BACKGROUND:Guangdong Province in the Pearl River Delta of Southeast China is among the areas in the country with the highest rates of avian flu cases. In order to control the outbreak of human-infected H7N9 cases, Guangdong launched a new policy on the central slaughtering of live poultry in 2015. This study aims to evaluate attitudes of consumers and live-poultry workers toward the policy. The live-poultry workers consisted of two sub-groups: live-poultry traders and poultry farm workers.METHODS:Consumers and live-poultry workers from Guangdong were enrolled by stratified multi-stage random sampling. Online and field surveys were conducted to investigate participants' attitudes on policy implementation. Questionnaires were developed to quantify participant demographics, to collect information about attitudes toward the policy, and to identify influential factors of policy acceptability. Proportional odds logistics regression was used in the univariate and multivariate analyses. A total of 1449 consumers, 181 live-poultry traders, and 114 poultry farm workers completed the study.RESULTS:Policy acceptability percentages among consumers, live-poultry traders, and poultry farm workers were 57.1, 37.9, and 62.6%, respectively. Logistics regression shows that consumers tended not to support the policy if they were males, if they were concerned with the food safety of chilled products, and if they preferred purchasing live poultry. Live-poultry traders tended not to support if they were subsidized by the government, if they were males, if they experienced a drop in trading volume, and if they were unclear whether avian flu was a preventable disease. Finally, poultry farm workers tended not to support if they experienced a drop in trading volume, if they operated a poultry farm on a small to medium scale, and if they experienced inconvenience in their work due to the policy.CONCLUSIONS:The study reveals a substantial refusal or slowness to accept the policy. Failure to accept the policy results from varying reasons. Among consumers, concern about food safety and dietary preference are two major causes of disapproval. Policy acceptability among live-poultry workers diverges within the two sub-groups. While a large percentage of poultry farm workers accept the policy, the drop in trading and an insufficient subsidy hamper acceptance by live-poultry traders. We recommend that policy-makers promote health education and alleviate the policy impact on trading with a reformed subsidy policy to increase acceptability. These findings are crucial for the prevention of human-infected H7N9 cases in Guangdong.

Background: Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Methods: Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Results: Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Conclusions: Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

Objective To evaluate the intervention strategies in Guangdong initiative for comprehensive control of syphilis (GICCS) frown the aspect of health economics,and to provide the scientific basis for optimization and formulation of syphilis prevention and control strategy.Methods Two kinds of syphilis intervention strategies were considered:one was 80 percent coverage of syphilis screening (Strategy 1) and the other was 85 percent coverage of syphilis screening (Strategy 2).A Markov model for syphilis screening was applied based on the results of field surveys in GICCS and published literature.Cost-effectiveness analysis and sensitivity analysis were conducted through simulating the total costs and expected health outcomes of 10 000 syphilis high-risk people during the time horizon of 20 years under strategy 1 and Strategy 2 respectively from the societal perspective.Results Compared to strategy 1,strategy 2 would cost 3 998.88 million yuan more but avert 28 primary syphilis,34 secondary syphilis,337 latent syphilis and 8 tertiary syphilis cases and 392 disability adjusted life years (DALYs) at the same time.The incremental cost effectiveness ratio was 101.95 thousand yuan per DALYs.Sensitivity analyses showed that syphilis screening programme would have more cost effectiveness when the incidence of syphilis and the probability of late latent syphilis progressing to tertiary syphilis increased and the treatment rates of secondary syphilis and late latent syphilis decreased.Conclusion The syphilis intervention strategies GICCS adopts have cost effectiveness and can be popularized.

[目的]分析广东省2005-2014年梅毒流行趋势和疾病负担,为全面认识梅毒的危害性、合理制定卫生政策提供参考.[方法]利用广东省2005-2014年梅毒病例报告数据和广东省人口数据,分别以发病率和伤残调整寿命年(DALY)为分析指标,对广东省不同年份、不同性别、不同年龄组的梅毒疫情和疾病负担进行分析比较.[结果]梅毒报告发病率从2005年的21.08/10万,增长到2014年的52.55/10万,梅毒疾病负担强度从2005年的2.00 DALYs/1O万,增长到2014年的3.16 DALYs/10万.一期和二期梅毒在全部梅毒病例所占的构成比不断减少,而隐性梅毒的构成比不断增加.虽然三期和胎传梅毒的发病率很低,但其所致疾病负担却远远高于其他分期梅毒.隐性梅毒女性发病率高于男性,但各分期梅毒所致疾病负担均是男性高于女性.一期和二期梅毒的发病高峰为20～35岁,隐性梅毒有两个发病高峰,一个是20 ～ 35岁,另一个是60岁及以上年龄人群.[结论]广东省梅毒疫情形势严峻,梅毒疾病谱已经发生改变,隐性梅毒病例占大多数,三期和胎传梅毒发病率处于较低水平,但其所致疾病负担巨大.本研究提示要把各分期梅毒的防控工作放在同等重要的位置上.

目的 分析我国伤害所致疾病负担,为政府确定卫生工作的重点提供依据.方法 人口来源于《中国人口和就业统计年鉴2013》,伤害死亡数据来源于《中国卫生统计年鉴2013》,人均国内生产总值来源于《中国统计年鉴2013》,门诊费用和住院费用来源于国家卫生服务调查.采用全球疾病负担的方法,计算死亡损失生命年(years of life lost,YLLs)、直接和间接经济负担.结果 2012年我国伤害所致疾病负担强度为8.38 YLLs/1 000.疾病负担顺位的前5位为:机动车辆交通事故、自杀、意外跌落、机动车以外的运输事故和淹死.各类伤害所致疾病负担均存在农村高于城市、男性高于女性的特征.交通事故所致疾病负担主要集中在20 ～ 60岁年龄段,自杀疾病负担强度存在随年龄增加的趋势,意外跌落多见于老年人(60岁及以上),淹死所致疾病负担主要集中在1 ～15岁年龄段.伤害所致总经济负担高达3 792.31亿元.结论 伤害给我国居民健康和社会经济造成了巨大损失,应加强对各类伤害尤其是交通事故、自杀、意外跌落和淹死的预防和干预.

Background Suicide intervention programs have been guided by findings that attitude towards suicide and suicidal behavior may be causally linked. These findings also make it imperative to identify the factors that influence attitudes towards suicide. However, there has been little research on attitudes towards suicide among the general population, especially in low-income and middle-income countries. This population-based, cross-sectional study investigated the associated factors of attitudes towards suicide among a representative sample of urban and rural adult residents in China. Methods A multi-stage, stratified random sampling approach was implemented to select participants. Data were collected by a survey using the Scale of Public Attitudes about Suicide (SPAS). The survey also collected some socio-demographic factors and suicidal history of participants. Statistical tests were conducted to identify associated factors that account for variations in attitudes towards suicide. Results The residents in China generally hold a neutral attitude towards suicide. Attitudes towards suicide among Chinese residents were associated with age, duration of formal education, marital status, job and suicidal ideation. Different attitudinal subscales seemed not to share the same risk factors. However, gender, ethnicity, religious belief, housing style and economic status might not influence residents’ attitudes towards suicide. Attitudes towards suicide among Chinese urban and rural residents generally had no statistical difference with one notable exception: opinions on whether or not suicides and suicide attempts are different phenomena. Conclusions Age, duration of formal education, marital status, job and suicidal ideation seem to have an impact on attitudes towards suicide among residents. Urban and rural residents have similar attitudes towards suicide with the only statistically significance difference being their opinions on whether or not suicides and suicide attempts are different phenomena.

The primary care in China can be provided by general practitioners (GPs) and other physicians (non-GPs). However, China’s general practice system has never been really established. Chinese patients tend to consider the quality of primary care provided by GPs much lower than that of non-GPs. Besides, many GPs presently prefer leaving their own positions and seeking better development in big hospitals, which has made the already weak GP system weaker. Yet, few studies have specially compared the quality of primary care provided by Chinese GPs and other physicians and no studies have explored the independent predictors of Chinese GPs’ intentions to stay on their current job. In this study, we aimed to compare the quality of primary care offered by GPs with non-GPs and to explore the independent predictors of GPs’ future work intentions.