Qisheng Gao

Objective: This study aims to systematically characterize the global, regional, and national trends of myocarditis among individuals aged 15–39 years between 1990 and 2021, identify associated influencing factors, and forecast future burden through 2050. Findings from this research are expected to support the development of evidence-based health policies and enhance resource allocation for this vulnerable population. Methods: Data on incidence, mortality, and disability-adjusted life years (DALYs) attributable to myocarditis among individuals aged 15–39 years were obtained from the Global Burden of Disease (GBD) study. Analyses were stratified by region, country, age, sex, and sociodemographic index (SDI) to explore heterogeneity across populations. Temporal trends were evaluated by estimating the annual percentage change (APC) using the Segment regression model, with the estimated average annual percentage change (EAPC) calculated through log-linear models for robustness. Results: There were 349,033.33 incident cases of myocarditis in adolescents and young adults worldwide in 2021[95% uncertainty interval (UI), 235,755.91–494,002.44]. Mortality was recorded at 3,300.73 deaths (95% UI, 2,643.01–4,256.11), while DALYs totaled 208,644.28 (95% UI, 169,653.92–267,518.34). The high SDI region recorded the highest incidence rate among the five SDI categories, reaching 13.66 per 100,000 population (95% UI, 9.84–18.62). The greatest number of myocarditis-related deaths occurred regionally in East Asia (1,097.59; 95% UI, 726.99–1,426.58). India reported the most incident cases at the national level (71,257.12; 95% UI, 46,817.01–100,807.05). In 2021, the incidence, mortality, and DALYs of myocarditis were all higher in men than in women. The highest incidence was observed in the 30–34 years age group, whereas the 35–39 years age group had the highest mortality and DALYs. Both high and low temperatures were found to be significant risk factors for myocarditis in this group, based on the 2021 GBD data. Frontier analyses indicate that there is potential for alleviating the burden of myocarditis in adolescents and young adults, considering national and regional levels of development. Through 2050, incidence and DALYs rates are expected to continue to drop. Conclusion: While global incidence, mortality, and DALYs rates of myocarditis among adolescents and young adults have shown a declining trend, the numbers of incident cases, deaths, and DALYs continue to rise. Enhancing the understanding of its epidemiological characteristics can facilitate more effective prevention and control strategies.

Objective Standardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the quality of residency training. This study aimed to analyse the results and associated factors of the graduation examination of standardised residency training in Zhejiang Province in 2020. Design Cross-sectional analysis of examination results data. Setting Medical and health institutions and universities in Zhejiang Province. Participants A total of 5555 examinees took the graduation examination of standardised residency training in Zhejiang Province in 2020. Primary outcomes Pass rates of the practical skill examination and written examination. Results The pass rates for the practical skill examination and written examination were 91.8% and 96.5%, respectively. Examinees aged 30 and above (adjusted OR (AOR)=0.48, 95% CI 0.26 to 0.89), those with 3 years (AOR=0.19, 95% CI 0.09 to 0.43) and 2 years (AOR=0.61, 95% CI 0.40 to 0.96) of training, those who retook the examination (AOR=0.28, 95% CI 0.20 to 0.391) and those from primary healthcare institutions (AOR=0.56, 95% CI 0.40 to 0.77) were less likely to pass the practical skill examination. Examinees with a postgraduate degree and those from colleges and universities had higher pass rates in the written examination (AOR=6.37, 95% CI 1.95 to 23.34; AOR=2.87, 95% CI 1.40 to 6.65, respectively). Examinees aged 30 and above (AOR=0.08, 95% CI 0.01 to 0.30), those aged between 25 and 30 (AOR=0.22, 95% CI 0.03 to 0.80), those who retook the examination (AOR=0.04, 95% CI 0.03 to 0.07), those from second-level hospitals (AOR=0.58, 95% CI 0.39 to 0.87) and those who failed the practical skill examination (AOR=0.17, 95% CI 0.12 to 0.25) were less likely to pass the written examination. Conclusions The pass rate of the graduation examination of standardised residency training was associated with the individual characteristics of the examinees. The results of practical skill examination were related to the results of the written examination.

The integrated county healthcare consortium (ICHC) is becoming an important measure to improve the capacity of primary-level medical services and to achieve grading diagnosis and treatment system in China. However, it is not clear whether health professionals are satisfied with this reform and what are the problems with it. This study aimed to understand the satisfaction of healthcare professionals to the ICHC in Zhejiang Province, China, and analyze the problems and improvement measures of the ICHC. A cross-sectional study was carried out in the 11 pilot counties (cities and districts) implementing the construction of the ICHC in Zhejiang in November 2019. Healthcare professionals from the leading county-level hospital, three township health centers (THCs) or community health centers (CHCs) in each ICHC were invited to participate in this survey. A total of 3531 healthcare professionals were included, 85.92% of the participants agreed that the integration of the Centers for Disease Control and Prevention (CDC) and other professional public health institutions into the construction of ICHC could actively promote basic public health work. The most severe problem was the lack of financial guarantee fund input (severity score: 2.92 ± 1.76). The most crucial measure to promote the construction of the ICHC was to increase government financial input and improve the security mechanism (importance score: 4.81 ± 0.47). The satisfaction of the healthcare professionals to the ICHC was 89.41%. The satisfaction of healthcare professionals from county-level hospitals was 2.37 (95% CI: 1.760–3.238) times higher than that of healthcare professionals from the township health centers (THCs) or community health centers (CHCs). The satisfaction of health professionals with a college degree or below was 3.215 (95% CI: 1.413–6.786) times higher than that of health professionals with a master’s degree or above. Zhejiang Province has taken adequate measures to promote the construction of the ICHC. However, there are still some problems. Appropriate and effective policies should be implemented to enhance policy coordination and promote competition among ICHCs, as well as to strengthen medical service quality management and improve performance appraisal scheme.

Background Standardized residency training is an important part of post-graduation medical education for medical students in China, and the graduation examination is a necessary part to test the effect of residency training and an important measure to guarantee the quality of residency training. This study analyzed the graduation examination results of standardized residency training in Zhejiang Province in 2020. Methods This study calculated the pass rates for the practical skills examination and written examination for 5555 examinees and analyzed the relationship between examinees' demographic characteristics and pass rates. Results The pass rates for practical skills examination and written examination were 91.8% and 96.5%, respectively. Gender, age, education, and type of organizations were significantly associated with the pass rates. Examinees who retook the examination were less likely to pass the practical skills examination (AOR = 0.266, 95% CI = 0.189-0.377) and the written examination (AOR = 0.043, 95% CI = 0.025-0.074) than examinees who took the examination for the first time. If an examinee did not pass the practical skills examination initially, he or she was less likely to pass the written examination (AOR = 0.172, 95% CI = 0.120-0.249) Conclusion The pass rate of graduation examination of standardized residency training was not only influenced by the individual characteristics of the examinees but also related to the level of training hospitals and lead teachers. Therefore, it is necessary to take comprehensive measures to further improve the system of standardized residency training.

Background: It has become increasingly important to measure the health-related quality of life (HRQoL) of rare diseases in children and adolescents in recent decades. Much attention has been paid to investigate the HROoL of a specific rare disease by self-report in previous studies. This study aimed to evaluate and compare the HROoL of 11 rare diseases in Chinese children by parent proxy-report, to explore the factors associated with HROoL of patients, and to understand the problems of most concern. Methods: A total of 651 children aged from 2 to 18 were enrolled from the Children’s Hospital Affiliated Zhejiang University in 2018. Their parents completed the parent proxy-report version of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). Independent samples t-test, one-way ANOVA, or Kruskal–Wallis H test was used to compare HROoL scores between groups. Multilevel linear regression models with random intercept were applied to analyze the relationship between socioeconomic variables and both the total score and subdomain scores. Results: The total PedsQL scores of Patent ductus arteriosus (PDA), Infantile agranulocytosis, Autoimmune thrombocytopenia (ITP), Polysyndactyly, Hirschsprung disease, Cleft lip and palate, Tetralogy of fallot, Myasthenia gravis, Guillain–barre syndrome, Glycogen storage disease, and Langerhans cell histiocytosis children were 79.65 ± 5.46, 95.88 ± 3.48, 71.39 ± 3.27, 91.77 ± 6.35, 76.18 ± 6.92, 96.33 ± 4.22, 77.85 ± 8.90, 95.99 ± 3.31, 85.77 ± 4.56, 82.97 ± 4.13 and 77.6 ± 5.15, respectively. Age was significantly associated with physical functioning, school functioning, and psychosocial health scores. The household registration place was significantly related to the total score. The most urgent desire of patients was to reduce the overall medical costs. Conclusions: This study showed that patients with PDA had the lowest physical functioning score, while patients with ITP scored the lowest in the emotional functioning, social functioning, school functioning, psychosocial health, and total scores. Incentive policies should be further adopted to improve orphan drug availability and reduce the economic burden of rare diseases.

Background: It has become increasingly important to measure the health-related quality of life (HRQoL) of rare diseases in children and adolescents in recent decades. Much attention has been paid to investigate the HROoL of a specific rare disease by self-report in previous studies. This study aimed to evaluate and compare the HROoL of 11 rare diseases in Chinese children by parent proxy-report, to explore the factors associated with HROoL of patients, and to understand the problems of most concern. Methods: A total of 651 children aged from 2 to 18 were enrolled from the Children’s Hospital Affiliated Zhejiang University in 2018. Their parents completed the parent proxy-report version of the Pediatric Quality of Life Inventory^TM 4.0 (PedsQL^TM 4.0). Independent samples t-test, one-way ANOVA, or Kruskal-Wallis H test was used to compare HROoL scores between groups. Multilevel linear regression models with random intercept were applied to analyze the relationship between socioeconomic variables and both the total score and subdomain scores.Results: The total PedsQL scores of Patent ductus arteriosus(PDA), Infantile agranulocytosis, Autoimmune thrombocytopenia(ITP), Polysyndactyly, Hirschsprung disease, Cleft lip and palate, Tetralogy of fallot, Myasthenia gravis, Guillain-barre syndrome, Glycogen storage disease(GSD), and Langerhans cell histiocytosis children were 79.65±5.46, 95.88±3.48, 71.39±3.27, 91.77±6.35, 76.18±6.92, 96.33±4.22, 77.85±8.90, 95.99±3.31, 85.77±4.56, 82.97±4.13 and 77.6±5.15, respectively. Age was significantly associated with physical functioning, school functioning, and psychosocial health scores. The household registration place was significantly related to the total score. The most urgent desire of patients was to reduce the overall medical costs.Conclusions: This study showed that patients with Patent ductus arteriosus(PDA) had the lowest physical functioning score, while patients with Autoimmune thrombocytopenia(ITP) scored the lowest in the emotional functioning, social functioning, school functioning, psychosocial health, and total scores. Incentive policies should be further adopted to improve orphan drug availability and reduce the economic burden of rare diseases.

Supplier evaluation in tourism supply chain (TSC) is a typical multi-criteria group decision problem. An evaluation approach that makes use of 2-tupple linguistic model, quality function deployment (QFD), and fuzzy information aggregation is proposed. The establishment process of assessment criteria based on fuzzy linguistic term sets has been discussed, and house of quality (HOQ) based on 2-tuple linguistic model is constructed to compute the weights of suppliers' factors and the rank order. By using of ordered weighted averaging (OWA), the aggregation approach of multi-granularity linguistic term can manage non-homogenous decision information problem successfully. At last a case study on a travel operator's evaluation of suppliers solved by the proposed approach is illustrated.

Appropriate healthcare technologies (AHTs) are an important strategy for improving the availability and accessibility of healthcare services. It is not clear what impact AHTs have on health workers and consumers; and whether those AHTs can continue in place without special or ongoing financial support. This study investigated the attitudes of health workers and consumers towards AHTs. Health facilities from five counties in Zhejiang were surveyed. Participants of the study included all health workers who were involved in the delivery of AHTs in the selected organizations and a group of randomly selected patients who sought services from the participating organizations. A total of 822 questionnaires from health workers and 693 questionnaires from patients were collected for data analyses. The questionnaires measured perceptions and attitudes of respondents towards AHTs using a Likert scale. The respondents delivering public health services rated the highest scores to AHTs (4.42 ± 0.7), followed by those engaged in management of chronic conditions (4.41 ± 0.57) and Traditional Chinese Medicine (TCM) (4.29 ± 0.55). Around 90 % of health workers believed that AHTs were meaningful for rural patients; however, only 69 % of health workers believed that the technologies encouraged by the government were sufficiently developed or “mature”, and more than 24 % acknowledged difficulties in using those technologies. Overall, patients were satisfied with AHTs, with 71.6 % feeling “very satisfied” or “satisfied”, 24.2 % feeling “acceptable” and 1.6 % feeling “dissatisfied”. Most (83 %) patients were satisfied or very satisfied with Traditional Chinese Medicine, compared with management of chronic conditions (80 %), family planning (67 %), public health services (64 %), and finally with maternal and child health care (59 %). Local acceptability should be taken into consideration in determination of AHTs; consumer health literacy needs improvement, particularly in relation to public health and preventive services.