Shiwei Gong

Exercise brings great benefits to patients with depression and is recommended as adjunct treatment for depressive disorder. The low compliance to exercise makes the effective management of depression a serious challenge. Preferences for exercise are important for promoting intrinsic motivation, enjoyment, and behavior maintenance. This study quantified the exercise preferences of patients with depression by a discrete choice experiment (DCE), which provided references for the development of intervention programs, so as to improve the physical activity level of patients with depression and promote the effective management of depressive symptoms. The six attributes (Professional guidance, Interestingness, Type, Special venue, Frequency, and Safety) and their levels were developed through a literature review, in-depth interviews, and focus group discussions. The software Ngene 1.2 was used to generate 36 choice sets, which were divided into 4 blocks. A survey instrument was developed adhering to the design-principles of DCE. A mixed logit model was used to estimate the preferences of patients with depression. The choice probability of exercise scenarios were predicted. The preferences of 323 depressed patients were analyzed. High level of interestingness was the most important attribute level (coefficient = 0.84, P < 0.01), followed by high safety (coefficient = 0.79, P < 0.01). There is a gender-based and daily steps-based difference in preference. The optimal exercise strategy should be fun and safe, exercise 3–4 times a week, venue without restrictions, professional guidance, and a combination of teams and individuals. Based on the findings, patients with depression in this target population prefer exercises with attributes such as intrerestingness, safety, while considering gender-based and daily steps-based deference in preferences.

Psychiatric nurses are instrumental in enhancing accessibility to care and addressing the mental health care needs of individuals. However, the field faces a significant shortage of nurses coupled with a high turnover rate. Developing policies to attract or retain psychiatric nurses is imperative, but little is known about the preferences of psychiatric nurses regarding the economic and non-economic attributes of work. Here, a discrete choice experiment (DCE) was used to explore psychiatric nurses’ job preferences. A survey instrument was developed adhering to the design-principles of DCE. Psychiatric nurses were surveyed nationwide based on convenience sampling. A mixed logit model was used to estimate the psychiatric nurses’ preferences. Willingness to pay was calculated and the change in the probability of psychiatric nurses accepting a job when attribute levels changed was simulated. The attribute level most valued by respondents was ‘violent coping strategies-impeccable’ (coefficient = 1.002, p < 0.01) and willingness to pay for it is 4476.5323 CNY. The most important attribute level for psychiatric nurses living in cities was ‘respect-high’ (coefficient = 0.505, p < 0.01), and for psychiatric nurses living in town is ‘study assistance for children-thorough’ (coefficient = 0.620, p < 0.01). Notably, psychiatric nurses with less than ten years of work experience exhibited significant preferences for ‘opportunity to upgrade-sufficient’ (coefficient = 0.417, p < 0.01), whereas this preference was insignificant among those with ten years or more of experience (p > 0.05). Changing ‘violence coping strategies’ from ‘without’ to ‘impeccable’ increased the probability of psychiatric nurses accepting the job by 37.04%. The optimal job increased the probability of psychiatric nurses accepting the job by 86.06%. Psychiatric nurses would prefer jobs with higher income, more respect, better coping strategies with violence, better opportunities for promotion, and a good working atmosphere. Psychiatric nurses with different seniority and residence had different preferences. What is already known. Psychiatric nurses play a pivotal role in improving access to care and meeting mental health care needs. Job characteristics that are important to clinical nurses have been identified, but these may not be value most for psychiatric nurses. How psychiatric nurses can make trade-offs between desirable and undesirable job characteristics to determine the best possible choice has not adequately demonstrated. What this paper adds. This study used the discrete choice experiment, a novel and innovative methodology, to estimate psychiatric nurse job preferences in developing country. Psychiatric nurses would prefer jobs with higher income, more respect, impeccable violence coping strategies, better opportunities for promotion, and a good working atmosphere. Findings can inform policy makers and healthcare managers about which job characteristics optimization should be prioritized when developing policies and strategies to attract and retain psychiatric nurses.

Introduction: Tumor necrosis factor (TNF) inhibitors (adalimumab, infliximab, etanercept, golimumab, and certolizumab pegol) have revolutionized the treatment of severe immune-mediated inflammatory diseases, including rheumatoid arthritis, Crohn’s disease, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. This study assessed adverse drug reactions (ADRs) after the use of TNFα inhibitors in VigiAccess of the World Health Organization (WHO) and compared the adverse reaction characteristics of five inhibitors to select the drug with the least risk for individualized patient use.Methods: The study was a retrospective descriptive analysis method in design. We sorted out five marketed anti-TNFα drugs, and their ADR reports were obtained from WHO-VigiAccess. Data collection included data on the age groups, sex, and regions of patients worldwide covered by ADR reports, as well as data on disease systems and symptoms caused by ADRs recorded in annual ADR reports and reports received by the WHO. By calculating the proportion of adverse reactions reported for each drug, we compared the similarities and differences in adverse reactions for the five drugs.Results: Overall, 1,403,273 adverse events (AEs) related to the five anti-TNFα agents had been reported in VigiAccess at the time of the search. The results show that the 10 most commonly reported AE manifestations were rash, arthralgia, rheumatoid arthritis, headache, pneumonia, psoriasis, nausea, diarrhea, pruritus, and dyspnea. The top five commonly reported AE types of anti-TNFα drugs were as follows: infections and infestations (184,909, 23.0%), musculoskeletal and connective tissue disorders (704,657, 28.6%), gastrointestinal disorders (122,373, 15.3%), skin and subcutaneous tissue disorders (108,259, 13.5%), and nervous system disorders (88,498, 11.0%). The preferred terms of myelosuppression and acromegaly were obvious in golimumab. Infliximab showed a significantly higher ADR report ratio in the infusion-related reaction compared to the other four inhibitors. The rate of ADR reports for lower respiratory tract infection and other infections was the highest for golimumab.Conclusion: No causal associations could be established between the TNFα inhibitors and the ADRs. Current comparative observational studies of these inhibitors revealed common and specific adverse reactions in the ADR reports of the WHO received for these drugs. Clinicians should improve the rational use of these high-priced drugs according to the characteristics of ADRs.

Background: The study aims to explore the association between cigarette smoking with blood exposure to volatile organic compounds using population data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Methods: Based on the data of NHANES 2017–2018, we identified 1117 participants aged 18 to 65 years, who had complete VOCs testing data and filled out the Smoking-Cigarette Use and Volatile Toxicant questionnaires. The participants consisted of 214 dual-smoking persons, 41 E-cigarette smokers, 293 combustible-cigarette smokers and 569 non-smokers. We used One-way ANOVA and Welch’s ANOVA to compare differences of VOCs concentration among 4 groups and multivariable regression model to confirm the factors associated with VOCs concentration. Results: In dual-smoking and combustible-cigarette smokers, blood concentration of 2,5-Dimethylfuran, Benzene, Benzonitrile, Furan, Isobutyronitrile were higher than non-smokers. When compared with people who never smoked, E-cigarette smokers had similar blood concentrations of VOCs. Blood concentrations of Benzene, Furan, and Isobutyronitrile were significant higher in combustible-cigarette smokers than in E-cigarette smokers. In the multivariable regression model, dual-smoking and combustible-cigarette smoking were associated with elevated blood concentrations of several VOCs except 1,4-Dichlorobenzene, while E-cigarette smoking was only associated with elevated 2,5-Dimethylfuran concentration. Conclusions: Smoking, mainly dual-smoking and combustible-cigarette smoking, is associated with elevated blood concentration of VOCs, while the effect is weak in E-cigarette smoking.

Background: The implementation of the NVBP policy has generated considerable reductions in drug procurement prices and an increase in the market share of the NVBP drugs.This study aimed to investigate patients' attitudes towards switching to drugs of national volume-based procurement (NVBP) and identify their underlying influencing factors in Wuhan, China. Methods: A total of 21 eligible patients from the Wuhan Union Hospital who were switched to NVBP drugs between January 2022 and May 2022 were included in our study. Semi-structured face-to-face interviews were conducted to collect interview information and the interview data was analyzed by the Colaizzi seven-step method. Results: Twenty-one semi-structured face-to-face interviews were conducted. The duration of each interview was 25–35 min and three themes related to patients' attitudes and their influencing factors were extracted, including (1) Patients' perception of the NVBP drugs; (2) Family and social influence to patients; (3) Medication habits of patients. This study found: 1) 71.4% patients (15/21) showed a positive attitude towards switching to NVBP medicines; 2)80.9% patients (17/21) have felt a significant reduction in their medication cost after the implementation of the NVBP policy; 3)Advices from healthcare professionals and health insurance reimbursement policies showed great impacts on patients' attitude towards switching to NVBP drugs; 4)Attitudes towards switching to NVBP drugs varied considerably among patients with different severities of disease. Conclusion: The implementation of the NVBP policy has significantly reduced the cost of healthcare for patients and has been supported by71.4% (15 of 21) patients. However, some issues have been identified in the implementation of the policy in this study. Health professionals in general need to contribute more efforts to improve patients' preconceptions about the NVBP drugs and boost their confidence in the NVBP drugs.

Objective: In 2017, China launched a new round of medical reform (NMR) to address the inaccessibility of high-priced drugs for patients with serious diseases. This study explored the impact of the NMR on the accessibility and affordability of high-priced monoclonal antibodies (mAbs), and the effective promotion policies after the NMR. Methods: We used a standard method developed by the World Health Organization to conduct two surveys on the availability of mAbs and their prices before and after the NMR in the public hospitals in Hubei province, China. By interviewing hospital pharmacy experts, we identified the potential value of the current NMR in improving the access to therapeutic mAbs. Results: The average availability of 13 mAbs increased by 8.1% in the surveyed hospitals of Hubei province after the NMR. The median unit price of 10 mAbs dropped by 34.3%. The average affordability of a treatment cycle of 10 mAbs dropped from 680 days to 298 days of the disposable daily income for a middle-income resident (56.2% reduction). The drug price negotiation of medical insurance inclusion and the promotion of consistent evaluation of generic and original drugs could effectively promote the accessibility of mAbs. However, the zero markup of drug pricing and the limit on the proportion of drug revenues in public hospitals showed certain negative effects on the availability of mAbs. Conclusion: Not all current NMR policies play a positive role in promoting the accessibility of mAbs. To further improve the accessibility of mAbs in the future in China, it is therefore critical to increase the investment in independent research and development of high-quality mAbs, establish localized guidelines for the rational use of mAbs in clinical practice, and have a cost-sharing mechanism for high-priced drugs with multiple stakeholders.

Objective Generic drugs provide an opportunity for savings in drug expenditure since they are available at a lower cost and do not affect patients’ health. A better understanding of pharmacists’ knowledge, attitudes, and perception can promote the quality use of generic drugs. The objective of this study was to investigate the knowledge, attitudes, and perception of pharmacists from tertiary hospitals in China regarding generic drugs. Methods A cross-sectional survey using a postal questionnaire was conducted, which was sent to 200 hospital pharmacists randomly selected from tertiary hospitals in Hubei Province. A total of 125 questionnaires out of 200 were received. Of the respondents, 80 were female and 45 were male. Results The majority of respondents (87.2%) could clearly distinguish between original and generic drugs. Pharmacists agreed that generic drugs were less effective (52.8%) and produced more side effects (52%). Fortynine respondents thought that generic drug products were not adequately tested. Approximately 78% and 60% of the pharmacists indicated that generic substitution was not feasible for drugs with narrow therapeutic windows and drugs for critical diseases, respectively. Most of them supported the recommendation of generic drugs based on professional judgment. Conclusion Our study showed that a considerable portion of Chinese hospital pharmacists hold negative perceptions of generic drugs. Interventions to improve pharmacists’ knowledge of generic drugs are needed.

Background: For patients with rare diseases (RD), misdiagnosis (or erroneous diagnosis) is one of the key issues that hinder RD patients’ accessibility to timely treatment. Yet, little is known about the main factors that are associated with RD patients’ misdiagnosis. The objective of this study is to analyze data from a national survey among 2040 RD patients from China to explore the association between misdiagnosis and various factors, including patients’ demographics, socio-economic status, medical history, and their accessibility to RD information. Results: Three binary logistic regression analyses were performed to assess the relationships between misdiagnosis and level of rarity of the RDs (mild, moderate, and severe), demographics, health insurance levels, and accessibility to disease-related information by using the total sample, and the adult and non-adult sub-samples. We found that accessibility to RD information is the most critical factor influencing the patients’ chances of being misdiagnosed (odds ratio [OR] = 4.459, p < 0.001). In other words, the greater the difficulty in accessing the information on RD management, the higher the possibility of experiencing misdiagnosis. Such influences of information accessibility on misdiagnosis were repeatedly discovered when examining the adult (OR = 3.732, p < 0.001) and the non-adult (OR = 5.174, p < 0.001) sub-samples. The association between perceived economic status and misdiagnosis was only significant in the total sample. The only other factor significantly associated with misdiagnosis was disease multimorbidity: participants who reported no multimorbidity are less likely to experience misdiagnosis (OR = 0.42, p < 0.001). Conclusions: Our study indicated that patients with RDs who have difficulty in accessing disease-related information are two to five times more likely to have experienced misdiagnosis. Even after adjusting for the patients’ age, gender, economic levels, and education levels, the impact of information accessibility was still significant. Our finding highlights the importance of access to information in reducing misdiagnosis among RD patients.

BackgroundFor patients with rare diseases (RD), misdiagnosis (or erroneous diagnosis) is one of the key issues that hinder RD patients’ accessibility to timely treatment. Yet, little is known about the main factors that are associated with RD patients’ misdiagnosis. The objective of this study is to analyze data from a national survey among 2,040 RD patients from China to explore the association between misdiagnosis and various factors, including patients’ demographics, socio-economic status, medical history, and their accessibility to RD information.ResultsThree binary logistic regression analyses were performed to assess the relationships between misdiagnosis and level of rarity of the RDs (mild, moderate, and severe), demographics, health insurance levels, and accessibility to disease-related information by using the total sample, and the adult and non-adult sub-samples. We found that accessibility to RD information is the most critical factor influencing the patients’ chances of being misdiagnosed (odds ratio [OR] =4.459, p<0.001). In other words, the greater the difficulty in accessing the information on RD management, the higher the possibility of experiencing misdiagnosis.Such influences of information accessibility on misdiagnosis were repeatedly discovered when examining the adult (OR=3.732, p<0.001) and the non-adult (OR=5.174, p<0.001) sub-samples. The association between perceived economic status and misdiagnosis was only significant in the total sample. The only other factor significantly associated with misdiagnosis was disease multimorbidity: participants who reported no multimorbidity are less likely to experience misdiagnosis (OR=0.42, p<0.001).ConclusionsOur study indicated that patients with RDs who have difficulty in accessing disease-related information are two to five times more likely to have experienced misdiagnosis. Even after adjusting for the patients’ age, gender, economic levels, and education levels, the impact of information accessibility was still significant. Our finding highlights the importance of access to information in reducing misdiagnosis among RD patients.

Background: Increasing attention is being paid to improve the quality of life of patients with rare diseases in China. However, we are currently unaware of the problems encountered in the medical services of rare diseases from the viewpoints of doctors and patients. This study addressed the differences in the perceived barriers of diagnosis and treatments for rare diseases between doctors and patients in China. Methods: Two independent cross-sectional surveys on the perception of Chinese doctors’ and patients’ experiences with rare diseases were launched online between January and February 2018. A non-probability, convenience sampling method was employed to recruit participants. Results: In all, 45 rare diseases were reported by 139 doctors and 1853 patients. Patients with rare diseases faced significantly more difficulties in receiving accurate diagnosis (72.0%) and accessing information related to diagnosis and treatment (77.3%) as compared with doctors (34.5% and 40.3%, p < 0.0001, respectively). Specially, patients felt more difficulties than doctors in obtaining sustainable treatment for rare diseases (84.3% vs. 49.6%, p < 0.001). A higher percentage of patients (58.7%) than that of doctors (39.1%) had concerns in terms of the affordability of drugs. Further, 66.3% patients claimed that the drugs used to treat their conditions were not covered by their current medical insurances, whereas only 21.6% for doctors (p < 0.0001). Moreover, 35.3% of doctors responded that they recommended patients to visit the specialist they knew or were acquainted with, whereas 30.0% of patients said that their doctors chose to treat them based on their past experiences (p < 0.001). Conclusion: The perceived experience of patients with regard to diagnosis and treatment was significantly different from that of doctors. An integrated medical service platform should be established to facilitate better communication and mutual understanding of rare diseases between patients and doctors.