Elderly hospitalization and the New-type Rural Cooperative Medical Scheme (NCMS) in China: multi-stage cross-sectional surveys of Jiangxi province

Studies assessing the impacts of China's New-type Rural Cooperative Medical Scheme (NCMS) reform of 2003 among rural elderly have been limited. Method: Multistage stratified cluster sampling household surveys of 1838, 1924, 1879, 1888, 1890 and 1896 households from 27 villages in Jiangxi province were conducted in 2003/2004, 2006, 2008, 2010, 2012 and 2014. Data from older adults age 65 and above were analyzed. Weighted logistic regression was applied to find factors of elderly hospitalization services. Results: Since 2003, hospitalization rates for elderly increased, while rates of patients leaving against medical advice and patients avoiding the hospital decreased (P < 0.05). Factors associated with a higher likelihood of reporting hospitalization in the past year for elderly were the per-capita financial level V in 2012 for NCMS (Adjusted Odds Ratios [aOR]: 2.295), the level VI in 2014 (aOR: 3.045) versus the level I in 2003 and chronic disease (aOR: 2.089) versus not having a chronic disease. Lower rate of elderly left against medical advice was associated with the financial level V in 2012 (aOR: 0.099) versus the level I. The higher rate of hospital avoidance was associated with chronic disease status (aOR: 5.759) versus not having a chronic disease, while the lower rate was associated with the financial level VI in 2014 (aOR: 0.143) versus the level I. Among reporting reasons for elderly hospital avoidance, the cost-related reasons just dropped slightly over the years. Conclusions: NCMS improved access to health services for older adults. The utilization of hospitalization services for rural elderly increased gradually, but cost-related barriers remained the primary reporting barrier to accessing hospitalization services

The Association between Family and Parental Factors and Obesity among Children in Nanchang, China

Background: With rapid economic development in China, traditional patterns of health behaviors are changing, concurrent with a rise in childhood obesity. While the home environment and parenting behaviors are modifiable factors that could be targeted for intervention, little is known about their relationship with children’s health behaviors. Therefore, the purpose of this study was to investigate the relationship between obesity and home and parenting factors in Chinese children. Methods: A cross-sectional survey was conducted in Nanchang, China in 2013 with caregivers (N = 470) of a child between the ages of 2-10 years. Regression analyses were conducted to determine risk factors for childhood obesity. Results: Obesity prevalence (21.7%) did not differ by demographic variables. Eight physical activity, nutrition, and sedentary variables had significant relationships to obesity status. Logistic regression analysis revealed three significant predictors of obesity: the number of days the family eats meals together (odds ratio = 0.84, 95% CI 0.73-0.96) and parental home computer use time (odds ratio = 0.83, 95% CI 0.72-0.96) were related to lower levels of obesity, while parental television time (odds ratio = 1.25 95% CI 1.07-1.47) was related to higher levels of obesity. Conclusions: The prevalence of obesity among children is high in Nanchang. Family and environmental risk factors are significantly related to obesity

Impact of the New Cooperative Medical Scheme on the Rural Residents’ Hospitalization Medical Expenses: A Five-Year Survey Study for the Jiangxi Province in China

This survey study was conducted to understand the effect of the New Cooperative Medical Scheme (NCMS) on farmers&rsquo; medical expenses through comparing the information from five investigations and to obtain a scientific basis for a more applicable NCMS. The survey was carried out through interviewing farmers in their homes. The multi-phase stratified cluster random sampling was adopted to select 3 counties from all 92 counties of the Jiangxi province, 9 townships from the 3 selected counties, 27 villages from the selected 9 townships, and 60 families from each village between 2006 and 2014, and a longitudinal comparative analysis was conducted. The numbers of households/overall sample for the five years were 1924/8082, 1879/8015, 1885/7506, 1890/7857, and 1896/7811, respectively. We collected family members&rsquo; social demographic characteristics, health resources, and peoples&rsquo; health and medical expenses and reimbursement of each family member. The adjusted hospitalization expenses per capita of township hospitals and county hospitals were totally on a rising trend. However, the costs of tertiary hospitals were on a decreasing tendency. In addition, the expenses for county hospitalization per admission were on an upward trend in general. Furthermore, the total hospitalization expenses and reimbursement per capita (the insurance paid out for the hospitalization expenses) were also all on an upward trend. The proportion of reimbursement also had a tendency of increasing from 24.41% in 2006 to 41.34% in 2014. The costs paid from farmers&rsquo; pockets were fluctuated, but in general all lower than the costs in 2006. Furthermore, the percentage of hospitalization expenses from farmers&rsquo; annual incomes gradually decreased each year from 56.38% in 2006 to 26.58% in 2014. NCMS program has had an obvious impact on the hospitalization expenses in the Jiangxi rural area. It reduced the hospitalization expenses of the tertiary hospitals significantly. In addition, the program has also encouraged farmers to get more health care. However, there are still some shortages associated with present construction of the NCMS. Hence, there is a need for local government to continue to take effective countermeasures to control the rising trend of hospitalization expense

Social Capital Associated with Quality of Life among People Living with HIV/AIDS in Nanchang, China

Background: This study aims to explore the relationship between quality of life (QOL) and social capital factors among &ldquo;people living with HIV/AIDS&rdquo; (PLWHA), in order to improve their quality of life and help them to release AIDS discrimination. Methods: A cross-sectional survey with 225 PLWHA was done in Nanchang, China, between January and June of 2015. Questionnaires consisted of a socio-demographic questionnaire, Personal Social Capital Scale and Medical Outcomes Study HIV Health Survey. To identify social capital factors influencing QOL among PLWHA, t-test and multiple linear regression were used as statistical tools. The analysis of data was conducted using SPSS 22.0 with a significant value of p &lt; 0.05. Results: The scores of total social capital, bonding social capital and bridging social capital were 23.68 &plusmn; 5.55, 14.11 &plusmn; 3.40 and 9.46 &plusmn; 3.43 respectively. The scores of Physical Health Summary (PHS) and Mental Health Summary (MHS) were 51.88 &plusmn; 7.04 and 49.29 &plusmn; 6.60. Multiple linear regression analysis showed that age (B = &minus;0.137, p = 0.020), income (B = 0.2170, p &le; 0.001), employment (B = 0.112, p = 0.043) and bonding social capital (B = 0.178, p = 0.001) had significant effects on PHS. Bonding social capital was the most important influencing factor for MHS (B = 0.506, p &lt; 0.001). There was no significant relationship between bridging social capital and QOL (p &gt; 0.05). Conclusions: The PLWHA community has low social capital and a poor QOL in Nanchang. Bonding social capital had a positive impact on the QOL of PLWHA. There is an urgent need to build a better social support system based on bonding social capital for PLWHA. It is worth further exploring to identify how to make full use of bridging social capital for improving QOL among PLWHA

Willingness to Pay for Improved Air Quality and Influencing Factors among Manufacturing Workers in Nanchang, China

(1) Background: Air quality apt to deteriorate in decades in China, people are seeking improvement measures. To assess the willingness to pay (WTP) for improved air quality among manufacturing workers and associated factors influencing their WTP. (2) Methods: A cross-sectional questionnaire survey was conducted in combination with contingent valuation in Nanchang between September and October of 2015. A face-to-face interview was conducted to obtain basic demographic information from manufacturing workers and to understand their WTP for air quality improvement. (3) Results: A total of 600 effective questionnaires were collected in this study and showed that more than half of the respondents (53%) expressed their WTP for improved air quality. Multivariable logistic regression analysis revealed that the main factors associated with manufacturing workers&rsquo; WTP were their residence areas, education level, annual household income and travel experience. (4) Conclusions: These findings have provided (a) important information of the concern and desire for air pollution control through their WTP from manufacturing workers, (b) baseline information for the policy-maker and local government for their development of more effective policy in air pollution prevention and control and (c) the need for more study for WTP among different population groups in future

Hospitalization Services Utilization Between Permanent and Migrant Females in Underdeveloped Rural Regions and Contributing Factors—A Five-Time Data Collection and Analysis

The proportion of migrating females has increased, and more often, old females are left in rural regions. Resources are needed to provide suitable hospitalization service to females in underdeveloped rural regions. Using multi-stage hierarchical cluster random sampling method, nine towns from three counties were enrolled in five-time points between 2006 and 2014 in this study. The research subjects of this study were females age 15 and up. Data regarding the utilization of inpatient services were collected and analyzed. Complex sampling logistic regression was conducted to analyze influencing factors. This study reveals that for both permanent females and migrant females, the older their age, the higher their hospitalization rate. The utilization of hospitalization service for permanent females was associated with the occurrence of chronic diseases (adjusted Odds Ratio (aOR) = 5.402). In addition, permanent females suffering from chronic diseases were more likely to avoid hospitalization despite their doctor&rsquo;s advice (aOR = 34.657) or leave the hospital early against medical advice (AMA) (aOR = 10.009). Interventions to combat chronic diseases and adjust compensation schemes for permanent females need to be provided

Physical activity and park use of youth in Nanchang, China

Physical inactivity is a growing issue in Chinese youth, but parks can facilitate traditional and non-traditional forms of physical activity for little to no cost. Despite this opportunity, very little is known regarding park use among Chinese youth. The purpose of this study was to conduct a cross-sectional observational study of park usage and physical activity of youth in municipal parks in Nanchang, China. Data were collected in June of 2014 in eight parks across Nanchang, Jiangxi a large city in southeast China. Physical activity was measured by a modified version of System for Observing Play and Recreation in Communities. Ordered hierarchic generalized linear models were estimated using a logit link function. The influence of the park was estimated using random effects, with fixed effects and park, environmental, and park user characteristics. Youth were most often seen active in the afternoon, on weekends, and during cooler times (≤29°C). Paradoxically, more children were active when air quality was poorer. Older boys were more active than younger boys, but no differences were observed in girls. More children were seen active in unstructured play compared to structured activities. The results suggest parks are an important setting for physical activity among Chinese youth, and that unstructured activities can play an important role in promoting greater youth physical activity. Keywords: Exercise, Adolescent, Recreatio