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While internal migration is widely occurring in countries across the world and older people are more likely to be left behind by family members who out-migrated to other locations, little attention has been paid to the cognitive health of those people who have been left behind (PLB). Understanding how these demographic patterns relate to older persons’ cognitive health may inform efforts to reduce the disease burden due to cognitive decline. Data came from the China Health and Nutrition Survey in 1997, 2000 and 2004. Participants aged 55 to 93 who participated in a cognitive function screening test (score range: 0–31) in two or more waves and provided information on family members’ migration (n = 1,267) were included in the analysis. A mixed linear model was used to investigate the association between being left behind by any members who had not resided in the household for at least 6 months at baseline and cognitive function. Approximately 10% of the participants had been left behind by family members who migrated out of their communities. A significant interaction was observed in relation to cognitive function between being left behind and the number of years from the first test. Specifically, there was a less steep decline in cognitive function of PLB compared to people not left behind. This longitudinal study showed that PLB tended to have a higher cognitive function compared to those not left behind due to their relatively stable transition in cognitive function during the study period. [ABSTRACT FROM AUTHOR]

Background: The performance of primary health care providers regarding DM management is poor in rural China, and effective training methods for providers are urgently needed. This study aimed to evaluate the effect of web-based training for improving knowledge about DM management among primary health care providers in rural China and to further compare the effects of the training effect between primary health care providers with different backgrounds. Methods: A pre-post intervention study was conducted from April to August 2014. In this study, a total of 901 primary health care workers were recruited from six counties in Hubei province. To evaluate the effect of the web-based training, the knowledge achievement of participants was measured with multiple choice questions (MCQ) at baseline, at the end of two weeks of training and at three months after training. A mixed linear model (MLM) was used to measure group differences in the mean scores at baseline and follow-up. Results: After the web-based training, the knowledge scores of the village doctors increased from 73.58 at baseline to 89.98 at posttest and to 84.57 three months after the training. For township health workers, we observed an upward trend in scores from 78.87 at the pre-test to 91.72 at the second test, and at the three months after the training, the scores increased to 94.91. For village doctors, greater knowledge achievement was observed between the scores at baseline and after two weeks of training(adjusted difference: 3.55, P = 0.03) compared to that observed for the township health workers, while decreased their knowledge achievement between baseline and the third-test compared with that of township health workers (adjusted difference: 5.05, P = 0.01). Conclusions: This study suggested that web-based training was an effective method for improving the knowledge of primary health care providers about management of DM in remote areas. Compared with the effect of the training on village doctors, the training had a poor short-term effect on township health workers but a better long-term effect. [ABSTRACT FROM AUTHOR]

China relaxed its family planning policy and adopted a universal two-child policy on January 1, 2016 to actively address the country’s aging trend. However, the policy has failed to have any significant effect on the fertility rate of many provinces. In light of the country having the highest sex ratio at birth in the world and the huge burden of the aging population, improving the fertility rate is an urgent priority in China. This facility-based cross-sectional survey aimed to study determinants of fertility decision-making among couples based on the Theory of Planned Behavior. The study was conducted in Inner Mongolia Autonomous Region of China. A structured self-administered questionnaire was completed by 1,399 couples, consisting of wives aged 20–49 years and their husbands. Based on the structural equation modeling method of analysis, determinants of fertility decision-making were perceived behavior control (perceived importance of having a stable income and cost of raising a child), subjective norms (perceived social pressure about “sex preference of the newborn by themselves and their partner”) and attitudes (only healthy parents can have a child). Other significant factors influencing fertility decision were ethnicity and education level, with ethnic minority couples having less perception of social norm towards fertility and those with higher education having higher perceived control toward having a (further) child. The study reveals the importance of the China’s infrastructure and public facilities to support child-rearing to increase the fertility rate among couples of child-bearing age, which in turn will reduce the burden associated with an aging society. [ABSTRACT FROM AUTHOR]

Background: The general benefit of physical activity (PA) to one’s mental health has been widely acknowledged. Nevertheless, the specific type and amount of PA that associates with lower risk of depression in China awaits further investigation. The present study was conducted on middle- and older-aged Chinese population with two objectives: 1) to understand the patterns of PA; 2) to measure the associations between depression and PA at different levels from various aspects. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2015), we selected 9118 community residents aged 45 years and older. Depressive symptoms were measured by 10-item Center for Epidemiologic Studies (CES-D 10). Multivariate logistic regression model was performed to examine the association between risk of depression and PA from four aspects including intensity, frequency, duration, and volume. Results: Spending 1–2 days/week (OR = 0.58, 95% CI: 0.36, 0.91), less than 30 minutes each time (OR = 0.66, 95% CI: 0.42, 1.03) or 150–299 min/week (OR = 0.49, 95% CI: 0.28, 0.87) on Moderate Physical Activity (MPA) was associated with lower odds of depression in women. Spending 3–5 days/week (OR = 1.98, 95% CI: 1.29, 3.05) or 6–7 days/week (OR = 1.50, 95% CI: 1.07, 2.11), 4 hours and longer each time (OR = 1.65, 95% CI: 1.18, 2.32), 300 min/week or longer (OR = 1.65, 95% CI: 1.22, 2.24) on Vigorous Physical Activity (VPA) in total, or 2250 Metabolic Equivalent of Task (OR = 1.73, 95% CI: 1.26, 2.38) on Moderate-to-Vigorous PA was associated with higher risk of depression in men. Conclusions: The association between depression and PA depended largely on intensity and gender. Lower frequency, shorter duration, and moderate amount of MPA was associated with lower risk of depression in women. Risk of depression was higher in men who spent higher frequency, longer duration, and overlong time on VPA. [ABSTRACT FROM AUTHOR]

Tourist congestion at hot spots has been a major management concern for UNESCO World Heritage Sites and other iconic protected areas. A growing number of heritage sites employ technologies, such as cameras and electronic ticket-checking systems, to monitor user levels, but data collected by these monitoring technologies are often under-utilized. In this study, we illustrated how to integrate data from hot spots by camera-captured monitoring and entrance counts to manage use levels at a World Heritage Site in Southeastern China. 6,930 photos of a congestion hotspot (scenic outlook on a trail) were collected within the park at a 10-minute interval over 105 days from January to November 2017. The entrance counts were used to predict daily average and maximum use level at the hotspots. Results showed that the average use level at the congestion hotspot did not exceed the use limit mandated by the park administration agency. However, from 9:20 am to 12:00 pm, the use level at hotspots exceeded visitor preferred use level. Visitor use level was significantly higher at the hotspot during a major Chinese “Golden Week”. The daily entrance counts significantly predicted the average and maximum use level at the hotspot. Based on our findings, park managers can achieve the management goals by permitting the corresponding number of visitors passing the entrances. The gap manifested the complexities in visitor capacity management at high-use World Heritage Sites and other protected areas and calls for innovative monitoring and management strategies. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of this study was to explore the associations of family relationships and negative life events with depressive symptoms among Chinese adolescents. Methods: A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete questionnaires regarding family relationships, negative life events, and depressive symptoms. A mediation analysis was carried out using a multiple regression analysis and the PROCESS macro method. Results: Of all participants, 19.9% reported experiencing depressive symptoms. The prevalence of depressive symptoms was 13.0% and 29.2% in participants with good and poor parental relationships, and the prevalence of depressive symptoms was 11.4% and 30.9% in participants with closed and alienated parental-child relationships, respectively. Parental relationships, parental-child relationships, and negative life events were positively correlated with depressive symptoms. The effect of parental relationships on depressive symptoms was fully mediated by negative life events (Effect = 0.052, 95% CI = [0.023, 0.082]), while the effect of parent-child relationships on adolescent depressive symptoms was partially mediated by negative life events (Effect = 0.075, 95% CI = [0.048, 0.104]). Conclusions: Our results showed a high prevalence of depressive symptoms in Chinese adolescents. Poor family relationships may have the potential to increase the risk of depressive symptoms, and they could affect depressive symptoms through negative life events. [ABSTRACT FROM AUTHOR]

This paper reports the development and baseline data of a vignettes-based measure of gender equality. Methods: Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes were then tested in DR Congo, Ecuador and China. Results: Young adolescents can successfully respond to vignettes; and can differentiate self from hypothetical protagonists of same and opposite sex. Response differences by sex of respondent and protagonist were statistically significant across a range of scenarios and settings. Conclusion: This is the first vignettes-based measure for young adolescents assessing young adolescent perceptions of relationships differentiated by sex of the protagonist. [ABSTRACT FROM AUTHOR]

As part of the cultural landscape, administrative toponyms do not only reflect natural and sociocultural phenomena, but also help with related management and naming work. Historically, county-level administrative districts have been stable and basic administrative regions in China, playing a role in the country’s management. We explore the spatio-temporal evolutionary characteristics of the county-level administrative toponyms cultural landscape in China’s eastern plains areas. A Geographical Information System (GIS) analysis, Geo-Informatic Tupu, Kernel Density Estimation, and correlation coefficients were conducted. We constructed a GIS database of county-level administrative toponyms from the Sui dynasty onward using the Northeast China, North China, and Yangtze Plains as examples. We then summarized the spatio-temporal evolutionary characteristics of the county-level administrative toponyms cultural landscape in China’s eastern plains areas. The results indicate that (1) the number of toponyms has roughly increased over time; (2) toponym densities on the three plains are higher than the national average in the corresponding timeframe since the Sui; and (3) county-level administrative toponyms related to mountains and hydrological features accounted for more than 30% of the total in 2010. However, the percentage of county-level administrative toponyms related to natural factors on the three plains has decreased since the Sui. To explore the factors influencing this spatio-temporal evolution, we analyzed the correlations between the toponyms and natural factors and human/social factors. The correlation degree between toponym density and population density is the highest, and that between toponym density and Digital Elevation Model (DEM) the lowest. Temperature changes were important in toponym changes, and population changes have influenced toponym changes over the last 400 years in China. [ABSTRACT FROM AUTHOR]

Lane change violations are a major cause of traffic conflicts and accidents at urban intersections and one of many road-safety issues in China. This study aims to explore the socio-psychological factors underlying drivers’ motivation for lane change violation behavior at urban intersections and examines how these factors predict this violation behavior. A self-reported questionnaire is designed by applying the construct of the theory of planned behavior (TPB) to collect data. Five hundred-six valid responses are received from the questionnaire survey conducted on the Internet in China. The data are then analyzed using structural equation modeling (SEM). The results of the analysis show that behavioral intention is the strongest predictor of self-reported lane change violation behavior at urban intersections. Perceived behavioral control has both direct and indirect effects on self-reported lane change violation behavior. Furthermore, attitude, subjective norms and perceived behavioral control are found to have significant correlations with drivers’ intention of lane change violations at urban intersections. The results of this study could provide a reference for designing more effective interventions to modify drivers’ lane change violation behavior at urban intersections. [ABSTRACT FROM AUTHOR]

The existing literature concentrates on the relationship between amenities and migrants or residents. However, only a few studies have focused on the role of city amenities in determining the intentions of rural–urban migrants. Such a relation is a key issue in Chinese urbanisation development. The current study investigates the effects of urban amenities on the settlement intentions of rural–urban migrants in China. We find that medical amenities have a significantly positive effect on rural–urban migrants’ intentions. We also indicate that educational amenities and transportation services attract rural–urban migrants to settle in cities. Furthermore, we explore the heterogeneous effects of amenities on different cohorts by education and age. High- and low-skilled rural–urban migrants focus on transportation amenities, while young and middle–aged migrants are attracted by urban educational amenities. Results suggest that increasing access to urban amenities for rural–urban migrants and improving urban amenities enhance the willingness of rural–urban migrants to stay in cities. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impacts of socio-economic status (SES) on visual impairment (VI), and the mediating role of lifestyles in developed rural areas of China. Methods: A cross-sectional study was conducted among people living in rural districts of Tianjin, a developed municipality in China. An interviewer-administered survey along with free eye screenings was conducted with participants. The questionnaire included questions about demographic characteristics, SES, medical histories and lifestyles. Presenting visual acuity (PVA) and main causes of VI were identified by ophthalmologists. χ2 test was undertaken to determine whether significant differences (p<0.05) exist between VI and demographic, SES, medical history and lifestyle factors. A stepwise regression method was conducted to investigate whether lifestyles play mediating roles between SES and VI. Multivariable logistic and ordinal logistic regression were used contingent on different types of dependent variables in each regression, and adjusted odds ratio (OR) values were estimated. Results: Of the 12,233 participants, 6,233 were male (50.59%); the mean age was 34.61 years; 310 (2.54%) had VI. Hypertension, diabetes and cardiopathy were main medical histories, with 1,640 had hypertension (13.41%), 854 had diabetes (6.98%) and 483 had cardiopathy (3.95%). About SES factors, higher education level (Adjusted OR, 0.84; 95% CI, 0.75–0.95) and higher income level (Adjusted OR, 0.54; 95% CI, 0.39–0.76), were significantly associated with VI in a gradient across severity of VI. Lifestyles including smoking (Adjusted OR, 1.55; 95% CI, 1.31–1.83) and drinking (Adjusted OR, 1.36; 95% CI, 1.06–1.74) played mediating roles between SES and VI when considering the full sample. Besides smoking and drinking, reading every week (Adjusted OR, 2.07; 95% CI, 1.53–2.82) and exercising more than 2h every day (Adjusted OR, 0.39; 95% CI, 0.15–1.00) also played mediating roles between SES and VI when considering the subsample (age≥16). Conclusion: This study revealed the crucial impacts of SES factors on VI, and the mediating role played by several lifestyles. Targeted public health interventions for reducing VI should thus be proposed in developed rural areas of China. [ABSTRACT FROM AUTHOR]

In preterm infants (i.e. the gestational age less than 37 weeks), postnatal growth remains a concern. This study used multicenter longitudinal data from China’s Under 5 Child Nutrition and Health Surveillance System to investigate the postnatal growth in the weight and length of preterm infants. Gender-stratified differences in weight and length were assessed between preterm and term infants. 1221 preterm infants and 1221 matched term infants were included. The rates of growth in weight and length in preterm infants was greater than those in term infants, especially from the first to sixth month. The rates were higher in males compared to females in the first 3 months. The differences of weight and length between preterm and term infants decreased with increasing age, however, these measurements did not reach the level of their term peers until 12 months before adjusting for gestational age. The median values of weight and length were even larger in preterm infants in the first month after adjusting for gestational age. [ABSTRACT FROM AUTHOR]

Background: Migration of physicians has been a cause for global concern. In China, reforms of the higher education and healthcare systems have led to a shortage of postgraduate training positions relative to the number of medical graduates. Medical graduates opt for non-clinical roles or move abroad to pursue further training and practice opportunities. The impact of this physician migration is not known. This study quantifies where Chinese migrant physicians to the U.S. were educated, where they went to practice, and how these trends have changed over time. Methods: We combined data on physician characteristics from the 2008 and 2017 American Medical Association Physician Masterfiles with demographic information from the Educational Commission for Foreign Medical Graduates. Using a repeated cross-sectional approach, we reviewed the available data, including citizenship at entry to medical school, medical school attended, practice specialty, and practice location. Results: The number of Chinese-educated physicians (CEPs) to the United States (US) has increased over the past 10 years, from 3,878 in 2008 to 5,355 in 2017 (+38.1%). The majority held Chinese citizenship at entry to medical school (98.4% vs 97.1%) with the remainder being citizens of other East Asian nations. Of the Chinese citizens identified in 2008, 913 (19.3%) attended medical school outside of China; in 2017, 376 (6.7%) attended medical school outside of China, representing a decrease of 58.8%. Overall, in 2017, four Chinese medical schools provided 32.1% of all Chinese-educated physicians in the US. Over 50% of the CEPs were practicing in Internal Medicine, Anatomic/ Clinical Pathology, Anesthesiology, Family Medicine or Neurology. Compared with all IMGs, CEPs are more likely to be Anatomic/ Clinical Pathologists and Anesthesiologists. CEPs were concentrated in several states, including New York, California and Massachusetts. In 2017, a lower proportion of CEPs in the US healthcare workforce were in residency training, compared to 2008 (13.2% vs 22.8%). Conclusions: Unlike trends from some other South Asian countries, the number of CEPs in the US has increased over the past 10 years. Migration trends may vary depending on citizenship and country of medical school training. The majority of Chinese-educated graduates come to the US from relatively few medical schools. Fewer CEPs currently in residency training might indicate lower success rates in securing GME training in the US. [ABSTRACT FROM AUTHOR]

In this paper, we aim to establish a mathematical model to design a maximizing social welfare intervention mechanism of healthcare service goods in China. The intervention mechanism is helpful to facilitate the adoption of the healthcare service goods. We consider a research problem that regulates the supply chain system for healthcare service goods by an intervention mechanism, and two intervention strategies composed of demand-growth strategy and subsidy strategy are used to the combination of intervention mechanism. Then this paper presents a new method based on fuzzy set and bilevel programming to design the intervention mechanism. To demonstrate the effectiveness of the proposed model, we conduct a case study for Wudang personalized health package and verify our model by the specific result analysis, the result indicates that our joint intervention mechanism is helpful to achieve the target and increase social welfare. [ABSTRACT FROM AUTHOR]

Background: Early pregnancy among unmarried youth is a serious public health challenge. Male youth’s knowledge, attitude and practice (KAP) of sexual and reproductive health (SRH) and its association with the risk of their sexual partners’ pregnancy in China remains unexplored. This study investigates the KAP among Chinese unmarried male youth aged 15–24 years and identifies its association with partner pregnancy using nationally representative data from Survey of Youth Access to Reproductive Health in China (YARHC) in 2009. Methods: Chi-square tests were applied to explore the prevalence of partner pregnancy by male youth’s KAP of SRH and logistic regression were applied to identify the associations of partner pregnancy with knowledge, attitudes and practice among male youth. Results: Among 2853 sexually experienced male youth, totally 597 unmarried male youth caused 852 partner pregnancies and the prevalence rate was 20.93%. Lacking the knowledge of contraception access (OR: 0.66, 95% CI: 0.44–0.99) was significantly associated with lower risk of causing partner pregnancy. Contraception discussion before (1.49, 1.04–2.11) or after first sexual intercourse (1.46, 1.11–1.93), not using valid contraception (1.29, 1.03–1.64) and male contraception decision-maker (1.79, 1.41–2.28) were significantly associated with higher risk of causing partner pregnancy. Conclusion: Our results indicated that male youth’s knowledge and behaviors of sexual and reproductive health were significantly associated with the risk of causing partner pregnancy, and highlighted the importance and need of sexual and reproductive programs targeting male for the prevention of unintended partner pregnancy in China. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to identify the social factors that shape the disaster response knowledge of residents in Beijing, China. This study aims to provide evidence supporting the development and promotion of effective strategies for disaster response knowledge, including natural and human-made ones. Methods: A cross-sectional household survey on disaster response knowledge was conducted in Beijing, 2015. Using the multistage sampling method, data were collected from community residents through a self-administered questionnaire, and analyzed by descriptive methods and logistic regression models. Results: Among the 847 respondents, 44.2% had advanced disaster response knowledge in general, while only 9.4% knew how to react to human-made disasters, and 61.4% had advanced natural disaster response knowledge. Rural residents and those with higher education had more disaster response knowledge (P<0.05). Economic status did not show significant effects on residents’ disaster response knowledge. Conclusion: People’s disaster response knowledge in Beijing was low, especially regarding human-made disasters. The findings implicate further health education on disaster preparedness and response should be implemented, also residents who lived in peri-urban and urban areas or with less education should be given more attention. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is one of the most common zoonoses worldwide, causing direct losses to the livestock industry and threatening human health. Little is known about the status and factors affecting farmers’ private investment in the prevention and control of sheep brucellosis in China. Methodology/Principal findings: From April to October 2017, a cross-sectional, house-based study was conducted in 7 Chinese provinces. A total of 1037 households included in the study were analyzed. The average amount of private investment in the prevention and control of brucellosis was $0.73±0.54 per sheep. Multivariable analysis showed that factors facilitating private investment included older age of householder (OR = 1.07, 95%CI: 1.03–1.11), herd size >100 (OR = 2.49, 95%CI: 1.38–4.51), a higher percentage of income from sheep farming comparing to the total household income (OR = 1.14, 95%CI: 1.11–1.16), higher score of brucellosis knowledge (OR = 3.85, 95%CI: 1.40–10.51), actively learning related knowledge (OR = 2.98, 95%CI: 1.55–5.74), actively participating in related training courses (OR = 3.07, 95%CI: 1.52–6.18), care about other people’s attitudes (OR = 1.75, 95%CI: 1.35–2.28), concern about the health of neighbors’ livestock (OR = 1.75, 95%CI: 1.23–2.51). The analysis found a discouraging factor for private investment, supporting culling policy (OR = 0.67, 95%CI: 0.49–0.91). Conclusions/Significance: In addition to providing interventions related to farmers’ knowledge, attitudes and practices, guidance must be offered to help farmers understanding the importance of private investment in the prevention and control of brucellosis. [ABSTRACT FROM AUTHOR]

Masonry city walls were common defense facilities in the cities of the Eurasian before the industrial revolution. However, they were not widespread in China until the Ming Dynasty (1368–1644). Limited in research methods, previous studies failed to make convincing arguments on this phenomenon. We collected, organized and analyzed relevant historical documents to reconstruct the spatio-temporal process of the construction of masonry walls from 1st to 17th century in China. We conducted a time series analysis primarily based on factors such as wars, garrisons, economy, and natural disasters. Analysis of the correlation among the construction of masonry walls and these factors provides insights into this process. From the 1st to 14th century, only 125 masonry city walls were built in China and the annual average number was below 0.1. While in the Ming Dynasty, a total of 1,493 masonry walls were built, with an annual average of 5.41. The construction activities in 1368–1456 spread throughout the country, but mainly appeared in the high-grade administrative cities and garrisons, as a result of the planned implementation of the central government. The construction activities in 1457–1644 had corresponding cluster areas during different periods, mainly at county-level. We found that the wall construction was stimulated by external factors such as wars and disasters. We believe that the mass construction of masonry walls in the Ming Dynasty is a phenomenon of cultural diffusion. The central government plan, the complex interactions between local governments and community, and the stimulation of external factors worked together to contribute to the diffusion of masonry city walls in the Ming Dynasty. [ABSTRACT FROM AUTHOR]

School socioeconomic status (SES) is studied primarily as a variable to explain academic achievement; however, few previous studies have investigated how SES can influence individual student's academic achievement. The present study used a national representative sample of 10,784 grade 7 to 9 students (53.2% boys and 46.8% girls) in mainland China to examine the links between school SES and students' math and Chinese achievements, including the math and Chinese teacher-student relationships as mediating factors. The parents provided family socioeconomic information and the students reported on their teacher-student relationships. Achievements in math and Chinese were assessed using standardized tests. Multilevel mediation analyses revealed that school SES was positively related to students' math and Chinese achievements. Moreover, the link between school SES and students' math achievement was partially mediated by students' perception of the math teacher-student relationship. The Chinese teacher-student relationship had no mediating effect. This study indicated that school SES can influence individual student's academic achievement via their perception of teacher-student relationship. The poverty and lack of resources is obvious, yet low SES schools could make efforts in improving teacher-student relationship's quality to promote students' academic performance. Meanwhile, low SES schools should receive more attention from policymakers to improve teaching quality and school climate. Furthermore, the study findings could be used for future research on the gap between low and high SES schools. [ABSTRACT FROM AUTHOR]

Despite extensive literature on leadership and its impact employee innovative behavior, few studies have explored the relationship between inclusive leadership and employee innovative behavior. To address this gap, this study aimed to investigate how inclusive leadership influenced employee innovative behavior by examining perceived organizational support (POS) as a mediator. We used multi-wave and multi-source data collected at 15 companies in China to test our theoretical model. Results revealed that inclusive leadership had significantly positive effects on POS and employee innovative behavior. Furthermore, POS was positively related to employee innovative behavior and partially mediated the relationship between inclusive leadership and employee innovative behavior. We discussed implications and limitations of this study as well as avenues for future research. [ABSTRACT FROM AUTHOR]

The Ministry of Industry and Information Technology (MIIT) universities are important bases for science and technology research and play a critical role in China’s National Innovation System. Based on the Web of Science (WoS), this article analyzes the statistics of paper published by MIIT universities and universities from across China including MIIT universities. The results are as follows: (1) Both the MIIT universities and universities nationwide in China have increased their international academic publications, and MIIT have shown a greater increase for the past decade. (2) In terms of U-I-G interaction, for UG relations, the Tug value of MIIT universities has remained stable, while that of universities in China has become declined. For UI relations, the Tui value of both MIIT universities and universities in China has shown steady growth. For UIG relations, MIIT universities have a greater synergistic effect of Triple Helix relationship than universities in China. (3) For more details in seven MIIT universities, universities elected into “Project 985”, including HIT, BUAA, BIT and NPU, have published more papers, and been more synergistic with government and industry (UIG relations) than other three universities, including NUAA, NUST and HEU. Based on the empirical results, we discuss our findings, and make certain suggestions regarding policy incentives, reasonable administrative system and U-I-G interaction mode, which is significant not only for Chinese universities but also for universities in other developing countries. [ABSTRACT FROM AUTHOR]

Objective: To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. Methods: A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. Results: The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs. Conclusion: Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account. [ABSTRACT FROM AUTHOR]

Background: China used to be among the countries with a high prevalence of trachoma. At the launch of The Global Elimination of Trachoma (GET) 2020 campaign by the World Health Organization (WHO) in 1996, China was placed on the list of countries endemic for trachoma based on historical data. However, empirical observation and routinely collected eye care data were suggesting that trachoma was no longer a public health problem. To determine whether the GET 2020 goals had been met in P. R. China, we conducted a targeted assessment with national scope. Methodology/principal finding: Province assessment teams, trained in WHO Trachoma Rapid Assessment (TRA) methodology and in WHO simplified trachoma grading system, carried out assessments in 16 provinces (among them, 2 provinces conducted pilot assessment). Based on the published literature, including national and international reports, suspected trachoma-endemic areas within each province were identified. Within these areas, trachomatous inflammation- follicular (TF) assessments were carried out in at least 50 grade-one children in primary schools serving villages with the lowest socio-economic development. Trachomatous trichiasis (TT) and corneal opacity (CO) assessments were conducted among persons aged 15 and over in villages within the catchment area of the selected schools. Of 8,259 children examined in 128 primary schools in 97 suspected trachoma endemic areas, only 16 cases of conjunctivitis were graded as TF. 38 cases with TT were found among the 339,013 examined residents in villages surrounding the schools. Among these 97 suspected trachoma endemic areas in only three was the prevalence of TT more than 0.2%. Conclusions/significance: This large study suggested that trachoma was not a public health problem in 16 provinces that had been previously suspected to be endemic. These findings will facilitate planning for elimination of trachoma from PR China. [ABSTRACT FROM AUTHOR]

Purpose: The literature lacks population-based epidemiologic studies on the incidence and risk factors for traumatic foot fractures. The purpose of this study was to update information concerning the incidence of foot fractures in China and to identify associated risk factors. Methods: All the data on foot fractures were available from the China National Fracture Survey (CNFS), which was conducted between January and May in 2015. A total of 8 provinces, 24 urban cities and 24 rural counties in China were selected, using stratified random sampling and the probability proportional to size method. Individuals who had lived in their current residence for 6 months or longer were personally interviewed about any foot fracture that had occurred in 2014. Questionnaires were completed by every participant for data collection and quality control was accomplished by our research team members. The information included age, gender, height, weight, ethnic group, education, occupation, smoking, alcohol consumption, sleeping time per day, dietary habits and others. Fracture was initially identified by patients' self report and further confirmed by their providing medical records. Results: A total of 512187 individuals participated in the CNFS. There were 201 patients with foot fractures in 2014. Mean age at the time of fracture was 45.4 years. The incidence rate of foot fractures was 39.2 (95%CI: 33.8–44.7)/100000/year. Fall and traffic accident were the most common causes for foot fractures and over 60% of these occurred at home or on the road. Alcohol consumption, history of previous fracture and average sleep time <7h/d were identified as independent risk factors for foot fractures both in males and females. Cigarette smoking was identified as a significant risk factor for foot fracture in males. For females, BMI >24 kg/m2 was a risk factor whilst living in the west region was associated with a lower incidence rate of foot fracture. Conclusions: The present study shows an incidence of 39.2/100000/year of foot fractures in China. Specific public health policies focusing on decreasing alcohol consumption and encouraging individuals to obtain sufficient sleep should be implemented. Females with a higher BMI should focus more on foot health care, especially in those with history of previous fracture. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate patients’ sense of responsibility to healthcare providers and to determine its predictors using on a national sample in China. Methods: We conducted a national cross-sectional survey in China with a stratified cluster sample of patients treated in 77 hospitals between July 2014 and April 2015. Patients’ sense of responsibility to healthcare providers was measured with four questions assessing patients’ perceptions regarding their responsibilities to respect doctors, respect nurses, coordinate with health professionals, and comply with hospital rules. Predictors included patient sociodemographic characteristics and their past hospitalization experience. Results: Small proportions of respondents reported that they perceived having no responsibility to respect doctors (8.9%), respect nurses (7.9%), comply with hospital rules (6.7%), or coordinate with health professionals (6.3%). Multivariate regression analyses showed that the strongest predictor of patients’ sense of responsibility to healthcare providers was patinets’ trust in health professionals, followed by patients’ education level. Familiarity with healthcare professionals and past hospitalization frequency were inversely associated with patients’ sense of responsibility to healthcare providers. Conclusions: Although only a small proportion of the patients reported feeling no or low sense of responsibility to healthcare providers, the lack of respect and collaboration from these patients can negatively affect patient-provider relationships. Healthcare administrators need to communicate clearly with the patients and the public about the role of patients and the limitations of medicine in order to instill a sense of patients’ responsibility. [ABSTRACT FROM AUTHOR]

Objectives: To examine the factors associated with the routine immunization status of children aged 2–3 years in China for gaining a better understanding of the Expanded Program on Immunization and to provide evidence for formulating specific strategies to guide the allocation of health resources. Methods: We analyzed data from 45095 children aged 2–3 years in the 2013 National Immunization Coverage Survey to identify the sociodemographic and provider-associated factors affecting the full immunization status of children. Univariate and multiple logistic regression analyses were performed. Results: The immunization rate for children aged 2–3 years ranged from 95.9% (diphtheria and tetanus toxoid with pertussis vaccine, 4th dose) to 99.5% (Japanese encephalitis vaccine, 1st dose) and was 93.1% for full immunization. In terms of sociodemographic factors, male children [adjusted OR (AOR): 1.115; 95% confidence interval(CI):1.016–1.222], minority children (AOR: 1.632; 95% CI: 1.457–1.828), children of fathers with less than high school education (AOR: 1.577; 95% CI: 1.195–2.081), those born at home (AOR: 4.655; 95% CI: 3.771–5.746), those who immigrated from an adjacent county (AOR: 2.006; 95% CI: 1.581–2.546), and those living in urban-rural fringe areas (AOR: 1.807; 95% CI: 1.475–2.214) or mountainous areas (AOR: 1.615; 95% CI: 1.437–1.814) had significantly increased odds of not being fully immunized. In terms of provider-associated factors, administration of vaccines at home (AOR: 2.311; 95% CI: 1.316–4.059), household reminders (AOR: 2.292; 95% CI: 1.884–2.789), and travel time to vaccination providers of >40 minutes (AOR: 1.622; 95% CI: 1.309–2.010) were negatively associated with immunization rates. In addition, compared to 3-year-old years, 2-year-old children (AOR: 1.201; 95% CI: 1.094–1.318) were less likely to be fully immunized. Conclusions: All included factors except maternal education level and distance from home to vaccination providers significantly affected immunization rates. Appropriate reminders and accessibility of immunization services played key roles in improving the immunization status. More attention to high-risk groups identified in this study may reduce the disparities in routine childhood immunization in China. [ABSTRACT FROM AUTHOR]

Background: In China, the mode of HIV transmission and the types and routes of drug use have changed in the past decade. HIV testing amongst drug users needs further improvement. Methods: Interviewer-administered questionnaires were used for data collection amongst 600 heterosexual drug users from the community and a municipal detention centre, where criminal suspects are supervised. Descriptive statistics, univariate analysis and multilevel logistic regression analysis were used to identify the factors associated with HIV testing amongst heterosexual drug users. All participants were screened HIV and sexually transmitted infections. Results: Amongst 600 participants, 554 (92.3%) were methamphetamine users, and 155 (25.8%) underwent HIV testing in the past year. Multivariate analysis results revealed that drug users who were single (adjusted odds ratio(AOR) = 1.923, 95% confidence interval(CI) = 1.189–3.109), had less knowledge of HIV (AOR = 1.706, 95% CI = 1.074–2.711), used only one kind of drug (AOR = 2.649, 95% CI = 1.155–6.077), used drug via a non-injection route (AOR = 2.121, 95% CI = 1.103–4.078), did not receive free condoms (AOR = 2.307, 95% CI = 1.129–4.715) and who did not receive free publicity material from health workers in the past year (AOR = 2.828, 95% CI = 1.757–4.552) were less likely to undergo HIV testing. A total of 594 participants underwent HIV and syphilis screening in this survey. Amongst these participants, 2 (0.3%) were HIV antibody positive, and 88 (14.8%) showed positive results in both non-treponemal test (rapid plasma regain test) and treponemal test (Treponema pallidum particle agglutination test) for the first time. Conclusions: The rate of HIV test uptake amongst heterosexual drug users in China remains low. Thus, more specific interventions are urgently needed to improve the utilisation of HIV testing amongst heterosexual drug users, particularly amongst non-injection drug users in China. [ABSTRACT FROM AUTHOR]

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies. [ABSTRACT FROM AUTHOR]

Background: So far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life(HRQOL) of the elderly. Objective: This study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China. Methods: The data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly. Results: The EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA,LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health. Conclusion: The findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the nutritional status and its risk factors among children under 5 years, with special focus on the coexistence of under and over nutrition in population level. Methods: We enrolled 6,570 children under 5 years among 26 counties in poor areas of China. Prevalences of malnutrition (stunting, underweight, wasting, overweight) were calculated. Overweight was evaluated using two indicators–weight for height Z score (WHZ) and body mass index for age Z score (BAZ), and results were compared. Results: The total prevalence of malnutrition was 19.2%. The prevalence of stunting and overweight were as high as 8.4% and 8.8%, respectively. The BAZ-estimated prevalence of overweight was 9.9%, which was higher than the WHZ-estimated prevalence (p<0.001). Children older than 12 months age, within a minority group, with a caregiver of illiteracy/primary education level were significantly associated with stunting in multilevel regression models (p<0.05). Children younger than 24 months age and boys were significantly associated with overweight (p<0.05). Conclusions: Stunting and overweight were coexisted in surveyed areas. In conclusion, BAZ tended to overestimate the overweight prevalence compared with WHZ. While with the raising problem of childhood overweight, stunting should still be on the agenda for the poor areas in China. To improve children’s nutritional status in poor areas of China, caregivers with children at high risk of malnutrition should be guided for healthy feeding practices. [ABSTRACT FROM AUTHOR]

Few studies have investigated the distribution of sexual orientation among Chinese university students and identified the socio-demographic factors associated with sexual orientation. For the present study, we administered a paper-based, 5-point, self-report, sexual orientation scale to a stratified, random sample of 9071 undergraduates across all 10 universities in Guangzhou Higher Education Mega Center, Guangzhou, China. Multivariable ordinal regression analysis was used to explore the relationship between demographic factors and sexual orientation. A total of 8320 respondents completed the survey. Of 8182 valid respondents, 80.6% self-reported as exclusively heterosexual, 12.6% self-reported as mostly heterosexual, 5.4% self-reported as bisexual, 0.7% self-reported as mostly homosexual, and 0.8% self-reported as exclusively homosexual. About one fifth of male students and one fourth of female students reported some degree of divergence from exclusive heterosexuality. This indicates that in China there are a large number of university students who are potentially involved in same-sex sexual attraction. [ABSTRACT FROM AUTHOR]

Objectives: Non-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003−2013 and explore how these changes differ by subpopulation. Methods: Three independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003. Results: In 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly. Conclusions: Chronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Data was limited on prevalence of overweight and obesity among primary school-aged children in Jiangsu Province. We aimed to present the current situation of obesity in Jiangsu Province and explore the relationship between obesity and other common diseases in children. Methods: Physical examination among children aged 7 to 14 years in Jiangsu Province was conducted since 2014, and more than one third primary schools were covered annually. The physical measurements included body height, weight, blood pressure, vision, sex, age, and so on. Results: The prevalence of overweight and obesity among primary school children was 15.2% (18.7% for male students and 11.0% for female students), and 11.7% (14.5% for male students and 8.2% for female students) respectively. Obesity/overweight prevalence varied by regions. Among them the lowest prevalence was found in the southern region of Jiangsu Province, where residents had the highest average income level. Obesity group had elevated blood pressure comparing with the normal group, and obesity group especially in the male children aged 7 to 12 years had a higher prevalence of uncorrected visual acuity (UCVA) than that of normal group. Conclusion: This study found that obesity/overweight prevalence differed by sex, age, and regions in Jiangsu Province. In addition, obese children were closely associated with other common disease. Further studies are needed to explore the basis of biological and statistical theories. [ABSTRACT FROM AUTHOR]

Individuals’ attitudes toward evidence-based practices (EBP) are critical in adopting, implementing and maintaining the EBP in clinical settings. Multiple empirical studies have examined how work context may shape perceptions and attitudes towards EBP. The current study aims to further explore how both work and family contexts, as assessed by three psychosocial indicators (i.e., occupational stress, work-related social support from coworkers, and work-related social support from family), may affect attitudes toward EBP among health care providers in HIV clinics in China. We analyzed cross-sectional survey data from 357 health care providers recruited from 40 HIV clinics across 16 cities/counties in Guangxi China. Structural equation model (SEM) was constructed to test the hypothesized relationships among key study variables. Occupational stress was negatively associated with work-related social support from coworkers (β = -.19, 95%CI = [-.31,-.12]), which in turn was positively associated with attitudes toward EBP (β = .17, 95%CI = [.04, .30]). Similarly, occupational stress was negatively related to work-related social support from family (β = -.34, 95%CI = [-.42,-.25]), which in turn was positively related to attitudes toward EBP (β = .23, 95%CI = [.12, .35]). Occupational stress was negatively associated with attitudes toward EBP, but the magnitude of association did not reach statistical significance at α = .05. Work-related social support from family partially mediated the association between occupational stress and attitudes toward EBP (Sobel’s z = 3.27, p < .05). Our findings suggest the importance of integrating work and family contexts, especially family support into the strategies of facilitating the adoption and implementation of EBP. The current study also underscores the needs to reduce occupational stress and enhance work-related social support among health care providers who are in frequent contact with HIV patients. In addition, lack of work-related family support may be a main barrier preventing health care providers from developing a positive attitude toward EBP. Therefore, the interventions aiming for promoting adoption and utilization of EBP need to involve specific strategies to resolve work-family conflicts and improve family members’ understanding and support for health care providers in China, especially those who work in a stressful work context such as HIV care. [ABSTRACT FROM AUTHOR]

Background: In the past decades, extremely serious road accidents with a death toll over ten in each have become a severe public health problem in China. This study investigates risk factors contributing to extremely serious road accidents, which will be crucial for accident prevention. Methods: Collecting data from The Road Accident Statistical Annual Report openly issued by China’s Traffic Management Bureau of the Public Security Ministry for the time period 2004–2015, we used the monthly case number of extreme serious road accidents as the dependent variable. We then selected ten risk factors as primary independent variables: professional driver, driving under influence (alcohol or drug), fatigue, vehicle type, overload, brake problem, weather, road classification, terrain, and region. The method of negative binominal regression was implemented to investigate the association between these risk factors and extremely serious road accidents. Results: A total of 346 extremely serious road accidents were included in our analysis. On a national scale, we found that professional driver [incidence rate ratio (IRR): 1.10, 95% CI: 1.02–1.19], fatigue (IRR: 1.15, 95% CI: 1.03–1.29), large vehicle type (IRR: 1.11, 95% CI: 1.03–1.21), overload (IRR: 1.09, 95% CI: 1.03–1.16), and terrain (IRR: 1.09, 95% CI: 1.01–1.18) were significantly associated with extremely serious road accidents. Besides, separate analyses on western and non-western region indicated that both regions had shared risk factors as well as distinct factors. Conclusions: Our study identifies professional driver, fatigue, large vehicle type, overload, and terrain as significant risk factors of extremely serious road accidents in China, and targeted and preventative measures could be taken based on our findings. [ABSTRACT FROM AUTHOR]

The rapidly developing economy and growing urbanization in China have created the largest rural-to-urban migration in human history. Thus, a comprehensive understanding of the pattern of rural flight and its prevalence and magnitude over the country is increasingly important for sociological and political concerns. Because of the limited availability of internal migration data, which was derived previously from the decennial population census and small-scale household survey, we could not obtain timely and consistent observations for rural depopulation dynamics across the whole country. In this study, we use aggregate location-aware data collected from mobile location requests in the largest Chinese social media platform during the period of the 2016 Chinese New Year to conduct a nationwide estimate of rural depopulation in China (in terms of the grid cell-level prevalence and the magnitude) based on the world’s largest travel period. Our results suggest a widespread rural flight likely occurring in 60.2% (36.5%-81.0%, lower-upper estimate) of rural lands at the grid cell-level and covering ~1.55 (1.48–1.94) million villages and hamlets, most of China’s rural settlement sites. Moreover, we find clear regional variations in the magnitude and spatial extent of the estimated rural depopulation. These variations are likely connected to regional differences in the size of the source population, largely because of the nationwide prevalence of rural flight in today’s China. Our estimate can provide insights into related investigations of China’s rural depopulation and the potential of increasingly available crowd-sourced data for demographic studies. [ABSTRACT FROM AUTHOR]

We investigate the interdisciplinarity of mathematics based on an analysis of projects sponsored by the NSFC (National Natural Science Foundation of China). The motivation of this study lies in obtaining an efficient method to quantify the research interdisciplinarities, revealing the research interdisciplinarity patterns of mathematics discipline, giving insights for mathematics scholars to improve their research, and providing empirical supports for policy making. Our data set includes 6147 NSFC-sponsored projects implemented by 3225 mathematics professors in 177 Chinese universities with established mathematics departments. We propose the weighted-mean DIRD (diversity of individual research disciplines) to quantify interdisciplinarity. In addition, we introduce the matrix computation method, discover several properties of such a matrix, and make the computation cost significantly lower than the bitwise computation method. Finally, we develop an automatic DIRD computing system. The results indicate that mathematics professors at top normal universities in China exhibit strong interdisciplinarity; mathematics professors are most likely to conduct interdisciplinary research involving information science (research department), computer science (research area), computer application technology (research field), and power system bifurcation and chaos (research direction). [ABSTRACT FROM AUTHOR]

Objective: Medical students in China are currently facing a dilemma of whether to clarify their identity as students to patients. Further investigation is needed to support policy-making. The aim was to identify factors influencing medical students’ decision on whether or not to clarify their identity to patients and to examine the effects of their decision. Methods: The study was a cross-sectional nationwide multicenter survey consisting of 947 medical students. A self-designed questionnaire was composed of 19 structured questions investigating the present situation and participants’ perception of the ethical dilemma surrounding medical student identity. The questionnaires were distributed randomly in teaching hospitals affiliated with 13 medical schools across China from June 2015 to January 2016. Results: A total of 947 valid questionnaires were retrieved with a valid response rate of 83.7%. Most medical students (71.4%) tended to be ambiguous about their student identity in front of patients. The frequency of encountering distrust and patients’ or patient relatives’ refusal to allow students to perform procedures was significantly lower for students who explicitly stated their identity than for those who were ambiguous about their identity (p<0.001). Less experience in clinical rotations (<0.5 y/0.5–1 y, OR 2.7, 95% CI 1.7–4.3; <0.5 y/>1 y, OR 3.6, 95% CI 2.0–6.5), preceptors’ straightforward introduction of the students (OR 8.7, 95% CI 5.4–13.8) and students’ acknowledgment of patients’ right to know (OR 2.3, 95% CI 1.2–4.5) were related to students’ clear self-introduction to patients. Conclusion: It is beneficial for medical students to clearly explain their identity to patients in order to decrease patient distrust and prevent the refusal to have certain appropriate procedures performed. Several methods, including emphasizing the role of mentors, developing curriculum for medical students, and creating clear regulations and guidelines for revealing the identity of medical students on the healthcare team can help address and ideally resolve this ethical dilemma of identity disclosure. [ABSTRACT FROM AUTHOR]

Background: Adolescent health risk behaviors are a public health priority given their prevalence and their associations with chronic diseases and life quality in adulthood. This study examined the heterogeneity of adolescent health risk behaviors and the associations between demographic characteristics and subgroup membership in rural western China. Methods: In fall 2015, 2805 students from rural middle schools in Sichuan Province were surveyed using the Health-Related Behavior Questionnaire for Adolescents. Latent class analysis (LCA) was used to identify subgroups of adolescents with distinct patterns of health risk behaviors. Differences in class membership related to selected demographic characteristics were examined using multinomial logistic regression analysis. Results: A four-class model emerged: (1) high-risk group (n = 108, 4.0%), (2) high-physical-inactivity and suicide-risk group (n = 340, 12.1%), (3) moderate-risk group (n = 897, 32.0%), and (4) low-risk group (n = 1460, 52.1%). The multinomial logistic regression analysis revealed that boys and adolescents with poor parental relationships and high allowances (spending money) were significantly more likely to be in the high-risk group than the low-risk group. Conclusions: Adolescents in rural western China are a heterogeneous population requiring different tailored and effective interventions. [ABSTRACT FROM AUTHOR]

Background: Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized. Methodology/Principal findings: Utilizing school based sampling, we conducted a cross-sectional study, administering a questionnaire and collecting blood for T. solium cysticercosis antibodies in 2867 fifth and sixth grade students across 27 schools in west Sichuan. We used mixed-effects logistic regression models controlling for school-level clustering to study associations between risk factors and to characterize factors influencing the administration of deworming medication. Overall prevalence of cysticercosis antibodies was 6%, but prevalence was significantly higher in three schools which all had prevalences of 15% or higher. Students from households owning pigs (adjusted odds ratio [OR] 1.81, 95% CI 1.08–3.03), from households reporting feeding their pigs human feces (adjusted OR 1.49, 95% CI 1.03–2.16), and self-reporting worms in their feces (adjusted OR 1.85, 95% CI 1.18–2.91) were more likely to have cysticercosis IgG antibodies. Students attending high prevalence schools were more likely to come from households allowing pigs to freely forage for food (OR 2.26, 95% CI 1.72–2.98) and lacking a toilet (OR 1.84, 95% CI 1.38–2.46). Children who were boarding at school were less likely to have received treatment for gastrointestinal worms (adjusted OR 0.58, 95% CI 0.42–0.80). Conclusions/Significance: Our study indicates high prevalences of cysticercosis antibodies in young school aged children in rural China. While further studies to assess potential for school-based transmission are needed, school-based disease control may be an important intervention to ensure the health of vulnerable pediatric populations in T. solium endemic areas. [ABSTRACT FROM AUTHOR]

In keeping with China’s President Xi Jinping’s “Chinese Dream,” China has set a goal of becoming a world-class innovator by 2050. China’s higher education Science, Technology, Engineering, and Math (STEM) research environment will play a pivotal role in influencing whether China is successful in transitioning from a manufacturing-based economy to an innovation-driven, knowledge-based economy. Past studies on China’s research environment have been primarily qualitative in nature or based on anecdotal evidence. In this study, we surveyed STEM faculty from China’s top 25 universities to get a clearer understanding of how faculty members view China’s overall research environment. We received 731 completed survey responses, 17% of which were from individuals who received terminal degrees from abroad and 83% of which were from individuals who received terminal degrees from domestic institutions of higher education. We present results on why returnees decided to study abroad, returnees’ decisions to return to China, and differences in perceptions between returnees and domestic degree holders on the advantages of having a foreign degree. The top five challenges to China’s research environment identified by survey respondents were: a promotion of short-term thinking and instant success (37% of all respondents); research funding (33%); too much bureaucratic or governmental intervention (31%); the evaluation system (27%); and a reliance on human relations (26%). Results indicated that while China has clearly made strides in its higher education system, there are numerous challenges that must be overcome before China can hope to effectively produce the kinds of innovative thinkers that are required if it is to achieve its ambitious goals. We also raise questions about the current direction of education and inquiry in China, particularly indications that government policy is turning inward, away from openness that is central to innovative thinking. [ABSTRACT FROM AUTHOR]

Background: A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students’ participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. Methods: Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson’s chi-squared tests and binary logistic regression analyses were performed for data analyses. Results: Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students’ intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05–1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48–2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background. Conclusions: Rural clinical clerkship is likely to increase the odds of having intentions to work in rural medical institutions after graduation among medical students in western China, especially for those with an urban background. Related policy makers could consider developing compulsory rural clerkship programs and implement them among medical students to increase early rural exposure. [ABSTRACT FROM AUTHOR]

Births outside marriage (BoM) account for around 15% of all births globally. However, the distribution around the world is very uneven, as are cultural and political attitudes towards them. Studies from East Asia have shown that the percentage of such births is very low, with only modest increases in recent years. The orthodox demographic view holds that the maintenance of conservative views around the relationship between marriage and childbearing can play a role in keeping fertility low. Prenuptial pregnancies (PNP) (where births occur within eight months of marriage) have been identified as a growing phenomenon in Japan, possibly being an ‘alternative’ Asian pathway to family formation. As yet, no comprehensive statistical analysis of the trends of BoM or PNP has been performed for Hong Kong. Using a comprehensive microdata set of birth registration in Hong Kong from 1984–2015 (N = 1,680,831) we provide evidence of recent trends in such ‘alternative pathways’ to family formation and examine predictors through regression analysis. Our results indicate, in common with elsewhere in East Asia, low overall period rates of either BoM or PNP (although the latter has risen notably in recent years). While more recent birth cohorts exhibit higher prevalence of such births, their incomplete nature and higher expected propensity suggests that the figures are exaggerated. In our regression analysis, we find that lower educational attainment is a strong predictor of both BoM and PNP, suggesting that a bifurcation of experience may be occurring. This adds further evidence to the theory that the maintenance of traditional family formation systems in the context of revolutionised educational and work opportunities for women mean that the opportunity costs of the ‘marriage package’ become too high. Current disparities in rights and privileges between married and unmarried parents–and especially their children–means that targeted family planning services and support for vulnerable families are policy priorities. [ABSTRACT FROM AUTHOR]

Hearing loss is the most common sensory impairment, but limited studies focused on the association of socioeconomic status (SES) with hearing loss among adults of working age. This paper aimed to fill this gap among Chinese adults. We obtained data from Ear and Hearing Disorder Survey conducted in four provinces of China in 2014–2015. The survey was based on WHO Ear and Hearing Disorders Survey Protocol and 25,860 adults aged 25 to 59 years were selected in this study. Trained local examiners performed pure tone audiometry to screen people with hearing loss, and those who were screened positively for hearing loss were referred to audiologists to make final diagnosis. SES was measured by occupation, education and income. Results show after adjusting for SES measures and covariates, in urban areas, compared with white-collar workers, blue-collar workers and the unemployed were more likely to have hearing loss, with an odds ratio of 1.2 (95%CI: 1.0, 1.3) and 1.2 (95%CI: 1.0, 1.4), respectively. Compared with people with education of senior high school or above, those with junior high school, primary school and illiteracy had 1.6 (95%CI: 1.4, 1.8), 2.1(95%CI: 1.7, 2.5) and 2.6 (95%CI: 1.9, 3.7) times as likely to have hearing loss, respectively. In rural areas, the unemployed had 1.5 (95%CI: 1.0, 2.3) times the risk of hearing loss compared with white-collar workers, and illiterates had 1.6 (95%CI: 1.6, 2.1) times the risk of hearing loss compared with people with education of senior high school or above, after SES variables and covariates were taken into considerations. Income was not significantly associated with hearing loss in urban and rural areas. In conclusion, SES, in the form of occupation and education, was associated with hearing loss among working-aged population, and further studies are needed to explore the mechanism of such association. [ABSTRACT FROM AUTHOR]

Background: Postpartum Family Visits (PFVs) have been advocated as a way to improve health outcomes for puerperal women and their newborns. This study aimed to identify individual factors associated with the utilization of PFVs in rural Jiangsu Province, China. Methods: We employed responses of the household survey in Jiangsu province, part of the National Health Service Survey (NHSS), a nationally representative survey in China. The data analysis framework was designed based on Andersen’s behavioral model. The outcome variables included nonuse and deficient use of PFVs, and the explanatory variables were organized into three hierarchical levels: predisposing, enabling and need factors. Univariate analysis and multivariate logistic regression analysis were conducted to examine the impact of the three hierarchical levels on PFVs utilization. Results: A total of 884 rural women who had a childbearing history in the prior five years answered PFVs questions. About 23.4% of them had never received any PFVs, and 40.4% received <3 visits. In the results of multivariate logistic regression, educational level (OR = 0.43, 95% CI: 0.24–0.77), income (OR = 0.62, 95% CI: 0.43–0.88), the distance from the nearest hospital (OR = 1.49, 95% CI: 1.07–2.07) and parity (OR = 2.17, 95% CI: 1.54–3.05) had significant relationship with nonuse. Factors significantly associated with deficient use of PFVs included employment (OR = 0.62, 95% CI: 0.39–0.98), the distance from the nearest hospital (OR = 1.73, 95% CI: 1.26–2.36), level of delivery institution (OR = 1.57, 95% CI: 1.14–2.17), and parity (OR = 1.45, 95% CI: 1.03–2.05). Conclusion: The study found lower Social Economic Status (SES), long distance with primary health institutions, and the increased need for services stemming from multi-parity reduced the likelihood of nonuse or deficient use of PFVs in rural areas. Multiparous, low SES women and those living far away from primary health institutions should be paid more attention to assure the coverage of postpartum care. [ABSTRACT FROM AUTHOR]

Introduction: In 2009, China officially launched the New Health Care Reform (NHCR). One important purpose of the reform was to reduce financial burden of health care through health insurance expansion and health care provider regulations. This study aimed to provide evidence on the effect of the NHCR reform on catastrophic health expenditure (CHE) by comparing the occurrence and inequality of CHE among households with chronic diseases patients before and after the reform. Methods: This study used the subset of data from the 2008 and 2013 National Health Services Survey conducted in Shaanxi Province. Our sample included households with chronic diseases patients and excluded observations with key variables missing. The final sample size was 1942 households in 2008 and 7704 households in 2013. We defined CHE occurrence following the definition of the World Health Organization (WHO). The income-related inequality in CHE was measured by the concentration index. A multi-level logistic regression model was used in the study to explore the influence of the NHCR on CHE occurrence, controlling for important covariates. Results: From 2008 to 2013, the occurrence rate of CHE in rural areas declined from 29.15% to 23.62%. However, the CHE rate in urban areas increased from 19.18% to 24.95%. The interaction term between year and rural/urban location was statistically significant, confirming that the influence of the NHCR on the CHE occurrence rates were heterogeneous between rural and urban areas. As for the CHE inequality, the concentration index in rural areas decreased from -0.4572 to -0.5499 with a p-value less than 0.05. This implied that the CHE occurrence inequality was increased after the implementation of the NHCR. Conclusion: Our study suggested that the implementation of the NHCR might not have been effective in reducing the CHE occurrence for households with chronic disease patients. Although the occurrence of CHE of rural households had decreased, the occurrence of CHE in urban areas was higher than before. In addition, the income inequality of CHE occurrence was greater in 2013 compared to that in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts on developing the current health insurance system and optimizing the hierarchical health care system are required to improve the protection against CHE. [ABSTRACT FROM AUTHOR]

Objectives: Among the dramatic increased internal migration in China in past three decades, a considerable proportion of young females migrated to urban areas and found employment in “entertainment venues”, who may be vulnerable to psychological distress. This study examines the prevalence of depression and explores its associations with health-risk behaviors and social capital among this subgroup. Methods: 358 female migrants were recruited from entertainment venues in a rapidly growing urban city in China. A survey which included measures of depressive symptoms, health-risk behaviors, social capital, and socio-demographic characteristics was administered. Multivariable logistic regression was conducted to identify the independent correlates of depression. Results: Of participants, 31.0% had clinically significant depressive symptoms (CES-D score ≥ 16). In multivariable models, greater likelihood of depressive symptoms was associated with working in massage centers/hotels (OR = 3.20, 95% CI: 1.80–5.70), having probable alcohol dependence (OR = 2.25, 95% CI: 1.22–4.16), self-reported lifetime use of illicit drugs (OR = 2.98, 95% CI: 1.26–7.06), growing up in a non-nuclear family (OR = 2.46, 95% CI: 1.18–5.16), and poor social capital (OR = 6.01, 95% CI = 2.02–17.87). Conclusion: Intervention strategies to address the high prevalence of depression among female migrants are needed, and should also aim to reduce problematic alcohol and drug use, improve social capital, and target women working in massage centers or hotels. [ABSTRACT FROM AUTHOR]

Objective: To develop a Chinese version of the Newest Vital Sign (NVS-CHN) instrument and evaluate its psychometric properties. Methods: To deal with cross-cultural adaptation problems, after translation of the NVS into Chinese, the Delphi method was used for experts and cognitive testing was used for participants. A cross-sectional study including 351 participants was conducted to assess the validity of the NVS-CHN. Internal reliability, criterion validity, and known-groups validity were investigated. The NVS-CHN was further validated against a suitable standard, the Chinese Citizen Health Literacy Questionnaire (CCHLQ). Results: The validity of the NVS-CHN was established by conducting a Delphi survey (three rounds) and cognitive testing (three rounds). Cronbach’s alpha was 0.71, indicating that internal consistency was acceptable. A Spearman’s correlation coefficient of 0.68 between the NVS-CHN and CCHLQ revealed excellent criterion validity. Differences in NVS-CHN scores by education level confirmed known-groups validity. A receiver operating characteristics analysis showed that the area under the curve was 0.81, indicating that the NVS-CHN was an accurate health literacy assessment tool. A score ≥ 4 out of 6 best identified participants with adequate health literacy. Conclusions: The NVS-CHN has excellent psychometrical reliability and validity, which make it a suitable tool to evaluate health literacy in China. [ABSTRACT FROM AUTHOR]

Background: Offering free glasses can be important to increase children’s wear. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China. Methods: In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization. Results: Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56–1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69. Conclusions: Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income. Trial registration: ClinicalTrials.gov Identifier: . Registered on 31 August 2014. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between birth season and physical development and provide a necessary reference value to inform the implementation of public health services. Design: Cross-sectional study. Setting: Forty-five counties in ten provinces in western China in 2005. Subjects: A sample of 13,387 children under 3 years old and their mothers were recruited using a stratified, multistage, cluster random sampling method. Results: The results of the circular distribution analysis suggested that stunting and underweight exhibited time aggregation (Z = 32.57, P<0.05; Z = 10.42, P<0.05) among children under 3 years old. The Z − value for wasting, however, was not statistically significant (P>0.05). The generalized linear mixed models showed that children born in the summer were less likely to exhibit stunting (OR: 0.74~0.97) than were children born in the winter after adjusting for confounders, but no significant differences were identified for the other seasons. In addition, among children aged 25 to 36 months, those born in the summer and autumn were less likely to exhibit stunting after adjusting for confounders than were children born in the winter, but the association between birth in spring and stunting was not statistically significant. Conclusions: Stunting was associated with season of birth among children under 3 years old in low-income counties in western China, especially children aged 25 to 36 months, and children born in the summer and autumn were less likely to exhibit stunting than were children born in the winter. [ABSTRACT FROM AUTHOR]