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Background: With a growing health demand, patient satisfaction analysis is essential for evaluating the accessibility and performance of medical services. Previous studies had explored the Chinese outpatient satisfaction and influencing factors in developed areas and tertiary hospitals. Considering the lower education level, less income, and heavier economic burden, it was necessary to conduct a region-specific questionnaire survey for the outpatient's satisfaction in rural Western China.Objective: To analyze the satisfaction of primary outpatient service in rural Western China, and explore the factors affecting outpatients' satisfaction.Methods: Questionnaire composed of nine 5-Likert items was applied to survey outpatient satisfaction among randomly selected samples in 11 provinces of Western China. Exploratory factor analysis (EFA) was conducted to study the factor structure of questionnaire. Stepwise multiple linear regression analysis was performed to study the influencing factors.Results: A total of 2,754 outpatients completed the questionnaire, the response rate was 88.7%. Respondents were most satisfied with medical staff service attitude (3.71±0.83) and least satisfied with medical cost (2.97±0.83). A 3-factor solution was adopted in EFA to explain the overall satisfaction. Factors identified were "Service attitude", "Facility and professional skills", and "Patients' cost". And, the questionnaire was proved to have good reliability and acceptable internal consistency. The stepwise multiple linear regression analysis results presented that factors, including sample hospital type (P<0.05), age (P<0.001), education level (P<0.05), occupation (P<0.01), monthly income (P<0.05), and chronic disease conditions (P<0.01) were significantly associated with the dimensional or overall satisfaction.Conclusion: The primary health care outpatient satisfaction in rural Western China is lower than developed areas and tertiary hospitals. Care providers in backward regions should pay more attention to patients' demographic characteristics and health status, to meet outpatients' actual demand. Efficient hospital management methods, modern technology, and staff training are needed to improve the service quality and care efficiency. [ABSTRACT FROM AUTHOR]

Background: Few studies about gender differences in job quality and job satisfaction among medical professionals have been carried out in China. So the objectives of this study were to examine whether and to what extent gender differences existed in job quality and job satisfaction of doctors in rural western China.Methods: From 2009 to 2011, a total of 1472 doctors from 103 selected county-level health care facilities in rural western China were recruited into the study. Information about the doctors' demographic characteristics, job quality, and job satisfaction was collected through a designed questionnaire. Besides examining gender differences in single dimensions of job quality and job satisfaction, principal component analysis was used to construct a composite job quality index to measure the differences in the comprehensive job quality, and exploratory factor analysis was applied to evaluate the differences in the overall job satisfaction. Chi-square test was used to calculate differences between proportions, and t-test was used to compare differences between means.Results: Among the doctors, there were 705 males and 767 females (ratio 1:1.09). Male doctors had significantly higher monthly salaries, longer working hours, more times of night shifts per month, longer continuous working hours, and longer years of service at current facilities, and marginally significantly higher hourly wage and longer years of service in current professions. However, female doctors showed greater overall job qualities. Significant and marginally significant gender differences were only found in satisfaction with remuneration compared to workload, the chance of promotion and working environment. But female showed greater satisfaction in the overall job satisfaction and the factor including sub-aspects of working environment, remuneration compared to workload, the chance of promotion, utilization of subjective initiative, and sense of achievement.Conclusions: Gender differences in job quality and job satisfaction did exist among doctors in rural western China. The participating female doctors were shown to have better job quality and greater job satisfaction. [ABSTRACT FROM AUTHOR]

The E-W trending Central Qiangtang metamorphic belt (CQMB) is correlated to the Triassic orogeny of the Paleo-Tethys Ocean prior to Cenozoic growth of the Tibetan Plateau. The well-exposed Lanling high-pressure, low-temperature (HP-LT) metamorphic complex was chosen to decipher the process by which it was exhumed, which thereby provides insights into the origin of the CQMB and Qiangtang terrane. After a detailed petrological and structural mapping, three distinct N-S-trending metamorphic domains were distinguished. Microscopic observations show that core domain garnet (Grt)-bearing blueschist was exhumed in a heating plus depressurization trajectory after peak eclogitic conditions, which is more evident in syntectonic vein form porphyroblastic garnets with zoning typical of a prograde path. Grt-free blueschist of the mantle domain probably underwent an exhumation path of temperature increasing and dehydration, as evidenced by pervasive epidote veins. The compilation of radiometric results of high-pressure mineral separates in Lanling and Central Qiantang, and reassessments on the published phengite data sets of Lanling using Arrhenius plots allow a two-step exhumation model to be formulated. It is suggested that core domain eclogitic rocks were brought onto mantle domain blueschist facies level starting at 244-230 Ma, with exhumation continuing to 227-223.4 Ma, and subsequently were exhumed together starting at 223-220 Ma, reaching lower greenschist facies conditions generally after 222-217 Ma. These new observations indicate that the CQMB formed as a Triassic autochthonous accretionary complex resulting from the northward subdcution of the Paleo-Tethys Ocean and that HP-LT rocks therein were very probably exhumed in an extensional regime. [ABSTRACT FROM AUTHOR]

Background: The National Essential Medicine System (NEMS) is a new policy launched by the Chinese government in 2009. The effects of its introduction have been widely investigated. However, little research has focused on individual patients' perspectives. The purpose of this study was to examine current understanding and opinions of China's NEMS of primary care providers (PCPs) and patients.Methods: Providers (n = 134) and patients (n = 175) were examined based on self-completed questionnaire surveys conducted in 16 primary healthcare centers in Ningxia, northwestern China. Questions addressed the topics of: participants' socio-demographic characteristics; awareness of NEMS policies; perceptions of NEMS-related changes; satisfactions with NEMS.Results: The patients had a low awareness of NEMS while a majority of providers were familiar with NEMS. All participants were satisfied with the price and quality of essential medicines, but not satisfied with the quantity. Patients felt there had been a decrease in their total medical expenses per visit and improved pharmaceutical services. Most providers perceived no change in their personal or departmental income. The overall satisfaction rate related to NEMS among providers and patients was 92.54 and 93.31%, respectively. Overall there was a link between knowledge about NEMS and satisfaction with the program: patients who had greater knowledge of reimbursement policy, and the providers with greater knowledge of NEMS, reported higher satisfaction.Conclusions: The findings revealed a high level of satisfaction towards NEMS among primary care providers and patients, which is a reflection of the improvements in the health care system. However, some patients' low awareness of NEMS should be paid attention to, as it could reduce their knowledge of essential medicines and hinder the full potential of NEMS. [ABSTRACT FROM AUTHOR]

Objectives: Prior evidence suggests geographic disparities in the effect of maternal education on child nutritional status between countries, between regions and between urban and rural areas. We postulated its effect would also vary by micro-geographic locations (indicated by mountain areas, plain areas and the edge areas) in a Chinese minority area. Methods: A cross-sectional study was conducted with a multistage random sample of 1474 school children aged 5-12 years in Guyuan, China. Child nutritional status was measured by height-for-age z scores (HAZ). Linear mixed models were used to examine its association with place of residence and maternal education. Results: Micro-geographic disparities in child nutritional status and the level of socioeconomic composition were found. Children living in mountain areas had poorer nutritional status, even after adjusting for demographic (plain versus mountain, β = 0.16, P = 0.033; edge versus mountain, β = 0.29, P = 0.002) and socioeconomic factors (plain versus mountain, β = 0.12, P = 0.137; edge versus mountain, β = 0.25, P = 0.009). The disparities significantly widened with increasing years of mothers’ schooling (maternal education*plain versus mountain: β = 0.06, P = 0.007; maternal education*edge versus mountain: β = 0.07, P = 0.005). Moreover, the association between maternal education and child nutrition was negative (β = -0.03, P = 0.056) in mountain areas but positive in plain areas (β = 0.02, P = 0.094) or in the edge areas (β = 0.04, P = 0.055). Conclusions: Micro-geographic disparities in child nutritional status increase with increasing level of maternal education and the effect of maternal education varies by micro-geographic locations, which exacerbates child health inequity. Educating rural girls alone is not sufficient; improving unfavorable conditions in mountain areas might make such investments more effective in promoting child health. Nutrition programs targeting to the least educated groups in plain and in edge areas would be critical to their cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: The expanding use of the internet contributes to more effective searches for health-related information and opens up opportunities for direct Web-based communication with health care professionals. However, little is known about how users' characteristics on the demand side influence health-related internet use, especially in remote and rural areas within developing countries. The absence of accurate estimates of users' characteristics and their impact on adaptations of health care services in developing countries constrains focused policy-centered discussions and the design of appropriate policies.Objective: The aim of this study was to assess the prevalence of health-related internet use and to identify its determinants in a remote province in China.Methods: We conducted a cross-sectional survey in June and July of 2018 in Ningxia, located in northwestern China. Rural households were selected by multistage random sampling, and households' key members were interviewed face-to-face at the respondents' home. Dependent variables were whether the households use Web health services or not. Independent variables were chosen based on the Andersen behavioral model. Sociodemographic characteristics were compared between households that used health-related Web services with nonusers. We applied logistic regression models to evaluate multivariate associations between respondents' characteristics and their usage of Web-based health services and obtained odds ratios with 95% CI.Results: A total of 1354 respondents from rural households were interviewed, of whom 707 (52.22%) were men. The mean age of the respondents was 44.54 years (SD 10.22). Almost half of the surveyed households (640/1354, 47.27%) reported using 1 or more Web-based health care services, whereas 37.8% (502/1354) reported using the internet to obtain health-related information, 15.51% (210/1354) used the internet to communicate with professionals about health issues, and 7.24% (98/1354) had engaged in Web-based consultations in the last year. After controlling for potential confounders, households engaged in health-related internet use were found to be wealthier, have higher health demands, and have less geographic access to high-quality health care compared with other households.Conclusions: The internet has become a major health information resource in rural Ningxia. Social structures, family enabling factors, health needs, and characteristics relating to health care access were significant predictors of households' health-related internet use in rural and remote areas in China. Those who belong to older age groups, have low income, and whose education levels do not extend beyond primary school education are significantly less likely to use Web-based health care services and to benefit from Web-based health care programs. A need for continued collaborative efforts involving multiple stakeholders, including communities, Web-based and other health care providers, family members, and the government is needed. [ABSTRACT FROM AUTHOR]

Background: The National Essential Medicine System (NEMS) is a new policy in China launched in 2009 to improve the appropriate use of medications. This study aims to examine the outcomes of the NEMS objectives in terms of the rational use of medicines in primary health care facilities in China.Methods: A total of 28,651 prescriptions were collected from 146 township health centers in four provinces of China by means of a field survey conducted in 2010-2011. Indicators of rational drug use were extracted and compared using a pre/post design and then evaluated with regard to the World Health Organization (WHO) Standard Guidelines and data from previous research.Results: The average number of drugs per prescription decreased from 3.64 to 3.46 (p < 0.01) between 2009 and 2010. Little effect was found for the NEMS on the average number of antibiotics per prescription, but the percentage of prescriptions including antibiotics decreased from 60.26 to 58.48% (p < 0.01). Prescriptions for injections or adrenal corticosteroids also decreased, to 40.31 and 11.16% of all prescriptions, respectively. All these positive issues were also recorded in 2011. However, each of the above values remained higher than WHO standards. The percentage of drugs prescribed from the Essential Drug List increased after the implementation of the NEMS (p < 0.01). Where the available data allowed changes in costs to be assessed, the average expense per prescription increased significantly, from 25.77 to 27.09 yuan (p < 0.01).Conclusions: The NEMS effectively improved rational medicine use in China. However, polypharmacy and the over-prescription of antibiotics and injections remain common. There is still a large unfinished agenda requiring policy improvements. Treatment guidelines, intensive support supervision, and continuing training for both professionals and consumers are the essential actions that need to be taken. [ABSTRACT FROM AUTHOR]

Background: We examined the relationship between health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area.Methods: We conducted in-person interviews with 913 rural women aged 23 - 57 (57.5% Hui minorities/42.5% Han ethnicity) enrolled in the Ningxia Women Health Project, gathering data on EQ-5D, self-designed HL, socio-demographic characteristics, and chronic diseases. The extent of impairments in the five dimensions of the EQ-5D was used to measure HRQoL. Factor analysis yielded a single HL factor, which was used as a dichotomous variable in multivariate log-binomial regression models that examined the adjusted association of HL with HRQoL.Results: Nearly half of the women had no formal education. The most prevalent impairments were pain/discomfort and anxiety/depression (42.42% and 32.09%, respectively). The Hui minorities had 1.65 times higher rates of low HL (defined as less than mean of the factor score for HL) and 1.22 and 1.25 times for pain/discomfort and anxiety/depression impairments, respectively. Low HL was associated with poor HRQoL, with a 23% increase in the prevalence of pain/discomfort impairments after adjusting for socio-demographics. This association was significant in the Hui group (PR=1.30, 95% CI=1.06-1.58) but not for the Han group (PR=0.99, 95% CI=0.76-1.30). HL-stratified analysis revealed modification for ethnic disparities in HRQoL; for pain/discomfort impairments, high HL-PR=0.88 (95% CI=0.71-1.08), low HL-PR=1.24 (95% CI = 1.01-1.52); for anxiety/depression impairments, high HL-PR=0.98 (95% CI=0.73-1.32), low HL-PR=1.44 (95% CI = 1.05-1.98).Conclusions: Low HL is associated with poor HRQoL across the entire sample and the association may be modified by ethnicity. Similarly, ethnic disparities in HRQoL may be modified by HL, larger in low HL group. Health services should address HL in vulnerable minority women to improve their HRQoL. [ABSTRACT FROM AUTHOR]

Purpose: Apoptosis induced by excessive endoplasmic reticulum (ER) stress is accompanied by the occurrence and progression of myocardial ischemia/reperfusion (I/R) injury. COX-2 is also known to affect the development of I/R damage in myocardium. However, the interaction between COX-2 and ER stress in aggravating myocardial I/R lesion is not well characterized. Therefore, the purpose of our research was to explore the interaction between COX-2 and ER stress on myocardial apoptosis., Methods: The left anterior descending (LAD) coronary artery was ligatured with a 6-0# suture for 0.5 hours and subsequently subjected to reperfusion for 3 hours to simulate myocardial I/R in mice. Oxygen glucose deprivation/reoxygenation (OGD/R) was performed on H9c2 cells to construct an in vitro model of this experiment. NS398 (COX-2 specific inhibitor) and Salubrinal (Sal, ER stress inhibitor) were administered to assess the function of COX-2 and ER stress in myocardial I/R impairment. CCK-8 assay was used to evaluate the viability of H9c2 cells under different treatment conditions. TUNEL and Hoechst staining were used to detect the occurrence of apoptosis. Infarct area/area at risk and Hematoxylin-eosin stained sections were assessed after I/R. Protein expressions of glucose-regulated protein 78 (GRP78), COX-2, phosphorylation of eukaryotic translation initiation factor 2 alpha (p-eIF2α), CCAAT/enhancer-binding protein homologous protein (CHOP), and Cleaved caspase 3 in the myocardium were examined using Western blotting. Changes in Cleaved caspase 3 expression in myocardial slices were measured by immunohistochemistry., Results: Sal or NS398 partly reduced I/R-induced damage as testified by the apparent decrease in infarct size after I/R and reduced cell viability following OGD/R. Sal distinctly increased p-eIF2α, but caused decreased expression of COX-2, Cleaved caspase 3, and ER stress-associated proteins after I/R, suggesting that Sal effectively inhibited ER stress, apoptosis, and COX-2. Pretreatment with NS398 blocked I/R or OGD/R-induced upregulation of COX-2, Cleaved caspase 3, and ER stress-related marker proteins., Conclusions: Interaction of COX-2 and ER stress regulates apoptosis and contributes to Myocardial lesion induced by I/R., Competing Interests: None., (AJTR Copyright © 2022.)

Background: Few studies about gender differences in job quality and job satisfaction among medical professionals have been carried out in China. So the objectives of this study were to examine whether and to what extent gender differences existed in job quality and job satisfaction of doctors in rural western China., Methods: From 2009 to 2011, a total of 1472 doctors from 103 selected county-level health care facilities in rural western China were recruited into the study. Information about the doctors' demographic characteristics, job quality, and job satisfaction was collected through a designed questionnaire. Besides examining gender differences in single dimensions of job quality and job satisfaction, principal component analysis was used to construct a composite job quality index to measure the differences in the comprehensive job quality, and exploratory factor analysis was applied to evaluate the differences in the overall job satisfaction. Chi-square test was used to calculate differences between proportions, and t-test was used to compare differences between means., Results: Among the doctors, there were 705 males and 767 females (ratio 1:1.09). Male doctors had significantly higher monthly salaries, longer working hours, more times of night shifts per month, longer continuous working hours, and longer years of service at current facilities, and marginally significantly higher hourly wage and longer years of service in current professions. However, female doctors showed greater overall job qualities. Significant and marginally significant gender differences were only found in satisfaction with remuneration compared to workload, the chance of promotion and working environment. But female showed greater satisfaction in the overall job satisfaction and the factor including sub-aspects of working environment, remuneration compared to workload, the chance of promotion, utilization of subjective initiative, and sense of achievement., Conclusions: Gender differences in job quality and job satisfaction did exist among doctors in rural western China. The participating female doctors were shown to have better job quality and greater job satisfaction.

Background: The National Essential Medicine System (NEMS) is a new policy launched by the Chinese government in 2009. The effects of its introduction have been widely investigated. However, little research has focused on individual patients' perspectives. The purpose of this study was to examine current understanding and opinions of China's NEMS of primary care providers (PCPs) and patients., Methods: Providers (n = 134) and patients (n = 175) were examined based on self-completed questionnaire surveys conducted in 16 primary healthcare centers in Ningxia, northwestern China. Questions addressed the topics of: participants' socio-demographic characteristics; awareness of NEMS policies; perceptions of NEMS-related changes; satisfactions with NEMS., Results: The patients had a low awareness of NEMS while a majority of providers were familiar with NEMS. All participants were satisfied with the price and quality of essential medicines, but not satisfied with the quantity. Patients felt there had been a decrease in their total medical expenses per visit and improved pharmaceutical services. Most providers perceived no change in their personal or departmental income. The overall satisfaction rate related to NEMS among providers and patients was 92.54 and 93.31%, respectively. Overall there was a link between knowledge about NEMS and satisfaction with the program: patients who had greater knowledge of reimbursement policy, and the providers with greater knowledge of NEMS, reported higher satisfaction., Conclusions: The findings revealed a high level of satisfaction towards NEMS among primary care providers and patients, which is a reflection of the improvements in the health care system. However, some patients' low awareness of NEMS should be paid attention to, as it could reduce their knowledge of essential medicines and hinder the full potential of NEMS.

Objectives: The rapid increase in drug expenditure has become a major source of public criticism in China. In 2009, the National Essential Medicine System (NEMS) was launched in China to control drug prices and improve access to medicines. This study investigated whether and to what extent the prices of essential medicines were reduced after the introduction of NEMS., Methods: Data were obtained from 149 public primary healthcare centers (PHCs) in four Chinese provinces (Shandong, Zhejiang, Anhui and Ningxia) using a facility-based survey. In total, 10,988 essential medicines were investigated. Individual price differences and a price index were used to measure price changes for three different lists: 2009-2010, 2010-2011, and 2009-2011., Results: In the comparison between 2009 and 2010, a median decrease of 34.4% [95% confidence interval: 30.4%-39.1%] was observed in drug prices and the number of drug sales increased by 1.5%. The higher the retail price in 2010, the more the drug sales increased compared with 2009 (χ (2) = 75.9, p < 0.01). The drug revenues in 100 of the 149 surveyed PHCs decreased by an average of 39%. Where the available data allowed price changes for 2009-2011 to be assessed, drug prices were reduced significantly in 2010, but a modest decrease was seen in 2011. The Laspeyres index was less than 100 and the Paasche index was larger than the Laspeyres index in 2010 and 2011, which indicated that the frequently prescribed drugs usually had higher prices and any price reduction was milder., Conclusions: The introduction of NEMS in PHCs in China led to price reductions in essential medicines. However, more-expensive drugs were preferred in the postreform period. Most PHCs had less drug revenue and could encounter financing dilemmas after the implementation of NEMS. Policy options such as improving the compensation mechanism and rational use of drugs should be further promoted in PHCs.