Strategies of human resource management in China's community health service institutions: a case study in Guangzhou

Human resource is the first factor for development. For community-based health services, the rational allocation and full utilization of their human resources are important guarantees to meet people’s growing demands for the health service. This research takes community health service institutions in Guangzhou as an example.By semi-structured interviews with 15 key insiders from community health service centers and field survey conducted among 328 medical staff, this research aims to find the quality of human resource allocation, recruiting and staffing, training and development, performance management, salary and welfare of community health service institutions. Through a combination of theories of human resource management and advanced experience of human resource management in community health service institutions at home and abroad, this research aims to put forward a strategy, which fits the China's national conditions, for human resource management in community health service institutions. The results can provide a theoretical basis for the human resource development planning of Chinese community health service institutions.According to the survey results: in regard to staff allocation, the current human resource quantity in Guangzhou community health service centers basically meets the document requirement. However, the structures of gender, education background and professional title are facing imbalance, thus the quality of human resource remains to be improved. In regard to staff recruitment, system of employment under contract is basically fulfilled and generally recognized by staff. But owing to the limitation of the current management system for human resources, it is hard to recruit and retain in-need talents. In regard to staff training, most of the Guangzhou community health service centers have developed cooperation in training with other institutions including Class III Grade I hospitals or medical associations. However, the single training content, slow knowledge update and relatively fragmented training still fail to meet the diversified human resource demands in community health service institutions.In regard to performance management, though a performance appraisal mechanism has been basically established, it has not been well systemized due to a lack of an objective, scientific assessment index system.Seeing that Guangzhou community health service centers are facing a lot of problems, such as human resources being short of quantity and quality, talents introduction mechanism and incentive mechanism being yet undeveloped, training and development of human resources being monotonous and fruitless, performance assessment being formalistic, this research proposes the five following targeted suggestions to solve the problems: first, continue to deepen the medical and health system reform; second, draw up rational human resources planning; third, optimize the mode of community health talents introduction; forth, build a systematic training and development system; fifth, develop a scientific performance appraisal and salary system.Os recursos humanos são o primeiro fator importantedo desenvolvimento. A disposição adquadaeaplena utilização de recursos humanos nos serviços de saúde da comunidade é uma garantia importante para atender à crescente demanda por serviços de saúde dos habitantes. Este estudo terá como exemploosserviçosde saúde dascomunidades deGuangzhou, através de entrevistas no local com 15 informantes-chave doscentros de serviços de saúde dascomunidades, e de investigações de 328 profissionais médicos, combinado com as teorias de gestão de recursos humanos nacionais e internacionais e as experiências avançadas de gestão de recursos humanos das instituições de serviços de saúde da comunidade, obtendo informações sobre as vantagens e desvantagens na disposição, recrutamento, formação, gestão de desempenho, remuneração e nos subsídios dos recursos humanos em organizações de serviços de saúde da comunidade, e explorandouma estratégia de gestão de recursos humanos para instituições de saúde da comunidade que atende às condições nacionais da China e fornecer uma base teórica para o programa de desenvolvimento dos serviços de saúde da comunidade da China.Os resultados da pesquisa mostram que，em termos de disposição do pessoal médico, a quantidade do pessoal que se destina aos serviços de saúde da comunidade de Guangzhou satisfaz os requisitos elementares para os recursos humanos, no entanto, existem diferenças estruturais de sexo, educação e de títulos profissionais, etc., poranto, a qualidade dos recursos humanos ainda está sujeito a mais melhoramento. Por outro lado, em relação à introdução de talentos, o sistema de recrutamento foi realizado e tem sido amplamente reconhecido pelos médicos, no entanto, devidoàs limitações do sistema de gestão do pessoal médico, mantém difícil introduzir e reter os talentos necessários. No que diz respeito à formação do pessoal médico, a maior parte deles já tinham estabelecido as relações de cooperação comos hospitais do nível 3A e as assiciações da área, mas os conteúdos da formação são uniformes e fragmantários, a atualização do conhecimento também é atrasada, por consequência, ainda não consegue atender aos requisitos dos recursos humanos dos serviços de saúde da comunidade. Toca à gestão de desempenho, o mecanismo de avaliação de desempenho já foi estabelecido, mas não tem um conjunto de indicadores científicos e objetivos para a avaliação do desempenho, portanto, o grau de sistematicidade do mecanismo de avaliação de desempenho ainda está sujeito ao mais aprefeiçoamento

Impact of meteorological disaster shocks and collective action on farmers' adoption of soil and water conservation technologies: evidence from the Loess Plateau, China

IntroductionHighlighting the importance of addressing the meteorological disaster shocks (MDS) experiences of potential adopters, alleviating disaster-induced anxiety, and harnessing risk aversion psychology, along with promoting the essence of collective action, can be crucial in facilitating the adoption of soil and water conservation technologies (SWCT).MethodsThis study delves into the intricate dynamics governing the adoption of SWCT among grain growers. This study draws on field survey data from 1,106 farming households across three provinces. Using a binary Probit model and mediation effect analysis, it explores how MDS and collective action influence farmers' adoption of SWCT.ResultsThe results reveal several key findings. First, MDS significantly and positively affect farmers' adoption of different types of SWCT. Second, collective action also has a significant positive impact on SWCT adoption. Third, collective action mediates the relationship between MDS and SWCT adoption, indicating that part of MDS's influence is transmitted through collective action. Finally, heterogeneity analysis shows that the impact of MDS on SWCT adoption varies significantly across farmer subgroups defined by age, education level, and planting scale. Likewise, government subsidies, total household land management area, and the number of household agricultural machinery significantly affect farmers' decisions to adopt SWCT.Discussion and suggestionsBased on the research, the following suggestions are put forward: promote adaptive technologies and strengthen demonstrations and guidance; improve meteorological early warning, establish a disaster case database, and subsidize disaster-stricken farmers; support cooperatives in participating in technology promotion and reward excellent organizations; for farmers aged 55 and below with low educational levels, promote simple technologies, strengthen training, increase subsidies, and drive adoption through demonstrations; optimize subsidy policies, allocate technologies based on resources, and establish an evaluation mechanism for dynamic policy adjustment

Associations of anxiety and depression with restless leg syndrome: a systematic review and meta-analysis

BackgroundThe levels of anxiety and depression among patients with restless leg syndrome (RLS) are controversial. The aim of this systematic review and meta-analysis was to compare the levels of depression and anxiety among individuals with RLS with those of healthy controls.MethodsWe conducted an extensive electronic search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases from their inception dates to 20 June 2023. Studies presenting data on depression and anxiety in individuals with RLS were included, and a comprehensive meta-analysis was performed.ResultsTwenty-one studies matched the inclusion criteria. Significantly more depressive symptoms were present in the individuals with RLS than in those without RLS, as measured by the Beck Depression Inventory [mean difference (MD) = 6.58, 95% confidence interval (CI) = 5.54–7.62, p < 0.01; heterogeneity I2 = 0%, p = 0.99]. Similarly, the results from the Beck Anxiety Inventory indicated that there were significantly more pronounced anxiety symptoms in the individuals with RLS than in those without RLS (MD = 9.30, 95%CI = 7.65–10.94, p < 0.01; heterogeneity I2 = 0%, p = 0.92). The other anxiety and depression scales also yielded statistically significant results. Significant heterogeneity was observed in the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, with the primary contributing factor probably being the scoring criteria of the scales.ConclusionThis meta-analysis found that the levels of depression and anxiety symptoms were significantly higher in individuals with RLS than in their healthy counterparts.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023410364, (identifier CRD42023410364)

Nanoparticles Containing Anti-inflammatory Agents as Chemotherapy Adjuvants II: Role of Plasma Esterases in Drug Release

The pre-administration of the anti-inflammatory drugs dexamethasone (DEX) and cortisone acetate reduces toxicity and enhances efficacy of anticancer agents in murine models and in human clinical trials (1–5). We previously reported on the formulation of the lipophilic dexamethasone palmitate ester (DEX-P) in nanoparticles (NPs) employing a microemulsion template engineering technique to achieve tumor-specific delivery of dexamethasone (6). The nanoparticles exhibited significantly enhanced stealth properties as indicated by reduced macrophage uptake and decreased adsorption of opsonin proteins in in vitro assays (6). Unexpectedly, preliminary biodistribution studies of NPs containing [3H]-DEX-P in tumor-bearing mice showed that the radiolabel was cleared from the circulation rapidly and exhibited high liver uptake. Our previous in vitro release studies demonstrated that rapid release of the radiolabel from the NPs was observed when 10% mouse plasma was used as the medium, while nominal release was observed in phosphate-buffered saline (PBS) buffer (6). Esterolysis of NP-associated DEX-P was presumed to be the main cause for the rapid drug release in plasma, as most of the released radioactivity was in the form of DEX and not DEX-P. High degradation rates of ester prodrugs in rodent plasma has been attributed to increased esterase activity, while only minimal degradation in human plasma has been observed (7–9). Based on our observation of the release of [3H]-DEX from NPs in mouse plasma, we studied the release of DEX from nanoparticles in various plasma sources as a guide for the design of future in vivo experiments

High Payload Dual Therapeutic-Imaging Nanocarriers for Triggered Tumor Delivery

The in vitro and in vivo characterization of an optimized formulation of nanoparticles (NPs) loaded with a high content of dexamethasone palmitate (DEX-P), a chemotherapeutic adjuvant that decreases interstitial fluid pressure in tumors, and 111In, a signaling agent, is described. These NPs are uniform in size and composition. Single photon emission computed tomography imaging demonstrates significant tumor uptake of 111In-labeled DEX-P NPs in tumor-bearing mice. As with many nanoparticle-based drug delivery systems, significant liver accumulation is observed. Assessment of liver histology and blood tests show no apparent hepatic or renal toxicity of the DEX-P NPs. Conversion of DEX-P to DEX occurs when DEX-P NPs are incubated with mouse plasma, human tumor homogenate and ascites from tumor bearing mice, but not with human plasma. This conversion is slower in plasma from Es1e(−/−)/SCID mice, a potential alternative animal model that better mimics humans; however, plasma from these mice are not completely devoid of esterase activity. The difference between blood and tumor esterase activity in humans facilitates the delivery of DEX-P NPs to tumors and the release of dexamethasone by an esterase trigger

On the origin and evolutionary consequences of gene body DNA methylation

In plants, CG DNA methylation is prevalent in the transcribed regions of many constitutively expressed genes (gene body methylation; gbM), but the origin and function of gbM remain unknown. Here we report the discovery that Eutrema salsugineum has lost gbM from its genome, to our knowledge the first instance for an angiosperm. Of all known DNA methyltransferases, only CHROMOMETHYLASE 3 (CMT3) is missing from E. salsugineum Identification of an additional angiosperm, Conringia planisiliqua, which independently lost CMT3 and gbM, supports that CMT3 is required for the establishment of gbM. Detailed analyses of gene expression, the histone variant H2A.Z, and various histone modifications in E. salsugineum and in Arabidopsis thaliana epigenetic recombinant inbred lines found no evidence in support of any role for gbM in regulating transcription or affecting the composition and modification of chromatin over evolutionary timescales

Enzyme-Nanoporous Gold Biocomposite: Excellent Biocatalyst with Improved Biocatalytic Performance and Stability

Background: Applications involving biomolecules, such as enzymes, antibodies, and other proteins as well as whole cells, are often hampered by their unstable nature at extremely high temperature and in organic solvents. Methodology/Principal Findings: We constructed enzyme-NPG biocomposites by assembling various enzymes onto the surface of nanoporous gold (NPG), which showed much enhanced biocatalytic performance and stability. Various enzymes with different molecular sizes were successfully tethered onto NPG, and the loadings were 3.6, 3.1 and 0.8 mg g 21 for lipase, catalase and horseradish peroxidase, respectively. The enzyme-NPG biocomposites exhibited remarkable catalytic activities which were fully comparable to those of free enzymes. They also presented enhanced stability, with 74, 78 and 53 % of enzymatic activity retained after 20 successive batch reactions. Moreover, these novel biocomposites possessed significantly enhanced reaction durability under various thermal and in organic solvent systems. In a sample transesterification reaction, a high conversion rate was readily achieved by using the lipase-NPG biocomposite. Conclusion/Significance: These nano-biocomposite materials hold great potential in applications such as biosensing, molecular electronics, catalysis, and controlled delivery

Overcoming Wnt–β-catenin dependent anticancer therapy resistance in leukaemia stem cells

Leukaemia stem cells (LSCs) underlie cancer therapy resistance but targeting these cells remains difficult. The Wnt–β-catenin and PI3K–Akt pathways cooperate to promote tumorigenesis and resistance to therapy. In a mouse model in which both pathways are activated in stem and progenitor cells, LSCs expanded under chemotherapy-induced stress. Since Akt can activate β-catenin, inhibiting this interaction might target therapy-resistant LSCs. High-throughput screening identified doxorubicin (DXR) as an inhibitor of the Akt–β-catenin interaction at low doses. Here we repurposed DXR as a targeted inhibitor rather than a broadly cytotoxic chemotherapy. Targeted DXR reduced Akt-activated β-catenin levels in chemoresistant LSCs and reduced LSC tumorigenic activity. Mechanistically, β-catenin binds multiple immune-checkpoint gene loci, and targeted DXR treatment inhibited expression of multiple immune checkpoints specifically in LSCs, including PD-L1, TIM3 and CD24. Overall, LSCs exhibit distinct properties of immune resistance that are reduced by inhibiting Akt-activated β-catenin. These findings suggest a strategy for overcoming cancer therapy resistance and immune escape