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Background: It is well known that patients with nonalcoholic fatty liver disease (NAFLD) suffer from impaired quality of life (QoL) and decreased health-related fitness. Studies on the relationship between them have been scarce. Methods: A cross-sectional survey was performed in 104 NAFLD patients. Liver fat content and fibrosis were assessed using transient elastography. Health-related fitness was measured by fitness test. VO2max was determined by YMCA submaximal cycle ergometer test. Body composition was tested by bioimpedance analysis. QoL was evaluated using the 36-item Short Form Health Survey Questionnaire (SF-36). Results: Most patients had severe liver steatosis without significant fibrosis. Most of them exhibited poor health-related fitness. Multiple linear regression analyses demonstrated that body compositions (waist circumference, hip circumference, percent body fat, percent skeletal muscle, visceral fat area) dependently contributed to QoL (health transition, role limitation due to physical problem, general health, physical functioning and vitality). VO2max was positively related with physical functioning. Conclusion: For NAFLD patients, decreased health-related fitness was associated with impaired QoL both in the physical and mental dimension. Our results indicate that visceral fat together with muscle mass and VO2max could serve as individual exercise intervention targets to improve QoL.

The current study aimed to investigate the antiproliferative effect of Resv on the growth of VSMCs and to determine the association between Resv and STAT3 and the mitochondrial biogenesis signaling pathway under high-glucose conditions. Male Wistar rats weighing between 180 and 200 g were killed by cervical vertebra dislocation. Primary VSMCs were obtained by outgrowth methods. Cells from different treatment groups were then collected, and changes in cell proliferation and signaling pathway activity were analyzed by PCR and Western blotting. And the MTT assay was used to investigate the effect of Resv on VSMC proliferation. Resv inhibited proliferation of VSMCs under high-glucose conditions. Resv suppressed the transcriptional activity of STAT3, but the mitochondrial gene GRIM-19, which is responsible for STAT3 activation, was simultaneously upregulated. The mitochondrial biogenesis signaling pathway components NRF1, NRF2, TFB1m, and TFB2m were also upregulated. In addition, the mitochondrial genes NDUFA1, NDUFA2, and NDUFA3 were involved in the function of Resv. The results of the study suggest that Resv has an antiproliferative effect in high-glucose-cultured VSMCs partly through inhibiting STAT3 function and upregulating mitochondrial biogenesis.

Background: Sports university students are usually expected to lead an active life and have a lower risk of depression. Therefore, there are few studies on depression and its risk factors among this population. This study aimed to investigate depression and its association with sedentary behavior and physical activity in sports university students. Methods: A cross-sectional survey was conducted among undergraduates majoring in physical education in a sports university in Beijing in March 2021. Students were asked about sociodemographic information, domain-specific sedentary behavior, physical activity, and depression (using a nine-item Patient Health Questionnaire). Chi-squared test and logistic regression were carried out to analyze the data. Results: Among a total of 584 participants, the detection rate of depression was 49.1%. The median of total sedentary time was 7.29 h per day. After adjusting for covariates, recreational screen time (OR = 1.540, p = 0.035), sedentary time spent completing schoolwork (OR = 0.658, p = 0.038), and participation in vigorous physical activity everyday (OR = 0.415, p = 0.001) and a few times per week (OR = 0.423, p &lt, 0.001) were significantly associated with depression. Conclusions: Sports university students are not immune to depression and inactive lifestyles. Excessive recreational screen time may have an adverse effect on depression, which is somewhat independent of physical activity.

Background Understanding the long-term inpatient service cost and utilization of psychiatric patients may provide insight into service demand for these patients and guide the design of targeted mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China. Methods We identified patients admitted for one of three major psychiatric disorders (schizophrenia, bipolar and depressive disorders) between January 1 and December 31, 2013 in Beijing, China. Inpatient admissions during the following 3 years were extracted and analyzed using sequence analysis. Clinical characteristics, psychiatric and non-psychiatric service use of included patients were analyzed. Results The study included 3443 patients (7657 hospitalizations). The patient hospitalization sequences were grouped into 4 clusters: short stay (N = 2741 (79.61% of patients), who had 126,911 or 26.82% of the hospital days within the sample), repeated long stay (N = 404 (11.73%), 76,915 (16.26%) days), long-term stay (N = 101 (2.93%), 59,909 (12.66%) days) and permanent stay (N = 197 (5.72%), 209,402 (44.26%) days). Length and frequency of hospitalization, as well as readmission rates were significantly different across the 4 clusters. Over the 3-year period, hospitalization days per year decreased for patients in the short stay and repeated long stay clusters. Patients with schizophrenia (1705 (49.52%)) had 78.4% of cumulative psychiatric stays, with 11.14% of them in the permanent stay cluster. Among patients with depression, 23.11% had non-psychiatric hospitalizations, and on average 46.65% of their total inpatient expenses were for non-psychiatric care, the highest among three diagnostic groups. Conclusion Hospitalization patterns varied significantly among psychiatric patients and across diagnostic categories. The high psychiatric care service use of the long-term and permanent stay patients underlines the need for evidence-based interventions to reduce cost and improve care quality.

Additional file 1.

Additional File 1. Results of supplementary analyses and the list of comorbidities included in the Elixhauser Comorbidity Index (ECI). Supplementary Table 1 listed the comorbidities of ECI. Supplementary Table 2–4 showed the results of the supplementary descriptive and univariate analyses. Supplementary Table 5–7 presented the results of the sensitivity analyses. Supplementary Table 8–9 showed the results for post-regression diagnostics and calibration plots of the primary and sensitivity analyses models.

Background and Purpose Exaggerated hypotension following administration of propofol is strongly predicted in patients with hypertension. Increased PKCs play a crucial role in regulating vascular tone. We studied whether propofol induces vasodilation by inhibiting increased PKC activity in spontaneously hypertensive rats (SHRs) and, if so, whether contractile Ca2+ sensitization pathways and filamentous–globular (F/G) actin dynamics were involved. Experimental Approach Rings of thoracic aorta, denuded of endothelium, from normotensive Wistar-Kyoto (WKY) rats and SHR were prepared for functional studies. Expression and activity of PKCs in vascular smooth muscle (VSM) cells were determined by Western blot analysis and elisa respectively. Phosphorylation of the key proteins in PKC Ca2+ sensitization pathways was also examined. Actin polymerization was evaluated by differential centrifugation to probe G- and F-actin content. Key Results Basal expression and activity of PKCβ2 and PKCθ were increased in aortic VSMs of SHR, compared with those from WKY rats. Vasorelaxation of SHR aortas by propofol was markedly attenuated by LY333531 (a specific PKCβ inhibitor) or the PKCθ pseudo-substrate inhibitor. Furthermore, noradrenaline-enhanced phosphorylation, and the translocation of PKCβ2 and PKCθ, was inhibited by propofol, with decreased actin polymerization and PKCβ2-mediated Ca2+ sensitization pathway in SHR aortas. Conclusion and Implications Propofol suppressed increased PKCβ2 and PKCθ activity, which was partly responsible for exaggerated vasodilation in SHR. This suppression results in inhibition of actin polymerization, as well as that of the PKCβ2- but not PKCθ-mediated, Ca2+ sensitization pathway. These data provide a novel explanation for the unwanted side effects of propofol.

Background Measuring family members’ satisfaction with inpatient psychiatric care may help improve the quality of healthcare in psychiatric hospitals. This survey aimed to investigate the satisfaction of family members with inpatient psychiatric care and to explore its associated factors, using a newly-developed 5-item questionnaire. Methods This study included 1598 family members of psychiatric inpatients in 32 tertiary public psychiatric hospitals in 29 provinces of China. Satisfaction and demographic data were collected by research staff while patient and hospital data were retrieved separately. Results We found that the overall satisfaction level was 93.84% (23.46/25). The total satisfaction score in Northeast China was the highest, followed by the East, Middle and West regions (p Conclusions We suggest government and hospital managers recruit more mental health professions to improve family satisfaction. If feasible, providing more psychologic treatments to inpatients may also improve families’ satisfaction and involvement.

ObjectivesChina launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients’ perspective.DesignThis nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China.SettingA total of 117 tertiary hospitals in mainland China.Participants48 422 responses from outpatients and 35 957 responses from inpatients were included in this study.Primary outcome measureThe scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating.ResultsMore than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016–2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings.ConclusionsThe national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

Aims To identify and group hospitalization trajectory of alcohol use disorder (AUD) patients and its associations with service utilization, healthcare quality and hospital-level variations. Methods Inpatients with AUD as the primary diagnosis from 2012 to 2014 in Beijing, China, were identified. Their discharge medical records were extracted and analyzed using the sequence analysis and the cluster analysis. Results Eight-hundred thirty-one patients were included, and their hospitalization patterns were grouped into four clusters: short stay (n = 565 (67.99%)), mean psychiatric length of stay in 3 years: (32.25 ± 18.69), repeated short stay (n = 211 (25.39%), 137.76 ± 88.8 days), repeated long stay (n = 41 (4.93%), 405.44 ± 146.54 days), permanent stay (n = 14 (1.68%), 818.14 ± 225.22 days). The latter two clusters (6.61% patients) used 37.26% of the total psychiatric hospital days and 33.65% of the total psychiatric hospitalization expenses. All the patients in the permanent stay cluster and 41.77% of the patients in the short stay cluster were readmitted at least once within 3 years. Two-hundred thirty-four patients (28.16%) were admitted at least once for non-psychiatric reasons, primarily for diseases of circulatory and digestive systems. Cluster composition varied significantly among different hospitals. Conclusion Hospitalization pattern of patients with AUD varies greatly, and while most (>2/3) hospitalizations were short stay, those with repeated long stay and permanent stay used more than one third of the hospital days and expenses. Our findings suggest interventions targeting at certain patients may be more effective in reducing resource utilization.

Background Psychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China. Methods Data on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics. Results The 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p Conclusion More than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

Social media has been used as data resource in a growing number of health-related research. The objectives of this study were to identify content volume and sentiment polarity of social media records relevant to healthcare services in China. A list of the key words of healthcare services were used to extract data from WeChat and Qzone, between June 2017 and September 2017. The data were put into a corpus, where content analyses were performed using Tencent natural language processing (NLP). The final corpus contained approximately 29 million records. Records on patient safety were the most frequently mentioned topic (approximately 8.73 million, 30.1% of the corpus), with the contents on humanistic care having received the least social media references (0.43 Million, 1.5%). Sentiment analyses showed 36.1%, 16.4%, and 47.4% of positive, neutral, and negative emotions, respectively. The doctor-patient relationship category had the highest proportion of negative contents (74.9%), followed by service efficiency (59.5%), and nursing service (53.0%). Neutral disposition was found to be the highest (30.4%) in the contents on appointment-booking services. This study added evidence to the magnitude and direction of public perceptions on healthcare services in China&rsquo, s hospital and pointed to the possibility of monitoring healthcare service improvement, using readily available data in social media.

Objective: To study the socio-demographic characteristics, the working environment, and the level of career satisfaction among psychiatry residents in China. Method: This was a part of a large-scale, nation-wide online survey of hospitals, healthcare professionals, and patients. Data, including socio-demographics, work hours, income, job satisfaction, and intention to quit were collected anonymously. Respondents also completed the Minnesota Satisfaction Questionnaire (MSQ). Results: One thousand sixty residents nested in 32 psychiatric hospitals in 29 provinces in China completed the survey. Respondents were predominantly female (69.0%), worked an average of 47.8 ± 11.6 h per week, and 28.97% had experienced medical disputes in the previous year. The top three reported reasons for dissatisfaction were low pay (50.1%), contentious doctor-patient relationships (17.6%), and high workload (10.8%). An intention to quit their current job was reported by 18.7% of residents. The overall mean MSQ score was 73.8 ± 13.8, with significant differences across post-graduate training years and regions. A multilevel regression analysis found that a higher MSQ score was significantly associated with fewer years in residency, shorter work hours, higher monthly pay, having medical liability insurance, and feeling satisfied with the level of doctor-nurse cooperation, their hospitals' medical disputes prevention/management, and the healthcare workers' social environment. Conclusion: Psychiatry residents in China are predominantly female and well-educated. They are only moderately satisfied with their career. Poor salaries, contentious doctor-patient relationships and high workload are among their top complaints and may explain why a considerable proportion are intending to leave their current residency. More support from the government regarding residents' salaries, workload and working environment may help improve their job satisfaction and retention, ensuring that China will have a pool of well-trained and engaged psychiatrists for the future.

The selenium accumulation characteristics ofSolanum nigrumwith different ploidy were studied by the pot experiment, and the biomass, selenium content and selenium accumulation of diploid (Solanum photeinocarpum), tetraploid (Solanum photeinocarpum) and hexaploid (Solanum nigrum) plants were determined, the results showed that there was a difference between the biomass and selenium content of three kinds of ploidy plants ofS. nigrum. The biomass of various organs and shoots of hexaploidS. nigrumplants was significantly higher than that of tetraploid and diploid plants. In terms of selenium content and selenium accumulation, the hexaploid plants had the highest selenium content and selenium accumulation in stems, leaves and shoots. After comprehensive comparison, the hexaploidS. nigrumhas large biomass and strong selenium-enriching ability, so it can be used as an excellent plant material for soil selenium absorption and transformation.

Background Surveying patients’ satisfaction is essential to improve patient-centered care, however, studies on satisfaction and their correlates among psychiatric inpatients are rare in China. This study aimed to measure satisfaction levels of psychiatric inpatients in a national sample and to examine individual and institutional correlates. Methods As part of the National Survey for the Evaluation of Psychiatric Hospital Performance, psychiatric inpatients from 32 tertiary psychiatric hospitals in 29 Chinese provinces were interviewed on the day of discharge by trained research staff. Satisfaction was assessed using a five-item questionnaire. Patients’ sociodemographic and clinical information were manually retrieved from medical records and institutional data were provided by participating hospitals. Multilevel linear regression was used to assess factors associated with level of satisfaction. Results Among 1663 inpatients, the reported satisfaction levels were high, with a mean score of 23.3 ± 2.4 out of 25. Education level was positively associated with global satisfaction, satisfaction with costs, and satisfaction with privacy protection. Treatment response was associated with global satisfaction and with the doctor-patient communication subscore. The number of psychotherapy sessions was positively associated with the privacy protection subscore (coefficient = 0.0, P = 0.046). The Global Assessment of Function score was positively associated with the doctor-patient communication subscore (coefficient = 0.0, P = 0.003). Total satisfaction scores and all five subscores were positively associated with hospital-level factors, and patients discharged from hospitals with better staffing and resources reported significantly higher levels of satisfaction. Conclusion Overall, psychiatric inpatients in China were satisfied with the services they received. To further improve patient satisfaction, mental health professionals should optimize their patients’ treatment response as much as possible before discharge and provide more psychological treatment during the hospitalization. The government should also provide more resources to increase the number of mental health professionals (nurses, psychologists, and psychiatrists) working in psychiatric hospitals.

To study the cadmium accumulation characteristics of Solanum nigrum with different ploidies, the biomass, cadmium content and cadmium accumulation of diploid (Solanum photeinocarpum), tetraploid (Solanum photeinocarpum) and hexaploid (Solanum nigrum) were measured by a pot experiment. The results showed that the biomass of roots, stems, leaves and shoots of S. nigrum plants with different ploidy all ranked as follows: hexaploid > tetraploid > diploid. Cadmium content and cadmium accumulation in stems, leaves and shoots of hexaploid plants were significantly higher than those in tetraploid and diploid plants, and the cadmium translocation factor and translocation accumulation factor of hexaploid were the largest, too. Therefore, hexaploid S. nigrum had a highest ability to extract and transport cadmium, which can be used as an ideal plant for remediation of cadmium-contaminated soil.

Background/Aims: Phorbol myristate acetate (PMA) exerts a pleiotropic effect on the growth and differentiation of various cells. Protein kinase Cs (PKCs) plays a central role in mediating the effects of PMA on cells. The present study investigated whether the down-regulation of protein kinase C-ε (PKC-ε) is involved in the inhibition of vascular smooth muscle cell (VSMC) proliferation caused by prolonged PMA incubation. Methods: Using cell counting, Cell Counting Kit-8 (CCK-8) and EdU incorporation assay on VSMCs, we evaluated the inhibitory effects of prolonged incubation of PMA, of lentiviruses carrying the short-hairpin RNAs (shRNA) of PKC-ε and of the PKC-ε inhibitor peptide on the proliferation and viability of cells. The effect of PKC-ε down-regulation on growth of rat breast cancer SHZ-88 cells was also measured. Results: The prolonged incubation of VSMCs with PMA for up to 72 hours resulted in attenuated cell growth rates in a time-dependent manner. The expression of PKC-ε, as assessed by Western blotting, was also decreased accordingly. Notably, the number of EdU-positive cells and the cell viability of VSMCs were decreased by shRNA of PKC-ε and the PKC-ε inhibitor peptide, respectively. The proliferation of rat breast cancer SHZ-88 cells was also attenuated by lentivirus-induced shRNA silencing of PKC-ε. Conclusions: Prolonged incubation of PMA can inhibit the expression of PKC-ε. The effect results in the inhibition of VSMC proliferation. PKC-ε silencing can also attenuate breast cancer cell growth, suggesting that PKC-ε may be a potential target for anti-cancer drugs.

A pot experiment was conducted to study the effects of intercropping with Youngia erythrocarpa, Conyza canadens and Mazus japonicus on physiological and biochemical characteristics of hyperaccumulator Galinsoga parviflora under cadmium (Cd) stress. The results showed that intercropping with Y. erythrocarpa (GIY), C. canadens (GIC) and M. japonicus (GIM) all increased the superoxide dismutase (SOD), peroxidase (POD), peroxidase (CAT) activity and the soluble protein content of G. parviflora compared with monoculture (MG), the photosynthetic pigment (chlorophyll a, chlorophyll b, total chlorophyll, carotenoid) content and chlorophyll a/b of G. parviflora increased after intercropping, too. Among all treatments, GIC had the highest antioxidant enzyme activity, soluble protein content and photosynthetic pigment content. As for photosynthetic characteristics, GIC had the highest net photosynthetic rate (Pn), followed by GIY, GIM and MG. Compared with MG, the stomatal conductance (Gs) and transpiration rate (Tr) of GIC and GIM all increased significantly while that of GIC had no significant change, moreover, GIC had significantly lower CO2 concentration of intercellular (Ci) than other treatments, there was no significant difference in value of pressure deficit leaf (Vpdl) among all treatments. Therefore, under Cd stress, intercropping with C. canadens can improve the antioxidant enzyme activity and photosynthetic capacity of G. parviflora to the greatest extent, which was conducive to its remediation of Cd contaminated soil.

As materials for the study, peach seedlings were sprayed with various concentrations (0, 1, 2, 4 and 6 g/L) of chitosan for the sake of the uptake of total iron, manganese and boron content and a more particular knowledge of the growth of the seedlings. The results in experiment showed that the total manganese content accumulated more in peach seedlings compared with other two elements. The total manganese and boron content in roots and leaves of chitosan-treated seedlings could increase in general. In the wake of the chitosan concentration increased, the total iron content in roots and leaves of seedlings gradually decreased but increased in stems. When it comes to the absorption of nutrients by peach seedlings, there were existing synergism and antagonism in this experiment among iron, manganese and boron, which were good for the growth of peach seedlings.

Objective: Involuntary admission is one of the most controversial issues in psychiatry in China. This study aimed to examine the implementation of the new risk criteria for involuntary admission, as defined by the new Mental Health Law (MHL), in major psychiatric hospitals; and to explore factors associated with the implementation. Method: We selected 32 psychiatric hospitals in 29 provincial capital cities in mainland China. We included all involuntarily admitted psychiatric inpatients who were discharged from December 25 to 27, 2017. Patients' demographic and clinical data and reasons for admission were retrieved. Hospitals' information was also collected. Multilevel logistic regression was applied to explore factors associated with the implementation. Results: We collected valid data from 814 inpatients. Rates of risk criteria implementation ranged from 7.9 to 88.5% in these hospitals. Only 369 inpatients (45.3%) met the MHL-defined risk criteria. Overall, between 62.2 and 78.5% of the variance in risk criteria implementation was at the patient level, and between 21.5 and 37.8% of the variance was at the hospital level. Patients with higher Global Assessment of Functioning (GAF) scores at admission were less likely to meet the risk criteria (OR 1.02, 95% CI 1.01–1.03). No statistically significant association was found between risk criteria implementation and other patient level or hospital level factors. Conclusion: Our findings show the implementation rate of the MHL's risk criteria overall was low, with only 45.3% of involuntary admissions meeting the MHL-defined criteria. This suggests that some patients' civil rights might have been violated.

Objectives To develop a medical record-based, comprehensive system of healthcare quality indicators for psychiatric hospitals in China. Design A modified Delphi process with analytic hierarchy process (AHP) was used. Participants Twenty nationally-recognized experts were invited to participate in two rounds of Delphi expert consultation and AHP. Methods Fifty potential indicators were included based on literature review, and 20 experts were asked to rate the importance of each indicator using two rounds of email surveys. The AHP was used to determine the relative importance of the finalized quality indicators. Results The average authoritative coefficient was 0.92 ± 0.07. After two rounds of Delphi consultation, 47 healthcare quality indicators were identified for Chinese psychiatric hospitals. The mean importance ratings ranged from 7.06 to 8.84 on a nine-point scale, with variation coefficients ranging from 0.04 to 0.22. The percentage of full score for potential indicators ranged from 16% to 74%. In two rounds, the Kendall's W coefficients ranged from 0.423 to 0.535. The weights of structure, process and outcome were 0.175, 0.211 and 0.614, respectively. Conclusion We developed the first set of healthcare quality indicators for psychiatric hospitals in mainland China, and it will provide a standardized and meaningful guide to evaluate the healthcare quality of psychiatric hospitals across the country.

The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

Medical staff in China&rsquo, s tertiary public hospitals are responsible for providing healthcare to a considerable number of patients, and their job satisfaction needs attention. The aim of this study is to investigate the job satisfaction of medical staff in tertiary public hospitals and to explore its associated factors. Based on a national survey conducted in 2016, this study included 43,645 physicians and nurses nested in 136 tertiary public hospitals in 31 provinces of China. Multi-level logistic regression was used to examine job satisfaction and its association with individual characteristics and job-related factors. Results showed that 48.22% respondents were satisfied with their job, and they were least satisfied with their compensation. Individual characteristics including occupation, gender, education background, alcohol drinking and self-reported health status, as well as job-related factors regarding professional title, work years, income, workload, doctor-patient relationship and practice setting were found to be significantly associated with job satisfaction. Given that some of these factors may be amenable to interventions, we suggest that government and hospital administrators could take some measures to promote continuing education, improve personal health, balance workload and compensation for medical staff, in order to improve the job satisfaction of medical staff in tertiary public hospitals.

Background Suicide is an urgent public health challenge for China. This study aims to examine the prevalence, influence factors, and gender differences of suicidal ideation among general population in Northwestern Urban China. Methods Data used in this study were derived from the third wave of a cohort study of a randomized community sample with 4291 participants (≥20 years) in 2008 in Lanzhou City and Baiyin City, Gansu Province. Data were collected via face-to-face interview by the trained interviewers. Descriptive analyses, chi-square tests and multivariate logistic regressions were performed by using Stata 12.0, as needed. Results The prevalence of 12-month suicidal ideation was 4.29 %, there was no significant difference between males and females [5.04 % vs 3.62 %, Adjusted Odds Ratio (AOR) = 0.83, p = 0.351]. Several risk factors for suicidal ideation were confirmed, including being unmarried (AOR = 1.55, p = 0.030), having depression symptoms (AOR = 2.33, p

Background In 2009, health-care reform was launched to achieve universal health coverage in China. A good understanding of how China’s health reforms are influencing village doctors’ income structure will assist authorities to adjust related polices and ensure that village doctors employment conditions enable them to remain motivated and productive. This study aimed to investigate the village doctors’ income structure and analyse how these health policies influenced it. Methods Based on a review of the previous literature and qualitative study, village doctors’ income structure was depicted and analysed. A qualitative study was conducted in six counties of six provinces in China from August 2013 to January 2014. Forty-nine village doctors participated in in-depth interviews designed to document their income structure and its influencing factors. The themes and subthemes of key factors influencing village doctors’ income structure were analysed and determined by a thematic analysis approach and group discussion. Results Several policies launched during China’s 2009 health-care reform had major impact on village doctors. The National Essential Medicines System cancelled drug mark-ups, removing their primary source of income. The government implemented a series of measures to compensate, including paying them to implement public health activities and provide services covered by social health insurance, but these have also changed the village doctors’ role. Moreover, integrated management of village doctors’ activities by township-level staff has reduced their independence, and different counties’ economic status and health reform processes have also led to inconsistencies in village doctors’ payment. These changes have dramatically reduced village doctors’ income and employment satisfaction. Conclusions The health-care reform policies have had lasting impacts on village doctors’ income structure since the policies’ implementation in 2009. The village doctors have to rely on the salaries and subsidies from the government after the drug mark-up was cancelled. China’s national health reforms are attempting to draw village doctors into the national health workforce, but the policies have impacted their income and independence. Further research into these concerns and monitoring of measures to adequately compensate village doctors should be undertaken. Reasonable compensation strategies should be established, and sufficient subsidies should be allocated in a timely manner. Electronic supplementary material The online version of this article (doi:10.1186/s12960-015-0019-1) contains supplementary material, which is available to authorized users.

Background To effectively provide public health care for rural residents, the Ministry of Health formally unveiled the contract service policy in rural China in April 2013. As the counterpart to family medicine in some developed countries, the contract service established a compact between village doctors and local governments and a service agreement between doctors and their patients. This study is a rare attempt to explore the perspectives of health providers on the contract service policy, and investigate the demand side’s attitude toward the public health services delivered under the contract policy. This evidence from Xinjian County, Jiangxi Province, the first and most representative pilot site of the contract service, could serve as a reference for policymakers to understand the initial effects of the policy, whereby they can regulate and amend some items before extending it to the whole country. Methods Official documents were collected and semi-structured interviews with human resources and villagers in Xinjian County were conducted in September 2013. A purposive sampling method was used, and eight towns from the total 18 towns in Xinjian County were selected. Ultimately, eight managers (one in each township health center), 20 village doctors from eight clinics, and 11 villagers were interviewed. A thematic approach was used to analyze the data, which reflected the people’s experiences brought about by the implementation of the contract service policy. Results While the contract service actually promoted the supply side to provide more public health services to the villagers and contracted patients felt satisfied with the doctor-patient relationship, most health providers complained about the heavy workload, insufficient remuneration, staff shortage, lack of official identity and ineffective performance appraisal, in addition to contempt from some villagers and supervisors after the implementation of the contract service. Conclusions Contract service is a crucial step for the government to promote public health services in rural areas. To inspire the positive perspective and optimal work performance of the health workforce, it is imperative for the Chinese government to fortify financial support to health providers, adopt an advanced management model and escalate administrative capacity.