Performance comparison among the major healthcare financing systems in six Cities of the Pearl River Delta Region, Mainland China

<br><b>Background</b> The healthcare system of mainland China is undergoing drastic reform and the optimal models for healthcare financing for provision of primary care will need to be identified. This study compared the performance indicators of the community health centres (CHCs) under different healthcare financing systems in the six cities of the Pearl River Delta region.</br> <br><b>Methods</b> Approximately 300 hypertensive patients were randomly recruited from the computerized chronic disease management records provided by one CHC in each of the six cities in 2011 using a multi-stage cluster random sampling method. The major outcome measures included the treatment rate of hypertension, defined as prescription of ≥ one antihypertensive agent; and the control rate of hypertension, defined as systolic blood pressure levels <140 mmHg and diastolic blood pressure levels <90 mmHg in patients without diabetes mellitus, or <130/80 mmHg among patients with concomitant diabetes. Binary logistic regression analyses were conducted with these two measures as outcome variables, respectively, controlling for patients’ socio-demographic variables. The financing system (Hospital- vs. Government- vs. private-funded) was the independent variable tested for association with the outcomes.</br> <br><b>Results</b> From 1,830 patients with an average age of 65.9 years (SD 12.8), the overall treatment and control rates were 75.4% and 20.2%, respectively. When compared with hospital-funded CHCs, patients seen in the Government-funded (adjusted odds ratio [AOR] 0.462, 95% C.I. 0.325–0.656) and private-funded CHCs (AOR 0.031, 95% C.I. 0.019–0.052) were significantly less likely to be prescribed antihypertensive medication. However, the Government-funded CHC was more likely to have optimal BP control (AOR 1.628, 95% C.I. 1.157–2.291) whilst the privately-funded CHC was less likely to achieve BP control (AOR 0.146, 95% C.I. 0.069–0.310), irrespective of whether antihypertensive drugs were prescribed.</br> <br><b>Conclusions</b> Privately-funded CHCs had the lowest rates of BP treatment and control due to a variety of potential factors as discussed.</br&gt

Genetic optimization of fabric utilization in apparel manufacturing

In apparel manufacturing, cut order planning (COP) plays a significant role in managing the cost of materials as fabric usually occupies more than 50% of the total manufacturing cost. Following the details of retail orders in terms of quantity, size and colour, COP seeks to minimize the total manufacturing costs by developing feasible cutting order plans with respect to material, machine and labour. In this paper, a genetic optimized decision-making model using adaptive evolutionary strategies is proposed to assist the production management of the apparel industry in the decision-making process of COP in which a new encoding method with a shortened binary string is devised. Four sets of real production data were collected to validate the proposed decision support method. The experimental results demonstrate that the proposed method can reduce both the material costs and the production of additional garments while satisfying the time constraints set by the downstream sewing department. Although the total operation time used is longer than that using industrial practice, the great benefits obtained by less fabric cost and extra quantity of garments planned and produced largely outweigh the longer operation time required.

Coordinating supply chains with sales rebate contracts and vendor-managed inventory

Coordinating supply chains is an effective way to improve channel performance. This paper details how a sales rebate contract helps achieve supply chain coordination which allows decentralized decisions of chain members to perform a centralized decision for the whole system. A model in the context of a two-echelon supply chain with a single supplier serving multiple retailers in vendor-managed inventory (VMI) partnership is proposed. VMI facilitates the application of the sales rebate contract since information sharing in VMI partnership allows the supplier to obtain actual sales data in a timely manner and determine the rebate for retailers. Retailers are considered in two scenarios: independent retailers with a demand function sensitive only to their own price and competing retailers with a demand function depending on all retailers' prices. The proposed model demonstrates that the supplier gains more profit with competing retailers than without as competition among the retailers lowers the prices and thus stimulates demand.Supply chain coordination Sales rebate contract Vendor managed inventory Newsvendor model

Association between air pollution and general outpatient clinic consultations for upper respiratory tract infections in Hong Kong

10.1371/journal.pone.0086913PLoS ONE91e8691

Mental health of migrant children: an overview of the literature

Migration is a complex social process that subjects children to physical and social stressors and may result in mental health problems. This paper explores the current understanding on how migration, in terms of the premigration experience, migration process, and postmigration, impacts on children's mental health. A literature search was conduced for articles published in the English language within Medline, PUBMED, Eldis, and Google since 1990. Results indicate that previous studies have (a) highlighted the challenges of defining mental health in children and in different cultural groups, (b) reported the barriers toward access to health care for adults and children with mental health problems, and (c) reported the risk of mental health problems for certain migrant subgroups (e.g., war/conflict victims). Limited information is available on how premigration experience and the migration process affects children's mental health. Most studies on children migration experiences have been conducted in Western countries despite migration being very common elsewhere (e.g., China). More research is required in this area and, in particular, into effective interventions that may influence mental health outcomes in migrant children

Chronic psychosocial stress: does it modulate immunity to the influenza vaccine in Hong Kong Chinese elderly caregivers?

Previous studies evaluated the effects of psychosocial stress on influenza vaccine responses. However, there were methodological limitations. This study aims to determine whether chronic stress is associated with poorer influenza-specific immune responses to influenza vaccines in Hong Kong Chinese elderly people. This is a prospective study with a 12-week follow-up. <p></p> Subjects were recruited from government general out-patient clinics, non-government organizations, and public housing estates in Hong Kong. Participants include 55 caregivers of spouses with chronic conditions that impaired their activities of daily living and 61 age- and sex-matched non-caregivers. A single-dose trivalent influenza vaccine was given to all subjects by intramuscular ingestion. Blood samples were collected before vaccination, at 6 weeks, and at 12 weeks after vaccination. Influenza vaccine strain-specific antibody titers were measured by the hemagglutination inhibition method. Lymphocyte subsets were analyzed for ratios and absolute counts, and cytokine concentration were measured by flow cytometry. Validated scales were used to assess psychological (depressive symptoms, perceived stress, and caregiver strain), social (multidimensional social support scale), and lifestyle factors (physical exercise, cigarette smoking, and alcohol consumption) at baseline prior to vaccination. Demographic and socioeconomic variables were also collected. Albumin levels were measured as an indicator for nutritional status in subjects.<p></p> Caregivers had statistically significant (p < 0.05) lower cell-mediated immune responses to influenza vaccination at 12 weeks when compared with those of the controls. No differences in humoral immune response to vaccination were observed between caregivers and controls. Hong Kong Chinese elderly who experience chronic stress have a significantly lower cell-mediated immune response to influenza vaccination when compared with non-caregivers

The underlying drivers of multimorbidity in middle-income developing countries (E-letter)

No abstract available