No abstract

Background: China has achieved nearly universal coverage of the Social Basic Medical Insurance (SBMI), which aims to reduce the disease burden and improve the utilization of health services. We investigated the association between China's health insurance schemes and health service utilization of middle-aged and older adults at different quantiles, and then explored whether the SBMI could help reduce the underutilization of health services among the middle-aged and older adults in China. Methods: Survey data of middle-aged and older adults were drawn from the China Health and Retirement Longitudinal Study (CHARLS). A linear quantile mixed regression model was utilized to provide a comprehensive understanding of the relationship between SBMI and health service utilization, which was measured by the total medical expenditure. We took the New Rural Cooperative Medical Scheme (NCMS) as the reference level and examined the associations of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic Medical Insurance (URBMI) with health service utilization. Results: The quantile regression analysis revealed a significant positive association between URBMI and health service utilization at the 0.75 (β = 1.608, p < 0.01), 0.8 (β = 1.578, p < 0.01), 0.85 (β = 1.473, p < 0.01), 0.9 (β = 1.403, p < 0.01) and 0.95 (β = 1.152, p < 0.01) quantiles, and also a significant positive association between UEBMI and health service utilization at the 0.85 (β = 1.196, p < 0.01), 0.9 (β = 1.070, p < 0.01) and 0.95 (β = 0.736, p < 0.01) quantiles. Results showed that URBMI was significantly associated with an improvement in inpatient health service utilization of the middle-aged and older adults, and a significant positive association between UEBMI and inpatient health service utilization was observed at 0.1 (β = 0.559, p < 0.01), 0.25 (β = 0.420, p < 0.05), 0.5 (β = 0.352, p < 0.05), and 0.75 (β = 0.306, p < 0.05) quantiles. Conclusions: Inequity in health service utilization exists among the middle-aged and older adults across urban and rural Chinese areas, and it can be explained by the different reimbursement benefits of SBMI types.

Obesity and other chronic conditions linked with low levels of physical activity (PA) are associated with deprivation. One reason for this could be that it is more difficult for low-income groups to access recreational PA facilities such as swimming pools and sports centres than high-income groups. In this paper, we explore the distribution of access to PA facilities by car and bus across mainland Scotland by income deprivation at datazone level. GIS car and bus networks were created to determine the number of PA facilities accessible within travel times of 10, 20 and 30 minutes. Multilevel negative binomial regression models were then used to investigate the distribution of the number of accessible facilities, adjusting for datazone population size and local authority. Access to PA facilities by car was significantly (p<0.01) higher for the most affluent quintile of area-based income deprivation than for most other quintiles in small towns and all other quintiles in rural areas. Accessibility by bus was significantly lower for the most affluent quintile than for other quintiles in urban areas and small towns, but not in rural areas. Overall, we found that the most disadvantaged groups were those without access to a car and living in the most affluent areas or in rural areas.

This cross-sectional study examines health care utilization and expenditures that are attributable to unauthorized immigrants vs authorized immigrants or US-born individuals.

In Western countries, ultraviolet (UV)-induced skin cancer has been studied extensively regarding the high incidence of skin cancers in the white population; however, for people of color, cataracts are the main public health issue in relation to increased ambient ultraviolet radiation (UVR). To our knowledge, few studies have been conducted examining the relationship between cataracts and ambient UVR in China. In this study, we aimed to explore the relationship between and the factors influencing the disability prevalence of cataracts and annual ambient erythemal UVR exposure in 31 regions of China. The data used to determine the disability prevalence of cataracts was obtained from the Second China National Sample Survey on Disability. The regional annual erythemal UVR was calculated using Geographic Information System (GIS) methods based on data from the National Aeronautics and Space Administration (NASA) database. The relationship between the disability prevalence of cataracts and the annual ambient erythemal UVR was examined by using logistic regression. Both the age-standardized disability prevalence of cataracts (OR = 3.97, 95%CI 1.30–12.13, per 100KJ/m2 increase in annual ambient erythemal UVR) and the disability prevalence of cataracts among a population ≥65 years old (OR = 3.97, 95%CI 1.30–12.13, per 100KJ/m2 increase in annual ambient erythemal UVR) were higher in association with higher ambient erythemal UVR. Regions with higher urbanization and educational levels had lower disability prevalence of cataracts. We found positive associations of the age-standardized disability prevalence of cataracts and the disability prevalence of cataracts among a population ≥65 years old with ambient erythemal UVR in 31 regions of China.

Background COVID-19 is a highly contagious and highly pathogenic disease caused by a novel coronavirus, SARS-CoV-2, and it has become a pandemic. As a vulnerable population, university students are at high risk during the epidemic, as they have high mobility and often overlook the severity of the disease because they receive incomplete information about the epidemic. In addition to the risk of death from infection, the epidemic has placed substantial psychological pressure on the public. In this respect, university students are more prone to psychological problems induced by the epidemic compared to the general population because for most students, university life is their first time outside the structure of the family, and their mental development is still immature. Internal and external expectations and academic stress lead to excessive pressure on students, and unhealthy lifestyles also deteriorate their mental health. The outbreak of COVID-19 was a significant social event, and it could potentially have a great impact on the life and the mental health of university students. Therefore, it is of importance to investigate university students’ mental health status during the outbreak of COVID-19. Objective The principal objective of this study was to investigate the influencing factors of the psychological responses of Chinese university students during the COVID-19 outbreak. Methods This study used data from a survey conducted in China between February 21 and 24, 2020, and the data set contains demographic information and psychological measures including the Self-Rating Anxiety Scale, the Self-Rating Depression Scale, and the compulsive behaviors portion of the Yale-Brown Obsessive-Compulsive Scale. A total of 2284 questionnaires were returned, and 2270 of them were valid and were used for analysis. The Mann-Whitney U test for two independent samples and binary logistic regression models were used for statistical analysis. Results Our study surveyed 563 medical students and 1707 nonmedical students. Among them, 251/2270 students (11.06%) had mental health issues. The results showed that contact history of similar infectious disease (odds ratio [OR] 3.363, P=.02), past medical history (OR 3.282, P<.001), and compulsive behaviors (OR 3.525, P<.001) contributed to the risk of mental health issues. Older students (OR 0.928, P=.02), regular daily life during the epidemic outbreak (OR 0.410, P<.001), exercise during the epidemic outbreak (OR 0.456, P<.001), and concern related to COVID-19 (OR 0.638, P=.002) were protective factors for mental health issues. Conclusions According to the study results, mental health issues have seriously affected university students, and our results are beneficial for identifying groups of university students who are at risk for possible mental health issues so that universities and families can prevent or intervene in the development of potential mental health issues at the early stage of their development.

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This study aimed to develop and validate nomograms predicting the survival of osteosarcoma patients from the SEER database and our hospital. Data of 1,066 osteosarcoma patients from the SEER database were randomly divided into a development cohort (n=800) and validation cohort one (n=266). Another cohort of 126 patients from our hospital was utilized as validation cohort two. Univariate and multivariate Cox analyses were performed to identify the independent prognostic factors for overall survival (OS) and cancer-specific survival (CSS). Nomograms predicting the 3-and 5-year OS and CSS probability were constructed and validated. The predictive performances of the established nomograms were evaluated by the concordance index (C-index) and the calibration plot. Variables of age, surgical stage, surgery, grade, tumor site, and tumor size were identified as independent prognosticators for OS and CSS in Cox analyses. The C-indexes for OS and CSS in the development cohort were 0.818 and 0.829. Comparatively, the C-indexes for OS and CSS were 0.843 and 0.834, 0.736 and 0.782 for validation cohort one and two, respectively. Calibration plots showed excellent consistency between nomogram prediction and actual survival. Nomograms based on the SEER database are of high accuracy and can serve as a reliable tool for individualized consultation and survival prediction in osteosarcoma patients.