Objective To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia.Design Cluster randomized, investigator masked, controlled trial.Setting 252 primary schools in two prefectures in western China, 2012-13.Participants 3177 of 19 934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study.Interventions Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class.Main outcome measures Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations.Results Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, −0.04 to 0.09) or family wealth (0.01, −0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect. ConclusionsThe provision of free glasses to Chinese children with myopia improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting.Trial Registration Current Controlled Trials ISRCTN03252665.

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Although reforms have reduced incentives to overprescribe, more needs to be done to link performance to quality and ensure primary care doctors are adequately paid, say Xiaochen Ma and colleagues

Both health resources and access to these resources increased after China’s health care reform launched in 2009. However, it is not clear if the inequalities were reduced within rural China, which was one of the main targets in the reform. This study aims to examine the changes in inequalities in health resources and access following the reform. Data came from the routine report of rural counties in every other year from 2008 to 2014. Health professionals and hospital beds per 1000 population were used for measuring health resources, and the hospitalization rate was used for access. Descriptive analysis and the fixed effect model were used in this study. Health resources and access increased by about 50% between 2008 and 2014 in rural China. The counties in richer quintiles got more health resources and hospitalizations. As for health professionals, the absolute differences between the richer and the poorest quintile were significantly enlarging in 2014 when compared to 2008. Regarding the hospitalization rate, the differences between the richest and the poorest quintile showed no significant change after 2012. In sum, absolute inequalities of health resources were increased, while that of health utilization kept constant following China’s health care reform. The reform needs to continually recruit qualified health workers and appropriately allocate health infrastructures to strengthen the capacity of the health care system in the impoverished areas.

In highly competitive global markets, organizations have to distinguish themselves with creative and innovative solutions to satisfy discerning customers. Creativity, an important precursor for innovation, provides organizations with a competitive advantage in a reinforcing loop of improved customer service, increased staff morale, increased retention of quality staff and further improvements in service (Glisson & Durick, 1988; Anderson & College, 1992). Creative output comes from the performance of individuals with particular cognitive and personality traits (Masten & Caldwell-Colbert, 1987; Kirton, 1989) who are supported within a facilitative work environment (Scott & Bruce, 1994; Amabile et al., 1996; Rice, 2006). Confidence in one's own ability or one's self-efficacy is an important cognitive and social trait determining and sustaining work performance. Appropriate behaviours and performance standards are defined within the work environment and the ability and support received in meeting performance expectations enhance the individual's self-efficacy (Gist & Mitchell, 1992; Bandura, 1997).Both creativity and self-efficacy have been associated with particular individual traits and environmental conditions in the workplace. While much has been written on these two concepts separately, less has been done to explore them as a single construct. This paper addresses the gap in the literature by linking creativity at work and occupational self-efficacy. It reviews the literature on antecedent concepts and current research into creative self-efficacy. In doing this, it provides the basis for further empirical exploration of possible linkages between creative self-efficacy and individual and work environment variables. The contribution this paper makes is in the identification of specific variables that are significantly related to creative self-efficacy. A model is proposed showing significant linkages between the identified variables.

Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system.

PURPOSE: To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children.DESIGN: Cluster-randomized controlled trial. METHODS: Children with visual acuity (VA) £6/12 in either eye owing to refractive error in 94 randomly chosen primary schools underwent randomization by school to receive free glasses, education on their use, and a teacher incentive (Intervention), or glasses prescriptions only (Control). Intervention group teachers received a tablet computer if ‡80% of children given glasses wore them during unannounced visits 6 weeks and 6 months (main outcome) after intervention. OR [ 43.7,.5, P < .001). Other predictors of observed wear at 6 months included baseline spectacle wear (P < .001), uncorrected VA <6/18 (P [ .01), and parental spectacle wear (P [ .02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives.CONCLUSIONS: Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions. (Am J Ophthalmol 2015;160(5): 889-896. Ó 2015 by Elsevier Inc. All rights reserved.)

Using a survey of 19,977 children in two provinces, this paper explores the prevalence, correlates and potential consequences of poor vision among children in China's vast but understudied rural areas. We find that 24% of sample students suffer from reduced uncorrected visual acuity in either eye and 16% in both eyes. Poor vision is significantly correlated with individual, parental and family characteristics, with modest magnitudes for all correlates but home province and grade level. The results also suggest a possible adverse impact of poor vision on academic performance and mental health, particularly among students with severe poor vision.