Demographic transitions are reshaping health needs and challenging the sustainability of health governance, with the coordination of population and health services systems closely connected to these processes. This study investigates China’s population and health services systems from 2010 to 2022, aiming to explore the spatiotemporal evolution and key driving factors of their coupling coordination. Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook, covering 31 provinces from 2010 to 2022. An evaluation model was developed to assess the coupling coordination degree (CCD) between the population and health services systems. Spatial autocorrelation analysis was employed to examine spatial dependence, and a Spatial Durbin Model (SDM) was applied to identify key driving factors. From 2010 to 2022, the development indices of China’s population and health services systems rose steadily, with the CCD increasing from 0.407 to 0.835, indicating a progression from initial imbalance toward advanced coordination. Regionally, the pattern of “east–strong, central–rising, west–weak” persisted, though disparities have diminished as central and western regions steadily caught up. Spatial analysis confirmed significant dependence and stable in provincial CCD, with patterns dominated by “high–high” clusters in the Yangtze River Delta and Beijing–Tianjin–Hebei region, which gradually extended into central provinces, and by persistent “low–low” clusters in the west and northeast, alongside several outliers. Spatial econometric results identified government health expenditure, health insurance coverage, digital and transport infrastructure as significant positive drivers, with government health expenditure and digital development showing stronger cross-regional spillovers. Coordination between the population and health services systems improved substantially, although regional disparities persisted. Further progress requires closer alignment between demographic change and health service capacity. Differentiated regional strategies are therefore needed: economically and resource-advantaged regions could harness agglomeration and spillover effects through cross-regional collaboration; central provinces should consolidate their catch-up momentum and strengthen their regional service capacity; and western and other low-coordination regions, facing population mobility and ageing pressures, should prioritise targeted fiscal transfers, workforce retention incentives and improved service accessibility to promote more equitable and sustainable development.

Middle-aged and older people are high-risk groups for chronic disease morbidity, and the healthcare expenditure burden they face has become an important social issue that must be addressed. Although the internet serves as a key tool for health management, little is known about its role in the healthcare expenditure of these groups. This study aims to explore how internet usage is associated with healthcare expenditure among middle-aged and older adults with chronic conditions, along with the underlying mechanism. The study employed data from the Chinese Family Panel Survey (CFPS) conducted between 2014 and 2018. The sample was restricted to individuals aged 45 years or above with chronic diseases (n = 12,601). The fixed effects model was used to investigate the relationship between internet usage and healthcare expenditure of respondents. Instrumental variable method, subsample regression, supplementary variable method and propensity score matching were adopted to test robustness. The Karlson–Holm–Breen method and an IV-based mediation method were also used to assess the mediating effect of self-rated health. Findings indicate that internet usage is significantly associated with lower healthcare expenditure burden among respondents (β = -0.068, P < 0.001). Self-rated health plays a mediating role in the relationship between internet usage and healthcare expenditure, accounting for 30.14

Among the social determinants of health, social interaction is considered a modifiable factor and an essential component of the global active ageing strategy. This study examined the associations of various types and frequencies of social interaction with health outcomes among older adults in China, while accounting for potential simultaneity and heterogeneity biases. This study used data from the Chinese Health and Retirement Longitudinal Study (CHARLS), a five-wave Panel survey conducted in 2011, 2013, 2015, 2018, and 2020, comprising 38,420 observations from 7,864 individuals aged 60 years and above. Social interaction was categorised into three types: leisure-based individual interaction, community-based organisational interaction, and responsibility-driven caregiving interaction, to capture its diversity. Descriptive statistics were used to summarise health status and social interaction. Generalised estimating equation regression models were used to examine the associations between one- or two-wave-lagged social interaction and health outcomes (self-rated health, mental health, cognitive function, and diagnosed diseases). Random-effects estimation addressed individual-level heterogeneity. The 2SLS model was applied to assess potential bidirectional associations between interaction frequency and health, followed by endogeneity test. Social interaction was associated with more favourable health outcomes among older adults, particularly in the medium to long term. One-wave-lagged interaction was linked to better self-rated health (β = 0.014, P < 0.05), lower mental distress (β=-0.232, P < 0.05), and better cognitive function (β = 0.233, P < 0.001), with no significant association with diagnosed disease. Leisure-based and community-based interactions corresponded to more favourable physical and mental health, whereas responsibility-driven interactions were associated with better cognition but also greater mental distress. Interaction frequency was positively associated with health, and was higher among those with better access to facilities and public transport. Living with children or a spouse, being employed and having a higher income tended to report more favourable health outcomes. Active social interaction, regular participation in leisure activities, organized social activities, and informal social interactions are associated with more favourable health outcomes among older adults. Policies should prioritize supportive environments and age-friendly community renovations, while families and society should strengthen internal and external support systems to help foster active and healthy aging.

Background Coordinating population and health service systems is essential for the modernization and sustainable development of health governance. This study investigates China’s population and health care systems from 2010 to 2021, aiming to explore the spatiotemporal evolution and key driving mechanisms of system coupling coordination. Methods Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook, covering 31 provinces from 2010 to 2021. An evaluation model was developed to assess the coupling coordination degree (CCD) between the population and health care systems. Spatial autocorrelation analysis was employed to examine spatial dependence, and a Spatial Durbin Model (SDM) was applied to identify key driving factors. Results From 2010 to 2021, the development indices of the population and health service systems increased from 0.213 to 0.686 and from 0.079 to 0.781, respectively, while the CCD rose from 0.361 to 0.855, reflecting a shift from imbalance to high-level coordination. Regionally, the pattern of “east–strong, central–rising, west–weak” persisted. A shift in developmental stages was observed, with nearly 60% of provinces health care–lagged in 2010, and about 53% population–lagged by 2021. Significant spatial clustering was observed (global Moran’s I: 0.379–0.473, P < 0.001), with high–high clusters concentrated in the Yangtze River Delta (Shanghai, Jiangsu, Zhejiang), Pearl River Delta (Guangdong), and Beijing–Tianjin–Hebei region, and low–low clusters in western and inland provinces. Key drivers such as government health expenditure, digital infrastructure, transport infrastructure, and health insurance coverage significantly promoted local coordination and exhibited notable spatial spillover effects, with digital infrastructure being the most influential. Population density facilitated neighboring coordination via service demand diffusion, while economic development had limited spatial spillovers. Conclusion The findings show sustained improvement in population–health system coordination, accompanied by persistent regional disparities and shifting constraint structures. Policy should focus on developing population–responsive health services, enhancing coordination capacity in less–developed regions through targeted fiscal support, and strengthening digital and transport infrastructure to promote regional synergy.

Background: The coupling coordination of population, medical care and public health system is crucial for advancing health care development and improving health governance efficiency. The dramatic shifts in global population structures are reshaping health demands, placing unprecedented challenges on health care systems. This study investigates the population, medical care system and public health system in China from 2011 to 2021, revealing their spatiotemporal dynamic evolution. The findings are expected to provide valuable insights for promoting the coordinated development of population and health care system and improve health governance. Methods: The data for this study were sourced from the China Statistical Yearbook and the China Health Statistics Yearbook. On the basis of relevant data, an evaluation model was developed to assess the coupling coordination degree of the population health multisystem. A quantile regression model was adopted to explore the influencing factors. Results: From 2010 to 2021, China experienced significant improvements across the three major systems. The evaluation index for the medical care system increased from 0.109 to 0.782, whilst the population and public health indices rose from 0.195 and 0.008 to 0.702 and 0.842, respectively. This development can be categorised into two phases: ‘rapid growth’ (2010–2018) and ‘fluctuating growth’ (2019–2021). The coupling coordination degree amongst the three systems steadily increased from 0.155 in 2010 to 0.668 in 2021, with an average annual growth rate of 14.2%. This phenomenon marked a shift from a state of severe dysfunction to one of primary coordination. However, significant regional disparities persisted, with varying rates of development and coordination. The eastern regions consistently led, followed by the western and central regions. This study identified multiple factors influencing the coupling coordination of the population–health care multisystem, including population structure, economic income, medical service efficiency, public health resources and health management service. Notably, health management emerged as a crucial factor at Q1 (b=2.283, P=0.002), whilst population structure was the most significant factor at Q3 (b=3.439, P<0.001). Conclusion: Structural adjustments for enhancing coupling coordination can effectively boost overall health sector efficiency and address reform challenges. Development strategies involve two pathways: economy- and policy-driven pathways. Economically disadvantaged areas should focus on policy-driven efforts to enhance coupling coordination, whereas economically developed areas should leverage economic momentum to accelerate the development of integrated health services to meet people’s needs throughout their life cycle. Additionally, considering population and regional characteristics is crucial, emphasising the need for health care systems tailored to the unique structural features and developmental strengths of each region.

Background The choice of old-age care methods or places plays an important role in improving the quality of life and well-being of older adults. This study aimed to analyze the choices of various old-age care modes (OCMs) among middle-aged and older adults (MOA) aged 40 years and older in Henan Province, China, and to explore the influence of personal health status, perspectives on old-age (POA) and external support received on their choices. Methods This study analyzed the data from the previous survey which included 911 MOA. The mean comparison method was used to analyze the evaluation of MOA prior to selecting OCMs, and the effect of individual characteristics, external support received, and personal health status on the choice of OCM for MOA was assessed by Logistic regression (LR) and Concentration Index. The Mediation Effect Model was used to explore effect manner and scope of MOA’ POA in their choice of OCM. Results The overall scores for MOA on the choice of the home-based, community-family, retirement village, nursing homes OCM were 4.06 ± 0.81, 3.70 ± 0.88, 3.72 ± 0.90, 3.49 ± 0.97, respectively. The LR model indicated that education level, number of children, relationship between family members and the relationship with neighbors affected the choice of OCM for MOA ( P < 0.05). Difference in OCM selection was relatively the largest based on the individual’s POA (Concentration index = -0.0895 ~ -0.0606), and it was shown to play a mediating role in other factors influencing the choice of OCM for MOA (Mediation effect = -0.002 ~ 0.013). Conclusions The evaluation of MOA on choosing a non-home OCM was generally, and the number of children and external support received were shown to have a relatively substantial impact on the choice of OCM among MOA, however, their power was affected by MOA’ POA. Policy makers could encourage the MOA’ selection of non-home OCM by improving the relationship among MOA persons while positively transforming their POA.

Background Self-rated health among old adults (SHOA) indicates individuals' subjective assessments and evaluations of their overall health based on objective physical circumstances. The purpose of this study was to analyze the current state and influencing factors of the subjective perception-based self-rated health (SH) by qualifying selected older adults with similar objective physical conditions, as well as to explore the equality and changing trends of SHOA based on influencing factors. Methods This study designed a cross-sectional study, conducted in three provinces in east, central and west China, and included 1,153 older adults (> = 60 years) with intact physical condition (IPC). The current state of SHOA and its influencing factors were analyzed using mean comparisons and Logistic regression (LR) models. The equality level and trend of SHOA's effect on health literacy, health habits, and access to health care were determined using the Lorenz curve, Gini coefficient, and Vector Autoregression (VAR) model. Results The mean SHOA with IPC was 74.37 ± 13.22. Findings from LR modeling indicated that SHOA with IPC was mainly influenced by age and communication methods ( P < 0.05). It was also observed that the total Gini coefficient of the allocation of SHOA with IPC based on communication methods was equal to 0.0188, and the VAR results showed that the total effect of change in SHOA on health literacy among older adults was negative and its duration of the effect exceeded 50. Conclusions The SHOA with IPC was shown to be better and was primarily influenced by age and communication methods. The observed effect of SHOA on health literacy was negative and lasting. To improve SHOA with IPC even further, policymakers could consider promoting the use of modern and convenient communication methods (such as smartphones) through training and purchasing subsidies, as well as focusing on increasing sustained attention and promoting health literacy and behavior among older adults with improved SH.

The self-rated health of older adults (SHOA) plays an important role in enhancing their medical service utilization and quality of life. However, the determinants and magnitude variations in SHOA at the family level (SHOAFL) remain unknown. The purpose of this study was to assess the status and equitable level of SHOAFL in China, as well as to analyze the influencing factors and the precise nature and scope of their impacts. This study analyzed the data from the "Chinese residents' health service needs survey in the New Era", and included a total of 1413 families with older adults. The status and influencing factors of SHOAFL were analyzed using mean comparison and Logistic regression (LR) models. The Concentration Index method was used to explore the equity of the distribution of SHOAFL. The relationship between differences in personal characteristics among family members and differences in SHOA was determined by the method of Coupling Coordination Degree (CCD). The total score of SHOAFL was 66.36 ± 15.47, and LR results revealed that the factors with a significant impact on SHOAFL were number of people living in family, distance to the nearest medical service institution, travel time to the nearest medical service institution, annual family income, yearly family medical and health expenditures, average age, and residence (all P < 0.05). The Concentration index of SHOAFL ranged from -0.0315 to 0.0560. CCD of the differences between SHOA and medical insurance and smoking status were 0.9534 and 0.7132, respectively. The SHOAFL was found to be generally but more inclined towards urban families with high incomes and a short time to medical service institution. The observed disparities in SHOA among family members were mostly attributable to differences in health insurance and pre-retirement occupations. The status and equality of SHOAFL may be improved if policymakers prioritize making services more accessible to older rural residents with low incomes. Concurrently, reducing the existing discrepancy in health insurance coverage between older couples may also enhance their health.

Declining total fertility rates pose a severe challenge to the economy, society, culture, and politics of any region. Low fertility rates among China's rural floating population with strong fertility are aggravating these challenges. Previous research has confirmed the relationships between health insurance and fertility intention. However, it is still unclear whether the existing association is favorable or not. Moreover, the majority of existing studies in China employ data from either urban or rural populations, whereas evidence from rural floating populations remains scarce. Based on the "China Migrants Dynamic Survey (CMDS)" in 2016, the current study used the logistic regression model to explore the impact of health insurance policy on the fertility intention of the rural floating population in China. Propensity Score Matching (PSM) was used to address potential selection bias. Three important findings were observed: Firstly, participating in the Basic Medical Insurance System (BMISUR) significantly improved rural floating populations' fertility intentions in China. Secondly, the association between age and the fertility intention of the floating population was "inverted u-shaped" with the highest fertility intention among those aged 25 to 34. There was also a positive correlation between personal income and fertility intention, and it was found between local housing purchase, formal employment, the co-residents scale, and the fertility intention in the rural floating population in China. Interprovincial mobility was positively associated with the fertility intention among rural migrants. Thirdly, the impact of health insurance policies on the fertility intention of the rural migrant population varies by gender, age, and inflow areas. The aforementioned findings can guide the Chinese government in its efforts to improve the fertility intention of the rural floating population, reform the social security system with a focus on "targets", and implement differentiated welfare policies aimed at promoting the equalization of basic public services, thereby contributing to China's population structure and long-term development.

Background Meeting the demands of older adults for health promotion services (DOAHPS) is essential for maintaining their health and enhancing their quality of life. The purpose of this study was to construct a model for evaluating DOAHPS to quantitatively evaluate the current state and equity level of DOAHPS in China, as well as to explore the main factors affecting DOAHPS’ current state and equity level. Methods This study analyzed the DOAHPS data from the "Survey on Chinese Residents' Health Service Demands in the New Era", which included 1542 older adults aged 65 and older. Relationships between evaluation indicators of DOAHPS were explored using Structural Equation Modeling (SEM). The Weighted TOPSIS method and Logistic regression (LR) were used to analyze the current state and factors impacting DOAHPS. The equity level of DOAHPS’ allocation among different older adult groups and its influencing factors were determined using the Rank Sum Ratio (RSR) method and T Theil index. Results The evaluation score for DOAHPS was 42.57 ± 1.51. Health status, health literacy and behavior were positively correlated with DOAHPS ( r = 0.40, 0.38; P < 0.05). The LR results revealed that the most significant determinants of DOAHPS were sex, residence, education level and pre-retirement occupation (all P < 0.05). The number of older adults with very poor, poor, general, high and very high level health promotion service demands accounted for 2.27%, 28.60%, 53.05%, 15.43% and 0.65%, respectively. The total T Theil index of DOAHPS was 2.7433*10 –4 , and the intra-group difference contribution rate exceeded 72%. Conclusions Compared to the maximum level, the total DOAHPS level was found to be moderate, although the demands of urban seniors with higher levels of education may be substantially greater. The observed inequities in the allocation of DOAHPS were primarily related to differences in education level and pre-retirement occupation within group. To better address health promotion services for older adults, policymakers could target older males with low education who reside in rural regions.

Abstract Background The social participation ability among older adults (SPAOA) plays an important role in enhancing their quality of life and utilization of medical services. This study aimed to evaluate the current state and equity level of SPAOA in Henan Province, China, as well as explore the factors associated with the current state and equity level of SPAOA. Methods This study analyzed data from the “2019 Henan Provincial Older Adults Ability Assessment Survey”, which included 4,593 older people (over 60 years old). The relationships among the SPAOA indicators were explored using the Structural Equation Model (SEM). The Dynamic Material Element Analysis (DMA) and Logistic Regression (LR) were used to examine the current state of SPAOA and its associated factors. The equity level of SPAOA and its correlated factors were determined using the concentration index and T Theil index. Results SPAOA received an overall score of 91.89 ± 9.83. Daily living, perception ability and mental state were positively correlated with SPAOA (r = 0.13, 0.83, 0.11, all P < 0.05). Results of LR indicated that the most significant predictors of SPAOA were age, education level, pre-retirement occupation, and income (all P < 0.05). The concentration index of SPAOA based on age and income were -0.0058 and 0.0096, respectively. SPAOA had a total T Theil index of 0.030–0.031, and the contribution rate of the difference within the group was greater than 94%. Conclusions While the overall level of SPAOA has been demonstrated to be outstanding, persons with a higher educational level and income are likely to benefit the most. The observed unequal distribution of SPAOA is primarily related to disparities in age or income within the group. To better serve older adults and improve their position and equity in terms of social participation ability, policymakers could emphasize older males with little income who live in urban areas, as well as unhealthy older females who live in rural residences.

目的:构建医学生健康素养状况客观评价模型并应用,为有针对性地开展健康素养干预提供参考.方法:以某民办医学院校一至三年级所有在校本科医学生为研究对象,采用分层整群随机抽样方法使用自制问卷调查学生健康素养情况.应用结构方程模型构建学生健康素养状况客观评价模型,使用动态物元分析方法对学生开展健康素养评价.结果:医学生健康素养总体评分为62.60分,一年级、二年级和三年级学生评分分别为61.55分、61.63分和65.00分,差异有统计学意义(F=7.096,P=0.001);健康知识通过健康行为间接影响健康素养;性别、母亲学历的高低和是否参与过健康相关社会实践活动是影响民办医学院校学生健康素养的主要因素.结论:大学校园生活和教育经历可以显著提升学生健康素养,民办学校应为学生参与健康相关社会实践活动提供更多机会和支持.

Background Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate important attributes and train popular machine learning (ML) algorithms to correctly classify neonates with a low Apgar scores from an imbalanced learning perspective. Methods We analyzed 7716 induced vaginal deliveries from the electronic birth registry of the Kilimanjaro Christian Medical Centre (KCMC). 733 (9.5%) of which constituted of low (< 7) Apgar score neonates. The ‘extra-tree classifier’ was used to assess features’ importance. We used Area Under Curve (AUC), recall, precision, F-score, Matthews Correlation Coefficient (MCC), balanced accuracy (BA), bookmaker informedness (BM), and markedness (MK) to evaluate the performance of the selected six (6) machine learning classifiers. To address class imbalances, we examined three widely used resampling techniques: the Synthetic Minority Oversampling Technique (SMOTE) and Random Oversampling Examples (ROS) and Random undersampling techniques (RUS). We applied Decision Curve Analysis (DCA) to evaluate the net benefit of the selected classifiers. Results Birth weight, maternal age, and gestational age were found to be important predictors for the low Apgar score following induced vaginal delivery. SMOTE, ROS and and RUS techniques were more effective at improving “recalls” among other metrics in all the models under investigation. A slight improvement was observed in the F1 score, BA, and BM. DCA revealed potential benefits of applying Boosting method for predicting low Apgar scores among the tested models. Conclusion There is an opportunity for more algorithms to be tested to come up with theoretical guidance on more effective rebalancing techniques suitable for this particular imbalanced ratio. Future research should prioritize a debate on which performance indicators to look up to when dealing with imbalanced or skewed data.

新型冠状病毒肺炎(简称新冠肺炎)疫情已持续1年多,河南农村疫情防控期间暴露出制度建设、财政投入、医疗资源配置、信息获取等多方面的问题,广大农村居民根据各自地域特点采取了许多"土办法",虽然在一定程度上、一定时间内遏制了疫情的传播,但给居民的生活带来不少困扰与不便,这些办法与措施不具有可持续性,对待疫情需要建立长久、有效的防控机制,确保农村社会稳定与农民健康生活.本文通过分析河南省新冠肺炎疫情防控工作中农村应急管理工作现状和存在的问题,提出建立归一化调查权与应急管理权、建设多点触控预警机制、提高检测力度和精度、培养专业化人才队伍和完善物资保障体系等基层公共卫生应急工作机制.

1Department of Epidemiology and Health Statistics, Zhengzhou University, Zhengzhou, People’s Republic of China; 2Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania; 3Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA; 4College of Sanquan, Xinxiang Medical University, Xinxiang, People’s Republic of China; 5Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania Objective: The goal of this study was to establish the most efficient boosting method in predicting neonatal low Apgar scores following labor induction intervention and to assess whether resampling strategies would improve the predictive performance of the selected boosting algorithms. Methods: A total of 7716 singleton births delivered from 2000 to 2015 were analyzed. Cesarean deliveries following labor induction, deliveries with abnormal presentation, and deliveries with missing Apgar score or delivery mode information were excluded. We examined the effect of resampling approaches or data preprocessing on predicting low Apgar scores, specifically the synthetic minority oversampling technique (SMOTE), borderline-SMOTE, and the random undersampling (RUS) technique. Sensitivity, specificity, precision, area under receiver operating curve (AUROC), F-score, positive predicted values (PPV), negative predicted values (NPV) and accuracy of the three (3) boosting-based ensemble methods were used to evaluate their discriminative ability. The ensemble learning models tested include adoptive boosting (AdaBoost), gradient boosting (GB) and extreme gradient boosting method (XGBoost). Results: The prevalence of low (<7) Apgar scores was 9.5% (n = 733). The prediction models performed nearly similar in their baseline mode. Following the application of resampling techniques, borderline-SMOTE significantly improved the predictive performance of all the boosting-based ensemble methods under observation in terms of sensitivity, F1-score, AUROC and PPV. Conclusion: Policymakers, healthcare informaticians and neonatologists should consider implementing data preprocessing strategies when predicting a neonatal outcome with imbalanced data to enhance efficiency. The process may be more effective when borderline-SMOTE technique is deployed on the selected ensemble classifiers. However, future research may focus on testing additional resampling techniques, performing feature engineering, variable selection and optimizing further the ensemble learning hyperparameters.

目的 构建医疗设备用户满意度评价模型并应用模型客观、真实评价医共体内医疗设备用户满意度,为优化县域医共体内医疗设备使用和配置提供参考建议.方法 基于我国中西部地区医共体内诊断类医疗设备使用调查数据,使用结构方程模型(SEM)构建满意度评价模型,应用动态物元分析方法(DMA)客观评价医疗设备用户满意度.结果 医疗设备用户满意度评价模型准确性良好(c2/df=1.49),结果区别度高;医共体内医疗设备用户满意度综合评价结果为70.34;不同品牌、类别和不同级别机构内设备的满意度评价存在显著差异(t=-2.275,P=0.025;t=-2.649,P=0.009;t=3.490,P=0.001).结论 进口品牌、县级医疗机构的设备使用满意度相对更高,政府和医院应加强对设备的临床效果和创新功能的关注,以促进国产品牌、乡级机构医疗设备使用效果的提高.

目的 了解民办医学院校学生基层医疗机构就业意愿现状及其内外部影响因素,为促进医学生基层医疗机构就业提供参考依据.方法 2020年10月使用自制问卷调查河南省某民办医学院校学生基层医疗机构就业意愿,应用t检验、方差分析和二元logistic回归方法分析学生就业意愿的影响因素.结果 民办医学院校学生基层医疗机构就业意愿总体评分为2.60±0.943,一至三年级中对基层医疗机构认知程度较好的学生分别占8.50％、11.33％和11.71％;不同年级、性别、母亲学历和政治面貌学生的就业意愿差异有统计学意义(F/t=10.734、-2.246、10.944、6.590,P＜0.05),学生自认为的专业对口情况和就业机率的影响与其就业意愿无关(P＞0.05);多因素分析显示:性别、政治面貌和对工作强度的关注度是学生基层医疗机构就业意愿的影响因素,其中女生有较高的基层医疗机构就业意愿(OR=1.912,95％ CI=1.204～3.036),高年级、非党员和对工作强度的关注度高的学生,对基层医疗机构的就业意愿低(OR=0.674,95％ CI=0.504～0.901;OR=0.583,95％ CI=0.343～0.991;OR=0.679,95％ CI=0.529～0.873).结论 民办医学院校学生基层就业意愿总体不高,且随年级升高呈下降趋势.学校应重点对高年级男性非党员学生开展基层医疗机构中工作强度、个人发展规划等宣传,以提升学生基层就业意愿.

目的:了解河南省基层全科医生工作满意度现状及其影响因素.方法:依据人类发展指数抽取河南省“个样本乡镇社区,于2019年对在职在岗的全科医务工作者进行问卷调查.从总体满意度、执业状况、职业环境、职业支持几个维度评价,依据Liketer五级赋分法对满意度赋分.发放问卷450份,回收有效问卷416份,回收有效率为92.4％.结果:基层全科医生整体满意度评价(百分制)得分为76.83;Logistic回归方法分析得出基层全科医生满意度主要受年龄、学历和职称的影响(P＜0.05).结论:河南省基层全科医生工作满意度一般水平偏上.中年基层全科医生比青年基层全科医生工作满意度高,大学学历比中专以下学历满意度低,高职称基层全科医生比低职称满意度高,主要工作职责为基本公共卫生服务的全科医生比主要职责为基本医疗的满意度高.

Hospitals in many countries face the need for balancing different categories of expenditures to achieve multiple goals within a limited budget. This study established a two-stage fuzzy linear programming (FLP) estimation model to explore the optimal allocation decision-making of expenditure budget under the multi-objective constraints. Taking all urban public hospitals in Henan province of China as a sample, the optimal allocation decision-making of total expenditure budget was tested with the human resources expenditures (HE) as the dependent variable. And the outcome was compared with the actual expenditure data of these hospitals between 2010 and 2016. The study found that when the HE achieves the maximum and minimum feasible scale, the expenditure scales of the budget allocation categories including pharmaceutical expenditures, medical supplies expenditures, and other expenditures were all within a reasonable range. Among them, the observed promoting space for HE was 3.78 billion yuan. The results show that the FLP method can help urban public hospitals to make better total expenditure budget allocation decisions, which can maintain their reasonable expenditure structure under the hospitals' development goals and the government's regulatory requirements.

目的:分析和评价贫困地区县域医联体内医务人员医疗设备创新数字功能的应用体验,为基层医疗机构医疗设备的优化配置和升级更新提供依据.方法:构建包含数据云存储、结果网络传输、数据远程调取、数据自动分析和故障自动预警5个维度的医疗设备创新数字功能评价指标体系,应用自制问卷调查10个县级医联体内医务人员对5种常用医疗设备(全自动化学发光免疫分析仪、便携式彩超、全自动生化分析仪、CT、DR)创新数字功能的应用体验.基于可拓集合理论,应用动态物元分析方法评价医疗设备的创新数字功能.结果:数据云存储、结果网络传输、数据远程调取、数据自动分析和故障自动预警5个维度的平均权重系数分别为0.1880、0.2182、0.2141、0.1901和0.1896;10个县域医联体内医疗设备创新数字功能综合评价结果为0.7259;评价等级为"良"的医联体1个,"中"的医联体5个,"差"的医联体4个.结论:贫困地区县域医联体内医疗设备创新数字功能总体有待提升,不同医联体间医疗设备创新数字功能评价结果和权重均存在较大差异,建议政府进一步加强对贫困地区乡镇卫生院医疗设备的优化配置和升级更新,以提高该地区医务人员对医疗设备创新数字功能的应用体验.