Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? : results from cross-sectional studies in 2010 and 2013

Objectives Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China's rural ethnic minority areas. Setting Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. Design Two rounds of cross-sectional study. Participants One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. Methods Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted. Findings The overall CI for outpatient care was -0.0146 (P>0.05) in 2010 and -0.0992 (P0.05) and '0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was -0.1353 (P0.05) and -0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively. Conclusion Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients' care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution

Influence of lecithin cholesterol acyltransferase alteration during different pathophysiologic conditions: A 45 years bibliometrics analysis

Background: Lecithin cholesterol acyltransferase (LCAT) is an important enzyme responsible for free cholesterol (FC) esterification, which is critical for high density lipoprotein (HDL) maturation and the completion of the reverse cholesterol transport (RCT) process. Plasma LCAT activity and concentration showed various patterns under different physiological and pathological conditions. Research on LCAT has grown rapidly over the past 50 years, but there are no bibliometric studies summarizing this field as a whole. This study aimed to use the bibliometric analysis to demonstrate the trends in LCAT publications, thus offering a brief perspective with regard to future developments in this field.Methods: We used the Web of Science Core Collection to retrieve LCAT-related studies published from 1975 to 2020. The data were further analyzed in the number of studies, the journal which published the most LCAT-related studies, co-authorship network, co-country network, co-institute network, co-reference and the keywords burst by CiteSpace V 5.7.Results: 2584 publications contained 55,311 references were used to analyzed. The number of included articles fluctuated in each year. We found that Journal of lipid research published the most LCAT-related studies. Among all the authors who work on LCAT, they tend to collaborate with a relatively stable group of collaborators to generate several major authors clusters which Albers, J. published the most studies (n = 53). The United States of America contributed the greatest proportion (n = 1036) of LCAT-related studies. The LCAT-related studies have been focused on the vascular disease, lecithin-cholesterol acyltransferase reaction, phospholipid, cholesterol efflux, chronic kidney disease, milk fever, nephrotic syndrome, platelet-activating factor acetylhydrolase, reconstituted lpa-i, reverse cholesterol transport. Four main research frontiers in terms of burst strength for LCAT-related studies including “transgenic mice”, “oxidative stress”, “risk”, and “cholesterol metabolism “need more attention.Conclusion: This is the first study that demonstrated the trends and future development in LCAT publications. Further studies should focus on the accurate metabolic process of LCAT dependent or independent of RCT using metabolic marker tracking techniques. It was also well worth to further studying the possibility that LCAT may qualify as a biomarker for risk prediction and clinical treatment

Two-year impact of an educational intervention in primary care on blood glucose control and diabetes knowledge among patients with type 2 diabetes mellitus: a study in rural China

Background: Type 2 diabetes mellitus is increasing in rural China and should be managed in primary health care, but knowledge is lacking. Educational interventions have been implemented but not followed up long-term. Objective: The study aimed to assess the long-term impact of an educational intervention on patients’ diabetes knowledge and fasting blood glucose (FBG) level, and whether these outcomes differed between two rural counties. Methods: The study was nested in an educational intervention project in primary health care in Jiangsu province. Patients with type 2 diabetes mellitus from Huaiyin county and Gaochun county were randomly divided into an intervention group receiving an educational intervention and follow-up visits, and a control group with standard care. Questionnaires and medical records, including FBG level and diabetes knowledge score, were compared, at baseline in 2015 and two follow-ups, in 2016, and 2017, respectively. A paired t-test and two mixed-effects linear regression models were used. Results: The diabetes knowledge score increased in the intervention group in 2016 and in 2017, compared with 2015. The FBG level decreased in 2016 compared with 2015 in the intervention and control groups. Comparing data in 2015 and 2017, there was no significant change in FBG level in the intervention or control group, but the diabetes knowledge score increased in the intervention group both in 2016 and 2017. A significant association between FBG level and the interaction of time and group, suggesting a long-term effect, was only found in Gaochun county in 2017. Conclusion: The educational intervention improved the diabetes knowledge score in the intervention group, while no significant improvement was found in the control group in both year 2016 and 2017. Meanwhile, the intervention had a positive impact on FBG level in the intervention group in 2017. Patients in Gaochun county had better improvement in both diabetes knowledge and controlling FBG level, compared with Huaiyin county

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China

This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up

Do integrated health care interventions improve well-being among older adults with hypertension? : evidence from rural China

As a prevalent chronic disease later in life, hypertension affects physical health in older adults. In this paper, we investigated whether an integrated health care intervention improved health-related quality of life (HRQoL) and well-being among older patients with hypertension in rural China. An intervention focused on older patients with hypertension (395 participants in the intervention group and 394 in the control group) was implemented. In the intervention townships, the health care professionals from all three levels of health care institution work as a team and receive skills training and regular meeting, etc. Patients in the intervention group received health education and periodical follow-up interviews, etc. Patients’ data including the blood presure, HRQoL and sociodemographic characteristics were collected at baseline (2016) and follow-up (2017). Symptom control and patient’s compliance with healthy lifestyle were self-reported by participants using questionnaires. After the intervention, a decrease was observed in the number of patients reporting problems, such as anxiety or depression. About 31.4% of patients in the intervention group perceived that they had greater control over their physical conditions during the study. Although patients’ health awareness and knowledge improved, their rate of compliance with a healthy lifestyle was low

Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China – a study protocol

Abstract Background Chronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care. Methods An educational intervention was conducted in three pilot counties in Jiangsu province, a high-income province in southeast China. The intervention was based on the model of vertical integrated care between the three-levels of healthcare institutions. In the pilot counties, 22 townships were included (11 in the intervention and control groups, respectively). Service teams assembled by the local health bureaus implemented the intervention which provides services for both patients and healthcare professionals. Questionnaire interviews (n = 4259) and medical records were used to collect patient data (physiological measures, health-related quality of life, satisfaction with care). Data from healthcare professionals (n = 282) was gathered through questionnaires and in-depth interviews (knowledge about chronic diseases, general procedure of diagnosing and registering, chronic disease management situation, perceptions of chronic disease treatment and prevention). Baseline data were collected before the start of the intervention in Nov 2015, follow-up data in Oct-Nov 2016, and final data completed in Jul-Aug 2017. Discussion The intervention has been conducted smoothly and gotten support from patients, healthcare institutions and local health authorities. The research team anticipates that the vertical integrated model will improve patients’ health, satisfaction with care, and their understanding of their chronic disease. We also anticipate that healthcare professionals can acquire more information about chronic diseases and improve their strategy for providing good quality care for patients. Trial registration ISRCTN13319989 Registration date: 4th April, 2017

Stronger Increases in Cognitive Functions among Socio-Economically Disadvantaged Older Adults in China: A Longitudinal Analysis with Multiple Birth Cohorts

Highly variable changes in cognitive functions occur as people get older, and socio-economically disadvantaged older adults are more likely to suffer from cognitive decline. This study aims to identify the longitudinal trend in cognitive functions among different socio-economic groups of older adults. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) followed up 32,323 individuals aged 65 years and older over a 12-year period. A series of mixed-effects models was used to explicitly assess cohort trend and its socio-economic disparity in the cognitive functions of older adults. Scores for significant increase in cognitive functions by birth cohort were smaller by 0.49, 0.28, and 0.64 among older adults with more educational experience, a lower household income, or economic dependence relative to their counterparts. Scores for differences in cognitive function between older adults with higher and lower incomes were smaller by 0.46 among those living in urban areas than among those living in rural areas. Although there were larger cohort growth trends in cognitive functions among older adults with lower educational attainment, lower household income, and who were economically dependent, effective public intervention targeting these socio-economically disadvantaged populations is still necessary

Additional file 2: Table S1. of Socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension over the life course in China

Coefficients (95% confidence intervals) from mixed effects models (model 1 and 2) predicting of the probability of Awareness, Treatment, and Control of Hypertension over the Life Course among China adults. (DOC 56 kb