Chinese Rural Community Research Articles

Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial

BackgroundDiabetes has become a major public health problem in China. Support of patient self-management is a key component of effective diabetes care and improved patient outcomes. A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999. However, the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai. This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai.Methods208 patients with type 2 diabetes aged 35–80 years were randomly assigned to the intervention group (n=119) of 12 monthly group visit sessions or to a control group (n=89) of usual care. The trial was undertaken in two rural communities in Shanghai, China. Randomization and allocation to study group were carried out by using a random number table. Analysis of covariance was used to compare changes in the 17 self-management behavior, self-efficacy and health status related variables in two groups at 12 months’ follow-up based on 176 patients (n=98; n=78).ResultsCompared with controls, the intervention patients, on average, increased their duration of aerobic exercise by more than 40 minutes per week (p=0.001); had significant increase of 0.71 in mean score on self-efficacy to manage diabetes (p=0.02); and had significant improvements in measures of illness intrusiveness and systolic blood pressure. The intervention patients attended an average of 10.1 of the 12 program sessions with 75.6% of them attended 10 and more sessions.ConclusionThe Chinese diabetes group visit model is a feasible, acceptable and effective alternative for supporting diabetes patient self-management in Chinese rural communities. The model requires larger studies to determine its effect on blood glucose control and health care utilization.Trial registrationISRCTN87909028

Developing Rural Tourism: the PAT Program and ‘Nong jia le’ Tourism in China

ABSTRACTDespite the fact that the last three decades have witnessed the rapid development of rural tourism (RT) in China, which is being promoted by the Chinese government as an important new type of tourism due to its special role in revitalizing China's rural economy, there is still little knowledge about the economic impacts of RT on Chinese rural communities in terms of socio‐economic development and regeneration. Accordingly, this study represents an attempt to address this issue by examining the Poverty Alleviation through Tourism program and ‘Nong jia le’ (Happy Farmer Home) tourism within the Chinese context. The findings not only confirm the widely held importance of RT, as expected, but also identify the problems and challenges relating to the sustainable development of RT in the future. Copyright © 2012 John Wiley & Sons, Ltd.

Long-term efficacy of 10–12 years after being immunized with Chinese hamster ovary cell derived hepatitis B vaccine in Chinese Rural Communities

To evaluate the long-term efficacy of Chinese hamster ovary (CHO) cell derived hepatitis B vaccine in country community in China. A cross-sectional investigation was carried out. Children who were born between 1997 and 1999 and vaccinated with the three doses of CHO-derived hepatitis B vaccine were selected as study objects. Their serum samples were taken to test for hepatitis B virus (HBV) markers, and the results were compared to that before vaccination. In addition, for HBsAg positive children, their mothers were visited. 1254 Children were enrolled in the study. The prevalence of HBsAg was 0.24% and the vaccine efficacy was 97.0%, similar to that of yeast derived hepatitis vaccines. Among 3 mothers of HBsAg positive children, 2 were HBsAg positive, indicating maternal HBV transmissions. The long-term efficacy of the CHO-derived hepatitis B vaccine is good and after vaccination maternal transmission is the most important route of spreading HBV.

Emergence of income inequality and its impact on subjective quality of life in an ethnic minority community in Hainan Island, China

To understand the complex process underlying the emergence and growth of inequality in a population and its impact on individuals’ subjective quality of life (QOL), the authors conducted fieldwork in 2001 and 2009 in a rural minority community in Hainan Island, China. The tourism industry, which developed in 2001, provided paid jobs for half of the adult men in 2009. Responses on the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) indicated that subjective QOL, socioeconomic status, and dietary quality were significantly higher among the individuals with paid jobs. The present case study suggests that Chinese minority communities that have undergone significant economic growth have experienced the emergence and growth of inequality in job opportunities, which has stratified the subjective QOL, dietary quality, and socioeconomic status within the community. These findings suggest that the stages of ‘health transition’ differed among individuals in the community, and that analysis of inter-individual variation in a community may contribute to a better understanding of health in rural Chinese communities.

High prevalence of hyperglycaemia and the impact of high household income in transforming Rural China

BackgroundThe prevalence of hyperglycaemia and its association with socioeconomic factors have been well studied in developed countries, however, little is known about them in transforming rural China.MethodsA cross-sectional study was carried out in 4 rural communities of Deqing County located in East China in 2006-07, including 4,506 subjects aged 18 to 64 years. Fasting plasma glucose (FPG) was measured. Subjects were considered to have impaired fasting glucose (IFG) if FPG was in the range from 5.6 to 6.9 mmol/L and to have diabetes mellitus (DM) if FG was 7.0 mmol/L or above.ResultsThe crude prevalences of IFG and DM were 5.4% and 2.2%, respectively. The average ratio of IFG/DM was 2.5, and tended to be higher for those under the age of 35 years than older subjects. After adjustment for covariates including age (continuous), sex, BMI (continuous), smoking, alcohol drinking, and regular leisure physical activity, subjects in the high household income group had a significantly higher risk of IFG compared with the medium household income group (OR: 1.74, 95% CI: 1.11-2.72) and no significant difference in IFG was observed between the low and medium household income groups. Education and farmer occupation were not significantly associated with IFG.ConclusionsHigh household income was significantly associated with an increased risk of IFG. A high ratio of IFG/DM suggests a high risk of diabetes in foreseeable future in the Chinese transforming rural communities.

Prevalence of depressive disorders in the elderly

Community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20%, depending on cultural situations. A retrospective study based on analysis of various study reports was conducted, to determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world. All the studies that constituted the sample were conducted between 1955 and 2005. Included are only community-based, cross-sectional surveys and some prospective studies that had not excluded depression at baseline. These studies were conducted on a homogenous community of the elderly population in the world, who were selected by a simple random sampling technique. After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 487 275 elderly individuals, in the age group of 60 years and above, residing in various parts of the world, were included for the final analysis. The median prevalence rate and its corresponding interquartile range were calculated. The chi-square test and chi-square for linear trend were applied. A P value of <.05 was considered as statistically significant. The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% (interquartile range [IQR], 4.7%-16.0%). The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% (IQR, 11.6%–31.1%). Although there was a significant decrease in the trend of world prevalence of geriatric depression, it was significantly higher among Indians, in recent years, than the rest of the world.

Low serum pepsinogen I and pepsinogen I/II ratio and Helicobacter pylori infection are associated with increased risk of gastric cancer: 14‐year follow up result in a rural Chinese community

The correlation between low serum PG level and H. pylori infection with the development of gastric cancer has caused considerable concerns all over the world. Some authors exclaimed that gastric cancer developed only in patients infected with H. pylori, whereas the other had different findings. In this study, 1,501 adult local residents with determined serum PG levels and anti H. pylori IgG status were followed for 14 years for the development of gastric cancer in a rural community with high risk of gastric cancer in Hebei Province, China. The results showed the accumulated gastric cancer incidence in the subjects with abnormal PG level and those with H. pylori infection were all significantly higher than that in the corresponding normal controls (53.9‰ vs. 12.7‰, p < 0.05 and 23.1‰ vs. 5.93‰, p < 0.05). The highest gastric cancer incidence was seen in the subjects with both abnormal serum PG and positive H. pylori (56.0‰), and followed by the subjects with abnormal PG and negative H. pylori (47.6‰) and those with normal serum PG and positive H. pylori (18.4‰). The abnormal serum PG level (OR 3.029) and H. pylori infection (OR 4.345) were all risk factors for the development of gastric cancer. The results suggested that the subjects with abnormal serum PG level and/or positive H. pylori infection in the rural area of China were all high risk population for gastric carcinoma and the subjects with both abnormal serum PG and positive H. pylori infection were at especially high risk for the development of gastric carcinoma.

Antioxidant micronutrient supplementation increases erythrocyte membrane fluidity in adults from a rural Chinese community

The objective of the present study was to investigate age-related differences in erythrocyte membrane fluidity (EMF) and changes in antioxidant capacity following supplementation. A total of seventy-four children were randomly divided into two groups: group A1 was the placebo-controlled group and group A2 was supplemented daily with 600 μg retinol, 1·0 mg β-carotene, 100 mg tocopherol, 300 mg ascorbic acid and 200 μg Se. A total of ninety young people were randomly divided into B1 and B2 groups, and ninety-one elderly subjects were divided into C1 and C2 groups. Groups B1 and C1 were placebo-controlled groups, and groups B2 and C2 were daily supplemented with 900 μg retinol, 1·5 mg β-carotene, 200 mg tocopherol, 500 mg ascorbic acid and 400 μg Se. Results showed that plasma malondialdehyde (MDA) was 5·35 μmol/l in children, which was lower than in young and elderly people. The MDA levels of the young and elderly individuals in the treated groups were significantly lower compared with the control groups, but the supplementation did not alter MDA levels in children. At baseline, there was a lower value of polarisation (ρ) and microviscosity (η) in children, indicating a higher EMF, than in both the young and elderly subjects. After the 2-month trial, the ρ and η values of young and elderly subjects in the treated groups decreased significantly in comparison with the placebo groups, indicating an increase in EMF. In conclusion, there was a background of higher MDA levels and lower EMF in young and elderly people than in children, which could be improved by antioxidant supplementation.

Effectiveness of a Chinese hamster ovary cell derived hepatitis B vaccine in Chinese Rural Communities

Objective To evaluate the effectiveness of a Chinese hamster ovary cell derived hepatitis B vaccine in a country community in Hebei Province, PR China. Method A cross-sectional investigation was carried out in 4 of 7 randomly selected country communities in Zhengding County in 2005. All of the children who were born between 1997 and 1999 were selected as study objects. Their serum samples were taken to test for HBV markers, and HBsAg prevalence was compared to that of the same age group before hepatitis B vaccination in 1983. In addition, for HBsAg positive children, their mothers were visited and tested for serum HBV markers, in order to distinguish maternal HBV transmissions. Results Among the 2205 children of the selected birth cohort, 1696 (76.9%) were visited. The prevalence of HBsAg was 0.53%, and by comparing to that of before hepatitis B vaccination, the effectiveness was 95.3%, similar to that of yeast derived hepatitis B vaccines. Among 7 mothers of HBsAg positive children, 5 were HBsAg positive, indicating maternal HBV transmissions; and although one mother was HBsAg negative, her kid was not vaccinated, which indicates a horizontal transmission. As for the other kid, he was adopted and the HBV infection status of his birth mother was unknown. Conclusion The effectiveness of the CHO derived hepatitis B vaccine is comparable to yeast derived ones, and after the hepatitis B vaccination maternal transmission is the most important route of spreading HBV.

Social Support, Health Service Use and Mental Health Among Caregivers of the Elderly in Rural China

This cross-sectional study was designed to investigate the status of social support, health service use and mental health among caregivers for the elderly in a Chinese rural community. With randomized stratified sampling method, 199 caregivers providing long-term care for the elderly recruited from a Chinese rural community responded to the survey and were administered the questionnaire, measuring the caregiving outcome for the elderly. The social support was assessed with the social support scale (SSS) and social network scale (SNS). Health service utilization was assessed with the questionnaire on health service use (HSU). Depression was evaluated with the Center for Epidemiological Studies—Depression Scale (CES-D). Most caregivers are elder’s spouse (39.7%), son (26.1%) and daughter-in-law (18.1%). Three common health service used by the caregivers are visiting physician (68.0%), help from relatives or friends (43.9%) and seeking help of herbal doctors or traditional healers (34.0%). Between caregivers for healthy and non-healthy elders, there was significant difference of depression scale score (t = 3.195, p 0.05). The score of depression scale are associated with caregivers’ age (β = 0.260) and income (β = −0.231), care-recipients’ gender (β = 0.187) and age (β = 0.800), caring time (β = 0.138) and the total SNS score (β = −0.194) (all p < 0.05). The findings suggest, in Chinese rural area, family provides main source for caregiving to the elderly, with spouse and sons playing central roles. Most often elderly caregivers utilize medical resources. Depression during the process of caregiving is associated with caregivers and care-recipients’ background characteristics, with potential mediator effect of social support. It is implied that social support may be important when providing mental health service to the elderly caregivers in Chinese rural areas.

Stigmatizing attitudes and behaviors toward PLHA in rural China

Stigma is a significant barrier to effective control of HIV/AIDS, despite laws to control it. The purpose of this study was to examine factors associated with HIV stigma in a rural Chinese community. A survey was conducted in north-west Anhui province among 963 residents to assess HIV-related knowledge, attitudes, and behaviors. Participants scored a mean of 16.6/26 (63.8%) for knowledge. Sixty-eight percent of respondents held at least one fear of casual transmission, 42% would blame people living with HIV/AIDS (PLHA) for their disease, and 73% thought having HIV is shameful. More than half reported that they had observed at least one stigmatizing behavior toward PLHA in their villages. Multivariable analysis indicated that people with higher education, higher HIV knowledge, higher household wealth and who learned about HIV from professional sources were less likely to hold a stigmatizing attitude, while people who had observed discriminating behaviors toward PLHA in their community and lived in villages with fewer PLHA were more likely to hold a stigmatizing attitude. Despite education campaigns, knowledge remains low and stigmatizing attitudes and behaviors toward PLHA remain a problem.

A comparison of sleeping problems in school‐age children between rural and urban communities in China

To investigate differences in sleeping behaviours in school-age children between urban and rural Chinese communities. Children aged between 6 and 12 years old were selected from rural (n= 472) and urban communities (n= 576). Children's sleep habits questionnaire was completed by the parents to assess sleep patterns and sleep problems of the children. In the 6-8 and 9-12 years groups, the average sleep time in urban children was shorter than in the children from rural areas (9.0 +/- 1.1 vs. 11.3 +/- 1.1 h, and 9.2 +/- 1.0 vs. 10.2 +/- 0.9 h, respectively, all P < 0.01). The rate of abnormal sleep behaviour in the urban and rural cohort was 82.8 and 70.1%, respectively (P < 0.05). The prevalence of sleep delays in the 6- to 8-year-old children from urban areas was higher than in the rural areas (60.3 vs. 40.3%, P < 0.01). In the urban 9-12 years group, the rate of day-time sleepiness was higher than in the rural group (52.6 vs. 26.8%, P < 0.01), whereas the night waking rate was lower (43.8 vs. 58.6%, P < 0.01). Multivariate logistic regression analysis showed that the location of the residence, mother's age, parent's sleep habits and education levels predict the sleeping problems in these children. Children from urban communities appear to have sleeping problems than children from a rural setting. A parent's sleep habits, education levels and the location of children's residence have significant impact on the children's sleep behaviour and habits.

Mortality of Geriatric and Younger Patients with Schizophrenia in the Community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.

Association of misconceptions about HIV transmission and discriminatory attitudes in rural China

This study examined HIV-related knowledge and attitudes among 524 randomly selected adult residents from 12 rural Chinese communities where HIV infection among plasma donors has been reported. Most participants were familiar with the main routes of HIV transmission but had substantial misconceptions about risk of HIV transmission through casual social contacts. Higher score of misconception and being older and married independently predicted stronger discriminatory attitude. Intervention programs with focus on eliminating misconceptions about HIV transmission may reduce stigma.

From subsistence farming towards a multifunctional agriculture: Sustainability in the Chinese rural reality

The rural economic situation in China—with a living standard mostly at subsistence level—lags far behind the prosperous development in the cities and coastal areas. To balance this disequilibrium, comprehensive concepts and endeavors are necessary keeping in view all—not just economic—interests and needs that contribute to lively rural identities. In this context the role of agriculture, where still 50% of the Chinese population are working, will be newly defined, and sustainability concepts can help to find a readjusted position within the Chinese economy focusing on environmental health and food safety as main targets of political and other supporting measures. Within the SUCCESS project, a Concept of Sustainable Agriculture was developed and it drafts one conceivable relation between the exposure to natural resources and economy and tries to find new answers to the broad range of rural challenges in China. It is a qualitative model and, therefore, not always fully applicable, but in the concrete situation of villages, it shows possible directions of sustainability-oriented development by considering the typical local potentials. In the Chinese context that means identifying the different functions of agriculture—the well-known and the hidden—to make them explicit for the Chinese public and therewith to give them new significance. The article is based on a 3-years study within the EU-China Project SUCCESS with field research in four Chinese rural communities. It analyzes the agricultural sustainability potential of these selected villages against the background of massive structural changes within the next 20 years in rural China. Starting from the current agricultural reality, based on a qualitative analysis of the actual situation, local potentials and needs towards sustainable production and marketing are identified, and possible functions of the Chinese agriculture are formulated for the future.

Chronic iodine excess does not increase the incidence of hyperthyroidism: a prospective community-based epidemiological survey in China

An increasing incidence of hyperthyroidism has been observed when iodine supplementation has been introduced to an iodine-deficient population. Moreover, the influence of chronic more than adequate or excessive iodine intake on the epidemiological features of hyperthyroidism has not been widely and thoroughly described. To investigate the influences of different iodine intake levels on the incidence of hyperthyroidism, we conducted a prospective community-based survey in three communities with mild-deficient, more than adequate (previously mild deficient iodine intake), and excessive iodine intake. In three rural Chinese communities, a total of 3761 unselected inhabitants aged above 13 years participated in the original investigation and 3018 of them received identical examinations after 5 years. Thyroid function, levels of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody and urinary iodine excretion were measured and thyroid ultrasound examination was also performed. In three communities, median urinary iodine excretion was 88, 214, and 634 microg/l (P<0.05) respectively. The cumulative incidence of hyperthyroidism was 1.4, 0.9, and 0.8% (P>0.05) respectively. Autoimmune hyperthyroidism was predominant in thyroid hyperfunction in all the three cohorts. Either positive TPOAb (>50 U/ml) or goiter in original healthy participants was associated with the occurrence of unsuspected hyperthyroidism in 5 years (logistic regression, OR=4.2 (95% CI 1.7-8.8) for positive TPOAb, OR=3.1 (95% CI 1.4-6.8) for goiter). Iodine supplementation may not induce an increase in hyperthyroidism in a previously mildly iodine-deficient population. Chronic iodine excess does not apparently increase the risk of autoimmune hyperthyroidism, suggesting that excessive iodine intake may not be an environmental factor involved in the occurrence of autoimmune hyperthyroidism.

Correlates of Lifetime Suicide Attempts Among Individuals with Affective Disorders in a Chinese Rural Community

The aim of this study was to compare the demographic and clinical characteristics of individuals with affective disorders who had attempted suicide at some time in their lives and those who had not made a suicide attempt. In a Chinese rural community, individuals with suicide attempt (N = 30) and those without suicide attempt (N = 166) were assessed with Present State Examination (PSE). Attempters had a significantly higher level of family economic status, higher rate of lifetime depressed mood and hopelessness, and delusions than nonattempters. The logistic regression models also indicated that depressed mood and hopelessness were the most important predictors of suicide attempts. No significant difference in treatment condition was found between attempters and non-attempters. Early identification and interventions focusing on reducing depressed mood, hopelessness, and controlling psychotic symptoms may be helpful in reducing the risk of suicide attempts among individuals with affective disorders residing in the community.

A control study psychoeducational family intervention for relatives of schizophrenics in a Chinese rural community

目的 探讨精神分裂症患者心理教育性家庭干预的特点、方式及效果.方法 200例精神分裂症患者随机分为干预组(家庭干预加药物治疗,100例)、药物组(单用相同药物治疗,100例).采用精神现状检查、社会功能缺陷筛选量表等于干预前后(共4次)进行评定.结果干预组药物治疗的依从性优于药物组(P＜0.05);干预组复发率(16.3%)低于药物组(37.8%);干预组家属对疾病的认识水平提高(P＜0.05),对患者的照管态度改善.结论有针对性的心理教育性家庭干预能提高药物治疗的依从性,降低疾病的复发率,改善家属对患者照管的态度。

Characteristics of Suicide Attempters and Nonattempters with Schizophrenia in a Rural Community

In this study, demographic and clinical characteristics of individuals with schizophrenia in a Chinese rural community who had attempted suicide at some time in their lives and those who had not made a suicide attempt were compared. Among individuals with schizophrenia, subjects with (n = 38) and without (n = 472) a lifetime history of suicide attempt were assessed with the Present State Examination. The results indicate that attempters had a significantly younger age, higher level of education, higher rate of lifetime depressed mood and hopelessness, and a larger number of positive symptoms than patients without suicide attempts. The logistic regression models also indicated that hopelessness, the number of positive symptoms and age were the most important predictors. Early interventions focusing on reducing hopelessness and controlling positive symptoms may help reduce the risk of suicide attempts among patients with schizophrenia.

From being to becoming: Nüshu and sentiments in a Chinese rural community

ABSTRACTIn this article, I explore the sentiments of kelian (the miserable) that were accentuated in the Chinese literature written in a script called nüshu (female writing), which men could not read. Not known to the outside world until the 1980s when it was becoming extinct, nüshu was used for centuries by peasant women in Jiangyong County, Hunan Province, southern China. By examining the textual, contextual, and performative meanings of nüshu, I argue that sentiment is not only part of human phenomenological experience, but it also partakes in the way lives are defined, articulated, reflected, and reconfigured. In Jiangyong, sentiment was not merely a carrier of nüshu women's worldview or an embodiment of their existence as isolated and powerless beings in a Confucian–androcentric agrarian community. More importantly, it functioned as an energy flow that prompted inspiration and engagement—which these women needed to offset and transform their isolation and powerlessness. This research fills the void in understandings of peasant women's expressive traditions in rural China in the early 20th century. It also lends insights into the dialectical relations between human existence (perspective and lived reality, being and becoming, subjectivity and collectivity) and forms of emotional expression.