We aim to quantitatively synthesise available epidemiological evidence on the prevalence rates of workplace violence (WPV) by patients and visitors against healthcare workers. We systematically searched PubMed, Embase and Web of Science from their inception to October 2018, as well as the reference lists of all included studies. Two authors independently assessed studies for inclusion. Data were double-extracted and discrepancies were resolved by discussion. The overall percentage of healthcare worker encounters resulting in the experience of WPV was estimated using random-effects meta-analysis. The heterogeneity was assessed using the I2 statistic. Differences by study-level characteristics were estimated using subgroup analysis and meta-regression. We included 253 eligible studies (with a total of 331 544 participants). Of these participants, 61.9% (95% CI 56.1% to 67.6%) reported exposure to any form of WPV, 42.5% (95% CI 38.9% to 46.0%) reported exposure to non-physical violence, and 24.4% (95% CI 22.4% to 26.4%) reported experiencing physical violence in the past year. Verbal abuse (57.6%; 95% CI 51.8% to 63.4%) was the most common form of non-physical violence, followed by threats (33.2%; 95% CI 27.5% to 38.9%) and sexual harassment (12.4%; 95% CI 10.6% to 14.2%). The proportion of WPV exposure differed greatly across countries, study location, practice settings, work schedules and occupation. In this systematic review, the prevalence of WPV against healthcare workers is high, especially in Asian and North American countries, psychiatric and emergency department settings, and among nurses and physicians. There is a need for governments, policymakers and health institutions to take actions to address WPV towards healthcare professionals globally.

Agriculture accounts for approximately 11% of China?s national greenhouse gas (GHG) emissions. Through adoption of region-specific best management practices, Chinese farmers can contribute to emission reduction while maintaining food security for its large population (>1300 Million). This paper presents the outcome of a bottom?up assessment to quantify technical potential of mitigation measures for Chinese agriculture using meta-analysis of data from 240 publications for cropland, 67 publications for grassland and 139 publications for livestock, and provides the reference scenario for the cost analysis of identified mitigation measures. Management options with greatest mitigation potential for rice, or rice-based cropping systems are conservation tillage, controlled irrigation; replacement of urea with ammonium sulphate, nitrogen (N) inhibitor application, reduced N fertilizer application, integrated rice-fish-duck farming and biochar application. A 15% reduction in current average synthetic N fertilizer application for rice in China i.e., 231 kg N ha?1, would result in 12% decrease in direct soil nitrous oxide (N2O) emissions. Combined application of chemical and organic fertilizer, conservation tillage, biochar application and reduced N application are possible measures that can reduce overall GHG emissions from upland cropping systems. Conventional fertilizer inputs for greenhouse vegetables are more than 2?8 times the optimal crop nutrient demand. A 20?40% reduction in N fertilizer application to vegetable crops can reduce N2O emissions by 32?121%, while not negatively impacting the yield. One of the most important mitigation measures for agricultural grasslands could be conversion of low yielding cropland, particularly on slopes, to shrub land or grassland, which is also a promising option to decrease soil erosion. In addition, grazing exclusion and reduced grazing intensity can increase SOC sequestration and decrease overall emissions while improving the largely degraded grasslands. For livestock production, where poor quality forage is commonly fed, improving grazing management and diet quality can reduce methane (CH4) emissions by 11% and 5%, on average. Dietary supplements can reduce CH4 emissions further, with lipids (15% reduction) and tannins or saponins (11% reduction) showing the greatest potential. We also suggest the most economically cost-effective mitigation measures, drawing on related work on the construction of marginal abatement cost curves for the sector.authorsversionPeer reviewe

BackgroundHigh occupational burnout among general practitioners (GPs) is an important challenge to China’s efforts to strengthen its primary healthcare delivery; however, data to help understand this issue are unavailable. This study aimed to investigate the prevalence of burnout and associated factors among GPs.MethodsA cross-sectional design was used to collect data from December 12, 2014, to March 10, 2015, with a self-administered structured questionnaire from 1015 GPs (response rate, 85.6%) in Hubei Province, Central China. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS). MBI-HSS scores and frequency were analyzed by the three dimensions of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Factors associated with burnout among GPs were estimated using a multiple linear regression model.ResultsOf the respondents, 2.46% had a high level of burnout in all three dimensions, 24.83% reported high levels of EE, 6.21% scored high on DP, and 33.99% were at high risk of PA. GPs who were unmarried, had lower levels of job satisfaction, and had been exposed to workplace violence experienced higher levels of burnout. Intriguingly, no statistically significant associations were found between burnout and the duration of GP practice, age, sex, income, practice setting, and professional level.ConclusionThis is the first study of occupational burnout in Chinese general practice. Burnout is prevalent among GPs in Hubei, China. Interventions aimed at increasing job satisfaction, improving doctor-patient relationships and providing safer workplace environments may be promising strategies to reduce burnout among GPs in Hubei, China.

Summary Studies on turnover intention among Chinese general practitioners (GPs) at the national level are limited. This study aimed to assess intention to leave and its associated factors among a nationally representative sample of GPs. The participants were selected using a multistage stratified random sampling method. A self‐administered structured questionnaire was used to collect data from 3236 GPs in China between October 2017 and February 2018. A multiple linear stepwise regression analysis was used to identify factors associated with turnover intention. Over 70.0% GPs had a moderate or high turnover intention. GPs who were male, were younger, had a higher education level, had a lower professional title, had a lower income level, and had a temporal work contract had higher turnover intention. In addition, GPs who worked night shifts, had low job satisfaction, and had few opportunities for professional development reported higher turnover intention. Substantial gender and regional differences in predictors of turnover intention among GPs were observed. The study showed that turnover intention in Chinese GPs is high, and the factors influencing turnover intention were low professional title and income level, high education level, having a temporary work contract, working night shifts, and limited opportunities for professional development.

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