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Governments across the globe have made repeated attempts to reform their health systems in recent decades with the purpose of improving access while containing costs. What is the role of government in contemporary health policy in achieving these somewhat contradictory goals? This paper conceptualises this role as one of "active stewardship" wherein the government is a central actor steering and coordinating the sector through a portfolio of diverse policy tools. In this conceptualisation, the government is not a passive participant—in merely financing, delivering, or regulating the sector—but a steersman at the helm that sets policy objectives and actively pursues them. We argue that active stewardship is central to achieving contemporary health policy priorities of universal healthcare. We apply this conceptualisation to China's recent healthcare forms and show that the role of the government in governing the sector has changed substantially over time, particularly since 2009, and the changes are showing promising results. China's experience suggests that governments need to more actively guide and shape the behaviour of both public and private players in order to achieve the goals of universal health coverage. It also suggests that a high degree of policy capacity is essential if active stewardship is to be effective. [ABSTRACT FROM AUTHOR]

Along with the increase in modern industry, original facilities and cultures have disappeared progressively, leading to the disappearance of traditional values. However, from the perspective of the stewardship of industrial heritage, preservation is vital for Western Europe, where the Industrial Revolution emerged firstly, and it has leading technology in terms of the advanced stewardship of industrial heritage protection. Meanwhile, there is a large market for industrial heritage growth in China, but its stewardship began later. Horizontal and vertical research into the stewardship of the industrial heritage of these two regions offers a review of the developed industrial regions and experiences for developing industrial regions in their future expansion. By analysing the values and dilemmas and the features of the legal, administrative, and fund guarantee systems, this paper summarizes the advanced expertise of the stewardship of industrial heritage in Western Europe and China and proposes strategies based on them. [ABSTRACT FROM AUTHOR]

Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before–after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed. [ABSTRACT FROM AUTHOR]

Urban agriculture (UA) encompasses different practices and dissimilar agendas, not all environmentally and socially savoury, ranging from food security to leisure and recreation. Although there is a wealth of literature on UA, little research has investigated its presence and role in a Chinese global city against the backdrop of unbridled urbanisation. This article focuses on Nanshan District in Shenzhen, a vast, rapidly urbanising region in China. We analyse the social and spatial characteristics of UA and its regulation. Employing a mixed-method approach that combines spatial analysis and in-depth semi-structured interviews, the results demonstrate the coexistence and interaction of diverse types of UA. What emerges is a socio-biologically rich heterogeneity of precarious practices, overlooked by the local authorities, but contributing to stewardship, social development and community engagement, while preserving a precious agricultural heritage. This article presents policy insights and advocates for government involvement in recognising the social significance of UA. [ABSTRACT FROM AUTHOR]

Background: Inappropriate prescribing of antibiotics for acute respiratory infections at the primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China's primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: (1) training using new operational guidelines, (2) improved management and peer-review of antibiotic prescribing, (3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months' post-trial long-term follow-up.Discussion: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All interventional activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs.Trial Registration: ISRCTN, ID: ISRCTN96892547. Registered on 18 August 2019. [ABSTRACT FROM AUTHOR]

Background: An antimicrobial stewardship campaign was launched in 2011 by the Ministry of Health. This study aimed to assess the achievements and trends in the clinical use of antibiotics in secondary and tertiary hospitals following this campaign in China.Methods: This observational study analyzed nationwide hospital antibiotic procurement and consumption data and antibiotic-resistance surveillance data based on claims filed in 2010-2016.Results: After a 6-year national campaign, the proportion of outpatients and surgical patients who received antibiotic treatment decreased from 19.5% to 8.5% and from 97.9% to 38.3%, respectively. The intensity of antibiotic use among inpatients decreased from 85.3±29.8 defined daily dosage (DDD) per 100 patient days to 48.5±8.0 DDD per 100 patient days. Moreover, the antibiotic procurement expenditure among hospitals declined from 22.3% of total drug procurement costs in 2010 to 12.1% in 2016, although total drug procurement costs doubled during that time. The incidence of methicillin-resistant Staphylococcus aureus isolates also dropped (from 54.4% in 2010 to 34.4% in 2016), as did the proportion of carbapenem-resistant Pseudomonas aeruginosa isolates (from 30.8% to 22.3%).Conclusions: The 6-year campaign successfully reduced antibiotic consumption and irrational drug use in Chinese hospitals which was associated with declines in the prevalence of common antibiotic-resistant bacteria. [ABSTRACT FROM AUTHOR]

Technologies such as medical treatment, assistive care devices, and monitoring tools represent strategies for dealing with the progression of dementia. Drawing on ethnographic data from Shanghai, this study examines how family caregivers engage with technology to enhance their care performance. I argue for a stewardship approach to dementia care given that care is not only a moral experience but also an intellectual labor, which requires the competence of family caregivers. This stewardship approach contributes to our understanding of family caregivers' efforts at coming to terms with the changing discourse on dementia and the broad social change in China.

The article focuses on the challenges faced by the government against barriers to creating a sustainable timber market in China. The number of forest products industries in the country increased rapidly because of the booming domestic demand and expanding exports. Deforestation in the country has negative effect to its environment which resulted to flood severity in the upper Yangtze River. The negative effect of their business activity led the government to pursue an environmental restructuring and prohibited logging. World Wildlife Fund and Forest Stewardship Council helped the government to combat global deforestation and forest degradation by suggesting promotion of certified wood products.

Objectives: To explore doctors' knowledge, willingness, concerns and the countermeasures to the most stringent antimicrobial stewardship regulations of China which implemented in August 2012., Design: Cross-sectional survey. A pretested 32-point structured questionnaire was distributed to doctors by sending a web link via the mobile phone application WeChat through snowball sampling methods and email groups of medical academic societies., Setting: China., Participants: Doctors., Primary and Secondary Outcome Measures: The questionnaire inquired about the doctors' experiences, knowledge, willingness, concerns and the countermeasures to the stewardship policies., Results: Total of persons in the groups was 19 791, among them 1194 submitted the answers, within them, 807 were doctors. Doctors had a mean age of 39.0 years. The majority (78.9% in 2012, 89.1% in 2016) reported that they were willing or very willing to accept the regulations. Almost all respondents (93.2%) felt the stewardship regulations had the potential to adversely affect the prognosis of patients who would have been prescribed antimicrobials before they were implemented, and >65% (65.7% in 2012, 66.9% in 2016) of doctors were often or always concerned about the prognosis of these patients. In 2012, 32% of doctors prescribed restricted antimicrobials or suggested patient self-medication with restricted antimicrobials to address doctors' concerns, and this number decreased to 22.6% in 2016. Although compulsory antimicrobial stewardship training was frequent, less than half of respondents (46.8%) responded correctly to all three knowledge questions., Conclusion: Antimicrobial stewardship regulations had some positive effect on rational antimicrobial use. Willingness and practice of doctors towards the regulations improved from 2012 to 2016. Knowledge about rational antimicrobial use was still lacking. Doctors found ways of accessing restricted antibiotics to address their concerns about the prognosis of patients, which undermined the implementation of the stewardship regulations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)