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Prof. Ning Zhang
Xi'an Jiaootng University

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Journal article
Published: 16 August 2021 in Healthcare
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As a southwestern province of China, Sichuan is confronted with geographical disparities in access to healthcare professionals because of its complex terrain, uneven population distribution and huge economic gaps between regions. With 10-year data, this study aims to explore the county-level spatial disparities in access to different types of healthcare professionals (licensed doctors, registered nurses, pharmacists, technologists and interns) in Sichuan using temporal and spatial analysis methods. The time-series results showed that the quantity of all types of healthcare professionals increased, especially the registered nurses, while huge spatial disparities exist in the distribution of healthcare professionals in Sichuan. The local Moran’s I calculations showed that high–high clusters (significantly high healthcare professional quantity in a group of counties) were detected in Chengdu (capital of Sichuan) and relatively rich areas, while low–low clusters (significantly low healthcare professional quantity in a group of counties) were usually found near the mountain areas, namely, Tsinling Mountains and Hengduan Mountains. The findings may deserve considerations in making region-oriented policies in educating and attracting more healthcare professionals to the disadvantaged areas.

ACS Style

Ning Zhang; Wei Ning; Tao Xie; Jinlin Liu; Rongxin He; Bin Zhu; Ying Mao. Spatial Disparities in Access to Healthcare Professionals in Sichuan: Evidence from County-Level Data. Healthcare 2021, 9, 1053 .

AMA Style

Ning Zhang, Wei Ning, Tao Xie, Jinlin Liu, Rongxin He, Bin Zhu, Ying Mao. Spatial Disparities in Access to Healthcare Professionals in Sichuan: Evidence from County-Level Data. Healthcare. 2021; 9 (8):1053.

Chicago/Turabian Style

Ning Zhang; Wei Ning; Tao Xie; Jinlin Liu; Rongxin He; Bin Zhu; Ying Mao. 2021. "Spatial Disparities in Access to Healthcare Professionals in Sichuan: Evidence from County-Level Data." Healthcare 9, no. 8: 1053.

Review
Published: 10 May 2021 in Sustainability
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To analyse the prevalence of severe and critical COVID-19 cases and its determinants, a systematic review and meta-analysis were conducted using Review Manager. Four English and two Chinese databases were used to identify and explore the relationships between the severity of COVID-19 and its determinants, with no restrictions on publication date. The odds ratio and 95% CI were combined to assess the influencing level of all factors. Twenty-three articles containing a total of 15,828 cases of COVID-19 were included in this systematic review. The prevalence of severe and critical COVID-19 cases was 17.84% and 4.9%, respectively. A total of 148 factors were identified, which included behavioural, symptom, comorbidity, laboratory, radiographic, exposure, and other factors. Among them, 35 factors could be included in the meta-analysis. Specifically, for example, the male (OR 1.55, 95% CI 1.42–1.69) and elderly (OR 1.06, 95% CI 1.03–1.10) populations tended to experience severe and critical illness. Patients with cough, dyspnea, fatigue, fever, and gastrointestinal symptoms could have severe and critical diseases. Regarding laboratory results, albumin, aspartate aminotransferase, creatinine, D-dimer, fibrinogen, neutrophils, procalcitonin, platelets, and respiratory rate were potential factors that could be used to predict the severity of COVID.

ACS Style

Ning Zhang; Tao Xie; Wei Ning; Rongxin He; Bin Zhu; Ying Mao. The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China. Sustainability 2021, 13, 5305 .

AMA Style

Ning Zhang, Tao Xie, Wei Ning, Rongxin He, Bin Zhu, Ying Mao. The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China. Sustainability. 2021; 13 (9):5305.

Chicago/Turabian Style

Ning Zhang; Tao Xie; Wei Ning; Rongxin He; Bin Zhu; Ying Mao. 2021. "The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China." Sustainability 13, no. 9: 5305.

Research article
Published: 23 April 2021 in PLOS ONE
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Introduction The equity of health resource allocation geographically is a contested topic. Sichuan Province, located in Southwest China, has varied topography, providing us with natural materials to explore the determinants of health resource distribution. Materials and methods Spatial panel econometric models were constructed to explore the relationship between health resources and factors such as health care service demand and socioeconomic and demographic perspectives using data from Sichuan Province for eight consecutive years (2010–2017). Results Health care service demands were found to be a major driving force behind the distribution of health resources, showing that an increase in health care service demands draws health resources to specific counties and surrounding areas. From a socioeconomic perspective, gross domestic product per capita and the average wage show a positive association with health resources. In addition, the total population and proportion of the urban population have diverse effects in regard to health-related human resources but have the same effects on material and financial health resources. Conclusions Our results provide the Chinese government with evidence needed to formulate and promulgate effective policies, especially those aiming to tackle inequity among different regions.

ACS Style

Li Ding; Ning Zhang; Ying Mao. Addressing the maldistribution of health resources in Sichuan Province, China: A county-level analysis. PLOS ONE 2021, 16, e0250526 .

AMA Style

Li Ding, Ning Zhang, Ying Mao. Addressing the maldistribution of health resources in Sichuan Province, China: A county-level analysis. PLOS ONE. 2021; 16 (4):e0250526.

Chicago/Turabian Style

Li Ding; Ning Zhang; Ying Mao. 2021. "Addressing the maldistribution of health resources in Sichuan Province, China: A county-level analysis." PLOS ONE 16, no. 4: e0250526.

Journal article
Published: 26 March 2021 in International Journal of Environmental Research and Public Health
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With a surge of conflicts between healthcare workers and patients in recent years, the therapeutic relationship (TR) in China is presently in tension. Meanwhile, consequent issues have begun to emerge, such as the distrust between healthcare workers and patients and the decline in the quality of medical services. Although many empirical studies about the TR have been conducted in China, previous studies on TR and its influencing factors have been contradictory. Therefore, this study conducted a systematic review and meta-analysis to assess the current situation of the TR and to identify factors associated with the TR in Chinese hospitals from three perspectives (healthcare worker, patient, and therapeutic interaction). Two reviewers independently searched the literature, selected researches, and extracted data through comprehensively searching of three international electronic databases and three Chinese electronic databases to identify all relevant observational studies on influencing factors for TR in China published in English and Chinese from January 2000 to January 2020. Among the 3290 records initially identified, 11 studies met the selection criteria. A total of 96,906 individuals were included in the review. The results showed that 55.73% of healthcare workers consider the TR to be tense, and 33.7% of patients hold this view. The meta-analysis indicated that healthcare workers who were male, older, less educated, working in a non-surgical department, and had a senior title were more likely to be pessimistic about the TR. Patients who were rural residents, highly educated, and had no medical insurance were more likely to be pessimistic about the TR. Furthermore, the mutual trust could improve rapport between healthcare workers and patients. The 25 other related factors related to the TR were analyzed and described using a narrative approach. The findings might deserve consideration in the design of relative policies to promote harmony between doctors and patients.

ACS Style

Ying Mao; Wei Ning; Ning Zhang; Tao Xie; Jinnan Liu; Yongbo Lu; Bin Zhu. The Therapeutic Relationship in China: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health 2021, 18, 3460 .

AMA Style

Ying Mao, Wei Ning, Ning Zhang, Tao Xie, Jinnan Liu, Yongbo Lu, Bin Zhu. The Therapeutic Relationship in China: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18 (7):3460.

Chicago/Turabian Style

Ying Mao; Wei Ning; Ning Zhang; Tao Xie; Jinnan Liu; Yongbo Lu; Bin Zhu. 2021. "The Therapeutic Relationship in China: A Systematic Review and Meta-Analysis." International Journal of Environmental Research and Public Health 18, no. 7: 3460.

Journal article
Published: 20 March 2021 in BMC Women's Health
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Background Women's cancers, represented by breast and gynecologic cancers, are emerging as a significant threat to women's health, while previous studies paid little attention to the spatial distribution of women's cancers. This study aims to conduct a spatio-temporal epidemiology analysis on breast, cervical and ovarian cancers in China, thus visualizing and comparing their epidemiologic trends and spatio-temporal changing patterns. Methods Data on the incidence and mortality of women’s cancers between January 2010 and December 2015 were obtained from the National Cancer Registry Annual Report. Linear tests and bar charts were used to visualize and compare the epidemiologic trends. Two complementary spatial statistics (Moran’s I statistics and Kulldorff’s space–time scan statistics) were adopted to identify the spatial–temporal clusters. Results The results showed that the incidence and mortality of breast cancer displayed slow upward trends, while that of cervical cancer increase dramatically, and the mortality of ovarian cancer also showed a fast increasing trend. Significant differences were detected in incidence and mortality of breast, cervical and ovarian cancer across east, central and west China. The average incidence of breast cancer displayed a high-high cluster feature in part of north and east China, and the opposite traits occurred in southwest China. In the meantime, the average incidence and mortality of cervical cancer in central China revealed a high-high cluster feature, and that of ovarian cancer in northern China displayed a high-high cluster feature. Besides, the anomalous clusters were also detected based on the space–time scan statistics. Conclusion Regional differences were detected in the distribution of women’s cancers in China. An effective response requires a package of coordinated actions that vary across localities regarding the spatio-temporal epidemics and local conditions.

ACS Style

Rongxin He; Bin Zhu; Jinlin Liu; Ning Zhang; Wei-Hong Zhang; Ying Mao. Women’s cancers in China: a spatio-temporal epidemiology analysis. BMC Women's Health 2021, 21, 1 -14.

AMA Style

Rongxin He, Bin Zhu, Jinlin Liu, Ning Zhang, Wei-Hong Zhang, Ying Mao. Women’s cancers in China: a spatio-temporal epidemiology analysis. BMC Women's Health. 2021; 21 (1):1-14.

Chicago/Turabian Style

Rongxin He; Bin Zhu; Jinlin Liu; Ning Zhang; Wei-Hong Zhang; Ying Mao. 2021. "Women’s cancers in China: a spatio-temporal epidemiology analysis." BMC Women's Health 21, no. 1: 1-14.

Journal article
Published: 17 February 2021 in BMC Public Health
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Background Hand, foot and mouth disease (HFMD) is one of the common intestinal infectious diseases worldwide and has caused huge economic and disease burdens in many countries. The average annual incidence rate of HFMD was 11.66% in Shaanxi during the time span from 2009 to 2018. There are distinct differences within Shaanxi, as it is a special region that crosses three temperature zones. Hence, in this study, a spatiotemporal analysis of Shaanxi was performed to reveal the characteristics of the distribution of HFMD and to explore the meteorological determinants of HFMD. Methods The county-level and municipal data from Shaanxi Province from 2009 to 2018 were applied to research the spatiotemporal characteristics of HFMD and its meteorological determinants. Time series and spatial autocorrelation analyses were applied to assess the spatiotemporal characteristics of HFMD. This study used spatial econometric panel models to explore the relationship between HFMD and meteorological factors based on the data of 107 counties and 10 municipalities. Results The incidence rate of HFMD displayed no variable trend throughout the whole research period. A high incidence rate of HFMD was observed from June to September, corresponding to a time when the climate is characterized by heavy rain, high temperature, and high humidity. The high-incidence areas were mainly located in the central region in Shaanxi, whereas the low-incidence spots were mainly found in Northern Shaanxi. Regarding the meteorological factors analysed in this study, in general, the incidence rate of HFMD in specific regions was positively associated with the rainfall, temperature and humidity. Conclusion These results could be applied by the government and the general public to take effective measures to prevent disease. Region-targeted policies could be enacted and implemented in the future according to specific situations in different areas and the relevant meteorological determinants. Additionally, meteorological conditions normally extend to a wide-ranging region; thus, cooperation among surrounding regions is necessary.

ACS Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. Spatiotemporal characteristics and meteorological determinants of hand, foot and mouth disease in Shaanxi Province, China: a county-level analysis. BMC Public Health 2021, 21, 1 -14.

AMA Style

Li Ding, Ning Zhang, Bin Zhu, Jinlin Liu, Xue Wang, Feng Liu, Ying Mao. Spatiotemporal characteristics and meteorological determinants of hand, foot and mouth disease in Shaanxi Province, China: a county-level analysis. BMC Public Health. 2021; 21 (1):1-14.

Chicago/Turabian Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. 2021. "Spatiotemporal characteristics and meteorological determinants of hand, foot and mouth disease in Shaanxi Province, China: a county-level analysis." BMC Public Health 21, no. 1: 1-14.

Journal article
Published: 12 February 2021 in International Journal of Environmental Research and Public Health
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With the rapid development of urbanization and industrialization in China, environmental issues have become an urgent problem, especially issues related to air, water, and solid-waste pollution. These pollutants pose threats to the health of the population and to that of communities and have a vicious influence on the healthcare system. Additionally, pollution also exhibits spill-over effects, which means that pollution in the local region could affect the healthcare services in a neighboring region. Therefore, it is necessary to explore the relationship between pollution and healthcare. A spatial autocorrelation analysis was conducted and spatial panel econometric models were constructed to explore the characteristics of pollution and healthcare services in China and the relationship between them using data on all 31 provinces over 12 consecutive years (2006–2017). The results showed that the utilization of healthcare services and environmental pollution were not randomly distributed; unsurprisingly, air pollution and solid-waste pollution were mainly found in parts of northern China, while water pollution was highest in southern and coastal China. In addition, environmental pollution exhibited spill-over effects on healthcare services. For example, a 1% increase in solid waste in one specific geographical unit was estimated to increase the inpatient visits per capita in adjacent counties by 0.559%. Specifically, pollution showed different degrees of influence on healthcare services, which means that the impact of environmental pollution on the number of outpatient visits is greater than on the number of inpatient visits. Our results provide the government with evidence for effectively formulating and promulgating policies, especially policies aimed at tackling spill-over effects among different regions.

ACS Style

Ning Zhang; Ying Mao. Spatial Effects of Environmental Pollution on Healthcare Services: Evidence from China. International Journal of Environmental Research and Public Health 2021, 18, 1784 .

AMA Style

Ning Zhang, Ying Mao. Spatial Effects of Environmental Pollution on Healthcare Services: Evidence from China. International Journal of Environmental Research and Public Health. 2021; 18 (4):1784.

Chicago/Turabian Style

Ning Zhang; Ying Mao. 2021. "Spatial Effects of Environmental Pollution on Healthcare Services: Evidence from China." International Journal of Environmental Research and Public Health 18, no. 4: 1784.

Preprint
Published: 13 January 2021
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With the rapid development of urbanization and industrialization in China, environmental issues have become a knotty problem, especially issues related to air, water, and solid-waste pollution. These pollutants pose threats to the health of the population and to that of communities and have a vicious influence on the healthcare system. Additionally, pollution also exhibits spill-over effects, which means that pollution in the local region could affect the healthcare services in a neighbouring region. Therefore, it is necessary to explore the relationship between pollution and healthcare. A spatial autocorrelation analysis was conducted and spatial panel econometric models were constructed to explore the characteristics of pollution and healthcare services in China and the relationship between them using data on all 31 provinces over twelve consecutive years (2006-2017). The results showed that the utilization of healthcare services and environmental pollution were not randomly distributed; unsurprisingly, air pollution and solid-waste pollution were mainly found in parts of northern China, while water pollution was highest in southern and coastal China. In addition, environmental pollution exhibited spill-over effects on healthcare services. For example, a 1% increase in solid waste in one specific geographical unit was estimated to increase the inpatient visits per capita in adjacent counties by 0.559%. Specifically, pollution showed different degrees of influence on healthcare services, which means that the impact of environmental pollution on the number of outpatient visits is greater than on the number of inpatient visits. Our results provide the government with evidence for effectively formulating and promulgating policies, especially policies aimed at tackling spill-over effects among different regions.

ACS Style

Ying Mao; Ning Zhang. Spatial effects of environmental pollution on healthcare services: Evidence from China. 2021, 1 .

AMA Style

Ying Mao, Ning Zhang. Spatial effects of environmental pollution on healthcare services: Evidence from China. . 2021; ():1.

Chicago/Turabian Style

Ying Mao; Ning Zhang. 2021. "Spatial effects of environmental pollution on healthcare services: Evidence from China." , no. : 1.

Preprint content
Published: 11 January 2021
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Background: Hand, foot and mouth disease (HFMD) is one of the common intestinal infectious diseases worldwide and has caused huge economic and disease burdens in many countries. The average annual incidence rate of HFMD was 11.66% in Shaanxi during the time span from 2009 to 2018. There are distinct differences within Shaanxi, as it is a special region that crosses three temperature zones. Hence, in this study, a spatiotemporal analysis of Shaanxi was performed to reveal the characteristics of the distribution of HFMD and to explore the meteorological determinants of HFMD.Methods: The county-level and municipal data from Shaanxi Province from 2009 to 2018 were applied to research the spatiotemporal characteristics of HFMD and its meteorological determinants. Time series and spatial autocorrelation analyses were applied to assess the spatiotemporal characteristics of HFMD. This study used spatial econometric panel models to explore the relationship between HFMD and meteorological factors based on the data of 107 counties and 10 municipalities.Results: The incidence rate of HFMD displayed no variable trend throughout the whole research period. A high incidence rate of HFMD was observed from June to September, corresponding to a time when the climate is characterized by heavy rain, high temperature, and high humidity. The high-incidence areas were mainly located in the central region in Shaanxi, whereas the low-incidence spots were mainly found in Northern Shaanxi. Regarding the meteorological factors analysed in this study, in general, the incidence rate of HFMD in specific regions was positively associated with the rainfall, temperature and humidity.Conclusion: These results could be applied by the government and the general public to take effective measures to prevent disease. Region-targeted policies could be enacted and implemented in the future according to specific situations in different areas and the relevant meteorological determinants. Additionally, meteorological conditions normally extend to a wide-ranging region; thus, cooperation among surrounding regions is necessary.

ACS Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. Spatiotemporal Characteristics and meteorological determinants of Hand, Foot and Mouth Disease in Shaanxi Province, China: a county-level analysis. 2021, 1 .

AMA Style

Li Ding, Ning Zhang, Bin Zhu, Jinlin Liu, Xue Wang, Feng Liu, Ying Mao. Spatiotemporal Characteristics and meteorological determinants of Hand, Foot and Mouth Disease in Shaanxi Province, China: a county-level analysis. . 2021; ():1.

Chicago/Turabian Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. 2021. "Spatiotemporal Characteristics and meteorological determinants of Hand, Foot and Mouth Disease in Shaanxi Province, China: a county-level analysis." , no. : 1.

Journal article
Published: 29 December 2020 in International Journal of Environmental Research and Public Health
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Health Literacy (HL) is an important determinant of health. Many scholars have conducted a large number of studies on the level of Chinese students’ HL and its associated factors. However, previous studies on HL level and the factors that influence it have been contradictory. Therefore, this systematic review and meta-analysis was conducted to estimate the level of Chinese students’ HL and its three dimensions (knowledge, behavior and skills) and to identify factors associated with HL in Chinese students. Two investigators independently searched literature, selected research and extracted data through comprehensively searching of four international electronic databases and three Chinese electronic database to identify all relevant observational studies on affecting factors for HL in Chinese students published in English and Chinese from database January, 2010 to September, 2020. In total, 61 articles were extracted in the study. The results showed that the level rates of HL and its three dimensions were 26%, 35%, 26%, 51%, respectively. For Chinese students, the significant factors were urban residents, senior class students, well performance at school, the Han nationality, focus on health knowledge, less exposure to video games, highly educated parents, income of one-child families, receiving health education, having medical background. This study provides some inspirations for improving the level of Chinese students’ HL and their health. First, the findings may help Chinese policy makers understand the overall HL of Chinese students and their levels across three dimensions (knowledge, behavior and skills). Second, protective factors for Chinese students’ HL were found in this research, which will help to improve the level of Chinese students’ HL, stimulate students’ awareness of prevention, and lay the foundation for a healthy China.

ACS Style

Ying Mao; Tao Xie; Ning Zhang. Chinese Students’ Health Literacy Level and Its Associated Factors: A Meta-Analysis. International Journal of Environmental Research and Public Health 2020, 18, 204 .

AMA Style

Ying Mao, Tao Xie, Ning Zhang. Chinese Students’ Health Literacy Level and Its Associated Factors: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2020; 18 (1):204.

Chicago/Turabian Style

Ying Mao; Tao Xie; Ning Zhang. 2020. "Chinese Students’ Health Literacy Level and Its Associated Factors: A Meta-Analysis." International Journal of Environmental Research and Public Health 18, no. 1: 204.

Health policy
Published: 16 October 2020 in BMJ Open
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ObjectivesTo analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures.DesignSystemic review and meta-analysis.Data sourcesFour English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019.Eligibility criteriaEligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study.Data extraction and synthesisData were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle–Ottawa Scale and heterogeneity was evaluated using the I2 statistic.ResultsWe identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on).ConclusionThis study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs’ lives outside of work and meet their living needs.

ACS Style

Rongxin He; Jinlin Liu; Wei-Hong Zhang; Bin Zhu; Ning Zhang; Ying Mao. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open 2020, 10, e037117 .

AMA Style

Rongxin He, Jinlin Liu, Wei-Hong Zhang, Bin Zhu, Ning Zhang, Ying Mao. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open. 2020; 10 (10):e037117.

Chicago/Turabian Style

Rongxin He; Jinlin Liu; Wei-Hong Zhang; Bin Zhu; Ning Zhang; Ying Mao. 2020. "Turnover intention among primary health workers in China: a systematic review and meta-analysis." BMJ Open 10, no. 10: e037117.

Review
Published: 12 October 2020
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BackgroundWith a surge of medical disputes in recent years, the health worker-patient relationship (HWPR) in China is presently in a tense situation. Meanwhile, consequent social problems have begun to emerge, such as the practice of defensive medicine and distrust between health workers and patients. Although many empirical studies about the HWPR have been conducted in China, no related systematic reviews have been found. This study can convey the general findings from China to other areas of the world.MethodsA systematic review and meta-analysis of the HWPR and related determinants were conducted. Six databases were comprehensively searched for articles to include in the review, with no restrictions on language. Articles published between January 1, 2000 and January 1, 2020 were included.ResultsAmong the 3,290 records initially identified, 11 studies met the selection criteria. A total of 96,906 individuals were included in the review. The meta-analysis indicated that health workers who were male (male vs. female, OR: 1.48, 95% CI: 1.42- 1.55), older (≤50 vs. >50, 0.86, 0.80-0.93), less educated (undergraduate or below vs. masters or above, 1.39, 1.21-1.60), working in a non-surgical department (surgery vs. other, 0.92, 0.88-0.96), and had a senior title (intermediate or below vs. senior, 0.77, 0.74-0.81) were more likely to be pessimistic about the HWPR or to encounter medical disputes. Patients who were rural residents (urban vs. rural, 0.92, 0.87-0.97), highly educated (below undergraduate vs. undergraduate or above, 0.75, 0.72-079), and had no medical insurance (medical insurance vs. no medical insurance, 0.77, 0.67-0.89) were more likely to be pessimistic about the HWPR or to encounter medical disputes. Furthermore, mutual trust could improve rapport between health workers and patients. The 25 other related factors were analysed and described using a narrative approach.ConclusionOn average, 55.73% of health workers consider the HWPR to be tense, which is higher than the proportion of patients who hold this view (33.7%). The HWPR was significantly associated with individual factors and socioeconomic factors of both health workers and patients, as well as factors related to the health worker-patient interaction. More targeted strategies should be developed to improve the HWPR.

ACS Style

Ying Mao; Wei Ning; Junyao Zheng; Ning Zhang; Tao Xie; Jinnan Liu; Yongbo Lu; Rongxin He. A Systematic Review of the Health Worker-Patient Relationship in China. 2020, 1 .

AMA Style

Ying Mao, Wei Ning, Junyao Zheng, Ning Zhang, Tao Xie, Jinnan Liu, Yongbo Lu, Rongxin He. A Systematic Review of the Health Worker-Patient Relationship in China. . 2020; ():1.

Chicago/Turabian Style

Ying Mao; Wei Ning; Junyao Zheng; Ning Zhang; Tao Xie; Jinnan Liu; Yongbo Lu; Rongxin He. 2020. "A Systematic Review of the Health Worker-Patient Relationship in China." , no. : 1.

Preprint content
Published: 07 October 2020
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Background: Hand, foot and mouth disease (HFMD) is one of the common intestinal infectious diseases worldwide and has caused huge economic and disease burdens in many countries. The average annual incidence rate of HFMD was 11.66% in Shaanxi during the time span from 2009 to 2018. There are distinct differences within Shaanxi, as it is a special region that crosses three temperature zones. Hence, in this study, a spatiotemporal analysis of Shaanxi was performed to reveal the characteristics of the distribution of HFMD and to explore the meteorological determinants of HFMD.Methods: The county-level and municipal data from Shaanxi Province from 2009 to 2018 were applied to research the spatiotemporal characteristics of HFMD and its meteorological determinants. Time series and spatial autocorrelation analyses were applied to assess the spatiotemporal characteristics of HFMD. This study used spatial econometric panel models to explore the relationship between HFMD and meteorological factors.Results: The incidence rate of HFMD displayed no variable trend throughout the whole research period. A high incidence rate of HFMD was observed from June to September, corresponding to a time when the climate is characterized by heavy rain, high temperature, and high humidity. The high-incidence areas were mainly located in the central region in Shaanxi, whereas the low-incidence spots were mainly found in Northern Shaanxi. Regarding the meteorological factors analysed in this study, in general, the incidence rate of HFMD in specific regions was positively associated with the rainfall, temperature and humidity.Conclusion: These results could be applied by the government and the general public to take effective measures to prevent disease. Region-targeted policies could be enacted and implemented in the future according to specific situations in different areas and the relevant meteorological determinants. Additionally, meteorological conditions normally extend to a wide-ranging region; thus, cooperation among surrounding regions is necessary.

ACS Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. Spatiotemporal Characteristics and meteorological determinants of Hand, Food and Mouth Disease in Shaanxi Province, China: a county-level analysis. 2020, 1 .

AMA Style

Li Ding, Ning Zhang, Bin Zhu, Jinlin Liu, Xue Wang, Feng Liu, Ying Mao. Spatiotemporal Characteristics and meteorological determinants of Hand, Food and Mouth Disease in Shaanxi Province, China: a county-level analysis. . 2020; ():1.

Chicago/Turabian Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. 2020. "Spatiotemporal Characteristics and meteorological determinants of Hand, Food and Mouth Disease in Shaanxi Province, China: a county-level analysis." , no. : 1.

Preprint content
Published: 20 April 2020
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Background: Hand-foot-mouth disease (HFMD) is one of the common intestinal infectious diseases worldwide, which caused a huge economic and disease burden in many counties. In China, the Chinese Center for Disease Control and Prevention included the HFMD into the Class C reported infectious diseases. The average annual growth rate of HFMD is 16.43%. Shaanxi is a special region which across three temperature zones. Hence, in this study, the spatial-temporal analysis of Shaanxi would reveal the characteristics of distribution of HFMD and explore the related determinants of HFMD.Methods: The county-level and municipal data of Shaanxi province from 2009 to 2018 were applied to research the spatio-temporal characteristics of HFMD and its meteorological determinants. Time series analysis and spatial autocorrelation analysis were applied to analyze the spatial-temporal characteristics of HFMD. This study used spatial econometric panel models to explore the relationship between HFMD and meteorological factors.Results: The incidence rate of HFMD displayed no long-term changing pattern from temporal perspective. The high incidence rate of HFMD were observed from June to September, which is the season with a climate characterized by heavy rain, high temperature, and high humidity. The high spot is mainly located in central region in Shaanxi. The Low-low clusters were mainly found in Northern Shaanxi. As for the meteorological factors analyzed in this study, the waterfall, temperature and humidity in one specific and surrounding region is positive association with incidence rate of HFMD in specific region.Conclusion: The results could be applied by government and general public to take effective measures to prevent diseases. The region-targeted policies could be enacted and implemented in the future. The local government needs take responsible for the health management of immigration and mobile population. The citizen should cultivate good living habits such as hand-washing habit and the eating habit.

ACS Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. Spatio-Temporal Characteristics and its determinants of Hand, Food and Mouth Diseases in Shaanxi province, China: a county level analysis. 2020, 1 .

AMA Style

Li Ding, Ning Zhang, Bin Zhu, Jinlin Liu, Xue Wang, Feng Liu, Ying Mao. Spatio-Temporal Characteristics and its determinants of Hand, Food and Mouth Diseases in Shaanxi province, China: a county level analysis. . 2020; ():1.

Chicago/Turabian Style

Li Ding; Ning Zhang; Bin Zhu; Jinlin Liu; Xue Wang; Feng Liu; Ying Mao. 2020. "Spatio-Temporal Characteristics and its determinants of Hand, Food and Mouth Diseases in Shaanxi province, China: a county level analysis." , no. : 1.

Journal article
Published: 29 March 2020 in International Journal of Environmental Research and Public Health
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Nowadays, tuberculosis, scarlet fever, measles, influenza, and mumps are five major notifiable respiratory infectious diseases (RIDs) in China. The objective of this study was to describe, visualize, and compare the spatial-temporal distributions of these five RIDs from 2006 to 2016. In addition to descriptive epidemiology analysis, seasonality and spatial autocorrelation analysis were also applied to explore the epidemiologic trends and spatial changing patterns of the five RIDs, respectively. The results indicated that the incidence of tuberculosis, measles, and mumps presented a downtrend trend, while those of scarlet fever and influenza was in a strong uptrend across the research period. The incidences of the five diseases all peaked in spring. There were significant spatial disparities in the distribution of tuberculosis, scarlet fever, and measles cases, with the hotspots mainly located in the western plateau region, northern plain region, and southern mountainous region. To conclude, notable epidemiological differences were observed across regions, indicating that some provincial units should pay more attention to prevent and control respiratory infectious diseases.

ACS Style

Ying Mao; Rongxin He; Bin Zhu; Jinlin Liu; Ning Zhang. Notifiable Respiratory Infectious Diseases in China: A Spatial–Temporal Epidemiology Analysis. International Journal of Environmental Research and Public Health 2020, 17, 2301 .

AMA Style

Ying Mao, Rongxin He, Bin Zhu, Jinlin Liu, Ning Zhang. Notifiable Respiratory Infectious Diseases in China: A Spatial–Temporal Epidemiology Analysis. International Journal of Environmental Research and Public Health. 2020; 17 (7):2301.

Chicago/Turabian Style

Ying Mao; Rongxin He; Bin Zhu; Jinlin Liu; Ning Zhang. 2020. "Notifiable Respiratory Infectious Diseases in China: A Spatial–Temporal Epidemiology Analysis." International Journal of Environmental Research and Public Health 17, no. 7: 2301.

Preprint content
Published: 12 February 2020
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Background The health workforce is a key determinant in achieving health equity. As a southwestern province of China, Sichuan confronted with the geographical variation of health workforce in recent years. The misdistribution of health workforce in Sichuan is severe for its complex terrain, uneven population distribution and huge economic differences. The study of Sichuan province is of great significance to other regions of China. Methods This study applied time-series analysis, spatial autocorrelation and space-time scan analysis to explore and visualize the spatial changing patterns of different types of health workforce (health technicians, licensed doctors, registered nurses, pharmacists, technologists, and intern) at the municipal and county level in Sichuan. Results The box plots displayed the temporal trend of health workforce from 2009 to 2018 via the county-level data. All types of health workforce were in rising generally especially the registered nurses. The space-time analysis and Global Moran' I revealed the distinctive geographical clusters among all the counties. The local Moran' I detected that HH clusters mainly in the capital and some rich places of Sichuan, while some mountain areas in eastern Sichuan displayed LL clusters. Four main findings should be paid attention to the whole health workforce of Sichuan province had an upward trend. Comparing with other provinces, the growth rate also was in a high rank; the areas with the scarcest resources were eastern place, including areas of Tsinling Mountains, Yunnan-Guizhou Plateau, Hengduan Mountains and the transition zone of mountains and basins; misdistribution of health workforce had two levels, among the province and cities; the Qinghai Tibet Plateau has enough intern while being short of other health technicians. Conclusions The policies makers should pay more attention to the eastern Sichuan. As to the intern-related policies, the primary health tasks did not achieve, Qinghai Tibet Plateau areas needed to find practical ways to attract the interns

ACS Style

Ning Zhang; Wei Ning; Tao Xie; Jinlin Liu; Bin Zhu; Rongxin He; Xue Wang; Ying Mao. Spatio-temporal Clusters of Health Workforce Distribution in Sichuan Province, China: a county-level analysis. 2020, 1 .

AMA Style

Ning Zhang, Wei Ning, Tao Xie, Jinlin Liu, Bin Zhu, Rongxin He, Xue Wang, Ying Mao. Spatio-temporal Clusters of Health Workforce Distribution in Sichuan Province, China: a county-level analysis. . 2020; ():1.

Chicago/Turabian Style

Ning Zhang; Wei Ning; Tao Xie; Jinlin Liu; Bin Zhu; Rongxin He; Xue Wang; Ying Mao. 2020. "Spatio-temporal Clusters of Health Workforce Distribution in Sichuan Province, China: a county-level analysis." , no. : 1.

Journal article
Published: 12 September 2019 in International Journal of Environmental Research and Public Health
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Global concerns persist regarding the shortage and misdistribution of health workers in rural and remote areas. Medical education is an important input channel of human resources for health. This study aimed to identify the association between medical graduates' job choices for rural practice and their initial intentions when they began to look for a job in China. Data were extracted from a cross-sectional survey among medical students in ten western provinces in China in 2013. Only medical students who were in the last year of study (i.e., medical graduates) and had found a job were included in this study. Of the 482 participants, 61.04% (293) presented an initial intention of rural practice when they began to look for a job, and 68.88% (332) made a final job choice for rural practice. However, of the 332 graduates with a final job choice of rural practice, only 213 (64.55%) had an initial intention. A univariate association was identified in which medical graduates who were more likely to make final job choices for rural practice were those having initial intentions (OR: 1.59; 95% CI: 1.08-2.36); however, after adjusting for controlled variables, it became insignificant and was reduced to a 1.31-fold increase (95% CI: 0.82-2.07). The initial intentions of medical graduates are not assurance of ultimate job outcomes, and it cannot be deduced that all medical graduates who made a final job choice for rural practice had authentic desires for rural practice. Twenty years of age or below, low-income families, majoring in non-clinical medicine, and studying in a junior medical college or below were associated with medical graduates' final job choices for rural practice. More studies are required on how to translate medical student's intention of rural medical practice into reality and how to retain these graduates via a job choice in rural practice in the future.

ACS Style

Jinlin Liu; Bin Zhu; Ning Zhang; Rongxin He; Ying Mao. Are Medical Graduates' Job Choices for Rural Practice Consistent with their Initial Intentions? A Cross-Sectional Survey in Western China. International Journal of Environmental Research and Public Health 2019, 16, 3381 .

AMA Style

Jinlin Liu, Bin Zhu, Ning Zhang, Rongxin He, Ying Mao. Are Medical Graduates' Job Choices for Rural Practice Consistent with their Initial Intentions? A Cross-Sectional Survey in Western China. International Journal of Environmental Research and Public Health. 2019; 16 (18):3381.

Chicago/Turabian Style

Jinlin Liu; Bin Zhu; Ning Zhang; Rongxin He; Ying Mao. 2019. "Are Medical Graduates' Job Choices for Rural Practice Consistent with their Initial Intentions? A Cross-Sectional Survey in Western China." International Journal of Environmental Research and Public Health 16, no. 18: 3381.

Review
Published: 02 September 2019 in BMC Medical Education
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Medical students in China face severe depression and anxiety because of their difficult circumstances, such as the long length of schooling, academic pressure, and the stress of clinical practice. Although there have been many empirical studies about depression or anxiety in medical students in China, no previous studies have conducted a related systematic review about this topic in English. This analysis can convey the general findings from China to other areas of the world. A systematic review and meta-analysis of depression or anxiety in medical students and related determinants were conducted. Three Chinese and three English databases were searched for the review, with no restrictions on language. Articles published between January 1, 2000 and April 1, 2018 were included. Twenty-one articles investigating a total of 35,160 individual Chinese medical students were included in this review. The prevalence of depression ranged from 13.10 to 76.21% with a mean of 32.74%, and the prevalence of anxiety ranged from 8.54 to 88.30% with a mean of 27.22%. Based on the meta-analysis, gender, grade level, residence, satisfaction with current major and monthly household income per capita were significantly associated with depression. Grade level and satisfaction with current major were significantly associated with anxiety. Other risk factors were identified and described using a narrative approach. The mean prevalence of depression was 32.74% amongst medical students in China, whereas the mean prevalence of anxiety was 27.22%. The determinants of depression and anxiety included individual factors, social and economic factors, and environmental factors. More measures should be taken towards at-risk medical students based on the identified risk factors.

ACS Style

Ying Mao; Ning Zhang; Jinlin Liu; Bin Zhu; Rongxin He; Xue Wang. A systematic review of depression and anxiety in medical students in China. BMC Medical Education 2019, 19, 1 -13.

AMA Style

Ying Mao, Ning Zhang, Jinlin Liu, Bin Zhu, Rongxin He, Xue Wang. A systematic review of depression and anxiety in medical students in China. BMC Medical Education. 2019; 19 (1):1-13.

Chicago/Turabian Style

Ying Mao; Ning Zhang; Jinlin Liu; Bin Zhu; Rongxin He; Xue Wang. 2019. "A systematic review of depression and anxiety in medical students in China." BMC Medical Education 19, no. 1: 1-13.

Journal article
Published: 02 September 2019 in BMC Infectious Diseases
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Intestinal infectious diseases (IIDs) have caused numerous deaths worldwide, particularly among children. In China, eight IIDs are listed as notifiable infectious diseases, including cholera, poliomyelitis, dysentery, typhoid and paratyphoid (TAP), viral Hepatitis A, viral Hepatitis E, hand-foot-mouth disease (HFMD) and other infectious diarrhoeal diseases (OIDDs). The aim of the study is to analyse the spatio-temporal distribution of IIDs from 2006 to 2016. Data on the incidence of IIDs from 2006 to 2016 were collected from the public health science data centre issued by the Chinese Center for Disease Control and Prevention. This study applied seasonal decomposition analysis, spatial autocorrelation analysis and space-time scan analysis. Plots and maps were constructed to visualize the spatio-temporal distribution of IIDs. Regarding temporal analysis, the incidence of HFMD and Hepatitis E showed a distinct increasing trend, while the incidence of TAP, dysentery, and Hepatitis A presented decreasing trends over the last decade. The incidence of OIID remained steady. Summer is the season with the greatest number of cases of different IIDs. Regarding the spatial distribution, approximately all p values for the global Moran’s I from 2006 to 2016 were less than 0.05, indicating that the incidences of the epidemics were unevenly distributed throughout the country. The high-risk areas for HFMD and OIDD were located in the Beijing-Tianjin-Tangshan (BTT) region and south China. The high-risk areas for TAP were located in some parts of southwest China. A higher incidence rates for dysentery and Hepatitis A were observed in the BTT region and some west provincial units. The high-risk areas for Hepatitis E were the BTT region and the Yangtze River Delta area. Based on our temporal and spatial analysis of IIDs, we identified the high-risk periods and clusters of regions for the diseases. HFMD and OIDD exhibited high incidence rates, which reflected the negligence of Class C diseases by the government. At the same time, the incidence rate of Hepatitis E gradually surpassed Hepatitis A. The authorities should pay more attention to Class C diseases and Hepatitis E. Regardless of the various distribution patterns of IIDs, disease-specific, location-specific, and disease-combined interventions should be established.

ACS Style

Ying Mao; Ning Zhang; Bin Zhu; Jinlin Liu; Rongxin He. A descriptive analysis of the Spatio-temporal distribution of intestinal infectious diseases in China. BMC Infectious Diseases 2019, 19, 1 -14.

AMA Style

Ying Mao, Ning Zhang, Bin Zhu, Jinlin Liu, Rongxin He. A descriptive analysis of the Spatio-temporal distribution of intestinal infectious diseases in China. BMC Infectious Diseases. 2019; 19 (1):1-14.

Chicago/Turabian Style

Ying Mao; Ning Zhang; Bin Zhu; Jinlin Liu; Rongxin He. 2019. "A descriptive analysis of the Spatio-temporal distribution of intestinal infectious diseases in China." BMC Infectious Diseases 19, no. 1: 1-14.

Journal article
Published: 12 December 2018 in BMC Health Services Research
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Health workforce misdistribution leads to severe inequity and low-efficiency in health services in the developing countries. Targeting at China, this research aims to reveal, visualize and compare the geographical distribution patterns of different subtypes of urban and rural health workforce and identify the priority regions for health workforce planning and allocation policies designing. The health workforce density (workforce-to-population ratio) is adopted to represent the accessibility to health workforce in each geographical unit. Besides a descriptive geography of health workforce as a whole, the local indicators of spatial association (LISA) are used to explore the spatial clusters of different subtypes of health workforce, which are visualized by geographical tools. Results reveal that regional disparities and spatial clusters exist in China's health workforce distribution, with different types of workforce exhibiting relatively different spatial distribution characteristics. Besides, huge urban-rural disparities are found in the distribution of health workforce in China. Unexpectedly but intriguingly, most of the high-high and high-low cluster area of urban health workforce are concentrated in the western China (Xinjiang, Xizang etc.), indicating the relative abundant stock of urban health workforce in these units, while the low-low and low-high cluster area of different types of urban health workforce are mainly distributed in middle China. Regarding the rural health workforce, there is an obvious and similar low-low and low-high clustering pattern in western provinces (Sichuan, Yunnan) for the licensed doctors, pharmacists, technologists, which play a critical role in health services delivery. Different types of health workforce displayed distinct spatial distribution patterns, while the misdistribution of rural health workforce imposed more challenges to the Chinese health sector due to its poorer stock and more disadvantaged positions of backward regions (i.e., low-low and low-high cluster area). Subtype-specific and region-oriented health workforce planning and allocation policies are suggested to be made, aiming at the urban and rural health workforce respectively, by prioritizing the identified low-low and low-high cluster areas.

ACS Style

Bin Zhu; Yang Fu; Jinlin Liu; Rongxin He; Ning Zhang; Ying Mao. Detecting the priority areas for health workforce allocation with LISA functions: an empirical analysis for China. BMC Health Services Research 2018, 18, 957 .

AMA Style

Bin Zhu, Yang Fu, Jinlin Liu, Rongxin He, Ning Zhang, Ying Mao. Detecting the priority areas for health workforce allocation with LISA functions: an empirical analysis for China. BMC Health Services Research. 2018; 18 (1):957.

Chicago/Turabian Style

Bin Zhu; Yang Fu; Jinlin Liu; Rongxin He; Ning Zhang; Ying Mao. 2018. "Detecting the priority areas for health workforce allocation with LISA functions: an empirical analysis for China." BMC Health Services Research 18, no. 1: 957.