Use of home care services by elderly Chinese immigrants

Using the Anderson Service model, this study examined the level and predictors of using selected home care services by elderly Chinese immigrants in Canada. Data from 1,537 randomly selected Chinese immigrants aged 65 years and older were used. Only 5.2% of participants reported using home care services. Being older, living alone, having a post-secondary education, immigrating from Hong Kong or Southeast Asia, having a higher level of agreement with Chinese health beliefs, higher social support, and poorer physical and mental health were predictors for home care service use among elderly Chinese. The probability of using homecare services lessens with increased self-rated financial adequacy. These findings point to the need for service providers to address the gap in use of home care between elderly Chinese immigrants and overall elderly Canadians through promoting appropriate use of home care among elderly Chinese immigrants.     

Health Behaviors of Older Chinese Adults Living in New York City

The dramatic increase in the number of older immigrants living in the U.S. presents new challenges to policy makers concerned with promoting healthy aging. To date, however, strikingly little is known regarding the health and health trajectories of older immigrants. This paper examines the prevalence and predictors of important health behaviors associated with chronic disease prevention, including current smoking status, physical activity, alcohol use, and body mass index (BMI). We analyzed data from the 2003 New York City Chinese Health Survey (NYC CHS), the largest probability-based sample of Chinese immigrants residing in two distinct communities. In-person interviews were conducted with 517 representative men and women aged 55-75. Logistic regression modeling was used to test the influence of demographic, socioeconomic status, acculturation, and health characteristics on selected health behaviors. Results revealed that having more education and better physical health status were associated with greater participation in physical activity. Gender-specific analyses indicated that the effect of selected predictors varied between the sexes. For example, among older Chinese women, acculturation was negatively associated with alcohol use. This study provides some of the first evidence on health behaviors of one of the fastest growing older immigrant groups in the U.S. Study results add to the emerging literature on the complex nature of immigrant health trajectories, and demonstrate that contrary to prior research, living a greater proportion of time in the U.S. can be associated with selected positive health behaviors. Further longitudinal studies are needed to help inform policy initiatives to encourage healthy aging among diverse older immigrant groups.     

Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two‐staged research design was used. Stage 1 explored the participants’ experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty‐four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title ‘Bridge People’. Bridge People have different backgrounds: family and friends, public sector workers and staff from community‐based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.     

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50–75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81 % females, mean age = 62) included 67 % who spoke English poorly or not at all, 34 % who reported needing a medical interpreter, and 37 % who reported “often” or “always” needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74 %) and language-concordant (86 %) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants.     

The Social Meanings of Traditional Chinese Medicine: Elderly Chinese Immigrants’ Health Practice in the United States

We situate elderly Chinese immigrants' utilization of traditional Chinese medicine (TCM) in social contexts (e.g., family and social networks), exploring how TCM is used as a tool, a resource, and a product of meaning-construction in their everyday life. We conducted in in-depth interviews with 20 elderly Chinese immigrants in the United State, exploring the complexity of their understanding and practice of TCM. We used grounded theory to identify the set of meanings that are particular to elderly Chinese immigrants' use of TCM as a part of their health practice. For our participants, TCM is not just a resource for illness management. Instead, incorporating TCM in their health practice allows them to: (a) perform and reaffirm their cultural identity as Chinese, (b) maintain their moral status and fulfill their social roles, and (c) pass down health knowledge and cultural heritage. Clinical implications were discussed.     

Predictors of health service barriers for older Chinese immigrants in Canada

Elderly people from ethnic minority groups often experience different barriers in accessing health services. Earlier studies on access usually focused on types and frequency but failed to address the predictors of service barriers.This study examined access barriers to health services faced by older Chinese immigrants in Canada. Factor analysis results indicated that service barriers were related to administrative problems in delivery, cultural incompatibility, personal attitudes, and circumstantial challenges. Stepwise multiple regression showed that predictors of barriers include female gender, being single, being an immigrant from Hong Kong, shorter length of residency in Canada, less adequate financial status, not having someone to trust and confide in, stronger identification with Chinese health beliefs, and not self-identified as Canadian. Social work interventions should strengthen support and resources for the vulnerable groups identified in the findings. Service providers should adjust service delivery to better serve elderly immigrants who still maintain strong Chinese cultural values and beliefs.     

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants’ health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N = 3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health‐related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β = 0.065, p < 0.05) and were marginally more likely to use inpatient services (OR = 1.15, CI: 0.88–1.04, p = 0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR = 0.68, CI: 0.46–0.99, p < 0.05). The findings showed that family relations play a role in Chinese older immigrants’ health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations.     

武汉市社区卫生服务中心中医药服务现状调查

目的 调查武汉市社区卫生服务中心中医药服务现状。方法 于2021年3月对武汉市10个城区28家社区卫生服务中心的28名管理者、211名中医药从业人员以及481名社区就诊居民进行问卷调查。采用Excel 2013软件统计分析数据。结果 28家社区卫生服务中心2021年度中医就诊人次仅占总就诊人次的11.18%,均开设了中医药相关科室,中医治疗设备基本配备,但中医药服务项目较单一,仅围绕老年人群的保健项目开展率较高;均不同程度开展了中医慢病管理项目,但仅糖尿病(消渴病)、高血压(眩晕病)开展率为100%,其他慢病管理项目开展率均≤50%。28家社区卫生服务中心中医药从业人员以大专学历、初级职称为主,且有8.1%无职称人员。社区居民对中医药服务需求较高,但了解程度较低。结论 应以加强中医药慢病管理为切入点拓宽中医药服务范围,加强社区中医药人才培养和队伍建设,加大中医药宣传力度,创新中医药服务模式,加强监督与考核。     

Use frequency of traditional Chinese medicine in Taiwan

Background

Use of Traditional Chinese medicine (TCM), an important category of complementary and alternative medicine (CAM), has increased substantially in Western countries during the past decade. Use of TCM is also widespread in the Chinese population. However, few informative data have been obtained to date by large-scale investigations of TCM use in the Chinese population. This study was aimed at elucidating the demographics and patterns of TCM use in Taiwan.

Methods

We employed the complete datasets of TCM outpatient reimbursement claims from 1996 to 2001, including the use of Chinese herbal remedies, acupuncture and traumatology manipulative therapy, to analyse use frequencies, the characteristics of TCM users, and the disease categories that were treated by TCM in Taiwan.

Results

At the end of 2001, 6,142,829 (28.4%) among the 21,653,555 valid beneficiaries of the National Health Insurance in Taiwan had used TCM during the year. However, 13,536,266 subjects (62.5%) had used TCM at least once during the whole 6-year period from 1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The mean number of TCM users per annum was 5,733,602, with a mean increment of 1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher than male (female:male = 1.13:1), and the age distribution displayed a peak at around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%) were the most common TCM modality used by this population, followed by acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private TCM clinics provided most of the TCM care (82.6%), followed by private TCM hospitals (12.0%). The top ten major disease categories for TCM visits were diseases of the respiratory system, musculoskeletal system and connective tissue; symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the digestive system, genitourinary system, skin and subcutaneous tissue, nervous system and sense organs, circulatory and endocrine system; nutritional and metabolic diseases; and immunological disorders.

Conclusion

TCM was popular among the Chinese population in Taiwan during the period studied. More than 60% of all subjects had used TCM during the 6-year interval. TCM was widely used by the Chinese population to treat problems and diseases of major human organ systems recognised by western medicine. This study provides information about the use frequencies of TCM and the disease categories treated by TCM, which should be useful for health policy makers and for those considering the integration of TCM and Western medicine.     

Exploring the Determinants of Food Choice in Chinese Mainlanders and Chinese Immigrants: A Systematic Review

Determinants of food choice in Chinese populations have not been systematically synthesised using a cultural lens. This study reviewed qualitative studies exploring food choice determinants of both Chinese mainlanders and Chinese immigrants living in Western countries. Ovid Medline, CINAHL Plus, Web of Science, ProQuest, and China National Knowledge Infrastructure database (CNKI) were searched from database inception to 1 April 2021. Studies were included if they involved qualitative research methods, were written in English or Chinese, investigated the factors influencing food choices, and targeted Chinese mainlanders or Chinese immigrants living in Western countries. Twenty-five studies (24 in English, 1 in Chinese) were included, involving 2048 participants. Four themes were identified; (1) the principles of traditional Chinese medicine (TCM), (2) perceptions of a healthy diet in Chinese culture (e.g., regular eating, eating in moderation, and emphasis on food freshness), (3) the desire to maintain harmony in families/communities, and (4) physical/social environmental factors all significantly influenced Chinese people’s food choices. It is important to acknowledge these factors when developing culturally appropriate nutrition programs for promoting health in Chinese mainlanders and Chinese immigrants.     

医学院校学生的中医药健康文化素养水平及影响因素分析

目的 了解某医学院校学生的中医药健康文化素养水平并探索其影响因素,为有针对性地提升医学生中医药健康文化素养水平提供参考依据.方法 采取分层整群抽样方法 ,对某医科大学的2600名学生采用《2017年中国公民中医药健康文化素养调查问卷》进行问卷调查,并采用Logistic回归模型探讨影响医学生中医药健康文化素养水平的因素...     

Medicinal herb use in a population-based survey of adults: prevalence and frequency of use, reasons for use, and use among their children

PURPOSE: There is sparse population-based data on health factors related to medicinal herb use and use of medicinal herbs in children. For a sample of American adults, we estimated the prevalence and frequency of medicinal herb use, factors related to use, reasons for use, patient-physician discussion, and the proportion of respondents who gave herbs to their children. METHODS: The data used in this study was from the 2001 North Carolina Behavioral Risk Factor Surveillance System, a population-based telephone survey of English-speaking adults (n = 2982). RESULTS: Approximately 20% of respondents reported using medicinal herbs in the past year. Of these, 34% reported discussion of herb use with a physician; 69% reported taking herbs to maintain health, 20% to prevent illness, and 11% to treat illness. Of the total sample, 7% reported using herbs everyday and 5% of the respondents reported giving their children herbal medicines in the past year. CONCLUSIONS: Medicinal herb use is common in this population sample. The lack of discussion between users and their physicians highlights the importance of patient-physician communication to avoid possible herb-drug interactions and surgical complications. Herb use appears to be a popular strategy for maintaining health. Children may be vulnerable to herbal toxicity and therefore clinicians need to know about their medicinal herb use and counsel appropriately.     

老年人中医体质及体质指数与高血压的关系

目的 探讨60岁及以上老年人中医体质及体质指数(body mass index,BMI)与高血压之间的关系。 方法 整群抽样的方法抽取2018年1—6月在某社区卫生服务中心建档管理的60岁及以上老年人,用标准中医体质判定量表进行中医体质测评,测量身高体重计算BMI,同时收集调查对象的基本信息,采用描述性统计、χ²检验和多因素logistic回归等进行分析研究。 结果 共纳入2 757名调查对象,平均年龄(72.21±7.41)岁,男性占 45.77%,高血压患病率为59.09%。单因素分析显示,年龄、吸烟、饮酒、锻炼、 BMI及中医体质均为高血压的影响因素。随着年龄增大,高血压患病率有升高趋势(χ²=23.36,P＜0.001);BMI越大,高血压的患病率越高(χ²=58.62,P＜0.001);不同中医体质的人群高血压患病率有差异(P＜0.001),其中痰湿质(70.45%)、阳虚质(65.38%)和阴虚质(64.64%)人群的高血压患病率位列前三。多因素logistic回归示,年龄越大患高血压的危险越大,80岁～人群高血压患病率高于60岁～人群(OR=1.88,95%CI:1.48～2.38);超重(OR=1.41,95%CI:1.17～1.69)、肥胖(OR=1.59,95%CI:1.17～2.16)、痰湿质(OR=1.77,95%CI:1.45～2.16)、阳虚质(OR=1.60,95%CI:1.12～2.29)、阴虚质(OR=1.50,1.08～2.09)是高血压的危险因素。 结论 BMI升高是高血压的危险因素,痰湿质、阳虚质、阴虚质是高血压的易发体质,应针对此类体质的老年人开展针对性的健康宣教。     

Development and Validation of a Nomogram to Predict Frailty Progression in Nonfrail Chinese Community-Living Older Adults

ObjectiveFrailty state progression is common among older adults, so it is necessary to identify predictors to implement individualized interventions. We aimed to develop and validate a nomogram to predict frailty progression in community-living older adults.DesignProspective cohort study.Setting and ParticipantsA total of 3170 Chinese community-living people aged ≥60 years were randomly assigned to a training set or validation set at a ratio of 6:4.MethodsCandidate predictors (demographic, lifestyle, and medical characteristics) were used to predict frailty state progression as measured with the Fried frailty phenotype at a 4-year follow-up, and multivariate logistic regression analysis was conducted to develop a nomogram, which was validated internally with 1000 bootstrap resamples and externally with the use of a validation set. The C index and calibration plot were used to assess discrimination and calibration of the nomogram, respectively.ResultsAfter a follow-up period of 4 years, 64.1% (917/1430) of the participants in the robust group and 26.0% (453/1740) in the prefrail group experienced frailty progression, which included 9.1% and 21.0%, respectively, who progressed to frailty. Predictors in the final nomogram were age, marital status, physical exercise, baseline frailty state, and diabetes. Based on this nomogram, an online calculator was also developed for easy use. The discriminative ability was good in the training set (C index = 0.861) and was validated using both the internal bootstrap method (C index = 0.861) and an external validation set (C index = 0.853). The calibration plots showed good agreement in both the training and validation sets.Conclusions and ImplicationsAn easy-to-use nomogram was developed with good apparent performance using 5 readily available variables to help physicians and public health practitioners to identify older adults at high risk for frailty progression and implement medical interventions.     

基于中医总费用核算的北京市中医药服务能力发展状况研究

目的:分析北京市机构法中医总费用的总量、发展及结构等,研究北京市中医药服务能力的发展状况.方法:运用机构法中医总费用、机构法卫生总费用核算方法.结果:北京市中医医疗服务能力整体快于卫生服务的发展;中医药资源在机构间流向逐步优化;中医类医院提供了更多的中医药服务,非中医类医院中医资源发展缓慢;城郊中医药资源差异逐步减小;北京市对中医服务的利用整体优于全国.结论:深化中医医疗服务价格改革,平衡各方利益;引导中医优质资源下沉,使中医药费用继续向基层流动;加强非中医类医院中医科的建设发展;完善郊区中医资源配置,缩小城郊医院中医服务差距;引导社会资本进入中医医疗服务行业,形成多元化办医局面.     

Factors associated with the use of publicly funded services by Hong Kong Chinese older adults

This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. We examined whether the use of publicly funded health services by older adults is equitable under the framework of Andersen model. A number of predisposing, enabling, and need factors were assessed as predictors of utilization in four categories of services including hospital admission, emergency room, general outpatient clinics, and specialist outpatient clinics. It was found that utilization of these four health services was consistently correlated with need factors. Specifically, self-rated health status and particular types of chronic illness were consistently and significantly related to utilization for all four of services in Hong Kong. On the other hand, age and family support were related to hospital admission whereas functional impairment was associated with the use of emergency room and general outpatient clinics. Findings suggest that publicly funded health services in Hong Kong are used equitably by elderly people.     

2018年全国中药饮片抽验情况分析及治理对策

目的:提高我国中药饮片质量。方法:通过对2018年国家药品监督管理局中药品种抽检不合格报告的文献收集,整理汇总出其中抽检不合格的中药饮片品种及超标指标,寻找影响中药饮片质量的原因。结果:不合格中药饮片涉及的品种多、范围广,以农药残留、黄曲霉毒素、二氧化硫残留超标为代表的不合格尤显突出。结论:中药饮片的治理是一项系统工程,只有多管齐下,建立对中药产业链全环节的安全监管措施,才能保障处于产业链中游的中药饮片环节的安全,促进中药饮片产业健康发展。     

Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese

OBJECTIVE: To explore the attitudes of Hong Kong Chinese towards the strengths and weaknesses of traditional Chinese medicine (TCM) and Western medicine. DESIGN: Qualitative study of subjects' opinions using semi-structured focus group interviews. SETTING: Southern district of Hong Kong Island where many of the residents have a fisherman background. PARTICIPANTS: Twenty nine participants took part in eight focus group interviews. MEASUREMENTS AND MAIN RESULTS: Participants' attitudes towards TCM and Western medicine were explored in the interviews. Both TCM and Western medicine are used concurrently by many people in Hong Kong. Patients make decisions on which type of doctors they want to see for the specific illnesses that they are suffering from. They consider both types of medicines to have strengths and weaknesses: TCM being better in curing the root of the problem but quite slow in action while Western medicine is more powerful but sometimes too powerful with significant side effects. CONCLUSIONS: It is important for medical practitioners to be aware of the health attitudes of their patients from different ethnic backgrounds. It will lead to a better patient-doctor relationship and better compliance of treatment.