Basic Public Health Research Articles

Bolstering the Public Health Workforce: Recruitment and Retention of Public Health Majors

Undergraduate public health programs play a dual role in training the next generation of public health professionals while equipping nonmajors with basic public health knowledge. Our study aimed to understand if introductory public health courses were effective for recruitment and retention of majors. We used 5 years of institutional data to explore the public health course-taking and major enrollment patterns for students who enrolled in two introductory public health courses at a research-intensive, minority-serving institution. For students who enrolled in Principles of Public Health (PH1), 73% went on to take one or more additional public health courses. Trends show that most took Case Studies in Public Health Practice (PH2) after PH1 during their first 2 years in college, and the majority of nonmajors who took PH1 in their second year enrolled in PH2 within one quarter. Seventy-two percent of students who enrolled in both PH1 and PH2 graduated in public health regardless of their major at entry to the university, and 77% of public health graduates joined through a change of major. Importantly, 19% of all students took at least one public health course. Enrollment in both PH1 and PH2 may be important for major recruitment and retention, and efforts to encourage students to consider or stay in the public health major during these courses should be considered. Our analyses highlight that introductory public health courses provide critical opportunities for students to learn about public health and may serve as gateways to the major and possibly a public health career.

Cross-sectional study of factors affecting the receipt of mental health education in older migrants in China

BackgroundPopulation migration in China has increasingly included middle-aged and older populations. Relatedly, the lack of mental health education among China’s older migrants is still an important but neglected problem. This study aimed to understand the current situation of mental health education received by the older migrant population in China and to explore related influencing factors.MethodsThis cross-sectional study included 5729 older migrants who participated in the 2017 China Migrants Dynamic Survey. The independent variables included four components: demographic and socioeconomic characteristics, migration factors, public health service utilization, and social integration factors. Data were analyzed using the chi-square test for single factors and a binary logistic regression model for multiple factors.ResultsA total of 1749 older migrants received mental health education, for a receipt rate of 30.53%. Regression analysis showed that older migrant individuals who had an average monthly household income > 3000 CNY, self-rated their health as healthy, had chronic diseases, had heard of National Basic Public Health Services, had established health records, received ≥2 types of health education were willing to integrate into the local population, and were highly involved in the community were more likely to receive mental health education. Older migrants who were ≥ 70 years old, had an elementary school education or below, had difficulties in the local community, had migrated ≥11 years prior, moved for their offspring, and moved across provinces were less likely to receive mental health education.ConclusionsThe older migrant population does not receive sufficient mental health education. Mental health interventions should be tailored to the characteristics of older migrants to increase their mental health literacy and meet their psychological needs.

Effectiveness and cost-effectiveness of a group-based intervention to improve social-emotional development of young children in poverty-stricken areas: A cluster randomized controlled trial.

Social-emotional ability is key to the well-being and future success of children; however, disparities in social-emotional development during an individual's early age can last a lifetime, which is particularly evident among children living in poverty-stricken areas. We aimed to determine the effectiveness, cost-effectiveness, and feasibility of a group-based intervention called the Care Group on social-emotional development for families living in poverty-stricken counties. We conducted a cluster (township) randomized controlled trial (C-RCT) every two weeks from July 2019 to June 2020 in a poverty-stricken area located in Shanxi, China. The outbreak of the COVID-19 pandemic suspended the implementation of the intervention in January 2020. The caregiver-child pairs in the intervention group participated in 12 group-based sessions with a structured curriculum and learning materials emphasizing nurturing ability and early childhood development. We applied a difference-in-differences (DID) model to estimate the intervention's impact. The analysis follows the intention-to-treat (ITT) principle. We used standard economic costing methods to estimate the cost of implementing the Care Group over the intervention period and adopted a societal perspective in the analysis. We included 322 eligible caregiver-child pairs in the baseline (intervention n = 136, control n = 186) and surveyed 258 pairs in the endline (intervention n = 117, control n = 141). Compared with the control group, children in the intervention group had significantly fewer social-emotional problems (adjusted mean difference of Z score = -0.374, 95% CI = -0.718, -0.030, P = 0.033) six months after intervention. In the first year, the annual cost of implementing Care Group was US$146.10 per child, reduced to US$47.20 per child in the second year due to the exclusion of non-recurrent costs. The incremental cost-effectiveness ratio (ICER) was US$390.60. Care Group is an effective approach for promoting children's social-emotional development in poverty-stricken areas at an affordable cost and with high feasibility for scale-up. Considering the planned per capita health expenditure of the Chinese government for 2022, we believe that the presented evidence makes a solid scientific and financial case for integrating the Care Group intervention into the basic public health services (BPHS) package. Chinese Clinical Trials Registry (ChiCTR): ChiCTR1900022894.

Estimation of the population, death, and quality of life in Shaanxi Province, western China: a cross-sectional study.

Measuring the health of the population is of great significance to the development of a region. We aimed to estimate the population, probability of death, and quality of life in western China. We calculated the age-specific mortality rate and prevalence rate of diseases and injuries using the Full Population Database and the Home Page of Inpatient Medical Record. We used multiple interpolation methods to insert missing information from the death data and the model of Kannisto to adjust the mortality rate for elderly individuals. The age-specific prevalence rate of diseases and injuries was adjusted according to the standard ratio of age and methods of equal proportional allocation. Life expectancy was calculated by a life table, and the quality of life was estimated using the Sullivan method. The total population continued to increase in 2015 to 2019 in the Shaanxi Province, China. The mortality rate of children under five has improved, and the mortality rate of people over 65 is decreasing year by year. Life expectancy increased from 74.66 years in 2015 to 77.19 years in 2019. Even with the total risk of disease and injury, the health-adjusted life expectancy increased by 1.90 years within 5 years, and the number of unhealthy years significantly improved. Health-adjusted life expectancy increased by 1.75 years when only considered the ten major disease systems (tumors; endocrinology, nutrition and metabolism; mental and behavioral disorders; nervous system; sensory diseases; circulatory system; respiratory system; digestive system; genitourinary system; musculoskeletal system and connective tissue), and the number of unhealthy years increased slightly. In the past five years, Shaanxi Province has made progress in improving life expectancy and controlling the development of chronic diseases. It is necessary to take specific preventive measures and improve the quality of basic public health services.

Unlocking life-threatening COVID-19 through two types of inborn errors of type I IFNs.

Since 2003, rare inborn errors of human type I IFN immunity have been discovered, each underlying a few severe viral illnesses. Autoantibodies neutralizing type I IFNs due to rare inborn errors of autoimmune regulator (AIRE)-driven T cell tolerance were discovered in 2006, but not initially linked to any viral disease. These two lines of clinical investigation converged in 2020, with the discovery that inherited and/or autoimmune deficiencies of type I IFN immunity accounted for approximately 15%-20% of cases of critical COVID-19 pneumonia in unvaccinated individuals. Thus, insufficient type I IFN immunity at the onset of SARS-CoV-2 infection may be a general determinant of life-threatening COVID-19. These findings illustrate the unpredictable, but considerable, contribution of the study of rare human genetic diseases to basic biology and public health.

The Impact of Basic Public Health Services on Migrant Peasant Workers’ Urban Integration: Evidence from China

The key to promoting urbanization in China is to achieve urban integration of migrant peasant workers, and basic public health services may have a potential social impact on the subjective welfare of migrant peasant workers. In this paper, we use data from the China Migrants Dynamic Survey (CMDS) to study the impact of basic public health services on the urban integration of migrant peasant workers. The results show that basic public health services can significantly improve the probability of migrant peasant workers’ urban integration. The conclusions remain robust after mitigating potential endogeneity issues using the propensity score matching method (PSM), the CMP method, and robustness testing by replacing the explanatory variables with the reduced tail treatment. Further research found that the impact of basic public health services on migrant peasant workers’ urban integration is heterogeneous. The urban integration effect of basic public health services is more significant in male, high school and above, migrant peasant workers’ groups. The urban integration effect of basic public health services gradually increases with upgrading of the urban grade at the second-tier city and higher urban levels, and it also plays a vital role in the urban integration of the migrant peasant workers at the third-tier city and lower urban levels. Our findings also provide an evidence-based policy for China to promote equalizing basic public health services and a path to the urbanization of migrant peasant workers.

Does China’s Equalization of Basic Public Health Services policy improve delivery care for migrant women?

BackgroundAs of 2020, 1 in 4 people in China is a domestic migrant. However, their lack of access to health care in destination cities has been largely neglected by the Chinese government until recently.MethodsDrawing on data from the 2010–2016 China Migrants Dynamic Survey, this study evaluated the impact of a pilot program of the Equalization of Basic Public Health Services launched in 2014 and focused on place of childbirth, an important indicator of delivery care. A difference-in-differences design was employed for statistical inference.ResultsThe migrant pilot program increased the likelihood of a migrant childbirth at a migration destination by about 4 to 8 percentage points, depending on the model specification. Further analyses revealed that this positive effect was short-term and benefited relatively better-off migrant families.ConclusionThe migrant pilot program improved delivery care for migrant women. The Chinese government needs to expand this pilot program to more cities and improve its benefits to better serve the massive migrant population.

PS-BPP06-3: NON-HIGH-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS AS A RISK FACTOR FOR SHORT-TERM MORTALITY IN ELDERLY CHINESE: A POPULATION-BASED COHORT STUDY

Background: Non-high density lipoprotein (non-HDL) levels were an important predictor of cardiovascular disease risk. However, it is unclear the relationship between non-HDL and mortality risk. This study explores the relationship between non-high-density lipoprotein levels and the risk of mortality, and the impact on long-term and short-term mortality risk. Methods: We analysis 621,164 elderly individuals from healthcare management receiving check-up in China basic public health service in 2010–2020. We analyzed the non-linear rela-tionship between non-HDL and all-cause and cause-specific mortality in patients receiving lipid-lowering treatment or not. Finally, the relationship between non-HDL and long-term or short-term mortality was investigated. Results: 26,758 (4.3%) deaths were recorded at a mean follow-up of 2.03 years. The association between non-HDL and mortality was non-linear for elderly individuals. After multivariable adjustment, individuals with non-HDL < 3.29 mmol/L and > = 4.85 mmol/L increase the risk of all-cause mortality and cardiovascular mortality compared to non-HDL of 3.29 - 4.85 mmol/L. Only non-HDL < 3.29 mmol/L significantly increase the risk of cancer mortality (HR: 1.11; 95% CI: 1. 04 - 1.18, P < 0.001) and other mortality (HR: 1.16; 95% CI: 1.10 - 1.22, P < 0.001). Non-optimal concentrations of non-HDL had significant effects on both the long-term and the short-term risk of mortality, but the effect was more powerful for short-term (3 months) mortality. The non-optimal concentrations of non-HDL significantly in-creased the risk of all-cause mortality, cardiovascular mortality, and cancer mortality within 3 months. The association between non-HDL and all-cause and cause-specific mortality was not statistically significant in the elderly population receiving lipid-lowering treatment. Conclusions: Non-HDL was non-linearly associated with the risk of mortality, and non-optimal con-centrations of non-HDL significantly increased short-term mortality in elderly Chinese. As the possibility of confounding may exist, further research is necessary.

PS-C31-9: A RANDOMISED TRIAL OF THE TRADITIONAL CHINESE MEDICINE (TCM) CONSTITUTION-BASED DIETARY REGIME IN GRADE 1 HYPERTENSIVE PATIENTS: RATIONALE AND DESIGN

Background and Objective: Cardiovascular disease (CVD) represents enormous challenges to population health. Body constitution, from the perspective of traditional Chinese medicine (TCM), differentiates how individuals feel and behave, and ultimately affects how different bodies respond to dietary intake. We hypothesise that the TCM constitution-based dietary intervention would be an effective approach to achieving favourable clinical and TCM-related outcomes when compared to usual care alone among the Chinese grade 1 hypertensive patients. Design and method: This is a parallel-group, randomised trial (registered as ChiCTR2000034749; http://www.chictr.org.cn). Participants consist of 274 primary care adults, aged 35 years or older, with uncomplicated grade 1 hypertension and at low risk of cardiovascular and renal events. Participants will be randomly assigned to either control or intervention group with a 1:1 allocation as per computer-generated random numbers. Permuted blocks of random sizes will be used. Subjects in the invention group will receive an on-site constitution assessment based on physical signs, personality, body symptoms, and the susceptibility to environmental changes. This will be conducted by the attending TCM practitioners trained in a prior session to improve the inter-rater reliability. A colour-printed constitution-specific brochure will be provided onsite. Health education materials will be made available to patients by courier service thereafter. All participants receive routine care provided by the ‘family doctor team’ in the context of the national basic public health service delivery. Measurements will be undertaken at three time-points, i.e., at baseline, at 6- and 12-month follow-ups. At each follow-up interview, subjects in the intervention group will be questioned about the constitution types of their own, and a full awareness of the constitution profile will be seen as an adherence to the protocol. Results and outcome evaluation: The primary outcome of the study is the difference between the two arms in the proportion of participants who had optimal control of blood pressure at 12 months. A point estimate of 25% inferiority in effectiveness would be acceptable assuming a gain that is considered to be clinically relevant. The secondary outcome measures include differences in the profile of clinical parameters and TCM symptoms between the two arms. Conclusions: We believe that this study offers new insights for cardiovascular health management through TCM constitution-based strategies in primary care settings to target those who need continuous attention in dietary modifications. The findings may advance our knowledge of the practical contribution of complementary and alternative medicine in the prevention and control of CVD.

Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the "BPHS"?

To alleviate the rising mortality burden due to hypertension and other non-communicable diseases, a new public health policy initiative in 2009 called the Basic Public Health Services (BPHS). Program was introduced by the Chinese government. The goal of the study is to assess the feasibility and impact of a nationwide health care service-the "BPHS". From January to December 2021, a stratified multistage random sampling method in the survey was conducted to select 6,456 people from 8 cities/districts in Yunnan Province, China, who were above the age of 35 years. 1,521 hypertensive patients were previously aware of their high blood pressure status were matched to the BPHS program database based on ID number and then further divided into BPHS group and non-BPHS (control) group. The results of the current study are based on their responses to a short structured questionnaire, a physical examination, and laboratory tests. The association between BPHS management and its effect on the control of hypertension was estimated using multivariable logistic regression models. We evaluated the accessibility and efficacy of BPHS health care services by analyzing various variables such as blood pressure, BMI, lifestyle modification, anti-hypertensive drugs taken, and cardiovascular risk factors. Among the 1,521 hypertensive patients included in this study, 1,011 (66.5%) were managed by BPHS programme. The multivariable logistic regression model demonstrated that the BPHS facilitated hypertension control (OR = 1.640, 95% CI: 1.237-2.175). A higher proportion of participants receiving lifestyle guidance from the BPHS management showed lowering of total cholesterol. In comparison to the non-BPHS group, those under BPHS management adhered better to antihypertensive medications either single drug (54.3%) or in combination (17.3%) of drugs. Additionally, we also noticed that urban areas with centralized and well-established digital information management system had better hypertension treatment and control. Nearly two-thirds of the hypertensive patients in Yunnan Province were included in BPHS management. The impact of the national BPHS program was evident in lowering risk factors for cardiovascular diseases, promoting healthy lifestyles, lowering blood pressure, increasing medication adherence, and the better control rate of hypertension.

Trends and Comparisons of Blood Pressure and Fasting Plasma Glucose in Patients with Hypertension, Diabetes, and Comorbidity: 4-Year Follow-Up Data.

Patients with both diabetes and hypertension could face more health risks than those with either condition alone, and less attention has been paid to their management outcomes, so this study may be the first to specifically address this problem. We aimed to examine the management outcomes of blood pressure (BP) in hypertensive patients with/without diabetes and fasting plasma glucose (FPG) in diabetic patients with/without hypertension. Follow-up data were obtained from the National Basic Public Health Service Project in Sanming (2017-2021). A total of 25,795 adults with hypertension only, 4111 adults with diabetes only, and 5729 comorbid adults (namely, hypertensive patients with diabetes) were included. Generalized estimating equations were applied. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension only both dropped significantly (Coef. = -0.00088, P < 0.001; Coef. = -0.00081, P < 0.001). DBP in comorbid patients decreased considerably (Coef. = -0.00033, P < 0.001). Pulse pressure in comorbid patients grew rapidly (Coef. = 0.00044, P < 0.001). BP control rate in patients with hypertension only increased significantly (OR = 1.00039, P < 0.001). FPG control rates in diabetic patients with/without hypertension grew markedly (OR = 1.00013, P < 0.001; OR = 1.00020, P < 0.001). Comorbid patients had lower baseline SBP and DBP but higher latest SBP than patients with hypertension only (Coef. = -1.18872, P < 0.001; Coef. = -1.16049, P < 0.001; Coef. = 1.0634, P < 0.001). Comorbid patients had lower baseline BP and FPG control rates than those with either condition alone, and differences were greater at the latest follow-up (OR = 0.28086, P < 0.001; OR = 0.91012, P = 0.049; OR = 0.04020, P < 0.001; OR = 0.69465, P < 0.001). BP and FPG management outcomes have achieved progress. Comorbid patients have poorer performance than patients with either disease alone in BP levels especially the SBP level and control rates of SBP, DBP, and FPG. Future studies should be conducted using national data and include more confounding factors.

City Size and Public Service Access: Evidence from Brazil and Indonesia

Most global population growth over the next two decades is projected to occur in small- and medium-sized cities in low- and middle-income countries. Expectations derived from the literature on fiscal federalism suggest that this is a cause for concern, as larger cities are thought to deliver public goods more effectively than smaller ones owing to economics of scale. Drawing on detailed cross-sectional data from Brazil and Indonesia, we show that smaller municipalities tend to possess more basic public health clinics and schools per capita, scattered throughout their territory, than larger cities. We theorize that the greater prevalence of such facilities in small cities reflects a relative lack of non-state alternatives, fewer concerns regarding “urban” problems faced in larger cities, and politicians’ greater ability to secure and claim credit for such facilities. We illustrate the logic of this argument in case studies of otherwise-similar cities of different sizes in Brazil, and with shadow cases from Indonesia. Our analysis underscores how jurisdiction size and non-state service provision can affect government services.

Compliance with COVID-19 preventive measures among chronic disease patients in Wolaita and Dawuro zones, Southern Ethiopia: A proportional odds model.

So far, shreds of evidence have shown that COVID-19 related hospitalization, serious outcomes, and mortality were high among individuals with chronic medical conditions. However, strict compliance with basic public health measures such as hand washing with soap, social distancing, and wearing masks has been recommended and proven effective in preventing transmission of the infection. Therefore, this study aimed to determine the level of compliance with COVID-19 preventive measures and identify its predictors among patients with common chronic diseases in public hospitals of Southern Ethiopia by applying the proportional odds model. A facility-based cross-sectional study was employed in public hospitals of Southern Ethiopia between February and March 2021. Using a systematic random sampling technique, 419 patients with common chronic diseases were recruited. Data were collected using an Open Data Kit and then submitted to the online server. The proportional odds model was employed, and the level of significance was declared at a p-value of less than 0.05. This study revealed that 55.2% (95%CI: 50.4%-59.9%) of the study participants had low compliance levels with COVID-19 preventive measures. The final proportional odds model identified that perceived susceptibility (AOR: 0.91, 95%CI: 0.84, 0.97), cues to action (AOR: 0.89, 95%CI: 0.85, 0.94), having access to drinking water piped into the dwelling (AOR: 0.52, 95%CI: 0.32, 0.84), having no access to any internet (AOR: 0.62, 95%CI: 0.42, 0.92), having no functional refrigerator (AOR: 2.17, 95%CI: 1.26, 3.74), and having poor knowledge (AOR: 1.42, 95%CI: 1.02, 1.98) were the independent predictors of low compliance level with COVID-19 preventive measures. In the study area, more than half of the participants had low compliance levels with COVID-19 preventive measures. Thus, the identified factors should be considered when designing, planning, and implementing new interventional strategies, so as to improve the participants' compliance level.

What factors contribute to maintaining mental well-being during the COVID-19 pandemic?

Abstract Background The COVID-19 pandemic posed numerous challenges for many people and first results indicate high variability of responses in mental well-being. Thus, this research aimed to identify longitudinal factors contributing to the maintenance of mental well-being despite the adverse life circumstances and derive recommendations suitable for the promotion of mental well-being in the context of future pandemic or similar stressful situations. Methods We analysed representative longitudinal panel data of the Socio-Economic Panel (SOEP) from 15,122 adults (age range 18-99 years) who participated in the collaborative SOEP-CoV and RKI-SOEP surveys comprising self-reports of mental well-being (e.g., life satisfaction) and potentially relevant factors (e.g., control beliefs). By taking data from before (2015-2019) and during the COVID-19 pandemic (2020-2021) into account, we investigated different patterns of mental well-being trajectories and factors associated with the maintenance of mental well-being over time. Results Preliminary results suggest that the majority of adults in Germany managed to maintain or even enhance their mental well-being in the considered time frame. Moreover, results suggest that certain factors seem to be of universal importance (e.g., altruism, locus of control) while others are particularly relevant for distinct mental well-being dimensions (e.g., life goals). Most decisively, the probability of experiencing mental well-being deterioration during the COVID-19 pandemic was enhanced in individuals with an internal locus of control. Conclusions The findings revealed longitudinal factors that contribute to maintaining mental well-being during the COVID-19 pandemic. Promoting altruism, family-related life goals and external locus of control beliefs can help fostering resilient responses in the face of challenging life events such as the COVID-19 pandemic. Key messages • Several factors (e.g., locus of control) offer the potential to maintain or even improve mental well-being in times characterized by the COVID-19 pandemic. • To enhance preparedness for stressful life events such as the COVID-19 pandemic, the identified key factors should be included in basic universal public health promotion.

Examine the public health impacts of functional somatic disorders using the DanFunD study

Background: Persistent physical symptoms (e.g. pain, fatigue) are prevalent in the population and some persons may develop a functional somatic disorder (FSD). We still need to explore the limits between general bodily sensations and FSD, and great controversies exist as regard delimitation, occurrence, risk factors, prognosis, and costs of FSD in the general population. This is mainly due to the lack of focused, sufficient powered, population-based epidemiological studies. Material and Methods: The DanFunD study is the largest focused population-based study on FSD and has the potential to answer these crucial questions regarding the FSD disorders. DanFunD has its origin in the Copenhagen area of Denmark and was initiated in 2009 by an interdisciplinary team of researchers including basic scientists, clinical researchers, epidemiologists, and public health researchers. A population-based cohort of nearly 10,000 people have filled in detailed questionnaires, gone through a thorough health examination, and a biobank is established. The cohort was re-examined after five years. Results:The prevalence of FSD in the Danish population is about 10-15% and is twice as common in women as in men. Persons with FSD report impaired daily activities and low self-perceived health, which qualifies FSD as a major public health problem. The research plan to unravel the risk factors for FSD employs a bio-psycho-social approach according to a detailed plan. Preliminary results are presented, and work is in progress. Likewise, plans for assessing prognosis and health care costs are provided. Conclusion: We invite researchers in the field to collaborate on this unique data material.

The impact of basic public health services on migrants' settlement intentions.

An important task in the urbanization process of developing countries is to promote and support migrants’ settlement in cities. Based on the China Migrants Dynamic Survey of 2018, this paper analyzes how basic public health services (BPHSs) impact migrants’ settlement intentions. This study shows that establishing health records and access to health-related knowledge significantly and positively impact migrants’ intentions to settle permanently in inflow areas by increasing their health status and degree of social integration. Yet, this paper discusses how the trends are heterogeneous, finding that BPHSs more significantly impact the settlement intentions of female, less-educated and rural migrants. The findings of this paper provide new factual evidence that may support government policymaking to further improve migrants’ utilization of medical and health resources and their intention to settle down.

Clinical evaluation of AI-assisted screening for diabetic retinopathy in rural areas of midwest China.

BackgroundAlthough numerous studies have described the application of artificial intelligence (AI) in diabetic retinopathy (DR) screening among diabetic populations, studies among populations in rural areas are rare. The purpose of this study was to evaluate the application value of an AI-based diagnostic system for DR screening in rural areas of midwest China.MethodsIn this diagnostic accuracy study, diabetes mellitus (DM) patients in the National Basic Public Health Information Systems of Licheng County and Lucheng County of Changzhi city from July to December 2020 were selected as the target population. A total of 7824 eyes of 3933 DM patients were enrolled in this screening; the patients included 1395 males and 2401 females, with an average age of 19–87 years (63±8.735 years). All fundus photographs were collected by a professional ophthalmologist under natural pupil conditions in a darkroom using the Zhiyuan Huitu fundus image AI analysis software EyeWisdom. The AI-based diagnostic system and ophthalmologists were tasked with diagnosing the photos independently, and the consistency rate, sensitivity and specificity of the two methods in diagnosing DR were calculated and compared.ResultsThe prevalence rates of DR according to the ophthalmologist and AI diagnoses were 22.7% and 22.5%, respectively; the consistency rate was 81.6%. The sensitivity and specificity of the AI system relative to the ophthalmologists’ grades were 81.2% (95% confidence interval [CI]: 80.3% 82.1%) and 94.3% (95% CI: 93.7% 94.8%), respectively. There was no significant difference in diagnostic outcomes between the methods (χ2 = 0.329, P = 0.566, P>0.05), and the AI-based diagnostic system had high consistency with the ophthalmologists’ diagnostic results (κ = 0.752).ConclusionOur research demonstrated that DR patients in rural area hospitals can be screened feasibly. Compared with that of the ophthalmologists, however, the accuracy of the AI system must be improved. The results of this study might lend support to the large-scale application of AI in DR screening among different populations.

Increased Rates of Health Management and Health Education on Hypertension and Diabetes in Inner Mongolia, China: 10-Year Population Level Trends (2009-2018).

Health management and health education are two important tasks in the national basic public health service project with a wide audience, large service volume, and high accessibility. From 2009 to 2018, the Inner Mongolia Autonomous Region of China launched the basic public health service (BPHS) project comprehensively. The implementation of health management and health education was supported and instructed actively. This study aimed to document population-level trends in health management and health education on chronic diseases such as hypertension and diabetes in Inner Mongolia, China. We collected monthly and annual reports on the implementation progress of the BPHS project in Inner Mongolia, China. A two-stage random sampling method was used to investigate health management and health education for hypertension and diabetes patients. The rate of standard health management for both hypertension and diabetes has significantly increased. The blood pressure control rate and glycemic control rate have also improved. This work provides the most comprehensive evidence to date regarding the upward trends in health management and health education on chronic diseases such as hypertension and diabetes in Inner Mongolia, China.

A prospective cohort study on socioeconomic status and risk of all-cause mortality among patients with type 2 diabetes based on latent class analysis

Objective: To investigate the relationship between socioeconomic status (SES) and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 553 patients with type 2 diabetes were recruited under the National Basic Public Health Service Project in Changshu county, Qingjiangpu district, and Huai'an district in Huai'an city of Jiangsu province as participants. Latent class analysis was applied to classify the individuals based on five socioeconomic indicators. Then, Cox proportional hazards regression models were used to estimate the associations of different levels of SES with all-cause mortality, and stratified analysis was performed according to age and area. Results: Among 100 529.08 person-years of the fo1low-up, the median follow-up time was 5.7 years, and 1 829 deaths occurred during the follow-up period. According to the relevant results of the latent class model, the model of the "three classes" was the best. The related population was then divided into low SES (8 256 people, 47.0%), medium SES (4 427 people, 25.2%), and high SES groups (4 870 people, 27.8%). Compared to patients with high SES, the multivariate-adjusted hazard ratio (95%CI) of all-cause mortality associated with low SES for males and females were 1.84 (1.53-2.21) and 1.41 (1.51-1.72), respectively. Stratified analysis showed that the hazard ration (95%CI) of all-cause mortality associated with low SES for males and females were 1.99 (1.12-2.95) and 2.01 (1.20-3.23), respectively, in people younger than 60 years old, and were 1.90 (1.57-2.31) and 1.40 (1.13-1.73) in people over 60 years old. The HR values (95%CI) for all-cause mortality associated with low SES for the male and females were 1.54 (1.17-2.04) and 1.27 (1.02-1.59) in the urban population with 2.11 (1.55-2.85) and 2.64 (1.17-3.35) in rural population, respectively. Conclusions: Lower SES increased the risk of all-cause mortality in type 2 diabetic patients, which is more significant in younger and rural populations.

Relationship between social cohesion and basic public health services utilisation among Chinese internal migrants: a perspective of socioeconomic status differentiation

ABSTRACT Social cohesion and socioeconomic status (SES) have been widely considered important factors influencing health services utilisation, but little is known about the association between social cohesion and health services utilisation across different SES groups. Based on a nationally representative survey, this study explores the influence of social cohesion on basic public health services utilisation in Chinese internal migrants at different SES levels. It is observed that objective and subjective cohesion forms have different effects on health record establishment and health education receipt. The positive effect of objective cohesion on health services utilisation is significantly larger than that of subjective cohesion, but two cohesion forms show similar effect sizes on health services utilisation among poor-SES migrants. With the promotion of SES, the effect size of objective cohesion gradually increases while that of subjective cohesion declines, showing a distribution of ‘scissors gap'. For basic public health services utilisation, migrants not only have the agency to receive but are constrained by their SES. For migrants with poor SES, strong structural constraints hinder the utilisation of basic public health services.