In China, family doctor services originated in 2009. After two years, the Chinese government proposed the establishment of a family doctor contract system suitable for China’s national conditions. Then, in 2016, a multi-department jointly issued an important document, which further clarified the development goals of family doctor contract services in the next five years. Zhejiang Province has been exploring responsible doctor contract services since 2012, which was promoted throughout the province in 2015. Objectives: The aim of this study was to investigate the residents’ awareness of Zhejiang Province, China, of family doctor contract services, the status of signing such a contract, and the demand for service items in the contracted service package. Further, we sought to explore the relevant influential factors in order to provide a reference and evidence-based recommendations for the further development of family doctor contract services. Design: We enrolled 3960 residents from nine counties in Zhejiang Province using a multistage stratified random sampling method. A survey using a self-designed questionnaire was used to collect the demographic data, residents’ awareness of family doctor contract services, the status of contracting, and demand for different items from October to December 2017. Data were analyzed by SPSS 21.0. Results: In total, 3871 residents returned valid questionnaires, with a response rate of 97.75%. The awareness rate of residents of family doctor contract services was 71.58% (2771/3871). Age, education level, and chronic medical history status were the influencing factors affecting residents’ awareness. The contracted rate was 50.43% (1952/3871). Age, education level, personal monthly income, chronic disease history, and awareness of family doctor contract services were the influencing factors. Residents who have a contract with family doctors have a higher demand for family doctor contract services, and different residents have different needs for the project because of their physical condition, education level, marital status, household registration, and personal monthly income level. The top three needs of the residents for contracted services were health consultation (84.64%), regular physical examination (81.71%), and increasing the proportion of medical insurance reimbursements (80.06%). Conclusions: The awareness rate of family doctor contract services and the contracting rate are unsatisfactory among residents of Zhejiang Province. It is suggested that the government should more heavily publicize family doctor contract services, expand the coverage, introduce personalized contract schemes to meet the needs of different groups, and promote the rapid development of family doctor contract services in Zhejiang Province.

Chinese elders are under high threats of seasonal influenza, while showing low influenza vaccination coverage comparing with other countries. The study explored the impacts of free vaccination policy and associated factors on influenza vaccination behavior of the elderly in Zhejiang Province, China, offering a guidance of interventions for protecting elders from seasonal influenza. 1210 elders ≥60 years were conveniently recruited between July and September of 2019. 607 of them were sampled from 6 counties with free vaccination policy, while the other 603 elderly people were sampled from another 6 comparable counties without the policy. A self-reported questionnaire, involving socio-democratic information, physical status and behavior, influenza knowledge, vaccination awareness, relatives of healthcare workers, and vaccination behavior, was completed by elders under supports of research assistants. Chi-square tests and logistic regression analyses were performed to explore the impacts of research factors. A total of 464 (38.3%, 95%CI: 36.9-39.7%) elders claimed that they got vaccinated, and the vaccination coverages of elders in the counties with and without free vaccination policy were 68.4% (95%CI: 64.7-72.1%) and 8.1% (95%CI: 5.9-10.3%), respectively. Protective and risk factors of vaccination behavior were identified, including free vaccination policy (ORstep = 27.29, 95%CI: 18.69-39.82), positive vaccination awareness (ORstep = 7.93, 95%CI: 5.50-11.43), catching cold frequently (ORstep = 2.00, 95%CI: 1.32-3.05), and having relatives of healthcare workers (ORstep = 0.56, 95%CI: 0.34-0.93). Age, education level, monthly income, family structure, physical status, and influenza knowledge were significantly associated with vaccination behavior. Having relatives of healthcare workers may indirectly affect vaccination behavior through vaccination awareness. Free vaccination policy plays the most fundamental role of improving vaccination coverage among studied factors. To protect elders from seasonal influenza, effective measurements, such as issuing free vaccination policy, enriching influenza knowledge, and guiding positive vaccination awareness for both elders and healthcare professionals are recommended to be included into influenza immunization strategies.

This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables. Univariate and multivariable logistic regression analyses were used to identify determinants of the GP contract service demand and signing decisions, respectively. Among the 1440 urban elderly, 56.67% had signed contracts with their GP, and 55.35% had a demand of the GP contract service. The influencing factors of demand were a history of diabetes or cardiovascular disease (OR = 1.33, 95% CI, 1.05–1.68); urban resident basic medical insurance (URBMI) vs. urban employee basic medical insurance (UEBMI) (OR = 1.96, 95% CI, 1.46–2.61); and middle-income vs. low-income (OR = 0.67, 95% CI, 0.50–0.90 for RMB 1001–3000; OR = 0.59, 95% CI, 0.39–0.90 for RMB 3001–5000). Having a demand for the GP contract service was the strongest determinant of signing decisions (OR = 13.20, 95% CI, 10.09–17.27). Other factors also contributed to these decisions, including gender, caregiver, and income. The urban elderly who had signed contracts with GPs were mainly based on their health care needs. Elderly people with a history of diabetes or cardiovascular disease, as well as those with URBMI, were found to have stronger needs of a GP contract service. It is believed that the high-income elderly should be given equal priority to those of low-income.

Alcohol consumption and metabolic syndrome(MetS), both prevalent in the general population, frequently co-occur. They are recognized as significant contributors to liver dysfunction, yet their combined effect is often challenging to delineate. This study delves into the compounding influence of alcohol consumption and metabolic disorder on liver dysfunction within an elderly demographic in Zhejiang Province, China. Our findings spotlight a heightened risk of liver dysfunction among females, younger individuals, rural dwellers, those with minimal educational attainment, single individuals, and those diagnosed with MetS. We also discerned a positive correlation correlation between the number of MetS components and the propensity for liver dysfunction. Furthermore, the risk of liver dysfunction escalated in tandem with the frequency of alcohol consumption. Interestingly, a prolonged abstinence period (≥ 5 years) seemed to mitigate this risk. Our research underscores the significance of refraining from excessive alcohol consumption, embracing a healthy lifestyle, and managing MetS components-especially triglyceride levels-for effective prevention of liver dysfunction.

Obesity has been arousing a critical public health issue, and posting threats to senior population. We aimed to explore gender differences in associations between general/central obesity (body mass index/waist circumference) and hypertension, diabetes, dyslipidemia based on electronic health records of 3.5 million Chinese senior population over 65 years. 3571189 electronic health records of Chinese senior population were collected from platform of Zhejiang provincial Basic Public Health Services Project. Sociodemographic characteristics, behavioral lifestyle, physical data, and biochemical indices were included in the research. Multivariate logistic regression models and restricted cubic spline models were used to explore associations between obesity and diseases. 7.7% (5.3% for male, 9.7% for female) senior population were having general obesity, and 31.8% (25.2% for male, 37.4% for female) of them had central obesity. 48.0% (46.0% for male, 49.7% for female), 14.0% (12.3% for male, 15.5% for female), and 58.9% (51.6% for male, 65.2% for female) senior population were having hypertension, diabetes, and dyslipidemia, respectively. 37.9% (29.5% for male, 45.1% for female) and 33.7% (28.1% for male, 38.5% for female) senior population were having abnormal TC and TG, respectively. General obesity and central obesity strongly and negatively associated with hypertension [OR = 2.61 (95%CI: 2.58–2.63), and 2.20 (95%CI: 2.18–2.21)], diabetes [OR = 1.33 (95%CI: 1.31–1.35), and 1.56 (95%CI: 1.54–1.57)], and dyslipidemia [OR = 1.66 (95%CI: 1.64–1.68), and 1.84 (95%CI: 1.83–1.85)] based on existing obesity standards. Male population with BMI higher than 28.7 kg/m2, 30.1 kg/m2, 22.7 kg/m2, and with WC higher than 99.0 cm, 95.9 cm, 82.1 cm, while female population with BMI higher than 26.9 kg/m2, 23.3 kg/m2, 18.1 kg/m2, and with WC higher than 92.1 cm, 83.1 cm, 65.7 cm, the ORs were over 1.0 for having hypertension, diabetes, and dyslipidemia, respectively. Senior population were more likely to have central obesity over general obesity, and nearly half of them were having hypertension and dyslipidemia. Obesity negatively and strongly associated with chronic diseases in senior population, yet general obesity exerted more impact on hypertension, whereas central obesity exerted more impact on diabetes and dyslipidemia. Female population with obesity were in higher risk than male having hypertension, diabetes, and dyslipidemia. We recommended senior population control BMI lower than 28.7 kg/m2 and 23.3 kg/m2, as well as WC lower than 95.9 cm and 83.1 cm for male and female, respectively. Optimal BMI and WC in senior population may be around the overweight or mild obesity range. There were risks for having dyslipidemia or abnormal lipid-related indices even in senior population without obesity. TC and TG were major indicators of discovering disease and preventing senior population from dyslipidemia.

We aimed to quantitatively estimate the amount of pressure that was placed on basic public health care services (BPHS) due to the universal two-child policy issued in 2015 by comparing the workload change in maternal and child health management and the immunization of children. BPHS performance surveillance data from 2014 to 2018 in Zhejiang Province, China were analyzed to calculate the workload of the above three services using the equivalent method of BPHS cost estimation of community health services. From 2014 to 2018, the numbers of births from the Statistical Yearbook in Zhejiang Province were 578,000, 581,000, 624,000, 670,000, and 628,000, respectively, and those from the surveillance data were 416,941, 41,490, 434,163, 546,816, and 45,964, respectively. The number of births reached a peak in 2017, with the yearbook and surveillance data showing increases of 15.92% and 31.15%, respectively, over 2014. The workload of maternal and child health management and children’s immunization also peaked in 2017, increasing by 30.37%, 12.70%, and 4.33% over 2014, respectively. In 2018, the workload of maternal and child health management and children’s immunization dropped to 107.34%, 107.73%, and 98.81% over 2014, respectively. The indicators of maternal and child health management and children’s immunization services remained stable, and the related services did not decline, even in 2017. The maternal health management workload was more affected by the universal two-child policy than child health management and children’s immunization.