5 research outputs found
Determinants of village doctors’ job satisfaction under China’s health sector reform: a cross-sectional mixed methods study
Background: To strengthen rural health workforce, the Chinese government has launched a series of policies to
promote the job satisfaction of village doctors since the health sector reform. The purpose of this mixed-method
study is to describe village doctors’ job satisfaction under the context of health sector reform and investigate the
associated factors.
Methods: Data was obtained from a survey of village doctors across three Chinese provinces in 2014. Using a
multistage sampling process, quantitative data was collected from village doctors through the self-administered
questionnaire and analyzed by multilevel logistic regression models. Qualitative data was collected through
face-to-face semi-structured interviews on both village doctors and health managers. Theoretical coding was
then conducted to analyze qualitative data.
Results: Among the 1221 respondents, 48.6% felt satisfied with their job. Older village doctors with less of a workload
and under high-level integrated management were more likely to feel satisfied with their job. Village doctors who earned
the top level of monthly income felt more satisfied, while on the county level, those who lived in counties
with the highest GDP felt less satisfied. However, enrollment in a pension plan showed no significant difference in
regards to village doctors’ job satisfaction.
Among 34 participants of qualitative interviews, most believed that age, income, and integrated management had a
positive influence on the job satisfaction, while pension plan and basic public health care policies exhibited negative
effects. Also, the increasing in availability of healthcare and health resources along with local economic development
had negative effects on village doctors’ job satisfaction.
Conclusion: Village doctors’ job satisfaction was quite low in regards to several determinants including age, income,
workload, enrollment in a pension plan, integrated management, and county economic and medical
availability development
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Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus e-antigen
Background: Chronic hepatitis B virus (HBV) infection is complicated by cirrhosis and liver cancer. In Thailand, 6-7 % of adults are chronically infected with HBV. The risk of mother-to-child transmission (MTCT) of HBV has been estimated to be about 12 % when mothers have a high hepatitis B viral load, even if infants receive passive-active prophylaxis with HBV immunoglobulin (HBIg) and initiate the hepatitis B vaccine series at birth. We designed a study to assess the efficacy and safety of a short course of maternal tenofovir disoproxil fumarate (TDF) among women with a marker of high viral load for the prevention of MTCT of HBV. Methods: The study is a phase III, multicenter (17 sites in Thailand), placebo-controlled, double-blind, randomized 1:1, two-arm clinical trial of TDF 300 mg once daily versus placebo among pregnant women from 28 weeks’ gestation through 2-month post-partum. All infants receive HBIg at birth, and a hepatitis B (HB) vaccination series according to Thai guidelines: birth, and age 1, 2, 4 and 6 months. Participant women at study entry must be age ≥18 years, hepatitis B surface antigen (HBsAg) and e-antigen (HBeAg) positive, have alanine aminotransferase (ALT) level 50 mL/min, and no history of anti-HBV antiviral treatment. The target sample size of 328 mother/infant pairs assumed 156 evaluable cases per arm to detect a ≥9 % difference in MTCT transmission (3 % experimental arm versus 12 % placebo arm) with 90 % power. Mothers and infants are followed until 12 months after delivery. The primary infant endpoint is detection of HBsAg, confirmed by detection of HBV DNA at six months of age. Secondary endpoints are maternal and infant adverse events, acute exacerbations of maternal hepatitis B disease (ALT >300 IU/L, defined as a “flare”) following discontinuation of study treatment, infant HBV infection status and growth up to 12 months of age. Discussion The results of this randomized trial will clarify the efficacy and safety of a short course of antiviral treatment to prevent mother-to-child transmission of HBV and inform international guidelines. Trial registration ClinicalTrials.gov Identifier NCT01745822