•This paper describes the epidemiology of influenza viruses among children in Wuhan, China during nine influenza seasons (2007–2015) and predicts the positive rate of different types of influenza ...virus in the future.•In contrast to previous research at home and abroad, this paper is the first study that explores the application of time series analysis using the positive rate of influenza virus in children to predict the future incidence.•The ARIMA model is a good instrument that forecasts the positive rate of different types of influenza virus.•The wide use of influenza vaccines, especially for influenza B(Yamagata) and B(Victoria), can potentially reduce the effects of influenza on the children of China.
Influenza is a common childhood disease and protecting children by predicting the positive rate of influenza virus is important as vaccines are not routinely administered in China. Our study aims to describe the epidemiology of influenza viruses among children in Wuhan, China during the past nine influenza seasons (2007–2015) and to predict the positive rate of different types of influenza virus in the future.
During the last nine influenza seasons (2007–2015), a total of 10,232 nasopharyngeal swabs collected from pediatric outpatients (age <15years) with influenza-like illness (ILI) infections in two sentinel children’s hospitals were examined for influenza A and B by real-time one step RT-PCR. An autoregressive integrated moving average (ARIMA) model was used to fit the time series and to predict the future (first half of 2016) positive rates of different types of influenza virus.
A total of 1,341 specimens were positive for influenza A and 490 for influenza B. The majority of infected patients were 1–11 years old (87.7%). The ARIMA model could effectively predict the positive rate of influenza virus in a short time. ARIMA(0,0,11), SARIMA(1,0,0)(0,1,1)12, ARIMA(0,0,1) and SARIMA(0,0,1)(1,0,1)12 were suitable for B(Victoria), B(Yamagata), A(H1N1)pdm09, and A(H3N2), respectively.
Additional policies must be formulated to prevent and control influenza. The wide use of influenza vaccines, especially for influenza B, especially for influenza B(Yamagata) and B(Victoria), can potentially reduce the effects of influenza on children of China.
District- and county-level maternal and child health hospitals (MCHHs) are positioned to provide primary maternal and child healthcare in rural and urban areas of China. Their efficiencies and ...productivity largely affect the equity and accessibility of maternal and child health care. This study aimed to assess the efficiency of district- and county-level MCHHs in China and identify their associated factors.
Thirty-three district- and 84 county-level MCHHs were selected from Shanxi Province in 2017. At the first stage, bootstrapping data envelopment analysis (DEA) models were established to calculate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of district- and county-level hospitals. At the second stage, the estimated efficiency scores were regressed against external and internal hospital environmental factors by using bootstrap truncated regression to identify their determinants.
The average TE, PTE and SE scores for district-level MCHHs were 0.7433, 0.8633 and 0.9335, respectively. All hospitals were found to be weakly efficient, although more than 50% of the hospitals performed with efficient SE (SE scores≥100%). As for county-level MCHHs, their average TE, PTE and SE scores were 0.5483, 0.6081 and 0.9329, respectively. The hospitals with TE and PTE scores less than 0.7 accounted for more than 60%, and no hospital was observed to operate effectively. Truncated regressions suggested that the proportion of health professionals, including doctors, nurses, pharmacists, inspection technician and image technician (district level: β = 0.57, 95% CI = 0.30-0.85; county level: β = 0.33, 95% CI = 0.15-0.52), and the number of health workers who received job training (district level: β = 0.67, 95% CI = 0.26-1.08; county level: β = 0.34, 95% CI = 0.14-0.54) had a positive association with efficiency scores. The amount of financial subsidy (β = 0.07, 95% CI = 0.05-0.09) was found to be directly proportional to the productive efficiency of the county-level MCHHs.
The operational inefficiency of district- and county-level MCHHs in Shanxi Province is severe and needs to be substantially improved, especially in terms of TE and PTE. Hiring additional medical personnel and ensuring the stability of the workforce should be prioritised. The Chinese government must provide sufficient financial subsidy to compensate for service costs.
Family doctor teams, serving as health gatekeepers, are extensively advocated in China. Their composition, comprising a heterogeneous mix of professionals, contributes to a more comprehensive ...service, but also poses challenges. Consequently, scholarly interest has arisen in comprehending how these compositions, known as faultlines, influence team dynamics and outcomes. However, there is a lack of comprehensive exploration into how faultlines influence team members’ communication processes and knowledge sharing. This study aims to provide insights into the associations between faultlines in primary care teams and team performance, specifically exploring how knowledge sharing may mediate these effects, with the goal of revealing key insights to optimize contracted family doctor services. Survey data from 291 family doctor teams in China was utilized to test hypotheses, revealing a negative association between (social-category and information-based) faultlines and knowledge sharing. Team knowledge sharing acts as a mediator in the relationship between these faultlines and team performance. Our findings advance faultlines theory and emphasize the mediating role of knowledge sharing in elucidating the interplay between faultlines and team performance. These insights are crucial for fostering collaboration, managing faultlines, and enhancing healthcare team performance.
Abstract
Background
Inappropriate hospitalization day (IHD) is recognized as an important indication of the excessive demand for health-care services, especially for surgical patients. We aim to ...examine the degree of IHDs, predictors associated with higher incidences of IHDs, and reasons for each IHD in different periods of hospitalization.
Methods
A total of 4586 hospital days from 408 cases were evaluated by a cross-sectional and retrospective audit program carried out in a tertiary hospital with 5613 beds and 9623 faculty in Wuhan, China. This study used the revised Chinese version of the Appropriateness Evaluation Protocol (C-AEP) to assess IHDs, and the Delay Tool to ascertain each reason for IHDs. A binary logistic regression model was performed to examine the predictors of higher incidences of IHDs.
Results
The average frequency of IHDs was 23.24 %, and a total of 322 cases (78.92 %) were reported to have experienced at least one IHD. The multivariate analysis showed that patients at the age of 60–69 with respect to under 50, and with overlength of stay were predictors of higher incidences of preoperative IHDs, while admission from outpatient, multiple diagnosis, higher surgical incision level, and overlength of stay were predictors of higher incidence of postoperative IHDs. The most frequent reasons related to health providers for IHDs were doctor’s conservative views of patient management and delays in inspection, prescription, appointment, or result report. Patient factors gave rise to nearly a quarter of postoperative IHDs.
Conclusions
Findings from this study indicate that measures including paying more attention to the construction of MDT for diagnosis and treatment in general surgery, reducing laboratory turnaround time, dispelling distrust among health-care providers and patients, setting stricter discharge standards and, providing integrated out-of-hospital services could be adopted accordingly to improve the inappropriateness of hospital stays.
Outbreaks of an epidemic, such as coronavirus disease 2019 (COVID-19), always brings about far-ranging discrimination and stigmatization to the epicenter. This was a cross-sectional survey conducted ...to assess experienced discrimination, internalized stigma, shame, and mental health (anxiety, depression, distress, insomnia) among college students who merely had a perceived linkage with COVID-19, and explore the linkage between discrimination and negative mental health outcomes through the mediating effects of shame and internalized stigma. A total of 995 participants (53% female) were involved in this study, in which 40.9% of college students were reported to be discriminated against because of their experience in Wuhan. The experience of COVID-19-related discrimination is indirectly associated with anxiety, depression, and insomnia, in which shame and internalized stigma play a complete mediating effect. Meanwhile, it is both directly and indirectly associated with distress through shame and internalized stigma. The findings of this study suggest that COVID-19-related discrimination is associated with shame and internalized stigma, which in turn predict psychological symptoms over time.
(1) Background: Undifferentiated function for medical institutes in different levels had been a barrier to China’s healthcare reform. Thus, this study aimed to detect medical services that were ...capable offered both in tertiary and county hospitals in China and discuss the process of detection. (2) Method: Data of 2 tertiary hospitals that were city level and 12 county-level hospitals from one city in China were collected and grouped into diagnosis-related groups (DRGs). A strategy with four steps was devised by considering the aspects of service volume, in-hospital mortality rate, in-hospital adverse events rate, and inpatient cost. Additionally, a comparison of each indicator was made between city- versus county-level hospitals. (3) Results: There were no differences in service quality between the two levels of hospitals while county hospitals had lower average inpatient costs in 129 DRGs that covered 39.5% of all cases. About CNY 0.26 billion would be saved if certain cases were paid at county-level prices. (4) Conclusion: The study proposed a strategy with four steps that could help in locating the range of diseases in which patients’ admission suffered from the problem of undifferentiation between hospitals’ functions to reduce the irrational growth of healthcare expenditure.
The COVID-19 pandemic had brought the increased levels of depression and anxiety on people. Our study investigated the levels of mental health and influencing factors among back-to-Wuhan university ...students.
A cross-sectional questionnaire survey was conducted from 31 August 2020, to 14 September 2020 by convenience sampling on the back-to-Wuhan university students, which included the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index-7 (ISI-7), the revised Impact of Event Scale (IES-R) scales, and the basic demographic characteristics. Moreover, quantile regression analysis was used to identify the key factors related to the mental health variables of the back-to-Wuhan university students during the COVID-19 period.
The results from 1017 participants suggested that the prevalence rates of the anxiety, depression, insomnia, and distress were 44%, 47.5%, 37.7%, 57.7%, respectively. Quantile regression showed that mental health scores were negatively associated to age, years from graduation, being discriminated against owing to the experience in Wuhan, and the attitude on the future of COVID-19, while was positively related to the education level (P < 0.05). Especially, the education level was highly related with anxiety (25th = 1.64, 50th = 2.54).
The finding showed that the respondents who were near graduation, discriminated owing to the experience in Wuhan, and worried about the future trend of COVID-19 had a higher risk of negative psychologic status, especially in the bottom and median quantile, and might require more psycho-social interventions or support.
Elevated triglyceride (TG) levels are a biomarker for cardiovascular disease (CVD) risk. The correlation between serum uric acid (SUA) and TG concentrations in adults or obese children is well ...established. However, studies on SUA and TG in children with short stature are limited.
To determine the relationship between SUA and TG levels in short children and adolescents.
This was a cross-sectional evaluation of a cohort of 1095 patients with short stature (720 males and 375 females). The related clinical characteristics, including anthropometric and biochemical parameters, were determined.
Smooth curve fitting, adjusted for potential confounders was performed, which indicated the existence of a non-linear relationship between these measures. Piecewise multivariate linear analysis revealed a significant positive relationship between SUA and TG at SUA concentrations over 7 mg/dL (β = 0.13, 95% CI: 0.05-0.22, P = 0.002) but no significant correlation at lower SUA levels (β = 0.01, 95% CI: 0.01-0.04, P = 0.799). Furthermore, a stratified analysis was performed to appraise changes in this relationship for different sexes and standard deviation levels of body mass index (BMI). The non-linear relationship remained consistent in males and females with BMI standard deviation scores (BMI SDS) ≥ 0, with inflection points of 6.71 mg/dL and 3.93 mg/dL, respectively. Within these two groups, SUA and TG levels showed a positive association when SUA levels were higher than the inflection point (β = 0.21, 95% CI: 0.11-0.31, P < 0.001 for males and β = 0.1, 95% CI: 0.03-0.17, P = 0.005 for females). However, a specific relationship was not observed at lower SUA levels. No significant relationships were found between SUA and TG levels in males and females with BMI SDS < 0.
The present study identified the non-linear association of SUA and TG levels with short children and adolescents. This relationship was based on BMI status. This finding suggests that health status should be considered for short stature children with high SUA levels, especially in children with a high BMI standard deviation score.
Objectives
To examine the effects of holiday and weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in China.
Methods
Patients with AMI in 31 tertiary ...hospitals in Shanxi, China from 2014 to 2017 were included (
N
= 54,968). Multivariable logistic regression models were used to examine the effects of holiday and weekend admission on in-hospital mortality.
Results
Compared to non-holiday and weekday admissions, holiday and weekend admissions, respectively, were associated with increases in risk-adjusted mortality rates. Chinese National Day was associated with an additional 10 deaths per 1000 admissions (95% confidence interval (CI): (0, 20))—a relative increase from baseline mortality of 64% (95% CI: (1%, 128%)). Sunday was associated with an additional 4 deaths per 1000 admissions (95% CI: (0, 7))—a relative increase from baseline mortality of 23% (95% CI: (3%, 45%)). We found no evidence of gender differences in holiday or weekend effects on mortality.
Conclusions
Holiday and weekend admissions were associated with in-hospital AMI mortality. The admissions on Chinese National Day and Sunday contributed to the observed “holiday effect” and “weekend effect,” respectively.
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