Behavioral/Cognitive Acute and Long-Term Suppression of Feeding Behavior by POMC Neurons in the Brainstem and Hypothalamus, Respectively

POMC-derived melanocortins inhibit food intake. In the adult rodent brain, POMC-expressing neurons are located in the arcuate nucleus (ARC) and the nucleus tractus solitarius (NTS), but it remains unclear how POMC neurons in these two brain nuclei regulate feeding behavior and metabolism differentially. Using pharmacogenetic methods to activate or deplete neuron groups in separate brain areas, in the present study, we show that POMC neurons in the ARC and NTS suppress feeding behavior at different time scales. Neurons were activated using the DREADD (designer receptors exclusively activated by designer drugs) method. The evolved human M3-muscarinic receptor was expressed in a selective population of POMC neurons by stereotaxic infusion of Cre-recombinase–dependent, adenoassociated virus vectors into the ARC or NTS of POMC-Cre mice. After injection of the human M3-muscarinic receptor ligand clozapine-N-oxide (1 mg/kg, i.p.), acute activation of NTS POMC neurons produced an immediate inhibition of feeding behavior. In contrast, chronic stimulation was required for ARC POMC neurons to suppress food intake. Using adeno-associated virus delivery of the diphtheria toxin receptor gene, we found that diphtheria toxin–induced ablation of POMC neurons in the ARC but not the NTS, increased food intake, reduced energy expenditure, and ultimately resulted in obesity and metabolic and endocrine disorders. Our results reveal different behavioral functions of POMC neurons in the ARC and NTS, suggesting that POMC neurons regulate feeding and energy homeostasis by integrating long-term adiposity signals from the hypothalamus and short-term satiety signals from the brainstem

Evaluation of a village-based digital health kiosks program: A protocol for a cluster randomized clinical trial

Background To address disparities in healthcare quality and access between rural and urban areas in China, reforms emphasize strengthening primary care and digital health utilization. Yet, evidence on digital health approaches in rural areas is lacking. Objective This study will evaluate the effectiveness of Guangdong Second Provincial General Hospital's Digital Health Kiosk program, which uses the Dingbei telemedicine platform to connect rural clinicians to physicians in upper-level health facilities and provide access to artificial intelligence-enabled diagnostic support. We hypothesize that our interventions will increase healthcare utilization and patient satisfaction, decrease out-of-pocket costs, and improve health outcomes. Methods This cluster randomized control trial will enroll clinics according to a partial factorial design. Clinics will be randomized to either a control arm with clinician medical training, a second arm additionally receiving Dingbei telemedicine training, or a third arm with monetary incentives for patient visits conducted through Dingbei plus all prior interventions. Clinics in the second and third arm will then be orthogonally randomized to a social marketing arm that targets villager awareness of the kiosk program. We will use surveys and Dingbei administrative data to evaluate clinic utilization, revenue, and clinician competency, as well as patient satisfaction and expenses. Results We have received ethical approval from Guangdong Second Provincial General Hospital (IRB approval number: GD2H-KY IRB-AF-SC.07-01.1), Peking University (IRB00001052-21007), and the University of North Carolina at Chapel Hill (323385). Study enrollment began April 2022. Conclusions This study has the potential to inform future telemedicine approaches and assess telemedicine as a method to address disparities in healthcare access. Trial registration number: ChiCTR210005387

Seasonal influenza vaccination coverage rate of target groups in selected cities and provinces in China by season (2009/10 to 2011/12).

BackgroundThe objectives of the survey were to identify the level of influenza vaccination coverage in China in three influenza seasons 2009/10 to 2011/12, and to find out potential predictors for seasonal influenza vaccination.MethodsIn September and October 2011, representative urban household telephone surveys were conducted in five provinces in China with a response rate of 6%. Four target groups were defined for analysis: 1) children ≤ 5 years old; 2) elderly persons aged ≥ 60 years old; 3) health care workers (persons working in the medical field) and 4) chronically ill persons.ResultsThe overall mean vaccination rate was 9.0%. Among the four target groups, the rate of vaccination of children aged ≤ 5 years old (mean = 26%) was highest and the rate of elderly people aged ≥ 60 years old (mean = 7.4%) was the lowest, while the rates of persons who suffer from a chronic illness (mean = 9.4%) and health care workers (9.5%) were similar. A subsidy for influenza vaccination, age group, health care workers, suffering from a chronic illness and living in Eastern China were independent significant predictors for influenza vaccination.ConclusionsThe seasonal influenza vaccination coverage rates among urban populations in selected cities and provinces in China were far below previously reported rates in developed countries. Influenza vaccination coverage rates differed widely between different target groups and provinces in China. Subsidy policy might have a positive effect on influenza vaccination rate, but further cost-effectiveness studies, as well as the vaccination rate associated factors studies are still needed to inform strategies to increase coverage

Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study

BackgroundThe shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. ObjectiveWe aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. MethodsOur study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. ResultsA total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. ConclusionsThis study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support

Multivariate analyses results of predictors for seasonal influenza vaccination in three seasons (2009/10–2011/12)^*.

<p>C.I.: Confidence Interval.</p><p>OR: Odds ratio.</p>*<p>All variables, including age group, sex, health care workers, suffering from a chronic illness, location and city category, and subsidy policy, were included for the full model regression analyses in the multivariable analysis.</p>†<p>Reference category: people 15–59 years old.</p>‡<p>Reference category: Small City.</p

Overview of study participants.

<p>Overview of study participants.</p