Background:Infection prevention and control (IPC) behaviors among healthcare workers are influenced by multiple components and complex features of the work system. Complexity refers to the multicomponent, non-linear, and context-dependent characteristics of system elements, and is increasingly recognized as a key feature of healthcare delivery. However, evidence on the role of IPC complexity in these relationships remains limited. Methods:A cross-sectional survey was conducted in 3 branch hospitals of a tertiary hospital in Wuhan, China. A total of 833 healthcare workers completed a structured questionnaire assessing IPC person, organization, tools and technology, tasks, internal environment, external environment, IPC complexity, and IPC behaviors based on Systems Engineering Initiative for Patient Safety (SEIPS) model. Structural equation modeling and bias-corrected bootstrap analyses were used to evaluate direct and indirect associations. Results:IPC complexity (β= 0.106, P=0.048) positively associated with IPC behaviors. IPC tasks (β= 0.172, P=0.003) and internal environment (β= 0.221, P<0.001) directly associated with IPC behaviors; IPC person (95% CI:0.001-0.033, P=0.015), internal environment (95% CI:0.009-0.088, P=0.015) and external environment (95% CI:0.007-0.075, P=0.018) indirectly associated with IPC behaviors through the complexity. Conclusion:IPC behaviors were linked to multiple work system factors, with complexity serving as an important intermediate correlate. Efforts to improve IPC practice should address task demands, environmental support, and perceived work complexity rather than focusing on individual behaviors alone.

Aging leads to a range of adverse health outcomes and increases the economic burden of healthcare. Therefore, understanding how to achieve and maintain successful aging is crucial for ensuring the future health of older adults. This study aimed to examine the relationships between social capital, resilience, self-care, and successful aging among older adults, with the objective of fostering and promoting successful aging. This study conducted a cross-sectional study on 584 older adults in China. Data were collected using the Successful Aging Scale, Self-care Scale, Resilience Scale, and Social Capital Scale. Hierarchical linear regression and structural equation modeling were used for analysis.The results showed that Self-care had the greatest impact on successful aging (P < 0.01) ; Social capital did not have a direct impact on successful aging (standardized direct effect = 0.054, P > 0.05); The total indirect effect of social capital on successful aging was 0.594 (P < 0.01); The individual mediation effects of resilience and self-care between social capital and successful aging were 0.200 and 0.315 (P < 0.01), respectively, while the chain mediation effect was 0.079 (P < 0.01). These findings suggested that social capital influenced successful aging mainly by enhancing resilience and promoting self-care.

BackgroundHealthcare-associated infections underscore the critical role of infection prevention and control (IPC), a concern sharpened by the COVID-19 pandemic. Although organizational commitment and job satisfaction are recognized drivers of IPC compliance, their combined association with IPC execution and the mechanism linking them remain insufficiently understood. This study quantitatively examined the association between organizational commitment and IPC self-reported execution (SR-execution), with job satisfaction as a mediator.MethodsA cross-sectional study was conducted among 394 IPC professionals from 231 hospitals in Hubei Province, China. Organizational commitment comprised value, effort, and retention commitment (Cronbach’s α = 0.994); job satisfaction comprised coworker relationships, professional opportunities, praise and recognition, and extrinsic rewards (Cronbach’s α = 0.971); and IPC self-reported execution (SR-execution) comprised motivation, process, and outcomes (Cronbach’s α = 0.975). All items were rated on a five-point Likert scale. Structural equation modeling (SEM) was used to assess the proposed mediation framework.ResultsThe SEM demonstrated acceptable fit (χ2/df = 3.482, RMSEA = 0.079, CFI = 0.918, TLI = 0.906, IFI = 0.918, PGFI = 0.666). Organizational commitment was positively associated with job satisfaction (β = 0.628, p < 0.001) and IPC SR-execution (β = 0.556, p < 0.001). Job satisfaction was positively associated with IPC SR-execution (β = 0.307, p < 0.001). Job satisfaction significantly mediated the association between organizational commitment and IPC SR-execution (β = 0.193, SE = 0.052, 95% CI = 0.094–0.295), accounting for 25.78% of the total effect.ConclusionOrganizational commitment was positively associated with IPC SR-execution, and job satisfaction was a key mediator. These findings identify modifiable organizational factors that may strengthen IPC professionals’ implementation of IPC practices.

Background: Depression has become a prevalent and serious public health problem worldwide, attracting widespread attention from governments and international organizations and being included in key health policy issues. There is a close interaction between depression and economic factors such as household savings, a link particularly pronounced in Asian countries. However, evidence of a two-way association is limited. This study aims to explore the two-way relationship between depression and savings among middle-aged and older adults. Methods: Data were collected from 6746 respondents in the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, and 2018. A cross-lagged panel model was used to test the two-way relationship between depression and savings. Results: The results showed a significant cross-time effect of depression on savings (T0 → T1: β = -0.052; T1 → T2: β = -0.077), suggesting that higher levels of depression in the early stages are associated with lower levels of savings later. Moreover, savings had a stronger negative predictive effect on depression (T0 → T1: β = -0.463; T1 → T2: β = -0.510), indicating that higher levels of savings in the early stages are associated with lower levels of depression later. Furthermore, the grouping test showed that the two-way negative effect remained stable in both male and female groups (p ≤ 0.001). Conclusions: This study reveals the dynamic two-way influence between depression and savings, providing a basis for policy formulation that synergistically promotes residents' mental health and household financial stability.

BackgroundGiven the rising prevalence of chronic diseases and multimorbidity among middle-aged and older individuals in China, it is crucial to explore the patterns of chronic disease multimorbidity and uncover the underlying mechanisms driving the co-existence of multiple chronic conditions.MethodsThis study analyzed data from 19,206 participants in the China Health and Retirement Longitudinal Study (CHARLS 2018). The IsingFit model was used to build the chronic disease co-morbidity network, where nodes represented diseases and edges reflected conditionally independent partial correlations. Community detection identified groups of closely related diseases using the Louvain algorithm. Multivariable linear regression with forward stepwise selection explored factors influencing chronic disease co-morbidity. A random forest model ranked these factors by importance, providing insights into relationships and key contributors.ResultsThis study identified the most frequent multimorbidity pairs in the middle-aged and older adult population as hypertension with arthritis, and digestive diseases with arthritis. Multimorbidities were classified into four subgroups: respiratory diseases, metabolic syndrome, neurological diseases, and digestive diseases. Heart disease showed centrality in the multimorbidity network, while memory-related diseases played a bridging role. Key factors associated with multimorbidity included age, gender, pain, sleep, physical activity, depression, and education. Random forest analysis revealed that age and pain had the greatest impact on multimorbidity development, offering insights for targeted prevention and management strategies.ConclusionThis study systematically analyzed multimorbidity patterns and their influencing factors in the Chinese middle-aged and older adult population. The data were examined at three levels: overall network, key influencing factors, and individual characteristics. Cardio-metabolic diseases were identified as a core component of the multimorbidity network. Advanced age, pain, and depression were found to be independent risk factors affecting the number of multimorbidities, while healthy behaviors acted as significant protective factors. The study enhances understanding of multimorbidity mechanisms and provides a scientific basis for public health interventions, emphasizing the importance of behavioral modification, health education, and social support for high-risk groups.

Antimicrobial resistance has caused tremendous loss of life, health, and economic property, and Enterobacteriaceae bacteria have been classified by the World Health Organization as one of the key pathogens for which drug development is urgently needed. There is a lack of in-depth research on spatial effect analysis of Escherichia coli (E. coli) by researchers. The study was analyzed using spatial effect analysis with data from the China Antibiotic Resistance Surveillance System covering the prevalence of third-generation cephalosporins-resistant E. coli (3GCREC), carbapenem-resistant E. coli (CREC) and quinolone-resistant E. coli (QREC) in 30 provinces during 2014-2023. Spatial Durbin model and effect decomposition were used to determine the spatial effects of E. coli and their influencing factors, including Ambient temperature, Particulate matter (PM2.5), Precipitation, Absolute Humidity, Hospital beds, Physicians, Health facility, and GDP per capita. 3GCREC, CREC, and QREC showed significant spatial autocorrelation and regional differences (p < 0.001). The results of the time-fixed spatial Durbin model showed that ambient temperature, PM2.5, hospital beds, and healthcare facilities had significant effects on antimicrobial resistance of different E. coli strains with spatial spillover effects. Direct and indirect effects of ambient temperature, PM2.5, and healthcare facilities on CREC and QREC were determined by effect decomposition. The prevalence of different E. coli strains exhibits spatial autocorrelation, with provinces in close geographical proximity often having more similar resistance rates. More attention should be paid to areas with higher E. coli prevalence and interregional dynamics. The effects of ambient temperature, PM2.5, hospital beds, and healthcare facilities on E. coli prevalence should be fully recognized.

Carbapenem-Resistant Organisms (CROs) pose a serious threat to human health, which is a significant concern and urgently requires further research. However, the spatial effects of CROs are under explored. Data were obtained from the China Antimicrobial Resistance Surveillance System, covering the prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB) in 30 provinces from 2014 to 2023.Spatial Durbin Model (SDM) and effect decomposition were used to determine the spatial effects of CROs and their influencing factors including urbanization rate (UR), the number of health institutions (HOS), annual GDP per capita (PGDP), annual pesticide usage (PUSE) and PM2.5. Spillover of spatial effects were observed among CROs significantly. CRKP and CRPA demonstrated spatial clustering; CRPA and CRAB exhibited negative spatial effect spillovers. It implies that regions with high levels of CROs and the dynamic changes between regions should be given more attention first. This study has further identified significant associations between the spatial effects of CROs and various factors, including the aggregation and mobility of population, socioeconomic factors, as well as soil and air pollution. It is crucial to recognize the roles of these factors in the spatial spread of CROs, as it provides a new perspective for the prevention and control of CROs.

Antimicrobial resistance (AMR) has been causing tremendous loss of life, health and economic property, and WHO identified carbapenem-resistant gram-negative (CRGN) as the most urgent bacteria. The impact of climate change on AMR has received worldwide attention, but the evidence is insufficient. The prevalence of carbapenem-resistant antibiotic-resistant Klebsiella pneumoniae (CRKP), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA) from the Chinese Antibiotic Resistance Surveillance System from 2014 to 2023 were used as the dependent variable, the average ambient temperature from the China Statistical Yearbook was used as the independent variable. After controlling factors from socio-economic, environmental and medical services, natural log-linear regression analysis was used and found that CRKP and CRAB increased 1.093-fold and 1.021-fold, respectively, for every 1˚C ambient temperature increase. And this effect was similarly validated in the subgroup models for seasons and regions. In addition, we determined that health facilities, hospital beds per capita, and PM2.5 had a significant effect on the AMR of different strains. Changes in ambient temperature have a cumulative effect, with the greatest cumulative four-year impact. The effects of ambient temperature and its changes on AMR and the identification of influencing factors in this study provide innovative insights and important evidence for combating AMR.

Background: Goal setting has always been a crucial management factor for workforce motivation and is quite complex due to multiple goal characteristics. Considering that the emergence of Quiet Quitting (QQ) has inflicted harm on employees’ mental well-being in the healthcare field, urgent attention needs to be paid to the impact of goal setting on QQ. This study aimed to assess the current state of work goal setting and QQ among primary health professionals and to explore the effect of goal characteristics on QQ. Methods: A cross-sectional study was performed among 520 primary health professionals from 11 primary health centers. The Modified Goal Setting Scale and Quiet Quitting Scale were utilized to measure goal characteristics and QQ. Descriptive analysis, cluster analysis, and multiple regression were used for statistical analysis. Results: The mean score of QQ was 2.12. The eight goal characteristics were clustered into five categories. Among them, two categories demonstrated significant negative effects on QQ: Goal Specificity and Identity (Category 1; β = −0.096, p < 0.05) and Goal Fulfillment and Organizational Support (Category 2; β = −0.466, p < 0.001). Conversely, three categories showed significant positive effects: Goal Difficulty (Category 3; β = 0.112, p < 0.05), Goal Attainability (Category 4; β = 0.142, p < 0.01), and Goal Conflict (Category 5; β = 0.185, p < 0.001). Conclusions: The phenomenon of QQ requires attention among Chinese primary health professionals. Setting work goals scientifically may prove to be beneficial in curbing its spread. From a practical perspective, goal setting should be specific, moderately challenging, yet attainable, recognized and accepted by employees, and strongly supported by the organization. This approach is valuable for reducing QQ and fostering supportive work environments in primary healthcare. It should be noted, however, that while this study identifies significant associations, its cross-sectional design precludes causal inference, and the findings are context-specific to Chinese primary healthcare institutions.

Background:Approximately 240 million children worldwide are living with disabilities. Understanding the association between disability status and reported antibiotic use for common illnesses can help develop strategies to address the critical intersection of antimicrobial resistance (AMR) and disability. Methods:Data were collected from 42 low- and middle-income countries through the UNICEF-supported Multiple Indicator Cluster Survey (2017-2023). Disability status was assessed using the Washington Group-Child Functioning Module. Reported antibiotic use was measured by whether children with disabilities received antibiotic treatment for common childhood illnesses. Logistic regression models were applied to investigate the association between disability status and the prevalence of acute respiratory infection (ARI), diarrhea, and fever in the past two weeks, as well as reported antibiotic use for these illnesses. Analyses controlled for age, sex, place of residence, mother's education, the number of children under five in the household and country. Findings:The study included 301,857 children, 6.9% of whom were living with disabilities. Children with disabilities were more likely to experience common illnesses compared to those without disabilities: aOR = 1.78 (95% CI: 1.34-2.36) for ARI and aOR = 1.54 (95% CI: 1.22-1.96) for fever. The odds of antibiotic use among children with disabilities were comparable to those without disabilities: aOR = 1.13 (95% CI: 0.68-1.87) for ARI, aOR = 0.93 (95% CI: 0.64-1.36) for diarrhea, and aOR = 1.23 (95% CI: 0.81-1.86) for fever. This varied across countries, the lower-middle income countries had lower odds of reported antibiotic use for ARI and diarrhea (aOR = 0.85, 95% CI: 0.74-0.97, aOR = 0.78, 95% CI: 0.64-0.95, respectively). Lesotho, Iraq, Comoros and Honduras had higher odds of reported antibiotic use for children with disabilities, and in Pakistan where children with disabilities had lower odds of reported antibiotic use. Subgroup analyses showed that girls with disabilities were less likely to use antibiotics for diarrhea (aOR = 0.78, 95% CI: 0.63-0.96) compared to girls without disabilities. Similarly, girls with disabilities had lower odds of using antibiotics (aOR = 0.53, 95% CI: 0.29-0.98) compared to boys with disabilities. The associations also varied by impairment type, children with seeing, controlling behaviour or learning impairments are less likely to have reported antibiotic use. Interpretation:Children with disabilities are at a higher risk of developing common illnesses but are not necessarily more or less likely to use antibiotics for these conditions compared to children without disabilities. However, gender, country and impairment type disparities persist. Targeted efforts are needed to address these health inequities and ensure equitable access to care. Funding:This research was partially supported by National Natural Science Foundation of China (grant number: 72374228, 72074234), Guangdong Basic and Applied Basic Research Foundation (grant number: 2023A1515010163), Guangzhou Basic and Applied Basic Research Program (grant number: 2025A04J5118), and Fundamental Scientific Research Funds for Central Universities, China (grant number: SYSU-25wkjc02).

IntroductionQuiet quitting among primary healthcare (PHC) workers is prevalent and seriously reducing healthcare productivity and quality. Temporal leadership takes advantage of effective time scheduling, which can avoid unreasonable working arrangements and then mitigate quiet quitting. However, there is little known about the influence and mechanism of temporal leadership on quiet quitting. This study aims to explore the influencing mechanism of temporal leadership on quiet quitting among PHC workers, in addition to test the chain-mediating roles of time management competency and work-family enrichment of PHC workers, as well as the moderating roles of organizational communication.MethodsAn on-site survey of 520 PHC workers was conducted in a health reform area. The participants were asked to complete five self-report questionnaires, including Temporal Leadership Scale (TLS), Time Management Scale (TMS), Work-Family Enrichment Scale (WFES), Quiet Quitting Scale (QQS), and organizational Culture Scale (OCS).ResultsTemporal leadership, time management, and work-family enrichment all significantly and negatively predict quiet quitting among PHC workers. Time management and work-family enrichment played the chain-mediating roles between temporal leadership and quiet quitting. The relationship between temporal leadership and time management was moderated by organizational communication. Temporal leadership can mitigate quiet quitting among PHC workers by enhancing their time management competencies and work-family enrichment, and high levels of organizational communication can strengthen the effect of temporal leadership on time management competency.ConclusionsThese findings highlight the importance of temporal leadership in health systems and provide an evidence-based strategy for leaders to effectively address quiet quitting.

ObjectiveMental health has become a widely concerned topic worldwide. However, the impact and mechanism of positive activities on mental health still needed to be explored. This study aimed to apply the positive-activity model to investigate the effect of participation in positive activities on mental health and the mediating role of positive emotion.MethodsThis study used data from the 2021 China Comprehensive Social Survey (CGSS) and included 2,581 individuals. Ordinary Least Squares (OLS) and a three-step method was used for analysis.ResultsThe average of positive activities was 15.83. The positive activities affected positively mental health (β = 0.0132, p < 0.001). The positive emotion played a mediating role (β =0.2281, p < 0.001). The effect of positive activities on mental health was significant in older adults group (β = 0.024, p < 0.001), female (β = 0.015, p < 0.01) and male group (β = 0.01, p < 0.01), unmarried/divorced/widowed group (β = 0.024, p < 0.01), cohabitation/first marriage with spouse/remarriage with spouse/separation without divorce group (β = 0.010, p < 0.001), middle(β = 0.013, p < 0.05), and upper-middle-level SES group (β = 0.054, p < 0.001).ConclusionsWe concluded that the participation level of positive activities still needs to be improved and positive activities improve mental health through positive emotion, which implied that positive activities, as an easily implementable measure, should be greatly encouraged in mental health policies. And older adults, female, people without spouse, middle and upper-middle-income individuals need to be paid more attention.

Background: There is poor self-reported (SR) execution of infection prevention and control (IPC) among physicians and nurses. Self-leadership is considered an important factor to enhance IPC SR-execution. This study aims to explore the associations between self-leadership and IPC SR-execution among physicians and nurses. Methods: A cross-sectional study of 26,252 physicians and nurses was conducted in all secondary and tertiary hospitals in Hubei province, China. A questionnaire was designed to measure physicians' and nurses' self-leadership, which includes positive traits and negative traits, and IPC SR-execution, which includes motivation, process, and outcome. Results: Positive traits and negative traits of self-leadership had significant positive associations with SRexecution motivation (fi = .582, P < .001) (fi = .026, P < .001), SR-execution process (fi = .642, P < .001) (fi = .017, P < .001), and SR-execution outcome (fi = .675, P < .001) (fi = .013, P < .001). Conclusions: This study recommends that health care institutions should focus on cultivating positive traits of self-leadership among physicians and nurses. Although negative traits of self-leadership can also promote IPC SR-execution, the association is limited and may lead to risks. (c) 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

With the intensification of population aging, chronic diseases have become one of the major public health problems facing China. Obtaining and using authoritative health information is the foundation of chronic disease management. Currently, the channels for middle-aged and elderly patients with chronic diseases to obtain health information are increasingly diversified, but incorrect and false information is prevalent, and the health information discrimination ability of this population is relatively weak. In order to promote the rational use of health information by middle-aged and elderly patients with chronic diseases, this article systematically summarizes the current research progress on health information authority identification behavior (including behaviors in two aspects: health information trust evaluation and health information adoption evaluation) among middle-aged and elderly patients with chronic diseases at home and abroad based on authority theory.

Background: Frailty has become a common health issue among older adults, imposing a burden on both society and individuals. The relationship between social participation and frailty has received widespread attention, but the mechanism remains to be explored. The aim of this study is to explore the impact of social participation on frailty among older adults and to analyze the mediating role of loneliness and sleep quality, providing suggestions to alleviate frailty. Methods: Data related to social participation, loneliness, sleep quality, and frailty from 7779 older adults were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018). The chain mediation model was conducted to explore the relationship between variables, and the Bootstrap method was used to examine the path coefficients. Results: Social participation negatively affected frailty (β = −0.00391049, 95% CI = [−0.042296, −0.035465]); the indirect effect of social participation on frailty mediated by loneliness was −0.0019505 (95% CI = [−0.002551, −0.001371]); the indirect effect of social participation on frailty mediated by sleep quality was −0.0011104 (95%CI = [−0.001692, −0.000557]); the effect mediated by both loneliness and sleep quality was −0.0004263 (95% CI = [−0.000593, −0.000304]). Conclusions: Social participation negatively affected frailty. Loneliness and sleep quality not only mediated independently, but also played a chain mediating role. This suggested that encouraging older adults to engage in more social participation, reducing loneliness, and improving sleep quality are feasible measures to improve frailty.

Background The evidence of preferences for infection prevention and control (IPC) intervention from system perspective was lacked. This study aimed to elicit nurses’ preferences for the intervention designed to improve IPC behaviors based on the Systems Engineering Initiative to Patient Safety (SEIPS) model using Discrete Choice Experiment (DCE). Methods A DCE was conducted among nurses who were on active duty and willing to participate from July 5th to 10th, 2021 in a tertiary hospital in Ganzhou City, Jiangxi Province, using convenience sampling. A self-administered questionnaire included scenarios formed by six attributes with varying levels based on SEIPS model: person, organization, tools and technology, tasks, internal environment and external environment. A conditional logit and latent class logit model were performed to analyze the data. Results A total of 257 valid questionnaires were analyzed among nurses. The results from the latent class logit model show that nurses’ preferences can be divided into three classes. For nurses in multifaceted-aspect-preferred class (41.9%), positive coefficients were obtained in those six attributes. For person-preferred class (19.7%), only person was positively significant. For environment-preferred class (36.4%), the most important attribute were tasks, tools and technology, internal environment and external environment. Conclusions This finding suggest that nurses have three latent-class preferences for interventions. Multifaceted interventions to improve IPC behaviors based on the SEIPS model are preferred by most nurses. Moreover, relevant measured should be performed targeted the latent class of person-preferred and external-environment-preferred nurses.

BACKGROUND:Healthcare-associated infections have become a serious public health problem. Various types of information systems have begun to be applied in hospital infection prevention and control (IPC) practice. Clinicians are the key users of these systems, but few studies have assessed the use of infection prevention and control information systems (IPCISs) from their perspective.OBJECTIVE:This study aimed to (1) apply the extended DeLone and McLean Information Systems Success model (D&M model) that incorporates IPC culture to examine how technical factors like information quality, system quality, and service quality, as well as organizational culture factors affect clinicians' use intention, satisfaction, and perceived net benefits, and (2) identify which factors are the most important for clinicians' use intention.METHODS:A total of 12,317 clinicians from secondary and tertiary hospitals were surveyed online. Data were analyzed using partial least squares-structural equation modeling and the importance-performance matrix analysis.RESULTS:Among the technical factors, system quality (β=.089-.252; P<.001), information quality (β=.294-.102; P<.001), and service quality (β=.126-.411; P<.001) were significantly related to user satisfaction (R2=0.833), use intention (R2=0.821), and perceived net benefits (communication benefits [R2=0.676], decision-making benefits [R2=0.624], and organizational benefits [R2=0.656]). IPC culture had an effect on use intention (β=.059; P<.001), and it also indirectly affected perceived net benefits (β=.461-.474; P<.001). In the importance-performance matrix analysis, the attributes of service quality (providing user training) and information quality (readability) were present in the fourth quadrant, indicating their high importance and low performance.CONCLUSIONS:This study provides valuable insights into IPCIS usage among clinicians from the perspectives of technology and organization culture factors. It found that technical factors (system quality, information quality, and service quality) and hospital IPC culture have an impact on the successful use of IPCISs after evaluating the application of IPCISs based on the extended D&M model. Furthermore, service quality and information quality showed higher importance and lower performance for use intention. These findings provide empirical evidence and specific practical directions for further improving the construction of IPCISs.

Purpose: Healthcare-associated infections (HCAIs) have become a global public health problem, resulting in high mortality, serious morbidity, and heavy healthcare costs. Infection prevention and control (IPC) is a significant priority for healthcare workers (HCWs) to eliminate HCAIs. However, barriers exist in the IPC implementation in daily clinical work. This study aimed to explore the relationship between HCWs' knowledge, attitudes, barrier perception, as well as their effects on IPC practice.Patients and Methods: A structured questionnaire survey was conducted among HCWs who were responsible for IPC in a large tertiary hospital in China. Cronbach's alpha, average variance extracted (AVE), composite reliability (CR), as well as confirmatory factor analyses (CFA) were performed for reliability and validity. Structural equation modelling (SEM) was applied to establish the relationship between knowledge, attitudes, barrier perception and IPC practice. A Multiple Indicators Multiple Causes (MIMIC) model was conducted to detect the effects of covariates on factor structure. Results: In total, 232 valid questionnaires were eventually collected. The average score of knowledge, attitudes, barrier perception and IPC practice were 2.95 +/- 0.75, 4.06 +/- 0.70, 3.14 +/- 0.86, and 4.38 +/- 0.45, respectively. The instrument demonstrated good reliability and validity. The SEM results showed that knowledge was positively associated with attitudes (beta=0.151, p=0.039), and attitudes had positive effects on IPC practice (beta=0.204, p=0.001), whereas barrier perception was negatively associated with attitudes and IPC practice (beta=-0.234, p<0.001; beta=-0.288, p<0.001, respectively). Additionally, time proportion spent on IPC was significantly associated with attitudes and practice (beta=0.180, p=0.015; beta=0.287, p<0.001, respectively), and training on HCAIs was a predicator for barrier perception and practice (beta=0.192, p=0.039; beta=-0.169, p=0.038, respectively).Conclusion: IPC practice was indirectly affected by knowledge through the mediation of attitudes, whereas barrier perception had a negative impact. Designing deficiency-based training programs, developing sustained IPC habits, and strengthening management support are recommended to optimize IPC practice.

BackgroundImproving the rural residents’ accessibility to and affordability of health care is recognized as a common target globally. The Health in All Policies approach, from the Declaration of Helsinki to the United Nations’ Decade Of Healthy Ageing, strengthened the far-reaching effect of large-scale public policies on health care–seeking behavior; however, the effects of national transport policy on health care–seeking behavior is unclear. ObjectiveThis quasi-experimental study aimed to examine the effects of the implementation of transport-driven poverty alleviation (TPA) policy on health care–seeking behavior and medical expenditure among older adults in rural areas and the mechanism underlying these effects. MethodsWe designed a quasi-experiment to estimate the effects of TPA policy implementation on health care–seeking behavior and medical expenditure among older adults in rural areas through a difference-in-differences (DID) analysis based on data from the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. The underlying mechanism was analyzed and effect modification patterns were further investigated by poor households, health status, and age. ResultsOur findings validated a positive contribution of TPA policy on health care–seeking behavior among older adults in rural areas. After the implementation of TPA policy, the number of inpatient visits increased by annually 0.35 times per person, outpatient medical expenditure increased by 192% per month, and inpatient medical expenditure increased by 57% annually compared with those of older adults in rural areas without the implementation of TPA policy. Further, there was a significant modification effect, with a positive effect among poor households, healthier older adults, and those aged 60-80 years. Additionally, the policy improved the patients’ capabilities to seek long-distance care (β=23.16, 95% CI –0.99 to 45.31) and high-level hospitals (β=.08, 95% CI –0.02 to 0.13), and increased individual income to acquire more medical services (β=4.57, 95% CI –4.46 to 4.68). ConclusionsThese findings validate the positive contribution of TPA policy on health care–seeking behavior among older adults in rural areas; however, the medical expenditure incurred was also high. Concerted efforts are needed to address health care–seeking dilemmas in rural areas, and attention must be paid to curbing medical expenditure growth for older adults in rural areas during TPA policy implementation.

Objective To explore behavior patterns of rational antibiotics use and their impact factors among community residents for providing evidence to implement targeted-promotion of rational antibiotics use in China.Methods Using convenient sampling and a questionnaire self-designed according to capacity-opportunity-motivation-behaviors（COM-B）model,we conducted an online survey among 481 adults（≥ 18 years） from three urban communities in Hubei,Hebei and Jiangsu province during 5–19 of September,2020.Latent class analysis was used to identify the public antibiotic use behavior patterns and multi-nominal logistic regression model was adopted in analyses on influencing factors of different behavior patterns.Results Among the 413 participants with valid responses,three behavioral patterns of antibiotic use were identified,namely “irrational antibiotics use”,“antibiotic self-medication”,“relatively rational antibiotics use”,and the proportion of the participants for the three groups was 27.12% 27.12% and 45.76%,respectively.The results of logistic regression analysis showed that in comparison with the participants assessed as having “relatively rational antibiotics use ”,higher scores of medication-related skills（odds ratio [OR] = 0.663,P = 0.037）,social influence（OR = 0.475,P = 0.002）,resource and environment（OR = 0.643,P = 0.042）,self-capability beliefs（OR = 0.589,P = 0.034）,and intentions（OR = 0.504,P = 0.004） were protective factors against irrational antibiotics use but with a family member suffering from chronic diseases（OR = 1.895,P = 0.039） was a promoting factor for irrational antibiotics use for the participants assessed as having “irrational antibiotics use”;for the participants having “antibiotic self-medication”,higher scores of social influence（OR = 0.565,P = 0.004）,behavioral reinforcement（OR = 0.486,P = 0.013） and knowledge（OR = 0.379,P = 0.019） were significant protective factors against irrational antibiotics use.Conclusion In this survey,three different antibiotic use behavior patterns were identified among community adults in China;lack of relevant skills,adverse social influence,inadequate environment resources,insufficient belief in ability,strong intention to use antibiotics,and with family member suffering from chronic diseases are risk factors for irrational antibiotics use in the adults.