Reasons for underutilization of community care facilities for the elderly in China.

BACKGROUND: China's government has invested a great deal of resources to improve the coverage rate of community care facilities for the elderly. However, the facilities that have been built are underutilized. METHODS: Referring to the Anderson model, a framework for analyzing the utilization of community care facilities for the elderly was constructed. Descriptive statistics on survey data from 17 communities demonstrated the status of the utilization, and binary logistic regression analysis examined the influencing factors of the utilization. RESULTS: Built community care facilities for the elderly are underutilized and there are significant differences in the influencing factors of the utilization between daily care facilities, medical care facilities, recreation facilities, and spiritual comfort facilities. CONCLUSIONS: The main reasons for the underutilization can be delineated as follows: (1) The demand for community care facilities is outstripped by the supply, resulting in a surplus; (2) Complex constraints on demand for facilities due to insufficient enabling resources; (3) Inadequacy of community care facilities in meeting expectations. (4) High substitutability of community care facilities; (5) Bureaucratic pressure hindering facility development. To address the underutilization of community care facilities, it is recommended to clarify the community responsibility boundaries for elderly care and the role that the market plays in community care facilities for the elderly.

Small field chaos in spin glasses: Universal predictions from the ultrametric tree and comparison with numerical simulations.

Replica symmetry breaking (RSB) for spin glasses predicts that the equilibrium configuration at two different magnetic fields are maximally decorrelated. We show that this theory presents quantitative predictions for this chaotic behavior under the application of a vanishing external magnetic field, in the crossover region where the field intensity scales proportionally to [Formula: see text], being N the system size. We show that RSB theory provides universal predictions for chaotic behavior: They depend only on the zero-field overlap probability function [Formula: see text] and are independent of other system features. In the infinite volume limit, each spin-glass sample is characterized by an infinite number of states that have a tree-like structure. We generate the corresponding probability distribution through efficient sampling using a representation based on the Bolthausen-Sznitman coalescent. Using solely [Formula: see text] as input we can analytically compute the statistics of the states in the region of vanishing magnetic field. In this way, we can compute the overlap probability distribution in the presence of a small vanishing field and the increase of chaoticity when increasing the field. To test our computations, we have simulated the Bethe lattice spin glass and the 4D Edwards-Anderson model, finding in both cases excellent agreement with the universal predictions.

Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer.

OBJECTIVE: Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use. STUDY DESIGN: A retrospective study of the 2004 to 2020 National Cancer Database.gg METHODS: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life. RESULTS: Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76-0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07-1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53-0.77) and high-income (aOR, 078; 95% CI, 0.71-0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11-2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42-1.75). High-income (aOR, 0.78; 95% CI, 0.71-0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52). CONCLUSION: Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service.

Placement into Scattered-Site or Place-Based Permanent Supportive Housing in Los Angeles County, CA, During the COVID-19 Pandemic.

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all.

Utilization of dental health services and its associated factors among adult population in Ernakulam district, Kerala, India: A mixed-method analysis.

Background: There exists a high burden of oral diseases. Yet, the utilization of oral health care remains low. Understanding how, when, and why/why not individuals utilize dental healthcare resources is essential for planning health services and developing policies as it reflects the population's oral health needs, helps allocate resources efficiently, and formulate policies that are tailored to address their needs. Objectives: To assess the utilization of dental health services and its associated factors along with barriers and facilitators among adults residing in Ernakulam district, Kerala, using the Anderson healthcare model for healthcare utilization. Methods: A mixed-method study was conducted among adults aged 18 years and above in urban and rural wards of Ernakulam district using the cluster sampling method. Univariate and multivariate analysis were used for the quantitative part, and thematic analysis was used for the qualitative aspect. The total sample size was 544. Results: The dental healthcare utilization was 15.4 ± 2.9 % among the study participants. Age and education were associated with dental healthcare utilization. The level of education, pain, and self-consciousness of oral diseases were independent predictors. Barriers identified were negative attitudes, financial restraints, and difficulty in access, while facilitators were trust in service providers, availability of services, and a positive attitude. Conclusion: Utilization was poor despite the perceived need for oral health care. This was affected by several personal and system-level facilitators and barriers.

A comparison of factors associated with unmet healthcare needs in people with disabilities before and after COVID-19: a nationally representative population-based study.

BACKGROUND: People with disabilities, who require numerous healthcare services, are vulnerable to unmet healthcare needs. This study aimed to investigate and identify the factors that influence unmet healthcare needs among people with disabilities and to compare these factors before and after the COVID-19 pandemic in South Korea. METHODS: A propensity score matching analysis was conducted using two datasets from the National Survey of Disabled Persons collected in 2017 and 2020. The participants were matched based on variables known to influence healthcare utilization. Based on the Andersen model, logistic regression was performed to analyze the key characteristics of the factors associated with unmet healthcare needs, including predisposing, enabling, and need factors. RESULTS: Propensity score matching resulted in the inclusion of 1,884 participants in each group: an experimental group and control group. Before COVID-19, factors associated with unmet healthcare needs included sex, age, marital status, and education level (predisposing factors), instrumental activities of daily living dependency, satisfaction with medical staff's understanding of disability, satisfaction with medical institutional facilities and equipment (enabling factors), subjective health status, and depressive symptoms (need factors). After COVID-19, factors included physical disability, instrumental activities of daily living dependency, and discrimination (enabling factors), and subjective health status, chronic diseases, depressive symptoms, and regular medical care (need factors). No significant predisposing factors affecting unmet healthcare needs were identified after COVID-19. CONCLUSIONS: This study compared the factors affecting unmet healthcare needs among people with disabilities before and after COVID-19. Recognizing the different factors associated with unmet healthcare needs before and after COVID-19, (e.g., sex, type of disability, satisfaction with medical staff's understanding of disabilities, medical institutional facilities and equipment considering the disabled, discrimination, chronic diseases, and regular medical care) may help governments and policymakers establish strategies to reduce and prevent unmet healthcare needs during and a future crisis.

A study on the factors influencing the utilization of public health services by China's migrant population based on the Shapley value method.

BACKGROUND: The health of migrants has received significant global attention, and it is a particularly significant concern in China, which has the largest migrant population in the world. Analyzing data on samples from the Chinese population holds practical significance. For instance, one can delve into an in-depth analysis of the factors impacting (1) the health records of residents in distinct regions and (2) the current state of family doctor contracts. This study explores the barriers to access these two health services and the variations in the effects and contribution magnitudes. METHODS: This study involved data from 138,755 individuals, extracted from the 2018 National Migration Population Health and Family Planning Dynamic Monitoring Survey database. The theoretical framework employed was the Anderson health service model. To investigate the features and determinants of basic public health service utilization among the migrant population across different regions of China, including the influence of enabling resources and demand factors, x2 tests and binary logistic regression analyses were conducted. The Shapley value method was employed to assess the extent of influence of each factor. RESULTS: The utilization of various service types varied among the migrant population, with significant regional disparities. The results of the decomposition of the Shapley value method highlighted variations in the mechanism underlying the influence of propensity characteristics, enabling resources, and demand factors between the two health service types. Propensity characteristics and demand factors were found to be the primary dimensions with the highest explanatory power; among them, health education for chronic disease prevention and treatment was the most influential factor. CONCLUSION: To better meet the health needs of the migrant population, regional barriers need to be broken down, and the relevance and effectiveness of publicity and education need to be improved. Additionally, by considering the education level, demographic characteristics, and mobility characteristics of the migrant population, along with the relevant health policies, the migrant population needs to be guided to maintain the health records of residents. They should also be encouraged to sign a contract with a family doctor in a more effective manner to promote the equalization of basic health services for the migrant population.

Methods of Modeling of Strongly Correlated Electron Systems.

The discovery of high-Tc superconductivity in cuprates in 1986 moved strongly correlated systems from exotic worlds interesting only for pure theorists to the focus of solid-state research. In recent decades, the majority of hot topics in condensed matter physics (high-Tc superconductivity, colossal magnetoresistance, multiferroicity, ferromagnetism in diluted magnetic semiconductors, etc.) have been related to strongly correlated transition metal compounds. The highly successful electronic structure calculations based on density functional theory lose their predictive power when applied to such compounds. It is necessary to go beyond the mean field approximation and use the many-body theory. The methods and models that were developed for the description of strongly correlated systems are reviewed together with the examples of response function calculations that are needed for the interpretation of experimental information (inelastic neutron scattering, optical conductivity, resonant inelastic X-ray scattering, electron energy loss spectroscopy, angle-resolved photoemission, electron spin resonance, and magnetic and magnetoelectric properties). The peculiarities of (quasi-) 0-, 1-, 2-, and 3- dimensional systems are discussed.

Analysis on influencing factors of e-health literacy of college students based on the Anderson model / 中国职业医学

{L-End}Objective To analyze the current status of e-health literacy (e-HL) among college students and its influencing factors based on the Anderson model. {L-End}Methods A total of 7 230 college students from Guangdong Province, Hebei Province, Jiangsu Province and other places were selected as the study subjects using the convenient sampling method based on the theoretical framework of the Anderson model. The e-HL level, anxiety symptoms and depression symptoms were investigated using the e-Health Literacy Scale, the 7-item Generalized Anxiety Scale and the Patient Health Questionnaire-9 items. {L-End}Results The score of e-HL was (29.2±6.7), with the pass rate of 42.8%. The result of multiple linear regression analysis showed that college students with lower class rank, higher average monthly family income, better online health information judgment ability, and lower degree of depression symptoms had higher e-HL level (all P<0.01). College students living in urban areas had higher e-HL levels than those living in rural areas (P<0.01). College students who engaged in regular physical exercise had higher e-HL levels than those who did not (P<0.01). College students with mild anxiety symptoms had lower e-HL levels than those without anxiety symptoms (P<0.01). {L-End}Conclusion The e-HL level of college students needs to be improved. From the perspective of the Anderson model, predisposing characteristics (class grade ranking), resources (place of residence, online health information judgment ability, regular physical exercise), demand factors (anxiety symptoms, depression symptoms) affect the level of e-HL of college students.

Application of Anderson model to analyze the influencing factors of lung function test behavior in middle-aged and elderly people in China.

Introduction: Lung function tests are valuable in assessing respiratory health and disease, and the Healthy China Initiative clearly states that people over 40 years of age should have a lung function test once a year. To explore the influence of propensity factors, ability factors, and need factors on lung function detection behaviors of middle-aged and elderly Chinese, the following studies are conducted. Method: A questionnaire was designed using Anderson's model, and multi-stage sampling was used to conduct a nationwide questionnaire survey based on geographical subdivisions and population distribution. Frequency and percentages were used for descriptive statistical analysis of lung function testing among middle-aged and elderly people in China, and chi-square tests and binary logistic regression analyses were used to investigate the factors influencing lung function testing behavior among middle-aged and elderly people in China. Result: A total of 404 study participants were included in this study. Education level (relative to primary school and below, middle school and high school and secondary school OR = 2.652, P = 0.018; college and above OR = 4.566, P = 0.002), mode of health care affordability (relative to those who paid for the test, non-payers OR = 2.205, P = 0.004), dimensions of the European Five Dimensional Health Scale (mobility OR = 4.571, P = 0.006; pain or discomfort OR = 0.397, P = 0.003; anxiety or depression OR = 0.511, P = 0.028), and self-efficacy (medium group 0R = 0.294, P < 0.001; low group OR = 0.162, P = 0.003) had a significant impact on lung function testing behavior in our middle-aged and older adults. Conclusion: This study found that there is still room for improvement in the participation of middle-aged and elderly people in lung function testing. Among the propensity factors, the factor that affects the rate of lung function tests is the highest degree of education, which determines the degree of patients' attention to lung function tests. Among the need factors, the factors affecting the rate of lung function detection are the physical conditions of middle-aged and elderly people, and those with poor physical conditions need medical detection. Among the ability factors, the factor that affects the rate of lung function tests is the way of bearing medical expenses, and economic status is the key factor that determines whether patients can accept lung function tests.

The hyperbolic Anderson model: moment estimates of the Malliavin derivatives and applications.

In this article, we study the hyperbolic Anderson model driven by a space-time colored Gaussian homogeneous noise with spatial dimension d = 1 , 2 . Under mild assumptions, we provide L p -estimates of the iterated Malliavin derivative of the solution in terms of the fundamental solution of the wave solution. To achieve this goal, we rely heavily on the Wiener chaos expansion of the solution. Our first application are quantitative central limit theorems for spatial averages of the solution to the hyperbolic Anderson model, where the rates of convergence are described by the total variation distance. These quantitative results have been elusive so far due to the temporal correlation of the noise blocking us from using the Itô calculus. A novel ingredient to overcome this difficulty is the second-order Gaussian Poincaré inequality coupled with the application of the aforementioned L p -estimates of the first two Malliavin derivatives. Besides, we provide the corresponding functional central limit theorems. As a second application, we establish the absolute continuity of the law for the hyperbolic Anderson model. The L p -estimates of Malliavin derivatives are crucial ingredients to verify a local version of Bouleau-Hirsch criterion for absolute continuity. Our approach substantially simplifies the arguments for the one-dimensional case, which has been studied in the recent work by [2].

Does health literacy promote COVID-19 awareness? Evidence from Zhejiang, China.

Background: Health literacy (HL) is considered a crucial determinant of disease prevention and control. However, the role of HL in the Coronavirus Disease 2019 (COVID-19) pandemic has not been studied using provincial representative data among Chinese residents. This study aimed to assess the association between HL and COVID-19 awareness among Zhejiang residents based on the 2020 China Health Literacy Survey (CHLS). Methods: The study was conducted among 5,596 residents aged 15-69 in Zhejiang using multistage, stratified, and probability proportional to size sampling. COVID-19 awareness and HL were assessed using the "Chinese Citizen Health Literacy Questionnaire (2020)" in Zhejiang. The covariates were divided into predisposing factors, enabling factors, and need factors according to Anderson's model. Data were analyzed by the chi-square test and logistic regression. Results: The study showed that HL and COVID-19 awareness levels of residents were 24.84% and 8.06%, respectively, in Zhejiang in 2020. After adjusting for covariates, residents with adequate HL were more likely to have better COVID-19 awareness (odds ratio [OR] = 5.22, 95% CI = 4.13-6.59, p < 0.001). Three dimensions of HL (knowledge and attitudes, behavior and lifestyle, and health-related skills) were associated with COVID-19 awareness. Additionally, COVID-19 awareness was associated with age, occupation, family size, annual household income, and chronic conditions. Conclusion: COVID-19 awareness is significantly associated with HL, suggesting that promoting HL is an important component of health education, disease prevention, and health promotion in response to the COVID-19 pandemic and even possible public health emergencies in the future.

Factors associated with the utilization of community-based health services among older adults in China-an empirical study based on Anderson's health behavior model.

Taking the modified Anderson health behavior model as the analysis framework and relying on 1136 empirical research data of S District in Foshan City, Guangdong Province of China, this study explores the influence of predisposing factors, enabling factors and need factors on the utilization of community-based health services among older adults in China. The results show that three variables have a significant impact on the use of family health services, which are whether the pension is the main source of living, income surplus, and major expenditure items. Seven variables have a significant impact on the use of preventive health services, which are household registration type, the basic endowment insurance coverage, the nature of the working unit before retirement, the self-rated health status, chronic diseases, self-care ability in daily life, and preventive health care needs.

Study the mixed valence problem in asymmetric Anderson model: Fano-Kondo resonance around Fermi level.

We numerically calculate the local density of states (LDOS) in asymmetric Anderson model in mixed valence regime using hierarchical equations of motion approach. Based on the idea that the asymmetric line shape of LDOS around Fermi level stems from the interference between the single particle resonance and the Kondo resonance, we perform a fitting. From the fitting results, we obtain the Kondo temperatures and the Fano factors with changing the single particle energy. The tendency of Kondo temperature agrees with the previous analytic expressions and the Fano factors are in an expected variation of Fano resonance. Our study shows that the Fano-Kondo resonance can reasonably explain the asymmetric line shape of the LDOS around the Fermi level.

Study on the utilization factors of oral health services of children aged 7-8 years in Weifang.

OBJECTIVES: This study aims to determine factors influencing the oral health service utilization behavior of children aged 7-8 years in Weifang based on Anderson health services utilization model. METHODS: Based on the National Comprehensive Oral Disease Intervention Project, 1 826 children aged 7-8 years were selected from 10 elementary schools in four districts of Weifang City by whole-group random sampling as the study population. The modified Anderson model was used as the theoretical framework to explore the effects of situational characteristics, population characteristics, and medical behavior on children ' s oral health service utilization. RESULTS: The oral visit rate of children within 1 year was 39.8% (726 cases), of which 47.2% (342 cases) were curative visits, 20.9% (152 cases) were consultative visits, and 10.7% (78 cases) were preventive visits. Multi-factor logistic regression analysis showed that frequent parental supervision during tooth brushing, frequent parental observation of dental health, parental education level of college and above, experience of dental pain or discomfort in the last year, and poor oral health evaluated by physician were the main factors that influenced the utilization of oral health services among children (P<0.05). CONCLUSIONS: The rate of preventive dental visits of children is low, and parents' awareness of children ' s oral health care affects the utilization rate of oral health services. Hence, parents should be taught more about children ' s oral health care to improve the utilization of children ' s health services.

Predisposing, Enabling, and Need Factors Associated with the Choice of Pharmacy Type in the US: Findings from the 2015/2016 National Consumer Survey on the Medication Experience and Pharmacists' Roles.

BACKGROUND: Knowing the type of pharmacy used by the patient is meaningful to the pharmacist. Previous studies have assessed different factors predicting the kind of pharmacy selection and reached inconsistent findings. OBJECTIVES: To identify patient and health-related factors associated with pharmacy type selection. METHODS: The Andersen Behavioral Model of Health Service Use was used to organize the selection of patient characteristics and categorize them as predisposing, enabling, and need factors. The dependent variable was the type of pharmacy used. Logistic regression was used to predict the association between patient-related characteristics and the type of pharmacy used. RESULTS: Older age respondents were less likely to use independent pharmacies (OR = 0.992) and more likely to use mail pharmacy services (OR = 1.026). Highly educated people showed higher use of chain and mail pharmacies (OR = 1.272, 1.185, respectively) and less tendency to use the independent, supermarket, and prescription-only pharmacy types. Men were less likely to use chain pharmacies (OR = 0.932) and more likely to use supermarket pharmacies than women. Patients who use Medication Therapy Management (MTM) services had higher odds of using independent and supermarket pharmacies (OR = 2.808, 1.689, respectively). Patients with a higher number of chronic diseases and experienced side effects of medications were more likely to use independent pharmacies (OR for number of disease = 1.097 and for side effects = 1.095). CONCLUSIONS: This study's findings identify characteristics associated with selecting certain pharmacy settings and direct future research to include other predictors encompassing beliefs, attitudes, and other social factors.

Influence of superconductivity on the magnetic moment of quantum impurity embedded in BCS superconductor.

We study the influence of superconductivity on the formation of the localized magnetic moment for a single-level quantum impurity embedded in an s-wave Bardeen-Cooper-Schrieffer (BCS) superconducting medium, modeled by single-impurity Anderson Hamiltonian. We have combined Bogoliubov transformation with Green's function method within self-consistent Hartree-Fock Mean Field approximation to analyze the conditions necessary in metal (in the superconducting) for the formation of the magnetic moment at the impurity site for the low-frequency limit $|\omega|<<\Delta_{sc}$ as well as for the finite superconducting gap $\Delta_{sc}$. We have compared these results with other theoretical results and with the single-level quantum impurity embedded in the normal metallic host. Further we analyze the electronic spectral density of the quantum impurity embedded in superconducting host with the finite superconducting gap to study the sub-gap states as a function of impurity parameters.

Using Anderson's Model of Health Service Utilization to Assess the Use of HIV Testing Services by Sexually Active Men in Ghana.

Introduction: Globally, HIV testing and counseling is considered a key cost-effective component of HIV prevention and treatment. This study sought to use Anderson's model of health service utilization to assess the uptake of HIV testing services by sexually active men in Ghana. Materials and Methods: Data were from the 2014 Ghana Demographic and Health Survey. Both bivariate and multivariate analysis were conducted. The multivariate analysis results are presented as Adjusted Odds ratios (AORs) with 95% confidence intervals (CI). Statistical significance was declared at p < 0.05. Results: A total of 3,052 sexually active men aged 15-59 were included in the analysis. Of these, 25.4% tested for their HIV status. Men aged 30-39 (AOR = 2.715, CI = 1.458, 5.054), those with higher level of education (AOR = 3.566,CI = 2.309, 5.509), married (AOR = 1.50, CI = 1.167, 1.931), and men in Upper East (AOR = 2.625, CI = 1.608, 4.285) had higher odds of HIV testing uptake than their counter parts aged 15-19, those with no formal education unmarried and those in Western Region, respectively. However, men with no religion (AOR = 0.606, CI = 0.376, 0.975) and those who belong to the Mole-Dagbani ethnic group (AOR = 0.633, CI = 0.429, 0.934) had lower odds of HIV testing uptake compared to those who are Christians, and Akans, respectively. Men who have subscribed to health insurance (AOR = 1.896, 95% CI = 1.361, 2.643), those in the rich wealth quintile (AOR = 1.896, CI = 1.361, 2.643), those who read newspaper (AOR = 1.552, CI = 1.198, 2.012), listened to radio (AOR = 1.530, CI = 1.087, 2.153) at least once a week, and men who experienced discharge from their penis (AOR = 1.056, CI = 1.200, 1.515) had higher odds of HIV testing uptake. Conclusion: Uptake of HIV testing among Ghanaian men is relatively low. There is the need for a concerted effort by various stakeholders to strengthen current efforts to target younger and unmarried men, men with low level of education, those who do not profess any religious affiliation and men belonging to Mole-Dagbani ethnic group.

Outpatient and Inpatient Service Use by Chinese Adults Living in Rural Low-Income Households.

This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted in 2017. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR] >1, p < .001). Individuals living in a poor household were less likely to use outpatient service (OR = 0.05, 95% confidence interval CI: 0.00, 0.71), and the longer in poverty status the less likely to use outpatient service (OR = 0.92, CI: 0.86, 0.99). Age was associated with a lower likelihood to use outpatient service (OR = 0.93, CI: 0.93, 1.00), and this relationship was stronger for larger households (OR = 1.01, CI: 1.00, 1.01). For inpatient service use, most household-level measures were insignificant. Rural Chinese health service use was influenced primarily by needs variables. Outpatient service use was constrained by household enabling variables. Older adults were at a disadvantage of using outpatient service when the family prioritized younger members in allocating resources. These results suggest the need for policy advocacy to expand insurance reimbursement and improve benefits for poor older adults.

Nonequilibrium Kondo effect in a graphene-coupled quantum dot in the presence of a magnetic field.

Background: Quantum dots connected to larger systems containing a continuum of states like charge reservoirs allow the theoretical study of many-body effects such as the Coulomb blockade and the Kondo effect. Results: Here, we analyze the nonequilibrium Kondo effect and transport phenomena in a quantum dot coupled to pure monolayer graphene electrodes under external magnetic fields for finite on-site Coulomb interaction. The system is described by the pseudogap Anderson Hamiltonian. We use the equation of motion technique to determine the retarded Green's function of the quantum dot. An analytical formula for the Kondo temperature is derived for electron and hole doping of the graphene leads. The Kondo temperature vanishes in the vicinity of the particle-hole symmetry point and at the Dirac point. In the case of particle-hole asymmetry, the Kondo temperature has a finite value even at the Dirac point. The influence of the on-site Coulomb interaction and the magnetic field on the transport properties of the system shows a tendency similar to the previous results obtained for quantum dots connected to metallic electrodes. Most remarkably, we find that the Kondo resonance does not show up in the density of states and in the differential conductance for zero chemical potential due to the linear energy dispersion of graphene. An analytical method to calculate self-energies is also developed which can be useful in the study of graphene-based systems. Conclusion: Our graphene-based quantum dot system provides a platform for potential applications of nanoelectronics. Furthermore, we also propose an experimental setup for performing measurements in order to verify our model.