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Influenza causes excessive morbidity and mortality among older adults. While influenza vaccine provides protection against its infection, the vaccination coverage in China among older adults has been very low. Previous evidence on the cost-effectiveness of government-sponsored free influenza vaccination programs in China was primarily based on literature data, which might not always reflect real-world patient populations. The Yinzhou Health Information System (YHIS) is a regional database that captures electronic health records, insurance claims data, etc. for all residents in Yinzhou district, Zhejiang province, China. We will use YHIS to study the effectiveness, influenza-related direct medical cost and cost-effectiveness analysis (CEA) of the free influenza vaccination program for older adults. In this paper, we describe the study design and innovations in detail. We will establish a retrospective cohort of permanent older residents aged 65 and over, using YHIS between 2016 and 2021. We will estimate the vaccine coverage rate, influenza incidence rate and influenza-related direct medical cost from 2016 to 2021. Regression discontinuity will be used to estimate vaccine effectiveness for the 2020/2021 season. We will build a decision tree model to compare the cost-effectiveness of three influenza vaccination options (free trivalent influenza vaccine, free quadrivalent influenza vaccine, and no policy) from both societal and health system perspectives. Parameter inputs will be gathered from both YHIS and published literature. We will calculate the incremental cost-effectiveness ratio with cost and quality-adjusted life years (QALYs) discounted at 5 % annually. Our CEA solidifies multiple sources including regional real-world data and literature for a rigorous evaluation of the government-sponsored free influenza vaccination program. The results will provide real-world evidence from real-world data on the cost-effectiveness of a real-world policy. Our findings are expected to support evidence-based policy making and to promote health for older adults. [ABSTRACT FROM AUTHOR]

Gentrification has now unfolded at a planetary scale and has broken down the center-periphery structuring of urban and rural areas. In the context of new-type urbanization and rural revitalization, tourism gentrification has gradually become a new frontier of the rural-urban relations in China. Taking Xizha as a case study, this paper aims to explore the characteristics and mechanisms of tourism gentrification in historic districts through temporal analysis and multi-scalar approaches. Based on recent field visits and semi-structured interviews with administrative staff, enterprise managers, residents, and tourists in the study area, three main arguments are put forward in this paper. First, a phased tourism gentrification process has taken place in Xizha, with significant shifts in lifestyle, industry and investment, physical infrastructure, property rights, and the rent gap. Second, tourism gentrification in Xizha is a multi-subject and multi-scalar consequence of uneven development in China, with power-oriented, capital-driven and class-separated processes as the core mechanisms. Third, Xizha's tourism gentrification is regional and endogenous, with the local government and the rural-urban dual structure being the principal influencing factors. Further discussions are provided to expand the general significance of the case study and increase the contribution to the planetary gentrification. • A temporal analysis of tourism gentrification in Xizha is proposed. • The mechanism of tourism gentrification in Xizha relies on the multi-logic of power, capital and the class. • The institutionally distinctive background and the socio-spatial structure for gentrification in China are discussed. [ABSTRACT FROM AUTHOR]

Previous studies have frequently taken urban density as a surrogate for economic efficiency and applied composite scores such as urban intensity to assess the existing physical forms of towns. However, measures of intensity might nuance crude calculations of density while considering how such measures relate to future plans and the process of transformations. This paper used open source geospatial data and regulatory detailed planning to measure urban intensity of the existing and the planned. Spatial analytical techniques were applied to compute accessibility to destinations, building density, compactness of development, and diversity of land use function of sixteen specialty towns in China. The results showed that the regulatory detailed planning of these cases might not improve town planning measured by intensity in terms of spatial arrangement in the time horizon of 15–20 years. We found that well-integrated monocentric forms with the finer street network could potentially provide a more suitable spatial distribution for mid-sized towns measured by urban intensity, no matter whether the urban form is linear or center-spreading. Moreover, the comparison between the existing and the planned implies that the poly-centric urban form for mid-sized towns in China could end up with a lower score of urban intensity. We outline a framework of urban intensity measures that include analytical consideration of what is there now, planned to what is forthcoming, and conceptual in terms of time and space. • Differentiating urban intensity from density • Using urban block as the spatial unit of study is more accurate than a synthetic spatial grid. • Comparing existing and planned conditions of medium-sized towns • Evaluation and intervention of town planning policies [ABSTRACT FROM AUTHOR]