BACKGROUNDOlder migrants in China without local resident registration (hukou) are a vulnerable population and face barriers to receiving local healthcare.OBJECTIVESWe aimed to quantify the disparities in healthcare utilization between older migrants and local residents in Shanghai, China.DESIGNThis was a cross‐sectional study.SETTINGThe study was conducted in Shanghai, China, in 2016.PARTICIPANTSOlder adults (aged ≥60 years) were recruited based on a three‐stage stratified cluster sampling method (2571 older locals and 1920 older migrants).MEASUREMENTSWe compared utilization of outpatient care, inpatient care, preventive care, emergency room (ER) admission, and dental care, as well as medication use between older migrants and local residents. The local‐migrant gap was parsed into observed and unobserved components using the Blinder‐Oaxaca decomposition method.RESULTSOlder migrants were less likely to utilize outpatient (odds ratio [OR] = 0.757; 95% confidence interval [CI] = 0.617‐0.928), inpatient (OR = 0.642; 95% CI = 0.443‐0.931), and preventive care (OR = 0.743; 95% CI = 0.643‐0.858) and were more likely to use medication (OR = 1.254; 95% CI = 1.089‐1.445) than local residents. Differences in ER admissions and dental care utilization were not significant in the regression analysis. The decomposition results indicated that 55% and 71% of the local‐migrant gap in outpatient and preventive care utilization were attributable to individual characteristics, like health insurance. Unobserved components, including hukou‐related factors and personal heterogeneous preferences, contributed 59% and 63% to utilization of inpatient care and medication use, respectively.CONCLUSIONWe identified local‐migrant gaps in healthcare utilization among older adults in China. Further research is needed into integration of the health insurance system, accessibility of public health welfare benefits, and reconstruction of social networks among older migrants. J Am Geriatr Soc 68:1560‐1567, 2020.

Purpose Decreased binocular and oculomotor function in strabismics has recently been considered as cortical in origin. This study aimed to investigate functional abnormalities using a frequency‐specific neuroimaging method in patients with concomitant exotropia (XT), and to demonstrate the clinical implications. Methods Resting‐state functional magnetic resonance imaging data were collected in 26 XT patients and 26 matched controls. To evaluate the local spontaneous neural activity, the amplitude of low frequency fluctuations (ALFF) was calculated in the typical frequency band (0.01–0.08 Hz) as well as five narrowly‐defined frequency bands (slow‐6: 0–0.01 Hz, slow‐5: 0.01–0.027 Hz, slow‐4: 0.027–0.073 Hz, slow‐3: 0.073–0.167 Hz, and slow‐2: 0.167–0.25 Hz), respectively. Results Patients with XT showed decreased ALFF in the bilateral parieto‐occipital sulcus (POS), and increased ALFF in the bilateral thalamus within the typical frequency band. Frequency‐dependent ALFF alterations were found in the higher visual areas such as the right lateral occipital complex (LOC). Furthermore, ALFF in the right LOC in the slow‐5 band was positively correlated with fusion control score (r = 0.70, p < 0.0001) and binocular function score (r = 0.67, p = 0.0002). Regression analyses showed that early age of onset remained the only significant explanatory factor for ALFF reduction in the right POS in the typically‐measured frequency band (also referred to as the typical frequency band) (Odds ratio, 0.038; 95% confidence interval, 0.001 to 0.075). Conclusions Our findings provide spatial information regarding the functionally disrupted regions in XT. Moreover, the frequency‐dependent ALLF alteration in the right LOC might reflect a potential plastic capacity in binocular function, which could be a potential objective index for evaluating disease severity.

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In this study, we explored the neural mechanism underlying impaired stereopsis and possible functional plasticity after strabismus surgery. We enrolled 18 stereo-deficient patients with intermittent exotropia before and after surgery, along with 18 healthy controls. Functional magnetic resonance imaging data were collected when participants viewed three-dimensional stimuli. Compared with controls, preoperative patients showed hypoactivation in higher-level dorsal (visual and parietal) areas and ventral visual areas. Pre- and postoperative activation did not significantly differ in patients overall; patients with improved stereopsis showed stronger postoperative activation than preoperative activation in the right V3A and left intraparietal sulcus. Worse stereopsis and fusional control were correlated with preoperative hypoactivation, suggesting that cortical deficits along the two streams might reflect impaired stereopsis in intermittent exotropia. The correlation between improved stereopsis and activation in the right V3A after surgery indicates that functional plasticity may underlie the improvement of stereopsis. Thus, additional postoperative strategies are needed to promote functional plasticity and enhance the recovery of stereopsis.