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Sean Sylvia Hao Xue Chengchao Zhou Yaojiang Shi Hongmei Yi Huan Zhou Scott Rozelle Madhukar Pai Jishnu Das 《Lancet》2017
Background
Future progress against tuberculosis in China will likely rely on improved detection, particularly in rural areas where prevalence remains high. The ability of rural providers to correctly diagnose Tuberculosis is largely unknown, as are the potential effects on tuberculosis patients of health-system reforms promoting initial contact with grassroots providers.Methods
We employed unannounced standardised patients presenting with classic pulmonary tuberculosis symptoms in a representative survey of village, township, and county level providers in three provinces and assessed provider management of standardised patients against international and national standards of care. We then measured the gap between knowledge and practice by comparing doctor care of standardised patients to their performance in clinical vignettes of an identical presumptive tuberculosis case. Finally, we simulated the management of patients at the health-system level under alternative managed care policies accounting for provider referrals.Findings
In July, 2015, we successfully completed 274 standardised patient interactions. Of 46 interactions in village clinics, 13 (28%) were correctly managed (95% CI 17–43%), compared with 79 (38%) of 207 in township health centers (32–45%) and 19 (90%) of 21 in county hospitals (71–97%). The same providers were 45 percentage points (95% CI 37–53%) more likely to correctly manage the same case in vignettes. Under existing policy, which allows patients to freely choose initial providers, simulations suggest that 40% (95% CI 34–47%) of patients encountering the health system are correctly managed. This would reduce to 16% with gatekeeping from village clinics and to 37% from township centers.Interpretation
We uncovered important quality deficits among grassroots providers in the management of a case of presumptive tuberculosis and a large gap between provider knowledge and practice. In view of the current quality of care, reforms encouraging first contact in village clinics could reduce the rate of detection of patients with tuberculosis.Funding
Fundamental Research Funds for the Central Universities and the Research Funds of Renmin University of China (2015030245), the 111 Project (B16031), the National Science Foundation of China (71473152), and the Department of Science and Technology of Shandong Province (BS2012SF010). 相似文献5.
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Background
The recent integration between the New Cooperative Medical Scheme (NCMS) and the Urban Residents Basic Medical Insurance (URBMI) into the Urban and Rural Resident Basic Medical Insurance (URRBMI) scheme has reduced the disparity among one billion rural and urban Chinese people. During the transition, URRBMI in some provinces provided two to three different plans with graded contributions and corresponding benefit packages; however, how enrolees make decisions among different plans is still unknown. Our study therefore aimed to provide the first longitudinal analysis on the enrolment of health insurance after the integration of NCMS and URBMI.Methods
We did a longitudinal study in Hangzhou, China. NCMS and URBMI in Hangzhou were integrated in 2011, and URRBMI had two packages: contribution for plan A was CNY1200 and plan B was CNY800. Both plans have the same benefits for hospital admission, whereas plan B has better benefits for outpatient visits. A prospective cohort of more than 800 households was established in 2009 and followed up annually for 5 years by the same household health survey. Individuals enrolled in URBMI–NCMS–URRBMI with at least two observations were eligible for analysis. The primary outcome was the association between insurance enrolment decision and the enrolees' health condition in the previous year. Demographic, socioeconomic, self-reported health (measured by the visual analogue scale [VAS] score of 1–100), health need, use of services, household income, and satisfaction on insurance in surveyed year T (2009–12) were inputted as independent variables; and enrolment decision (ie, upgrade or downgrade) in Year T?+?1 (2010–13) was inputted as a dependent variable for the multi-level regression model with random effect. Any change from uninsured to URRBMI or from plan B to plan A was defined as an upgrade, whereas a change from URRBMI to uninsured or from plan B to plan A was defined as a downgrade. The protocol was reviewed and approved by the Institutional Review Board of the School of Public Health, Fudan University, and all participants of this study gave written consent.Findings
Between June 1, 2009, and Aug 31, 2013, 1576 individuals with 5171 records (3595 pair of observations) were included, of whom 958 (26·6%) upgraded, 568 (15·8%) downgraded, and the rest remained on the same plan during the observation. Age, marriage, and household income significantly influenced the enrolment decision; whereas sex, education, or household size had no influence. Individuals with a VAS score of 0–59 were 37·2% more likely to upgrade their plan (p=0·041) than those with a VAS score of 80–89; individuals with one to three outpatient visits for non-communicable diseases within 3 months before the survey were 80·5% less likely to downgrade their plan than those without use of these services for non-communicable diseases (p=0·029); and individuals with hospital admissions were 58·4% less likely to downgrade than those who remained on the same plan (p=0·017). Condition of self-reported health status (ie, VAS score) and service use in the previous year significantly influenced individuals' insurance enrolment decision, indicating the existence of adverse selection.Interpretation
Enrolment flexibility within URRBMI is intended to serve different affordability but is accompanied with adverse selection, which might endanger the sustainability of insurance funds. Family enrolment should be encouraged at this current stage, and compulsory insurance with subsidies for people who live in poverty is recommended to achieve long-term universal health coverage in China.Funding
CMB Collaborative Program on Pharmaceutical Policy and Economics and the Fourth Round of Shanghai Three-year Action Plan on Public Health Discipline and Talent Program: Evidence-based Public Health and Health Economics (15GWZK0901) 相似文献7.
Background
The cumulative effect of childhood adversities on depressive symptoms in later life is well documented in many countries. However, there is a dearth of accurate information about this effect in the Chinese population. We aimed to examine the cumulative effect of childhood adversities on depressive symptoms in mid-to-late life, using data from the Chinese population.Methods
We retrieved data from the third and fourth wave of the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2014 and 2015. We included anonymised data from 17?425 respondents aged 45 years and older, and retrospectively collected information about childhood history, including socioeconomic status, health status, child neglect and abuse, friendship, and parental mental health. The information about socioeconomic status and health status in mid-to-late life was also included. The depressive symptoms were assessed using a ten-item Center for Epidemiologic Studies Depression Scale (CES-D). We used a structural equation model and depicted the direct or indirect pathways from five aspects of childhood adversities to depressive symptoms in mid-to-late life. Socioeconomic status and health status in mid-to-late life acted as a mediated factor in this model.Findings
The structural equation model had a good satisfactory fit (comparative fit index 0·927; Tucker–Lewis index 0·922; root mean square error of approximation 0·020). Parental mental health problems had a significant direct effect on depressive symptoms in mid-to-late life (β=0·180, p<0·001). Having no friends also showed a direct effect (β= 0·118, p<0·001) and there was an indirect effect of low socioeconomic status and poor health status in mid-to-late life (β=0·054, p<0·001). Poor health status, child neglect and abuse, and low socioeconomic status in childhood had an indirect effect on depressive symptoms in mid-to-late life (poor health status β=0·128, p<0·001; child neglect and abuse β=0·040, p<0·001; low socioeconomic status β=0·098, p<0·001).Interpretation
Childhood adversities were directly or indirectly associated with depressive symptoms in mid-to-late life, and the cumulative effects were mediated by poor health status and low socioeconomic status in mid-to-late life. These findings are crucial for the development of integrated practices and deployment of available resources to prevent childhood adversities, subsequently reducing the prevalence of depression. Moreover, the indirect pathways from childhood adversities to depressive symptoms in mid-to-late life indicate that early inequality may develop along multiple axes and shape life outcomes in later life, such as socioeconomic status. The findings suggested the interruptive potential of early resource mobilisation and human agency to curb the cumulative effects of adversity.Funding
China Medical Board (14-198) 相似文献8.
Background
The mortality of people with mental illness is consistently higher than that of the general population according to current literature in developed countries. However, evidence in China is scarce. Patients with severe mental disorders (SMD) have been managed in the community since 2009 in China, but there has been no study of mortality, or the impact of community management on mortality, in this patient population. This study aims to provide preliminary empirical evidence.Methods
This study identified 134 182 patients with SMD who were aged 15 years and over and managed in the community between January 2009 and January 2014. The patients were from 21 municipalities in Sichuan province, China. The follow-up duration (provided as part of the community management), risk behaviour (scored from low to high [1–6]), and stability of disease (scored from stable to unstable [1–3]) were treated as proxy measures of the extent and success of management in the community (improved disease stability and lower risk behaviour were targets of the community management team). The standardized mortality ratio (SMR) was compared with that of the general population, and the association between the above three factors and risk of death was estimated using multilevel Cox proportional hazards models.Findings
The percentage of patients with SMD followed up for 0, 0–1, 1–2, and greater than 2 years was 10·2%, 24·0%, 35·1%, and 30·7%, with death rates of 3·1%, 3·6%, 2·2%, and 0·8%, respectively. Over the study period, the median scores for disease stability and risk behaviour decreased from 1·76 to 1·0, and from 1·45 to 1·0, respectively. The standardized mortality rate of patients with SMD was 1.3 and 1.4 times higher than that of general population in 2012 and 2013, respectively. The SMR for patients aged 15 to 64 was 2, and for those aged 65 and over it was 0·85. With adjustment, the result showed that longer follow-up time was associated with lower risk of death (hazard ratio 0·533 for 1–2 years, 0·149 for >2 years [vs 0–1 year], p<0·0001). More stable disease and less high risk behaviour were associated with lower risk of death (hazard ratios of 0·667, p<0·0001, and 0·723, p<0·0001, respectively). Furthermore, a longer follow-up period (>2 years) was associated with higher disease stability (hazard ratio of 0·766, p<0·042). A longer follow-up period also seemed to be associated with lower risk behaviour, although the effect was not statistically significant (hazard ratio 0·961, p>0·687).Interpretation
Evidence from Sichuan province demonstrates higher mortality in patients with SMD than in the general population, and suggests that aspects of current community management affect mortality in patients with SMD. 相似文献9.
Bin Dong Zhiyong Zou Yi Song Peijing Hu Dongmei Luo Bo Wen Di Gao Xijie Wang Zhaogeng Yang Yinghua Ma Jun Ma Xiaobo Tian Xiaona Huang George C Patton 《Lancet》2018
Background
The Chinese government approved the Outline of the Healthy China 2030 (HC2030) Plan in 2016, and made public health a priority for all future economic and social development. Studies have demonstrated the importance of investment in health care throughout the 8000 days that it takes for a human to develop, on reducing the disease burden in this group. Therefore, as well as children, adolescents should be recognised as an essential target population for health-care investment, and HC2030 plans to achieve key goals in adolescent health. This study aims to explore the gaps in adolescent health care that must be bridged, and to examine experiences from previous policies for lessons that will help the goals of HC2030 in adolescent health to be realised.Methods
Policies relating to adolescent health issued by the Chinese government during the past three decades were reviewed. Data from the Global Burden of Disease study (1990–2016) and seven cycles of national successive cross-sectional survey, the Chinese National Survey on Students' Constitution and Health (1985–2014), were used. Trends and geographical distribution of essential indicators, including overweight and obesity, stunting, poor vision, oral health, physical activity, and smoking, were analysed in students aged 10–19 years who were selected from primary and secondary schools in 31 provinces of mainland China using a multistage cluster sampling method. The current situation was compared with the targets of the HC2030 to identify gaps between the two. This study was approved by the Ethic committee of Peking University Health Science Center (IRB00001052-18002) and informed verbal consent was obtained from participants or their guardians.Findings
Policies issued by the Chinese government have contributed to great improvements in adolescent health. For example, all-cause mortality has halved in the past 26 years, and the prevalence of stunting declined from 16·1% in 1985 to 2·8% in 2014. However, critical challenges to reaching the goals of HC2030 were also observed. The prevalence of overweight and obesity increased from 1·1% in 1985 to 18·2% in 2014, and only 1·6% of adolescents in 2014 had excellent physical fitness based on the National Student Physical Fitness Standard. According to the goals of HC2030, the increasing prevalence of overweight and obesity should be controlled, and 25% of adolescents should have excellent physical fitness in 2030. Thus, there is a substantial gap to be bridged by 2030. Additionally, the geographical imbalance in health achievements is substantial (eg, the prevalence of stunting was 0.48% in Beijing, but 11·1% in Guizhou province in 2014).Interpretation
Although great achievements have been obtained, our findings call for strengthened practical policies to improve adolescent health, reduce the geographical imbalance in health achievements, and to achieve the goals of HC2030.Funding
This work was supported by the National Natural Science Foundation (81673192 to JM and 81773454 to ZZ), and the Excellent Talents Fund Program of Peking University Health Science Center (BMU2017YJ002 to BD). 相似文献10.
Ya Yang Wanting Cheng Xiang Pan Yu Yang Robert W Scherpbier Xu Zhu Yibiao Zhou Qingwu Jiang 《Lancet》2017
Background
Haemophilus influenzae type b is an important cause of invasive bacterial disease in children worldwide. The establishment of epidemiological estimates is an essential first step towards the introduction of H influenzae type b vaccine into the Chinese national immunisation programme. We therefore undertook a systematic review and meta-analysis to estimate the prevalence of H influenzae type b in Chinese children.Methods
We systematically searched PubMed, Web of Science, CNKI, Wanfang, and Ovid databases for studies published up to Dec 31, 2016, that reported the prevalence of H influenzae type b among children in mainland China. We used random-effects meta-analysis to obtain the pooled prevalence of H influenzae type b in healthy children and in those with acute lower respiratory tract infection or bacterial meningitis.Findings
27 studies met prespecified inclusion criteria, and these included 15?783 children in 14 provinces. The pooled prevalence of H influenzae type b in healthy children, children with acute lower respiratory tract infection, and bacterial meningitis was 5·87% (95% CI 3·42–8·33), 4·06% (3·29–4·83), and 27·32% (0·41–54·24), respectively. Meta-regression showed that the prevalence of H influenzae type b in healthy children remained stable after the introduction of H influenzae type b vaccine in 1997 (p=0·725), whereas the proportion of children with acute lower respiratory tract infection due to H influenzae type b showed a decreasing trend (P<0·0001) and was higher in northern China than in the south (p<0·0001). Significant heterogeneity was noted across and within regions (P<0·0001). Differences in sex, age groups, and study sample size did not explain the heterogeneity.Interpretation
H influenzae type b is a common pathogen in healthy children and an important cause of lower respiratory tract infection and bacterial meningitis in China. Introduction of H influenzae type b vaccine into the Chinese national immunisation programme could reduce the burden of H influenzae type b disease in China.Funding
UNICEF China Office. 相似文献11.
Background
In China, internal migrants have been largely unable to claim for health-care visits in the location to which they have migrated. Under the household registration system, health reimbursement can often be claimed only in the registration locality, and benefit packages are inconsistent across areas, leading to a low reimbursement rate for visits out of the insured locality. To address this issue, the central government has urged all levels of local governments to explore offsite settlement of health claims. This study aims to investigate the effect of the policy on family migration decisions.Methods
Our study covers a period when the policy was implemented intensively across prefectures within provinces. Using a difference-in-difference and propensity score matching approach, we compared changes in migration outcomes before and after the policy for households in cities that implemented the policy earlier relative to those in cities that implemented it later. Information on the timing of policy implementation was collected from government notices. Information on migrants was obtained from the 2012–2016 China Migrants Dynamic Survey, a national representative cross-sectional survey. We termed the first individual of a family to migrate, the ‘main migrant’, and observed the migration status of his or her dependents. The final sample contained 266?919 families.Findings
We find that offsite settlement caused the probability of migrating with a spouse, at least one child, and at least one parent to increase by 1·6% (p=0·02), 5·6% (p=0·001), and 19·4% (p=0·03), respectively. We find no evidence of an increase in the number of main migrants deciding to move in response to the policy.Interpretation
Our results suggest that offsite settlement of health claims will cause more family members of the main migrants to move. How the changes in migration pattern will reshape the health-care market from the demand side should be a focus of future research.Funding
This study was funded by a grant from the Young Medical Talents Training Program of Scientific Research of the Shanghai Municipal Commission of Health and Family Planning (number 20164Y0083 to MQ), and a grant from the National Science Foundation of China (number 71403057 to HJ). 相似文献12.
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Background
There is a lack of accurate information about the associations between risk factors for type 2 diabetes and the incidence of this disease in China. We conducted a systematic review and meta-analysis to examine these associations and their spatio-temporal patterns.Methods
We searched PubMed, MEDLINE, Embase, EBSCO, Science Direct, and the Chinese databases CNKI, VIP, CBM, and Wanfang, for relevant studies from January 1997 to December 2017. Observational studies of the associations between risk factors and type 2 diabetes in adults (aged 18 and over) in mainland China were retrieved. Overall analysis and stratification analysis—including secular trends and temporal distributions—were conducted, and random-effects modelling was applied.Findings
35 studies were included in the final analysis. A family history of type 2 diabetes (pooled odds ratio [OR] 2·89, 95% CI 2·38–3·49), hypertension (2·73, 2·25–3·36), central obesity (2·28, 1·94–2·68), dyslipidaemia (2·23, 1·70–2·91), hypertriglyceridemia (2·18, 1·64–2·92), general obesity (1·90, 1·66–2·18), hypercholesterolemia (1·65, 1·32–2·06), smoking (1·26, 1·13–1·40), and drinking (1·20, 1·05–1·36) were associated with type 2 diabetes, while female gender (0·87, 0·78–0·97) was negatively related to type 2 diabetes. In terms of temporal stratification, the estimated effects of general obesity increased gradually during the periods 1992–2005, 2006–2010, and 2011–2017, whereas the estimated effects of a family history of type 2 diabetes decreased. In terms of regional stratification, the magnitude of the pooled effect for hypertension, dyslipidaemia, and hypercholesterolemia in northern areas (Beijing, Gansu, Hebei, Henan, Liaoning, Ningxia, Shandong, Shanxi, and Tianjin) was greater than in southern areas (Anhui, Chongqing, Fujian, Guangdong, Guangxi, Hubei, Jiangsu, Jiangxi, Shanghai, Sichuan, and Zhejiang), yet the magnitude of the pooled effect for a family history of type 2 diabetes in southern areas was larger than in northern areas. Lastly, in terms of provincial stratification, statistical maps showed that the estimated effect of a family history of type 2 diabetes was consistent with the overall results in all of the provinces included, but for the other nine factors, the effects were not consistent with the overall results and the effects also differed among provinces.Interpretation
As this is the first meta-analysis to focus on the spatio-temporal distributions of the associations between type 2 diabetes and its risk factors, our evidence may help to guide prevention and control of type 2 diabetes in different regions and populations of China.Funding
This work was supported by the National Key Research and Development Program (number 2017YFC0907300) and the China Medical Board (number 12-106). 相似文献14.
Background
The benefits of breastfeeding, to infant and mother, are supported by a comprehensive body of evidence. However, in China, only a small proportion of women achieve the breastfeeding recommendation from WHO. Previous studies in high-income countries have found a positive association between socioeconomic status and initiation and duration of breastfeeding. This association might differ between societies and be affected by rapid social and economic development, such as has occurred in China over the past decade. The purpose of this study was to investigate the role of socioeconomic status on breastfeeding initiation and duration in China.Methods
In this analysis we used data from the China Family Panel Studies (CFPS), funded by the 985 Program of Peking University and undertaken by the Institute of Social Science Survey of Peking University. CFPS is a nationally representative and longitudinal household survey that has been collecting individual, family, and community information annually in China since 2010. CFPS has surveyed 15?000 selected households in 25 provinces or directly governed municipalities. Our analysis included all surveyed children who were born between 2010 and 2014, and excluded children with missing breastfeeding information. We obtained data for initiation of breastfeeding (ie, breastfed or non-breastfed), and duration of breastfeeding time, expressed in months. Socioeconomic status was measured using household income per capita, parental years of education, and parental occupational status. We used Kaplan-Meier time-to-event analysis to compare duration of breastfeeding according to socioeconomic status variables, a logistic regression model to analyse the association between socioeconomic status and initiation of breastfeeding, and a Cox proportional hazards model to analyse breastfeeding duration and socioeconomic status. Sex of infant, birthweight of infant, birthplace, nationality, type of residence, age of parents, residential region, marriage status of mother, parity of mother, and birth year were adjusted for in the logistic and Cox model. CFPS was undertaken according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human participants were approved by the ethics committee of Peking University. Written informed consent was obtained from all participants.Findings
Our sample consisted of 2938 children. 2658 (90%) infants had ever breast-fed, and the mean duration of breastfeeding was 8·66 months (SD 6·15). After adjusting for potential confounders, we found that socioeconomic status variables were not significant predictors for breastfeeding initiation, but that low birthweight babies were less likely to be breastfed than normal weight babies (odds ratio 0·272, 95% CI 0·18–0·42; p<0·0001). As for breastfeeding duration, mothers with a high school or higher education were more likely to breastfeed for longer than those with a middle school or lower education (hazard ratio [HR] 1·15, 95% CI 1·02–1·29; p=0·021), as were infants with fathers with the highest occupation level versus those with fathers with the lowest occupation level (HR 1·29, 95% CI 1·04–1·59, p=0·019). Mother's occupation had an inverted U-shaped relationship with breastfeeding duration (HRs for low, high, and highest occupation level vs lowest occupation level were 1·17 [95% CI 1·02–1·33], p=0·023; 1·29 [1·08–1·54], p=0·005; and 1·11 [0·87–1·42], p=0·408, respectively).Interpretation
The finding that socioeconomic status in China was not a predictor of breastfeeding initiation is different from that reported in high-income countries. Comprehensive efforts to promote breastfeeding practices should be targeted towards women who are less well educated, and those in both the lowest and highest occupation levels, because we found that these variables were associated with shorter breastfeeding duration.Funding
Sichuan University (skqx201401 and 2015SCU04A19). 相似文献15.
Wenming Shi Cong Liu Dan Norback Qihong Deng Chen Huang Hua Qian Xin Zhang Jan Sundell Yinping Zhang Baizhan Li Haidong Kan Zhuohui Zhao 《Lancet》2018
Background
Evidence of the effects of fine particulate matter (PM2·5) and its chemical constituents on childhood pneumonia is scarce. We aimed to investigate the effects of PM2·5 and its chemical constituents on doctor-diagnosed pneumonia in preschool children in China.Methods
A cross-sectional study was done in six Chinese cities (ie, Shanghai, Nanjing, Chongqing, Changsha, Urumqi, and Taiyuan), based on the China, Children, Homes and Health project (2011–12), and included 30?759 preschool children across 205 preschools. Information on the prevalence of life-ever pneumonia, demographic characteristics, and home environmental factors were collected by validated questionnaires. Questionnaires were answered by parents or guardians of the children, and completed questionnaires were returned within 1 week, under the guidance of trained project investigators. The annual levels of ambient air pollutants (PM2·5, ozone, and dust) and five major PM2·5 chemical constituents (ie, black carbon, organic carbon, and three water-soluble ions [ammonium, NH4+; sulphate, SO42?; and nitrite, NO3?]) were obtained from a combination of satellite remote sensing, chemical transport modelling, and ground-based monitors (spatial resolution of 0·01° × 0·01° [ie, 1 km?×?1 km]). The ambient air pollutants and chemical constituents were allocated to children according to geocoded preschool addresses. A hierarchical multiple regression model was done to evaluate the associations between PM2·5 and chemical components and childhood pneumonia at the preschool level and at the individual level, after adjusting for covariates. The study was approved by the ethics committee of the School of Public Health, Fudan University, Shanghai, China.Findings
The prevalence of life-ever doctor-diagnosed pneumonia was significantly different between the six cities (p=0·004). Apart from family history of allergy, parental smoking, indoor dampness, and interior decoration, we found the prevalence of diagnosed pneumonia was significantly associated with the ambient PM2·5 (per 10 μg/m3) by an adjusted odds ratio (OR) of 1·10 (95% CI 1·00–1·21). The secondary chemical components, NH4+, SO42?, and NO3? (per 1 μg/m3), were significantly associated with childhood pneumonia, as shown by adjusted ORs of 1·08 (1·02–1·14), 1·04 (1·00–1·08), and 1·05 (1·01–1·09), respectively. Stratified analyses showed children who lived in urban areas or who were breastfed for less than 6 months had increased risk of pneumonia by ambient NH4+, SO42?, or NO3? exposure.Interpretation
The chemical constituents of PM2·5, especially the water-soluble parts of NH4+, SO42?, and NO3?, were significantly associated with childhood pneumonia in China. This association indicates that these constituents might be important environmental triggers of childhood pneumonia.Funding
National Key R&D Program of China, National Natural Science Foundation of China, the State Key Basic Research Program (973) Project. 相似文献16.
Monika Arora Ahmed ElSayed Birgit Beger Pamela Naidoo Trevor Shilton Neha Jain Kelcey Armstrong-Walenczak Jeremiah Mwangi Yunshu Wang Jean-Luc Eisel Fausto J. Pinto Beatriz M. Champagne 《Global Heart》2022,17(1)
Over the past several decades, the prevalence of cardiovascular disease (CVD) has nearly doubled, and alcohol has played a major role in the incidence of much of it. Alcohol has also been attributed in deaths due to infectious diseases, intentional and unintentional injuries, digestive diseases, and several other non-communicable diseases, including cancer.The economic costs of alcohol-associated health outcomes are significant at the individual as well as the country level. Risks due to alcohol consumption increase for most cardiovascular diseases, including hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, and stroke. The widespread message for over 30 years has been to promote the myth that alcohol prolongs life, chiefly by reducing the risk of coronary heart disease (CHD). Lack of universal advice and stringent policy measures have contributed towards increased uptake and easy availability of alcohol. The WHO has called for a 10% relative reduction in the harmful use of alcohol between 2013–2025. However, lack of investment in proven alcohol control strategies, as well as persistence of misinformation and industry interference, have hindered the efforts of public health professionals to make sufficient progress in reducing alcohol related harms and death. 相似文献
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Background
Depression is an important mental health disorder, which is facing a serious problem of inequality. However, compared with the field of physical health, there is not as much research into the fairness of mental health. Moreover, the research mainly focuses on cross-sectional studies. Vertical comparison is missing. Therefore, we aimed to measure the income-related inequality of depressive symptoms and its trends among elderly people in China.Methods
We extracted data from the 2011 baseline and 2015 follow-up of the China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative survey for elderly people aged 45 years and more in China. Depressive symptoms were evaluated with the Chinese version of the ten-item Center for Epidemiologic Studies-Depression Scale (CES-D). Participants were considered to have depressive symptoms once the CES-D score was 10 or more. We used five relative income levels derived from ratios between the participants' annual per capita household expenditure (PCE), excluding medical expenditure, and the median PCE of their cities. The concentration curve and index were used to measure and compare the magnitude of income-related inequality of depressive symptoms between 2011 and 2015. A logistic regression model was used to explore the crux of the inequality issue. Several confounding factors were controlled for in this model, including age, sex, marital status, and educational level.Findings
The prevalence of depression among the elderly in China decreased from 37·0% (5540 of 14?956 participants) in 2011 to 32·7% (5606 of 17?165) in 2015. However, the absolute value of the standardised concentration index increased from 0·005 in 2011 to 0·028 in 2015. The prevalence of depression in the lowest-income group had the weakest improvement of 2·4% points compared with the other four groups. In the logistic regression model, being a part of the population with the lowest income level in 2015 was a significant risk factor for depression compared with the other income groups.Interpretation
The prevalence of depression in people aged 45 years and more in China is declining, but the issue of income-related inequality has been exacerbated. The lowest-income group is the main factor contributing to the inequality. Policy analysis pointed out that China's current policy on equalisation of public health services has not specifically mentioned the issue of mental health. However, under the requirement of the Healthy China strategy, the fairness of mental health deserves attention.Funding
None. 相似文献18.
Xiaona Liu Hong Fang Qinghua Xia Yingyao Chen Peng Zhou Yujie Yan Junling Gao Yu Jiang Baodong Yao Russell L Rothman Wang Hong Xu 《Lancet》2017
Background
Patients with diabetes in China have low health literacy, which likely leads to poor glycaemic control and clinical outcomes. This study was designed to evaluate the effectiveness of health literacy-focused and exercise-focused interventions on glycated haemoglobin A1c (HbA1c) in the population.Methods
In this cluster-randomised controlled trial conducted from Feb 20, 2015, through April 30, 2017, in Shanghai, China, 799 patients aged 18 years or older with type 2 diabetes from 40 clusters of general practitioner teams were randomised into three intervention arms or a control arm in blocks of eight clusters. The control group received usual care, the health literacy group was supplemented with individualised low literacy communications delivered by trained health-care providers using an interactive diabetes education toolkit, and the exercise group had usual diabetes care but was also asked to walk 3–5 times a week, 30–40 min per day in the first 6 months and 60–70 min per day in the following 6 months. Patients in the comprehensive intervention group were given both the literacy and exercise interventions. Assessments were conducted upon enrolment and after 3, 6, and 12 months of intervention. The study analysed improvement in HbA1c at 12 months as a primary outcome. Ethics approval was obtained from the Medical Ethics Committee of Fudan University (IRB00002408 & FWA00002399, approval no 2013-06-0451). All participants provided written informed consent. This trial is registered with the International Standard Randomized Controlled Trial Number Register (no ISRCTN76130594).Findings
Complete 12-month data were available for 761 (95%) patients, 192 in the control group, 188 in the health literacy group, 188 in the exercise group, and 193 in the comprehensive intervention group. Compared with the control group, the three intervention groups had decreased HbA1c levels and were more likely to achieve goal HbA1c levels (HbA1c ≤7·0%). After 3 months of intervention, the largest decrease was observed in the comprehensive intervention group, with an adjusted β of ?0·47% (95% CI ?0·73 to ?0·20), followed by the health literacy group (?0·35%, ?0·60 to ?0·10) and exercise group (?0·32%, ?0·57 to ?0·06). At the 6-month and 12-month assessments, the effect of the exercise intervention increased, with an adjusted β of ?0·73% (95% CI ?0·98 to ?0·47) and ?0·75% (?1·05 to ?0·45), respectively, while those for the health literacy group were ?0·35% (?0·61 to ?0·10) and ?0·65% (?0·94 to ?0·35), respectively. The decrease in HbA1c was more pronounced in patients with higher literacy or numeracy levels at baseline.Interpretation
Both health literacy-focused and exercise-focused interventions improved glycaemic control in Chinese patients with diabetes, particularly in patients with higher literacy or numeracy levels at baseline. Implementation of these approaches could be helpful at other public health clinics across China.Funding
China Medical Board (CMB) Open Competition Project (No. 13-159) and the Social Science Fund of China National Ministry of Education (No. 14YJAZH092). 相似文献19.
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