Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. China has a long history of involving CHWs in public health intervention project. CHWs in China called village doctors who have both treatment and public health responsibilities. This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services. We searched studies published in Chinese or English, on Medline, PubMed, Cochrane, Google Scholar, and CNKI for public health services delivered by CHWs in China, during 1996–2016. The role of CHWs, training for CHWs, challenges, and facilitating factors were extracted from reviewed studies. Guided by National Basic Public Health Service Standards, services provided by CHW covered five major areas of noncommunicable diseases (NCDs) including diabetes and/or hypertension, cancer, mental health, cardiovascular diseases, and common NCD risk factors, as well as general services including reproductive health, tuberculosis, child health, vaccination, and other services. Not many studies investigated the barriers and facilitating factors of their programs, and none reported cost-effectiveness of the intervention. Barriers challenging the sustainability of the CHWs led projects were transportation, nature of official support, quantity and quality of CHWs, training of CHWs, incentives for CHWs, and maintaining a good rapport between CHWs and target population. Facilitating factors included positive official support, integration with the existing health system, financial support, considering CHW’s perspectives, and technology support. CHWs appear to frequently engage in implementing diverse public health intervention programs in China. Facilitators and barriers identified are comparable to those identified in high income countries. Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.

Physicians have a key role to play in combating tobacco use and reducing the tobacco induced harm to health. However, there is a paucity of information about tobacco-use and cessation among physicians in developing countries. To assess the need for and nature of smoking cessation services among physicians in developing countries, a detailed literature review of studies published in English, between 1987 and 2010 was carried out. The electronic databases Medline and Pub Med were searched for published studies. The findings show that there are regional variations in the current smoking prevalence, quitting intentions, and cessation services among physicians. Smoking prevalence (median) was highest in Central/Eastern Europe (37%), followed by Africa (29%), Central and South America (25%) and Asia (17.5%). There were significant gender differences in smoking prevalence across studies, with higher prevalence among males than females. Smoking at work or in front of patients was commonly practiced by physicians in some countries. Asking about smoking status or advising patients to quit smoking was not common practice among the physicians, especially among smoker physicians. Organized smoking cessation programs for physicians did not exist in all of these regions. This review suggests that while smoking of physicians varies across different developing regions; prevalence rates tend to be higher than among physicians in developed countries. Quitting rates were low among the physicians, and the delivery of advice on quitting smoking was not common across the studies. To promote tobacco control and increase cessation in populations, there is a need to build physicians’ capacity so that they can engage in tobacco use prevention and cessation activities.

The age of the population is shifting toward the elderly range, which may lead to an increased risk of mild cognitive impairment (MCI). The aims of this study are to evaluate the cognitive function in elderly people using the Montreal Cognitive Assessment (MoCA), to identify the relationship between cognitive function and different characteristics, and to evaluate the efficacy of the intervention after six months of cognitive training. In this study, we included 2886 subjects aged ≧60 years in the baseline survey, and 140 subjects with MCI who participated in the baseline survey were randomly divided into an intervention group (N = 70) and a control group (N = 70). The control group was not provided any intervention measures, and the intervention group was administered cognitive training. The education level, monthly income, sleep time, exercise time, reading times, and time spent engaging in community activities and performing housework were positively correlated with MoCA scores, but age was negatively correlated with MoCA scores. The total MoCA score of the intervention group increased from 19.77 ± 2.24 points to 21.09 ± 2.20 points after six months of cognitive training, but the score of the control group decreased from 20.41 ± 2.10 points to 19.17 ± 2.57 points. The two-way repeated-measures ANOVA revealed a very significant effect of the interaction between time and cognitive training on the total MoCA score. Seventeen participants in the intervention group improved to normal levels, and no participants progressed to dementia after six months of cognitive training. Thus, the efficacy of the intervention was statistically significant. Our study concludes that older age is associated with a cognitive decline. Factors that are more likely to protect against cognitive decline included a higher education level and monthly income, sufficient sleep time, regular physical exercise and reading, frequently engaging in community activities, and continuing to perform housework. Moreover, the cognitive training intervention is effective and may help to decrease the deterioration of cognitive function in patients with MCI, and the interaction between intervention time and cognitive training significantly improves cognitive function.

Background Tobacco use by physicians represents a significant barrier in promoting smoking cessation through physician interventions. To assess the need for and nature of smoking cessation services among physicians in China, a detailed literature review was conducted. Methods A literature review of studies published, in Chinese or in English, between 1987 and 2010, was carried out. The Medline, PubMed and Wanfang Data (a Chinese literature search database) electronic databases were searched for published studies. Results It was found that the overall current smoking prevalence among Chinese physicians ranged from 14% to 64% (men: 26% to 61%; women: 0% to 19%). There were significant gender differences in the smoking prevalence across studies with men smoking more than women. Though inconsistent, there were variations in smoking rates by professional posts and medical specialty. The quit smoking rates ranged from 5% to 14% across studies, with a higher rate among female physicians. Asking about smoking status or advising patients to quit smoking was not common practice among the physicians. Conclusions The results of this review suggest that while smoking habits of Chinese physicians vary among studies and across physicians in different specialties; prevalence rates tend to be higher than in physicians in the developed countries. Quitting rates were low among Chinese physicians, and the delivery of advice on quitting smoking was not common across the studies. Strategies to improve Chinese physicians' engagement in smoking cessation should address multiple factors including tobacco use and quitting practices among the physicians, their training needs and awareness of their professional responsibility with a healthcare system change approach.