Background: Although the Hierarchical Medical System has been utilized in China for many years, it is inadequate for guiding patients in adopting appropriate diagnose-seeking behaviors in accordance with related policies. This study examined how patients' diagnose-seeking behavior in tertiary hospitals that is dis-accordance with Hierarchical Medical System related policy (“DSB-dis-accordance”) arise and ways to guide patients away from such behaviors, both from the perspective of physicians. Methods: A qualitative study based on a mixed method including in-depth interviews and grounded theory. Twenty-seven physicians with more than 2 years of experience serving in tertiary hospitals of Shanghai were involved after reviewing the related purposes and requirements. Patients' “DSB-dis-accordance” was studied from the perspective of physicians. Results: Patient-related factors (habits, trust, and knowledge), physician-related factors (conservative preference, risk avoidance), and system-related factors (accessibility, operability) affected patients' diagnose-seeking behavior. Conclusions: Patient-related, physician-related, and system-related factors affecting patients' diagnose-seeking behaviors in tertiary hospitals should be addressed by investing more health resources in lower-level hospitals, enhancing dissemination of health-related and policy-related knowledge, refining the classification of diseases, incentivizing physicians, and developing appropriate follow-up measures. Physicians could then become more involved in guiding patients' “DSB-dis-accordance,” thereby benefitting development of the Hierarchical Medical System in China.

Urban clusters are the main trend of current and future urbanization worldwide, but their impact on environmental pollution has been controversial. This paper explores this issue in the context of urban development in China, and analyzes the underlying mechanisms, using panel data from 285 Chinese cities spanning 2006 to 2021. The findings show that a one unit increase in the degree of urban cluster is associated with a reduction in the comprehensive pollution index by approximately 7.5%, and the main mechanisms by which urban clusters facilitate environmental protection are congestion alleviation, industry structural optimization, and technological innovation. Firstly, urban clusters reduce environmental pollution by mitigating the crowding effects associated with urban expansion, although this alleviation is predominantly observed in larger cities. Secondly, urban clusters foster the upgrading of urban industrial structures, thereby decreasing environmental pollution. However, in less developed cities where industrialization is a major development goal, the impact of structural optimization is less pronounced. Finally, technological innovations, including advances in technologies of energy conservation and emission reduction, have assisted in the transformation of the economic growth model, which has reduced environmental pollution. Looking ahead, the urban cluster remains a pivotal strategic direction for social development, and planning and construction of urban clusters should actively incorporate environmental benefit considerations.

Objective: Many factors may affect the environmental satisfaction of elderly people, including their sense of involvement. This study examined the associations between community environment co-production and environmental satisfaction in older urban residents in China. Methods: A cross-sectional survey was conducted in four age-friendly communities in Shanghai, China. Co-production and environmental satisfaction were assessed through a self-developed questionnaire. General health status was measured through the EuroQol-Visual Analogue Scale (EQ-VAS). Data on affective commitment for the community demographic and health-related factors were also collected. Multilevel linear regression was used to detect the associations. Results: In total, 480 older urban residents completed the survey. On average, the environment satisfaction score was 76.82/90, 8/10 for co-production, and 87.5/100 for EQ-VAS. Univariate analysis demonstrated environmental satisfaction was associated with educational background, party membership, physical activity, community location, age, sleep hours, co-production, affective commitment, and EQ-VAS. After controlling for confounding factors, the co-production score was significantly associated with higher environmental satisfaction (β = 4.68, p < 0.001). Multiple linear regression revealed that effective commitment for the community (β = 6.17, p < 0.001) and EQ-VAS (β = 0.06, p = 0.002) were also significantly associated with environment satisfaction. Conclusion: Community environment co-production was positively associated with environmental satisfaction among older urban residents in Shanghai. Environmental co-production should be encouraged when developing age-friendly communities for the elderly.

In accordance with the similarity attraction paradigm, this paper investigates when and how proactive employees can be rated as proactive performers by proposing supervisor-subordinate marital status similarity as a relational moderator and leader-member exchange as the mediator. It therefore advances understanding of performance evaluation of proactive employees. Data from a sample of 471 Chinese employees and their 161 supervisors are used to examine the models hypothesized. The results show that LMX mediates the interaction effect between a proactive personality and supervisor-subordinate marital status similarity on supervisors’ evaluations of proactive performance. When proactive employees and their supervisors have similar (dissimilar) marital status, the indirect relationship between proactive personality and supervisor-rated proactive performance via LMX is stronger (weaker). Theoretical and practical implications are discussed.