Underdeveloped Areas Of China Research Articles

Regional Disparities, Economic Development, and Neonatal Mortality and Hospital Delivery in China

A negative association between neonatal mortality and hospital delivery has been found in some low- and lower-middle-income countries but not in rural settings characterized by poor quality of maternal and child health care. To examine the association between neonatal mortality and hospital delivery in China across urban and rural regions, regional disparities, and varying levels of economic development. This retrospective cohort study used county-level data from 2008 to 2020 from the National Maternal & Child Health Statistics across mainland China. Statistical analysis was conducted from March to December 2023. Since 2008, China has strategically leveraged hospital deliveries with national subsidies to diminish neonatal mortality, particularly in rural areas. Neonatal mortality and hospital delivery rates were calculated, and their association was estimated using multivariable fixed-effects linear models of county-level cohort data to adjust for time-invariant differences across counties and controls for gross domestic product (GDP) per capita, women's years of education, hospital beds, and health workers. The analysis included data from 2930 counties, with 198.7 million live births across 36 255 county-year records between 2008 and 2020. The mean (SD) neonatal mortality rate per 1000 live births decreased in rural areas from 12.3 (7.5) in 2008 to 3.9 (2.7) in 2020 and decreased in urban areas from 5.0 (3.1) in 2008 to 2.0 (1.3) in 2020. Hospital delivery rates increased in rural areas from a mean (SD) of 93.4% (11.8%) in 2008 to 99.9% (0.6%) in 2020 and increased in urban areas from 97.7% (6.1%) in 2008 to 100.0% (0.1%) in 2020. In rural areas, an increase of 10 percentage points in hospital deliveries was associated with a neonatal mortality rate of -1.4 (95% CI, -1.9 to -1.0; P < .001) per 1000 live births, whereas this negative association was not observed in urban areas. When the analysis was stratified by regions and incomes, the negative association became considerably stronger in the western and central regions of China, as well as in counties with lower GDP per capita. This cohort study of more than 2900 counties in China suggests that an increase in hospital deliveries was associated with reduced neonatal mortality in rural and economically underdeveloped areas in China. To further reduce neonatal mortality and improve newborn health, it is imperative to increase the accessibility of hospital delivery services.

Association of low socioeconomic status with cognitive decline among older persons in underdeveloped areas in China – a data analysis of the Gansu aging study

BackgroundIndividuals with low socioeconomic status (SES) bear a disproportionate share of the cognitive impairment (CI) burden, there are growing evidence focusing on socioeconomic inequalities in CI among older persons. However, data in the underdeveloped regions is limited. This study aims to measure socioeconomic inequalities in CI among individuals aged 65 years or older in Gansu, China, and determine the contributions of socioeconomic factors to the inequalities.MethodsData from the Gansu Aging Study in 2022 including 3241 participants. Participates’ SES was assessed by using education, income, and occupation. Multivariate logistic regression was conducted to identify the associated between SES and CI, and decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities in CI. The SES inequalities in CI were illustrated and quantified by the concentration curve index.ResultsOverall, 24.2% of participants suffered from CI in the study. The likelihood of CI was lower among those with a medium SES (OR = 0.04, 95% CI:0.03, 0.07), good SES (OR = 0.06, 95% CI: 0.04, 0.09) compared to those with lower levels of SES. Older adults with mild depression (OR = 3.66, 95% CI:2.70,4.95), moderate-severe (OR = 2.82, 95% CI:2.05,3.88) were more likely to have CI in comparison to those with no depression and regular social activities were protective factors for CI (OR = 0.28, 95% CI:0.11,0.75). The concentration index indicated that CI was more concentrated in households with poor SES. Subsequently, SES explained 34.65% of socioeconomic inequality in CI.ConclusionThis study suggested that, approximately one-quarter of older persons suffered from CI in Gansu, China. Low SES was substantially associated with risk of CI. Although interventions to modify traditional risk factors may decrease the risk of CI, disparities by SES may remain without addressing SES itself.

Contrasting Non-Timber Forest Products’ Case Studies in Underdeveloped Areas in China

Enhancing the sustainability of the non-timber forest products industry has dual significance for both the management of local forest resources and socio-economic development. This paper adopts a systems theory perspective to construct an analytical model for the sustainable development of non-timber forest products, based on a “social-economic-natural” framework. By analyzing case studies of non-timber forest products industry sustainability from four underdeveloped counties in China, the paper derives the following main conclusions and insights: The sustainability of non-timber forest products development models is influenced by factors such as resource endowments and institutional environments and includes both single and composite models. Underdeveloped regions can achieve considerable sustainability in the development of non-timber forest products, but this requires a rational allocation of six key elements—policy, model, stakeholders, natural resources, funding, and technology—to stimulate industry growth. To promote the sustainable development of this industry, optimization should be pursued across five aspects: “policy leadership and top-level design to guide industry development”, “selection of appropriate development models based on local natural endowments and socio-economic foundations”, “large enterprise-driven mechanisms to form multi-stakeholder interest connections”, “focus on product technology research and development, and establishment of technical training mechanisms”, and “market-driven funding to develop product sales markets”.

Associations Between Sleep Duration and Cardiometabolic Diseases Among Residents in Southwest China.

The burden of cardiometabolic diseases (CMDs), defined as stroke, coronary artery disease, and diabetes mellitus, continues to pose a global challenge. Sleep duration has been linked to cardiovascular health. However, there is a lack of focused investigations on CMDs in underdeveloped areas of China. This study aimed to examine the relationship between sleep duration and CMDs among residents from southwest China. This large cross-sectional study screened data from the National Key Research and Development Program (2018YFC1311400). Based on sleep duration reported through a standardized questionnaire, encompassing the sleep patterns of the past five years, participants were classified into three groups: <6, 6-8, >8 hours. Baseline characteristics were compared, and Poisson regression models were used to assess the relationship between sleep duration and CMDs. Subgroup analysis was conducted based on age and gender. This study included 28,908 participants with an average age of 65.6 ± 10.0 years, of whom 57.6% were female. The overall prevalence of CMDs was 22.6%. After multivariate adjustments, the prevalence ratios (PR) (95% CI) for CMDs across the three groups (6-8h, <6h and >8h) were: reference, 1.140 (1.068-1.218), 1.060 (0.961-1.169) (P for trend =0.003), respectively. The subgroup analysis revealed that among older females, a longer sleep duration (>8h) was also associated with an increased prevalence risk of CMDs, with PR 1.169 (1.001-1.365) (p=0.049). A shorter sleep duration (<6 hours) was associated with an increased risk of CMDs in the general population, while a longer sleep duration (>8 hours) also raised the prevalence risk among older females.

Gender income differences among general practitioners with compulsory services in early career stage in underdeveloped areas: evidence from a prospective cohort study in China

BackgroundGender equality and the gender income gap in medicine are long-standing global problems. Although gender-related differences have been widely studied in developed countries, they remain unclear in underdeveloped regions. In 2010, China initiated a national compulsory service program (CSP) to train qualified general practitioners in rural and remote areas. This study aimed to evaluate gender income differences for early career CSP and non-CSP (NCSP) graduates in underdeveloped areas.MethodsA cohort study was conducted with 3620 CSP and NCSP graduates from four medical universities in Central and Western China. Baseline surveys and six follow-up surveys were conducted between 2015 and 2022. Incomes, including monthly mean income and proportion of performance-based income, were measured as the key outcome variables. Multivariate linear regression models were used to identify the gender income gap.ResultsNCSP graduates had higher average monthly incomes than CSP graduates. In the seventh year after graduation, the average monthly income for NCSP graduates was 7859 CNY while was 5379 CNY for CSP graduates. After controlling for demographic characteristics, the gender monthly income gap for CSP graduates was expanded from the fourth year (3.0%) to the sixth year (5.9%) after graduation, and that for NCSP graduates was expanded from the fifth year (11.9%) to the seventh year (16.3%) after graduation. Regarding performance-based income, it was 58.9% for NCSP graduates and 45.8% for CSP graduates in the seventh year after graduation. After controlling for performance-based income proportion, the gender income gap was reduced from 5.9 to 4.0% in the sixth year after graduation for CSP graduates, and from 16.3 to 14.4% for NCSP graduates in the seventh year after graduation.ConclusionAn extensive and ever-increasing gender income gap exists among young doctors in the early stages of their careers in underdeveloped areas of China. The high proportion of performance-based income among men is one of the main explanations for the observed difference. A more explicit compensation system must be established to enhance support for female health workers.

Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China

BackgroundFrom year to year, the proportion of people living with overweight and obesity in China rises, along with the prevalence of diseases linked to obesity. Although bariatric surgery is gaining popularity, there are still several issues with its promotion compared to Western nations. Since less developed places in China are more widespread due to disparities in the development of different regions, there has been little exploration of the factors that might be related to acceptance of bariatric surgery in these regions.MethodsPatients who visited the Department of Gastrointestinal Surgery at the North Sichuan Medical College Affiliated Hospital from 2018 to 2022 and had obesity or other relevant metabolic problems were surveyed using a questionnaire. The relationship between demographic factors, socioeconomic status, and acceptance of bariatric surgery was analyzed.ResultsOf 334 patients, 171 had bariatric surgery. BMI, education level, marriage history, medical insurance, family support, and a history of type 2 diabetes were all linked to having bariatric surgery, according to a univariate analysis. In a multivariate analysis, BMI (P = 0.02), education (P = 0.02), family support (P<0.001), medical insurance coverage (P<0.001), and history of type 2 diabetes (P = 0.004) were all positively associated with a willingness to have bariatric surgery. Among 163 non-bariatric patients with obesity, 15.3% were not opposed to surgery but preferred trying medication first, 54.6% leaned towards medical therapy, and 30% were hesitant. Additionally, a majority of patients (48.55%) often lacked adequate knowledge about weight reduction therapy. Age, height, gender, smoking, drinking, family history of type 2 diabetes, education, and marital status did not significantly differ (P > 0.05).ConclusionsMany patients are concerned about the safety of surgical treatment and the possibility of regaining weight. Due to the relatively high cost of bariatric surgery, they tend to choose medical treatment. To enhance the acceptance of bariatric surgery in underdeveloped regions of China, it is crucial to focus on disseminating knowledge about bariatric surgery, offer pertinent health education to the community, and foster support from patients’ families. The government should pay more attention to obesity and provide support in the form of medical insurance.

Assessing Regional Public Service Facility Accessibility Using Multisource Geospatial Data: A Case Study of Underdeveloped Areas in China

Promoting the accessibility of basic public service facilities is key to safeguarding and improving people’s lives. Effective public service provision is especially important for the sustainable development of less developed regions. Lincang in Yunnan Province is a typical underdeveloped region in China. In parallel, multisource remote sensing data with higher spatial resolution provide more precise results for small-scale regional accessibility assessment. Thus, we use an assessment method to measure and evaluate the accessibility of three types of infrastructure in Lincang based on multisource geospatial data. We further analyze the matching between public service facility accessibility and the socioeconomic attributes of inhabitant clusters and different poverty groups. The results show that the accessibility of educational facilities is currently better than that of health facilities in Lincang and that of sanitation facilities is relatively poor. Public service facility accessibility varies significantly among different types of inhabitant clusters, with better accessibility in inhabitant clusters with high levels of population density, aging, and income. Accessibility to healthcare, education, and sanitation is negatively correlated to varying degrees of poverty levels of poor groups, and the mean values of accessibility to various types of public facilities vary significantly across poor groups. Our findings can help inform policy formulation and provide theoretical support for planning and optimizing the layout of public facilities.

Correcting the nighttime lighting data underestimation effect based on light source detection and luminance reconstruction

Nighttime light remote sensing provides a unique perspective on monitoring human activities and socioeconomic conditions. However, early studies on nighttime lighting usually neglected the evaluation of light source detection and luminance conditions in underdeveloped areas. Recent studies have identified a significant nighttime lighting underestimation effect in underdeveloped areas, which makes it difficult to use nighttime lighting as a valid proxy for other variables. To address this problem, this paper proposes a method based on light source detection and luminance reconstruction. Missing luminous pixels will be identified using the rich information provided by daily-scale lighting data and light blooming patterns, and diverse ancillary data will be utilized for the regression reconstruction of luminance values to supplement annual data and to correct the underestimation effect. The effectiveness of this method was verified using data from 7,776 townships in underdeveloped areas in China. The results demonstrated that the proposed method using the corrected NPP/VIIRS data improved light source detection accuracy by 23.23% and 17.71% at the village and township scales, respectively. The correlations between night lighting and proxy variables were also improved. Spearman's rank correlation coefficients between lighting and population, GDP, and electricity consumption at the county scale increased by 0.045, 0.020, and 0.018, respectively. The correlations between lighting and agriculture-related variables also increased to different degrees at both the township and county scales. The proposed method can contribute to improving modeling accuracy and correcting the nighttime lighting underestimation effect in underdeveloped areas. This will provide better support for sustainable development studies.

Coordinated development efficiency between cultivated land spatial morphology and agricultural economy in underdeveloped areas in China: Evidence from western Hubei province

Coordinated development efficiency between cultivated land spatial morphology and agricultural economy in underdeveloped areas in China: Evidence from western Hubei province

Retrospective analysis of cataract surgery outcomes in China from 2009 to 2018: from a national registry system data

ObjectiveTo evaluate patients’ benefits after cataract surgery and to form recommendations for Chinese national health policy decision makers and administration departments based on the quality of cataract treatments.MethodAn observational study...

Policy Framework for Prefabricated Buildings in Underdeveloped Areas: Enlightenment from the Comparative Analysis of Three Types of Regions in China

Prefabricated buildings (PBs) are vigorously promoted for their many advantages. However, obvious regional differences exist in the development of PBs in China, and underdeveloped areas significantly lag behind other areas. Regional “tactics” have a more direct effect on the development of PBs than national “strategies”. A targeted analysis of PB policies in underdeveloped areas in China is lacking in current research. Therefore, the aim of this study was to construct a comprehensive policy framework to help underdeveloped areas improve PB policies to develop PBs. In this study, we constructed a three-dimensional policy framework based on the content analysis method and policy instrument theory. Through a comparative analysis of 137 PB policies in three representative regions, 547 policy content codes were obtained, and reliability and validity tests were completed. The results indicate that (1) underdeveloped areas should focus on improving the number of policies rather than the accuracy in the early stages of development of PBs; (2) underdeveloped areas should focus on mandatory policy instruments (MPIs) supplemented by incentive policy instruments (IPIs) and social policy instruments (SPIs) rather than a balanced use of various policy instruments; and (3) underdeveloped areas should adjust the policy layout of the whole life cycle, and stakeholders should pay attention to the construction willingness of developers and the demands of consumers and seek policy support in the operation and maintenance stages, as well as during the demolition and recovery stages. In this study, we systematically analyzed the focus of PB policies for different stages and stakeholders and proposed an application strategy of policy instruments, contributing to the improvement of the PB policy system and the narrowing of regional development gaps with respect to PBs.

On the Influencing Factors of English Majors’ Participation in the “Excellent Teacher Program”

About 10,000 normal college students will receive targeted training annually from 2021 in a bid to improve the performance of primary and middle school teachers in underdeveloped areas in China’s central and western regions, according to a recent plan. The special training will be conducted by normal universities directly under the Ministry of Education (MOE). As the first batch of local normal universities to participate in the “Excellent Teacher Training Plan”, Hubei Normal University has undertaken the teacher training work, including English majors. The effectiveness of the scheme will be directly affected by whether the scheme is implemented or not. Therefore, by means of questionnaires and interviews, this study investigated the influencing factors of English majors’ joining of the plan and their willingness to return home upon graduation in Hubei Normal University. Through an analysis of teaching willingness, policy awareness, professional environment, and professional identity, this study attempts to find out the reasons for the differences and proposes corresponding strategies.

Investigation of children's habits of smartphone usage and parental awareness of myopia control in underdeveloped areas of China.

To investigate the behaviors of smartphone usage and parental knowledge of vision health among primary students in the rural areas of China. In this school-based, cross-sectional study, a total of 52 606 parents of students from 30 primary schools in the Xingguo County were investigated through an online questionnaire from July 2020 to August 2020. The self-designed questionnaire contained three parts: the demographic factors of both children and parents, parental knowledge and attitude toward myopia, and the preventive treatment of myopia. A total of 52 485 appropriately answered questionnaires were received, showing an effective response rate of 95.1%. The average age of the primary students was 10.1±0.98y and the prevalence of myopia among the primary students was 40.3%. The age of myopia occurrence in elementary students was significantly correlated with the parents' educational level (95%CI: 0.82-0.98, P=0.013), children's gender (95%CI: 1.08-1.20, P<0.001), school location (county or countryside) (95%CI: 0.59-0.66, P<0.001), children's smartphone ownership (95%CI: 1.09-1.26, P<0.001), and the average time spent on smartphone per day (95%CI: 0.78-0.88, P<0.001). School location in the county town, high family income, and high parents' educational level significantly affected both parents' myopia awareness and children's vision-threatening behaviors (P<0.01). Left-behind children showed a higher incidence of vision-threatening habits than those who lived with their parents (P<0.01). The results reveal the current situation of myopia development among rural primary school students and their parents. This survey will serve as a guidance for designing myopic prevention policies in the rural areas of China.

Development and clinical application of an electronic health record quality control system for pulmonary aspergillosis based on guidelines and natural language processing technology.

BackgroundThere are considerable differences in the diagnosis and treatment of pulmonary aspergillosis (PA) between specialized hospitals and primary hospitals or developed areas and underdeveloped areas in China. There is a lack of electronic systems that assist respiratory physicians in standardizing the diagnosis and treatment of PA.MethodsWe extracted 26 quality control points from the latest guidelines related to PA, and developed a PA quality control system of electronic health record (EHR) based on natural language processing (NLP) techniques. We obtained PA patient records in the Department of Respiratory Medicine of the First Affiliated Hospital of Guangzhou Medical University to verify the effectiveness of the system comparing with manually evaluation of respiratory experts.ResultsWe successfully developed quality control system of PA; 699 PA medical records from EHR of the First Affiliated Hospital of Guangzhou Medical University between January 2015 and March 2020 were obtained and assessed by the system; 162 defects were found, which included 19 medical records with diagnostic defects, 76 medical records with examination defects, and 80 medical records with treatment defects; 200 medical records were sampled for validation, and found that the sensitivity and accuracy of quality control system for pulmonary aspergillosis (QCSA) were 0.99 and 0.96, F1 value was 0.85, and the recall rate was 0.77 compared with experts’ evaluation.ConclusionsOur system successfully uses medical guidelines and NLP technology to detect defects in the diagnosis and treatment of PA, which helps to improve the management quality of PA patients.

Deep learning radiomics of dual-modality ultrasound images for hierarchical diagnosis of unexplained cervical lymphadenopathy

BackgroundAccurate diagnosis of unexplained cervical lymphadenopathy (CLA) using medical images heavily relies on the experience of radiologists, which is even worse for CLA patients in underdeveloped countries and regions, because of lack of expertise and reliable medical history. This study aimed to develop a deep learning (DL) radiomics model based on B-mode and color Doppler ultrasound images for assisting radiologists to improve their diagnoses of the etiology of unexplained CLA.MethodsPatients with unexplained CLA who received ultrasound examinations from three hospitals located in underdeveloped areas of China were retrospectively enrolled. They were all pathologically confirmed with reactive hyperplasia, tuberculous lymphadenitis, lymphoma, or metastatic carcinoma. By mimicking the diagnosis logic of radiologists, three DL sub-models were developed to achieve the primary diagnosis of benign and malignant, the secondary diagnosis of reactive hyperplasia and tuberculous lymphadenitis in benign candidates, and of lymphoma and metastatic carcinoma in malignant candidates, respectively. Then, a CLA hierarchical diagnostic model (CLA-HDM) integrating all sub-models was proposed to classify the specific etiology of each unexplained CLA. The assistant effectiveness of CLA-HDM was assessed by comparing six radiologists between without and with using the DL-based classification and heatmap guidance.ResultsA total of 763 patients with unexplained CLA were enrolled and were split into the training cohort (n=395), internal testing cohort (n=171), and external testing cohorts 1 (n=105) and 2 (n=92). The CLA-HDM for diagnosing four common etiologies of unexplained CLA achieved AUCs of 0.873 (95% CI: 0.838–0.908), 0.837 (95% CI: 0.789–0.889), and 0.840 (95% CI: 0.789–0.898) in the three testing cohorts, respectively, which was systematically more accurate than all the participating radiologists. With its assistance, the accuracy, sensitivity, and specificity of six radiologists with different levels of experience were generally improved, reducing the false-negative rate of 2.2–10% and the false-positive rate of 0.7–3.1%.ConclusionsMulti-cohort testing demonstrated our DL model integrating dual-modality ultrasound images achieved accurate diagnosis of unexplained CLA. With its assistance, the gap between radiologists with different levels of experience was narrowed, which is potentially of great significance for benefiting CLA patients in underdeveloped countries and regions worldwide.

Investigation of 3-year inpatient TB cases in Zunyi, China: Increased TB burden but improved bacteriological diagnosis.

BackgroundAs one of the top three high tuberculosis (TB) burden countries, China is a country where the overall TB incidence continues to decline. However, due to its large population and area, the increased TB burden exists in regional areas.MethodsThis retrospective study analyzed local inpatient pulmonary TB cases in the Affiliated Hospital of Zunyi Medical University (AHZMU) from January 2016 to December 2018 in a high TB incidence and economically-less-developed area of China. Four methods, acid-fast bacilli stain, culture, Xpert and LAMP, were used to detect Mycobacterium tuberculosis (M.tb), while proportional method and Xpert were used to identify rifampicin-resistant TB (RR-TB). Case number, treatment history, M.tb confirmed TB and rifampicin resistant proportion were analyzed to investigate the local TB epidemic.ResultsTotal 3,910 local inpatient cases with pulmonary TB were admitted to AHZMU during this study period. The annual numbers of total TB cases increased 26.4% (from 1,173 to 1,483), while new cases increased 29.6% (from 936 to 1,213) and RR-TB cases increased 2.7 times (from 31 to 84). Meanwhile, the percentage of previously treated cases declined from 20.2 to 18.2% and the M.tb confirmed TB proportion increased from 34.7 to 49.7%.ConclusionThe elevated M.tb confirmed TB proportion and the declined percentage of previously treated cases indicated the improved TB diagnosis and treatment of AHZMU. However, the increasing number of total TB cases, new and RR-TB cases showed an upward trend and increased TB burden in a relatively underdeveloped area of China.

The Disease Spectrum and Influencing Factors of NICU in Xiangxi, Underdeveloped Area of China: A 9-Year Retrospective Study.

ObjectiveInvestigation of the basic conditions and disease spectrum in neonatal intensive care unit (NICU) from 2012 to 2020, in the underdeveloped area of Xiangxi, China.MethodsAll newborns (N = 16,094) admitted to the NICU of a hospital in the Xiangxi area from 2012 to 2020 were selected for the retrospective study.ResultsThe average male/female ratio was 1.43:1, with 9,482 males and 6,612 females admitted to the NICU. The sample comprised 41.02% premature infants, and 56.52% had been delivered via cesarean delivery (CD). The most prevalent diseases diagnosed in the NICU were jaundice (22.01%), respiratory (18.45%) and neurological diseases (17.54%). Over the 9-year study window, the prevalence of jaundice and cardiovascular diseases increased, while respiratory and neurological diseases became less frequent. The prevalence of the remaining diseases remained unchanged. Prevalence of neonatal diseases is influenced by gender, patient sources, delivery methods, gestational age and birth weight (P < 0.05). The prevalence of neonatal diseases was significantly higher in males, infants born via CD, and in infants of lower gestational age and birth weight.ConclusionThe study contributes in-depth information about infant characteristics in an NICU in an undeveloped region of China. In the past 9 years, the average proportion of premature infants in the NICU decreased to 37.38% in 2020, but this figure remains higher than the Chinese national average of 26.2%. Similarly, the CD rate is higher than the Chinese average. The spectrum of neonatal diseases in the NICU in Xiangxi area is drawn, included jaundice, respiratory and neurological diseases, primarily. Through statistical analysis, it is found that the types and prevalence of neonatal diseases are closely related to different gender, gestational age, patient sources, delivery methods, and birth weight (P < 0.05). Newborns of specific gestational age, birth weight and delivery method should be considered “at-risk” and targeted in the formulation of preventive measures. There is a great need to improve the diagnosis and treatment of neonatal diseases—and perinatal health care in general—to ensure improved outcomes for newborns admitted to NICUs in underdeveloped regions.

Length of stay and influencing factors of NICU in the Western Hunan, an underdeveloped area of China: A 9-year retrospective study.

ObjectiveTo investigate the factors that influence the length of stay (LOS) in a neonatal intensive care unit (NICU).MethodsThis retrospective study analysed clinical data from all newborns hospitalized in the NICU of a tertiary hospital in the Western Hunan area of China over a 9-year period (2012–2020). Factors associated with the LOS were analysed using univariate analysis and Cox regression analysis.ResultsA total of 16 094 newborns were included in the study: of which 9615 were inborn and 6479 were outborn newborns. There were 9482 males and 6612 females. Over the 9-year period, the mean LOS was 11.08 days (median LOS, 9.00 days; range, 1–141 days); and the LOS first increased, then decreased and stabilized. A LOS of 8–28 days was the most common duration (8849 of 16 094; 54.98%). Cox regression analysis demonstrated that sex, patient source, delivery method, gestational age, birth weight and comorbidities were significantly associated with LOS.ConclusionBeing male, low gestational age and low birth weight increased the LOS. Reducing preterm and post-term infants, as well as eliminating comorbidities, could effectively shorten the LOS of newborns.

Long-term Care Facility and its Elderly Chronic Diseases in Jishou: Insights into Underdeveloped Area of China.

Insight into the current status of long-term care facilities (LTCFs) and chronic diseases in underdeveloped areas in China is scant. Using a census method to survey older adults ≥60 years old (154 older adult residents) in all LTCFs in Jishou area. The International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF) was used to collect information and analyze the current status of chronic diseases among older adult residents. There were 62 187 residents ≥60 years old in Jishou area. According to the survey, there were only 154 older adult residents living in the LTCFs of Jishou, with a ratio was 0.3% of all older adult residents, which was much lower than China’s 3.0%. Of respondents (109 older adult residents), the prevalence of chronic diseases was 70.6%. The prevalence increases with age, as well as in the female is higher than in the male. The top 3 chronic diseases were hypertension (41.3%), bone and joint disease (12.8%) and cerebrovascular disease (12.8%). It was found that different age groups and genders lead to differences in the prevalence and the order of chronic diseases. The prevalence of older adults with impaired balance ability, sleep disturbance and swallowing disturbance was higher than that of normal older adults. The results of the one-way analysis of variance showed that the age and balance ability of the older adults with chronic diseases were statistically significant (P < .05). In addition, the prevalence of chronic diseases in the LTCFs older adult was higher than the home care (HC) older adults in Jishou. The age and the prevalence of chronic diseases of LTCFs in older adults with professional nursing staff were higher than in those without. This study provides a theoretical basis for the healthcare distribution, prevention and treatment of chronic diseases in underdeveloped areas. The undeveloped area has lower LTCFs staying rate and chronic disease prevalence of older adults than relatively developed areas. More public health attention and capital investment are needed to increase the LTCFs number and strengthen disease testing and screening. As well as, the proportion of professional nursing staff and specialist doctors in LTCFs and improve the quality of care and medical treatment for older adults.

What Drives Rural Consumers to Change E-Commerce Attitude and Adopt E-Commerce through the Moderating Role of Corporate Social Responsibility in an Emerging Market? An Empirical Investigation in the Chinese Context

The present study aims to introduce a comprehensive framework that may help to better understand how to make rural consumers hold a favorable attitude and enhance their willingness to adopt e-commerce. To empirically assess the hypotheses posited in this paper, we started by conducting a qualitative interview-based study of 104 rural consumers. This analysis elucidates new problems or challenges faced by rural consumers in impoverished areas after several years of experience in e-commerce. To further understand the service quality and cultural context effects, we conducted a quantitative study in 434 rural consumers in relatively underdeveloped areas of China. Using a partial least squares of structural equation modeling (SEM) approach through smart PLS, this study empirically tested the hypotheses posited in the paper. The SEM results demonstrate a positive relationship between logistics and training service quality, subjective norms, self-efficiency sense, and rural consumers’ attitudes toward e-commerce platforms, which in turn positively contributes to their willingness to engage in word-of-mouth e-commerce promotion. In addition, it is shown empirically that corporate social responsibility positively moderates the effects of logistics and training services, subjective norms, and attitudes toward the use of e-commerce platforms. The findings from these two studies contribute to a better understanding of, and have major implications for, successful e-commerce entrepreneurial practices in areas undergoing the process of transition to an important emerging e-commerce marketplace.