Over the last two decades a growing body of research has shown that authoritarian regimes are trying to increase their legitimacy by providing public goods. But there has so far been very little ...research on whether or not these regimes are successful.
This article analyzes data from a 2012–2013 nationally representative survey in China to examine whether health care provision bolsters the Communist regime's legitimacy. Using multivariate ordinal logistic regression, we test whether having public health insurance and being satisfied with the health care system are associated with separate measures of the People's Republic of China's regime legitimacy: support for “our form of government” (which we call “system support”) and political trust.
Having public health insurance is positively associated with trust in the Chinese central government. Health care system satisfaction is positively associated with system support and trust in local government.
Health care provision may bolster the legitimacy of authoritarian regimes, with the clearest evidence showing that concrete benefits may translate into trust in the central government. Further research is needed to understand the relationship between trends in health care provision and legitimacy over time and in other types of authoritarian regime.
Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are both considered to be part of standard care in the management of glycemia ...in type 2 diabetes. Recent trial evidence has indicated benefits on primary kidney end points for individual drugs within each medication class. Despite the potential benefits of combining SGLT2is and GLP-1RAs for glycemia management, according to national and international guideline recommendations, there is currently limited data on kidney end points for this drug combination.
Objective
The aims of the study are to assess the real-world effects of combination SGLT2i and GLP-1RA therapies for diabetes management on kidney end points, glycemic control, and weight in people with type 2 diabetes who are being treated with renin-angiotensin system blockade medication.
Methods
This retrospective cohort study will use the electronic health records of people with type 2 diabetes that are registered with general practices covering over 15 million people in England and Wales and are included in the Oxford-Royal College of General Practitioners Research and Surveillance Centre network. A propensity score–matched cohort of prevalent new users of SGLT2is and GLP-1RAs and those who have been prescribed SGLT2is and GLP-1RAs in combination will be identified. They will be matched based on drug histories, comorbidities, and demographics. A repeated-measures, multilevel, linear regression analysis will be performed to compare the mean change (from baseline) in estimated glomerular filtration rate at 12 and 24 months between those who switched to combined therapy and those continuing monotherapy with an SGLT2i or GLP-1RA. The secondary end points will be albuminuria, serum creatinine level, glycated hemoglobin level, and BMI. These will also be assessed for change at the 12- and 24-month follow-ups.
Results
The study is due to commence in March 2022 and is expected to be complete by September 2022.
Conclusions
Our study will be the first to assess the impact of combination SGLT2i and GLP-1RA therapy in type 2 diabetes on primary kidney end points from a real-world perspective.
International Registered Report Identifier (IRRID)
PRR1-10.2196/34206
This article examines factors associated with trust in the public water utility and informal water vendors in the city of Dar es Salaam. We model trust in terms of citizens' perceptions of what water ...providers deliver, how well the service fits with their lifestyle and values, the ease with which they can contact and influence the provider, and how well the government handles water issues. Our data come from a survey of the adult population of the four main residential districts of Dar es Salaam, conducted in March 2018. We find that trust in water providers is built on different foundations for the public utility and informal vendors. For the public utility, trust depends mainly on habituation to the service, knowledge of the vernacular and evaluations of government performance. For informal vendors, trust depends mainly on habituation to the service and capacity for engagement with social issues. Our study illustrates the how trust in service providers is an outcome of social accountability at the micro-level.
BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia which is a major risk factor for stroke, transient ischaemic attacks and increased mortality. Primary care management of AF can ...significantly reduce these risks. We carried out an evaluation to asses the usability of an AF dashboard developed to improve data quality and the quality of care.MethodWe developed an online dashboard about the quality of AF management for general practices of the Oxford Royal College of General Practitioners Research and Surveillance Centre network. The dashboard displays (1) case ascertainment, (2) a calculation of stroke and haemorrhage risk to assess whether the benefits of anticogulants outweigh their risk, (3) prescriptions of different types of anticoagulant and (4) if prescribed anticoagulant is at the correct dose. We conducted the think aloud evaluation, involving 24 dashboard users to improve its usability.ResultsAnalysis of 24 transcripts received produced 120 individual feedback items (ie, verbalised tasks) that were mapped across five usability problem classes. We enhanced the dashboard based on evaluation feedback to encourage adoption by general practices participating in the sentinel network.ConclusionsThe think aloud evaluation provided useful insights into important usability issues that require further development. Our enhanced AF dashboard was acceptable to clinicians and its impact on data quality and care should be assessed in a formal study.
Objective
To identify factors associated with health‐care system satisfaction in China.
Context
Recent research suggests that socio‐demographic characteristics, self‐reported health, income and ...insurance, ideological beliefs, health‐care utilization, media use and perceptions of services may affect health‐care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health‐care system satisfaction.
Design
Stratified nationwide survey sample analysed using multilevel logistic regression. Setting and participants: 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013.
Main outcome measure
Satisfaction with the way the health‐care system in China is run.
Results
We find only weak associations between satisfaction and socio‐demographic characteristics, self‐reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health‐care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical.
Conclusions
To improve satisfaction, Chinese policymakers – and their counterparts in countries with similar health‐care system characteristics – should improve insurance coverage and the quality of health services, and tackle unethical medical practices.
This essay analyses the determinants of support for state social welfare provision in Russia and China on the basis of a four-stage recursive model using two waves of the World Values Survey. It ...hypothesises that support is a function of economic self-interest, tapped by subjective economic satisfaction and relative income; ideology including beliefs about market fairness and inequality aversion; as well as temporal context. It finds that subjective economic satisfaction reduces support; inequality aversion is a positive influence, while beliefs about market fairness matter in different ways. Support increased over the period spanning the 2008 global financial crisis.
This paper reports the results of an audit that assessed the prevalence of residual hypertriglyceridemia and the potential need for intensified management among patients with statin-treated type 2 ...diabetes mellitus (T2DM) in primary care in the UK.
A cross-sectional, observational, systematic audit of patients with diagnosed diabetes from 40 primary care practices was undertaken. The audit collected basic demographic information and data on prescriptions issued during the preceding 4 months. T2DM patients were stratified according to the proportion that attained European Society of Cardiology treatment targets.
The audit collected data from 14,652 patients with diagnosed diabetes: 89.5% (n = 13,108) of the total cohort had T2DM. Of the people with T2DM, 22.2% (2916) were not currently receiving lipid-lowering therapy. Up to approximately 80% of these people showed evidence of dyslipidemia. Among the group that received lipid-lowering therapy, 94.7% (9647) were on statin monotherapy, which was usually simvastatin (69.5% of patients receiving statin monotherapy; 6707). The currently available statins were prescribed, with the most common dose being 40 mg simvastatin (44.2%; 4267). Irrespective of the statin used, around half of the patients receiving statin monotherapy did not attain the European Society of Cardiology treatment targets for triglycerides, low-density lipoprotein, high-density lipoprotein, and total cholesterol.
T2DM patients managed in UK primary care commonly show persistent lipid abnormalities. Clinicians need to optimize compliance with lipid-lowering and other medications. Clinicians also need to consider intensifying statin regimens, prescribing additional lipid- modifying therapies, and specific treatments aimed at triglyceride lowering to improve dyslipidemia control in statin-treated patients with T2DM.
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