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Aim: To predict the long‐term benefits and economic costs of the improvements in haemophilia care in China demonstrated by increasing use of prophylaxis, compared with the current status. Methods: City‐level predictions from 2018 to 2033 were conducted for five representative cities in China. The long‐term clinical and economic outcomes in the scenario where haemophilia care has significantly improved and the existing scenario of haemophilia care were calculated and compared. The model input data were obtained from local records, expert interviews, published literature, and other sources. Outcome measures including number of bleeds and joint bleeds, number of target joints, disability rate, direct and indirect costs were calculated at the patient and population levels. Results: The long‐term predictions for 2033 demonstrated significantly improved bleed control and joint outcomes due to increased use of prophylaxis. The total number of averted bleed events per patient ranged from 3.9 in Shenyang to 16.1 in Zhengzhou in 2033, and the population‐level averted bleed events ranged from 1963 in Xiamen to 14,868 in Zhengzhou. The treatment improvement also leads to significant economic costs driven by increase in clotting factor costs (more than 90%). At the population level, the additional total costs were highest in Zhengzhou (CNY 177.4 million) and lowest in Shenyang (CNY 45.4 million), due to their different population sizes and various existing treatment regimens. The outpatient and hospitalization costs decreased, while the factor costs increased. Conclusion: The long‐term prophylaxis is associated with avoided bleed events and disabilities. The improved treatment regimens are also associated with a significant economic burden, driven by factor costs. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs). We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests. A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P < 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443–878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies. The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore the knowledge, attitudes, and practices concerning antibiotic prescriptions to children with URTIs among pediatricians and to identify barriers to appropriate antibiotic prescription among pediatricians. Methods: An online-based survey was conducted among pediatricians in Shaanxi province, western China, with a population of 38.35 million and an area of 205,600 square kilometers. Results: A total of 472 pediatricians completed this survey, with the response rate of 26.0%. The theoretical knowledge about antibiotics was excellent, with a median score of 8(0-8). However, 30.1% of the respondents still believed that antibiotics are anti-inflammatory drugs. The pediatricians' age, education level, and monthly income and whether had ever received training had significant associations with their knowledge level. The attitude scores were 41.1 ± 3.6, with a ranged of 29-52 points (total score of 55), indicating that most respondents had positive attitudes toward antibiotics. However, 22.7% of the respondents still preferred to use antibiotics for URTIs. It was found that uncertain diagnosis, parent requirements and insufficient time were barriers to appropriate antibiotic prescription. The indiscriminate prescription of antibiotics to children with URTIs was prevalent among pediatricians. Conclusion: Effective integrated interventions should be developed to promote the prudent use of antibiotics among pediatricians. [ABSTRACT FROM AUTHOR]

Context: Urban agglomeration is an advanced spatial organization of cities, usually caused by urbanization processes when cities develop to a certain level - typically associated with higher population density and a certain density of built environment. However, compared with various studies focusing on specific cities, urban agglomerations are still understudied, especially for the quantitative identification of spatiotemporal evolution of urban agglomerations. Objectives: This study aims to identify the boundary of urban agglomerations in China from 2000 to 2012, and to explore the temporal evolution and spatial difference of urban agglomerations. Methods: Firstly, the core zone of urban agglomerations was identified using an appropriate threshold of the digital number (DN) of nighttime light. Secondly, the mean patch area and gravity model were used to determine the affected zone of urban agglomerations. Thirdly, spatiotemporal contrast was conducted focusing on the 23 main urban agglomerations in China. Results: By 2012, the most highly developed Yangtze River Delta and Pearl River Delta urban agglomerations met the standard of world level, with the Beijing–Tianjin–Hebei urban agglomeration for regional level, as well as 11 urban agglomerations for sub-regional level. Regional differences in urban agglomerations between southern and northern China, or between coastal and inland China remained stable over the study period of 2000–2012. Compared with the western urban agglomerations, the outward expansion of eastern urban agglomerations decelerated. From 2000 to 2012, the overall development mode of urban agglomerations shifted from the core-expansion to the peripheral-development, together with slower expansion of urban agglomerations after 2006. Conclusions: Nighttime light data are effective in exploring the spatiotemporal evolution of urban agglomerations. [ABSTRACT FROM AUTHOR]

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Background: Examine the effects of regulated competition on the drug pricing in China.Methods: Based on product-level data, a regression method was employed for pricing by using data from Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. The market competition measures distinguished generic competition within the same molecule from therapeutic competition within the same therapeutic class.Results: The increases in pricing are inversely related to the number of generic competitions. The generic sub-group results vary from the originator sub-group. For the generics, generic competition has a significantly reduced effect on the price; however, only therapeutic competition has a significantly reduced effect on the originator price.Conclusions: Regulated competition has a positive role in shaping the pharmaceutical market. Furthermore, regulated competition affects the price differently for the sub-groups. The promotion of competition between generic and originator in order to reap full competition benefit and reduce frictions among policies are necessary. [ABSTRACT FROM AUTHOR]

Climate change has dramatic impacts on the growth and the geographical distribution of tea (Camellia sinensis L.). Assessing the potential distribution of tea will help decision makers to formulate appropriate adaptation measures to use the altered climatic resources and avoid the damage from climate hazards. The objective in this study is to model the current and future distribution of tea species based on the four SSPs scenarios using the MaxEnt model in China. For the modeling procedure, tea growth records in 410 sites and 9 climate variables were used in this paper. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the performance of the model. The AUC value was over 0.9 in this study, showing the excellent simulation result of the model. In relation to the current distribution, areas of 82.01 × 104 km2 (8.51% of total land area in China), 115.97 × 104 km2 (12.03% of total land area in China), and 67.14 × 104 km2 (6.97% of total land area in China) were recognized as Marginal, Medium, and Optimal climate suitable habitats for tea over China. Compared to the current distribution, most of the Optimal suitability areas in southeast China would be lost in four scenarios. The area of Marginal and Medium suitable habitats would expand in SSP370 and SSP585, especially in 2041–2061 and 2081–2100. The suitable area of tea would expand northwards and westwards, suggesting that additional new suitable habitats could be created for tea production with the future climate change, especially in Shandong, Henan, Guizhou, and Yunnan Provinces. This research would provide vital scientific understanding for policy making on tea production, tea garden site chosen and adopyion of adaptation methods in the future. [ABSTRACT FROM AUTHOR]

[Display omitted] • Vegetation coverage increased along with urbanization in PRD during 2000–2012. • Relationship between vegetation and urbanization varied at 1−20 km scales. • Mean local variance was used to identify appropriate analysis scale. • NTL-LAI appropriate analysis scale was mainly affected by urbanization level. Accurate quantification of the relationship between urbanization level and vegetation coverage can provide scientific support for urban sustainable development. However, the interaction between them across multi-scales is under-researched because of its complexity. Based on climate change (i.e. precipitation, temperature and solar radiation), partial correlation relationship between urbanization level (nighttime light, NTL) and vegetation coverage (leaf area index, LAI) at different scales (1–20 km) in the Pearl River Delta (PRD) was explored. Mean local variance was used to determine the appropriate scale of the relationship, at which these metrics could have the minimum information missing. The consistency in appropriate analysis scales of NTL, LAI, and NTL-LAI, was quantified to identify which factor more influenced the appropriate analysis scale of NTL-LAI correlation. The results showed from 2000 to 2012, the urbanization level increased at the rate of 0.58/yr and the average LAI increased slowly at the rate of 0.02 m2/m2/yr. The partial correlation between NTL and LAI depicted that urbanization promoted vegetation coverage in the PRD. Meanwhile, the appropriate analysis scale of NTL-LAI correlation was more determined by the analysis scale of urbanization level, than that of vegetation coverage. This study revealed the scale effect of the relationship between urbanization level and vegetation coverage, and identified the determine factor of appropriate analysis scale of the relationship, which could help for the scale selection in related studies. [ABSTRACT FROM AUTHOR]

Anaerobic digestion is one of the most sustainable and promising technologies for the management of organic residues. China plays an important role in the world's biogas industry and has accumulated rich and valuable experience, both positive and negative. The country has established relatively complete laws, policies and a subsidy system; its world-renowned standard system guarantees the implementation of biogas projects. Its prefabricated biogas industry has been developed, and several biogas-linked agricultural models have been disseminated. Nonetheless, the subsidy system in China's biogas industry is inflexible and cannot lead to marketization, unlike that of its European counterpart. Moreover, the equipment and technology levels of China's biogas industry are still lagging and underdeveloped. Mono-digestion, rather than co-digestion, dominates the biogas industry. In addition, biogas upgrading technology is immature, and digestate lacks planning and management. China's government subsidy is reconsidered in this work, resulting in the recommendation that subsidy should be based on products (i.e., output-oriented) instead of only input subsidy for construction. The policy could focus on the revival of abandoned biogas plants as well. [ABSTRACT FROM AUTHOR]

Influenza-associated excess death occurred most in the elderly. We aimed to assess the cost-effectiveness of quadrivalent influenza vaccine (QIV) versus trivalent influenza vaccine (TIV) for prevention of influenza infection among elderly population in China. A decision-analytic model was developed to compare 1-year clinical and economic outcomes of three influenza vaccination options (no vaccination, TIV, and QIV) in a hypothetical cohort of Chinese elderly aged 69 years. Outcome measures included cost, influenza infection rate, influenza-related mortality rate, quality-adjusted life-years (QALY) loss, and incremental cost-effectiveness ratio (ICER) from societal perspective. Sensitivity analyses were performed to examine the uncertainty of model inputs. Base-case results showed no vaccination was dominated (more costly at higher QALY loss) by TIV and QIV. QIV was more costly (USD56.29 versus USD54.28) with lower influenza infection rate (0.608 versus 0.623), mortality rate (0.00199 versus 0.00204), and QALY loss (0.01213 versus 0.01243) than TIV. QIV was cost-effective compared to TIV with ICER of 6,700 USD/QALY below the willingness-to-pay threshold (29,580 USD/QALY). One-way sensitivity analysis found the cost-effectiveness of QIV was subject to the relative risk of vaccine effectiveness of QIV versus TIV, and TIV would be cost-effective if the relative risk was below 1.05. In 10,000 Monte Carlo simulations, the probabilities of QIV, TIV, and no vaccination to be cost-effective were 86.3%, 13.7%, and 0%, respectively. QIV appears to be a cost-effective option compared to TIV and no influenza vaccination for elderly population in China. [ABSTRACT FROM AUTHOR]