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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3.
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Yaojiang Shi Hongmei Yi Huan Zhou Chengchao Zhou Hao Xue Scott Rozelle Alexis Medina Sean Sylvia 《Lancet》2017
Background
The quality of primary care is central to China's ongoing health system reforms. Although there is ample evidence on investments in health system infrastructure, little objective evidence is available on the quality of care delivered to patients, particularly by rural grassroots providers. The aim of this study was to assess the ability of rural primary care providers to diagnose and treat two common diseases.Methods
We deployed unannounced standardised patients (SPs) in a representative survey of village and township level primary care providers located in three prefectures in Sichuan, Shaanxi, and Anhui provinces. One case presented symptoms of unstable angina and another described symptoms of his or her child with diarrhoea. Physician performance in interactions with SPs was assessed against international and national standards of care yielding quality measures for clinical process (adherence to checklists of recommended questions and exams) and treatment. We used regression analysis to assess correlates of quality. We obtained approvals from the institutional review boards of Stanford University, CA, USA (FWA00000935) and Sichuan University (K2015025), China. Informed consent was obtained verbally from all providers participating in the study. All individuals who participated as SPs were trained to protect themselves from any invasive tests or procedures.Findings
We successfully completed 293 standardised patient interactions in July 2015. On average, interactions lasted 9·57 min. Providers completed 20% (95% CI 17–23) of recommended checklist items in village clinics and 25% (23–27) in township health-care centres. Only three (9%, 2–24) of 33 of village doctors and 15 (14%, 8–23) of 104 township doctors correctly treated the diarrhoea case according to national standards. In treating angina, 36 (67%, 53–79) of 54 village doctors and 60 (59%, 49–68) of 102 township doctors correctly referred patients. Doctor education, but not the value of facility infrastructure or equipment, was predictive of quality of care.Interpretation
We found evidence of low-quality health-care provided by grassroots providers in China's rural health system. Investments in facility infrastructure poorly proxy the quality of care. Policies to improve the quality of primary care among grassroots providers should be prioritised in current reforms.Funding
111 Project (B16031), the World Bank's Knowledge for Change Program (7172469), the Fundamental Research Funds for the Central Universities and the Research Funds of Renmin University of China (2015030245). 相似文献5.
Background
Chinese children left behind in rural areas while their parents seek work elsewhere experience a lack of parental monitoring and companionship, resulting in higher prevalence of health-risk behaviours. This study aimed to investigate the heterogeneity of health-risk behaviours among rural left-behind children in western China, and the associations between demographic characteristics and health-risk subgroups.Methods
In this cross-sectional survey study, rural left-behind children (those who had not seen their parents for >6 months) from middle schools (aged 10–17 years) in Sichuan province, selected using a stratified cluster sampling method, were surveyed between November and December, 2015. Participants were given a self-administered questionnaire, which measured eight health-risk behaviours (unhealthy diet, tobacco use, binge drinking, accidental injury, physical inactivity, self-injurious behaviour, unhealthy internet use, and suicidal thoughts), demographics, household characteristics, their parents' relationship status, and their economic status. Latent class analysis (LCA) was used to identify subgroups of rural left-behind children with distinct patterns of health-risk behaviours. Differences between health-risk subgroups in relation to demographic characteristics were examined using multinomial logistic regression analysis. Informed consent was obtained from children and parents, and ethics approval from the Medical Ethical Committee of Sichuan University, China (number 20140307).Findings
1596 rural left-behind children completed the questionnaire (mean age 14·7 years [SD 1·44]; 712 [45%] boys). Four classes were obtained from LCA: high risk (69 [4%] of 1596), high risk of self-injury and suicidal thoughts (321 [20%]), moderate risk (479 [30%]), and low risk (727 [46%]). The multinomial logistic regression model revealed that, compared with the low-risk group, boys (odds ratio [OR] 2·22, 95% CI 1·32–3·74), and children whose parents' relationship was poor (OR 4·49, 2·48–9·73) were more likely to be classified as high risk. Children whose parents' relationship was poor (OR 2·98, 1·93–4·62) and those with high living expenses (OR 2·03, 1·18–3·51) were more likely to have a high risk of self-injury and suicidal thoughts than be at a low risk.Interpretation
Our study is, to our knowledge, the first in-depth analysis of health-risk behaviours in left-behind children in rural western China. The clusters of heterogeneous health-risk behaviours in rural left-behind children are likely to require different tailored interventions. Particular attention should be paid to left-behind boys who have higher living expenses and those whose parents have a poor relationship when designing preventive group interventions.Funding
National Natural Science Foundation of China (81472994, 30972546). 相似文献6.
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7.
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8.
Background
The disparity in maternal and child health is a global issue. This study aimed to examine how much disparity in maternal and infant mortality exists between ethnic minority and non-minority counties in Sichuan province, and to examine the health-system determinants of this disparity.Methods
In this cross-sectional observational study, we obtained data for maternal mortality and infant mortality, and health system data on health-related human resources, institutions, and services, for 67 minority counties (based on an official classification that considered size of the minority population, number of townships with a high concentration of minority residence, and a history of minority residency) and 116 non-minority counties in Sichuan province for the years of 2002, 2006, 2010, and 2014. Data on maternal health-care service indicators were obtained from the Sichuan Maternal and Child Health Hospital; data on health human resources and health infrastructure were obtained from the Sichuan Health and Family Planning Statistic Information Centre; and data on socioeconomic and demographic characteristics were taken from the Sichuan Statistical Yearbook. A series of two-level Poisson regression models with different health system factors were fitted to identify the contributions of each factor to the inequality in maternal and infant mortality.Findings
Maternal mortality decreased in Sichuan province between 2002 and 2014 (from 65·4 deaths per 100?000 livebirths in 2002 to 18·6 deaths per 100?000 livebirths in 2014), as did infant mortality (from 19·2 to 5·1 deaths per 1000 livebirths), and the disparity in maternal mortality between minority and non-minority counties decreased (difference of 36·2 deaths per 100?000 livebirths in 2002, to 21·4 deaths per 100?000 livebirths in 2014), as did the disparity in infant mortality (from a difference of 12·21 to a difference of 2·37 deaths per 1000 livebirths). Between 2002 and 2014, health system indicators improved in minority counties and non-minority counties (eg, the proportion of hospital deliveries increased from 38% to 86% and from 78% to >99%, respectively). Lower maternal and infant mortality were associated with better socioeconomic conditions (maternal p=0·013; infant p=0·0005), more health-related human resources (maternal p=0·048; infant p=0·0002), and a higher proportion of maternal health-care services (maternal p<0·0001; infant p=0·006). Shorter travelling time to the nearest hospital was associated with lower infant mortality (p=0·006), but not lower maternal mortality (p=0·32). The proportion of deliveries in hospital explained 74·5% (95% CI 56·2–100) of the difference in maternal mortality between minority and non-minority counties. Hospital delivery and mean travelling time to the nearest hospital together explained 62·6% (95% CI 41·3–85·6) of the difference in infant mortality between minority and non-minority counties.Interpretation
Increasing the proportion of hospital deliveries in ethnic minority counties might narrow the disparity in maternal mortality by more than two-thirds. Similarly, increasing the proportion of hospital deliveries and the accessibility of health services in ethnic minority counties might further narrow the disparity in infant mortality by more than half the current level.Funding
China Medical Board (grant 12-106 to West China Research Centre for Rural Health Development) and the Countdown to 2015 for Maternal, Newborn, and Child Survival project (OPP1058954). 相似文献9.
Background
By the end of 2016, China was a country of about 230 million elderly individuals aged 60 years or more. Maintaining mental health has crucial roles in healthy ageing. Previously, we estimated that about 37% of Chinese individuals aged 45 years or more had depressive symptoms. In this study, we aimed to further assess the longitudinal associations between healthy lifestyles and depressive symptoms among the Chinese population.Methods
We used the data from the Chinese Health and Retirement Longitudinal Study, which were recorded in 2011–12, 2013–14, and 2015–16. We included data from individuals aged 45 years or more. Depressive symptoms were defined according to the ten-item Center for Epidemiologic Studies-Depression Scale. Lifestyles were defined by participation in social activities (11 items), smoking status, drinking status, and duration of sleep at night. The primary outcome was the longitudinal associations between lifestyles and depressive symptoms. We did this analysis using generalised estimating equations, adjusting for confounders including age group (45–59 years, 60–74 years, and ≥75 years), sex, urban or rural, socioeconomic factors, underlying conditions, and family death that occurred in the past 2 years. Ethical approval for this study was granted by the Ethical Review Committee of Peking University. We obtained written informed consent from all participants.Findings
From 2011–12 to 2015–16, 13?256 individuals were included in our analysis, contributing to a total of 34?523 observations. The overall prevalence of depressive symptoms was 37·0% (4369 of 11?802) in 2011–12, decreasing to 31·7% (3641 of 11?477) in 2013–14 and then increasing to 34·6% (3891 of 11?244) in 2015–16 (p<0·0001). Similar trends were observed for each age group, sex, urban or rural residents, and participants with underlying conditions. Engagement in one more social activity was associated with a reduction of depressive symptoms than in no social activities (odds ratio [OR] 0·90, 95% CI 0·87–0·93). Compared with the duration of 7–10 h of sleep at night, sleeping for less than 7 h was associated with a higher risk of depressive symptoms (OR 1·91, 95% CI 1·80–2·02). Additionally, current smokers were associated with increased risk of having depressive symptoms compared with never smokers (OR 1·21, 95% CI 1·09–1·33). Nevertheless, no significant association was observed between the presence of depressive symptoms and the individual status of being a past smoker, current drinker, and past drinker.Interpretation
The change in prevalence of depressive symptoms emphasises the need on establishing depression prevention programmes in China. Our results highlighted that smoking behaviour and a sleep duration less than 7?h might increase the risk of depressive symptoms among Chinese adults aged 45 years or more. Our study suggests that depression prevention programmes are likely to be benefitted by incorporating a series of social activities.Funding
None. 相似文献10.
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11.
Tiaoying Li John J Openshaw Xingwang Chen Alexis C Medina Stephen A Felt Huan Zhou Scott D Rozelle Stephen P Luby 《Lancet》2017
Background
Cysticercosis, an infection caused by the larval stage of Taenia solium, is a serious but neglected disease in developing countries. Information about the prevalence of taeniasis, the gastrointestinal infestation with the adult tapeworm, and cysticercosis is lacking in China. In the current study, we aimed to understand the prevalence of T solium taeniasis and cysticercosis in children in a Tibetan region of western Sichuan.Methods
A cross-sectional study was conducted through cluster sampling in two Tibetan primary schools of Muli County, Liangshan Prefecture, in 2016. Sample collection in two schools was carried out in April and September, respectively, whereas treatment of taeniasis carriers was performed in December. Each student was questioned about a history of segment expulsion within the previous year by showing a segment photo, and also provided faecal and blood samples. All faecal samples were examined for presence of Taenia spp eggs by direct smear, and serum samples were tested for specific IgG antibodies to T solium cysticercus using an ELISA based on low-molecular-weight antigens of T solium cyst fluids. Treatment with pumpkin seeds combined with areca nut extract was provided to confirmed (stool-positive for Taenia spp eggs by microscopy) and suspected taeniasis carriers (reporting a history of segment expulsion within the previous year). All collected tapeworms following treatment were subject to morphology examination and genotyping by multiplex PCR. χ2 test was used to compare the infection rate of T solium taeniasis and seroprevalence in different groups of students. Significance was set at p≤0·05. Informed consent was obtained and Institutional Review Board approval was received.Findings
A total of 636 students (mean sampling coverage 90%) were involved in the study, with a median age of 11 years (range 5–15). The overall prevalence of taeniasis due to all three endemic Taenia species (T solium, T saginata, and T asiatica) was 10·4% (95% CI 7·9–12·9). The prevalence of T solium taeniasis was 6·1% (95% CI 4·2–8·0). Eight (23%) of 35 T solium taeniasis carriers expelled multiple tapeworms (range 2–11), including concurrent infection with other Taenia species. The prevalence of T solium cysticercosis IgG antibodies was 12·9% (95% CI 10·4–15·4) in 619 tested students. Of 32 students with T solium taeniasis, 13 (41%) were seropositive, compared with 12% (63/529) in the group of students without T solium taeniasis (p<0·0001). When analysed separately, the two schools had similar T solium taeniasis prevalence and cysticercosis antibody seroprevalence.Interpretation
The current study suggests that the prevalence of T solium taeniasis and cysticercosis is high in schoolchildren in Tibetan rural areas of western Sichuan. Further studies to better understand transmission patterns and risk factors in poor-resource rural areas of western China are needed to aid further eradication efforts.Funding
Global Development and Poverty Initiative at Stanford University, Sichuan Provincial Department of Finance, and Science and Technology Department of Sichuan Province (2014SZ0151). 相似文献12.
Tao Jin Kun Jiang Lihui Deng Jia Guo Yuwan Wu Zhengyan Wang Na Shi Xiaoxin Zhang Ziqi Lin Varsha Asrani Peter Jones Anubhav Mittal Anthony Phillips Robert Sutton Wei Huang Xiaonan Yang Qing Xia John A. Windsor 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1082-1091
Background
Intravenous (IV) fluid resuscitation remains the cornerstone for early management of acute pancreatitis (AP), but many questions remain unanswered, including how to determine whether patients will benefit from additional fluids. The aim was to investigate the utility of serum biomarkers of responsiveness IV fluid resuscitation in patients with AP and systemic inflammatory response syndrome (SIRS).Methods
Eligible adult patients had abdominal pain for <36 h and ≥2 SIRS criteria. Mean arterial pressure (>65 mmHg) and urine output (>0.5 ml/kg/h) were used to assess responsiveness at 2 and 6–8 h after initiation of IV fluids. Comparison was made between responsive and refractory patients at time points for fluid volume, biomarkers and outcomes.Results
At 2 h 19 patients responded to fluids (Group 1) while 4 were refractory (Group 2); at 6–8 h 14 responded (Group 3) and 9 were refractory (Group 4). No demographic differences between patient groups, but Group 4 had worse prognostic features than Group 3. Refractory patients received significantly more fluid (Group 4 mean 7082 ml vs. Group 3 5022 mL, P < 0.001) in first 24 h and had worse outcome. No significant differences in biomarkers between the groups.Conclusions
The serum biomarkers did not discriminate between fluid responsive and refractory patients. Refractory patients at 6–8 h had more severe disease on admission, did not benefit from additional fluids and had a worse outcome. New approaches to guide fluid resuscitation in patients with AP are required. 相似文献13.
Lu Yang Shi Qiu Linghui Deng Haiyang Bian Ian Charles Tobias Chengyi Huang Liangren Liu Zhenhua Liu Yige Bao Qiang Wei 《Lancet》2017
Background
The introduction of three kinds of MRI-guided prostate biopsies (MRI-PB) has changed the model of practice regarding prostate biopsies. The most appropriate strategy is still unknown, we therefore aimed to compare and rank prostate biopsies strategies.Methods
We did a network meta-analysis to incorporate both direct and indirect evidence from relevant trials. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Scopus, Embase, and the reference lists of relevant articles for randomised controlled trials published up to Sept 1, 2016, of different strategies for prostate biopsy. Involved studies were full text reports of randomised trials that compared different biopsy strategies, and reported efficacy endpoints. The primary outcome was overall prostate cancer detection rate. We did pairwise meta-analyses by random effects model and network meta-analysis by Bayesian random effects model. We assessed the quality of evidence contributing to each network estimate using the GRADE framework. This study is registered with PROSPERO, number CRD42016044011.Findings
From a total of 3616 citations, 24 randomised trials with a total of 6497 participants were included in this network meta-analysis. We considered 11 strategies of prostate biopsy published between 2000 and 2016. Cognitive MRI prostate biopsy was significantly better (relative risk [RR] 2·66, 95% credible interval [CrI] 1·44–4·72) than TRUS (10-12; PCa detection from 10–12 needle core transrectal ultrasound prostate biopsy) prostate biopsy considering overall prostate cancer detection rate. Detection rates of clinically significant and insignificant prostate cancers suggested no significant difference between any group of all biopsy techniques.Interpretation
Although cognitive MRI prostate biopsy obtained better detection rates of overall prostate cancer than did TRUS (10-12) prostate biopsy, it had no remarkable advantages in detection of clinically significant and insignificant prostate cancers. Nevertheless, these results should be considered together with all known safety and economy information when selecting the strategy for individual patients.Funding
This study was supported by the Prostate Cancer Foundation Young Investigator Award 2013, the National Natural Science Foundation of China (81300627, 81370855) and Programs from Science and Technology Department of Sichuan Province (2013SZ0006, 2014JY0219). 相似文献14.
Background
Since the outbreak of HIV/AIDS caused by blood selling in Henan province in 2003, the Chinese government has adjusted the CD4 threshold for antiretroviral therapy (ART) several times to promote early treatment. However, the length of time between diagnosis and initiation of ART in China is unclear. This study aims to analyse the interval between HIV diagnosis and initial ART for patients infected with HIV/AIDS from 2004 to 2016.Methods
This retrospective study used hospital electronic health records data and a case report database for AIDS prevention and control in Yunnan province. We measured the time delay in months between diagnosis with HIV/AIDS and initial ART treatment. Differences in time intervals among different groups were studied with the Mann-Whitney U test and Kruskal-Wallis test. Multiple regression models were used to examine associated factors including the change of ART threshold in China.Findings
16957 people with HIV/AIDS infection were included in the study; the average age was 40 years (SD 13·34). The interval was longer than 6 months for 22·4% of homosexual people, 32·1% of heterosexual people, and 62·8% of drug users. The proportion of people who delayed treatment more than 6 months dropped from 93·8% in 2004 to 1·6% in 2016. The median time interval decreased from 59·2 months (SD 37·7) in 2004 to 0·5 months (SD 5·4) in 2016. Multiple regression analysis showed that the time between diagnosis and initiation of antiretroviral therapy differed significantly according to age, marital status, education level, group of people (heterosexual people, people who inject drugs, and homosexual people), and year of diagnosis (p<0·05).Interpretation
The interval between diagnosis and initial ART treatment among people with HIV/AIDS was substantially shorter in 2016 than in 2004. However, demographic differences in time to treatment exist among these people. Strategies to reduce time to treatment, especially for people using drugs and people with little education, are urgently needed.Funding
This study was supported in part by grants from the National Natural Science Foundation of China (project 71874100) and International Science and technology cooperation project of Tsinghua University (project 20163000254). 相似文献15.
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16.
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17.
Background
China's system of social health insurance is fragmented into three separated insurance plans and is not transferrable across regions, which can leave some migrants without insurance or with multiple insurance. This study aimed to investigate the health insurance status among internal migrants, and its relationship with migration characteristics.Methods
We used data from a national cross-sectional database from the 2014 and 2015 Migrant Dynamics Monitoring Survey in China for respondents aged 15 years or older. We applied multinomial logistic regressions to estimate the association between migration characteristics and health insurance status, adjusting for sociodemographic characteristics. Insurance status included being uninsured, having one insurance plan, and having multiple insurance.Findings
The 2014 sample included 200?937 respondents and the 2015 sample included 201?294 respondents. In 2014, 163?906 (81·6%) migrants were covered by one insurance plan, and 7098 (3·5%) had multiple insurance, while 29?933 (14·9%) were uninsured. In 2015, the uninsured rate and the multiple insurance rate decreased to 7·3% (n=14 783) and 2·9% (n=5780), respectively. Using the 2014 sample, cross-city migration within a province significantly increased the probability of being uninsured by 53% (relative risk ratio 1·53, 95% CI 1·46–1·61) and having multiple insurance by 35% (95% CI 1·22–1·46) compared with intra-city migration, whereas cross-province migration increased the probability of being uninsured by 105% (95% CI 1·93–2·13) and having multiple insurances by 14% (95% CI 1·03–1·23). Living in the destination city for 5 years or longer significantly increased the likelihood of being uninsured by 4% (95% CI 1·01–1·08) and having multiple insurance by 30% (95% CI 1·21–1·37), compared to those staying for less than 1 year. The same patterns held in the 2015 sample except that no statistically significant relationship was detected between years lived in the destination city and having multiple insurance.Interpretation
Cross-province migration and living in the destination city for longer times were positively associated with no insurance and multiple insurance, causing inequality and inefficiency in the insurance system. Policies that integrate the three insurance plans across the country should be urgently promoted to achieve universal coverage.Funding
National Nature Science Foundation of China (grant no 71403007 and 71503059). 相似文献18.
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19.
Background
China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.Methods
We obtained data from a nationwide longitudinal survey for 1006, 1472, and 1771 participants with diabetes who were surveyed as part of China Health and Retirement Longitudinal Study in 2011, 2013, and 2015, respectively. We described and analysed primary care coverage and hospital admission rates (proportion of patients with diabetes who were admitted to hospital) to assess the quality of PHC in eastern, central, and western China. Primary care coverage included proportion of patients who received diabetes-related health education, examinations, and treatments. We used logistic regressions to model the changes of primary care coverage and hospital admission rates in 2011–15 by adjusting for sociodemographic variables. Ethical approval is not applicable in this study as we use anonymised secondary data.Findings
Health education coverage decreased significantly in 2011–15 (76·17% in 2011, 73·15% in 2013, and 70·15% in 2015; OR 0·747 [95% CI 0·62–0·90]) whereas the proportion of patients who received diabetic-related examinations and medical treatments remained largely unchanged (78·88% in 2011, 78·35% in 2013, and 81·45% in 2015; OR 1·18 [95% CI 0·95–1·45]). Moreover, the proportion of patients who received diabetic-related examinations in the west was lower than that in the east (OR 0·52 [0·35–0·76]). Diabetes-related hospital admission rates increased from 4·01% in 2011 to 6·08% in 2013 (OR 1·47 [0·97–2·22]), and recurrent hospital admission rates increased from 18·87% in 2011 to 28·45% in 2015 (OR 1·78 [1·44–2·20]). Both diabetes-related admission rates (OR 1·80 [1·13–2·87]) and recurrent hospital admission rates (OR 1·92 [1·50–2·45]) were higher in the west than in the east.Interpretation
Judging by the patient-reported process and outcome indicators studied, quality of PHC has not improved in China between 2011–2015. Continuous evidence-based monitoring, evaluation and reporting of PHC quality are crucial for accomplishing the goals of health-care system reform in China.20.
Suizan Zhou Chunxia Zhao Xiaona Huang Zhiwen Li Rongwei Ye Huifeng Shi Qi Zhao Ye Zhou Xuefeng Chen Margo O&#x;Sullivan Ron Pouwels Kathryn Martin Jingxu Zhang Xiaoli Wang Robert W Scherpbier 《Lancet》2018