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Abstract: In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. We examine the impacts of these programs (Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS)) on health care utilization among older people in two provinces of China – Zhejiang and Gansu. The data comes from the pilot survey of the China Health and Retirement Longitudinal Study (CHARLS) collected in 2008, which contains 2685 individuals in 1570 households. We use a two-part model to analyze outpatient care. The first part is a binary equation modeling the probability of any use of outpatient service; For the second part, we use a zero-truncated Poisson model and a generalized linear model with a gamma distribution and a log link to explain the number of outpatient visits and the level of out-of-pocket (OOP) payments conditional on at least one visit to a service provider, respectively. For the inpatient care, the logistic regression is employed to predict the probability of being hospitalized. All analyses are weighted and marginal effects are reported. We find that compared with people without health insurance, people with UEBMI and URBMI are more likely to use outpatient services and people with UEBMI have less OOP payments in Zhejiang while in Gansu province, people with NCMS are less likely to have outpatient visits, while people with UEBMI are more likely to be hospitalized. In addition, among those who have at least one outpatient visit, different insurance types do not make much difference in terms of the number of outpatient visits in both provinces. Our study indicates that although the health insurance programs have some positive impacts on the health care utilization, these impacts are still limited. [Copyright &y& Elsevier]

Background: Optimal strategies for prevention and treatment for post-stroke depression (PSD) remain unclear and a greater understanding of effect of resilience on PSD is promising. The aim was to examine the association between baseline resilience and depression at 1, 3, and 6 months after discharge, which contributes to early detection and management of PSD.Methods: A total of 217 ischemic stroke survivors were recruited in two tertiary hospitals in Shanghai, China from February 2017 to January 2018. The Chinese version of Connor-Davidson Resilience Scale (CD-RISC) was used to assess resilience at acute hospitalization. Hospital Anxiety and Depression Scale (HADS) was employed to ascertain baseline anxiety, baseline depression, and post-discharge depression. Social-demographic and disease-related information were obtained from participants' self-report and medical records. Logistic regression analysis was used to determine which factors were independently associated with PSD.Results: The prevalence of depression at baseline was 21.2% and at 1, 3, and 6 months after discharge was 34.4%, 33.2%, and 29.2%, respectively. Logistics regression analyses indicated that resilience may independently predict PSD at 1 month (OR: 0.22, 95%CI: 0.097, 0.518), 3 months (OR:0.302, 95%CI: 0.151, 0.607), and 6 months (OR: 0.03, 95%CI: 0.006, 0.153) after controlling for social-demographics, disease-related characteristics, baseline anxiety, and baseline depression.Limitations: Non-multicenter survey and mild stroke severity may affect the generalization of these findings. Moreover, response bias should be acknowledged because some participants were read questionnaires out aloud.Conclusion: Resilience is independently associated with PSD at different timepoints. Our findings reveal the important role of resilience as a protective factor against PSD. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the relationships between high water fluoride exposure and essential hypertension as well as plasma ET-1 levels were investigated. A total of 487 residents aged 40 to 75 were randomly recruited from eight villages in Zhaozhou County from Heilongjiang Province in China and were divided into 4 groups according to the concentrations of fluoride in their water. Consumption levels of drinking water fluoride for normal, mild, moderate, and high exposure groups were 0.84±0.26mg/L, 1.55±0.22mg/L, 2.49±0.30mg/L, and 4.06±1.15mg/L, respectively. The prevalence of hypertension in each group was 20.16%, 24.54%, 32.30%, and 49.23%, respectively. There were significant differences between all the groups; namely, with the increase in water fluoride concentrations, the risk of essential hypertension in adults grows in a concentration-dependent manner. Significant differences were observed in the plasma ET-1 levels between the different groups (P<0.0001). In the multivariable logistic regression model, high water fluoride concentrations (F− ≥3.01mg/L, OR4/1 =2.84), age (OR3/1 =2.63), and BMI (OR2/1 =2.40, OR3/1 =6.03) were closely associated with essential hypertension. In other words, the study not only confirmed the relationship between excess fluoride intake and essential hypertension in adults, but it also demonstrated that high levels of fluoride exposure in drinking water could increase plasma ET-1 levels in subjects living in fluoride endemic areas. [Copyright &y& Elsevier]