This study aimed to assess the association between single or combined maternal complications and small-for-gestational-age (SGA) birth among very preterm, late preterm, and term births and to evaluate whether this association varied across gestational periods. This retrospective cross-sectional study included 46,829 singleton pregnancies. The maternal complications considered were gestational hypertension (GH), preeclampsia (PE), and gestational diabetes mellitus (GDM). The potential nonlinear association between gestational age and the risk of SGA birth was assessed using restricted cubic spline analysis. Binary logistic regression models were used to assess the associations between single or combined maternal complications and SGA birth within the very preterm, late preterm, and term groups. Results were reported as odds ratios (ORs) with 95

Objective This study investigated the impact of a hierarchical management model on enhancing the quality of nursing services within the nursing department (ND). Methods A retrospective comparative cohort study was conducted on outpatients treated at the hospital from January 2021 to December 2022. A total of 68 patients admitted from January 2021 to December 2021 were assigned to the control group, while 75 patients admitted from January 2022 to December 2022 were assigned to the observation group. During the study period, a consistent group of nurses was responsible for outpatient care and underwent hierarchical management beginning in January 2022. We compared nursing quality and patient satisfaction between the two groups and documented adverse events (AEs), which included medical disputes and misdiagnoses. The psychological status of the patients was assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Results In comparison to the control group, the observation group demonstrated significantly higher scores for nursing quality and patient satisfaction (P < .05) and a lower incidence of AEs (P < .05). Following diagnosis and treatment, the observation group exhibited decreased SAS and SDS scores, significantly lower than the control group (P < .05). Conclusions Implementing a hierarchical management model positively impacts nursing quality within the ND and enhances patient satisfaction. Therefore, it is recommended as an effective approach for improving nursing care quality and patient satisfaction.

Objectives This study aims to calculate the national prevalence of smoking among Chinese adults and to describe the hazard of smoking initiation by age during their adolescence, as well as the disparities in sex, residence and age groups.Design A cross-sectional study.Setting The data were derived from a multistage sampling study conducted in 120 cities in China Mainland.Participants A total of 9963 participants aged ≥19 years were included.Primary outcome measures Survival analysis was used to quantify the hazards of smoking initiation by a single year of age during adolescence, and the log-rank test was used to compare the hazard curves across subgroups.Results The prevalence of current smoking among males and females was 27.7% and 2.0%, respectively, and 56.2% of current smokers began smoking at or before the age of 18. The hazard of smoking initiation during adolescence for females was less than 0.5%, and the hazard for males increased gradually before 14 years of age and increased sharply at age 15 (4.34%), then peaked at age 18 (6.24%). Males in rural experienced a higher hazard of smoking initiation than those in urban (χ2=5.35, p=0.02) and no such difference was found in females. By the age of 18 years, 11.7% of participants (1.8% for females and 23.4% for males) had ever smoked.Conclusions The prevalence of smoking among Chinese adults was lower than once reported. Males experienced higher hazards of smoking initiation at all ages than females. The hazard pattern suggests that the key focus for smoking prevention are males and adolescents aged 15–18 years, and future interventions should be delivered to the right target population at the appropriate time.

Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.

Planetary health is an emerging field that emphasises that humans depend on a healthy Earth for survival and, conversely, that the sustainability of Earth systems is dependent on human behaviours. In response to member demands for resources to support teaching and learning related to planetary health, the Consortium of Universities for Global Health (CUGH) convened a working group to develop a set of planetary health learning objectives (PHLOs) that would complement the existing ten CUGH global health learning objectives. The eight PHLOs feature Earth system changes, planetary boundaries, and climate change science; ecological systems and One Health; human health outcomes; risk assessment, vulnerability, and resilience; policy, governance, and laws (including the UN Framework Convention on Climate Change and the Paris Agreement); roles and responsibilities of governments, businesses, civil society organisations, other institutions, communities, and individuals for mitigation, adaptation, conservation, restoration, and sustainability; environmental ethics, human rights, and climate justice; and environmental literacy and communication. Educators who use the PHLOs as a foundation for teaching, curriculum design, and programme development related to the health-environment nexus will equip learners with a knowledge of planetary health science, interventions, and communication that is essential for future global health professionals.

With the advent of the informationization era, the importance of the management and utilization of grid data assets, as the core resources of the enterprise, is becoming more and more prominent. For this reason, this study proposes a data asset management system framework applicable to power grid enterprises based on the theory of data asset management, combined with the actual business situation of Huzhou Company. In the construction process, this paper especially introduces a multi-factor correction model, which comprehensively considers the different situations of data quality, data circulation, data redundancy, data monopoly, and multiple factors of return on investment, and realizes the valuation of data assets through the method of assigning values to them, which is of great significance in promoting the improvement of the level of data asset management of power grid enterprises.

Improving the productivity and relative efficiency of traditional Chinese medicine (TCM) hospitals is pivotal for hospital managers and policymakers to optimize the utilization of TCM resources in China. This study aimed to measure the productivity and relative efficiency of public tertiary TCM hospitals in Hubei Province. The input and output indicators data were extracted from the Health Commission of Hubei Province (HCHP) from 2019 to 2021. The Bootstrap-Malmquist-DEA model was employed to measure the productivity and relative efficiency of the hospitals. The statistical significance was set at P < .05. The numbers of total diagnostic patients and discharged patients declined by 23.44% and 28.34% from 2019 to 2020, and then increased by 25.76% and 20.44% respectively from 2020 to 2021. The average bias-corrected technical efficiency (TE) scores of the TCM hospitals from 2019 to 2021 were 0.8391, 0.8048, and 0.8559, indicating good efficiency. The average total factor productivity (TFP) in 2020 and 2021 decreased compared to that in 2019, with scores of 0.7479 and 0.8996, respectively. Between 2019 and 2020, the TFP changes among 19 out of 21 (90.48%) TCM hospitals and the technological changes (TC) among 20 out of 21 (95.24%) were less than 1.0000 (P < .05). The TFP changes of 17 out of 21 (80.95%) TCM hospitals and the TC of 20 out of 21 (95.24%) were less than 1.0000 (P < .05) between 2019 and 2021. COVID-19 might have constrained the provision of healthcare services by the public tertiary TCM hospitals in Hubei Province. Priority should be given to the utilization of healthcare resources, performance evaluation, information system strengthening, and internal hospital management to boost technical efficiency. TCM hospitals need to focus further on technology innovation to improve their technological progress.

Objective The number of stroke patients has been increasing in China in recent years, but a comprehensive synthesis of the environmental risk factors on the development of stroke is yet to be conducted. The aim of this study is to determine the environmental risk factors for stroke, in order to provide evidence-based recommendations for health administration bodies to make relative policies and interventions.Methods We searched China National Knowledge Infrastructure, WanFang Database, VIP-Datebase, PubMed, Web of Science, and Scopus database to select articles published from January 2012 to May 2022. Articles were included if they examined the association between an environmental risk factor and stroke and were conducted in China. Descriptive analysis was made based on the categories and frequencies of the environmental risk factors, and narrative synthesis was made covering the association between environmental risk factors and stroke.Results Of 12,774 records obtained initially from searching databases, 215 articles were finally selected for our systematic review. There are 8 categories, including 43 environmental risk factors, of which 52.56% studied meteorological factors as the main environmental factor category, followed by air pollution (47.44%), and the most frequently reported indicators are air temperature (40.47%) and PM2.5 (28.37%). Among the meteorological factors, most of the studies involving air temperature suggest that it is the key factor influencing stroke and confirm that stroke and its subtypes are seasonal. Nearly half of the studies found that higher air pressure was associated with higher risk of stroke and its subtypes. For air pollution, this review found that higher levels of PM2.5, PM10, CO, NO2, O3 and SO2 are associated with greater risks. In addition, fuel exposure and passive smoking are also associated with the increased risk of stroke.Conclusion Environmental factors have a certain influence on the occurrence risk of stroke in Chinese people. Further studies are needed not only to evaluate these associations and elucidate the specific mechanisms involved, but also to explore potential health effects of more environmental factors on stroke.

Background: Healthcare-associated infections (HAIs) are a serious global public health issue. However, a comprehensive analysis of risk factors for HAIs has yet been undertaken at a large scale among general hospitals in China. The aim of this review was to assess risk factors associated with HAIs in Chinese general hospitals.Methods: Medline, EMBASE and Chinese Journals Online databases were searched to find studies published from 1st January 2001 to 31st May 2022. The random-effects model was used to estimate odds ratio (OR). Heterogeneity was assessed based on the sb2 and I2 statistics.Results: A total of 5037 published papers were identified from the initial search and 58 studies were included in the quantitative meta-analysis; 1,211,117 hospitalized patients were incorporated covering 41 regions in 23 provinces of China and 29,737 were identified as having HAIs. Our review showed that HAIs were significantly associated with socio-demographic characteristics including age older than 60 years (OR: 1.74 (1.38-2.19)) and male sex (1.33 (1.20-1.47)); invasive procedures (3.54 (1.50-8.34)); health conditions such as chronic diseases (1.49 (1.22-1.82)), coma (OR: 5.12 (1.70-15.38)) and immuno-suppression (2.45 (1.55-3.87)). Other risk factors included long-term bed (5.84 (5.12-6.66)), and healthcare-related risk factors such as chemotherapy (1.96 (1.28-3.01)), haemodialysis (3.12 (1.80-5.39)), hormone therapy (2.96(1.96-4.45)), immunosup-pression (2.45 (1.55-3.87)) and use of antibiotics (6.64 (3.16-13.96)), and longer than 15 hospitalization days (13.36 (6.80-26.26)). Conclusions: Being male and aged over 60 years, invasive procedure, health conditions, healthcare-related risk factors, and longer than 15 hospitalization days were the main risk factors associated with HAIs in Chinese general hospitals. This supports the evidence base to inform the relevant cost-effective prevention and control strategies. 2023 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

目的:探索胎膜早破患者按病种分值付费(DIP)分组方案及费用标准,为优化该病种细分组方案及提高医院精细化管理水平提供依据.方法:收集深圳市某地区两家二级医院2019—2021年主要诊断为胎膜早破出院患者1051例病案首页信息,利用单因素分析和多元线性回归分析影响住院费用的因素,采用决策树模型卡方自动交互检测算法(CHAID)建立胎膜早破病例组合方案并进行各组费用测算.结果:以手术操作为粗分组分类节点,根据多元线性回归结果将住院天数(t=14.465,P<0.001)和付费方式(t=-9.166,P<0.001)作为住院费用的主要影响因素纳入到细分组分类节点构建DIP分组决策树模型,最终共形成9个组内同质性强[各组变异系数(CV)值均小于0.3]、组间异质性大(χ2=519.346,P<0.001)的DIP细组及相应的费用标准.结论:采用决策树模型,并综合考虑治疗操作及患者个体特征进行分组后的病例组合符合临床诊疗实际,分组具有一定合理性,可为相关部门优化该病种的细分组方案提供参考;DIP细分组可为医院基金分配及构建绩效考核评价体系等提供决策依据.

Background COVID-19 has affected research productivity across all areas of knowledge. Current evidence suggests that COVID-19 has had a blockbuster effect on journal impact factors (JIFs) and publication trends, while little is known on global health journals. Methods Twenty global health journals were included to analyse the impact of COVID-19 on their JIFs and publication trends. Indicator data, including numbers of publications, citations, articles with different types, etc, were extracted from journal websites and Web of Science Core Collection database. The JIFs from 2019 to 2021 were simulated for longitudinal and cross-sectional analyses. Interrupted time-series analysis and non-parametric tests were applied to assess whether COVID-19 had decreased non-COVID-19 publications from January 2018 to June 2022. Results In 2020, 615 out of 3223 publications were COVID-19 related, accounting for 19.08%. The simulated JIFs of 17 out of 20 journals in 2021 were higher than those in 2019 and 2020. Notably, 18 out of 20 journals had a decrease in their simulated JIFs after excluding COVID-19-related publications. Moreover, 10 out of 20 journals decreased their monthly numbers of non-COVID-19 publications after the COVID-19 outbreak. For all the 20 journals as a whole, after the COVID-19 outbreak in February 2020, the total number of non-COVID-19 publications significantly decreased by 14.2 compared with the previous month (p=0.013), and since then, on average, the publications had decreased by 0.6 per month until June 2022 (p<0.001). Conclusions COVID-19 has impacted the structure of COVID-19-related publications, the JIFs of global health journals and their numbers of non-COVID-19 publications. Although journals may benefit from increased JIFs, global health journals should avoid relying on a single metric. More follow-up studies including more years of data with a combination of metrics should be conducted to generate more robust evidence.

The adoption of its 2015 constitution has converted Nepal to a federal government while simultaneously resulted in significant reforms of the health system in Nepal in terms of both structure and commitment. In this commentary, we review evidence ranging from health financing to health workforce development to show that the impact of federalization on Nepal's health system and its efforts to achieve equitable and affordable universal health care have been mixed. On the one hand, careful efforts of the federal government to support subnational governments during the transition appears to have avoided serious disruption, subnational governments have successfully taken on the financial burden of the health system, and increase subnational control has allowed more flexible adaptation to changing needs than might have otherwise been possible. On the other hand, financing resource and ability disparities across subnational governments contributes to significant disparities in workforce development, and subnational authorities appear to have underestimated significant health issues (e.g. NCDs) in their budgets. We then provide three recommendations to improve the success of the Nepalese system: (1) to assess whether the services covered by health financing and insurance schemes like the National Health Insurance Program adequately address the needs of the rising burden of NCDs in Nepal, (2) to set clear minimum requirements on key metrics for subnational health systems, and (3) to extend grant programs to address resource disparities.

目的:通过了解武汉市试点医院DRG改革现状、进展,对比分析各医院DRG改革的措施及进度,提出武汉市试点医院DRG改革现存的问题,并探讨相应对策,为完善医保支付制度提供参考.方法:采用现场调研法,对武汉市6家试点医院开展DRG改革情况实地调研,调查内容包括制定方案、组织架构、系统建设改造及数据支持、宣传培训、DRG管理体系建设5个方面,通过比较试点医院实施状况和差异分析得出试点医院DRG改革存在的问题,并提出改进建议.结果:武汉市6家试点医院DRG改革在政策落实、DRG管理体系和宣传培训等方面做出了有益探索,但在改革方案、组织架构、系统建设改造及编码规范性、宣传培训和DRG管理体系建设上存在问题.结论:武汉市DRG改革还需持续推进,建议完善医院DRG改革工作机制流程、改进医院内部实施方案、优化医疗信息系统,加强试点医院个性化培训及关注专科医院特殊需求.

Abstract Background China has been still suffering from high burden attributable to tuberculosis (TB) and healthcare-associated infections (HAIs). TB patients are at high risk to get HAIs. Evidence-based guidelines or regulations to constrain the rising HAIs among TB hospitalized patients are needed in China. The aim of this systematic review and meta-analysis is to investigate the risk factors associated with HAIs among TB hospitalized patients in Chinese hospitals. Methods Medline, EMBASE and Chinese Journals Online databases were searched. The search was limited to studies published from January 1st 2001 to December 31st 2020. Meta-analyses of ORs of the risk factors between patients with HAIs and patients without HAIs among TB hospitalized patients were estimated. Heterogeneity among studies was assessed based on the $$\widehat{{\uptau }}$$ τ ^ 2 and I 2 statistics to select the meta-analysis model. Review Manager 5.3 was employed and P < 0.05 was considered as statistical significance. Results 851 records were filtered from the databases, of which 11 studies were included in the quantitative meta-analysis. A total of 11,922 TB patients were included in the systematic review and meta-analysis, of which 1133 were diagnosed as having HAIs. Age older than 60 years (OR: 2.89 [2.01–4.15]), complications (OR: 3.28 [2.10–5.13]), diabetes mellitus (OR: 1.63 [1.22–2.19]), invasive procedure (OR: 3.80 [2.25–6.42]), longer than 15 hospitalization days (OR: 2.09 [1.64–2.64]), secondary tuberculosis (OR: 2.25 [1.48–3.42]), smoking (OR: 1.40[1.02–1.93]), underlying disease (OR: 2.66 [1.53–4.62]), and use of antibiotics (OR: 2.77 [2.35–3.27]) were the main risk factors associated with HAIs among TB hospitalized patients with a statistical significance (P < 0.05). Conclusions Age older than 60 years, presence of complications, presence of diabetes mellitus, invasive procedure, longer than 15 hospitalization days, secondary tuberculosis, smoking, presence of underlying disease, and use of antibiotics were the main risk factors which had a negative impact on HAIs among TB hospitalized patients in Chinese hospitals. These findings provided evidence for policy makers and hospital managers to make effective infection prevention and control measures to constrain the rising HAIs. It is also required that more cost-effective infection prevention and control measures should be widely applied in routinely medical treatment and clinical management to reduce the occurrence of HAIs among TB hospitalized patients.

Importance:Data are limited on the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in community populations.Objective:To investigate the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in older, community-dwelling populations in China.Design, Setting, and Participants:This cross-sectional study was based on the baseline survey from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based prospective cohort study that enrolled community-dwelling adults aged 50 to 75 years based on cluster sampling from 6 villages and 4 living communities of Lishui city in southeast China. Data were collected from May 2017 to September 2019 and analyzed from September to November 2021.Main Outcomes and Measures:Atherosclerotic plaque and stenosis at baseline were assessed in multiple vascular territories. Brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries; computed tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries; and ankle-brachial index for peripheral arteries were performed at baseline survey. The extent of atherosclerosis was assessed according to the number of these 8 vascular sites affected, and polyvascular lesions were defined as at least 2 affected sites.Results:A total of 3433 of 4202 invited individuals consented to participate in the study. After excluding 366 participants with contraindications for MRI or CTA scanning, with life expectancies of 4 years of fewer, or with mental disease, a total of 3067 community-dwelling adults were enrolled. The mean (SD) age was 61.2 (6.7) years; 1640 (53.5%) were women, and 74 (2.4%) had prevalent ASCVD. Most participants (2870 [93.6%]) had atherosclerotic plaques in at least 1 vascular territory. Atherosclerotic plaques were mostly detected in the aorta (2419 [79.6%]) and iliofemoral arteries (2312 [75.8%]), followed by subclavian (1500 [49.8%]), coronary (1366 [44.9%]), extracranial (1110 [36.4%]), renal (873 [28.7%]), and intracranial (542 [17.7%]) arteries. A substantial proportion of participants (1180 [38.5%]) had arterial stenosis of 50% or greater, predominantly affecting the coronary (542 [17.8%]) and iliofemoral (527 [17.3%]) arteries. Polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories, and polyvascular stenosis was observed in 412 patients (13.4%).Conclusions and Relevance:In this study, atherosclerotic plaque was highly prevalent in the older community population in China, and a substantial proportion of individuals reach stenosis of 50% or greater.

Delta and Omicron variants of 2019-nCoV are still spreading globally, and many imported infections have been identified in China as well. In order to control the spread chain from imported to local, China has implemented the dynamic Covid-zero policy. In this article we summarized China’s governance models and practices of fighting potential imported infections in two directions. One targets at international travelers, which can be outlined as four lines of defense: customs epidemic prevention, quarantine upon arrival, relevant laws and regulations, and community tracking. The other is against other vectors potentially carrying 2019-nCoV, which can be outlined by three lines of defense: customs epidemic prevention, disinfection and personal protection, and information management. However, there are still some challenges that are yet to be addressed, such as illegal immigration, accidental occupational exposure to 2019-nCoV, etc. China’s experience indicates that no country can stay safe during the global pandemic as long as there are local outbreaks in other countries, and active prevention and control measures based on science and a complete set of laws and regulations are still necessary at current stage. What’s more, accountable government commitment and leadership, strengthened health and social governance systems, and whole society participation are required. It is suggested that the global community continue to closely cooperate together and take active rather than passive actions to block the potential imported 2019-nCoV from causing local spreading.

The current decolonizing global health movement is calling us to take a post-colonial perspective at the research and practice of global health, an area that has been re-defined by contemporary scholars and advocates with the purpose of promoting equity and justice. In this article, we summarize the main points of discussion from the Symposium organized by the editorial board of Global Health Research and Policy, convened in July 2021 in Wuhan, China. Experts participating in the symposium discussed what decolonizing global health means, how to decolonize it, and what criteria to apply in measuring its completion. Through the meeting, a consensus was reached that the current status quo of global health is still replete with various forms of colonial vestiges-ideologies and practices-, and to fully decolonize global health, systemic reforms must be taken that target the fundamental assumptions of global health: does investment in global health bring socioeconomic development, or is it the other way around? Three levels of colonial vestiges in global health were raised and one guiding principle was proposed when thinking of solutions for them. More theoretical discussion needs to be explored to guide practices to decolonize global health.