BackgroundWe carried out an investigation in five provinces in China to assess treatment adherence and identify factors associated with insufficient treatment adherence in tuberculosis (TB) patients in mountainous, rural areas of China.MethodsIn each of the five provinces, all counties with > 80% mountainous area were stratified into three groups according to their gross domestic product. In each stratum, one county was randomly sampled. Study subjects were sampled from all smear positive TB cases registered in 2007 in the target counties. TB patients, village doctors, county doctors and directors of the TB prevention and control institutes were interviewed. Insufficient medication adherence was defined as taking less than 90% of anti-TB drug doses prescribed. Insufficient re-examination adherence was defined as having less than the recommended three sputum smear examinations during the treatment course.ResultsA minority of patients took drugs under direct observation: on average 29% during the intensive phase of treatment. In total, 524 TB patients were included, of whom 49 (9.4%) took less than 90% of all doses prescribed and 92 (17.6%) did not have all sputum smear examinations, with substantial variations between the provinces. In multivariable analysis, no direct observation of treatment during the intensive phase and the presence of adverse events were associated both with insufficient medication adherence and insufficient re-examination adherence. Overall, 79% of patients were adherent both to treatment and re-examinations.ConclusionsIn these remote and poor areas of China, the TB control program is not fully functioning according to the guidelines. The majority of patients are not treated under direct observation, while direct observation by health care staff was associated with better adherence, both to drug therapy and re-examinations. Insufficient adherence increases the risk of unsuccessful treatment outcomes and development of drug resistance. Measures should be taken urgently in these areas to strengthen implementation of the international Stop TB strategy.
Background China piloted a digital adherence technology called electronic medication monitor (EMM) to support self-administered treatment for tuberculosis. EMM is a portable plastic box that records each time the device is opened, offering an indirect measure of treatment adherence. During the monthly patient visits to tuberculosis designated hospitals, the doctors access the data from the EMM. Objectives Among people with tuberculosis notified in 30 counties in China (July-December 2018) where EMM supported self-administered treatment was suggested to all those eligible (no communication impairment, ambulatory care), we assessed the i) proportion eligible for using EMM ii) uptake of EMM and factors associated and iii) treatment adherence, including the proportion shifted to DOT. Methods This was an observational study using secondary programme data. Single instance of �50% or continued instance of 20-49% monthly missed doses was the eligibility criteria to shift to DOT. We used log binomial regression to identify factors associated with not using EMM within first month. Results Of 2227 with EMM eligibility data, 1810 (81%) were eligible for EMM. Of 1810 people, 1314 (73%) ever used EMM anytime during treatment, among them, 134 (10%) were eligible for shift to DOT (based on EMM data), and 29 (22%) were shifted. In addition, 70 were shifted
Information about the psychometric properties of items can be highly useful in assessment development, for example, in item response theory (IRT) applications and computerized adaptive testing. Although literature on parameter recovery in unidimensional IRT abounds, less is known about parameter recovery in multidimensional IRT (MIRT), notably when tests exhibit complex structures or when latent traits are nonnormal. The current simulation study focuses on investigation of the effects of complex item structures and the shape of examinees' latent trait distributions on item parameter recovery in compensatory MIRT models for dichotomous items. Outcome variables included bias and root mean square error. Results indicated that when latent traits were skewed, item parameter recovery was generally adversely impacted. In addition, the presence of complexity contributed to decreases in the precision of parameter recovery, particularly for discrimination parameters along one dimension when at least one latent trait was generated as skewed.
Among the edible jellyfish species, Rhopilema esculentum Kishinouye, 1891, is one of the most abundant jellyfish species consumed. Therefore, this jellyfish species is an important fisheries source in China. The jellyfish fisheries in China show annually considerable fluctuations and have a very short season. In the chapter, we firstly try to review the natural ecology of R. esculentum, which includes the distribution and migration, growth model, and survival rate in the Liaodong Bay (LDB) based on the results of our field studies for more than 20 years. Secondly, we focus on reviewing the jellyfish fishery and population dynamic in the LDB. Thirdly, we emphasize the themes, including the survey methods, catch prediction, enhancement assessment, and fishery management, based on our survey results from 2005 to 2010. Finally, we present our field and experiment results of resource restoration. The high commercial value of R. esculentum enhancement in the LDB has made this a very successful enterprise.
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