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Background: A shortage of community health professionals has been a crucial issue hindering the development of CHS. Various methods have been established to calculate health workforce requirements. This study aimed to use an economic-research-based approach to calculate the number of community health professionals required to provide community health services in the Xicheng District of Beijing and then assess current staffing levels against this ideal. Methods: Using questionnaires, we collected relevant data from 14 community health centers in the Xicheng District, including resident population, number of different health services provided, and service volumes. Through 36 interviews with family doctors, nurses, and public health workers, and six focus groups, we were able to calculate the person-time (equivalent value) required for each community health service. Field observations were conducted to verify the duration. Results: In the 14 community health centers in Xicheng District, 1752 health workers were found in our four categories, serving a population of 1.278 million. Total demand for the community health service outstripped supply for doctors, nurses, and public health workers, but not other professionals. The method suggested that to properly serve the study population an additional 64 family doctors, 40 nurses, and 753 public health workers would be required. Conclusions: Our calculations indicate that significant numbers of new health professionals are required to deliver community health services. We established time standards in minutes (equivalent value) for each community health service activity, which could be applied elsewhere in China by government planners and civil society advocates. [ABSTRACT FROM AUTHOR]

Background: In order to address several health challenges, the Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009. In China's large cities, the lack of funding for community health centers and consequent lack of comprehensive services and high quality care has become a major challenge. However, no study has been carried out to estimate the cost of delivering the services in the package. This project was to develop a cost estimation approach appropriate to the context and use it to calculate the cost of the NEPHSP in Beijing in 2011. Methods: By adjusting models of cost analysis of primary health care and workload indicators of staffing need developed by the World Health Organization, a model was developed to estimate the cost of the services in the package through an intensive interactive process. A total of 17 community health centers from eight administrative districts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate the costs of providing the NEPHSP in Beijing based on the applied model. Results: The total workload of all types of primary health care in 17 sample centers was equivalent to the workload requirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62 USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of the NEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests that the cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas was lower than suburban areas: 7.31 and 8.65 USD respectively. Conclusions: The average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed to meet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and a dynamic cost estimate mechanism should be introduced to ensure services remain adequately funded. [ABSTRACT FROM AUTHOR]

Background: China has had no effective and systematic information system to provide guidance for strengthening PHC (Primary Health Care) or account to citizens on progress. We report on the development of the China results-based Logic Model for Community Health Facilities and Stations (CHS) and a set of relevant PHC indicators intended to measure CHS priorities. Methods: We adapted the PHC Results Based Logic Model developed in Canada and current work conducted in the community health system in China to create the China CHS Logic Model framework. We used a staged approach by first constructing the framework and indicators and then validating their content through an interactive process involving policy analysis, critical review of relevant literature and multiple stakeholder consultation. Results: The China CHS Logic Model includes inputs, activities, outputs and outcomes with a total of 287 detailed performance indicators. In these indicators, 31 indicators measure inputs, 64 measure activities, 105 measure outputs, and 87 measure immediate (n = 65), intermediate (n = 15), or final (n = 7) outcomes. Conclusion: A Logic Model framework can be useful in planning, implementation, analysis and evaluation of PHC at a system and service level. The development and content validation of the China CHS Logic Model and subsequent indicators provides a means for stronger accountability and a clearer sense of overall direction and purpose needed to renew and strengthen the PHC system in China. Moreover, this work will be useful in moving towards developing a PHC information system and performance measurement across districts in urban China, and guiding the pursuit of quality in PHC. [ABSTRACT FROM AUTHOR]

Objective: Although His bundle pacing (HBP) has shown an improved therapeutic effect than conventional pacing in terms of reducing cardiovascular mortality, the basic characteristics of HBP has not been defined systematically. Therefore, a systematical review and meta-analysis on the HBP characteristics can be timely and favorable. In this study, we aimed to clarify the electrocardiogram and echocardiographic characteristics of the pre- and post-operation of HBP. Methods: Patients with HBP were exclusively included in this study. By evaluating their electrocardiogram characteristics, echocardiographic parameters, and cardiac function, the therapeutic effect of HBP was assessed. Results: A total of 23 studies were included in the analysis. The overall implant success rate for HBP was 83.64%. After HBP treatment, the paced QRS duration dropped from 147.73±19.46 ms to 116.84±17.32 ms (p<0.001). Left ventricular ejection fraction (LVEF) increased from 34.87%±9.62% to 46.40%±9.64% (p<0.001), and NYHA functional class improved from 2.90±0.57 to 1.78±0.58 within the HBP group (SMD-2.09; 95% CI-2.53,-1.64, p<0.001). Conclusion: HBP can significantly reduce the QRS duration, resulting in improvement of cardiac function in most patients. In addition, this approach is applicable to most patients without limitations. [ABSTRACT FROM AUTHOR]

Background. The effect of achieved blood pressure (BP) on first stroke and renal function decline among hypertensive patients with mild to moderate chronic kidney disease (CKD) is still uncertain. Methods. In total, 3230 hypertensive patients with estimated glomerular filtration rate 30-60 mL/min/1.73 m2 and/or proteinuria were included in the present analyses. Eligible participants were randomly assigned to a daily treatment of a combined enalapril 10mg and folic acid 0.8mg tablet or an enalapril 10mg tablet alone. Participants were followed up every 3months. The study outcomes included first stroke and the progression of CKD. Results. The median antihypertensive treatment duration was 4.7 years. Compared with participants with a time-averaged ontreatment systolic blood pressure (SBP) of 135 to-140mmHg, the incidence of total first stroke [1.7% versus 3.3%; hazard ratio (HR), 0.51; 95% confidence interval (CI): 0.26-0.99] and ischemic stroke (1.3% versus 2.8%; HR, 0.46; 95% CI: 0.22-0.98) decreased significantly in those with a time-averaged SBP of-135mmHg. Furthermore, a time-averaged diastolic blood pressure (DBP) of-80mmHg, compared with a time-averaged DBP level of 80 to-90mmHg, was significantly related to a decreased risk of hemorrhagic stroke (0.2% versus 0.9%; HR, 0.18; 95% CI: 0.04-0.80). However, compared with participants with a time-averaged SBP of 135 to-140mmHg, a lower but non-significant trend of CKD progression was found in those with a time-averaged SBP of-130mmHg. Conclusions. A BP treatment level of-135/80mmHg, compared with a BP treatment level of 135-140/80-90mmHg, could lead to a decreased risk of first stroke in hypertensive patients with mild-to-moderate CKD. [ABSTRACT FROM AUTHOR]