Background Medical students in China face severe depression and anxiety because of their difficult circumstances, such as the long length of schooling, academic pressure, and the stress of clinical practice. Although there have been many empirical studies about depression or anxiety in medical students in China, no previous studies have conducted a related systematic review about this topic in English. This analysis can convey the general findings from China to other areas of the world. Methods A systematic review and meta-analysis of depression or anxiety in medical students and related determinants were conducted. Three Chinese and three English databases were searched for the review, with no restrictions on language. Articles published between January 1, 2000 and April 1, 2018 were included. Results Twenty-one articles investigating a total of 35,160 individual Chinese medical students were included in this review. The prevalence of depression ranged from 13.10 to 76.21% with a mean of 32.74%, and the prevalence of anxiety ranged from 8.54 to 88.30% with a mean of 27.22%. Based on the meta-analysis, gender, grade level, residence, satisfaction with current major and monthly household income per capita were significantly associated with depression. Grade level and satisfaction with current major were significantly associated with anxiety. Other risk factors were identified and described using a narrative approach. Conclusion The mean prevalence of depression was 32.74% amongst medical students in China, whereas the mean prevalence of anxiety was 27.22%. The determinants of depression and anxiety included individual factors, social and economic factors, and environmental factors. More measures should be taken towards at-risk medical students based on the identified risk factors. Electronic supplementary material The online version of this article (10.1186/s12909-019-1744-2) contains supplementary material, which is available to authorized users.

Novel magnetic biochars (MBC) were prepared by one-step pyrolysis of FeCl-laden biomass and employed for Hg removal in simulated combustion flue gas. The sample characterization indicated that highly dispersed FeO particles could be deposited on the MBC surface. Both enhanced surface area and excellent magnetization property were obtained. With the activation of FeCl, more oxygen-rich functional groups were formed on the MBC, especially the C═O group. The MBC exhibited far greater Hg removal performance compared to the nonmagnetic biochar (NMBC) under N + 4% O atmosphere in a wide reaction temperature window (120-250 °C). The optimal pyrolysis temperature for the preparation of MBC is 600 °C, and the best FeCl/biomass impregnation mass ratio is 1.5 g/g. At the optimal temperature (120 °C), the FeMBC was superior in both Hg adsorption capacity and adsorption rate to a commercial brominated activated carbon (Br-AC) used for mercury removal in power plants. The mechanism of Hg removal was proposed, and there are two types of active adsorption/oxidation sites for Hg: FeO and oxygen-rich functional groups. The role of FeO in Hg removal was attributed to the Fe(t) coordination and lattice oxygen. The C═O group could act as act as electron acceptors, facilitating the electron transfer for Hg oxidation.

BackgroundHealth workforce turnover remains a global concern, particularly in rural and remote areas. Western rural areas are the least developed in China, where it faces the serious challenge on the rural health worker (RHW) management. This study aimed to investigate job satisfaction, work stress, and turnover intentions of RHWs, and to explore prominent factors associated with turnover intentions of RHWs in rural western China.MethodsFrom June to September 2013, based on a three-stage random sampling method, a cross-sectional survey was conducted among RHWs in 11 western provinces in China. A brief, structured questionnaire filled in by RHWs was used for data collection. A total of 5046 RHWs participated in the study. The response rate was approximately 93.1%. Exploratory factor analyses, Pearson’s chi-squared tests, one-way ANOVA, binary logistic regression analyses, and mediating effect tests were performed for data analyses.ResultsApproximately 29.1% of the 5046 RHWs indicated turnover intentions. Most of the RHWs disclosed low educational levels, income levels, and professional technical titles. The RHWs expressed slight job satisfaction (mean 3.20) and moderate work stress (mean 3.22). Age, income, medical institution, and job satisfaction (i.e., organizational management, reward, and occupation satisfaction) were significant predictors of the RHWs’ turnover intentions. The RHWs, who were younger (less than 41 years), receiving an income of $326.8–$490.1 per month, working in township hospitals, and having low job satisfaction, were more likely to have turnover intentions. Work stress had an indirect and positive effect on RHWs’ turnover intentions. Job satisfaction weakened the positive effect of work stress on turnover intentions of RHWs by playing a total mediating role. Reward satisfaction was the strongest mediator.ConclusionsThe turnover intentions of RHWs in western China are significantly associated with job satisfaction, work stress, age, income, and medical institution. Appropriate strategies should be implemented to improve RHWs’ job satisfaction and reduce their work stress. Meanwhile, providing more attractive wages and non-monetary support, improving working conditions, etc. could be effective to reduction in RHWs’ turnover intentions.Electronic supplementary materialThe online version of this article (10.1186/s12875-019-0904-0) contains supplementary material, which is available to authorized users.

ObjectivesTo analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures.DesignSystemic review and meta-analysis.Data sourcesFour English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019.Eligibility criteriaEligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study.Data extraction and synthesisData were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle–Ottawa Scale and heterogeneity was evaluated using the I2 statistic.ResultsWe identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on).ConclusionThis study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs’ lives outside of work and meet their living needs.

Objective: The aim of the study was to systematically review and meta-analyze the available evidence regarding the association between timing of repair or referral and clinical outcomes in bile duct injury (BDI). Background: Surgical repair is recommended for patients with complex BDI following laparoscopic cholecystectomy. However, consensus on the timing of surgery or referral to a specialist is lacking. Methods: We searched PubMed, Embase, Cochrane Library, and Scopus for eligible studies. The coprimary outcomes were repair failure in follow-up and postoperative complications. We pooled odds ratios (ORs) using random-effects models. Results: We included 32 studies. The rate of repair failure was significantly higher for early versus delayed repair [OR 1.65, 95% confidence interval (CI) 1.14–2.37, P = 0.007], lower for early versus delayed referral (OR 0.28, 95% CI 0.17–0.45, P < 0.001), but did not differ substantially for on-table versus postcholecystectomy repair (OR 2.06, 95% CI 0.89–4.73, P = 0.09). Regarding postoperative complications, early referral outperformed delayed referral (OR 0.24, 95% CI 0.09–0.68, P = 0.007); however, we found no significant differences between early and delayed repair (OR 1.34, 95% CI 0.96–1.87, P = 0.08), or between on-table and postcholecystectomy repair (OR 1.13, 95% CI 0.42–3.07, P = 0.81). At the cutoff time point of 6 weeks, early repair was associated with increased rates of repair failure (OR 4.03; P < 0.001), postoperative complications (OR 2.18; P < 0.001), and biliary stricture (OR 6.23; P < 0.001). Conclusions: Among patients with BDI, early referral and delayed repair appear to confer favorable outcomes.

BackgroundA large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students’ participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China.MethodsBased on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson’s chi-squared tests and binary logistic regression analyses were performed for data analyses.ResultsApproximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students’ intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05–1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48–2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background.ConclusionsRural clinical clerkship is likely to increase the odds of having intentions to work in rural medical institutions after graduation among medical students in western China, especially for those with an urban background. Related policy makers could consider developing compulsory rural clerkship programs and implement them among medical students to increase early rural exposure.

Background and Aims Cannabis use disorder (CUD) during pregnancy has increased dramatically in the United States (US). This study examined the associations between prenatal CUD and adverse neonatal outcomes and heterogeneities in the associations by mothers’ tobacco use status and race/ethnicity. Design Population‐based, retrospective cohort study. Setting California, USA. Participants A total of 4.83 million mothers who delivered a live singleton birth during 2001 to 2012 and their paired infants. Data were obtained from mother–infant linked hospital discharge records and birth and death certificates. Identified by ICD‐9 codes recorded at delivery, 20 237 mothers had prenatal CUD. Measurements Neonatal outcomes included length of gestation, preterm birth, birth weight, admission into neonatal intensive care unit, hospitalization within 1 year of birth, and death within 1 year of birth. Propensity score matching was used to balance maternal, paternal, and infant characteristics in the comparisons between infants exposed and unexposed to prenatal CUD. Findings CUD increased from 2.8 to 6.9 per 1000 deliveries during 2001 to 2012. Multivariable regressions in matched samples estimated that prenatal CUD was associated with greater odds of being small for gestational age (OR = 1.13, 95% CI = 1.08, 1.18), preterm birth (OR = 1.06, 95% CI = 1.01, 1.12), low birth weight (OR = 1.13, 95% CI = 1.07, 1.20), and death within 1 year of birth (OR = 1.35, 95% CI = 1.12, 1.62). Compared with infants whose mothers were tobacco non‐users, infants whose mothers were tobacco users had greater odds of preterm birth, low birth weight, hospitalization, and death in association with prenatal CUD. Compared with infants whose mothers were non‐Hispanic White, infants whose mothers were Hispanic had greater odds of hospitalization and death and infants whose mothers were non‐Hispanic Black had greater odds of being small for gestational age in association with prenatal CUD. Conclusion Prenatal cannabis use disorder appears to be associated with escalated odds of major adverse neonatal outcomes, with heterogeneities in the associations by mothers’ tobacco use status and race/ethnicity.

Viral hepatitis, as one of the most serious notifiable infectious diseases in China, takes heavy tolls from the infected and causes a severe economic burden to society, yet few studies have systematically explored the spatio-temporal epidemiology of viral hepatitis in China. This study aims to explore, visualize and compare the epidemiologic trends and spatial changing patterns of different types of viral hepatitis (A, B, C, E and unspecified, based on the classification of CDC) at the provincial level in China. The growth rates of incidence are used and converted to box plots to visualize the epidemiologic trends, with the linear trend being tested by chi-square linear by linear association test. Two complementary spatial cluster methods are used to explore the overall agglomeration level and identify spatial clusters: spatial autocorrelation analysis (measured by global and local Moran’s I) and space-time scan analysis. Based on the spatial autocorrelation analysis, the hotspots of hepatitis A remain relatively stable and gradually shrunk, with Yunnan and Sichuan successively moving out the high-high (HH) cluster area. The HH clustering feature of hepatitis B in China gradually disappeared with time. However, the HH cluster area of hepatitis C has gradually moved towards the west, while for hepatitis E, the provincial units around the Yangtze River Delta region have been revealing HH cluster features since 2005. The space-time scan analysis also indicates the distinct spatial changing patterns of different types of viral hepatitis in China. It is easy to conclude that there is no one-size-fits-all plan for the prevention and control of viral hepatitis in all the provincial units. An effective response requires a package of coordinated actions, which should vary across localities regarding the spatial-temporal epidemic dynamics of each type of virus and the specific conditions of each provincial unit.