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Bin Zhu
School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China

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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.

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: 29 May 2020 in International Journal of Drug Policy
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Consumers’ access to cannabis has been considerably expanded in US states where recreational cannabis was legalized and commercialized. However, little is known about the important factors influencing consumers’ purchase decisions in cannabis retail dispensaries. This study examined cannabis users’ perceptions of the relative importance of policy-relevant factors when they made cannabis purchase decisions. An online survey was administered to 817 adult cannabis users in seven states in the US (California, Colorado, Maine, Massachusetts, Nevada, Oregon, and Washington) that had approved cannabis commercialization by the time of interview in January 2018. Twenty policy-relevant cannabis attributes were evaluated, including those pertaining to product characteristics, quality, package characteristics, price and free sample, store characteristics, and restrictions on use. A best-worst scaling experiment was employed, which asked respondents to select the most and the least important attributes in a choice scenario. Each respondent answered 10 choice scenarios, each including a random combination of four attributes out of the 20. The relative importance of each attribute was evaluated using hierarchical Bayesian estimation of mixed logit models. Overall, ‘quality’, ‘strain type’, ‘price’, ‘THC’ (tetrahydrocannabinol) and ‘pesticide’ were the top five important attributes affecting cannabis users’ willingness to buy cannabis in a dispensary. These five attributes jointly accounted for approximately half of the total importance. In subsample analysis, both recreational and dual-purpose users attached higher importance to ‘quality’, ‘THC’, and ‘price’, whereas medical users tended to think ‘CBD’ (cannabidiol) and ‘pesticide’ were more important. All cannabis users perceived ‘package’ to be the least important attribute. Gender had no major differences in perceptions. Cannabis users in general perceived product characteristics, quality, and price to be important factors in their willingness to buy cannabis in dispensaries. There were heterogeneities in the perceptions by cannabis use purposes. The findings might deserve consideration in cannabis policy design.

ACS Style

Bin Zhu; Huiying Guo; Ying Cao; Ruopeng An; Yuyan Shi. Perceived Importance of Factors in Cannabis Purchase Decisions: A Best-worst Scaling Experiment. International Journal of Drug Policy 2020, 91, 102793 .

AMA Style

Bin Zhu, Huiying Guo, Ying Cao, Ruopeng An, Yuyan Shi. Perceived Importance of Factors in Cannabis Purchase Decisions: A Best-worst Scaling Experiment. International Journal of Drug Policy. 2020; 91 ():102793.

Chicago/Turabian Style

Bin Zhu; Huiying Guo; Ying Cao; Ruopeng An; Yuyan Shi. 2020. "Perceived Importance of Factors in Cannabis Purchase Decisions: A Best-worst Scaling Experiment." International Journal of Drug Policy 91, no. : 102793.

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.

Journal article
Published: 02 March 2020 in BMC Health Services Research
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Background The licensed doctor misdistribution is one of the major challenges faced by China. However, this subject remains underexplored as spatial distribution characteristics (such as spatial clustering patterns) have not been fully mapped out by existing studies. To fill the void, this study aims to explore the spatio-temporal dynamics and spatial clustering patterns of different subtypes of licensed doctors (i.e., clinicians, traditional Chinese medicine doctors, dentists, public health doctors, general practitioners) in China. Methods Data on the licensed doctor quantity and population during 2012–2016 was obtained from the National Health (and Family Planning) Yearbook. Functional boxplots were used to visualize and compare the temporal trends of densities of different subtypes of licensed doctors. This study adopted two complementary spatial statistics (space-time scan statistics and Moran’s I statistics) to explore the spatio-temporal dynamics and spatial clustering patterns of licensed doctor distribution in China. The former was used to explore the spatial variations in the temporal trends of licensed doctor density during 2012–2016, and the latter was adopted to explore the spatial changing patterns of licensed doctor distribution during the research period. Results The results show that the densities of almost all subtypes of licensed doctors displayed upward trends during 2012–2016, though some provincial units were left behind. Besides, spatial distribution characteristics varied across different subtypes of licensed doctors, with the low-low cluster area of general practitioners being the largest. Conclusions The misdistribution of licensed doctors is a global problem and China is no exception. In order to achieve a balanced distribution of licensed doctors, the government is suggested to introduce a series of measures, such as deliberative policy design and effective human resource management initiatives to educate, recruit, and retain licensed doctors and prevent a brain drain of licensed doctors from disadvantaged units.

ACS Style

Bin Zhu; Chih-Wei Hsieh; Ying Mao. Spatio-temporal variations of licensed doctor distribution in China: measuring and mapping disparities. BMC Health Services Research 2020, 20, 159 -16.

AMA Style

Bin Zhu, Chih-Wei Hsieh, Ying Mao. Spatio-temporal variations of licensed doctor distribution in China: measuring and mapping disparities. BMC Health Services Research. 2020; 20 (1):159-16.

Chicago/Turabian Style

Bin Zhu; Chih-Wei Hsieh; Ying Mao. 2020. "Spatio-temporal variations of licensed doctor distribution in China: measuring and mapping disparities." BMC Health Services Research 20, no. 1: 159-16.

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: 17 May 2019 in International Journal of Environmental Research and Public Health
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Background: The maldistribution of licensed doctors is one of the major challenges faced by the Chinese health sector. However, this subject remains underexplored, as the underlying causes of licensed doctor distribution have not been fully mapped out. To fill the research void, this study theoretically modeled and empirically measured various determinants of licensed doctor distribution from both the supply and demand sides while taking the spillover effect between the adjacent geographical units into consideration. Methods: The theory of demand and supply is adopted to construct a research framework so as to explain the imbalance in the licensed doctor distribution. Both direct effects and spillover effects of the supply-side factors and demand-side factors are empirically measured with the spatial panel econometric models. Results: The health service demand was found, as expected, to be the major driving force of the licensed doctor distribution across the nation. That is, the increase in health services demands in a province could significantly help one unit attract licensed doctors from adjacent units. Unexpectedly but intriguingly, the medical education capacity showed a relatively limited effect on increasing the licensed doctor density in local units compared with its spillover effect on neighboring units. In addition, government and social health expenditures played different roles in the health labor market, the former being more effective in increasing the stock of clinicians and public health doctors, the latter doing better in attracting dentists and general practitioners. Conclusions: The results provide directions for Chinese policy makers to formulate more effective policies, including a series of measures to boost the licensed doctor stock in disadvantaged areas, such as the increase of government or social health expenditures, more quotas for medical universities, and the prevention of a brain drain of licensed doctors.

ACS Style

Bin Zhu; Chih-Wei Hsieh; Ying Mao. Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective. International Journal of Environmental Research and Public Health 2019, 16, 1753 .

AMA Style

Bin Zhu, Chih-Wei Hsieh, Ying Mao. Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective. International Journal of Environmental Research and Public Health. 2019; 16 (10):1753.

Chicago/Turabian Style

Bin Zhu; Chih-Wei Hsieh; Ying Mao. 2019. "Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective." International Journal of Environmental Research and Public Health 16, no. 10: 1753.

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.

Review
Published: 01 October 2018 in The Lancet
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BackgroundPrimary health workers have great meaning for the whole health-care system. However, China faces a serious shortage of primary health workers in rural areas and urban communities because of their high turnover rates. We aimed to analyse the prevalence and determinants of turnover intention (the intent to change or leave current employment) in a systemic review and meta-analysis, to provide evidence for improving retention measures.MethodsIn this systemic review and meta-analysis, we searched five English language databases (PubMed, EMBASE, Cochrane Library, PsycINFO, and ASC) and three Chinese databases (CNKI, CSPD, and CBM) for studies published between Jan 1, 2000, and May 1, 2018. We used a combination of the terms "(Turnover Intention, Departure Intention, Demission Intention, or Leave Intention), (Primary, Community, Rural, Countryside, or Grass roots), (Health worker, Health Manpower, Health Personnel, Doctor, or Nurse), and (China, or Chinese)" to conduct the search. Eligible studies were observational or descriptive studies done in mainland China, with human participants. Number or percentage related to turnover intention of health workers and related exposures (potential risk factors) had to be explicitly reported in each included study. If it was not feasible to make a quantitative synthesis and conduct a meta-analysis with the data, we used a narrative approach and descriptive statistics by grouping studies that reported the same exposures, to compare their associations with turnover intention of health workers. We did all statistical analyses using Stata (version 13.0) and RevMan (version 5.3).FindingsWe identified 21 articles investigating a total of 21 466 workers in Chinese primary health institutions. The prevalence of turnover intention ranged from 11·80% to 78·40%. On the basis of our meta-analysis, age (younger vs older odds ratio [OR] 2·04, 95% CI 1·62–2·60), location (rural vs city 2·33, 1·85–2·68), position (junior job title vs senior job title 1·73, 1·45–2·16), salary (low salary vs high salary 2·37, 1·98–2·83), and working time (more than 8 h per day vs less than 8 h per day 2·20, 1·98–2·43) were significantly associated with turnover intention. Other risk factors including sex, attitude towards future career, education of children, and degree of education were identified using the narrative approach.InterpretationThe prevalence of turnover intention was relatively high among primary health workers in China. The determinants of turnover intention can be contained by the job embeddedness model, including two layers (on-the-job, [determinants directly related to the job] and off-the-job [determinants related to the family and community]) and three dimensions (links, fits, and sacrifices). More measures should be taken towards retaining primary health workers.FundingThe National Social Science Fund of China (grant number 17ZDA079).

ACS Style

Ying Mao; Rongxin He; Jinlin Liu; Ning Zhang; Bin Zhu. Turnover intention of primary health workers in China: a systematic review. The Lancet 2018, 392, S17 .

AMA Style

Ying Mao, Rongxin He, Jinlin Liu, Ning Zhang, Bin Zhu. Turnover intention of primary health workers in China: a systematic review. The Lancet. 2018; 392 ():S17.

Chicago/Turabian Style

Ying Mao; Rongxin He; Jinlin Liu; Ning Zhang; Bin Zhu. 2018. "Turnover intention of primary health workers in China: a systematic review." The Lancet 392, no. : S17.

Journal article
Published: 22 June 2018 in International Journal of Environmental Research and Public Health
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Existing measures of health equity bear limitations due to the shortcomings of traditional economic methods (i.e., the spatial location information is overlooked). To fill the void, this study investigates the equity in health workforce distribution in China by incorporating spatial statistics (spatial autocorrelation analysis) and traditional economic methods (Theil index). The results reveal that the total health workforce in China experienced rapid growth from 2004 to 2014. Meanwhile, the Theil indexes for China and its three regions (Western, Central and Eastern China) decreased continually during this period. The spatial autocorrelation analysis shows that the overall agglomeration level (measured by Global Moran’s I) of doctors and nurses dropped rapidly before and after the New Medical Reform, with the value for nurses turning negative. Additionally, the spatial clustering analysis (measured by Local Moran’s I) shows that the low–low cluster areas of doctors and nurses gradually reduced, with the former disappearing from north to south and the latter from east to west. On the basis of these analyses, this study suggests that strategies to promote an equitable distribution of the health workforce should focus on certain geographical areas (low–low and low–high cluster areas).

ACS Style

Bin Zhu; Chih-Wei Hsieh; Yue Zhang. Incorporating Spatial Statistics into Examining Equity in Health Workforce Distribution: An Empirical Analysis in the Chinese Context. International Journal of Environmental Research and Public Health 2018, 15, 1309 .

AMA Style

Bin Zhu, Chih-Wei Hsieh, Yue Zhang. Incorporating Spatial Statistics into Examining Equity in Health Workforce Distribution: An Empirical Analysis in the Chinese Context. International Journal of Environmental Research and Public Health. 2018; 15 (7):1309.

Chicago/Turabian Style

Bin Zhu; Chih-Wei Hsieh; Yue Zhang. 2018. "Incorporating Spatial Statistics into Examining Equity in Health Workforce Distribution: An Empirical Analysis in the Chinese Context." International Journal of Environmental Research and Public Health 15, no. 7: 1309.

Comparative study
Published: 05 April 2018 in PLOS ONE
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China is the largest developing country with a relatively developed public health system. To further prevent and eliminate the spread of infectious diseases, China has listed 39 notifiable infectious diseases characterized by wide prevalence or great harm, and classified them into classes A, B, and C, with severity decreasing across classes. Class A diseases have been almost eradicated in China, thus making class B diseases a priority in infectious disease prevention and control. In this retrospective study, we analyze the spatial distribution patterns of 12 class B notifiable infectious diseases that remain active all over China. Global and local Moran’s I and corresponding graphic tools are adopted to explore and visualize the global and local spatial distribution of the incidence of the selected epidemics, respectively. Inter-correlations of clustering patterns of each pair of diseases and a cumulative summary of the high/low cluster frequency of the provincial units are also provided by means of figures and maps. Of the 12 most commonly notifiable class B infectious diseases, viral hepatitis and tuberculosis show high incidence rates and account for more than half of the reported cases. Almost all the diseases, except pertussis, exhibit positive spatial autocorrelation at the provincial level. All diseases feature varying spatial concentrations. Nevertheless, associations exist between spatial distribution patterns, with some provincial units displaying the same type of cluster features for two or more infectious diseases. Overall, high–low (unit with high incidence surrounded by units with high incidence, the same below) and high–high spatial cluster areas tend to be prevalent in the provincial units located in western and southwest China, whereas low–low and low–high spatial cluster areas abound in provincial units in north and east China. Despite the various distribution patterns of 12 class B notifiable infectious diseases, certain similarities between their spatial distributions are present. Substantial evidence is available to support disease-specific, location-specific, and disease-combined interventions. Regarding provinces that show high–high/high–low patterns of multiple diseases, comprehensive interventions targeting different diseases should be established. As to the adjacent provincial units revealing similar patterns, coordinated actions need to be taken across borders.

ACS Style

Bin Zhu; Yang Fu; Jinlin Liu; Ying Mao. Spatial distribution of 12 class B notifiable infectious diseases in China: A retrospective study. PLOS ONE 2018, 13, e0195568 .

AMA Style

Bin Zhu, Yang Fu, Jinlin Liu, Ying Mao. Spatial distribution of 12 class B notifiable infectious diseases in China: A retrospective study. PLOS ONE. 2018; 13 (4):e0195568.

Chicago/Turabian Style

Bin Zhu; Yang Fu; Jinlin Liu; Ying Mao. 2018. "Spatial distribution of 12 class B notifiable infectious diseases in China: A retrospective study." PLOS ONE 13, no. 4: e0195568.

Research article
Published: 02 April 2018 in PLOS ONE
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A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students’ participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson’s chi-squared tests and binary logistic regression analyses were performed for data analyses. Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students’ intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05–1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48–2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background. Rural clinical clerkship is likely to increase the odds of having intentions to work in rural medical institutions after graduation among medical students in western China, especially for those with an urban background. Related policy makers could consider developing compulsory rural clerkship programs and implement them among medical students to increase early rural exposure.

ACS Style

Jinlin Liu; Bin Zhu; Ying Mao. Association between rural clinical clerkship and medical students’ intentions to choose rural medical work after graduation: A cross-sectional study in western China. PLOS ONE 2018, 13, e0195266 .

AMA Style

Jinlin Liu, Bin Zhu, Ying Mao. Association between rural clinical clerkship and medical students’ intentions to choose rural medical work after graduation: A cross-sectional study in western China. PLOS ONE. 2018; 13 (4):e0195266.

Chicago/Turabian Style

Jinlin Liu; Bin Zhu; Ying Mao. 2018. "Association between rural clinical clerkship and medical students’ intentions to choose rural medical work after graduation: A cross-sectional study in western China." PLOS ONE 13, no. 4: e0195266.

Journal article
Published: 02 April 2018 in International Journal of Environmental Research and Public Health
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Viral hepatitis, as one of the most serious notifiable infectious diseases in China, takes heavy tolls from the infected and causes a severe economic burden to society, yet few studies have systematically explored the spatio-temporal epidemiology of viral hepatitis in China. This study aims to explore, visualize and compare the epidemiologic trends and spatial changing patterns of different types of viral hepatitis (A, B, C, E and unspecified, based on the classification of CDC) at the provincial level in China. The growth rates of incidence are used and converted to box plots to visualize the epidemiologic trends, with the linear trend being tested by chi-square linear by linear association test. Two complementary spatial cluster methods are used to explore the overall agglomeration level and identify spatial clusters: spatial autocorrelation analysis (measured by global and local Moran’s I) and space-time scan analysis. Based on the spatial autocorrelation analysis, the hotspots of hepatitis A remain relatively stable and gradually shrunk, with Yunnan and Sichuan successively moving out the high-high (HH) cluster area. The HH clustering feature of hepatitis B in China gradually disappeared with time. However, the HH cluster area of hepatitis C has gradually moved towards the west, while for hepatitis E, the provincial units around the Yangtze River Delta region have been revealing HH cluster features since 2005. The space-time scan analysis also indicates the distinct spatial changing patterns of different types of viral hepatitis in China. It is easy to conclude that there is no one-size-fits-all plan for the prevention and control of viral hepatitis in all the provincial units. An effective response requires a package of coordinated actions, which should vary across localities regarding the spatial-temporal epidemic dynamics of each type of virus and the specific conditions of each provincial unit.

ACS Style

Bin Zhu; Jinlin Liu; Yang Fu; Bo Zhang; Ying Mao. Spatio-Temporal Epidemiology of Viral Hepatitis in China (2003–2015): Implications for Prevention and Control Policies. International Journal of Environmental Research and Public Health 2018, 15, 661 .

AMA Style

Bin Zhu, Jinlin Liu, Yang Fu, Bo Zhang, Ying Mao. Spatio-Temporal Epidemiology of Viral Hepatitis in China (2003–2015): Implications for Prevention and Control Policies. International Journal of Environmental Research and Public Health. 2018; 15 (4):661.

Chicago/Turabian Style

Bin Zhu; Jinlin Liu; Yang Fu; Bo Zhang; Ying Mao. 2018. "Spatio-Temporal Epidemiology of Viral Hepatitis in China (2003–2015): Implications for Prevention and Control Policies." International Journal of Environmental Research and Public Health 15, no. 4: 661.

Journal article
Published: 28 January 2018 in Sustainability
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Health workforce misdistribution is a major challenge faced by almost all countries. A more profound understanding of the dynamics of the health labor market provides evidence for policy makers to balance health workforce distribution with solid evidence. However, one major deficit of existing theoretical and empirical studies is that they often ignore the intra-regional spillovers of the health labor market. This study builds a theoretical “supply–demand–spillover” model that considers both intra-regional supply and demand-side factors, and inter-regional spillovers, hence providing a theoretical reference point for further in-depth studies. Using spatial econometric panel models, the effect of all determinants and spillovers were empirically measured based on a Chinese panel data set, shedding light on health workforce policies in China.

ACS Style

Bin Zhu; Yang Fu; Jinlin Liu; Ying Mao. Modeling the Dynamics and Spillovers of the Health Labor Market: Evidence from China’s Provincial Panel Data. Sustainability 2018, 10, 333 .

AMA Style

Bin Zhu, Yang Fu, Jinlin Liu, Ying Mao. Modeling the Dynamics and Spillovers of the Health Labor Market: Evidence from China’s Provincial Panel Data. Sustainability. 2018; 10 (2):333.

Chicago/Turabian Style

Bin Zhu; Yang Fu; Jinlin Liu; Ying Mao. 2018. "Modeling the Dynamics and Spillovers of the Health Labor Market: Evidence from China’s Provincial Panel Data." Sustainability 10, no. 2: 333.

Journal article
Published: 01 October 2017 in Sustainability
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Sexually transmitted infections (STIs) have become one of the major public health threats to the sustainable development of human beings. Among all of the STIs in China, three are listed as the notifiable infectious diseases, i.e., gonorrhea, syphilis, and HIV/AIDS, which demand more attention. This study aims to detect, describe, and compare the spatial-temporal clustering of these notifiable STIs in China and to relate spatial analysis results to epidemiologic trends during the past decade. A descriptive epidemiology analysis and a spatial autocorrelation analysis (global and local) are adopted to study the epidemiologic trends and spatial changing patterns of STIs respectively. The results indicated that there were regional disparities and spatial clusters in the spatial distribution of notifiable STIs in China. However, the incidence rates of the three notifiable STIs displayed relatively different characteristics in epidemiologic trends and the agglomeration level. Overall, the Yangtze River Delta region, the southwestern border area, and some other border regions are the places demanding more attention. In the end, we propose a three-dimensional prevention and control strategy, which focuses on not only the most-at-risk populations, but also the most-at-risk areas and most-at-risk timings. Besides, some measures targeting more than one STI should also be formulated.

ACS Style

Bin Zhu; Yang Fu; Jinlin Liu; Ying Mao. Notifiable Sexually Transmitted Infections in China: Epidemiologic Trends and Spatial Changing Patterns. Sustainability 2017, 9, 1784 .

AMA Style

Bin Zhu, Yang Fu, Jinlin Liu, Ying Mao. Notifiable Sexually Transmitted Infections in China: Epidemiologic Trends and Spatial Changing Patterns. Sustainability. 2017; 9 (10):1784.

Chicago/Turabian Style

Bin Zhu; Yang Fu; Jinlin Liu; Ying Mao. 2017. "Notifiable Sexually Transmitted Infections in China: Epidemiologic Trends and Spatial Changing Patterns." Sustainability 9, no. 10: 1784.