Exploring the Dynamics between Specialization and De-Specialization of Welfare Experiences: A Qualitative Study of the Special Families under the One-Child Policy in China.

The one-child policy, i.e., of having only one child per couple, was adopted as the essential family policy in China from 1979, and since the beginning of the 21st century, it has given rise to problems of special families under the one-child policy caused by the death or disability of only children. The existing research focused on the issue of special families from a macro-social level and analyzed the welfare demands and welfare policies of those families, whereas less research has been concerned with the families' individual experiences and interpretations. This study adopted a qualitative research method and conducted in-depth interviews with 33 participants to analyze the welfare experiences of special families in Jinan city, Shandong Province. The findings of the study were based on generalized analyses of the interviews, including the "specialization" dimension of welfare experiences with identity-oriented, targeted, and comprehensive characteristics, the "de-specialization" dimension of welfare experiences with identity-denied, excluded, and hidden characteristics. The dynamics between the two dimensions among different special families, different family members, and different periods in the families' lives were also examined. We present a discussion of the study's findings and their implications, categorized into the theoretical and practical domains.

[Factors associated with delay of reperfusion-decision for patients with ST-segment elevation myocardial infarction].

OBJECTIVE: To determine lengths and factors associated with delay of reperfusion-decision in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: This cross-sectional and multicenter survey was conducted in 19 hospitals from Beijing between 1 January and 31 December, 2006 and included STEMI patients receiving thrombolysis or primary percutaneous coronary intervention (PCI). Data were collected by structured interviews and medical records review within 1 week after admission. Reperfusion-decision delay was defined as time interval from the initial ECG after admission to sign of the thrombolysis or operation approval. Patients were categorized into an early decision group and a late decision group based on the 30 min cut-off time. RESULTS: Of the 635 STEMI patients interviewed, 129 (20.3%) received thrombolysis, and the remaining 506 (79.7%) received primary PCI. The median reperfusion-decision delay was 47 min. The median door-to-needle time was 82 min, and the median door-to-balloon time was 135 min. Multivariate logistic analysis showed that awareness of the time-dependent nature of reperfusion therapy (OR = 1.723, 95% CI: 1.156-3.212, P = 0.040), pre-hospital electrocardiogram (OR = 1.566, 95% CI: 1.018-2.409, P = 0.036), cardiac function of Killip > or = 2 at admission (OR = 1.579, 95% CI: 1.004-2.483, P = 0.021) and presenting to cardiovascular specialty hospital (OR = 5.075, 95% CI: 1.380-18.655, P = 0.014) were independent predictors early reperfusion-decision delay. Patients in early decision group had significantly shorter median door-to-needle (47 vs. 103 min, P < 0.001) and door-to-balloon (100 vs. 154 min, P < 0.001) times compared to patients in late decision group. CONCLUSIONS: The main reason of the in-hospital delay of reperfusion therapy of STEMI patients is reperfusion-decision delay. New public health strategies should be developed to educate patients and their family members to increase their awareness of the importance and benefits of prompt reperfusion therapy and facilitate the pre-hospital electrocardiogram recording for STEMI patients.

[Factors associated with use of emergency medical service for acute myocardial infarction in Beijing].

OBJECTIVE: To examine the current ambulance transport rates and ascertain factors associated with use of emergency medical service (EMS) in patients with acute myocardial infarction (AMI) in Beijing. METHODS: Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review within 1 week after admission. Patients were categorized into the EMS group and the self-transport group according to their modes of transport to the initial hospital. Data were analyzed by descriptive statistics, univariate and multivariate logistic analysis. RESULTS: Of the 789 patients with STEMI, only 260 (33.0%) arrived at the initial hospital by EMS, while the remaining 529 (77.0%) relied on self-transport. Multivariate logistic analysis showed that age >/= 65 years (OR: 1.530, 95%CI: 1.050 - 2.230, P = 0.027), higher education level (OR: 2.032, 95%CI: 1.257 - 3.284, P = 0.004), history of coronary artery disease (OR: 0.474, 95%CI: 1.049 - 2.458, P = 0.029), unbearable symptoms (OR: 0.592, 95%CI: 1.090 - 2.520, P = 0.008), anxiety (OR: 0.760, 95%CI: 1.238 - 3.695, P = 0.006) and attribution of symptoms to cardiac origin (OR: 0.402, 95%CI: 1.020 - 2.171, P = 0.041) were independent predictors of EMS use. However, presence of pre-infarction angina significantly decreased the likelihood of using EMS (OR: 0.626, 95%CI: 0.431 - 0.907, P = 0.013). CONCLUSIONS: Only one-third of patients with STEMI arrived at the hospital by EMS in Beijing. Demographics, history of coronary artery disease, symptoms characteristics and cognitive factors of patients were associated with the EMS use.

[Factors leading to delay in decision to seek treatment in patients with acute myocardial infarction in Beijing].

OBJECTIVE: To investigate the factors associated with delay in decision to seek treatment in patients with acute myocardial infarction (AMI) in Beijing. METHODS: This prospective, cross-sectional, multicenter survey was conducted from November 1, 2005 and December 31 ,2006. The participants consisted of 799 patients with STEMI admitted within 24 h of symptom onset to 19 hospitals in Beijing. Data were collected by semi-structured interviews and medical records review. The patients were categorized into an early decision group and the a late decision group based on the 30 min cut-off. RESULTS: The median (25%, 75%) decision delay in STEMI patients was 60 (20, 180) min. Factors associated with late decision in an univariate analysis were age > or = 65 years, retirement or unemployment, history of myocardial infarction, symptom onset at home and intermittent symptoms, whereas presence of bystanders such as friends, coworkers or even strangers, unbearable symptoms, dyspnea, sweating, syncope and attribution of symptoms to cardiac origin were related to early decision. Multivariate logistic analysis showed that history of myocardial infarction, absence of syncope, intermittent symptoms, bearable symptoms and attribution of symptoms to noncardiac origin were independent predictors of decision delay > 30 min. Patients in the early decision group had more chances to receive acute reperfusion therapies (P = 0.001) and shorter time intervals from symptom onset to reperfusion therapies (P <0.001). CONCLUSIONS: To a great extent patients with AMI in Beijing delayed in decision to seek treatment. History of myocardial infarction, symptom characteristics and symptom attribution were associated with decision delay.

Influence of ambulance use on early reperfusion therapies for acute myocardial infarction.

BACKGROUND: Ambulance use expedites the definitive treatment of acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of ambulance use on the administration of early reperfusion therapies for patients with AMI in Beijing, China. METHODS: Data were prospectively collected from 498 patients with ST-elevation myocardial infarction (STEMI) who were admitted within 12 hours of symptom onset to 19 hospitals in Beijing between November 1, 2005 and December 31, 2006. The baseline characteristics of and the initial management of the ambulance users and the non-ambulance users were compared. RESULTS: Only 186 (37.3%) patients used an ambulance as transportation to the hospital. Ambulance users were, on average, older and at relatively higher risk on presentation than the non-ambulance users. After adjustment for patient and hospital characteristics, ambulance use was associated with a greater early reperfusion rate, mainly because of a greater incidence of primary percutaneous coronary intervention. In addition, ambulance users had a significantly shorter median door-to-balloon (120 compared with 145 minutes, P < 0.001) and symptom onset-to-balloon (223 compared with 300 minutes, P < 0.001) time than non-ambulance users. CONCLUSIONS: Ambulances are underused by AMI patients in Beijing. Ambulance use may lead to more frequent and faster receipt of early reperfusion therapies. New public health strategies should be developed to facilitate an increased use of ambulances by AMI patients.

Public knowledge of heart attack symptoms in Beijing residents.

BACKGROUND: Definitive treatment for heart attack is early reperfusion with either angioplasty or thrombolytic therapy, and the benefit is strictly time-dependent. Patient outcomes are improved with either therapy when initiated as soon as possible. Recognition of heart attack symptoms is logically tied to taking action to receive prompt emergency care. Inadequate knowledge of heart attack symptoms may prolong delay. The purpose of this study was to document knowledge about heart attack symptoms in Beijing residents and to identify the characteristics associated with increased knowledge of heart attack. METHODS: A structured survey was conducted in 18 communities in Beijing from March 1 through June 10 in 2006. Addresses and participants were selected randomly following a stratification. The survey was designed to collect knowledge of heart attack symptoms from sampled adults in each community. RESULTS: A total of 4627 respondents completed the questionnaires correctly, and 50.29% of them were female. Totally 64.15% of the respondents reported chest pain or discomfort (common symptoms) as a symptom of heart attack; 75.38% reported at least one of the following eight symptoms as a symptom of heart attack: back pain, shortness of breath, arm pain or numbness, nausea or vomiting, neck, jaw or shoulder pain, epigastric pain, sweating, weakness (less common symptoms); 20.36% correctly reported four or more heart attack symptoms, only 7.4% knew all the correct heart attack symptoms, and 28.94% knew about reperfusion therapy for heart attack; 31.7% reported to call 120 or 999 while having a heart attack themselves; however 89.6% reported to call 120 or 999 when someone else is suffering from a heart attack. Very old persons and those with health insurance coverage, high education level, high household income, longer living in Beijing and previous experience with heart disease had greater knowledge of heart attack symptoms. CONCLUSIONS: Public knowledge of common heart attack symptoms as well as less common heart attack symptoms is deficient in Beijing residents. But their knowledge of calling emergency medical services when someone is having a heart attack is relatively adequate. Public health efforts are needed to increase the recognition of the major heart attack symptoms in both the general public and groups at high risk for an acute cardiac event, especially in socioeconomically disadvantaged subgroups, including persons with low education level, low household income, and no health insurance coverage.

[Experimental research of myogenic motor evoked potentials to transcranial magnetic stimulation for spinal cord monitoring].

OBJECTIVE: To evaluate the validity of intraoperative magnetic MEP (motor evoked potentials) monitoring in a spinal-cord-menaced surgery. METHODS: 32 rabbits were employed in weight-drop spinal cord contusion model. After anesthetized with a combination of Ketamine and Droperidol the spinal cords were surgically exposed with the dura intact, and the contusion injuries were delivered except the rabbits in control group. The MEPs were recorded and the relationship between the variation of the MEPs and the residual locomotor capacity after spinal cord injury was analyzed. RESULTS: The 6 rabbits in mild-spinal-cord-injury group experienced transient attenuation of their TMS-MEPs, and the locomotor capacity remained intact (scores of 5) in almost all rabbits (5 of 6) when assessed 24 hours later; In the moderate-spinal-cord-injury group the 8 rabbits lost their TMS-MEP immediately after the weight-drop contusion, but they regained them partly in 1 hour one after another and scored 4 or 5 in the assessment of muscle power next day except for one score of 2; 8 rabbits had their spinal cords impaired severely in the contusion procedure and lost their TMS-MEP too but without recovery, their locomotor capacity outcomes were very poor, 5 of them had no response to transcranial magnetic stimulation next day, and in the other 3 rabbits we only found some polyphase waves with variant latency and lower amplitude which did not resemble common compound muscle action potential (CMAPs) evoked by TMS. CONCLUSIONS: Myogenic TMS-MEPs was very sensitive to the spinal cord injury and should be a valid technique for intraoperative monitoring, and a slight change of them, even if a transient lose, should be unnecessarily related to a severe movement disorder. The warning threshold for a given patient should depend on the malady itself.