Objective To identify the key influencing factors of death anxiety in rural elderly and their mechanisms of action. Methods A total of 701 rural elderly individuals from 6 prefecture-level cities (prefectures) in Sichuan Province were selected for a questionnaire survey on death anxiety, health-related physical fitness, and subjective well-being. A structural equation model was constructed to thoroughly analyze the influencing factors of death anxiety and their mechanisms of action. Results Higher levels of health-related physical fitness, higher levels of subjective well-being, and having more children were the top three protective factors against death anxiety among elderly people in rural Sichuan, with effect values of −0.392, −0.287, and −0.154, respectively. In contrast, suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. Suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. The structural equation model fitting results showed that the medical insurance type of rural elderly in Sichuan (β=−0.062, P=0.002), suffering from chronic diseases (β=0.127, P=0.001), hospitalization due to health reasons in the past year (β=0.086, P=0.002), and educational level (β=−0.067, P=0.001) had indirect effects on death anxiety through health-related physical fitness. Not seeking medical treatment due to financial difficulties in the past year had an indirect effect on death anxiety through subjective well-being (β=0.060, P=0.002). The number of children had both a direct effect on death anxiety (β=−0.119, P=0.004) and an indirect effect through subjective well-being (β=−0.034, P=0.001). Health-related physical fitness had both a direct effect on death anxiety (β=−0.278, P=0.001) and an indirect effect through subjective well-being (β=−0.114, P=0.002). Conclusion Multiple factors directly or indirectly affect the level of death anxiety in the rural elderly population. Health-related physical fitness, subjective well-being, and the number of children are important protective factors. Moreover, health-related physical fitness and subjective well-being act as mediating variables in the chain of effects of multiple factors on death anxiety.
Objective To investigate the the status of Health manpower resources of rural hospitals, Health service, health personnel ’s reflection for the hospital’ current issues in Pingshan Xibaipo town in Hebei province, so as to provide baseline data for the establishment of a rural hospital’s comprehensive model. Method We conducted the survey which using questionnaires to collect the information of the rural hospital staff’s self-evaluation of health services, the reflecting of the problems of the current hospitals ,the views of the future building, village health humen resources for health, etc. SPSS 17.0 sofewarewas used for data analysis. Result The following problems are existing in Xibaipo town hospitals. (1) The rural hospital infrastructure is poor: 14 beds, housing a total area of 832 square meters is far below the national average. (2) The quality of the health personnel in the rural hospital is low.The proportion of doctors and nurses (1׃0.75) is higher than the Ministry of Health’s standard (1׃1), less educated (only 2 person’s first degree is college), low-level professional titled (the proportion of health officer of no professional title is 42.86%), etc. (3) Health resources in village are scarce: the quality of rural doctors is low (90.91% are non-formal school graduation), village clinics is lack of facilities (16 villages have only a total of 10 village clinics, 5 beds). Conclusion The infrastructure of the rural hospital was poor,while the situation of the personnel allocation in the rural hospital was irrational ,and the integrated management of the hospital in town and village is not good . The health personnel proposed recommendation about construction of health personnel, departments, information technology , etc .The rural hospital should introduce equipment and personnel, improve health care services and strengthen the integrated management of the hospital in town and village .
Objective To provide evidence for the establishment of an essential medicines list, we investigated the institutional medicine supply in rural hospitals and community health service centers in Chengdu. Methods The trained investigators collected medicine sales records and information about the management of institutional pharmacies. Through in-depth interviews with the pharmaceutical personnel, we inquired into the drug supervision and supply networks in rural areas. Then we performed secondary research based on a comparative analysis of drug classification, administration and pharmacies in developed countries. Results Seven township hospitals/community health service centers had pharmacies, facilities, storage, and a clean environment. Three of them used electrical databases to manage medicine sales records. Five township hospitals and 5 village medical rooms purchased medicines from the drug supervision and supply networks every week. In this way, they ensured the quality and accessibility of drugs in rural areas. In the urban community health service centers, medicines were supplied based on the traditional commercial distribution system. Conclusion Rational allocation of health resources to set up institutional pharmacies and village medicine rooms is important. The supervision of village medical rooms must be stricter. We should expand the use of electrical databases and integrate the supervision and supply networks with the supply system of the essential medicines.
ObjectiveTo explore the quality of life (QOL) of rural cognitive function impaired elderly in Guangyuan city and analysis the influencing factors, in order to provide evidence for improving the QOL of rural cognitive function impaired elderly. MethodsBy stratified cluster sampling method, Mini-Mental State Examination (MMSE) was adopted in the cognitive function impaired screening in Guangyuan rural area of Sichuan province in 2012, then we used SF-12 questionnaire to evaluate the QOL of those rural elderly (more than 60 years old) whose cognitive function was impaired. ResultsA total of 270 rural cognitive function impaired elderly were selected from 735 old people. The results of QOL assessment showed that:the mean of physical component summary (PCS) was 37.93±11.55, and the mean of mental component summary (MCS) was 44.07±13.14. Gender, age, education levels, economic situation of the selfassessment, chronic disease, being engaging in physical labour and daily life care were correlated with the score of QOL. ConclusionIn order to improve their QOL, we should help the elderly with cognitive function impaired and focus on prevention and individual treatment; their special difficulties should be fully considered when making the policy of health care and social security.
ObjectiveNew Rural Cooperative Medical Systems (NCMS) has been constructed as a financial protection for rural population commencing 2003. With the development of NCMS, there were quite a few management models existing across the nation. In order to assess the management alternatives, we try to explore how to set up a set of indicators to analysis management effect of different management models. MethodsBy literature review, we sorted all qualitative indicators into 8 types. Delphi and Multi-Attribute utility theories were applied to construct the appraisal indicators, including shaping first and second level indicators and assigning the weights for each type of indicators. ResultsWe managed to identify the indicator system which was comprised of 4 types of first level indicators, aiming at claim, manament process, transparency and supervision on accredited hospitals. Besides, there were 9 sub-indicators. ConclusionThe evaluation indicators are constructed for future assessment on management effect of rural health insurance.
Objective To systematically review the prevalence of depression in rural Chinese population aged 60 and above from 2010 to 2023. MethodsThe CNKI、WanFang Data、VIP、CBM、PubMed、Embase and Cochrane Library databases were electronically searched to collect cross-sectional studies on the prevalence of depression of elderly populations in rural China from January 2010 to March 2023. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 17.0 software. ResultsA total of 23 cross-sectional studies with a total sample of 34 916 cases and 11 308 depression patients were included. The meta-analysis results showed that the prevalence of depression in rural Chinese population was 31.02% (95%CI 26.10% to 36.16%). Subgroup analysis showed that the prevalence was higher among females than males; the GDS-30 scale had the highest detection rate, followed by the CES-D-10 and GDS-15 scales; the prevalence was higher in the Midwest than in the East; and the prevalence was higher in surveys conducted after 2015 than in 2015 and before. In addition, the prevalence of depression was higher in the rural elderly population aged 70 and above, non-married, illiterate or semi-literate, with poor self-rated health status, living alone, in poor economic status, with chronic diseases, and with low social activity. ConclusionThe prevalence of depression is high among the rural elderly population in China, and there are significant disparities in the prevalence of different characteristics of the elderly. These differences should be given more attention to improve the mental health of the rural elderly population. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To survey the relations between the rural residents’ occupational satisfaction, the health policies and demographic factors in Henan province and then to confirm the health policy order and its key target populations. Methods The questionnaires were distributed to 1 117 rural residents in 156 villages among 44 townships in 19 counties (cities, districts). The frequency analysis, multivariate linear regression analysis and multiple comparisons were conducted. Results The average value of rural residents’ occupational satisfaction scored 68.23, among which the complete dissatisfaction scored 0 accounting for 1.9%, the complete satisfaction scored 100 accounting for 9.0%, the one scoring no more than 50 accounted for 20.9%, and the one scoreing equal 80 or more than 80 accounted for 37.5%. By regarding the occupational satisfaction as the dependent variable, the independent variables stayed in the model were as follows in order according to their influence from heavy to little on the dependent variable: new rural cooperative medical system (NRCMS), occupation, village general practitioner’s work, family formation, age, disease prevention and control efforts. The occupational satisfaction was much higher when there were the following conditions: the higher satisfaction with the NRCMS, the more financial burden relieved by the NRCMS, and the higher satisfaction with village general practitioners’ work. The occupational satisfaction was the highest when villagers lived with their spouses, while it was the lowest when villagers lived with their spouses and children, as well as they lived with their parents, spouses and children. The peasants’ occupational satisfaction was the lowest. The occupational satisfaction had significantly negative correlation with cultural level, and had positive correlation with age. Conclusion The occupational satisfaction is an important indicator for assessing the level of social harmony, and is the basis for policy decision-making, implementation, and evaluation. The overall occupational satisfaction of the rural residents in Henan is lower, so the social harmoniy and stability should be alerted. The priority order of the existing rural health policy should be the NRCMS policy, village general practitioner work policy, and village disease prevention and control policy. When we are formulating and implementing the rural health policy, the key target populations should be considered among the people whose families comprise two or three generations, whose occupations are farmers, whose cultural level is lower, and whose ages are younger.
Objective To provide references for the rational allocation of health personnel in rural hospitals through understanding the status of health human resources of rural hospitals in remote and poor areas of Sichuan Province. Methodes This study used cluster sampling method, combined with questionnaire survey and qualitative interviews. A total of 711 health workers of 29 rural hospitals in Pengzhou and Baoxing of Sichuan Province were interviewed. SPSS16.0 was used for descriptive analysis.Results The average age of rural hospitals health personnel in remote and poor areas of Sichuan Province was 30 years old. Post-secondary education accounted for 58.12%, and Bachelor degree or above accounted for 7.2%. The number of medium and senior professional titles account for 8.4 %. The ratio of doctors to nurses was 1:0.55. In the survey of health workers, those doctors with practice (assistant) license accounted for 38.5%, and those without any qualification occupied 27.1 %. Conclusions The professional titles of medical personnel of rural hospitals in remote and poor areas in Sichuan province are generally low. The distribution of professional categories is irrational. The staff in charge of prevention and care are inadequate. There exist a large number of unqualified medical workers. Therefore, the government should increase the investment in rural health and take measures to stabilize the team structure, introduce the talented, and strengthen the training for health personnel of rural hospitals to improve their overall quality.
Objective To understand the current situation of Chengdu primary health workers’ performance baseline, and to provide decision-making proof and policy recommendations for Chengdu Coordinated and Balanced Urban-rural Development as well as improve primary health workers’ performance in China. Method See the second study in this series. Result The number of the patients of the Chengdu seven Rural Hospitals / Centers showed a trend of slow increase, and all was higher than the national rural hospital average level except the 2 most remote rural hospitals(“Renhe” and “Bailu”). The seven Rural Hospitals / Centers could provide data about the “Six in One” work, and the performance was generally better than that of the world and the national average level , but showed a decreasing trend from the first circle to the third circle in Chengdu. The rate of patients’ satisfaction and very satisfaction for the Rural Hospitals / Centers “Six in One” work reached 65%-80%, but the rate of health workers’ job satisfaction and very satisfaction only reached 9%-46%, and also showed a decreasing trend from the first circle to the third circle. Conclusion The Chengdu primary health workers provide “Six in One” health service with a higher quality than the world and the national average levels. However, the number of the workers is less than enough; the human managerial structure is irrational; the educational and professional levels are low; their treatment and the work environment are poor. The distribution density , the academic qualification and the structure rationality of professional ranks of health personnel show a decreasing trend, and the difficulty of the service is gradually increasing from the first circle to the third circle, which causes the satisfaction rate of the workers’ job to decrease gradually from the first circle to the third circle. Suggestion: ① To make special performance assessment standard for special health institutions or personnel, and to give the continual oriented training chance for current health personnel. ② To integrate the regional health resources; to establish long-term and stable regional bilateral appointment help policy, technical and rational two-way referral system and indicator systems. ③ To take measures to solve the problems affecting the professional promotion and improvement of the grass-root health personnel.
ObjectiveTo evaluate the disease characteristics,medical consultation model and barrier to get basic medical service rural patients with chronic obstructive pulmonary disease(COPD) in Chinese western. MethodsThe subjects were collected from a COPD epidemiology study conducted in Western rural district.The factors which were associated with disease characteristics,medical consultation model,and barrier to get basic medical service were analyzed by questionnaire,individual conversation,and laboratory tests. ResultsThis study enrolled 343 COPD patients confirmed by spirometry test.118 subjects consulted their doctors frequently because of apparent symptom.73(62%) subjects had symptom with 5 to 10 years,while 22(19%) subjects with more than 10 years.Among the symptomatic COPD subjects,only 2(2%) cases were diagnosed as COPD previously,15(13%) subjects with chronic bronchitis,and only 1(1%) subject underwent spirometry test.110(93%) subjects were prescribed as antibiotics,68(58%) subjects with theophylline,5(4%) subjects with ICS+LABA.COPD education was acceptable in most subjects(98%),however,the regular follow-up was acceptable in only 26% of subjects. ConclusionLack of disease information,inappropriate medical consultation model,and irregular COPD management in primary care are the major factors which influence diagnosis and treatment of COPD in Western rural area of China.