Hospital water supplies often contain waterborne pathogens, which can become a reservoir for healthcare-associated infections (HAIs). We surveyed the extent of waterborne pathogen contamination in the water supply of a Liver Transplant Unit. The efficacy of point-of-use (POU) water filters was evaluated by comparative analysis in routine clinical use. Our baseline environmental surveillance showed that Legionella spp. (28%, 38/136), Pseudomonas aeruginosa (8%, 11/136), Mycobacterium spp. (87%, 118/136) and filamentous fungi (50%, 68/136) were isolated from the tap water of the Liver Transplant Unit. 28.9% of Legionella spp.-positive water samples (n = 38) showed high-level Legionella contamination (≥10(3) CFU/L). After installation of the POU water filter, none of these pathogens were found in the POU filtered water samples. Furthermore, colonizations/infections with Gram-negative bacteria determined from patient specimens were reduced by 47% during this period, even if only 27% (3/11) of the distal sites were installed with POU water filters. In conclusion, the presence of waterborne pathogens was common in the water supply of our Liver Transplant Unit. POU water filters effectively eradicated these pathogens from the water supply. Concomitantly, healthcare-associated colonization/infections declined after the POU filters were installed, indicating their potential benefit in reducing waterborne HAIs.
To solve the problem of reimbursing trans-regional medical expenses, using only cross-regional manual reimbursement but not direct medical insurance card settlement, China implemented a pilot policy of direct settlement of trans-provincial outpatient expenses (DSTOE) in the Yangtze River Delta region. Due to the differences in inter-regional medical development, patients often migrate from areas with low-level medical resources to the high-level areas, a phenomenon that we define as the “siphoning” of trans-regional patients, which can cause a variety of problems. To study whether DSTOE aggravates the siphoning effect, we analyzed the changes in the volume of trans-provincial outpatient visits and conducted a questionnaire survey and factor analysis on the willingness of trans-provincial medical treatment under DSTOE. Results showed that manual reimbursement was gradually replaced by direct settlement, while the total volume was not increased significantly, and the ratio of outpatient visits flowing into and out from Shanghai decreased. The majority of questionnaire respondents confessed that their willingness toward trans-regional medical treatment increased, while their first choice of medical location was still mainly local, with only a few indicating that they would directly choose a cross-regional, higher-level medical institution. Spatial accessibility significantly restricted the seeking of trans-regional medical treatment, whereas age, education level, and policy awareness served as significant protective factors for the choice of medical location. In conclusion, due to space accessibility constraints, insufficient policy coverage, and the rationale for choice of location, DSTOE did not aggravate the siphoning effect of trans-regional patients.
This study aimed to analyze the changes in the 10 major categories of women’s healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women’s health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women’s healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women’s healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women’s health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.
Background Regulatory policy (RP) is known as a major factor to improve health care system performance. A significant difference in maternal mortality rates (MMRs) was observed between New York city (NYC) and Shanghai (SH), both first-class international metropolises. This study aims to adopt a quantitative evaluation model to analyze whether RP differences contribute to the different MMRs of the two cities. Methods Based on collection of all publicly released policy documents regarding maternal health in the two cities, we assessed and compared the status of their maternal health care RPs from 2006 to 2017 through a series of quantitative indicators as regulatory elements coverage rate (RECR), departmental responsibility clarity rate (DRCR), and accountability mechanism clarity rate (AMCR), based on two characteristics of comprehensiveness and effectiveness of RPs. Pearson correlation analysis, principal component analysis, and linear regression analysis were used to test the relationships between the indicators and MMR in SH and NYC. Results By 2017, disparities of maternal health care RP are found between SH and NYC, from the indicators of RECR (100% vs. 77.0%), DRCR (38.9% vs. 45.1%), and AMCR (29.2% vs. 22.5%). From 2006 to 2017, RECR, DRCR, and AMCR in SH have shown a higher growth of 8.7%, 53.2%, and 45.2%, compared with growth of 25.0%, 12.5%, and 2.9% in NYC. The three indicators were found all negatively correlated with MMR in SH (Coefficients = −0.831, −0.833, and −0.909, and P < 0.01), while only RECR and DRCR had negative correlation with MMR in NYC (Coefficients = −0.736 and −0.683, and P < 0.05). Linear regression showed that the principal components of the three indicators were found with significant impact on MMRs both in SH (R = 0.914, R 2 = 0.836, P < 0.001) and NYC (R = 0.854, R 2 = 0.357, P = 0.04). Conclusion Compared with NYC, the more comprehensive and effective maternal health care RPs in SH had a stronger impact on MMR control, which contributed to the differences between the two cities’ MMRs to some extent. The methods and indicators we adopted for assessment are reasonable and comparable.
BackgroundSince 1987, the Chinese government has promoted public mental health by continuously implementing mental health related policies. This research attempts to reveal the distribution and characteristics of mental health related policies. In addition, it can help stakeholders evaluate whether the environment for policy implementation has improved and identify key points in the development of the overall mental health system.MethodsWe used a bibliometric approach to analyze the evolution of mental health related policies in China from 1987 to 2020. A total of 239 mental health related policies were collected from Beida Fabao and official Internet websites of governmental departments. Co-wording, social networks, and citation analysis were applied to explore the evolutionary features of such policies.ResultsThe evolution of policy development showed that the number of mental health related policies in China has been increasing and their content has been enriched. Over time, mental health related policies not only gradually expanded its focus on common mental disorders, but also included an increasing number of keywords related to service provision, organization and administration. However, most policies were implemented independently by separate agencies and the number of policies jointly implemented by different agencies only accounted for 32.64% of all the policies implemented. The Ministry of Health (MOH) is at the core of the collaborative network associated with implementing mental health related policies in China.ConclusionThe environment associated with the implementation of mental health related policies in China is gradually improving. However, cross-sector collaboration among different agencies needs to be strengthened and financial support for related resources needs more attention. A clear division of responsibilities among various agencies and a sustainable financing mechanism are essential to the development and implementation of mental health related policies.
Objectives. There is a need to assess the 2009 new healthcare reform in China on hypertension prevention. It helps to control from the perspectives of multisectoral participation, government responsibility assignment, performance assessment, and service delivery. Design. Interrupted time-series study. Setting. 31 provinces in mainland China. Primary and Secondary Outcome Measures. Based on the content analysis of publicly available policy documents from 31 provinces regarding hypertension prevention and control, we analyzed the changes brought by the 2009 new healthcare reform through four quantitative indicators, including multisector participation (MP), main department responsibility coverage (MDRC), primary department assessment indicator coverage (MDAIC), and service type coverage (STC). We compared the changing trends of four indicators before and after 2009. Results. Nationally, MP, MDRC, and STC grew rapidly and increased to 88.9%, 96.4%, and 77.8%, respectively, in 2017, higher than MDAIC (36.9%). This growth was accelerated by the new healthcare reform, with the highest acceleration in MP (β3 = 6.345, p < 0.001 ), followed by MDRC (β3 = 3.829, p < 0.01 ), STC (β3 = 3.799, p < 0.001 ), and MDAIC (β3 = 3.585, p < 0.001 ). The MP and MDRC trend changes were higher in the central and western regions than in the east after the reform. Conclusions. Our research showed that the new healthcare reform had a positive effect in promoting multisectoral participation in preventing and controlling hypertension in China, improving the responsibility mechanism, and expanding the types of services provided. The government should lead the coordination and implementation of multidepartmental responsibilities and mobilize nonhealth departments to continuously participate in the prevention and control of chronic diseases by improving incentive and evaluation mechanisms.
Purpose China after 1949, especially since entering the 21st century, significant progress has been made in leadership research under Chinese context. However, so far there has been no systematic review and prospect of China's leadership research in the past 70 years. Therefore, with the help of scientific visualization software Citespace, this paper analyzes the research papers on leadership in the context of China from the top international journals of management science and applied psychology (1949–2018), supplemented and verified the previous research conclusions based on qualitative review, and quantitatively demonstrated the research evolution of leadership field. Design Methodology Approach Using a scientific visualization tool CiteSpace and 145 international leadership works, which were published in 64 top international journals and collected from the Web of Science database, and 852 domestic works which were published in 28 top domestic journals and collected from the CNKI database from 1949 to 2018, we draws keyword co-occurrence knowledge graph and keyword strategy map to visualize the landscape and evolution of leadership research and analyze the hot topics and research trends in the field of leadership. Findings The research found that: (1) Before 2002, there were only 7 articles published in 64 international top journal, mainly focusing on Western leadership theories such as transformational, cross-cultural comparison and the adaptability in Chinese context; (2) From 2003 to 2012, scholars had begun to introduce mainstream quantitative research paradigm in international academic community; (3) From 2013 to 2018, researches tended to be synchronized, with 461 and 99 papers published respectively. How emerging leaderships (such as ethical leadership) affect on various emerging outcome variables (such as creativity, voice behavior, unethical pro-organizational behavior etc.) is hot topic for future research. Originality Value Different from the previous qualitative reviews on organizational culture research, this paper, for the first time, uses bibliometric research methods to systematically analyze the evolution path of leadership research during the 70 years of China(1949–2018, and puts forward the future research prospects.
BackgroundThe World Health Organization has proposed an initiative to “end tuberculosis (TB).” Unfortunately, TB continues to endanger the health of people worldwide. We investigated the impact of public health services (PHS) in China on TB incidence. In this way, we provided policy ideas for preventing the TB epidemic.MethodsWe used the “New Public Management Theory” to develop two indicators to quantify policy documents: multisector participation (MP) and the Assessable Public Health Service Coverage Rate (ASCR). The panel data from 31 provinces in Chinese mainland were collected from 2005 to 2019 based on 1,129 policy documents and the China Statistical Yearbook. A fixed-effect model was used to determine the impact of MP and the ASCR on TB incidence.ResultsFrom 2005 to 2019, the average MP increased from 89.25 to 97.70%, and the average ASCR increased from 53.97 to 78.40% in Chinese mainland. However, the development of ASCR between regions was not balanced, and the average level in the western region was lower than that in the eastern coastal provinces. With an increase in MP and the ASCR, the TB incidence had been decreasing gradually in recent years. The panel analysis results showed that MP (β = −0.76, p < 0.05). and ASCR (β = −0.40, p < 0.01) had a negative effect on TB incidence, respectively. Even if the control variables were added, the negative effects of MP (β = −0.86, p < 0.05) and ASCR (β = −0.35, p < 0.01) were still statistically significant.ConclusionsPromoting the participation of multiple departments, as well as emphasizing the quality of PHS delivery, are important ways to alleviate the TB epidemic. The settings of evaluation indices for PHS provision should be strengthened in the future.
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