County-level Hospitals Research Articles

A novel sequence type of carbapenem-resistant hypervirulent Klebsiella pneumoniae strains from a county-level tertiary hospital in Southeastern China.

The whole-genome sequencing of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains is required for investigating the molecular epidemiology because of their diverse molecular types across geographical regions. CRKP strains were collected from a tertiary hospital in Southeastern China from January 2017 to December 2020. Following species identification, drug susceptibility phenotypes were determined based on minimum inhibitory concentrations using the VITEK 2 Compact system. In addition, whole-genome sequencing was performed to identify the resistance genes and high virulence genes (rmpA, rmpA2, iucA, iroB, and peg-344). Finally, a phylogenetic tree was constructed based on the core genes. Forty CRKP strains were identified, and 25% of the involved patients (n = 10) died during hospitalization. The dominant sequence type (ST) was ST11 (65%), followed by ST290 (n = 4, 10%) and a novel ST (n = 4, assigned as ST6242, 10%). CRKP strains with this new ST were resistant to amikacin but susceptible to sulfamethoxazole-trimethoprim, and the phylogenetic tree indicated that they were derived from ST11 strains. All ST6242 strains were classified as the hypervirulent type (positive for rmpA, rmpA2, iucA, and peg-344). CRKP strains with this novel ST harbored highly virulent genes and a unique resistance phenotype. Thus, they should be epidemiologically monitored.

Genomic epidemiology of ceftriaxone-resistant non-typhoidal Salmonella enterica strain in China

Non-typhoidal Salmonella (NTS) is one of the top causes of diarrhea worldwide. Ceftriaxone is commonly recommended as the initial treatment option for Salmonella infections due to its antibacterial effectiveness. The objective of this study was to investigate the molecular epidemiological characteristics of NTS and to compare the phenotypic and genotypic profiles of antimicrobial resistance in multidrug-resistant Salmonella strains by sequencing 329 NTS strains collected from a county-level hospital between 2018 and 2021. Multi-locus sequence typing (MLST), antimicrobial resistance genes and plasmid types were identified by BacWGSTdb 2.0 webserver. Phylogenetic analysis of all NTS strains was carried out using Snippy and Gubbins software. The transferability of ceftriaxone resistant plasmids was confirmed through plasmid conjugation assays, and verified by S1-PFGE-Southern blot assays. The predominant serotypes among all NTS strains were Typhimurium (161/329), Enteritidis (49/329) and London (45/329). The most common sequence type observed was ST34 (86/329), followed by ST19 (72/329) and ST11 (47/329). The antimicrobial resistance of Salmonella to a wide range of antimicrobials showed an overall increase. Out of these 37 (11.24%) ceftriaxone-resistant strains, with the majority of them (33/37) being blaCTX−M. The predominant plasmid types identified were IncHI2 (14/21) and IncI1 (6/21), ranging in size from 70 kb to 360 kb. The conjugation efficiency was calculated with the high conjugation efficiency of 1.1 × 10− 5 to 9.3 × 10− 2. The strains varied widely, ranging from 3 to 45,024 single nucleotide polymorphisms (SNPs). There are close linkages observed among the predominant lineage, with an average of 78 SNPs between each pair of ST34 strains. The findings contribute to our understanding of the transmission and resistance mechanisms of multidrug-resistant Salmonella, thereby facilitating the development of effective control strategies.

Adult intensive care unit nurses' knowledge of and compliance barriers to evidence-based guidelines for prevention of ventilator-associated pneumonia: A cross-sectional survey.

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs) and is a common cause of morbidity and mortality in intensive care patients. Previous studies show that insufficient knowledge and compliance barriers among nurses affect pneumonia. There have been no investigations into intensive care nurses' knowledge and compliance barriers to evidence-based guidelines (EBGs) for VAP prevention in county-level hospitals in China. To explore adult ICU nurses' knowledge and compliance barriers to EBGs for preventing VAP in county-level hospitals in Hunan Province, China, examine the correlation between knowledge and compliance barriers, and analyse associated factors. A cross-sectional electronic survey was conducted to focus on nurses' knowledge of and compliance barriers to EBGs for preventing VAP. A total of 386 valid questionnaires were collected, with a response rate of 97.47% (386/396 = 97.47%). The median scores for nurses' knowledge (out of 9) and compliance barriers (out of 8) to EBGs for preventing VAP were 7 (interquartile range: 5-8) and 3 (interquartile range: 2-4), respectively. Knowledge was negatively associated with compliance barriers (r = -0.437, p < .01). The results of the multiple linear regression analysis showed that hospital level, age, nurses' attendance at VAP training and years of experience in ICUs were related to the level of knowledge. Nurses' attendance at VAP training, age and years of experience in ICUs were associated with the level of compliance barriers. Intensive care nurses have satisfactory knowledge of EBGs for preventing VAP, but compliance barriers can be reduced. Better knowledge helps reduce the barriers to compliance among nurses. Nurse managers and nurse educators are suggested to examine nurses' knowledge and compliance barriers to EBGs for preventing VAP, develop personalized training plans, promote continuous education based on the latest EBGs and raise the nurse-patient ratio reasonably.

Research and analysis on the situation of diagnosis and treatment capabilities of breast cancer in China county.

8 Background: 1. In 2016, 306,000 breast cancer cases were newly diagnosed in China, with one-third in rural areas. Breast cancer ranked second in incidence (22.47/105) among female cancers in Sichuan Province. 2. Health resources are unequally distributed in China, especially in Sichuan Province where 43.27% reside rurally. County hospitals play a vital role in rural patients' diagnosis, treatment, and referrals. Methods: This cross-sectional observational study surveyed 124 county-level hospitals that had treated breast cancer in 183 counties in Sichuan Province from December 2023 to January 2024. Outcomes include: 1) hospital level; 2) oncology certification; 3) availability of dedicated breast department and staffing; 4) breast cancer diagnosis and treatment technology; 5) pre-treatment TNM staging rate; 6) anti-neoplastic drugs and support Accessibility of medicines. Results: Out of 124 hospitals surveyed, 6 excluded for zero breast cancer cases in 2023. The remaining 118 hospitals revealed: 1) 78.81% tertiary, 93.22% public; 2) 75.42% with special outpatient qualifications, 57.63% with concurrent special antineoplastic drug designations, 17.80% with one qualification; 3) 57.63% with dedicated breast units, but only 16.1% with specialized breast cancer staff; 4) 31.36% with full breast imaging modalities, 78.23% lacking mammography; PET-CT and bone scan availability: 5.93% and 9.32%; 5) 71.19% with independent pathology, but only 30.65% providing comprehensive services; 6) Surgeries for breast cancer: 86.44% (44.07% breast conservation), radiation therapy availability: 39.83%; 7) AJCC TNM staging rate: 77.12%; 8) Antineoplastic accessibility: conventional chemotherapy (93.22%), anti-HER2 therapy (28.81%), endocrine therapy (47.46%), CDK4/6 inhibitors (26.27%, with 41.53% having only one); 9) Analgesics: 87.90% (morphine 94.92%, tramadol 88.98%, fentanyl patches 34.75%, oxycodone 46.61%); antiemetics (5-HT3 antagonists 69.49%, NK1 antagonists 72.88%, olanzapine 48.31%, metoclopramide 64.41%); medications for hematologic toxicity: 51.61%. Conclusions: Shortages exist in specialized breast care units and trained personnel among county hospitals in Sichuan, China. Special outpatient qualifications and antineoplastic prescription credentials concentrated mainly at tertiary centers. Enhancing imaging and histopathology capacities for breast cancer diagnosis is an urgent need. While conventional chemotherapies demonstrate good accessibility, anti-HER2 targeted therapies, endocrine therapies, and CDK4/6 inhibitors covered by national insurance have limited availability. Enhanced provision of new antiemetics and analgesics is needed. [Table: see text]

Cross-sectional study on the current status of county-level cancer prevention and treatment capabilities in the four southwestern provinces of China.

184 Background: Lung cancer (LC) stands out as the most prevalent form of cancer in China, and it is also the primary cause of cancer-related mortality. Notably, 42.3% of newly diagnosed cancer patients are identified at the grassroots level each year. In response, the Chinese government is actively promoting tiered diagnosis and treatment approaches. This study aims to evaluate the current state of county-level cancer prevention and treatment capabilities in China, offering suggestion for policy and the standardized pathway development. Methods: A cross-sectional study was conducted in 470 district and county (city) hospitals across four provinces in southwest China: Sichuan, Yunnan, Guangxi, and Guizhou, from December 2023 to March 2024. The study was initiated by 13 hospitals, and all participating physicians signed informed consent forms. All analyses were conducted by SPSS 22.0. Results: Of the 470 county-level hospitals in China, 151 have a permanent population of over 500,000. 146 counties (198 hospitals) have established cancer specialties. There are 74 medical linear accelerators and 33 cobalt-60 treatment machines. Among them, 63.6% are tertiary hospitals, and 94.9% are public hospitals. 37.4% of hospitals have linear accelerators, and 16.7% have cobalt-60 treatment machines. 89.8% perform TNM staging, 79.1% perform radical surgery, 96.4% perform chemotherapy, 83.2% perform endocrine therapy, 97.5% perform targeted therapy, 87.3% perform immunotherapy, 54.8% perform interventional therapy, and 34.0% perform radiotherapy. Additionally, 56.8% conduct multidisciplinary diagnosis and treatment (MDT), and 37.0% provide palliative care. 83% hospitals have pathology departments, and 46.0% have established cancer centers. 79% hospitals can perform routine pathological diagnosis, and 17.0% can perform genetic testing in-hospital. Imaging departments have conducted CT plain scans in 96.4% of cases, CT enhancements in 87.7%, MRI plain scans in 84.1%, and MRI enhancements in 72.3%. Fibro-bronchoscopy was carried out in 87.2% of cases, and gastrointestinal endoscopy in 84.2%. Morphine injection was accessible in 84.8% of cases, oxycodone in 64.5%, and tramadol in 86.8%. Non-steroidal analgesics were accessible in 88.3% of cases. Conclusions: In the southwestern areas of China, the penetration rate of oncology expertise is 31.1%. Most medical institutions offering oncology specialties are tertiary public hospitals. The average number of radiotherapy machines per county or district is 0.16. The development of surgery, oncology, and the imaging is well. Radiotherapy is still in developing, and the genetic testing capacity in-hospital is insufficient. The application of TNM staging is satisfactory. Accessibility to analgesic and anti-inflammatory drugs is well, but the construction of county cancer centers still needs improvement.

Factors associated with tuberculosis care-seeking and diagnostic delays among childhood pulmonary tuberculosis in Zhejiang Province, China: a 10-year retrospective study

We conducted a retrospective study to investigate risk factors for tuberculosis care-seeking delay and diagnostic delays among pediatric pulmonary tuberculosis cases in Zhejiang Province from 2013 to 2022. Among 1274 cases, 49.61% experienced tuberculosis care-seeking delays (> 14 days from symptom onset to first hospital visit) and 14.91% faced diagnostic delays (> 14 days from initial consultation to diagnosis). The proportion of care-seeking delays ranged from 37.42 to 64.89%, while diagnostic delay fluctuated from 6.11 to 21.02%. Urban residence (OR = 0.78, 95% CI 0.62–0.98, P = 0.030), first visiting a municipal-level hospital (OR = 0.57, 95% CI 0.45–0.72, P < 0.001), and diagnostic method (OR = 0.66, 95%CI 0.52–0.84, P < 0.001) were associated with tuberculosis care-seeking delay, whereas first visiting a municipal-level hospital (OR = 2.05, 95% CI 1.49–2.80, P < 0.001) was linked to diagnostic delay. Further analysis using a 28-day cutoff point revealed that children aged 0–4 years, those from migrant populations, laboratory-confirmed patients, and those who first visited a county-level hospital were more likely to experience delays in seeking tuberculosis care. Thus, society should pay more attention to the health of rural, migrant, and 0–4-year-old children, as they are at higher risk of experiencing tuberculosis care-seeking delays.

Knowledge mapping of job burnout and satisfaction of medical staff and a cross-sectional investigation of county-level hospitals in Southern China

BackgroundJob burnout is a worldwide public health problem that has rarely been addressed among rural medical staff, particularly in county-level hospitals. Hence, we conducted a bibliometric study to gain global insights and research trends and a cross-sectional study to assess the current situation among medical staff of county-level hospitals in Southern China. By conducting these studies, we aim to identify factors associated with burnout among medical staff of county-level hospitals in China and provide recommendations for improvement. MethodsRelevant literature on job burnout among medical personnel was searched using the Web of Science Core Collection (WoSCC). CiteSpace was employed for an in-depth cluster analysis to determine research trends and identify the study population. Subsequently, a cross-sectional survey was randomly conducted in three county-level hospitals in Hunan Province of Southern China. Job burnout and satisfaction were assessed using the Maslach Burnout Inventory MBI-Human Services Survey (MBI-HSS) and Job Satisfaction Questionnaire in a total of 362 valid questionnaires collected. The influence factors of the prevalence of job burnout were investigated using logistic regression. ResultsIn this bibliometric study, 1626 articles were retrieved from 1999 to 2022. China lags behind the United States (US) in both the number and quality of publications in the field of medical staff burnout compared with the US. However, there is a lack of comparative research on job burnout across different job types. County-level medical staff articles are more in line with research hotspots in the field. In total, 362 valid questionnaires were obtained. The total incidence of job burnout among rural medical staff was 27.3 %. Nurses (p < 0.01, OR = 5.95), doctors (p < 0.01, OR = 6.43), and those with administrative jobs (p < 0.01, OR = 7.79) were more likely to experience burnout than those with technical jobs. Medical staff aged 40–49 years (p < 0.01, OR = 0.22) and 50–59 years (p < 0.05, OR = 0.14) were less likely to experience burnout than those aged 20–29 years. Job rewards satisfaction showed a positive correlation with job burnout (p < 0.01, OR = 1.32), but negative correlations with personal development satisfaction (p < 0.05, OR = 0.81) and work internal environment satisfaction (p < 0.05, OR = 0.81). ConclusionBetter working environments, more accessible resources, and higher job rewards contribute to job satisfaction and reduce job burnout among the medical staff of county-level hospitals in China.

Guideline concordance of recurrence risk assessment for early breast cancer in a county-level setting in China.

e23263 Background: Guideline-centric risk-based decision-making is crucial for the treatment of HR+HER2- and HER2+ early breast cancer (eBC). However, the consistency of recurrence risk assessment (RA) between real-life clinical practice and guidelines in China has not been thoroughly investigated. As part of the interim analysis of CHASE001 (NCT05544123), we explored the guideline concordance of RA for HR+HER2- and HER2+ eBC in a county-level setting in China. Methods: Cohorts of HR+HER2- and HER2+ eBC patients (pts) from a county-level observational study (CHASE001) were included in this analysis. Clinical recurrence risk were collected for each patient. Descriptive statistics reported the proportion of pts classified into each risk level under real-life assessment by healthcare professionals (HCPs) (H-low/intermediate/high) and guideline-consistent assessment (G-low/intermediate/high). To investigate the factors associated with lower consistency, univariate (UVA) and multivariate logistic regression analysis (MVA) were performed. Results: 1254 HR+HER2- and 841 HER2+ eBC pts from 26 county-level hospitals were included in this analysis. A comparison between recurrence risk under HCPs assessment (HA) and guideline-consistent assessment (GA) revealed divergence. In HR+HER2- cohort, the proportions of pts classified as low, intermediate (int), and high clinical risk for recurrence under HA/GA were 27.2%/2.0%, 48.0%/57.4%, 24.8%/40.6%, respectively. Notably, 36.8% of pts classified as G-int were categorized as H-low, while 47.5% G-high pts were classified as H-int/low. On UVA and MVA, pT1 stage, histological grade 1 and Ki67 &lt; 20% were associated with G-int/H-low; whereas lymphovascular invasion and pN1 were associated with G-high/H-lower. Among 562 G-int/high premenopausal pts, 280 (49.8%) achieved ovarian function suppression (OFS) and the OFS rates were 46.1% in G-int and 55.3% in G-high pts. In HER2+ cohort, the proportions of pts classified as low, int and high risk under HA/GA were 17.2%/0%, 48.2%/51.2% and 34.6%/48.8%. In pts with pN0, 17.2% were classified as H-low and 12% as H-high. In pts with positive lymph nodes (LN+), 11% were classified as H-low and 31% as H-int. Dual anti-HER2 target therapy was administered in 72% of pts with LN+. In both cohorts, HCPs who were medical oncologists had higher consistency with guideline for high-risk evaluation compared to surgical oncologists, whereas surgical oncologists showed higher consistency for int-risk evaluation compared to medical oncologists. Conclusions: This analysis highlights differences in clinical practice between county-level HCPs and guideline recommendations, revealing a significant underestimation of breast cancer recurrence risk. Further efforts should be made to enhance guideline adherence and promote guideline-centric clinical risk-based decision-making at county-level hospitals. Clinical trial information: NCT05544123 .

The impacts of national centralized drug procurement policy on drug utilization of medical institutions: an empirical study in a county-level hospital in China

PurposeUnder the background of the regular implementation of the National Centralized Drug Procurement (NCDP) policy, this study aimed to assess the impacts of the NCDP policy on drug utilization of county-level medical institutions, and probe into the influencing factors of the changes in drug utilization.MethodA pre-post study was applied using inpatient data from a county-level medical institution in Nanjing. Drug utilization behavior of medical institutions of 88 most commonly used policy-related drugs (by generic name, including bid-winning and bid-non-winning brands) was analyzed, and the substitution of bid-winning brands for brand-name drugs after policy intervention was evaluated.ResultsAfter policy intervention, 43.18% of policy-related drugs realized the substitution of bid-winning brands for bid-non-winning brands (6.82% of complete substitution, 36.36% of partial substitution). Meanwhile, 40.90% of policy-related drugs failed to realize brand substitution. Multiple factors affected brand substitution, including: (1) Policy effect: brand substitution was more obvious after the intervention of the first and third round of NCDP. (2) Drug market competition: the greater the price reduction of bid-non-winning brands, the more the drugs for the same indication, the more likely that medical institutions keep using the same brands as they did before policy intervention. (3) Previous drug utilization of medical institutions: brand substitution was more obvious in drugs with large number of prescriptions and weak preference for brand-name drugs.ConclusionThe NCDP policy promoted the substitution of bid-winning brands for bid-non-winning brands. However, the NCDP policy remained to be further implemented in county-level medical institutions. Policy implememtation efforts, drug market competition and drug utilization of medical institutions would affect the implementation of the NCDP policy.

How healthcare entrepreneurship enhances ecosystem outcomes: the relationship between venture capital-funded start-ups and county-level health

PurposeResearch has examined how new ventures strengthen local economic outcomes; however, limited research examines health-oriented ventures and their impact on social outcomes, including health outcomes. Increased VC investment in healthcare service start-ups signals more activity toward this end, and the need for further academic inquiry. We examine the relationship between these start-ups and county-level health outcomes, health factors, and hospital utilization.Design/methodology/approachData on start-ups funded via institutional venture capital from PitchBook were merged with US county-level outcomes from the County Health Rankings and Area Health Resources Files for 2010 to 2019. We investigated how the number of VC-funded healthcare service start-ups, as well as a subset defined as innovative, were associated with county-level health measures. We used panel models with two-way fixed effects and Propensity Score Matched (PSM), controlling for demographics and socioeconomic factors.FindingsEach additional VC-funded healthcare service start-up was related to a significant 0.01 percentage point decrease in diabetes prevalence (p < 0.01), a decrease of 1.54 HIV cases per 100,000 population (p < 0.1), a 0.02 percentage point decrease in obesity rates (p < 0.01), and a 0.03 percentage point decrease in binge drinking (p < 0.01). VC-funded healthcare service start-ups were not related to hospital utilization.Originality/valueThis work expands our understanding of how industry-specific start-ups, in this case healthcare start-ups, relate to positive social outcomes. The results underscore the importance of evidence-based evaluation, the need for expanded outcome measures for VC investment, and the possibilities for integration of healthcare services and entrepreneurship ecosystems.

Genomic characterization and outbreak investigations of methicillin-resistant Staphylococcus aureus in a county-level hospital in China.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen contributing to healthcare-associated infections, which can result in multiple sites infections. The epidemiological characteristics of MRSA exhibit variability among distinct regions and healthcare facilities. The aim of this study was to investigate the molecular epidemiology and nosocomial outbreak characteristics of MRSA in a county-level hospital in China. A total of 130 non-repetitive MRSA strains were collected from December 2020 to November 2021. Whole-genome sequencing (WGS) was performed to identify antimicrobial resistance and virulence factors. Phylogenetic analysis was conducted to ascertain genetic diversity and phylogenetic relationships. Independent transmission scenarios were determined by the phylogeny derived from single nucleotide polymorphisms (SNPs) within the core genome. All the MRSA isolates were collected from the intensive care unit (30.00%, 39/130), the department of otorhinolaryngology (10.00%, 13/130) and the department of burn unit (9.23%, 12/130). The clinical samples mainly included phlegm (53.85%, 70/130), purulent fluid (24.62%, 32/130), and secretions (8.46%, 11/130). The resistance rates to erythromycin, clindamycin and ciprofloxacin were 75.38, 40.00, and 39.23%, respectively. All the isolates belonged to 11 clonal complexes (CCs), with the major prevalent types were CC5, CC59, and CC398, accounting for 30.00% (39/130), 29.23% (38/130), and 16.92% (22/130), respectively. Twenty sequence types (STs) were identified, and ST59 (25.38%, 33/130) was the dominant lineage, followed by ST5 (23.84%, 31/130) and ST398 (16.92%, 22/130). Three different SCCmec types were investigated, most of isolates were type IV (33.85%, 44/130), followed by type II (27.69%, 36/130) and type III (0.77%, 1/130). The common clonal structures included CC5-ST5-t2460-SCCmec IIa, CC59-ST59-t437-SCCmec IV and CC398-ST398-t034-SCCmec (-), with rates of 16.92% (22/130), 14.62% (19/130), and 13.84% (18/130), respectively. Only 12 panton-valentine leucocidin (PVL) positive strains were identified. Two independent clonal outbreaks were detected, one consisting of 22 PVL-negative strains belongs to CC5-ST5-t2460-SCCmec IIa and the other consisting of 8 PVL-negative strains belongs to CC5-ST5-t311-SCCmec IIa. Overall, our study indicated that the CC5 lineage emerged as the predominant epidemic clone of MRSA, responsible for nosocomial outbreaks and transmission within a county-level hospital in China, highlighting the necessity to strengthen infection control measures for MRSA in such healthcare facilities.

Abstract P376: Comparison of Heart Failure Admission Rates Between Rural-Urban Continuum Code Designations

Introduction: Approximately 6 million adults in the US have heart failure (HF) and, from 2012 to 2030, the prevalence is estimated to increase by 46%. In 2017, the prevalence of HF among rural residents was 40% higher than among residents of small metropolitan and urban areas and this gap has continued to grow. However, only examining differences among metropolitan vs nonmetropolitan statistical areas or urban vs rural areas means it is impossible to understand within rural variation. Hypothesis: We assessed the hypothesis that county-level HF admission rates would differ by Rural-Urban Continuum Code (RUCC). Methods: Using 2017 data from the Healthcare Cost and Utilization Project, this cross-sectional study investigated the association between RUCC designation and county-level HF admission rates (number of admissions with a principal diagnosis of HF per 100,000 population aged 18+). The sample included 826 counties across 13 states. Rural, Urban, and Metro designations were defined through RUCCs. One-way ANOVA was performed to identify overall differences in HF admission rates across RUCC designations, with post-hoc pairwise comparisons performed using Tukey’s HSD. Results: There was a statistically significant difference in HF admission rates between at least two groups ( F (817, 8)=[13.99, p &lt;.001]). Results from 13 of the 36 pairwise comparisons were statistically significant ( Table ). Conclusion: We identified statistically significant differences in county-level HF hospital admission rates by RUCC. Metro counties had significantly higher HF admission rates than urban and rural counties, but differences across rural counties were not observed. HF prevalence is higher among rural Americans than those in urban and metro areas, but HF hospital admission rates in rural counties are much lower. Further research is needed to investigate the drivers of these differences in prevalence and healthcare utilization.

Is low-dose computed tomography for lung cancer screening conveniently accessible in China? A spatial analysis based on cross-sectional survey

BackgroundRegular Low-Dose Computed Tomography (LDCT) for lung cancer high-risk population has been proved to improve health outcomes and relieve disease burden efficiently for both individual and society. With geographical impedance becoming the major barrier preventing patients from getting timely healthcare service, this study incorporated health seeking behavior in estimating spatial accessibility of relative scarce LDCT resource in China, thus to provide real-world evidence for future government investment and policy making.MethodsTaking Sichuan Province in southwest China as the study area, a cross-sectional survey was first carried out to collect actual practice and preferences for seeking LDCT services. Using Computed Tomography (CT) registration data reported by owner institutions representing LDCT services capacity, and grided town-level high-risk population as demand, the Nearest Neighbor Method was then utilized to calculate spatial accessibility of LDCT services.ResultsA total of 2,529 valid questionnaires were collected, with only 34.72% of the high-risk populations (746 individuals) followed the recommended annual screening. Participants preferred to travel to municipal-level and above institutions within 60 min for LDCT services. Currently, every thousand high-risk populations own 0.0845 CT scanners in Sichuan Province, with 96.95% able to access LDCT within 60 min and over half within 15 min. Urban areas generally showed better accessibility than rural areas, and the more developed eastern regions were better than the western regions with ethnic minority clusters.ConclusionsSpatial access to LDCT services is generally convenient in Sichuan Province, but disparity exists between different regions and population groups. Improving LDCT capacity in county-level hospitals as well as promoting health education and policy guidance to the public can optimize efficiency of existing CT resources. Implementing mobile CT services and improving rural public transportation may alleviate emerging disparities in accessing early lung cancer detection.

Revealing spatiotemporal inequalities, hotspots, and determinants in healthcare resource distribution: insights from hospital beds panel data in 2308 Chinese counties

BackgroundEnsuring universal health coverage and equitable access to health services requires a comprehensive understanding of spatiotemporal heterogeneity in healthcare resources, especially in small areas. The absence of a structured spatiotemporal evaluation framework in existing studies inspired us to propose a conceptual framework encompassing three perspectives: spatiotemporal inequalities, hotspots, and determinants.MethodsTo demonstrate our three-perspective conceptual framework, we employed three state-of-the-art methods and analyzed 10 years’ worth of Chinese county-level hospital bed data. First, we depicted spatial inequalities of hospital beds within provinces and their temporal inequalities through the spatial Gini coefficient. Next, we identified different types of spatiotemporal hotspots and coldspots at the county level using the emerging hot spot analysis (Getis-Ord Gi* statistics). Finally, we explored the spatiotemporally heterogeneous impacts of socioeconomic and environmental factors on hospital beds using the Bayesian spatiotemporally varying coefficients (STVC) model and quantified factors’ spatiotemporal explainable percentages with the spatiotemporal variance partitioning index (STVPI).ResultsSpatial inequalities map revealed significant disparities in hospital beds, with gradual improvements observed in 21 provinces over time. Seven types of hot and cold spots among 24.78% counties highlighted the persistent presence of the regional Matthew effect in both high- and low-level hospital bed counties. Socioeconomic factors contributed 36.85% (95% credible intervals [CIs]: 31.84–42.50%) of county-level hospital beds, while environmental factors accounted for 59.12% (53.80–63.83%). Factors’ space-scale variation explained 75.71% (68.94–81.55%), whereas time-scale variation contributed 20.25% (14.14–27.36%). Additionally, six factors (GDP, first industrial output, local general budget revenue, road, river, and slope) were identified as the spatiotemporal determinants, collectively explaining over 84% of the variations.ConclusionsThree-perspective framework enables global policymakers and stakeholders to identify health services disparities at the micro-level, pinpoint regions needing targeted interventions, and create differentiated strategies aligned with their unique spatiotemporal determinants, significantly aiding in achieving sustainable healthcare development.

Comparative Study on the Satisfaction of Healthcare Service Providers with the Synergistic Development of Rural Healthcare Systems in China: Medical Alliance Counties vs. Non-Medical Alliance Counties.

This study aimed to explore whether the establishment of county medical alliances can improve satisfaction with the vertical integration of healthcare systems among rural medical and healthcare service provider managers and service providers. Our study also sought to provide recommendations for the sustainable development of vertical integration in healthcare systems. A semi-structured interview with 30 healthcare service providers was employed in this research, and Nvivo software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling method was used to select participants. The sample included two leading hospitals in medical consortia, 15 member units (healthcare service providers and medical staff), two county-level hospitals, and 15 township health centers/community healthcare service centers from non-medical consortia. Questionnaire surveys were conducted with these groups. Factor analysis was used to calculate satisfaction scores for healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)). Propensity score matching was employed to reduce confounding factors between groups. The Mann-Whitney U test was used to compare satisfaction differences between groups. The overall satisfaction scores for lead-county hospital managers, member institution managers, medical staff at the lead-county hospital, and medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively. Lead-county hospital managers' satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and resource integration in the Medical Alliance group showed higher satisfaction than the Non-Medical Alliance. Similarly, lead-county hospital medical staff in the Medical Alliance group reported greater satisfaction with collaboration efforts, supportive environment, and development capacity enhancement. Notably, while the Medical Alliance group's satisfaction scores were higher, the differences between the two groups were not statistically significant for lead-county hospital managers and medical staff. The Medical Alliance group did show statistically significant differences in member institution managers' satisfaction with collaboration, development capacity enhancement, and structure and resource integration. Additionally, medical staff of member institutions in the Medical Alliance group reported statistically significant higher satisfaction with collaboration, supportive environment, development capacity enhancement, healthcare service integration, and human resource development. To facilitate the establishment of county medical alliances, managers of leading county-level hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and healthcare services. Additionally, revamping remuneration and appraisal systems for members of county medical alliances is necessary. This will encourage cooperation among healthcare institutions within the three-tiered system and their medical staff, ultimately facilitating the provision of integrated services.

Guideline for the management path and quality control of breast cancer prevention and treatment in China's counties (2023 edition)

Breast cancer is the most common malignant tumor among women in China. In 2016, there were about 306 000 new cases of breast cancer in Chinese females. Of these, about 33% (100 400) occurred in rural areas. County-level (counties or county-level cities) hospitals are the first diagnosis units for most rural breast cancer patients and play an important role in cancer prevention, screening, maintenance treatment, rehabilitation, follow-up, and referral. Due to economic and geographical constraints, county-level hospitals are relatively deficient in medical equipment, health human resources, and drug accessibility. There is an imperative need for breast cancer prevention and management guidelines that are suitable for the actual situation in China's counties. Therefore, under the policy background of hierarchical diagnosis and treatment, the Chinese expert group formulated the "Guideline for the management path and quality control of breast cancer prevention and treatment in China's counties (2023 edition)", aiming to expand the availability of quality medical resources and ensure they are better distributed among regions, enhance the capacity for breast cancer prevention and treatment, so as to improve the prognosis and quality of life of patients in China's counties. This guideline provides path diagrams which are concise, unambiguous and easy to translate into clinical practice, as reference for clinicians in county-level hospitals.

Genomic Characteristics of a Carbapenem-Resistant Klebsiella pneumoniae Co-Carrying bla NDM-5 and bla KPC-2 Capsular Type KL25 Recovered from a County Level Hospital in China.

Hypervirulent carbapenem-resistant K. pneumoniae (hv-CRKP) has been spreading rapidly worldwide. Here, we investigated the genomic characteristics of ST11 K. pneumoniae isolate SM117 with capsular serotype KL25, co-carrying bla NDM-5, two copies of bla KPC-2 and multiple plasmid-borne virulence genes from a county level hospital in China. Antimicrobial susceptibility of K. pneumoniae SM117 was evaluated. The Illumina NovaSeq 6000 and Oxford Nanopore MinION platforms were applied to sequence the genome and then de novo assembled. The genome sequence was annotated using the NCBI Prokaryotic Genome Annotation Pipeline and further subjected to identify the sequence type (ST), capsular type, antibiotic resistance genes, plasmid replicon types and virulence genes. The phylogenetic analysis was performed based on the core genome single nucleotide polymorphisms (cgSNPs) using CSI Phylogeny 1.4, and further visualized by Interactive Tree of Life (iTOL) V5 web server. The whole-genome sequence of K. pneumoniae SM117 is made up of eight contigs totaling 6,104,486 bp, contain a 5,612,620 bp single chromosome and seven plasmids. The isolate was assigned to ST11 with capsular serotype KL25, co-carrying including bla NDM-5, bla KPC-2 and multiple plasmid-borne virulence genes including rmpA2 and aerobactin genes iucABCD-iutA. The coexistence of bla KPC and bla NDM in K. pneumoniae strains exhibit a high degree of resistance to β-lactam antibiotics. The strain SM117 also carries multiple antibiotic resistance genes, making it resistant to all antibiotics except polymyxin. The closest relative of K. pneumoniae C793 was identified in 2023 from a hospital surface sample in Zhejiang, China, with just 52 SNPs difference. This study reported the genomic characteristics of a multidrug-resistant ST11 K. pneumoniae with capsular serotype KL25, co-carrying bla NDM-5, two copies of bla KPC-2 genes and multiple plasmid-borne virulence genes in China. These findings will provide important knowledge of the antibiotic resistance mechanisms, genomic epidemiological characteristics and transmission dynamics of multidrug-resistant K. pneumoniae.

Active screening for tuberculosis among high-risk populations in high-burden areas in Zhejiang province, China

ObjectivesTuberculosis (TB) is a major global public health concern. Although the incidence of TB in China is declining, the country continues to face many challenges regarding TB control. This study aimed to develop an active case finding (ACF) strategy for high-risk populations in areas with high TB burden and evaluate the effectiveness of the ACF strategy for early TB detection in patients to reduce TB transmission. Study designThis was a descriptive study. MethodsFrom May to October 2019, active TB screening was conducted in Zhejiang Province, China. Overall, 24 high-burden townships were chosen as study sites. Residents aged ≥65 years, suffering from diabetes, diagnosed with HIV/AIDS, or with a history of TB were mobilized for screening. Chest radiography was performed for all participants in the community. Sputum specimens were collected for sputum smear tests and cultures at county-level TB-designed hospitals. A professional medical team performed the final diagnoses. ResultsOverall, 130,643 residents were included, accounting for 8.85% of the total population in the selected areas. After screening, 89 confirmed cases and 419 suspected cases were identified. The detection rates for suspected and confirmed cases were 320.72/100,000 and 68.12/100,000, respectively. Individuals with a history of TB accounted for a large proportion of detected cases, and the detection rate was higher among males than in females. This study identified 10.5% of reported cases in the selected areas in 2019. In Zhejiang province, compared with the previous year, the rates of TB notification in 2019 and 2020 declined by 7.0% and 7.4%, respectively, compared with the previous year. However, the TB notification rate in 2019 was almost the same as that in 2018 (a decline of 2.5%) but sharply declined in 2020 (14.4%) in the screened areas. ConclusionsOur findings suggest that the ACF strategy may have helped to maintain the downward trends in TB notification rates by detecting patients with TB and suspected cases in the short term.

Predicting long-term prognosis after percutaneous coronary intervention in patients with acute coronary syndromes: a prospective nested case-control analysis for county-level health services.

We aimed to establish and authenticate a clinical prognostic nomogram for predicting long-term Major Adverse Cardiovascular Events (MACEs) among high-risk patients who have undergone Percutaneous Coronary Intervention (PCI) in county-level health service. This prospective study included Acute Coronary Syndrome (ACS) patients treated with PCI at six county-level hospitals between September 2018 and August 2019, selected from both the original training set and external validation set. Least Absolute Shrinkage and Selection Operator (LASSO) regression techniques and logistic regression were used to assess potential risk factors and construct a risk predictive nomogram. Additionally, the potential non-linear relationships between continuous variables were tested using Restricted Cubic Splines (RCS). The performance of the nomogram was evaluated based on the Receiver Operating Characteristic (ROC) curve analysis, Calibration Curve, Decision Curve Analysis (DCA), and Clinical Impact Curve (CIC). The original training set and external validation set comprised 520 and 1,061 patients, respectively. The final nomogram was developed using nine clinical variables: Age, Killip functional classification III-IV, Hypertension, Hyperhomocysteinemia, Heart failure, Number of stents, Multivessel disease, Low-density Lipoprotein Cholesterol, and Left Ventricular Ejection Fraction. The AUC of the nomogram was 0.79 and 0.75 in the training set and external validation set, respectively. The DCA and CIC validated the clinical value of the constructed prognostic nomogram. We developed and validated a prognostic nomogram for predicting the probability of 3-year MACEs in ACS patients who underwent PCI at county-level hospitals. The nomogram could provide a precise risk assessment for secondary prevention in ACS patients receiving PCI.

Research on radiation sensitive biomarkers and status of radiation safety literacy under low dose irradiation: Radiation biomarkers and radiation safety culture

ObjectiveTo analyze the health status and radiation sensitivity index of radiation workers in provincial, county and township hospitals. To explore the methods of evaluation indicators, evaluation standards and scoring principles of radiation safety culture in medical institutions. MethodsIn 2021, the radiation safety status of all 172 medical institutions in a city was investigated by using retrospective investigation, current situation investigation and laboratory study. The occupational health monitoring data of all 1547 radiation workers were statistically analyzed, and the radiation safety status and health indicators of radiation workers in provincial, county and township level hospitals were compared. ResultsThe results of occupational health monitoring of radiation workers showed that there were statistically significant differences in ALT, lens opacity (P < 0.05) and lymphocyte micronucleus (P < 0.05) between the two groups, and there were statistically significant differences in the influence of radiation service on the detection rate of lens opacity (P < 0.05). The survey results of radiation safety culture construction in medical institutions show that there are differences in the level of radiation safety culture in hospitals of different grades. The radiation safety culture construction of provincial and municipal public hospitals is obviously better than that of county hospitals, especially township hospitals. ConclusionInterventional radiologists and nuclear medicine workers engaged in iodine therapy were exposed to higher radiation agents, and radiation workers in township health centers were not aware of radiation protection, and there was a certain occupational risk. At the same time, the evaluation index of radiation safety literacy in medical institutions was determined, Disease prevention and control personnel stationed in hospitals is an effective measure to strengthen the construction of radiation safety culture in hospitals.