Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients’ treatment adherence via electronic monitors and an app versus usual care in Tibet

Background Treatment non-adherence is a serious challenge to effective tuberculosis (TB) control in Tibet. In this study we will pilot and evaluate the effectiveness of using new electronic monitors (e-monitors) and a smartphone app to improve treatment adherence among new pulmonary TB patients in Tibet. Methods We will use a multicentre, parallel-group, individually randomised controlled, superiority trial with blinded outcome evaluation and unblinded treatment. We will randomise new pulmonary TB outpatients (aged ≥ 15 years old and free from communication impairment) from Shigatse, Tibet to either the intervention or control arm in a 1:1 ratio at the time of their diagnosis. All patients will be treated according to the World Health Organisation standard 6-month TB treatment regimen and the China National TB programme guidelines. Intervention arm patients will be given their medication via e-monitors that have automatic voice reminders, and record medication adherence data and share it with health staff via Cloud connection. Intervention patients will also be encouraged to receive smartphone-based video-observed treatment if their adherence is problematic. Control arm patients will receive their medication in e-monitors that will collect medication adherence history, but will have their reminder function deactivated and are not linked to the app. The primary outcome is the rate of poor adherence, measured monthly during treatment as a binary indicator where poor adherence means missing ≥ 20% of doses in a month. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and an analysis of the long-term effects of the intervention on TB control. Discussion Our study is one of the first trials to evaluate the use of e-monitors and smartphone apps for customised treatment support in low- and middle-income countries (LMICs). All intervention activities are designed to be embedded into routine TB care with strong local ownership. Through the trial we intend to understand the feasibility of our intervention, its effectiveness, its cost-effectiveness and its long-term impacts to inform future scale-up in remote areas of China and other LMICs. Trial registration Current Controlled Trials, ID: ISRCTN52132803. Registered on 9 November 2018

Planos de contingência para a vigilância em saúde na pandemia da COVID-19: análise de conformidades em uma rede de hospitais públicos de ensino

Introduction: In December 2019, China was plagued by coronavirus disease (COVID-19), a disease caused by the new coronavirus, SARV-CoV-2. Due to the high contagion power, the World Health Organization declared a Public Health Emergency of International Importance on January 30, 2020. In March of the same year, more than 100 countries had registered cases of the new disease; thus, due to geographical spread, the World Health Organization declared COVID-19 pandemic. Objective: To evaluate the adherence of public teaching hospitals to a Contingency Plan Model for Human Infection by the New Coronavirus published by the central management of a public company. Method: Descriptive-analytical study, using the model developed and published as a guiding document for adapting the contingency plan of each of the hospitals in the study. Results: After two evaluations of the plans, 36 (94.7%) hospitals showed compliance greater than 70.0%, with four (10.5%) of them showing 100% compliance with the model. Hospitals’ average adherence to the model increased from 82.3% in the first evaluation, to 91.3% in the second evaluation, a percentage increase equal to 11.0%. All hospitals in the study maintained or increased their adherence percentages. Conclusions: The research demonstrated the potential of the model to guide institutions in preparing their plans. Considering the positive results of this experience and the historical scarcity of hospital beds, especially those with ventilatory support, it is recommended that Brazilian health authorities can invest time and resources in the preparation of guiding documents that assist managers in reorganizing hospitals and response in crisis situations.Introdução: Em dezembro de 2019, a China foi assolada pela coronavirus disease (COVID-19), doença causada pelo novo coronavírus, o SARV-CoV-2. Devido ao alto poder  de contágio, a Organização Mundial de Saúde declarou Emergência de Saúde Pública de Importância Internacional em 30 de janeiro de 2020. Em março do mesmo ano, mais de 100 países haviam registrado casos da nova doença, assim, devido à disseminação geográfica rápida, a Organização Mundial de Saúde declarou pandemia da COVID-19. Objetivo: Avaliar a adesão de hospitais públicos de ensino a um Modelo de Plano de Contingência para Infecção Humana pelo Novo Coronavírus publicado pela gestão central de uma empresa pública. Método: Estudo descritivo-analítico, utilizando o modelo elaborado e publicado como documento orientador para adequações do plano de contingência de cada um dos hospitais do estudo. Resultados: Após duas avaliações dos planos, 36 (94,7%) hospitais apresentaram conformidade superior a 70,0%, sendo que quatro (10,5%) deles apresentaram 100,0% de conformidade com o modelo. A média de adesão dos hospitais ao modelo cresceu de 82,3% na 1ª avaliação, para 91,3% na segunda avaliação, um aumento percentual igual a 11,0%. Todos os hospitais do estudo mantiveram ou aumentaram seus percentuais de adesão. Conclusões: A pesquisa demonstrou a potencialidade do modelo em orientar as instituições na elaboração e aprimoramento dos seus planos. Considerando os resultados positivos dessa experiência  e a escassez histórica de leitos hospitalares, especialmente aqueles com suporte ventilatório, recomenda-se que as autoridades sanitárias  brasileiras possam investir  tempo e recursos na elaboração de   documentos orientadores que auxiliem gestores na reorganização e resposta dos hospitais em situações de crise

A Review of the Restorative Environment Research in the Mainland of China

More and more Chinese experts focus on the research field of the restorative environment and public health. We reorganized the theories of restorative environment and proposed a theory framework which consists of Attention Restorative Theory(ART) and psycho-evolutionary theory and other three auxiliary hypothesis included Biophilia Theory, Prospect-Refuge Theory and Stress: The "fight or flight" response We classified the experiments methods into three types; the psychological, subjective evaluation, physiological objective indicators, and  behavior improvements .We could figure out some shared questions at the current research in mainland China, such as limited research methods, limited senses used in the current research.© 2016. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.Keywords : Restorative; Theory;Questionnaire;Experiments

Corporate social responsibility practices of pharmaceutical companies in China: a scale development & empirical study

JEL Classification: M14 - Corporate Culture; Social Responsibility; I11 - Analysis of Health Care MarketsCorporate Social Responsibility (CSR) has been a hot topic in literature ever since a couple of decades ago, and it roughly refers to the positive influence that a company’s operations have on its stakeholders. Amongst various industries, the pharmaceutical sector is one of the most debated in that these companies produce disease-curing and even life-saving products in a for-profit manner, thereby involving many CSR-related issues. Now China’s pharmaceutical industry has the second largest output in the world, but various problems have also emerged and led to negative consequences, many of which were caused by failure to abide by CSR norms. In order to assess the CSR practices of pharmaceutical companies in China, a reliable and credible measurement instrument has to be available. However, currently there is still no universally accepted definition of CSR, and existing theoretical models fail to fit either characteristics of the pharmaceutical industry or China’s cultural context. As a result, a new model has to be built that takes both factors into account. The study has two main purposes: one is to design an original and valid scale for measuring the CSR practices of pharmaceutical companies in China, and the other is to use this tool to evaluate their actual CSR performance. Based on a standard scale development process (in-depth interviews, open-ended questionnaire, discussions with experts, reliability and validity evaluation with exploratory and confirmatory factor analyses), finally an eight-dimensional and 36-item measurement tool was validated. The eight initial dimensions (Shareholders, Managers, and Employees; Creditors & Suppliers, Patients & Doctors; Government, Environment, and Local Community) were then transformed into three second-order dimensions: CSR for Internal Parties, CSR for External Partners, and CSR for Public Entities. This conceptual model was later applied to reveal the circumstances within China’s pharmaceutical industry. Results show that CSR practices in the pharmaceutical industry in China coexist at very different levels: foreign-owned companies and joint ventures generally outperformed their state-owned and privately owned counterparts, and larger companies also had better CSR citizenship than smaller ones.A Responsabilidade Social das Empresas (RSE) tem sido um tópico recorrente na literatura nas duas últimas décadas e, de forma muito resumida, refere-se à influência positiva que a atividade empresarial pode ter nos seus diversos stakeholders. De entre os múltiplos setores de atividade, a indústria farmacêutica é uma das mais discutidas por produzir medicamentos que curam doenças e salvam vidas mas de forma lucrativa, e por isso, envolvendo muitos problemas relacionados com a RSE. Atualmente, a indústria farmacêutica na China é segunda em termos de produção mundial, mas apresenta problemas variados com consequências negativas, muitas delas resultantes do não cumprimento das normas de resonsabilidade social. Para que se possam avaliar as práticas de RSE na China, é necessário um instrumento de medida fiável e válido. No entanto, até ao momento não existe uma escala de medida da RSE universalmente aceite e os atuais modelos teóricos não incorporam as características da indústria farmacêutica e o contexto cultural específico da China. Daí a necessidade de desenvolvimento de um modelo teórico que possa incluir estas duas dimensões. Este estudo tem como principais objectivos desenhar e validar um instrumento de medida das práticas de RSE na indústria farmacêutica chinesa e, utilizando essa escala de medida, avaliar o atual desempenho das empresas chinesas deste setor em termos de práticas de responsabilidade social. Foi utilizada uma metodologia estandardizada para o desenvolvimento de uma escala de medida (entrevistas em profundidade, perguntas abertas, pré-teste ao questionário, validade e fiabilidade do questionário com análises fatoriais exploratória e confirmatória). Foi validada uma escala com 36 itens e oito dimensões (Acionistas, Gestores e Colaboradores; Credores & Fornecedores, Doentes & Médicos; Governo, Ambiente e Comunidade Local) que, de seguida, foram transformadas em três dimensões de segunda ordem: RSE para as partes internas, RSE para os parceiros externos e RSE para as entidades públicas. Este modelo conceptual foi depois aplicado para identificar as particularidades da indústria farmacêutica na China. Os resultados mostram que as práticas de RSE coexistem a níveis muito diferentes: em geral as empresas de capital estrangeiro ou joint ventures apresentam melhor performance que as empresas públicas ou privadas; as empresas maiores revelam mais práticas de RS que as mais pequena

Core capabilities of Chinese community health service centers: a dynamic capabilities approach

With China's population aging, rapid urbanization and social transformation, people's demand for multi-level and diversified medical services is growing rapidly. Insufficient allocation of CHSC medical resource and medical service lower capability still exist. Patients lack confidence in the medical service of CHSC. The service quality of community health service directly affects the accessibility, timeliness and effectiveness of residents' health management. It is necessary to strengthening the core capability building and improve the service efficiency of CHSC. Core capability by referring to relevant literatures and combined with expert correspondence of Delphi method. We constructed the index evaluation system of CHSC core capability with 5 first level indicators, 14 secondary indicators and 60 tertiary measurable items. This study selected 64 CHSCs in the main urban area of Shenyang city as the research object. Data were collected through questionnaires and interviews. A total of 1895 valid questionnaires were collected. The structural equation model was established by AMOS software. Several conclusions are achieved as follows: 1) the results of empirical research verify the rationality of the research model constructed in this study; 2) dynamic capability is the key influencing factor of the core capability of community health service center, and other affecting factors include management capability, service capability, organizational culture and organizational resources; 3) exploratory innovation in dynamic capability, strategic orientation in organizational culture, external electronic system integration in management capability and the training expenses spent to improve the quality and capability of employees are closely related to the core capability of community health service centers. The research results of this study are to construct the core capability index system of CHSC, to provide a basis for the standardized evaluation of CHSC service capability by health administrative governments.Com o envelhecimento da população da China, a urbanização rápida e a transformação social, a procura das pessoas por serviços médicos diversificados cresceu rapidamente. A alocação de recursos médicos aos Centros de Saúde Comunitários (CSC) é insuficiente, o problema da fraca qualidade de serviço médico persiste e os pacientes não confiam no nível médico dos centros de saúde da comunidade. A qualidade do serviço comunitário de saúde afeta diretamente a acessibilidade, a oportunidade e a eficácia da gestão da saúde dos residentes. Torna-se necessário reforçar a construção do núcleo de competência do CHSC e melhorar a eficiência dos serviços dos CSC. Este estudo analisa a literatura relevante no país e no estrangeiro, e a aplicação do método de Delphi identificou cinco indicadores primários, 14 dimensões secundárias e 60 itens mensuráveis para a construção do sistema de avaliação do índice de competência central dos CHSC. Este estudo selecionou 64 CHSC em Shenyang como objeto de pesquisa, e recolheu um total de 1895 questionários válidos, e aplicou o modelo de equações estruturais utilizando o software AMOS. Do estudo realizado retiramos algumas conclusões: 1) os resultados da pesquisa empírica confirmam a racionalidade do modelo que utilizamos; 2) a habilidade dinâmica é o fator que mais influencia as capacidades fulcrais dos centros comunitários de saúde, os outros fatores são a capacidade de gestão, a capacidade de serviço, a cultura organizacional e os recursos organizacionais; 3) a inovação exploratória na habilidade dinâmica, a orientação estratégica na cultura organizacional; um sistema electrónico na capacidade de gestão e as despesas em formação para melhorar a qualidade dos empregados estão fortemente relacionadas com as capacidades fulcrais dos centros de saúde comunitários. O resultado desta pesquisa consubstanciou-se na construção de um sistema de índice de competência central dos centros de saúde da comunidade, e forneceu uma base que permite aos departamentos administrativos de saúde padronizar a avaliação da competência do serviço CSC

PM2.5-Related Health Economic Benefits Evaluation Based on Air Improvement Action Plan in Wuhan City, Middle China

On the basis of PM2.5 data of the national air quality monitoring sites, local population data, and baseline all-cause mortality rate, PM2.5-related health economic benefits of the Air Improvement Action Plan implemented in Wuhan in 2013–2017 were investigated using health-impact and valuation functions. Annual avoided premature deaths driven by the average concentration of PM2.5 decrease were evaluated, and the economic benefits were computed by using the value of statistical life (VSL) method. Results showed that the number of avoided premature deaths in Wuhan are 21,384 (95% confidence interval (CI): 15,004 to 27,255) during 2013–2017, due to the implementation of the Air Improvement Action Plan. According to the VSL method, the obtained economic benefits of Huangpi, Wuchang, Hongshan, Xinzhou, Jiang’an, Hanyang, Jiangxia, Qiaokou, Jianghan, Qingshan, Caidian, Dongxihu, and Hannan District were 8.55, 8.19, 8.04, 7.39, 5.78, 4.84, 4.37, 4.04, 3.90, 3.30, 2.87, 2.42, and 0.66 billion RMB (1 RMB = 0.1417 USD On 14 October 2019), respectively. These economic benefits added up to 64.35 billion RMB (95% CI: 45.15 to 82.02 billion RMB), accounting for 4.80% (95% CI: 3.37% to 6.12%) of the total GDP of Wuhan in 2017. Therefore, in the process of formulating a regional air quality improvement scheme, apart from establishing hierarchical emission-reduction standards and policies, policy makers should give integrated consideration to the relationship between regional economic development, environmental protection and residents’ health benefits. Furthermore, for improving air quality, air quality compensation mechanisms can be established on the basis of the status quo and trends of air quality, population distribution, and economic development factors