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With an increasingly urbanized world, there is an urgent need to examine how cities may evolve and achieve sustainability. This paper systematically looks at the Greater Bay Area (GBA) and the Poyang Lake Region (PLR) in China to examine the spatial processes for insights into cities and urbanization, balancing the environmental and socio‐economic dimensions. A total of 226 805 cells are analyzed to unveil the relationship between sustainability changes in 2015–2019 period and urban form indicators, considering sociodemographic variables, geographical features, and city size as control variables. Two tree‐based machine learning models (Random Forest and XGBoost) are developed. This study provides evidence that a monocentric urban form and a high share of small activity clusters are not good for sustainability. For each urban form indicator, there is a non‐linear relationship with sustainability. The results of the machine learning models reconfirm the sustainability benefits of having a strong second activity cluster comparable to the largest one. When planning cities, some forms of land use buffering are desirable. There is also support for developing relatively large activity nodes and promoting compactness in urban form. Beyond urban form characteristics, the levels of urbanization, economic development, and population are still highly relevant. [ABSTRACT FROM AUTHOR]

The urban population are increasingly suffering from rising transport costs, worsening air quality, longer commuting time, and traffic congestion. Although much scholarly attention has focused on modeling urban traffic congestion, news contents about traffic jam have rarely been examined systematically. This study selects 12 large metropolitan cities across Asia (Beijing, Bengaluru, Hong Kong, Jakarta, Kuala Lumpur, Manila, and Singapore), Oceania (Auckland and Sydney), Europe (London) and North America (Los Angeles and Toronto) for an in-depth content analysis. More than 40,000 pieces of congestion-related articles in the 2009–2018 period have been identified in the local news media of these cities. We apply techniques of text analytics to analyze underlying themes in relation to sustainable transport and congestion-mitigation measures. Also, a sentiment analysis is conducted to examine the level of frustration expressed. Results show that traffic congestion is no longer perceived to be primarily an economic issue. Concerns over the environmental impacts of traffic congestion were increasingly discussed. Based on the content analysis, cities in Asia mentioned a lot about congestion-related PM2.5 pollution and climate change was a recurrent theme among non-Asian cities. Economic cost related to traffic congestion has received much more attention in high-income cities. With regard to congestion mitigation measures, terms related to promoting public and active transport was the most popular, followed by restriction and regulation measures, and then intelligent transport system (ITS) or smart mobility adoption. It is noteworthy that road capacity expansion has attracted the lowest coverage. Generally, high-density cities discussed more about public and active transport in alleviating traffic jams; and police enforcement was seen as important in tackling traffic congestion across all cities. In relation to the sentiment, there is a positive association between the overall traffic congestion level and the congestion frustration level expressed in local news. [ABSTRACT FROM AUTHOR]

Purpose: To systematically compare the efficacy and safety of sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia (CSEA), a systematic review and meta-analysis of randomized controlled trials targeting parturients requesting labor analgesia was conducted. Methods: The primary outcome measure was visual analog scale scores assessed at 10, 15, 30, and 60 min after intrathecal injection. Secondary outcomes included duration of spinal analgesia, incidence of side effects in parturients, and neonatal Apgar scores. Results: Twelve randomized controlled trials, including data from 881 patients fulfilled the inclusion criteria. No clinically meaningful differences in pain reduction after intrathecal injection were found between the two analgesics. Sufentanil extended the duration of spinal analgesia by 25.40 min (95% CI 21.82 to 28.98 min; p < 0.00001) compared with fentanyl. The risk for pruritus, nausea, and vomiting among parturients was 82% for those using sufentanil (relative risk 0.82 [95% CI 0.67–0.99]; p = 0.04) and 48% for those using fentanyl (relative risk 0.48 [95% CI 0.29–0.80]; p = 0.005). Both the synthesis results and sensitivity analysis demonstrated no differences in the risk for respiratory depression between parturients using sufentanil versus fentanyl. The neonates in sufentanil group exhibited higher Apgar scores than the fentanyl group 5 min after delivery (weighted mean difference 0.10 [95% CI 0.05–0.16]; p = 0.0002). Conclusion: Existing evidence suggests that compared with fentanyl, sufentanil used for analgesia in combined spinal-epidural during labor is more effective in extending the duration of spinal analgesia, and may be safer for the infant. There was overall low clinical and statistical heterogeneity among the included studies. For all outcomes, variations caused by heterogeneity across trials were acceptable. Thus the findings of this meta-analysis may provide additional evidence for future clinical practices of pain relief in labor involving CSEA. Stronger evidence supporting this conclusion will require data from more high-quality and multicenter randomized controlled trials. [ABSTRACT FROM AUTHOR]

China's healthcare reform aims to provide affordable and equitable basic healthcare for all by 2020. Access to medicines is an essential part of the healthcare. The efforts of promoting access to medicines have been moving from meeting the needs of the basic healthcare, towards increasingly dedicated resources to offer breakthrough therapies. Looking at access to novel medicines from a health system perspective, and placing the changes China has made into that system context, this paper makes a comprehensive review of the progress of access to novel medicines in China. The review drew on two sources of information, which included desk review of published and grey literature, and key informant interview. Five hurdles were identified which create barriers of access to novel medicines, ranging from regulation and financing of medicines, intellectually property rights protection, and development of innovation capacity, to other health system components. Multiple policies have been implementing in China to remove the multiple access barriers gradually. Universal access to medicines has been moving from towards the basic common conditions to the world breakthrough technologies. We see cause for optimism, but recognize that there is a long way to go. Achieving broader and better access to modern medicines for Chinese patients will require multiple and coordinated government efforts, which would need to target the whole lifecycle regulation of novel medicines with a health system perspective, from balancing IP protection, strengthening R&D and public health, to appropriate regulatory approach and financing mechanism, and to supply chain management, as well as smart use. [ABSTRACT FROM AUTHOR]

Little information is available on the need for opioid analgesics based on demographic, economic and disease spectrum data, or on patient affordability of opioid analgesics, in different regions of China. This study analysed the level of, and trends in, opioid analgesic use in different regions of China from 2006 to 2016, calculated the need for opioid analgesics based on demographic, economic and disease spectrum data from the different regions, and analysed the gap between need and actual consumption. Patient affordability of opioid analgesics for cancer pain management was also measured. Opioid analgesic consumption data were obtained from the China Hospital Pharmaceutical Audit (CHPA) database of IQVIA (formerly Quintiles and IMS Health). We assessed the clinical need for opioid analgesics by calculating the morphine use density (MUD, daily defined doses of morphine per 100 000 population) and its growth rate from 2006 to 2016 in China and its seven regions. Regional need for opioid analgesics (in morphine equivalents) was estimated based on regional cancer registration data and standard treatment doses of opioids, as defined by international guidelines for cancer pain management. The study adopts WHO and Health Action International (HAI) methods to evaluate patient affordability of opioid analgesics for cancer pain management using standardized costs in daily defined doses (DDD). The national MUD increased from 1·45 DDD/100 000/day in 2006 to 6·93 DDD/100 000/day in 2016. Southern China had the highest MUD (9·67 DDD/100 000/day), and northwest China had the lowest MUD (3·28 DDD/100 000/day) in 2016. The actual use of morphine equivalents accounted for only 21·5% of the morphine required for cancer pain management at the national level; 26% in east, 36% in south, 11% in southwest, and 12% in northwest China. The DDD costs of all studied opioid analgesics ranged from CNY ¥10·80 to ¥848·88. Except for morphine injections, the out-of-pocket payments for a standard full course of treatment with opioid analgesics were more than the daily disposable income in all regions. Patient affordability of opioid analgesics is low according to the WHO and HAI method. Opioid analgesic use for the management of cancer pain was insufficient relative to needs in China, and varied markedly across regions with different levels of economic development. Long-term use may pose a heavy economic burden to patients. The findings call for actions to strengthen cancer pain management, and to improve the affordability of drugs. The Peking Union Medical College Education Fund. [ABSTRACT FROM AUTHOR]