Medication adherence and costs of medical care among patients with Parkinson's disease: an observational study using electronic medical records.

BACKGROUND: Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson's disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in a single system when assessing clinical factors affecting adherence to PD treatment, and no international comparative data are available on the medical costs for Chinese patients with PD. The present study aimed to evaluate medication adherence and its associated factors among Chinese patients with PD using a systematic approach and to explore the impact of adequate medication adherence on direct medical costs. METHODS: A retrospective analysis was conducted using the electronic medical records of patients with PD from a medical center in China. Patients with a minimum of two APD prescriptions from January 1, 2016 to August 15, 2018 were included. Medication possession ratio (MPR) and proportion of days covered were used to measure APD adherence. Multiple linear regression analysis was used to identify factors affecting APD adherence. Gamma regression analysis was used to explore the impact of APD adherence on direct medical costs. RESULTS: In total, 1,712 patients were included in the study, and the mean MPR was 0.68 (± 0.25). Increased number of APDs and all medications, and higher daily levodopa-equivalent doses resulted in higher MPR (mean difference [MD] = 0.04 [0.03-0.05]; MD = 0.02 [0.01-0.03]; MD = 0.03 [0.01-0.04], respectively); combined digestive system diseases, epilepsy, or older age resulted in lower MPR (MD = -0.06 [-0.09 to -0.03]; MD = -0.07 [-0.14 to -0.01]; MD = -0.02 [-0.03 to -0.01], respectively). Higher APD adherence resulted in higher direct medical costs, including APD and other outpatient costs. For a 0.3 increase in MPR, the two costs increased by $34.42 ($25.43-$43.41) and $14.63 ($4.86-$24.39) per year, respectively. CONCLUSIONS: APD adherence rate among Chinese patients with PD was moderate and related primarily to age, comorbidities, and healthcare costs. The factors should be considered when prescribing APDs.

Generic substitution of amlodipine is not associated with increased risk of mortality or adverse cardiovascular events: An observational cohort study.

This study aims to assess clinical outcomes following switching from originator to generic amlodipine. This population-based, matched, cohort study included users of originator amlodipine using claims data during 2018-2020 from a health system in Tianjin, China, in which usage of generic amlodipine was promoted by a drug procurement policy, the national volume-based procurement. Non-switchers refer to those remained on originator after the policy, while pure-switchers were those who switched to and continued using generic amlodipine, and back-switchers were those switched to generic amlodipine but then back to the originator. Propensity score matching generates comparable non-switchers and pure-switchers pairs, and non-switchers and back-switchers pairs. The primary outcome was major adverse cardiovascular events (MACEs), defined as all-cause mortality, stroke, and myocardial infarction during follow-up (April 1, 2019 to December 30, 2020). Secondary outcomes included heart failure, atrial fibrillation, and adherence to amlodipine. The hazard ratio (HR) for each clinical outcome was assessed through Cox proportional hazard regression. In total, 5943 non-switchers, 2949 pure-switchers, and 3061 back-switchers were included (mean age: 62.9 years; 55.5% men). For the matched pairs, pure-switchers (N = 2180) presented no additional risks of clinical outcomes compared to non-switchers (N = 4360) (e.g., MACEs: 2.86 vs. 2.95 events per 100 person-years; HR = 0.97 [95%CI: 0.70-1.33]). Back-switchers (N = 1998) also presented no additional risk compared to non-switchers (N = 3996) for most outcomes except for stroke (HR = 1.55 [95%CI: 1.03-2.34]). Pure-switchers and back-switchers all had better amlodipine adherence than non-switchers. Generic substitution of amlodipine is not associated with increased risk of cardiovascular events or all-cause mortality, but improves medicine adherence.

Socioeconomic inequalities in depressive symptoms in China: The role of social capital.

This cohort study used the China Health and Retirement Longitudinal Study (CHARLS, 2015-2018) to investigate the effects of socioeconomic status and social capital to the incidence of depressive symptoms among middle-aged and older individuals in China, incorporating a sample size of 9949 participants. Socioeconomic status, social capital and other explanatory variables were collected in 2015, while depressive symptoms were assessed in 2018. Basic characteristics and social capital measures were compared between urban and rural residents using the chi-square test. Logistic regression was used to explore the relationship between socioeconomic status, social capital and depressive symptoms, and the Karlson, Holm, and Breen (KHB) method was employed to verify the mediating role of social capital. We reported persistent socioeconomic inequalities in depressive symptoms, with rural residents and the illiterate having 1.45 times and 1.34 times higher odds of depression. We ascertained social capital from both the cognitive and structural constructs, where we enriched the measurement of structural social capital from three specific dimensions, i.e., informal interaction, altruism, and formal social participation. We found that both cognitive and structural social capital were associated with lower incidence of depressive symptoms, where informal interaction had the largest effect. The mediation analysis further illustrated that informal interaction contributed most to explain 6 %-12 % of the socioeconomic inequalities in depressive symptoms. These results highlighted the unsatisfied mental wellbeing of the vulnerable older people living in rural areas. The finding suggested that older people may benefit more from personal interactions than formal participations. To fulfill the Health in All vision, government and social organizations should consider how to create opportunities to better integrate the older people into the community.

Short-term effects of air pollutants on hospital admissions for asthma among older adults: a multi-city time series study in Southwest, China.

Background: This study aimed to explore the relationship between air pollution and hospital admissions for asthma in older adults, and to further assess the health and economic burden of asthma admissions attributable to air pollution. Methods: We collected information on asthma cases in people over 65 years of age from nine cities in Sichuan province, as well as air pollution and meteorological data. The relationship between short-term air pollutant exposure and daily asthma hospitalizations was analyzed using the generalized additive model (GAM), and stratified by gender, age, and season. In addition, we assessed the economic burden of hospitalization for air pollution-related asthma in older adults using the cost of disease approach. Results: The single pollutant model showed that every 1 mg/m3 increase in CO was linked with an increase in daily hospitalizations for older adults with asthma, with relative risk values of 1.327 (95% CI: 1.116-1.577) at lag7. Each 10 µg/m3 increase in NO2, O3, PM10, PM2.5 and SO2, on asthma hospitalization, with relative risk values of 1.044 (95% CI: 1.011-1.078), 1.018 (95% CI: 1.002-1.034), 1.013 (95% CI: 1.004-1.022), 1.015 (95% CI: 1.003-1.028) and 1.13 (95% CI: 1.041-1.227), respectively. Stratified analysis shows that stronger associations between air pollution and asthma HAs among older adult in females, those aged 65-69 years, and in the warm season, although all of the differences between subgroups did not reach statistical significance. During the study period, the number of asthma hospitalizations attributable to PM2.5, PM10, and NO2 pollution was 764, 581 and 95, respectively, which resulted in a total economic cost of 6.222 million CNY, 4.73 million CNY and 0.776 million CNY, respectively. Conclusion: This study suggests that short-term exposure to air pollutants is positively associated with an increase in numbers of asthma of people over 65 years of age in Sichuan province, and short-term exposure to excessive PM and NO2 brings health and economic burden to individuals and society.

Role of residential greenspace in the trajectory of major neurological disorders: A longitudinal study in UK Biobank.

BACKGROUND: Stroke and dementia are major neurological disorders that contribute significantly to disease burden and are interlinked in terms of risk. Nevertheless, there is currently no study investigating the influence of residential greenspace on the trajectory of these neurological disorders. METHODS: This longitudinal study utilized data from the UK Biobank. Exposure to residential greenspace was measured by the percentage of total greenspace coverage within a 300-meter buffer zone surrounding the participants' residences. A multistate model was employed to illustrate the trajectory of major neurological disorders, and a piecewise Cox regression model was applied to explore the impact of residential greenspace on different time courses of disease transitions. RESULTS: With 422,649 participants and a median follow-up period of 12.5 years, 8568 (2.0 %), 5648 (1.3 %), and 621 (0.1 %) individuals developed incident stroke, dementia, and comorbidity of both conditions, respectively. An increase in residential greenspace by one interquartile range was associated with reduced risks of transitions from baseline to stroke, dementia, and death, as well as from stroke to comorbidity. The corresponding hazard ratios (HRs) were 0.967 (95 % CI: 0.936, 0.998), 0.928 (0.892, 0.965), 0.925 (0.907, 0.942), and 0.799 (0.685, 0.933), respectively. Furthermore, the protective effect of residential greenspace on the transition from stroke or dementia to comorbidity was particularly pronounced within the first year and over 5 years after stroke and during the 2 to 3 years after dementia onset, with HRs of 0.692 (0.509, 0.941), 0.705 (0.542, 0.918), and 0.567 (0.339, 0.949), respectively. CONCLUSION: This study observed a protective role of residential greenspace in the trajectory of major neurological disorders and contributed to identifying critical progression windows. These findings underscore the significance of environment-health interactions in the prevention of neurological disorders.

The heterogeneous impacts of government on health system efficiency in China's new health reform, 2010-2019.

BACKGROUND: Contextualizing in China's recent health reform, we empirically explore the heterogeneous effects of two distinct government roles, accommodating private hospitals vs investing in public hospitals, on health system efficiency. METHODS: We use panel data covering 31 provinces during 2010-2019 to assess health system efficiency. We incorporate health service volumes and population health outcomes to ascertain health system outputs, employing the non-radial directional distance function to estimate efficiency. We employ Bayesian Tobit quantile regression to explore the heterogeneous effects of the share of private hospitals and government subsidy to public providers on efficiency. RESULTS: China's health system inefficiency scores range from 0 to 0.45. The association between the share of private hospitals and inefficiency score are only significant in higher-inefficiency quantiles (coefficients -0.0258, -0.0315 and -0.0327 for quantiles 0.7, 0.8 and 0.9), meaning a heterogeneously positive impact for low-efficiency provinces. The association between government subsidy and inefficiency score are positive for all quantiles (from 0.0339 to 0.0567), meaning persistent negative impacts on efficiency. CONCLUSIONS: The heterogeneous impacts of the share of private hospitals suggest that the government should accommodate more private hospitals in provinces with low efficiency. The persistent negative impacts of government subsidy suggest that the government investment seems not be subjected to economic objectives.

Exploring the impact of water, sanitation and hygiene (WASH), early adequate feeding and access to health care on urban-rural disparities of child malnutrition in China.

To explore the effects of UNICEF-suggested modifiable factors, that is, water, sanitation and hygiene (WASH), early adequate feeding and health care on child malnutrition, and to examine the extent to which each factor contributes to urban-rural disparities of child malnutrition in China. Pooling two waves of regionally representative survey data from Jilin, China, in 2013 and 2018, we report on urban-rural relative risks (RRs) in the prevalence of child stunting, wasting and overweight. We employ Poisson regression to examine the effects of urban-rural setting and the three modifiable factors on the prevalence of each malnutrition outcome, that is, stunting, wasting and overweight. We perform mediation analyses to estimate the extent to which each modifiable factor could explain the urban-rural disparities in each malnutrition outcome. The prevalence of stunting, wasting and overweight were 10.9%, 6.3% and 24.7% in urban, and 27.9%, 8.2% and 35.9% in rural Jilin, respectively. The rural to urban crude RR was 2.55 (95% confidence interval [CI]: 1.92-3.39) for stunting, while the corresponding RRs for wasting and overweight were 1.31 (95% CI: 0.84-2.03) and 1.45 (95% CI: 1.20-1.76), respectively. The rural to urban RR for stunting reduced to 2.01 (95% CI: 1.44-2.79) after adjusting for WASH. The mediation analyses show that WASH could mediate 23.96% (95% CI: 4.34-43.58%) of the urban-rural disparities for stunting, while early adequate feeding and health care had no effects. To close the persistent urban-rural gap in child malnutrition, the specific context of rural China suggests that a multi-sectoral approach is warranted that focuses on the sanitation environment and other wider social determinants of health.

Breastfeeding practices in Northeast China in 2008 and 2018: cross-sectional surveys to explore determinants over a decade.

BACKGROUND: This study was conducted to investigate the prevalence and determinants of breastfeeding in 2008 and 2018, respectively, in Northeast China, where health service efficiency is at the lowest national level and regional data on breastfeeding are lacking. The influence of early initiation of breastfeeding on later feeding practices was specifically explored. METHODS: Data from the China National Health Service Survey in Jilin Province in 2008 (n = 490) and 2018 (n = 491) were analysed. Multistage stratified random cluster sampling procedures were used to recruit the participants. Data collection was conducted in the selected villages and communities in Jilin. Early initiation of breastfeeding was defined as the proportion of children born in the last 24 months who were put to the breast within one hour after birth in both the 2008 and 2018 surveys. Exclusive breastfeeding was defined as the proportion of infants 0-5 months of age who were fed exclusively with breast milk in the 2008 survey; while defined as the proportion of infants 6-60 months of age who had been fed exclusively with breast milk within the first six months of life in the 2018 survey. RESULTS: The prevalence of early initiation of breastfeeding (27.6% in 2008 and 26.1% in 2018) and exclusive breastfeeding during the first six months (< 50%) were low in two surveys. Logistic regression revealed that exclusively breastfeeding at six months was positively associated with early initiation of breastfeeding (OR 2.65; 95% confidence interval (CI) 1.65, 4.26) and negatively associated with caesarean section (OR 0.65; 95% CI 0.43, 0.98) in 2018. Continued breastfeeding at one year and timely introduction of complementary foods were associated with maternal residence and place of delivery, respectively, in 2018. Early initiation of breastfeeding was associated with mode and place of delivery in 2018 but residence in 2008. CONCLUSION: Breastfeeding practices in Northeast China are far from optimal. The negative effect of caesarean section and positive effect of early initiation of breastfeeding on exclusive breastfeeding suggest that an institution-based approach should not be substituted by the community-based one in the formulation of breastfeeding strategies in China.

Access, charge and quality of tele-dermatology e-consults in China: A standardized patients study.

Objective: Direct-to-consumer telemedicine is rapidly changing the way that patients seek medical care. This study provided the first report on access, cost and quality of text- and image-based tele-dermatology e-consults, in China. Methods: We adopted the Standardized Patients approach to evaluate the services of tele-dermatology e-consults in two metropolitan cities, that is, Beijing and Hangzhou, in China. We measured quality from four dimensions: service process, diagnosis accuracy, prescription and treatment comprehensiveness, based on China's national clinical guidelines. We performed logistic regressions to investigate factors that were associated with high-quality care. Results: For 114 physicians eligible for inclusion, we succeeded in 87 (76%) validated visits. The median waiting time was 100 minutes (IQR 19-243 minutes) and the median length of consultation was 636 minutes (about 10 hours, IQR 188-1528 minutes). Per visit costs varied from $0 to $38, with a median of $8 (IQR 4-9). Among all, 15% of visits showed high quality in service process, 84% arrived in the correct diagnosis, 24% provided high-quality prescriptions and 71% provided comprehensive treatment. Providing images was associated with high quality in service process (OR 7.22, 95% CI 1.49-34.88). Visits in metropolitan Beijing and on non-work days had better prescription quality than that in metropolitan Hangzhou (OR 6.05, 95% CI 1.75-20.95) and that on workdays (OR 3.75, 95%CI 1.27-11.04), respectively. Conclusions: Tele-dermatology e-consults seem to be easy to access and less expensive in China. However, great efforts are warranted to ensure that service processes and prescriptions adhere to clinical guidelines.

Tracking progress towards universal health coverage for essential health services in China, 2008-2018.

INTRODUCTION: We comprehensively evaluate whether the Chinese Government's goal of ensuring Universal Health Coverage for essential health services has been achieved. METHODS: We used data from the 2008, 2013 and 2018 National Health Services Survey to report on the coverage of a range of Sustainable Development Goals (SDG) indicator 3.8.1. We created per capita household income deciles for urban and rural samples separately. We report time trends in coverage and the slope index (SII) and relative index (RII). RESULTS: Despite much lower levels of income and education, rural populations made as much progress as their urban counterparts for most interventions. Coverage of maternal and child health interventions increased substantially in urban and rural areas, with decreasing rich-poor inequalities except for antenatal care. In rural China, one-fifth women could not access 5 or more antenatal visits. Coverage of 8 or more visits were 34% and 68%, respectively in decile D1 (the poorest) and decile D10 (the richest) (SII 35% (95% CI 22% to 48%)). More than 90% households had access to clean water, but basic sanitation was poor for rural households and the urban poorest, presenting bottom inequality. Effective coverage for non-communicable diseases was low. Medication for hypertension and diabetes were relatively high (>70%). But adequate management, counting in preventive interventions, were much lower and decreased overtime, although inequalities were small in size. Screening of cervical and breast cancer was low in both urban and rural areas, seeing no progress overtime. Cervical cancer screening was only 29% (urban) and 24% (rural) in 2018, presenting persisted top inequalities (SII 25% urban, 14% rural). CONCLUSION: China has made commendable progress in protecting the poorest for basic care. However, the 'leaving no one behind' agenda needs a strategy targeting the entire population rather than only the poorest. Blunt investing in primary healthcare facilities seems neither effective nor efficient.

Changes in rate and socioeconomic inequality of cervical cancer screening in northeastern China from 2013 to 2018.

Objective: Cervical cancer, the fourth leading cancer diagnosed in women, has brought great attention to cervical cancer screening to eliminate cervical cancer. In this study, we analyzed two waves of provincially representative data from northeastern China's National Health Services Survey (NHSS) in 2013 and 2018, to investigate the temporal changes and socioeconomic inequalities in the cervical cancer screening rate in northeastern China. Methods: Data from two waves (2013 and 2018) of the NHSS deployed in Jilin Province were analyzed. We included women aged 15-64 years old and considered the occurrence of any cervical screening in the past 12 months to measure the cervical cancer screening rate in correlation with the annual per-capita household income, educational attainment, health insurance, and other socioeconomic characteristics. Results: A total of 11,616 women aged 15-64 years were eligible for inclusion. Among all participants, 7,069 participants (61.11%) were from rural areas. The rate of cervical cancer screening increased from 2013 to 2018 [odds ratio (OR): 1.06; 95% confidence interval (CI): 1.04-1.09, p < 0.001]. In total, the cervical cancer screening rate was higher among participants who lived in urban areas than rural areas (OR: 1.20; 95% CI: 1.03-1.39, p = 0.020). The rate was also higher among those with the highest household income per capita (OR: 1.30; 95% CI: 1.07-1.56, p = 0.007), with higher educational attainment (p < 0.001), and with health insurance (p < 0.05), respectively. The rate of cervical cancer screening was also significantly associated with parity (OR: 1.62; 95% CI: 1.23-2.41, p = 0.001) and marital status (OR: 1.45; 95% CI: 1.15-1.81, p = 0.001) but not ethnicity (OR: 1.41; 95% CI: 0.95-1.36, p = 0.164). Conclusion: Cervical cancer screening coverage improved from 2013 to 2018 in northeastern China but remains far below the target 70% screening rate proposed by the World Health Organization. Although rural-urban inequality disappeared over time, other socioeconomic inequalities remained.

Quality Assessment of Hypertension Treatment-Related Information on WeChat: Cross-sectional Study.

BACKGROUND: The WeChat platform has become a primary source for medical information in China. However, no study has been conducted to explore the quality of information on WeChat for the treatment of hypertension, the leading chronic condition. OBJECTIVE: This study aimed to explore the quality of information in articles on WeChat that are related to hypertension treatment from the aspects of credibility, concreteness, accuracy, and completeness. METHODS: We searched for all information related to hypertension treatment on WeChat based on several inclusion and exclusion criteria. We used 2 tools to evaluate information quality, and 2 independent reviewers performed the assessment with the 2 tools separately. First, we adopted the DISCERN instrument to assess the credibility and concreteness of the treatment information, with the outcomes classified into five grades: excellent, good, fair, poor, and very poor. Second, we applied the Chinese Guidelines for Prevention and Treatment of Hypertension (2018 edition) to evaluate the accuracy and completeness of the article information with regard to specific medical content. Third, we combined the results from the 2 assessments to arrive at the overall quality of the articles and explored the differences between, and associations of, the 2 independent assessments. RESULTS: Of the 223 articles that were retrieved, 130 (58.3%) full texts were included. Of these 130 articles, 81 (62.3%) described therapeutic measures for hypertension. The assessment based on the DISCERN instrument reported a mean score of 31.22 (SD 8.46). There were no articles rated excellent (mean score >63); most (111/130, 85.4%) of the articles did not refer to the consequences-in particular, quality of life-of no treatment. For specific medical content, adherence to the Chinese Guidelines for Prevention and Treatment of Hypertension was generally low in terms of accuracy and completeness, and there was much erroneous information. The overall mean quality score was 10.18 (SD 2.22) for the 130 articles, and the scores differed significantly across the 3 types (P=.03) and 5 sources (P=.02). Articles with references achieved higher scores for quality than those reporting none (P<.001). The results from the DISCERN assessment and the medical content scores were highly correlated (ρ=0.58; P<.001). CONCLUSIONS: The quality of hypertension treatment-related information on the WeChat platform is low. Future work is warranted to regulate information sources and strengthen references. For the treatment of hypertension, crucial information on the consequences of no treatment is urgently needed.

Cost-Effectiveness of Presbyopia Correction Among Seven Strategies of Bilateral Cataract Surgery Based on a Prospective Single-Blind Two-Center Trial in China.

INTRODUCTION: The aim of this study was to explore a method to rank the cost-effectiveness of presbyopia correction in diverse strategies of bilateral cataract surgery to provide references for healthcare policymakers in rationalizing resource utilization and surgeons in customizing patient management. METHODS: The cost-effectiveness analysis based on a prospective single-blind two-center clinical trial included seven strategies in bilateral cataract surgery: monofocal, monovision, diffractive bifocal, blended, refractive bifocal, trifocal, and extended depth of focus (EDOF) strategies. The effectiveness according to the objective spectacle independence rate (hereafter "rate", a novel indicator defined as the proportion of patients with binocular uncorrected distance, intermediate and near visual acuity all better than 0.1 logMAR, logarithm of the minimum angle of resolution), costs, average cost-effectiveness ratios (ACERs, $/1% rate), and incremental cost-effectiveness ratios (ICERs, $/1% incremental rate) were estimated. RESULTS: In 194 participants (388 eyes), the trifocal strategy achieved the highest rate [93.10% (95% confidence interval (CI) 83.8-102.35%)]. The refractive bifocal strategy had the minimum ACER [$45.54/1% rate (95% CI 34.57-56.50)], followed by the blended [$59.10/1% rate (95% CI 31.72-86.48)], diffractive bifocal [$69.06/1% rate (95% CI 30.89-107.21)], EDOF [$72.85/1% rate (95% CI 52.02-93.70)], trifocal [$93.01/1% rate (95% CI 83.23-102.79)], monovision [$136.83/1% rate (95% CI - 55.40 to 329.14)], and monofocal [$264.45/1% rate (95% CI - 97.45 to 626.55)] strategies. Compared with the refractive bifocal strategy, the probabilities that the trifocal strategy (ICER $289.74/1% incremental rate) is very cost-effective and cost-effective were 81.7% and 93.2%, respectively, at the wiliness-to-pay threshold of one and three times China's annual disposable income per capita in 2021 per 10% incremental rates. CONCLUSIONS: Cost-effectiveness analysis with ACER and ICER according to objective spectacle independence rate is a helpful tool to identify highly cost-effective presbyopia-correcting strategies in cataract surgery for clinical and policy decisions. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04265846).

Can case-based payment contain healthcare costs? - A curious case from China.

We adopted a difference-in-difference (DID) design to evaluate the impact of a case-based payment pilot in Tianjin, China on hospital admission, utilization of varied therapeutic regimes, and the associated costs. We used claim data of all admissions of angina and acute myocardial infarction during July 2015 to June 2018, 18 months before and after the program. Our analyses were supported by convincing common trends tests and a couple of sensitivity analyses. As intended, for patients who received percutaneous coronary stenting (PCS) and were counted in the case-based payment system, we showed that the program decreased length-of-stay, per-admission spending, and out-of-pocket spending by 20.8%, 14.2%, and 95.5%, respectively, but did not increase readmissions. However, when considering all patients who suffered from the two types of coronary heart diseases, we found that the program otherwise increased per-admission spending by nearly 11%. As a result, the program took a perverse effect in increasing monthly spending for the health insurance scheme and the society by 1005.6 thousand USD (47·5%) and 1095·7 thousand USD (34·7%), respectively. Increases in hospital admissions, and proportion of performing PCS accounted for 66·7% and 39·2% of the rise, respectively. In addition, our analysis provided evidence of health providers' cream-skimming behaviors, including selecting younger patients with lower CCI in the case-based system, up-coding complications, and keeping higher cost patients in the fee-for-service payment system. We draw lessons that case-based payment may make an unintended impact that increases healthcare costs when incentives are not properly designed.

Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study.

BACKGROUND: Consultation length, the time a health provider spend with the patient during a consultation, is a crucial aspect of patient-physician interaction. Prior studies that assessed the relationship between consultation length and quality of care were mainly based on offline visits. Research was lacking in E-consults settings, an emerging modality for primary health care. This study aims to examine the association between consultation length and the quality of E-consults services. METHODS: We defined as standardized patient script to present classic urticaria symptoms in asynchronous E-consults at tertiary public hospitals in Beijing and Hangzhou, China. We appraised consultation length using six indicators, time waiting for first response, time waiting for each response, time for consultation, total times of provider's responses, total words of provider's all responses, and average words of provider's each response. We appraised E-consults services quality using five indicators building on China's clinical guidelines (adherence to checklist; accurate diagnosis; appropriate prescription; providing lifestyle modification advice; and patient satisfaction). We performed ordinary least squares (OLS) regressions and logistic regressions to investigate the association between each indictor of consultation length and E-consults services quality. RESULTS: Providers who responded more quickly were more likely to provide lifestyle modification advice and achieve better patient satisfaction, without compromising process, diagnosis, and prescribing quality; Providers who spent more time with patients were likely to adhere to clinical checklists; Providers with more times and words of responses were significantly more likely to adhere to the clinical checklist, provide an accurate diagnosis, appropriate prescription, and lifestyle modification advice, which achieved better satisfaction rate from the patient as well. CONCLUSIONS: The times and words that health providers provide in E-consult can serve as a proxy measure for quality of care. It is essential and urgent to establish rules to regulate the consultation length for Direct-to-consumer telemedicine to ensure adequate patient-provider interaction and improve service quality to promote digital health better.

Determinants of Infant Young Child Feeding Among Mothers of Malnourished Children in South Punjab, Pakistan: A Qualitative Study.

Inadequate feeding is one of the most critical underlying determinants of child malnutrition. In this study, we explore infant young child feeding (IYCF) and deconstruct breastfeeding barriers in mothers of severely malnourished children in one of the most marginalized districts of Punjab province of Pakistan. Using purposive sampling, 20 lactating mothers are recruited for open-ended semi-structured interviews. Results reveal that barriers to immediate and exclusive breastfeeding include the introduction of pre-lacteal, butter, and cow or formula milk by mothers and grandmothers. Birthing difficulties and ritualizing prelacteal to transfer religion and culture cause the delay of early initiation of breastmilk. The colostrum is also discarded based on its weird physical look. Moreover, household circumstances, limited diet, extra workload, and mental stress associated with marital relationships are other significant barriers. Mothers perceive their breastmilk as thin, impotent, and of bad quality and often complain against breastmilk insufficiency due to general weakness. Furthermore, poor mothers reduce breastfeeding when the fertility burden is high, especially if a female baby is in their womb. Alternatively, outer milk is recommended but washing bottles with detergents often becomes frequent. In conclusion, immediacy, exclusivity, frequency, and duration of breastfeeding are circumscribed owing to multiple social, cultural, and economic causes. Therefore, a holistic approach combining cultural and structural causes might be more relevant for successful IYCF practices in marginalized communities of Pakistan.

The Associations Between Parental Burnout and Mental Health Symptoms Among Chinese Parents With Young Children During the COVID-19 Pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic has caused numerous unexpected changes for families and societies, which have likely contributed to higher amounts of stress for most parents. This study aimed to examine the relationship between burnout and mental health among parents during the COVID-19. Pandemic exposure and household factors (e.g., family structure, family function) were examined as moderators. An online cross-sectional survey recruiting 1,209 adults was conducted from April 21st to April 28th, 2020 during the COVID-19 lockdown in China. The multivariable linear regression analysis was employed to test the association between burnout, household factors, and mental health among parents. Findings suggested that for parents with a young child, poorer mental health was related to a higher level of burnout (ß = 0.220, P < 0.001) and greater exposure to the pandemic. Mothers of a single and/or young child had considerably poorer mental health. Moreover, the relationship between mental health and burnout among parents was significantly moderated by epidemic exposure (ß = 2.561, P < 0.001), family structure (number of children: ß = -1.257, P < 0.001; first child age: ß=-1.116, P < 0.001) and family function (ß = -0.574, P < 0.05). This study indicated that burnout symptoms were significantly associated with worse mental health among parents in China. Besides, exposure to the pandemic, family structure, and family function was found to moderate the association between burnout and mental health among parents. Therefore, the present study stressed enhanced access to mental health resources and emotional supports for parents during a public crisis to reduce the deleterious effects of burnout.

Detecting and Measuring Depression on Social Media Using a Machine Learning Approach: Systematic Review.

BACKGROUND: Detection of depression gained prominence soon after this troublesome disease emerged as a serious public health concern worldwide. OBJECTIVE: This systematic review aims to summarize the findings of previous studies concerning applying machine learning (ML) methods to text data from social media to detect depressive symptoms and to suggest directions for future research in this area. METHODS: A bibliographic search was conducted for the period of January 1990 to December 2020 in Google Scholar, PubMed, Medline, ERIC, PsycINFO, and BioMed. Two reviewers retrieved and independently assessed the 418 studies consisting of 322 articles identified through database searching and 96 articles identified through other sources; 17 of the studies met the criteria for inclusion. RESULTS: Of the 17 studies, 10 had identified depression based on researcher-inferred mental status, 5 had identified it based on users' own descriptions of their mental status, and 2 were identified based on community membership. The ML approaches of 13 of the 17 studies were supervised learning approaches, while 3 used unsupervised learning approaches; the remaining 1 study did not describe its ML approach. Challenges in areas such as sampling, optimization of approaches to prediction and their features, generalizability, privacy, and other ethical issues call for further research. CONCLUSIONS: ML approaches applied to text data from users on social media can work effectively in depression detection and could serve as complementary tools in public mental health practice.