Medical education and health care in China and the USA: a follow-up study of a 4 year cardiovascular visiting programme between Peking University and the University of Minnesota

Background

China has witnessed a fast-developing social system in the past decades; meanwhile, its medical education and health-care system still face many challenges. A growing number of exchange programmes are being established to promote mutual awareness of medical education and health-care systems. The cardiovascular visiting programme between Peking University and University of Minnesota was established in 2013. The aim of this study was to investigate participating Chinese students' opinion about differences in medical education and health care between China and the USA.

Contemporary Chinese centenarians: Health profiles,social support and relationships in Suixi County

BackgroundCentenarians are the fastest growing population worldwide. However, this group has been less studied in developing countries. Contemporary centenarians in China have experienced many ups and downs due to historical reasons, which may have resulted in a population with different characteristics from those in other countries. This study aimed to investigate the current sociodemographic characteristics, health profiles, and social relationships of Chinese centenarians.MethodsWe conducted face-to-face surveys in April 2017 with centenarian residents in Suixi County, the first “International Healthy Longevity Area” in China. A total of 100 centenarians were involved, including 67 females and 33 males. Information for socioeconomic and demographics characteristics, quality of life (physical, cognitive, and psychological function), and social support and relationships was collected. Sex differences in each measure were examined.ResultsWe find that good self-reported health, good life satisfaction, intact memory function, independence, and unsatisfied healthcare needs were reported by 24.4%, 45.9%, 31.6%, 46.3%, and 33.4% of the respondents respectively. Subjective symptoms among males were less prevalent (p < 0.05). There were no statistical significant sex differences in cognitive and psychological function. The major source of care provision has been family. Generally, the centenarians had intimate relationships within families but maintained distant relationships with friends and communities.ConclusionOur results bring attention to family-based care to provide informal care, and health education to promote healthy behaviors and healthcare utilization, for the oldest-old in China. The findings also imply a crucial role of good relationships with family in exceptional longevity.     

Effects of Social Exclusion on Depressive Symptoms: Elderly Chinese Living Alone in Shanghai,China

Research has identified social exclusion as one of the social determinants of health. There are risks of social exclusion in later life in recent years. However, despite the fact that China has the largest aging population in the world and reports a rapid growth in the proportion of older people living alone, research on the role of social exclusion on depression is limited. This study examined the effects of social exclusion on depressive symptoms in older Chinese who are living alone in China, based on the data from one Shanghai neighbourhood. The data used were obtained between August and October 2008 through face-to-face interviews, using a structured survey questionnaire, from a simple random sample of 228 Chinese 60 and older living alone in a Shanghai community. Depressive symptoms were measured by a 15-item Chinese version Geriatric Depression Scale. Social exclusion was represented by income adequacy, social relations, civic participation, and housing condition. Over 30% of participants reported symptoms of a mild or above mild level of depression. When controlled for the demographics and health variables in hierarchical multiple regression, social exclusion variables, represented by a lower level income adequacy, a less favourable housing condition, and feeling more lonely correlated significantly with more depressive symptoms. Contrary to previous studies on depression in the older adults in China, this study has obtained findings indicating that social exclusion variables are more important than other socio-demographic factors in the context of contemporary China. While two significant social exclusion variables (i.e. income and housing) are related to structural changes in the economic context in China, the intra-personal role of feeling lonely that ties strongly living alone and role of older adults in an increasingly competitive market economy should not be underestimated. To address depression and mental health of older Chinese who live alone, social policies and programs to reduce various forms of social exclusion should be developed. In additional to providing assistance in financial support and housing improvement, services to strengthen the social networks and social relations of these older people are essential.     

Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China

Fuelled by rapid urbanization and changes in dietary and lifestyle choices, chronic diseases have emerged as a critical public health issue in China. The Healthy China 2020 programme recently announced by the Chinese government has set an overarching goal of promoting public health and making health care accessible and affordable for all Chinese citizens by year 2020. One of important components of the programme is to reduce chronic diseases by promoting healthy eating and active lifestyles. Chronic diseases not only affect health and quality of life, but also have economical and social consequences. With a limited infrastructure for chronic disease care, China is ill‐equipped to deal with the escalating chronic disease epidemic, which threatens to reverse the gains of economic development in recent decades. Population‐based intervention studies conducted in China and elsewhere have demonstrated the efficacy and effectiveness of several preventive strategies to reduce risk of chronic diseases in high‐risk individuals and the general population. However, translating these findings into practice requires changes in health systems and public policies. To achieve the goals set by the Healthy China 2020 programme, prevention of chronic diseases should be elevated to a national public policy priority.     

Social participation in health. An experience in Simojovel, Chiapas]

One of the basic foundations for the operation of health programs is the social participation of the population in actions going from planning to evaluation, promotion and control of actions related with their own health. In the work, we present the results of a preliminary and partial evaluation of an ongoing autopromoting health project in the communities of Lázaro Cárdenas and Las Limas, in the Municipality of Simojovel, Chiapas, México. The basic goal of this work is to identify factors derived from the relations of localities with the State and, on the other hand, from socioeconomic conditions of the populations, which favor or hinder the development of social participation in their own health projects. This is a comparative study, type before and after, within and between localities, intended to measure the effect of a health program with community participation in two communities having divergent relations with the State. For this, we carried out a socioeconomic and prevalent morbidity survey before and after the implementation of social participation in health actions. We also characterized social participation in health actions and identified the type of State intervention in the localities through governmental programs and institutions. The results convey the notion that the health program contributes to enhance hygienic sanitary conditions of the population and decrease the frequency of such ailments as diarrhea and parasitic diseases; social participation is more active in Lázaro Cárdenas than in Las Limas. State interventions in the communities are given through social programs and institutions in a mandatory way, with no opportunity for community participation in decision-making. The conclusion is that the demographic organization of the community and autopromotion favor the participation in health actions, while the presence of the State through political repression and actions delivered through social programs promote dependence and paternalism, hindering the ample social participation in actions for health.     

State-level spending on health care and social services for people living with HIV/AIDS in the USA: a systematic review

Every year for the past decade, approximately 50,000 people have been diagnosed with HIV or AIDS in the USA, and the incidence of HIV/AIDS varies considerably from state to state. Studies have shown that health care services, most notably treatment with combination antiretroviral therapy, can help people living with HIV/AIDS (PLWHA) live healthier, longer lives, and prevent the spread of HIV from person to person. In addition, social services, such as housing support and provision of meals, have also shown to be important for helping PLWHA adhere to antiretroviral treatment and maintain contact with health care providers for improved health outcomes. Although spending on health care and social services for PLWHA varies across the USA, the relationship between state-level spending on these services and HIV/AIDS-related outcomes is not clear. We therefore conducted a systematic review of peer-reviewed literature to identify studies that explore state-level spending on health care services and/or social services for PLWHA and HIV/AIDS-related health outcomes in the USA.     

Improving on success: what treating the urban poor in America can teach us about improving antiretroviral programmes in Africa

Current treatment approaches cannot predict, ensure, or sustain the needed adherence required to achieve long-term successful therapy in many of our urban poor patients. The current treatment paradigm in the United States thus relies heavily on sequential therapy to maintain patient health. This approach is often unsuccessful in achieving viral durable suppression, increases the complexities of care, increases the costs of care, and can fail to improve patients' health. As the HIV epidemic shifts into the urban poor in the USA, the success of the current antiretroviral therapy approach to achieve durable viral suppression in this population remains under question. New treatment delivery programmes designed to address these concerns for the urban poor in the USA may represent models that can achieve high levels of treatment success in resource-limited countries.     

Social Disorder in Adults with Type 2 Diabetes: Building on Race,Place, and Poverty

The recent resurgence of social and civic disquiet in the USA has contributed to increasing recognition that social conditions are meaningfully connected to disease and death. As a “lifestyle disease,” control of diabetes requires modifications to daily activities, including healthy dietary practices, regular physical activity, and adherence to treatment regimens. One’s ability to develop the healthy practices necessary to prevent or control type 2 diabetes may be influenced by a context of social disorder, the disruptive social and economic conditions that influence daily activity and, consequently, health status. In this paper, we report on our narrative review of the literature that explores the associations between social disorder and diabetes-related health outcomes within vulnerable communities. We also propose a multilevel ecosocial model for conceptualizing social disorder, specifically focusing on its role in racial disparities and its pathways to mediating diabetes outcomes.     

The demographic components of population aging in China

Past trends in fertility and mortality in China have led to an age composition that will age rapidly in the coming decades. In this paper we examine measures of population aging in China from 1953 to 1982, and then project population aging to the year 2050 using a cohort-components methodology. The projected measures of population aging that result from these forecasts are then decomposed into the relative contributions that are made to these changes by past, present, and future trends in fertility and mortality. Results indicate that China's population will age at an unprecedented rate over the next 70 years, both in terms of the absolute size of the elderly population and their proportion of the total population. At least 50 percent of the projected increase in population aging in China between 1980 and 2050 will be a product of the momentum for aging that is already built into the present age structure and vital rates. However, prospective trends in the measures of population aging become increasingly more sensitive to varying assumptions about fertility and mortality with time, and as older age groups are considered. This analysis provides the demographic basis for evaluating the possible effects of population aging on health care, social security, and other social and economic issues.     

Older Women,Marital Relationships,and Sexuality in China

Based upon field research conducted in China in the 1990s and 2000s, this article examines older Chinese women’s views and practices surrounding sexual interaction in later life. In contrast to local clinical depictions of middle-aged and elderly Chinese women as repressed by feudal superstitions concerning sex in later life, this research shows that more middle-aged and elderly Chinese women are sexually active than such clinical sources assume. Furthermore, there is no neat correspondence between sexual attitudes and sexual activity, and Chinese women’s attitudes concerning later life sex are often much more liberal than their behavior. Absence of sexual activity among older Chinese women is more closely related to problems in the marital relationship in general and/or to health problems than it is to attitudes about age and sex. At the same time, many Chinese women challenge the claims of western sexology that presume the marital relationship and sexual interaction to be a top necessity for a good quality of life in the later years. These findings have important implications for public health education, clinical training, and health and social service delivery in China.     

Health, Ageing and Social Differentials: A Case Study of Soweto, South Africa

This article analyses the relationship between health of people over sixty and a range of social differentials in a specific social context of a relatively deprived community in South Africa. Basic measures of social inequality as well as more sophisticated indicators of social relationships and access to social resources and how they are linked to peoples' perception of their own health are explored. The paper is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997 by a team of researchers based mainly in the Department of Sociology at the University of the Witwatersrand, Johannesburg. The results present an interesting scenario, which, while reaffirming the already established connection between social differentials, social ties and health, also sheds light on a different social context and specific relationships with regard to health.     

2014—2015年我国新发传染病临床诊治与相关研究进展

新发传染病具有疫情发生突然、传播速度快、人群易感率高等特点,对人类身体健康和社会生产生活秩序造成较大影响.国家近年来在公共卫生领域的建设投入初见成效,2014—2015 年我国境内发生的新发传染病中,人感染禽流感和手足口病等总体得到较好控制,中东呼吸综合征和埃博拉病毒病等境外疫情构成了潜在威胁.本文对近 2 年我国新发传染病的诊断、治疗、预防和基础研究进展进行综述.     

Network support,technology use,depression, and ART adherence among HIV-positive MSM of color

Depression is associated with poor antiretroviral therapy (ART) adherence among people living with HIV/AIDS. This relationship may be moderated by an individual’s social network characteristics. Our study sought to examine social network correlates of treatment adherence among HIV-positive men recruited from social service agencies throughout Los Angeles County (N?=?150) to inform technology-driven social support interventions for this population. We administered egocentric social network and computer-assisted survey interviews focused on demographic characteristics, health history, depressive symptoms, and ART adherence, where adherence was assessed by the number of reasons participants missed taking their medication, if ever. Significant univariate correlates of adherence were included in a multivariable regression analysis, where the moderating effect of having a network member who reminds participants to take their HIV medication on the relationship between depression and adherence was tested. Over 60% of participants reported clinically significant depressive symptoms; this was significantly associated with lower adherence among those without someone in their social network to remind them about taking their HIV medication, even after adjusting for covariates in an ordinary least squares regression (adjusted mean difference b?=??1.61, SE?=?0.42, p?=?0.0003). Having a network member who reminds participants to take their ART medication significantly ameliorated the negative association between depression and treatment adherence, especially for those reporting greater depressive symptoms (p?=?0.0394). Additionally, participants demonstrated high rates of technology use to communicate with social network members. In order to achieve the aims of the National HIV/AIDS Strategy, innovative interventions addressing mental health to improve ART adherence are needed. Network strategies that leverage technology may be helpful for improving ART adherence among HIV-positive men with comorbid depressive symptoms.     

The weight of US residence among immigrants: a systematic review

As the number of immigrants in the USA continues to rise, it becomes increasingly important to understand how their health differs from native‐born individuals. Obesity is a public health concern and a component of health that may differ and change in important ways in immigrants. This research synthesizes the current literature on the relationship between immigrant duration of residence in the USA and body weight. Five databases from the health and social sciences were searched for all pertinent publications. Fifteen articles met inclusion criteria, 14 of which reported a significant, positive relationship between body mass index and duration of residence in the USA (all P‐values <0.10). Two studies reported a threshold effect of weight gain after 10 years of US residence, and another study reported that body mass index peaks after 21 years of duration for men and after 15 years for women. The results of this review suggest that weight gain prevention programmes would be beneficial for many immigrants within the first decade of residence in the USA. Prevention efforts may be more successful if nativity and acculturation are considered in addition to race/ethnicity. Future research is needed to identify the specific mechanisms through which living in the USA may adversely affect health outcomes.     

Restorative integral support (RIS) for older adults experiencing co-occurring disorders

The restorative integral support (RIS) model is a whole person response that assists people to overcome adversity. The adverse childhood experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems. Older adults experiencing co-occurring disorders are an under-served and vulnerable population where gaps in both practice models and research to inform effective service provision exist. The current empirical case study presents Senior Hope as one social service agency employing RIS to intervene on the linkage between ACEs and co-occurring disorders to assist older adults. RIS usefully articulates the way in which Senior Hope is developing ACE-informed programs that mobilize resilience and recovery to help older adults achieve positive mental health outcomes. Implementation and research on the RIS model is recommended to enhance services for groups with ACE characteristics.     

Japanese universal health coverage: evolution, achievements, and challenges

Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to finance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times difference in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitable coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans.     

Can equitable distribution of health resources reduce under-five mortality rate? A cross-sectional study with multilevel analysis of rural counties in China

Background

In addition to the quantity of health resources, the equitable allocation of health resources may be another factor that improves the overall health outcomes within a population. The under-five mortality rate (U5MR) is a crucial indicator that reflects the health status of a population. We aimed to explore the association between inequality of health resource distribution and U5MR in rural China.

Societal Biases,Institutional Discrimination,and Trends in Opioid Use in the USA

History has demonstrated cyclical trends in opioid use in the USA, alternating between high rates of prescribing driven by compassion and marketing and restrictive prescribing driven by stigma and fear of precipitating addiction and other harms. Two under-recognized yet powerful forces driving these trends are societal biases against individuals who use and are addicted to drugs, as well as a recognized social determinant of health, institutional discrimination. In the context of these influential forces, which are often based on racist and classist ideologies, we examine the history of opioid use in the USA from the 1800s when the vast majority of those addicted to opioids were middle- to upper-class women to the present-day white-washed narrative of the opioid crisis. As the demographics of those affected by opioid use and addiction has started to shift from white communities to communities of color, we cannot allow the preliminary success observed in white communities to obscure rising mortality rates from opioids in black and Latinx communities. To do so, we highlight ways to prevent racist and classist ideologies from further shaping responses towards opioid use. It is important to acknowledge the long history that has influenced responses to opioid use in the USA and take active steps towards promoting a sense of compassion towards all individuals who use and those who are addicted to drugs.     

The Heart of New Ulm: A Vision for the Future

Coronary artery disease (CAD) continues to be a leading cause of death in the USA and throughout the world. Allina Health System, with the Minneapolis Heart Institute at Abbott Northwestern, recently announced a long-term study in the city of New Ulm, MN, to reduce risk factors for myocardial infarction and, ultimately, reduce myocardial infarction incidence. To achieve this goal, the focus will be on health promotion interventions and primary and secondary prevention strategies for CAD that are innovative, community-wide, and able to impact individuals at home, at work, in their community, and in their health care settings. Factors considered in selecting this city included the identification of health as a priority by the community, readiness and willingness of the community to change, the ability to provide and deliver systematic care, and partnerships established across multiple disciplines and sectors centered on improved health. The following stakeholders will be engaged: the community, employers, public health, health care, and health plans. Unique aspects of the intervention include centralized healthcare, including an automated medical record; genetic testing; integrated behavioral interventions; social environmental change and social circumstances; health promotion, primary prevention and secondary prevention interventions; advanced diagnostics and imaging; and state-of-the-art therapy.