Background As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users’ acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients’ willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.

IntroductionWe present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic.MethodsImplemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees.DiscussionFrom 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection.

Introduction We present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic. Methods Implemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees. Discussion From 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection.

Epidemics of cholera have been frequent in southern Africa since the reintroduction of the disease to the continent in 1970. In late 1992, following a severe drought and an influx of refugees from Mozambique, cholera reappeared in Zimbabwe for the first time since 1985 and rapidly spread through the rural areas of the country. Data relating to symptomatic cholera infection collected during 2 large outbreaks on the eastern border of the country showed that host age and sex were important factors relating to symptomatic infection, as were population density and access to water. Epidemic profiles for the 2 study areas differed in that one of the profiles exhibited a distinct second phase epidemic. This unusual pattern was compared qualitatively with the output of a series of simple mathematical models to examine the contribution of different epidemiological processes to the pattern of disease observed. Model output suggested a complex disease process, in which the dynamics may have been influenced by spatial components. Statistical analysis of these unusual data showed that the observed pattern was independent of the effects of host age or sex, and provided compelling evidence of a marked spatial component of the second phase epidemic.

mation avaailable to us; and many staff of the Medical Research Council Environmental Epidemiology Unit for their help, particularly Mick Merwood for computer analyses and Gill Strange for preparing the manuscript. Professor Geoffrey Rose kindly commented on an earlier version of the paper. The study was approved by the British Medical Association ethical committee and the West Cumbria ethics of research committee and was supported partially by a grant from the Department of Health. 1 Black D. Investigation o*f the possible increased incidence of cancer in W'est Cumbrna. London: HMSO, 1984. 2 Gardner MiJ Hall AJ, Downes S. Terrell JD. Follow up studv of children horn to mothers resident in Seascale, West Cumbria (birth cohort). Br Aled 7 1987;295:822-7. 3 Gardner MJ, Hall AJ, Downes S, Terrell JD. Follow up study of children born elsewhere but attending schools in Seascale, West Cumbria (schools