Social change, intensified by industrialization and globalization, has not only changed people’s work lives but also their personal lives, especially in developing countries. The aim of this study was to provide evidence and recommendations regarding family structure, function, and mental health to actively respond to rapid social change. A cross-sectional survey was conducted face-to-face and door-to-door from July 2011 to September 2012 in Hubei Province, central China. Family structure comprised alone, couple, nuclear family, and extended family; family function was measured using the family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve) scale, and mental health was measured using the Chinese version of the 12-item General Health Questionnaire (GHQ-12). The urban-vs-rural difference of family structure among alone, couple, nuclear family, and extended family was statistically significant (5.21% vs 4.62%; 27.36% vs 13.14%; 33.22% vs 27.74%; 34.20% vs 54.50%, respectively; p < 0.0001); and those difference of family function was not statistically significant (8.11 ± 2.13 vs 8.09 ± 2.27, p = 0.9372). The general linear regression showed that the effect of family structure on mental health, whether urban or rural, was not significant, however, the effect of family function was significant, especially regarding better family functioning with better mental health. Combined the effects of family structure and function on mental health, the external form of family (family structure) may not be important; while the internal quality of role (family function) might be key. Improving the residents’ family function would be a priority strategy for family practice with their mental health.

Background: Although the association of metabolic syndrome (MetS) and hearing loss has been evaluated, findings are controversial. This study investigated this association in a Chinese population. Methods: A cross-sectional study including a total of 18,824 middle-aged and older participants from the Dongfeng-Tongji Cohort study was conducted. Hearing loss was defined as the pure-tone average (PTA) of frequencies 0.5, 1.0, 2.0, and 4.0 kHz >25 decibels hearing level (dB HL) in the better ear and graded as mild (PTA 26–40 dB HL), moderate (PTA >40 to ≤60 dB HL), and severe (PTA >60 dB HL). MetS was defined according to the International Diabetes Foundation (IDF) criteria of 2005. Association analysis was performed by logistic regression. Results: After adjustment for potential confounders, participants with MetS showed higher OR of hearing loss (OR, 1.11; 95% CI: 1.03–1.19). The MetS components including central obesity (OR, 1.07; 95% CI: 1.01–1.15) and hyperglycemia (OR, 1.12; 95% CI: 1.04–1.20) were also positively associated with hearing loss. Low HDL-C levels were also associated with higher OR of moderate/severe hearing loss (OR, 1.21; 95% CI: 1.07–1.36). Conclusions: The MetS, including its components central obesity, hyperglycemia, and low HDL-C levels were positively associated with hearing loss.

Predictive Role of ERCC1 and XPD Genetic Polymorphisms in Survival of Chinese Non-small Cell Lung Cancer Patients Receiving Chemotherapy ERCC1;XPD;polymorphism;non-small cell lung cancer;prognosis;chemotherapy; Aim: There is increasing evidence that ERCC1 and XPD have roles in response to chemotherapy among patients with NSCLC, but the results are conflicting. Therefore, we conducted the present prospective study in a Chinese population. Methods: A total of 632 primary NSCLC patients were included, followed-up from May 2006 to May 2011. Polymorphisms were detected by real time PCR with TaqMan probse, using genomic DNA extracted from peripheral blood samples. The Cox regression model was used to analyze the hazard ratios (HR) for ERCC1 and XPD. Results: The median time of follow-up was 31.6 months. Our results showed the ERCC1 118 T/T(HR=1.65, 95% CI=1.17-2.43) and XPD 751 Gln/Gln genotypes (HR=1.52, 95%CI=1.04-2.08) were associated with an increased risk of death from NSCLC. Moreover, the ERCC118 T allele and XPD 751 Gln allele genotypes had a more higher risk of death from NSCLC among both ex-smokers and current smokers. Conclusion: In summary, ERCC1 and XPD gene polymorphisms might provide better prognostic predictive information for NSCLC patients in Chinese populations, with smoking possibly interacting with the genotypes.

Background As a developing country with the world’s largest population in a state of economic transition, reforms to China’s health system, including community health services (CHS), are very complex and difficult. The aim of this study is to provide evidence and policy recommendations for the sustainable development of CHS for China, which could also be applicable to other developing countries. Methods A cross-sectional survey was conducted door-to-door and face-to-face in Wuhan city, central China with a sample of 1134 individuals aged 15 and older. The independent variables were duration of residence, previous treatment experience, familiarity with health staff, self-reported family economic status and health insurance. The dependent variables were views on the usefulness of CHS and willingness to use them. Sociodemographic variables and health status were used as control variables. Multiple logistic regression analysis was used to analyse the influence of the independent variables on the dependent variables. Findings This study shows that 26.10% of participants reported that the CHSs are not useful and 37.74% reported they did not want to use their CHS. The results found ‘familiarity with health staff’ and ‘previous experience of using services’ had a negative influence on their views on usefulness of and willingness to use CHS. Conclusion The aim of CHS to see ‘minor illnesses treated in the community and serious illness treated in hospital’ is not being fully realized. The key to increasing the use of CHS may be to enhance the quality of services and health staff. A policy pathway of targeting older residents and those with higher education levels as the priority population, and using these groups to encourage the rest of the community to seek minor services at CHS, may be an effective and sustainable development mechanism.

To provide an empirical examination of patient–provider relationships (PPR) and its association with organizational and individual factors. A national cross-sectional survey was conducted by stratified cluster sampling in 77 hospitals across seven provinces in China between July 2014 and April 2015, involving 3621 doctors, 5561 nurses, and 8022 patients with response rates of 62.93%, 61.16%, and 33.08%, respectively. Self-perceived PPR was the outcome variable. Organizational factors included hospital type (western medicine [WM] and traditional Chinese medicine [TCM] hospital); hospital level (tertiary and secondary hospital); area of specialization (internal medicine and surgery); ratio of doctors (nurses) to ward beds; doctors/nurses’ concerns about performance assessment; and patients’ perceptions of healthcare cost. Individual factors included consultation, listening to patients and socio-demographic factors. 54.6% of doctors, 36.6% of nurses, and 10.2% of patients perceived PPR as poor. Organizational factors independently associated with providers’ perception of poor PPR included hospital type (WM vs TCM: OR = 1.25 [95% CI: 1.06–1.47]) and concerns about performance assessment (high vs low levels: OR = 1.40 [95% CI: 1.14–1.72]) for doctors, and concerns about performance assessment (average vs low levels: OR = 0.79 [95% CI: 0.67–0.93]) for nurses. Those associated with patients’ perception of poor PPR included hospital type (WM vs TCM: OR = 0.63 [95% CI: 0.53–0.74]) and hospital level (tertiary vs secondary: OR = 0.65 [95% CI: 0.51–0.82]). Doctors and nurses reporting listening to patients “frequently” had better perceptions of PPR (OR = 0.46 [95%CI: 0.38–0.56] and 0.49 [95% CI: 0.41–0.59] for doctors and nurses, respectively), as did their patients (OR = 0.24 [95% CI: 0.18–0.31] and 0.54 [95% CI: 0.35–0.84] for doctors and nurses, respectively). Although our findings require validation in different organizational settings given the likely variability of these associations across systems, our results suggest that implementing moderate levels promoting the level of medical treatment, and broadening doctors/nurses training regarding listening to patients, may benefit to enhance PPR.

Objectives To measure the burnout of doctors affiliated with western medicine (WM) and traditional Chinese medicine (TCM) hospitals and to evaluate its relationships with organisational and patient factors. Design A national cross-sectional study in China. Setting By convenience sampling, this study was conducted in 64 general hospitals from six provinces and Beijing between July 2014 and April 2015. There were a total of 2576 eligible participants, including 1766 WM doctors and 810 TCM doctors in this study. Primary outcome measures Burnout symptoms of emotional exhaustion, job involvement and personal accomplishment were measured. Results In total, 73.6% of doctors reported emotional exhaustion, the core component of burnout. In multivariable models, emotional exhaustion was significantly associated with organisational factors, including salary fairness [WM: odds ratio (OR)=2.36, 95% confidence interval (CI): 1.80 to 3.09; TCM: OR=1.59, 95% CI: 1.08 to 2.33], participation in organisational decision-making (WM: OR=1.58, 95% CI: 1.21 to 2.08; TCM: OR=1.84, 95% CI: 1.23 to 2.74), professional value (WM: OR=1.74, 95% CI: 1.35 to 2.25), frequency of participation in full-time training (TCM: OR=1.48, 95% CI: 1.01 to 2.16) and frequency of participation in clinical meetings (WM: OR=1.53, 95% CI: 1.11 to 2.10; TCM: OR=2.48, 95% CI: 1.57 to 3.92). Patient factors are also associated with burnout among both WM and TCM doctors, including respect (WM: OR=1.73, 95% CI: 1.31 to 2.28; TCM: OR=1.65, 95% CI: 1.10 to 2.45) and unreasonable demands (WM: OR=2.31, 95% CI: 1.68 to 3.20; TCM: OR=3.44, 95% CI: 2.15 to 5.49). Moreover, job involvement and personal accomplishment among both WM and TCM doctors were significantly associated with organisational and patient factors. Conclusions Our results suggest that improving organisational management and patient behaviours may be beneficial to reduce doctors’ burnout. Our findings require further validation in different organisational settings.