoms of emotional exhaustion, job involvement and personal accomplishment were measured. RESULTS: In total, 73.6% of doctors reported emotional exhaustion, the core component of burnout. In multivariable models, emotional exhaustion was significantly associated with organisational factors, including salary fairness [WM: odds ratio (OR)=2.36, 95% confidence interval (CI): 1.80 to 3.09; TCM: OR=1.59, 95% CI: 1.08 to 2.33], participation in organisational decision-making (WM: OR=1.58, 95% CI: 1.21 to 2.08; TCM: OR=1.84, 95% CI: 1.23 to 2.74), professional value (WM: OR=1.74, 95% CI: 1.35 to 2.25), frequency of participation in full-time training (TCM: OR=1.48, 95% CI: 1.01 to 2.16) and frequency of participation in clinical meetings (WM: OR=1.53, 95% CI: 1.11 to 2.10; TCM: OR=2.48, 95% CI: 1.57 to 3.92). Patient factors are also associated with burnout among both WM and TCM doctors, including respect (WM: OR=1.73, 95% CI: 1.31 to 2.28; TCM: OR=1.65, 95% CI: 1.10 to 2.45) and unreasonable demands (WM: OR=2.31, 95% CI: 1.68 to 3.20; TCM: OR=3.44, 95% CI: 2.15 to 5.49). Moreover, job involvement and personal accomplishment among both WM and TCM doctors were significantly associated with organisational and patient factors. CONCLUSIONS: Our results suggest that improving organisational management and patient behaviours may be beneficial to reduce doctors' burnout. Our findings require further validation in different organisational settings.

Effect of Physical Activity on Hospital Service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China.

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.

Patients' sense of responsibility to healthcare providers and its predictors: A national cross-sectional survey in China.

OBJECTIVES: To evaluate patients' sense of responsibility to healthcare providers and to determine its predictors using on a national sample in China. METHODS: We conducted a national cross-sectional survey in China with a stratified cluster sample of patients treated in 77 hospitals between July 2014 and April 2015. Patients' sense of responsibility to healthcare providers was measured with four questions assessing patients' perceptions regarding their responsibilities to respect doctors, respect nurses, coordinate with health professionals, and comply with hospital rules. Predictors included patient sociodemographic characteristics and their past hospitalization experience. RESULTS: Small proportions of respondents reported that they perceived having no responsibility to respect doctors (8.9%), respect nurses (7.9%), comply with hospital rules (6.7%), or coordinate with health professionals (6.3%). Multivariate regression analyses showed that the strongest predictor of patients' sense of responsibility to healthcare providers was patinets' trust in health professionals, followed by patients' education level. Familiarity with healthcare professionals and past hospitalization frequency were inversely associated with patients' sense of responsibility to healthcare providers. CONCLUSIONS: Although only a small proportion of the patients reported feeling no or low sense of responsibility to healthcare providers, the lack of respect and collaboration from these patients can negatively affect patient-provider relationships. Healthcare administrators need to communicate clearly with the patients and the public about the role of patients and the limitations of medicine in order to instill a sense of patients' responsibility.

The effects of family structure and function on mental health during China's transition: a cross-sectional analysis.

BACKGROUND: Social change, intensified by industrialization and globalization, has not only changed people's work lives but also their personal lives, especially in developing countries. The aim of this study was to provide evidence and recommendations regarding family structure, function, and mental health to actively respond to rapid social change. METHODS: A cross-sectional survey was conducted face-to-face and door-to-door from July 2011 to September 2012 in Hubei Province, central China. Family structure comprised alone, couple, nuclear family, and extended family; family function was measured using the family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve) scale, and mental health was measured using the Chinese version of the 12-item General Health Questionnaire (GHQ-12). RESULTS: The urban-vs-rural difference of family structure among alone, couple, nuclear family, and extended family was statistically significant (5.21% vs 4.62%; 27.36% vs 13.14%; 33.22% vs 27.74%; 34.20% vs 54.50%, respectively; p < 0.0001); and those difference of family function was not statistically significant (8.11 ± 2.13 vs 8.09 ± 2.27, p = 0.9372). The general linear regression showed that the effect of family structure on mental health, whether urban or rural, was not significant, however, the effect of family function was significant, especially regarding better family functioning with better mental health. CONCLUSIONS: Combined the effects of family structure and function on mental health, the external form of family (family structure) may not be important; while the internal quality of role (family function) might be key. Improving the residents' family function would be a priority strategy for family practice with their mental health.