Background:The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy(HAART).However,the issues of drug induced toxicities and co...Background:The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy(HAART).However,the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern.The aim of this study was to determine factors in uencing antiretroviral regimen changes among people living with HIV/AIDS in China.Methods:This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART,and gathered relevant information from infectious disease hospitals.The following information were collected:social-demographic characteristics,antiretroviral therapies,CD4 cell counts,virus loads,reasons for changing medication and other related data.Mean and percentages were used to describe the frequency of regimen change among patients,and binary logistic regression was employed to test the factors in uencing regimen change.Results:1,123 people who had experienced regimen change were included in the analysis.On average,patients remained on HAART for 10.2 months before changing regimen,and the average CD4 cell count and viral load(VL)were 383.1 cells/ l and 28,132.4 copies/mL respectively when changing regimen.The reasons for modi cation were determined as treatment failure(52.5%),adverse reactions(32.3%),and other reasons including pregnancy(15.2%).There are significant differences in regimen change among people with different genders(P<0.001),modes of transmission(P<0.001),duration of HAART(P<0.001)and initial CD4 cell counts(P=0.0024).Males,drug users,people taking long-term medication,and those with lower initial CD4 counts when starting HAART tend to change regimen.Conclusion:Treatment failure was the main reason for the change of HAART regimen.Males,drug users,people on longterm medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.展开更多
Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus(HIV)patients in whom antiretroviral therapy(ART)was un...Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus(HIV)patients in whom antiretroviral therapy(ART)was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004–2016 were included and divided into two treatment groups—Group 1(treatment time≤3 years,n1=5,218)and Group 2(treatment time>3 years,n2=4,200).Patient follow-up data,including age,cluster of differentiation 4(CD4)count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl(interquartile range,77.0–282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2(P<0.05).A significant interaction between group and time effects was observed(P<0.05)in total cholesterol(TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time(P=0.001).The initial CD4 count(odds ratio[OR]=0.756),female sex(OR=0.713),Zerit(d4T)(OR=1.443),TC(OR=1.285),and aspartate aminotransferase level(OR=1.002)were significantly associated with the survival time of dead patients with HIV(P<0.05).Additionally,the initial CD4 count(OR=1.456),age(OR=1.022),time interval(OR=0.903),patient’s living status(OR=0.597),d4T(OR=2.256),and triglyceride(OR=0.930)and hemoglobin levels(OR=0.997)were significantly associated with the treatment time of HIV patients with drug withdrawal(P<0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.展开更多
Background:As an emerging donor in health related development across the world,particularly towards Africa,the People’s Republic of China(PRC)has been increasing its influence within the field of global public health...Background:As an emerging donor in health related development across the world,particularly towards Africa,the People’s Republic of China(PRC)has been increasing its influence within the field of global public health over the past few decades.Yet between the period of 2000 and 2013,little is known about the scope,scale and priority of China’s grant-making programs.Methods:Based on data sourced from the China Aid Database(version-1.2),descriptive analyses were applied to analyze the features of 531 health related projects that were undertaken between 2000 and 2013.Spearmen correlation was also performed to assess the relationship between China’s export and aid to recipient countries.Results:The total value of China’s grant-making programs in the health related sector between 2000 and 2013 was 5.67 billion USD,with 531 projects undertaken.During the five year period between 2004 and 2008,China had a contribution of 1.54 billion USD,which increased to 3.8 billion USD during the five year period between 2009 and 2013-an 146.26%increase.In terms of specific diseases,China is most concerned with building an African public health system through donations targeted towards general health(313 projects),combating Malaria(115 projects)and maternal,neonatal and child health(MNCH),(12 projects).When it comes to recipient countries,if counted in total value,Zimbabwe received the most financial assistance from China,totaling 1.08 billion USD and 19 projects,while Angola and Tanzania received more projects-30 and 29 projects respectively.In terms of the channeling of aid funding,most projects were targeted towards infrastructure,equipment and medicine(304 projects in total),followed by medical teams(189 projects).Moreover,there is a statistically significant relationship between aid to Africa and Chinese exports to Africa.Conclusion:During the past decade,Chinese aid projects played an important role in the African public health system through providing funding for infrastructure,equipment and medicine,training health professionals,as well as disease treatment.However,very limited attention was paid towards disease prevention,health promotion and awareness initiatives,and health education.Furthermore,serious questions were raised regarding the long-term financial sustainability and actual impact these projects have on health development.展开更多
Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dyna...Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dynamics of female UI in China,and can inform further policies and have international implications.This study used three nationwide investigations:A national cross-sectional survey in 2021;another nationwide cross-sectional survey in 2006;and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019.The weighted prevalence of female UI and its subtypes,including stress UI(SUI),urgency UI(UUI),and mixed UI(MUI),were estimated as primary outcomes.Knowledge,attitude and care-seeking behaviors of UI were evaluated.It was found that the weighted prevalence of female UI was 16.0%(95%CI,13.3%–19.1%)with SUI remaining the predominant subtype(7.0%)in 2021,followed by MUI(6.5%)and UUI(1.9%).The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021.52.7%(95%CI,45.9%–59.4%)of women were aware that UI was a medical condition,and only 10.1%of women with UI sought health care.After 15 years of development,there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in ChinaDthey were found to be associated with UI prevalence.The UI prevalence in China was significantly lower in 2021 compared to that in 2006.Despite the achievement,UI remains a public health problem,especially given China's fast aging and three-child policy.More innovations,especially those that can facilitate care seeking,are needed to address this prevalent yet treatable condition.展开更多
Background Exploring factors that may influence general practitioners(GPs)’intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area.However,little...Background Exploring factors that may influence general practitioners(GPs)’intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area.However,little is known about how GPs’perception towards the National Compulsory Service Programme(NCSP)and job satisfaction impact their turnover intention.This paper explores GPs’intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions.Methods We conducted a cross-sectional,online survey from December 2021 to February 2022 to investigate GPs’perception towards NCSP,job satisfaction,and intentions to remain in rural area.Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China.Multinomial logistic regression analyses were performed to explore the associations between policy perceptions,job satisfaction,and intentions to remain.Results Of 3615 GPs included in the analysis,442(12.2%)would like to remain in rural area and 1266(35.0%)were unsure.Results of the multinomial logistic regression analyses showed that compared with GPs who would leave,GPs with higher perception scores for the restriction on taking postgraduate exam(RRR:1.93,95%CI 1.72,2.16)and the commitment to work for six years(RRR:1.53,95%CI 1.31,1.78)were more likely to remain.In contrast,GPs who had higher perception scores for completing standardised residency training(RRR:0.75,95%CI 0.64,0.88)and passing National Medical Licensing Examinations(RRR:0.74,95%CI 0.62,0.87)were more likely to leave.GPs who were satisfied with the freedom of choosing work methods(RRR:1.52,95%CI 1.25,1.84)and chances of promotion(RRR:1.60,95%CI 1.32,1.94)were more likely to remain.Conclusions This study highlights the significance of policy perception and job satisfaction on GPs’intentions to remain in rural area.Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes.展开更多
Summary What is already known about this topic?Antiretroviral therapy(ART)eligibility criteria and treatment regimens were updated in national guidelines.However,whether treatment was timely and followed guidelines wa...Summary What is already known about this topic?Antiretroviral therapy(ART)eligibility criteria and treatment regimens were updated in national guidelines.However,whether treatment was timely and followed guidelines was under-assessed.展开更多
基金National Natural Science Foundation of China(project no.71874100)Science and Technology Program of Beijing(project no.D171100006717002).
文摘Background:The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy(HAART).However,the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern.The aim of this study was to determine factors in uencing antiretroviral regimen changes among people living with HIV/AIDS in China.Methods:This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART,and gathered relevant information from infectious disease hospitals.The following information were collected:social-demographic characteristics,antiretroviral therapies,CD4 cell counts,virus loads,reasons for changing medication and other related data.Mean and percentages were used to describe the frequency of regimen change among patients,and binary logistic regression was employed to test the factors in uencing regimen change.Results:1,123 people who had experienced regimen change were included in the analysis.On average,patients remained on HAART for 10.2 months before changing regimen,and the average CD4 cell count and viral load(VL)were 383.1 cells/ l and 28,132.4 copies/mL respectively when changing regimen.The reasons for modi cation were determined as treatment failure(52.5%),adverse reactions(32.3%),and other reasons including pregnancy(15.2%).There are significant differences in regimen change among people with different genders(P<0.001),modes of transmission(P<0.001),duration of HAART(P<0.001)and initial CD4 cell counts(P=0.0024).Males,drug users,people taking long-term medication,and those with lower initial CD4 counts when starting HAART tend to change regimen.Conclusion:Treatment failure was the main reason for the change of HAART regimen.Males,drug users,people on longterm medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.
基金supported by grant from National Natural Science Foundation of China(Grant No.71874100)Science and Technology Program of Beijing(Grant No.D171100006717002).
文摘Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus(HIV)patients in whom antiretroviral therapy(ART)was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004–2016 were included and divided into two treatment groups—Group 1(treatment time≤3 years,n1=5,218)and Group 2(treatment time>3 years,n2=4,200).Patient follow-up data,including age,cluster of differentiation 4(CD4)count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl(interquartile range,77.0–282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2(P<0.05).A significant interaction between group and time effects was observed(P<0.05)in total cholesterol(TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time(P=0.001).The initial CD4 count(odds ratio[OR]=0.756),female sex(OR=0.713),Zerit(d4T)(OR=1.443),TC(OR=1.285),and aspartate aminotransferase level(OR=1.002)were significantly associated with the survival time of dead patients with HIV(P<0.05).Additionally,the initial CD4 count(OR=1.456),age(OR=1.022),time interval(OR=0.903),patient’s living status(OR=0.597),d4T(OR=2.256),and triglyceride(OR=0.930)and hemoglobin levels(OR=0.997)were significantly associated with the treatment time of HIV patients with drug withdrawal(P<0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.
基金supported by the Research Center for Public Health,Tsinghua University Beijingthe China and Youth of Excellence Scheme Scholarship,China.
文摘Background:As an emerging donor in health related development across the world,particularly towards Africa,the People’s Republic of China(PRC)has been increasing its influence within the field of global public health over the past few decades.Yet between the period of 2000 and 2013,little is known about the scope,scale and priority of China’s grant-making programs.Methods:Based on data sourced from the China Aid Database(version-1.2),descriptive analyses were applied to analyze the features of 531 health related projects that were undertaken between 2000 and 2013.Spearmen correlation was also performed to assess the relationship between China’s export and aid to recipient countries.Results:The total value of China’s grant-making programs in the health related sector between 2000 and 2013 was 5.67 billion USD,with 531 projects undertaken.During the five year period between 2004 and 2008,China had a contribution of 1.54 billion USD,which increased to 3.8 billion USD during the five year period between 2009 and 2013-an 146.26%increase.In terms of specific diseases,China is most concerned with building an African public health system through donations targeted towards general health(313 projects),combating Malaria(115 projects)and maternal,neonatal and child health(MNCH),(12 projects).When it comes to recipient countries,if counted in total value,Zimbabwe received the most financial assistance from China,totaling 1.08 billion USD and 19 projects,while Angola and Tanzania received more projects-30 and 29 projects respectively.In terms of the channeling of aid funding,most projects were targeted towards infrastructure,equipment and medicine(304 projects in total),followed by medical teams(189 projects).Moreover,there is a statistically significant relationship between aid to Africa and Chinese exports to Africa.Conclusion:During the past decade,Chinese aid projects played an important role in the African public health system through providing funding for infrastructure,equipment and medicine,training health professionals,as well as disease treatment.However,very limited attention was paid towards disease prevention,health promotion and awareness initiatives,and health education.Furthermore,serious questions were raised regarding the long-term financial sustainability and actual impact these projects have on health development.
基金supported by the National Key Research and Development Program of China(2021YFC2701300,2023YFC2706000 and 2018YFC2002201)the National Natural Science Foundation of China(72104247)the National High Level Hospital Clinical Research Funding(2022-PUMCH-B-087,2022-PUMCH-A-023)。
文摘Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dynamics of female UI in China,and can inform further policies and have international implications.This study used three nationwide investigations:A national cross-sectional survey in 2021;another nationwide cross-sectional survey in 2006;and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019.The weighted prevalence of female UI and its subtypes,including stress UI(SUI),urgency UI(UUI),and mixed UI(MUI),were estimated as primary outcomes.Knowledge,attitude and care-seeking behaviors of UI were evaluated.It was found that the weighted prevalence of female UI was 16.0%(95%CI,13.3%–19.1%)with SUI remaining the predominant subtype(7.0%)in 2021,followed by MUI(6.5%)and UUI(1.9%).The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021.52.7%(95%CI,45.9%–59.4%)of women were aware that UI was a medical condition,and only 10.1%of women with UI sought health care.After 15 years of development,there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in ChinaDthey were found to be associated with UI prevalence.The UI prevalence in China was significantly lower in 2021 compared to that in 2006.Despite the achievement,UI remains a public health problem,especially given China's fast aging and three-child policy.More innovations,especially those that can facilitate care seeking,are needed to address this prevalent yet treatable condition.
基金National Social Science Fund of China(reference number:BLA220240).
文摘Background Exploring factors that may influence general practitioners(GPs)’intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area.However,little is known about how GPs’perception towards the National Compulsory Service Programme(NCSP)and job satisfaction impact their turnover intention.This paper explores GPs’intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions.Methods We conducted a cross-sectional,online survey from December 2021 to February 2022 to investigate GPs’perception towards NCSP,job satisfaction,and intentions to remain in rural area.Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China.Multinomial logistic regression analyses were performed to explore the associations between policy perceptions,job satisfaction,and intentions to remain.Results Of 3615 GPs included in the analysis,442(12.2%)would like to remain in rural area and 1266(35.0%)were unsure.Results of the multinomial logistic regression analyses showed that compared with GPs who would leave,GPs with higher perception scores for the restriction on taking postgraduate exam(RRR:1.93,95%CI 1.72,2.16)and the commitment to work for six years(RRR:1.53,95%CI 1.31,1.78)were more likely to remain.In contrast,GPs who had higher perception scores for completing standardised residency training(RRR:0.75,95%CI 0.64,0.88)and passing National Medical Licensing Examinations(RRR:0.74,95%CI 0.62,0.87)were more likely to leave.GPs who were satisfied with the freedom of choosing work methods(RRR:1.52,95%CI 1.25,1.84)and chances of promotion(RRR:1.60,95%CI 1.32,1.94)were more likely to remain.Conclusions This study highlights the significance of policy perception and job satisfaction on GPs’intentions to remain in rural area.Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes.
文摘Summary What is already known about this topic?Antiretroviral therapy(ART)eligibility criteria and treatment regimens were updated in national guidelines.However,whether treatment was timely and followed guidelines was under-assessed.
