Rural Counties In China Research Articles

Assessing the validity of oscillometric device for blood pressure measurement in a large population-based epidemiologic study

To evaluate the accuracy of the Omron HBP-1300, an automatic device for blood pressure (BP) measurement, compared with the standard auscultatory method with a mercury sphygmomanometer, we conducted a large population-based survey. From 2012 to 2015, a total of 500,000 participants were randomly selected from the 262 urban cities and rural counties in China, of them BP was measured three times simultaneously with mercury sphygmomanometer and Omron HBP-1300 in 37,816 participants. Bias was estimated as the average of the auscultatory measurements minus the average of the oscillometric measurements, with its corresponding 95% limits of agreement. The Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocols were used to evaluate the accuracy of the oscillometric device. The results showed that the Omron underestimated systolic BP by 1.0 mm Hg (95% limits of agreement: −9.2, 11.2) and underestimated diastolic BP by 0.2 mm Hg (95% limits of agreement: −8.5, 8.1). The bias in systolic BP values was related to heart rate, systolic BP, and pulse pressure level, while the bias in diastolic BP was related to the heart rate and pulse pressure level. Omron HBP-1300 passed the Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocol requirements. The sensitivity and specificity of the Omron HBP-1300 to detect hypertension were 86.2% and 98.0%, respectively. Our results showed that the Omron HBP-1300 could be used for measuring BP in large epidemiology studies. The bias of BP measurement was related to the age, systolic BP, and pulse pressure level.

Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women.

Despite the significance of cervical cancer screening, motivating more women to participate remains a challenge in resource-limited settings. In this study, we tested the protection motivation theory (PMT) in predicting screening intentions. Participants were women from Wufeng, a typical rural county in China. Participants (n=3000) with no cervical cancer history were recruited from 10 randomly selected villages. As mediating variables, 6 PMT constructs (Perceived Risk, Fear Arousal, Perceived Severity, Response Efficacy, Response Cost, and Self-Efficacy) were measured using the standardized questionnaire. Structural equation modeling (SEM) method was employed to test PMT-based prediction models. Of the total sample, 57.77% believed that regular screening may reduce cervical cancer risk, and 45.26% agreed that women should be screened regularly. Our data fit the PMT model well (GFI=0.95, AGFI=0.93, CFI=0.90, RMSEA=0.06, SRMR=0.04, Chi-square/df=2.47). Knowledge of screening was directly and positively associated with screening intention. Age, annual income, and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost (P<0.05 for both). PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge, some demographic factors, and awareness of and previous experience with screening. These findings, if verified with longitudinal data, can be used for intervention program development.

What Impact Does Behavior of Doctors and Patients on Service Integration of Multi-institutional Readmission cross Township—county Hospitals in Rural China

Background : With the change of rural residents’ disease spectrum and patients with chronic diseases boom, multi-institutional health service utilization of rural residents and the continuous service demands are growing sharply in rural China. Objective : Evaluate the service integration of multi-institutional readmission cross township—county hospitals (MRCTCH) in rural China, and figure out determines of service integration. Methods : This study featured 7 sample counties in rural China. Based on the database of the inpatients with New Rural Cooperative Medical System (NCMS), using Microsoft Office Excel 2010 programming technology, we selected 630 cases of medical records of MRCTCH from 2012 to 2013 in diseases of respiratory system and cerebrovascular system. 2 medical specialists evaluated the service integration of the MRCTCH by matched medical records. Results : The probability of referral hospital is nearly 60%, and the average hospitalization time intervals is 5.49 days for 630 MRCTCH, and 50% of the patients who did not complete the treatment in township hospital were required to transfer. Only 73.1% of patients reflected its previous visits to doctors in the county hospital, and only 68.2% of this patient’s information is useful, and its effective information transmission probability is 36.2% which accounts for 49.5% patients with information transmission. Patients by referral were more unlikely to transfer information than others. Through the two system disease records evaluation, the X-ray (CT)/ecg examination paid again in useless by 69.5 % of patients who are transferred to the county hospital within one week. From evaluation from specialists on the medical records of 630 MRCTCH, the consistency of two-stage treatment ideas reached 71.3%, only 23.73% of the treatment is effective in health clinics in township hospital. There are risks of misdiagnosis or delay treatment in township hospital for MRCTCH. Experts believe that nearly 40% of the township medical records are good for the optimization of treatment in county hospitals on the basis of full understanding of the township treatment information. Conclusion : In conclusion, patients lacked of conscious awareness of information transfer, the information mentioned by patients during readmission was incomplete. The pattern and time interval of readmission had greater impact on information transfer, and the utilization of previous treatment is inadequate. All of these problems results from Patients’ lacking of conscious awareness of information transfer, not believing in the treatment of county hospitals, doctors’ lacking awareness of urging information transfer and utilizing information, etc. The impact of doctor behavior on service integration of multi-institutional readmission reflects on ability and cooperation, while the disordered hospitalization choices of patients have no benefit on information transfer and duty division. Service integration of multi-institutional readmission needs to strengthen the willingness of cooperation among doctors and the awareness of information transfer among patients. Relevant policy making should pay more attention to security and restraint mechanism. At the same time, the information system need to be constructed after considerably weighing the pros and cons.

Abstract 5315: Dietary intake and risk of lung cancer in non-smoking women: a hospital-based case-control study in Xuanwei and Fuyuan, China

Abstract Xuanwei and Fuyuan are rural counties in China that have the highest lung cancer rates in the country among non-smoking women. This alarming public health burden has been attributed to the combustion of smoky (bituminous) coal for heating and cooking, which can produce carcinogenic emissions such as polycyclic aromatic hydrocarbons (PAHs). Previous studies found that green leafy vegetables could absorb PAHs through air and direct soil contamination. Further, oral ingestion of PAHs was found be to associated with pulmonary adenoma development in animal feeding studies. Therefore, we investigated the associations between lung cancer risk and dietary intake of specific green leafy vegetables and other foods in non-smoking women of this farming region. We conducted a hospital-based case-control study of 1,074 female lung cancer patients and 977 frequency-matched controls from Xuanwei and Fuyuan, China in 2006-2013. Dietary intake was self-reported on questionnaires and categorized as never, several times/year, several times/month, several times/week, and every day. Unconditional logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of lung cancer in relation to intake of specific green leafy vegetables (i.e. lettuce, cabbage, fennel, spinach, hollow vegetables), corn, buckwheat, carrots, tomatoes, dried and fresh chili, pickled vegetables, bean curd, mushrooms, and preserved meats. Models were adjusted for age, county, first-degree relative with lung cancer, passive smoke exposure, education, lifetime smoky coal tonnage, respiratory disease history, time spent indoors, and menopausal status. Separate models were fitted for each dietary factor. We found that increased consumption of several green leafy vegetables was associated with increased risk of lung cancer. Eating hollow vegetables every day was associated with 2.50 (95% CI: 1.18, 5.27) times the odds of lung cancer compared to never. Similarly, eating lettuce (OR=2.13, 95% CI: 1.41, 3.21) and cabbage (OR=1.82, 95% CI: 1.21, 2.69) every day was associated with increased risks compared to several times a year or less. Conversely, eating bean curd (OR=0.54, 95% CI: 0.40, 0.72) several times a week was associated with decreased risk compared to several times a year or less; while eating buckwheat (OR=0.59, 95% CI: 0.40, 0.89) several times a week was associated with decreased risk compared to never. No significant associations were found for fennel, spinach, and other foods. Our findings suggest that increased consumption of a variety of green leafy vegetables may be related to elevated lung cancer risk in non-smoking women from Xuanwei and Fuyuan, China, independent of other risk factors. The increased risk may be due to environmental contamination of crops from coal combustion. Conversely, frequent consumption of bean curd and buckwheat was found to be protective. Citation Format: Jason Y. Wong, Bryan A. Bassig, Wei Hu, Jinming Zhang, Wei Jie Seow, Neil E. Caporaso, Bu-tian Ji, Robert S. Chapman, George S. Downward, Jihua Li, Jun He, Kaiyun Yang, Yunchao Huang, Roel Vermeulen, Nathaniel Rothman, Qing Lan. Dietary intake and risk of lung cancer in non-smoking women: a hospital-based case-control study in Xuanwei and Fuyuan, China [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5315. doi:10.1158/1538-7445.AM2017-5315

National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals.

Traumatic fractures place a substantial burden on health-care systems worldwide. Although detailed information about incidence, distribution, and risk factors for traumatic fractures is vital for planning and prevention, in China, national data are unavailable. We aimed to do an up-to-date national survey on the population-weighted incidence of traumatic fractures in China. The China National Fracture Study (CNFS) was a retrospective epidemiological study that recruited a nationally representative sample from eight provinces, 24 urban cities, and 24 rural counties in China using stratified random sampling and the probability proportional to size method. All eligible household members who had lived in their current residence for 6 months or longer were personally interviewed by trained research teams about traumatic fractures of the trunk, arms, or legs (not including the skull, sternum, and ribs) that had occurred in 2014. Telephone surveys were used for participants who were non-contactable after repeated visits. Fracture cases were verified by clinical records, medical history, and radiographs by orthopaedic surgeons and radiologists. We estimated incidence rates for traumatic fractures for the overall population and for subgroups by age and sex, as well as by demographic factors such as ethnic origin, occupation, geographical region, and residency category. We also studied potential associations between fractures and various factors of interest, such as age, ethnic origin, education, smoking, alcohol drinking, sleep time per day, and history of previous fracture. Data were weighted during statistical analysis to ascertain the national incidence rate. This study is registered with the Chinese Clinical Trial Registry, number ChiCTR-EPR-15005878. Between Jan 19, 2015, and May 16, 2015, 535 836 individuals were selected and invited to participate in the study. Questionnaires from 23 649 (4%) individuals were excluded due to missing items, insufficient responses, or logical errors. Following exclusions, 512 187 (96%) individuals participated in the CNFS, consisting of 259 649 (51%) boys and men and 252 538 (49%) girls and women. Of these individuals, 1763 individuals had experienced traumatic fractures during 2014 (n=1833). The population-weighted incidence rate of traumatic fractures of the trunk, arms, or legs was 3·21 (95% CI 2·83-3·59) per 1000 population in 2014 (3·65, 3·12-4·18 in men and 2·75, 2·46-3·04 in women). For all ages, sleeping less than 7 h per day was identified as a risk factor for traumatic fractures. We identified previous fracture history as a risk factor for adults aged 15 years and older. Alcohol consumption incurred a risk effect for men aged 15 years and older and women aged 15-64 years. Our results provide detailed information about fracture incidence, distribution, and risk factors, which can now be used as an up-to-date clinical evidence base for national health-care planning and preventive efforts in China and elsewhere. Specific public health policies that focus on decreasing alcohol consumption, prohibiting drunk driving, promoting smoking cessation, and encouraging individuals to obtain sufficient sleep and maintain a healthy bodyweight should be urgently implemented to help reduce the risk of traumatic fractures. The Hebei Province Medical Science Special Major Projects Research Fund.

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China.

A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed “two-step optimization for spatial accessibility improvement (2SO4SAI).” The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.

Life satisfaction and degree of suicide intent: A test of the strain theory of suicide

BackgroundVarious factors contribute to suicide. Psychological strains are hypothesized to precede suicidal thought and attempt. Life satisfaction can be a measure of relative deprivation strain and aspiration–reality strain. AimsThis study was to compare the suicide attempters with various levels of life satisfaction and find out how life satisfaction affects the degree of suicide intent among medically serious suicide attempters. MethodsSubjects for study were recruited in some rural counties in China. Interview data were from hospital emergency rooms with medically serious attempters of suicide (n=791). The subjects were aged between 15 and 54years and 293 males and 498 females. Face to face interview was conducted for each suicide attempter with a semi-structural protocol including life satisfaction, physical health, demographic, sociological, and psychological measures, as well as psychological strains. FindingsThe multiple linear regression analysis showed that mental disorder, aspiration strain and relative deprivation strain were significant risk factors for high intent of suicide among suicide attempters. The interaction between the two psychological strains also indicated that both failed aspiration and self-perceived low economic status in village play an important role in suicidal intent. ConclusionLow level of life satisfaction is associated with strong intent for suicide. Lack of life satisfaction is exemplified by relative deprivation perceived by the individuals and the discrepancy between an individual's aspiration for life and his/her reality. The findings from the suicide attempt data in rural China support the Strain Theory of Suicide.

Psychological Strains and Suicidal Intent: An Empirical Study to Relate the 2 Psychopathological Variables.

Psychological strains are hypothesized to precede a suicidal intent that may lead to suicide, where psychological strains can be considered a function of social structure embedded with negative life events. This study aimed to test the potential relationship between psychological strains and suicidal intent in Chinese rural suicide attempters. Data regarding medically serious suicide attempters (N = 791) were gathered from county-level emergency rooms in randomly selected counties in rural China (15-54 years of age). Face-to-face interview data were obtained with semistructured instruments. Results showed that the strain variables interacted with gender in predicting degree of suicide intent in Chinese rural suicide attempters. Specifically, aspiration strain and coping strain were associated with suicide intent in Chinese male suicide attempters, whereas value strain was associated with suicide intent in Chinese female suicide attempters. This study supported the strain hypothesis in Chinese rural suicide attempters.

Risk Factor Associated with Negative Spouse HIV Seroconversion among Sero-Different Couples: A Nested Case-Control Retrospective Survey Study in 30 Counties in Rural China.

BackgroundAntiretroviral therapy (ART) and condom use have been proven to reduce the risk of sexual transmission of human immunodeficiency virus (HIV) among HIV sero-different couples, but its full implementation remains a challenge. This study aims to assess HIV seroconversion rate of HIV-negative spouse and its associated risk factors among HIV sero-different couples in rural China.MethodsAn open cohort of HIV sero-different couples enrolled in 30 counties in China between October 1, 2010, and September 30, 2012, and followed-up to December 31, 2012, was constructed retrospectively. A nested case-control study of risk factors of HIV seroconversion among sero-different couples was conducted in April and May of 2013, based on the open cohort. Sero-different couples with the HIV-negative spouse seroconverting at least 3 months after the previous negative diagnosis during cohort observation period were labeled as “case couples”. The “control couples” were selected randomly from the same cohort that did not have the HIV-negative spouse seroconversion during the same period. The “case couples” and “control couples” were matched on gender, age, and region of residence. Sexual behaviors among HIV sero-different couples before and after the index spouses notifying their HIV infection status to their HIV-negative spouses were collected via face-to-face interview. Univariate and multivariate logistic regression models were used to assess factors associated with HIV seroconversion among HIV sero-different couples.ResultsOf 4481 HIV sero-different couples, a total of 53 seroconversions were observed within 5218 person-years of follow-up. The incidence rate was 1.02 (95%CI: 0.76–1.33) per 100 person-years. Forty “case couples” confirmed HIV-negative spouse seroconversions infected via marital sexual transmission, were matched to 80 “control couples”. Of the 120 couples, 81(67.5%) were receiving ART, and 70 (58.3%) reported consistently used condoms during intercourse after the index spouse was diagnosed HIV infection. Multivariate conditional logistic regression analysis showed that the desire to conceive a child (OR = 5.18, 95% CI: 1.19–22.58) significantly increased the odds of HIV seroconversion. Protective factors of spousal HIV seroconversion were currently receiving ART (OR = 0.09, 95% CI: 0.01–0.67) and consistent condom use (OR = 0.05, 95% CI: 0.01–0.28).ConclusionsIntention to conceive a child is the most important risk factor for HIV seroconversion among sero-different couples. Specific efforts on scientific use of ART to assist sero-different couples to achieve their wish to conceive a healthy child are needed to minimize the risk of HIV transmission.

Sex differences in the intellectual functioning of early school-aged children in rural China.

BackgroundGender disparities in China are concentrated in poor rural areas and among poor households. The difference in intelligence between boys and girls is less clear in rural China. The purpose of this paper was to assess sex differences in the intellectual function of early school-aged children in rural China.MethodsOne thousand seven hundred forty four early school-aged offspring of women who had participated in a prenatal supplementation trial with different combinations of micronutrients and continued to reside in two rural counties in China were followed. We measured their Full-Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Working Memory Index (WMI), Perceptual Reasoning Index (PRI) and Processing Speed Index (PSI) using the Wechsler Intelligence Scale for Children (WISC-IV). Multilevel analyses were used to assess sex differences in intellectual functioning in 7-10-year-old children in rural China.ResultsBoys’ adjusted mean FSIQ score was 0.97 points higher (95 % CI: -2.22 − 0.28) than that of girls. Girls obtained higher mean WMI and PSI scores, with 1.32 points (95 % CI: 0.14 − 2.51) and 3.10 points (95 % CI: 1.82–4.38) higher adjusted means, respectively. Boys’ adjusted mean VCI and PRI scores were significantly higher than those of girls, and the mean differences were 2.44 points (95 % CI: 0.95 − 3.94) and 3.68 points (95 % CI: 2.36 − 5.01), respectively.ConclusionsThere is no evidence to suggest sex differences in the general intelligence of early school-aged children in rural China. However, a difference in general intelligence between 10-year-old boys and girls was evident. Girls and boys in rural China tended to show different specific cognitive abilities.

Correlates of parental satisfaction: a study of late life family relationships in a rural county in China

This study aims to identify correlates of satisfaction in late life parental role, using a sample of 432 older parents (not couples) aged 60 to 79 with 1,223 adult children living in one of the least devel-oped counties of northern China. Drawing upon the symbolic interactionism perspective and Chin-ese cultural emphasis on filial piety, we tested a parental satisfaction model including a set of vari-ables capturing parental perceptions of relationship quality with each of their grown children (hereafter offspring), expectations of various forms of support from offspring, and evaluations of offspring’s filial piety (being filial). Most parents in our sample were satisfied with their parental role. Logistic regression analysis indicated that getting along with offspring, offspring met parental expectations in terms of pro-viding emotional, practical, and financial support, and offspring being filial were significantly associated with parental satisfaction, respectively, net of parent and offspring characteristics. When simultaneously examined in the full model, however, only two correlates remained significant: getting along with offspring and offspring being filial. Offspring’s filial piety was associated with parental satisfaction in a dose-re-sponse manner, indicating the importance of considering multiple children in a family on parental well-being. Findings underscore the significance of parental perceptions of relationship quality with offspring and offspring’s filial piety for parental satisfaction. Findings suggest that filial piety, a multifaceted concept deeply rooted in Confucianism, continues to exert a strong influence today on Chinese family relationships despite the dramatic socioeconomic and cultural transformation China has been experiencing in the past three decades.

Selenium Level and Dyslipidemia in Rural Elderly Chinese.

ObjectiveHigher selenium level has been hypothesized to have the potential to reduce the risk of cardiovascular diseases including dyslipidemia. However, results from previous studies are inconsistent. This study aims to determine the association between selenium level and dyslipidemia in elderly Chinese with relatively low selenium status.MethodsA cross-sectional study of 1859 participants aged 65 or older from four rural counties in China was conducted. Serum total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDLC) and low-density lipoprotein-cholesterol (LDLC), nail selenium concentration and APOE genotype were measured in all subjects. The four types of dyslipidemia were defined as >5.17mmol/L for High-TC, >1.69 mmol/L for High-TG, >3.36 mmol/L for High-LDLC, and <1.04 mmol/L for Low-HDLC according to Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. Logistic models adjusting for age, gender, APOE genotype, body mass index, alcohol consumption, smoking, physical activity, medication use for cardiovascular diseases were used to examine the relationship between selenium levels and the risk of dyslipidemia.ResultsMean nail selenium concentration was 0.465μg/gin this sample. Rates for High-TC, High-LDLC, High-TG, Low-HDLC were 18.13%, 13.23%, 12.21% and 32.76% respectively. Results from logistic models indicated that higher selenium levels were significantly associated with higher risk of High-TC, High-LDLC and lower risk of Low-HDLC adjusting for covariates (p < 0.0001). Compared with the lowest selenium quartile group, participants in selenium quartile groups 2, 3 and 4 had significantly higher rates of High-TC, High-LDLC, High-TG, and lower rate of Low-HDLC adjusting for covariates. No significant association was observed between selenium level and the risk of High-TG. APOEε4 carriers had higher rates of High-TC and High-LDLC. There was no interaction between selenium level and APOE with the rates of dyslipidemia.ConclusionsOur results suggest long-term selenium exposure level may be associated with the risk of dyslipidemia in elderly population. Future studies are needed to examine the underlying mechanism of the association.

Prenatal Micronutrient Supplementation Is Not Associated with Intellectual Development of Young School-Aged Children1–3

Background: Micronutrient supplementation is often prescribed during pregnancy. The effects of prenatal iron and multimicronutrient supplementation on intellectual development in young school-aged children are less than clear.Objective: The aim of this study was to examine the long-term effects of prenatal iron plus folic acid or multiple micronutrient (including iron and folic acid) supplementation vs. folic acid supplementation on the intellectual development of young school-aged children in rural China.Methods: Young school-aged children (aged 7−10 y,n = 1744) of women who had participated in a trial of prenatal supplementation with various combinations of micronutrients and remained residents in 2 rural counties in China were followed. We measured their intellectual development by Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV). The WISC-IV generated the Full-Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index (VCI), Working Memory Index (WMI), Perceptual Reasoning Index (PRI), and Processing Speed Index (PSI). Multilevel analyses were used to assess the effect of prenatal micronutrient supplementation on the intellectual development of children.Results: The mean differences in FSIQ, VCI, WMI, PRI, and PSI, respectively, were not significant between prenatal folic acid supplementation and either iron plus folic acid [−0.34 (P = 0.65), −0.06 (P = 0.95), −0.22 (P = 0.76), −0.01 (P = 0.99), and −1.26 (P = 0.11)] or multimicronutrient [−0.39 (P = 0.60), −0.64 (P = 0.48), 0.11 (P = 0.87), −0.43 (P = 0.59), and −0.34; (P = 0.65)] supplementation after adjusting for confounders.Conclusions: There is no evidence to suggest a different effect on intellectual development between prenatal iron plus folic acid, multimicronutrient supplementation, and prenatal folic acid supplementation in children aged 7−10 y. This trial was registered at www.isrctn.com as ISRCTN08850194.

Soil-Transmitted Helminths in Southwestern China: A Cross-Sectional Study of Links to Cognitive Ability, Nutrition, and School Performance among Children.

BackgroundEmpirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children’s healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children. The objective of this study is to examine the relationship between STH infections and developmental outcomes among a primary school-aged population in rural China.Methodology/Principal FindingsWe conducted a large-scale survey in Guizhou province in southwest China in May 2013. A total of 2,179 children aged 9-11 years living in seven nationally-designated poverty counties in rural China served as our study sample. Overall, 42 percent of the sample’s elementary school-aged children were infected with one or more of the three types of STH—Ascaris lumbricoides (ascaris), Trichuris trichuria (whipworm) and the hookworms Ancylostoma duodenale or Necator americanus. After controlling for socioeconomic status, we observed that infection with one or more STHs is associated with worse cognitive ability, worse nutritional status, and worse school performance than no infection. This study also presents evidence that children with Trichuris infection, either infection with Trichuris only or co-infected with Trichuris and Ascaris, experience worse cognitive, nutritional and schooling outcomes than their uninfected peers or children infected with only Ascaris.Conclusions/SignificanceWe find that STH infection still poses a significant health challenge among children living in poor, rural, ethnic areas of southwest China. Given the important linkages we find between STH infection and a number of important child health and educational outcomes, we believe that our results will contribute positively to the debate surrounding the recent Cochrane report.

The Perception of Health Care Management among Middle-aged and Elderly Patients with Major Cardiovascular Conditions in Rural Settings

Background: The population ageing and uneven socio-economic development are common across the globe in China. However, in rural village settings, it is common that health care management are largely overlooked by the attending clinical physicians. Objective: This study assessed the health status and explored the perception of health care management among those with cardiovascular conditions in rural counties in China where the ability to pay is dominant. Method: We performed a cluster random sampling to select patients (aged ≥50 years) at rural health infirmaries in eight villages from three countries in Guangdong province, China. Information on clinical parameters measured on-site and morbidity history from medical records were obtained. The presence of hypertension, diabetes, and dyslipidemia were examined from clinically-diagnosed parameters (including triglycerides, ≥1.69 mmol/L; total cholesterol, ≥5.69 mmol/L; and low-density lipoprotein cholesterol, ≥3.62 mmol/L) according to clinical guidelines. A validated questionnaire to assess the perception of health care management (in a 10-point Likert-type scale) was administered by trained researchers to study subjects. Multiple linear regression analysis was conducted to explore factors associated with the willingness to pay for health care management. Result: The study population (N = 4,670 out of 4,800) had an average age of 65.3 years (standard deviation 7.1). Nearly one-third of subjects (31.9%) were illiteracy. The most prevalent condition was hypertension (54.6%), followed by dyslipidemia (43.3%) and diabetes (25.3%). Two-thirds of patients had multiple chronic conditions, with an average score ≤2 (out of 10) on the perception of health care management. Single-living (p = 0.018), higher education level (p = 0.034), and higher income level (p = 0.001) were independently associated with higher willingness of participating in health care management among the study subjects. Conclusion: The prevalence of cardiovascular conditions was high among middle-aged and older adults in China's rural health infirmary setting. The low-level perception of health care management might be explained by the unaffordablility of patients.

Coping skill as a moderator between negative life events and suicide among young people in rural China.

In the present study, we aim to test whether the approach or the avoidance coping skill can be a moderator between negative life events and suicide, and to test the deficient coping strain in the strain theory. This sample comprised 392 suicide cases and 416 community living controls, aged 15-34 years, from 16 rural counties in China. An established psychological autopsy method and a case-control design were used in this study. The 48-item Coping Response Inventory evaluated the degree of coping skills of the people who died by suicide. Results indicated that the avoidance coping skill, but not the approach coping skill, can moderate between negative life events and suicide. The low level of the avoidance coping skill may represent a promising variable for screening for suicide risk in rural China.

Poor infant and young child feeding practices and sources of caregivers’ feeding knowledge in rural Hebei Province, China: findings from a cross-sectional survey

ObjectivesTo obtain a general overview of infant and young child feeding practices in one rural county in China and identify current delivery channels and challenges.DesignA cross-sectional study.SettingA rural county, Zhao...

Aging village doctors in five counties in rural China: situation and implications.

BackgroundThe aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former “barefoot doctors”) who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors’ aging situation and its implications in rural China.MethodsThe data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.ResultsThe average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.ConclusionsAging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.

Cognitive function, body mass index and mortality in a rural elderly Chinese cohort

BackgroundPrevious studies have shown that poor cognition and low body mass index were associated with increased mortality. But few studies have investigated the association between cognition and mortality across the entire cognitive spectrum while adjusting for BMI. The objective of this study is to examine the associations between cognitive function, BMI and 7-year mortality in a rural elderly Chinese cohort.MethodsA prospective cohort of 2,000 Chinese age 65 and over from four rural counties in China were followed for 7-years. Cognitive function, BMI and other covariate information were obtained at baseline. Cox’s proportional hazard models were used to determine the effects of cognitive function and BMI on mortality risk.ResultsOf participants enrolled, 473 (23.7%) died during follow-up. Both lower cognitive function (HR = 1.48, p = 0.0049) and lower BMI (HR = 1.6, p < 0.0001) were independently associated with increased mortality risk compared to individuals with average cognitive function and normal weight. Higher cognitive function was associated with lower mortality risk (HR = 0.69, p = 0.0312). We found no significant difference in mortality risk between overweight/obese participants and those with normal weight.ConclusionsCognitive function and BMI were independent predictors of mortality risk. Intervention strategies for increasing cognitive function and maintaining adequate BMI may be important in reducing morality risk in the elderly population.

Intestinal Parasite Co-infection among Pulmonary Tuberculosis Cases without Human Immunodeficiency Virus Infection in a Rural County in China

Epidemiologic studies of co-infection with tuberculosis (TB) and intestinal parasites in humans have not been extensively investigated in China. A cross-section study was conducted in a rural county of Henan Province, China. Pulmonary TB (PTB) case-patients receiving treatment for infection with Mycobacterium tuberculosis and healthy controls matched for geographic area, age, and sex were surveyed by using questionnaires. Fecal and blood specimens were collected for detection of intestinal parasites, routine blood examination, and infection with human immunodeficiency virus. The chi-square test was used for univariate analysis and multivariate logistic regression models were used to adjust for potential confounding factors. A total of 369 persons with PTB and 366 healthy controls were included; all participants were negative for human immunodeficiency virus. The overall prevalence of intestinal parasites in persons with PTB was 14.9%, including intestinal protozoa (7.9%) and helminthes (7.6%). The infection spectrum of intestinal parasites was Entamoeba spp. (1.4%), Blastocystis hominis (6.2%), Trichomonas hominis (0.3%), Clonorchis sinensis (0.3%), Ascaris lumbricoides (0.5%), Trichuris trichiura (2.2%), and hookworm (4.6%). The prevalence of intestinal parasites showed no significant difference between persons with PTB and healthy controls after adjusting for potential confounding factors. There was no factor that affected infection rates for intestinal parasites between the two groups. Infection with intestinal parasites of persons with PTB was associated with female sex (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.01-4.17), body mass index ≤ 19 (AOR = 3.02, 95% CI = 1.47-6.20), and anemia (AOR = 2.43, 95% CI = 1.17-5.03). Infection of healthy controls was only associated with an annual labor time in farmlands > 2 months (AOR = 4.50, 95% CI = 2.03-10.00). In addition, there was no significant trend between rates of infection with intestinal parasites and duration of receiving treatment for infection with M. tuberculosis in persons with PTB. The prevalence of intestinal parasites was not higher in persons with PTB, and there was no evidence that PTB increased susceptibility to intestinal parasites in this study. However, for patients with PTB, women and patients with comorbidities were more likely to be infected with intestinal parasites.