Basic Public Research Articles

Overview of Examination Status of Basic Public Health Nurses’ Education and Future Activities of JAPHNEI

Overview of Examination Status of Basic Public Health Nurses’ Education and Future Activities of JAPHNEI

Basic Public Services, Population Migration and Regional Economic Growth

The innovation of this paper is to propose a new impact path that by attracting migrant population, basic public services can stimulate national economic growth significantly. Based on the “cost-benefit” theory, this paper takes basic public services into the population migration decision-making model, then builds an endogenous economic growth model by using population immigration as an increase of human capital. Theoretical analysis finds that basic public services can attract people to move in positively and promote regional economic growth indirectly. Based on the above conclusions, this paper presents that, we should increase fiscal transfer payments in backward areas, develop and improve the equalization system of basic public services while adapting to local conditions. And some related policies and statutes need to be published by government at the same time, such as policies of talent attraction and investment promotion policies to promote orderly population flow and balance the distribution of population, to make sure regional economy develops healthily.

Rural Resident Experience on National Basic Public Health Services: A Cross-Sectional Survey in 10 Western Provinces of China.

National basic public health services (BPHSs) are important for promoting the health of rural populations. A better understanding of rural BPHSs from the viewpoint of residents utilizing the services can help health-related departments and primary health care (PHC) centers further improve rural BPHSs. By conducting a large-scale cross-sectional survey in 10 western provinces of China, the study depicts rural resident experiences with rural BPHSs. Of the 9019 participants, 59.33% and 66.48% did not receive services related to health examinations or health education in the six months prior to the survey, respectively. A total of 56.90% were satisfied with the rural BPHSs, and the mean overall satisfaction score was 3.61 ± 0.908 (out of a maximum of 5). The most satisfying domain for rural residents with BPHSs was the attitude of PHC workers, whereas rural residents with chronic diseases were the least satisfied with the health management. Satisfaction with the attitude of PHC workers was identified as the strongest determinant of rural residents’ overall satisfaction with BPHSs. This study could enlighten rural BPHSs management in China.

Does a Different Household Registration Affect Migrants' Access to Basic Public Health Services in China?

On the basis of the China Migrants Dynamic Survey Data of 2015, the author provides an analysis of how a different household registration impacts migrants’ access to preventive care provided by public health services, such as health records and medical knowledge, in areas of immigration. This study shows that eliminating the distinction between agricultural and non-agricultural permanent residence registration could raise the rate of establishing health files, but it has no significant effect on migrants’ health knowledge. In fact, encouraging those with non-agricultural registration to move to different counties that belong to the same city or to different cities that belong to the same province can notably eliminate the impact of a different household registration status. Improving the income level of low-income migrants can have the same impact. Recommendations to enable migrants to obtain basic public health services include abolishing the separation of agricultural and non-agricultural household registration, increasing the permanent settlement rate of resident migrants, promoting basic medical security systems across the whole country, strengthening career training, and enhancing the education level of migrants.

Role of community-based active case finding in screening tuberculosis in Yunnan province of China

BackgroundThe barriers to access diagnosis and receive treatment, in addition to insufficient case identification and reporting, lead to tuberculosis (TB) spreads in communities, especially among hard-to-reach populations. This study evaluated a community-based active case finding (ACF) strategy for the detection of tuberculosis cases among high-risk groups and general population in China between 2013 and 2015.MethodsThis retrospective cohort study conducted an ACF in ten communities of Dongchuan County, located in northeast Yunnan Province between 2013 and 2015; and compared to 136 communities that had passive case finding (PCF). The algorithm for ACF was: 1) screen for TB symptoms among community enrolled residents by home visits, 2) those with positive symptoms along with defined high-risk groups underwent chest X-ray (CXR), followed by sputum microscopy confirmation. TB incidence proportion and the number needed to screen (NNS) to detect one case were calculated to evaluate the ACF strategy compared to PCF, chi-square test was applied to compare the incidence proportion of TB cases’ demography and the characteristics for detected cases under different strategies. Thereafter, the incidence rate ratio (IRR) and multiple Fisher’s exact test were applied to compare the incidence proportion between general population and high-risk groups. Patient and diagnostic delays for ACF and PCF were compared by Wilcoxon rank sum test.ResultsA total of 97 521 enrolled residents were visited with the ACF cumulatively, 12.3% were defined as high-risk groups or had TB symptoms. Sixty-six new TB patients were detected by ACF. There was no significant difference between the cumulative TB incidence proportion for ACF (67.7/100000 population) and the prevalence for PCF (62.6/100000 population) during 2013 to 2015, though the incidence proportion in ACF communities decreased after three rounds active screening, concurrent with the remained stable prevalence in PCF communities. The cumulative NNS were 34, 39 and 29 in HIV/AIDS infected individuals, people with positive TB symptoms and history of previous TB, respectively, compared to 1478 in the general population. The median patient delay under ACF was 1 day (Interquartile range, IQR: 0–27) compared to PCF with 30 days (IQR: 14–61).ConclusionsThis study confirmed that massive ACF was not effective in general population in a moderate TB prevalence setting. The priority should be the definition and targeting of high-risk groups in the community before the screening process is launched. The shorter time interval of ACF between TB symptoms onset and linkage to healthcare service may decrease the risk of TB community transmission. Furthermore, integrated ACF strategy in the National Project of Basic Public Health Service may have long term public health impact.

Status of outpatient service for cancer patients in Beijing Yuetan Community Health Service Center

Objective To analyze the outpatient service for patients with malignancies in Yuetan Community Health Service Center of Xicheng District in Beijing. Methods Two hundred and nine patients with malignancies visiting Yuetan Community Health Service Center in Beijing from January 2016 to January 2018 were included for analysis. There were 92 patients who visited fixed physicians (fixed group) and 117 patients who visited non-fixed physician (non-fixed group), and the influencing factors affecting fixed physician visit were analyzed. Results Of the 209 patients, 65 (31.10%) were males and 144 (68.90%) were females with a mean age of (69.4±10.0) year. There were 114 cases (54.55%) complicated with, hypertension 52 cases (24.88%) complicated with type 2 diabetes and 40 cases (19.24%) complicated with dyslipidemia. The mean number of visit per patients was (23.16±3.86) times; and the time of visits in fixed group was significantly higher than that in non-fixed group [(27.72±2.67) vs. (22.93±2.61), χ2=4.621, P=0.01]. The mean number of visit in 107 patients having contracted family doctor service was (25.64±7.60) times, while the time of visits in fixed group was significantly higher than that of the non-fixed group [(32.10±2.10) vs. (13.56±3.34), χ2=3.938, P<0.01]. Multivariate logistic regression analysis showed that hypertension (OR=0.445, 95%CI:0.213-0.971) and contracted family doctor service (OR=0.212, 95%CI:0.104~0.435) were significantly associated with fixed physician visits. Conclusion The outpatient visits of patients with malignant tumors in Yuetan Community Health Service Center meet the follow-up requirements for chronic diseases in the National Basic Public Health Service Regulations. The number of visits to fixed physicians is high, and patients with hypertension and contracted family doctor service have higher rate of fixed physician visits. Key words: Malignancies; Ambulatory care; Family doctor service

Development and validation of a prognostic nomogram for HIV/AIDS patients who underwent antiretroviral therapy: Data from a China population-based cohort.

BackgroundAccurate forecast of the death risk is crucial to the administration of people living with HIV/AIDS (PLHIV). We aimed to establish and validate an effective prognosis nomogram in PLHIV receiving antiretroviral therapy (ART).MethodsAll the data were obtained from 2006 to 2018 in the Wenzhou area from China AIDS prevention and control information system. Factors included in the nomogram were determined by univariate and multiple Cox proportional hazard analysis based on the training set. The receiver operating characteristic (ROC) and calibration curves were used to assess its predictive accuracy and discriminative ability. Its clinical utility was also evaluated using decision curve analysis (DCA), X-tile analysis and Kaplan-Meier curve, respectively in an independent validation set.FindingsIndependent prognostic factors including haemoglobin, viral load and CD4+ T-cell count were determined and contained in the nomogram. Good agreement between the prediction by nomogram and actual observation could be detected in the calibration curve for mortality, especially in the first year. In the training cohort, AUC (95% CI) and C-index (95% CI) were 0.93 (0.90, 0.96) and 0.90 (0.85, 0.96), respectively. In the validation set, the nomogram still revealed excellent discriminations [AUC (95% CI): 0.95 (0.91, 1.00)] and good calibration [C-index (95% CI): 0.92 (0.82–1.00)]. Moreover, DCA also demonstrated that the nomogram was clinical beneficial. Additionally, participants could be classified into three distinct (low, middle and high) risk groups by the nomogram.InterpretationThe nomogram presents accurate and favourable prognostic prediction for PLHIV who underwent ART.FundingThis work was supported by Zhejiang Basic Public Welfare Research Project (LGF19H260011), Wenzhou Basic Public Welfare Research Project (Y20180201), the Initial Scientific Research Fund (KYQD170301), the Major Project of the Eye Hospital Wenzhou the Major Project of the Eye Hospital Wenzhou Medical University (YNZD201602). Part of this work was also funded by National Natural Science Foundation of China (81670777) and Science and Technology Innovation Activity Plan and New Talents Plan for College Students in Zhejiang Province (2019R413073). The funders had no roles in study design, data collection, data analysis, interpretation and writing of the report.

Alimentação para alunos com necessidades de alimentação especial como preceito educacional inclusivo

The DHAA is the right of every person to be free from hunger and to have adequate food and the PNAE guarantees the right of the student of Basic Public Education to food. It is in this sense that we aim to broaden the discussion about the possibilities of exclusion of these people in school, the objective of this article was to carry out a bibliographic survey about the inclusion of children with NAE in schools through a documentary and bibliographical review. Students with NAE can be excluded through unplanned pedagogic activities. Students with allergies may become contaminated with materials that contain allergens, students with food restrictions at school events may be left with no food option. The care with these students as analyzed, goes far beyond nutrients and should be promoted to include these in the school environment and pedagogical activities as it may affect their learning.

Social Organization Participation, Government Governance and the Equalization of Basic Public Services: Evidence from China.

This paper uses the methods of System Generalized method of moments (SYS-GMM), mediation effect and linkage effect to investigate the relationship among social organization participation, government governance and the equalization of basic public services from 2007 to 2017 in China. The empirical results show that the participation of social organizations and improvement in the government governance can promote the equalization of basic public services. The government has a greater capacity to drive the equalization of basic public services, but the density of social organizations can serve as a mediator in the equalization of basic public services. The government governance and social organization density have a strong linkage effect, but the link with social organization quality is weak. Furthermore, a linkage effect is evident in medical and health care, public education, environmental protection, and public culture but not in public science and social welfare.

La agenda periodística en el aula. Relato de una experiencia didáctica en epidemiología y salud pública básica veterinaria

Aunque la medicina veterinaria es uno de los pilares de la salud pública, esta relación no resulta tan evidente en los primeros años de la facultad. Esta situación, y las condiciones de adaptación por la que transitan los estudiantes hacen necesaria la intervención educativa para interesarlos en el área de salud pública. En este sentido, los medios de comunicación nos relatan hechos que involucran a los veterinarios en problemas actuales, reales y significativos de la práctica profesional constituyéndose en una herramienta didáctica de enorme potencial formativo. Así, en Epidemiología y Salud Pública Básica incorporamos el uso de la prensa escrita en el aula. Este trabajo, da cuenta de dicha experiencia y profundiza sobre el potencial de la prensa escrita como recurso educativo. Los resultados de la experiencia surgieron de una encuesta de opinión a los estudiantes y de un espacio de reflexión docente. La vinculación de la profesión con la actualidad, la motivación de estudiantes y docentes, y las potencialidades educativas de los medios de comunicación fueron lo más destacado. La “agenda periodística” en el aula, contribuyó a repensar la profesión en el área de Salud Pública y a la formación de profesionales más comprometidos con la sociedad.&#x0D;

Impact of the Universal Two-Child Policy on the Workload of Community-Based Basic Public Health Services in Zhejiang Province, China

We aimed to quantitatively estimate the amount of pressure that was placed on basic public health care services (BPHS) due to the universal two-child policy issued in 2015 by comparing the workload change in maternal and child health management and the immunization of children. BPHS performance surveillance data from 2014 to 2018 in Zhejiang Province, China were analyzed to calculate the workload of the above three services using the equivalent method of BPHS cost estimation of community health services. From 2014 to 2018, the numbers of births from the Statistical Yearbook in Zhejiang Province were 578,000, 581,000, 624,000, 670,000, and 628,000, respectively, and those from the surveillance data were 416,941, 41,490, 434,163, 546,816, and 45,964, respectively. The number of births reached a peak in 2017, with the yearbook and surveillance data showing increases of 15.92% and 31.15%, respectively, over 2014. The workload of maternal and child health management and children’s immunization also peaked in 2017, increasing by 30.37%, 12.70%, and 4.33% over 2014, respectively. In 2018, the workload of maternal and child health management and children’s immunization dropped to 107.34%, 107.73%, and 98.81% over 2014, respectively. The indicators of maternal and child health management and children’s immunization services remained stable, and the related services did not decline, even in 2017. The maternal health management workload was more affected by the universal two-child policy than child health management and children’s immunization.

Determinants of the Proactiveness of Female Migrant Workers with Psychological Distress Seeking Allied Health Services.

Seeking utilization of allied health services (AHS) has significant implications for psychological distress self-management. However, utilization of AHS by Chinese female migrant workers (FMWs) has not received enough attention. This study, therefore, aims to explore what contributes to FMWs' proactiveness in utilizing AHS. A cross-sectional study was conducted to collect data in terms of socio-demographic characteristics, work-related characteristics and AHS accessibility. A logistic regression model was adopted to examine association of these predictors with proactiveness in seeking AHS. 992 FMWs with psychological distress were interviewed with stratified multiple-stage sampling. The results indicated that Basic Public Health Services (BPHS) is a salient predictor affecting proactiveness in seeking AHS. BPHS includes psychological counseling (Odds Ratio (OR) =2.401, 95% Confidence Interval (CI) =1.284-4.490, p =0.006), psychotherapy (OR = 2.063, 95% CI = 1.438-2.960, p =0.000) and health knowledge lectures (OR = 1.613, 95% CI = 1.115-2.333, p =0.011). Moreover, sampled participants under 25 and those who received education for more than 9years are more likely to seek AHS compared with other groups. In addition, proactiveness in seeking AHS is clearly associated with working hours per day. The probability is only 31.1% for those working more than 12h per day to seek AHS actively compared with those working below 8h (95% CI = 0.119-0.812, p =0.017). There are no differences between those with 8-12 working hours and those working less than 8h (OR = 1.100, 95% CI = 0.798-1.518, p =0.560). The present findings suggest that policies be made to improve the coverage of BPHS and to provide specified AHS to meet the increasing demand of different social groups.

Development Process and Legislative Suggestions Regarding Disability Welfare Rights in China

ABSTRACTWelfare rights are among the social rights enjoyed by citizens of modern states. The welfare rights of persons with disabilities, as particularly vulnerable persons, are of special concern. Two guideline documents, Opinions of the CPC Central Committee and the State Council on Promoting the Development of Disabled Persons and The 13th Five-Year Plan of Promoting the Equalization of Basic Public Services, announce the establishment of a “social insurance” system and “public service,” which outlines social welfare for disabled persons in China. This article argues that regulations on disability protections should be legislated soon, establishing welfare standards for the disabled, refining the current general rules concerned with the welfare of the disabled in the legal and political contexts, and forming a comprehensive program to address the needs of disabled persons in China. New regulations should open new institutional space for promoting the wellbeing of disabled persons.

The development and reform of public health in China from 1949 to 2019

BackgroundPublic health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China.MethodsThe study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents.ResultsThis study identified four key stages that public health experienced in China: the initial stage centering on prevention, the stage of deviation with more attention to treatment but little to prevention, the recovery stage after SARS(Severe Acute Respiratory Syndromes) Crisis, and the new stage to an equitable and people-centered system. In the latest stage, the National Basic Public Health Service Program (NBPHSP) is implemented to respond the threat of noncommunicable diseases (NCDs) and has achieved some initial results, while there are still many challenges including service quality, poor integration among service items and IT system, lack of quality professionals and insufficient intersectoral endeavor.DiscussionThere are unique Chinese wisdom and remarkable achievements as well as twists and turns on the development of China’s public health. Prevention-first, flexible structure of the system, multi-agency collaboration and mass mobilization and society participation are the main experience of public health in early stage. Despite twists and turns since 1980s, public health system in China shows substantial resilience which may be from the government’s continuous commitment to social development and people’s livelihoods and its flexible governance. In 2010s, in order to achieve the well-off society, Chinese government pays unprecedented attention to health sector, which bring a new wave of opportunities to public health such as remaining the NBPHSP for priority. The evolution and reform of China’s public health is based on its national condition, accumulates rich experience but also faces many common worldwide challenges. Getting this development and reform right is important to China’s social and economic development in future, and China’s experience in public health may provide many lessons for other countries.ConclusionPublic health in China needs to focus on prevention, strengthen multi-agency coordination mechanism, improve the quality of public health services in the future.

What Are the Challenges Faced by Village Doctors in Provision of Basic Public Health Services in Shandong, China? A Qualitative Study.

Background: Village doctors, as gatekeepers for the health of rural residents in China, are confronted with adversity in providing the basic public health services (BPHS), which has significantly impeded them from providing high quality BPHS. This study aimed to explore the obstacles and difficulties faced by village doctors in order to improve the quality and efficiency of BPHS provision and increase the health level of the population. Methods: In-depth interviews were employed to conduct this qualitative study. A total of 51 village doctors in four cities of Shandong Province were interviewed. The interviews were transcribed, anonymized, and imported into NVivo11.0 to facilitate management. Thematic framework analysis employing the constant comparison method was applied to the data analysis. Results: The main challenges faced by village doctors comprised the shortage, gender imbalance, and poor education of village doctors; older village doctors in some villages; low income; lack of social security; inappropriate performance assessment; inadequate professional BPHS training; heavy workload; and insufficient cooperation from rural residents, which have exacerbated the quality, efficiency, and accessibility of BPHS to some extent. Conclusions: Village doctors, as the important BPHS providers in rural Shandong, are facing a wide range of challenges. It is urgent for government officials and policy makers to consider these challenges and concentrate on improving the quality of BPHS provision by developing relevant and practical strategies.

The influence of basic public health service project on maternal health services: an interrupted time series study

BackgroundReducing maternal mortality remains a global priority. In 2000, the United Nations Member States pledged to work towards a series of Millennium Development Goals (MDGs), in which the fifth target was to reduce maternal mortality ratio by 75% from 1990 to 2015. The Chinese government introduced Basic Public Health Service project in 2009 to the further improvement of maternal health services and reduction in maternal mortality. China had achieved the goal of MDG5 1 year ahead of the schedule in 2014, but the effects of the project on reducing maternal mortality were rarely evaluated with robust methods.MethodsWe conducted a longitudinal study on maternal mortality ratio by extracting mortality data from the National Maternal Mortality Surveillance System (1991–2016) and maternal health services measures from the China health statistic yearbook (2001–2016). We utilized the segmented linear regression model to assess changes and trends of maternal mortality ratio and maternal health services before and after the introduction of Basic Public Health Service project. Pearson correlation analysis was conducted to measure the strength of association between the maternal mortality ratio and maternal health services.ResultsThe yearly trend change of national maternal mortality ratio was − 1.76 (p < 0.01) after the introduction of Basic Public Health Service project in 2009, while the yearly trend change of maternal health record establish rate, prenatal examination rate, postpartum visit rate was 0.77 (p < 0.01), 0.61 (p < 0.01) and 0.83 (p < 0.01) separately. The negative correlations were also found between national maternal mortality ratio and prenatal examination rate (r = − 0.95, p < 0.01), maternal health record establish rate (r = − 0.93, p < 0.01) and postpartum visit rate (r = − 0.92, p < 0.01).ConclusionsThe Basic Public Health Service project was found to be associated with the improvements in the maternal health services and reduction in maternal mortality. The design and implementation of the project may serve as a positive example for other developing countries. Continued monitoring and assessment of project effects should be stressed.

A prospective cohort study on the duration of sleep and risk of all-cause mortality among patients with type 2 diabetes

Objective: To investigate the relationship between duration of sleep and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 452 type 2 diabetic patients who were under the National Basic Public Health Service Project, in Changshu county, Qinghe district and Huai'an district in Huai'an city of Jiangsu province, were recruited as participants. Cox proportional hazards regression models were used to estimate the associations between different levels on the duration of sleep and all-cause mortality. Stratified analysis was performed according to factors as gender, age, and lifestyle. Results: Among the 67 912 person-years of observation, from the fo1low- up program, the median time of follow-up was 4 years, with 1 057 deaths occurred during the follow-up period. Taking patients with duration of sleep as 7 h/d for reference, the multivariate adjusted hazard ratios (95%CI) of all-cause mortality appeared as ≤6, 8, 9 and ≥10 h/d were 1.14 (0.94-1.37), 1.10 (0.91-1.32), 1.33 (1.05-1.70), and 1.52 (1.24-1.87), respectively which were associated with the duration of sleep. Data from the subgroup analysis showed that this was consistent with the whole population. Longer duration of sleep was associated with the all-cause mortality but no significant association was found between shorter duration of sleep and the all-cause mortality. Conclusion: Longer duration of sleep seemed to have increased the risk of all-cause mortality in type 2 diabetic patients.

Identifying Determinants of Child Malnutrition Using Spatial Regression Analysis

As a public health problem, the nutritional status of childrens under five years old is a sensitive indicator of a country’s health status. Malnutrition affected by many factors, including spatial dependence factors. This factor indicates the value of observations from a region affected by the value of observations in other areas. It assumed that child health factor, maternal health, environmental health, and region influenced the prevalence of malnutrition among under-five children. The objective of the study was to determine factors that associated with malnutrition among under-five children in Sumatera Island and the spatial regression model for the case. The study used Basic Health Research (Riskesdas) and Public Health Development Index (IPKM) survey 2013 from 125 districts on Sumatera Island. . Spatial regression analysis and Spatial Autoregressive Model (SAR) applied in this study to obtain the significant determinants of child malnutrition. The results of this study revealed that the lack of chronic energy in women of childbearing age, the proportion of family planning users, households that having clean and healthy life behaviour (PHBS), and access to clean water were the significant factors of child malnutrition.

Suggestions on the Establishment of Basic Public Service Menu in Beijing

Suggestions on the Establishment of Basic Public Service Menu in Beijing

Equity and Efficiency in Spatial Distribution of Basic Public Health Facilities: A Case Study from Nanjing Metropolitan Area

ABSTRACTThe article assesses the equity and efficiency of spatial distribution of basic public health service facilities in the metropolitan area of Nanjing. The results show that the spatial distribution of public health service facilities is generally in disequilibrium within the Nanjing metropolitan area. In particular, it demonstrates a significant variation in spatial distribution across districts. Districts located in the central parts have a relatively higher level of equity and efficiency and show positive spatial correlations amongst themselves. However, equity and efficiency differ in urban fringes and rural areas.