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Li Y.,National Center for Women and Childrens Health | Ying C.,National Management Center for 12320 Public Health Hotline | Sufang G.,United Nations Childrens Fund | Brant P.,United Nations Childrens Fund | And 2 more authors.
Bulletin of the World Health Organization

Objective To evaluate implementation of the National Essential Medicines Scheme (NEMS) in rural China. Methods Two rural counties/districts in each of three provinces where NEMS had been implemented were surveyed. Information was collected from NEMS staff at the province, county/district, township and village levels; patients with chronic disease were also interviewed. Service provision, finances, prescriptions, inpatient records and the expenditures of patients with certain diagnoses were investigated in township hospitals and village clinics. The results were compared with the corresponding data recorded before NEMS was introduced. Findings Following the introduction of NEMS, drug procurement in each study location was systematized. Total drug costs declined. This, and improved prescribing, reduced the costs of outpatient and inpatient care and led, apparently, to increased uptake of health services. However, the prices of some drugs had increased and the availability of others had declined. The compensation of health-care providers for NEMS-related reductions in their incomes had been largely ineffective. As a result of the introduction of NEMS, health facilities relied more on public financing. Many health-care providers complained about higher workloads and lower incomes. Conclusion Although it was well conceived, the introduction of NEMS into China's decentralized, fee-for-service system of health care has not been straightforward. It has highlighted the problems associated with attempts to modernize health care and health financing for patients' benefit. Sustainable mechanisms to compensate health-care providers for lost income are needed to ensure that NEMS is a success. Source

Zuo X.,Shanghai Institute of Planned Parenthood Research | Zuo X.,Fudan University | Lou C.,Shanghai Institute of Planned Parenthood Research | Gao E.,Shanghai Institute of Planned Parenthood Research | And 3 more authors.
Journal of Adolescent Health

Purpose: Gender is an important factor in understanding premarital sexual attitudes and behaviors. Many studies indicate that males are more likely to initiate sexual intercourse and have more permissive perceptions about sex than females. Yet few studies have explored possible reasons for these gender differences. With samples of unmarried adolescents in three Asian cities influenced by Confucian cultures, this article investigates the relationship between underlying gender norms and these differences in adolescents' premarital sexual permissiveness (PSP). Methods: In a collaborative survey conducted in 20062007 in urban and rural areas of Hanoi, Shanghai, and Taipei, 16,554 unmarried participants aged 1524 years were recruited in the three-City Asian Study of Adolescents and Youth, with 6,204, 6,023, and 4,327 respondents from each city, respectively. All the adolescents were administered face-to-face interviews, coupled with computer-assisted self-interview for sensitive questions. Scales on gender-role attitudes and on PSP for both male and female respondents were developed and applied to our analysis of the data. Multilinear regression was used to analyze the relationship between gender-role attitudes and sexual permissiveness. Results: Male respondents in each city held more permissive attitudes toward premarital sex than did females, with both boys and girls expressing greater permissiveness to male premarital sexual behaviors. Boys also expressed more traditional attitudes to gender roles (condoning greater inequality) than did girls in each city. Adolescents' gender-role attitudes and permissiveness to premarital sex varied considerably across the three cities, with the Vietnamese the most traditional, the Taiwanese the least traditional, and the adolescents in Shanghai in the middle. A negative association between traditional gender roles and PSP was only found among girls in Shanghai and Taipei. In Shanghai, female respondents who held more traditional gender-role attitudes were more likely to exercise a double standard with respect to male as opposed to female premarital sex (odds ratio [OR] = 1.18). This relationship also applied to attitudes of both girls and boys in Taipei (OR = 1.20 and OR = 1.22, respectively). Conclusions: Although with variation across sites, gender differences in PSP and attitudes to gender roles among adolescents were very significant in each of the three Asian cities influenced by Confucian-based values. Traditional gender norms may still be deeply rooted in the three cities, especially among females; while it is important to advocate gender equity in adolescent reproductive health programs, the pathway of traditional gender norms in influencing adolescent reproductive health outcomes must be understood, as must differences and similarities across regions. © 2012 Society for Adolescent Health and Medicine. All rights reserved. Source

Xu T.,National Center for Control and Prevention | Xu T.,National Center for Women and Childrens Health | Wu Z.,National Center for Control and Prevention | Yan Z.,National Center for Control and Prevention | And 2 more authors.
Journal of Acquired Immune Deficiency Syndromes

Objectives: To investigate the preliminary reliability and validity of the Chinese Mandarin version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales in a sample of general children and children living in HIV/AIDS-affected families. Methods: The PedsQL 4.0 was administered to 116 children aged 8-18 years from HIV/AIDS-affected families and 115 of their caregivers. The questionnaire was also administered to a control group of 109 children and 107 of their caregivers. Results: Most of the self-report and proxy-report scales in both groups exceeded the reliability standard of 0.70, whereas the self-report emotional functioning and school functioning subscales were slightly less than 0.70. On average, children living in HIV/AIDS-affected families scored significantly lower than the control group. The level of agreement between self-reports and proxy reports was low. Correlations were higher on average for the younger age group than for the older age group. Conclusions: The Chinese Mandarin version of PedsQL 4.0 is a valid and reliable instrument for use with children living in HIV families. The health-related quality of life for children living in HIV families is lower than children from ordinary families. Copyright © 2010 by Lippincott Williams & Wilkins. Source

Wang L.H.,National Center for Women and Childrens Health
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]

To determine the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention (PMTCT) in China. From January 1st 2006 to Dec 30th 2008, a total of 1072 pairs of HIV positive pregnant women and their babies who were HIV antibody positive and older than 18 months were recruited in this study. These women who had received maternal health care in health care institutions were from 23 provinces. Subjects were investigated by questionnaire, including social demographic data, usage of ARVs, safe delivery and artificial feeding, and other PMTCT related informations. The trend of different antiretroviral drug regiments in different period were analyzed by Cochran-Mantel-Haenszel (CMH) χ(2) test. By stratified analysis and Fisher exact χ(2) test, the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention were studied. Antiretroviral drug regimens applications mainly included sd-NVP drug regimen, prophylaxis regimen and highly active anti-retroviral therapy (HAART). Among 1072 pairs of HIV positive maternities and babies, 31 babies older than 18 months were HIV infected, MTCT rate was 2.9% (31/1072). (1) The proportion of using ARVs was increasing from 76.4% (306/395) in 2006 to 83.8% (372/444) in 2008, the difference was significant (CMH χ(2) = 6.4, P < 0.05). (2) The ratio that HIV infected maternities adopted ARVs rose from 3.4% (6/178) in 2006 to 26.3% (104/395) in 2008, the ratio increased year by year (CMH χ(2) = 53.1, P < 0.01). On the contrary, usage of sd-NVP declined from 88.8% (158/178) in 2006 to 70.9% (264/372) in 2008 (CMH χ(2) = 48.5, P < 0.01). (3) Among maternities adopted vaginal delivery and artificial feeding, the MTCT rate of ARVs combination group was 1.0% (1/104), while the MTCT rate of sd-NVP group was 5.9% (16/272) (Fisher χ(2) = 5.5, P < 0.05). (4) In the case of artificial feeding, the MTCT rate of prophylaxis regimens and HAART among maternities adopted vaginal delivery was 3.1% (1/32) and 0 respectively. Among maternities adopted cesarean delivery, MTCT rate of prophylaxis regimens and HAART was 3.2% (2/63) and 3.1%(1/32) respectively, both showed no significant difference (Fisher χ(2) = 1.4, P > 0.05; Fisher χ(2) = 0.0001, P > 0.05). Effect of combination of antiretroviral drugs to PMTCT is obvious, the rate of mother to child HIV transmission of prophylaxis regimens and HAART has not shown significant difference. Source

Sun Z.C.,National Center for Women and Childrens Health
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi

To investigate the prevalence on reproductive tract infections (RTIs) status and influencing factors of women living in the rural areas of the middle and western regions in China and to develop the control strategy for RTIs. Questionnaire interview and gynecological examination were carried out to collect the related information. SPSS 16.0 was used to carry on the statistical analysis. 768 subjects (52.8%) had heard of RTIs, but 112 of them (14.6%) did not know the symptoms of it, 244 people (31.8%) do not know the infects of RTIs, 132 women (17.2%) did not know how to prevent RTIs. Gynecological examination revealed that 1111 subjects (76.4%) had at least one kind of RTIs, where the highest prevalence was chronic cervicitis, 621 women (42.7%) suffered from this, followed by bacterial vaginosis with 423 women suffered, accounted for 29.1%. Data from influencing factors analysis showed that region, educational level, occupation, whether having healthy check-up or not in the past 1 year and the habits of the reproductive women all contributed to the prevalence of the RTIs. Multiple regression analysis for influencing factors showed that reproductive aged women, living in western region, sharing the basin of washing genitals with others, not drying the cleaned underwear, not cleaning the pudendum before sexual intercourse and at 25 - 40 of age, having high prevalence of RTIs. RTIs is prevalent among women in the rural areas. Intervention programs should be done according to the influencing factors while knowledge on RTIs among women needs to be improved, including promotion on healthy behavior, quality of medical institutions and male participation. Source

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