Health Care Science最新文献

In 2009, China initiated a new round of health reform to establish a well-functioning health system. The 2009 health reform did make some significant achievements in improving affordability and accessibility. In particular, social health insurance has been expanded significantly and various social health insurance plans have covered over 95% of total population in China by 2011. The Chinese government also has significantly increased fiscal input for health financing. However, affordability remains a serious concern as the social health insurers, as purchasers, were not very effective in containing the growth of health expenditure. Accessibility to primary care and public health is another concern. In this context, health governance reforms are necessary to address affordability and accessibility issues. Health governance set rules for key actors of the health system (including service providers, health insurers and government departments) by taking into account the strategies and incentives of these actors in their interactions. In recent years, a series of reforms in health governance have been initiated. Some progresses have been achieved. For the next stage of health reform, issues including how to further reform the governance structure of medical institutions and how to improve resource allocation in the health system are critical.

The respiratory tract is known to harbor a microbial community including bacteria, viruses, and fungi. New techniques contribute enormously to the identification of unknown or culture-independent species and reveal the interaction of the community with the host immune system. The existing respiratory microbiome and substantial equilibrium of the transplanted microbiome from donor lung grafts provide an extreme bloom of dynamic changes in the microenvironment in lung transplantation (LT) recipients. Dysbiosis in grafts are not only related to the modified microbial components but also involve the kinetics of the host-graft “talk,” which signifies the destination of graft allograft injury, acute rejection, infection, and chronic allograft dysfunction development in short- and long-term survival. Microbiome-derived factors may contribute to lung xenograft survival when using genetically multimodified pig-derived organs. Here, we review the most advanced knowledge of the dynamics and resilience of microbial communities in transplanted lungs with various pretransplant indications. Conceptual and analytical points of view have been illustrated along the time series, gaining insight into the microbiome and lung grafts. Future endeavors on precise tools, sophisticated models, and novel targeted regimens are needed to improve the long-term survival in these patients.

Over 40 years ago, primary health care (PHC) was defined in the Alma-Ata Declaration as a critical component of the health care system to address the basic health demand of the people. In China, the Government attaches great importance to health care at the primary level. After the launch of the historical Reform of the Medical and Health Care System in 2009, the PHC system in China has witnessed major progress and breakthroughs, especially in its steadily increased capacity, continuously improved accessibility, and betterment in equality. In this review, we summarized published literatures and official policies, synthesized data from the electronic registration information system of the National Health Commission, national statistical reports, and yearbooks in health care. The review is intended to describe the systematic development of PHC in China in the last decade. The main results include: the solid national policy foundation, increasing number of PHC institutions and workforce, better training of PHC professionals, major achievements in primary health indicators, government financial support to PHC institutions, improved PHC budgeting and insurance coverage, and the advancement of supporting technologies. Challenges and prospects are also discussed.

The Covid-19 pandemic produced a complex combination of intense negative emotions among the general public, influencing people's coping reactions toward the pandemic. Yet each discrete emotion may affect people's behaviors in different ways. Unveiling the specific emotion–behavior relationships can provide valuable implications for designing effective intervention programs. Through the lens of the appraisal theory of emotion, we assessed the relationships between negative emotions and pandemic-related behaviors among the Chinese population midst the early outbreak of the pandemic. An anonymous online survey was distributed to mainland Chinese participants (n = 2976), which assessed individuals' emotional states and behavioral reactions to the pandemic. Consistent with the differential appraisal theme underlying each negative emotion as delineated by the appraisal theory, mixed relationships between emotions and pandemic-related behaviors were revealed. Specifically, anxiety was positively associated with behaviors of seeking pandemic-related information, sharing such information, and stockpiling preventive goods, yet, contrary to prediction, anxious people were reluctant to adopt preventive measures, which is maladaptive. Sad people sought information less frequently and exhibited lower intention to stockpile preventive goods; but, opposing prediction, they shared information less frequently. Angry people were more active in sharing information and in stockpiling preventive goods. These findings suggest that public health practitioners can utilize the emotion–behavior relationships to identify the vulnerable individuals who tend to adopt maladaptive coping behaviors, help them address emotional distress, and encourage their adoption of effective coping behaviors.

In 2021, China became an aged society when the share of its elderly population (age 65 years and above) exceeded 14%. In China, as in other upper-middle-income and high-income countries, life expectancy gains are increasingly concentrated at older ages with below-average health and economic activity. Governments worldwide are hence actively pursuing healthy and productive aging. Healthy aging by some measures is taking place. Similar with other upper-middle-income countries, China's young old in their 60s are healthier than the same age group two decades ago. The picture is more complex for the older age group (70 years and above). Although there is a substantial decline in leading disease burdens such as stroke and chronic obstructive pulmonary disease, diseases such as Alzheimer's and other dementia are on the rise. To meet the challenge of a rapidly aging population, China's healthy aging agenda should improve its multipronged approach that seeks to promote healthy lifestyles, enhance the healthcare system, create age-friendly communities, and tackle socioeconomic and health disparities.

This article explains how two AI systems have been incorporated into the everyday operations of two Singapore public healthcare nation-wide screening programs. The first example is embedded within the setting of a national level population health screening program for diabetes related eye diseases, targeting the rapidly increasing number of adults in the country with diabetes. In the second example, the AI assisted screening is done shortly after a person is admitted to one of the public hospitals to identify which inpatients—especially which elderly patients with complex conditions—have a high risk of being readmitted as an inpatient multiple times in the months following discharge. Ways in which healthcare needs and the clinical operations context influenced the approach to designing or deploying the AI systems are highlighted, illustrating the multiplicity of factors that shape the requirements for successful large-scale deployments of AI systems that are deeply embedded within clinical workflows. In the first example, the choice was made to use the system in a semi-automated (vs. fully automated) mode as this was assessed to be more cost-effective, though still offering substantial productivity improvement. In the second example, machine learning algorithm design and model execution trade-offs were made that prioritized key aspects of patient engagement and inclusion over higher levels of predictive accuracy. The article concludes with several lessons learned related to deploying AI systems within healthcare settings, and also lists several other AI efforts already in deployment and in the pipeline for Singapore's public healthcare system.