BackgroundThe association between obesity and depression has been documented in previous systematic studies but remains controversial. Many prospective studies have focused on children and youth, and several studies have examined this relationship among older populations. This study of the changes in obesity status aimed to examine the association between depression and obesity among middle-aged and elderly adults in China.MethodsThe data originated from the follow-up survey (2011 and 2013–2015) of the China Health and Retirement Longitudinal Study (CHARLS) and included 3337 residents aged at least 45 years who completed a physical examination and were evaluated with the Center for Epidemiological Studies Depression Scale (CES-D-10), which assessed depressive symptoms. Obesity status was defined by body mass index (BMI) and waist circumference (WC) according to Chinese criteria. A time-dependent Cox proportional hazards model was used to estimate the relationship between obesity status and depressive symptoms.ResultsThe rate of depression in men and women was 26.67 and 38.37%, respectively. Based on BMI, the proportion of the population that was overweight and obese was 28.07 and 9.26%, respectively, in males and 35.03 and 16.84%, respectively, in females. Males with obesity were less likely to suffer from depressive symptoms than males with a normal weight (ORHR = 0.506, 95% CI = 0.347~ 0.736). Based on WC, the proportion of abdominal obesity was 49.35% in males and 73.65% in females. Males with abdominal obesity were less likely to suffer from depressive symptoms than males without abdominal obesity (ORHR = 0.775, 95% CI = 0.644~ 0.933).ConclusionObesity is more likely to be associated with the onset of depression in males than in females. However, regardless of underweight or overweight status, the relationship between weight and depressive symptoms is negatively associated among females and males. In conclusion, both BMI and WC can be used as tools for examining the association between obesity and depression.

ObjectivesTo delineate hospital service areas (HSAs) using the Dartmouth approach in China and identify the hypothesised demand-side, supply-side and region-specific factors of health expenditure within HSAs.DesignPopulation-based descriptive study.SettingWe selected the metropolis of Chengdu, one of the three most populous cities in China as a case for the analysis, where approximately 16.33 million residents living.ParticipantsIndividual-level in-patient discharge records (n=904 298) during the fourth quarter of 2018 (from 1 September to 31 December) were extracted from Sichuan Health Commission. Cases of non-residents of Chengdu were excluded from the datasets.MethodsWe conducted three sets of analyses: (1) apply Dartmouth approach to delineate HSAs; (2) use Geographic Information System (GIS)-based method to demonstrate health expenditure variations across delineated HSAs and (3) employ a three-level multilevel linear model to examine the association between health expenditure and demand-side, supply-side and region-specific factors.ResultsA total of 113 HSAs with a median population of 60 472 (ranging from 7022 to 827 750) was delineated. Total in-patient expenditure per admission varied more than threefold across HSAs after adjusting for age and gender. Apart from a list of demand-side factors, an increased number of physicians, healthcare facilities at higher levels and for-profit healthcare facilities were significantly associated with increased total in-patient expenditures. At the HSA level, the proportion of private healthcare facilities located in a single HSA was associated with increased total in-patient expenditure generated by that HSA, while the increased number of healthcare facilities in a HSA was negatively associated with the total in-patient expenditures.ConclusionHSAs were delineated to help establish an accountable healthcare delivery system, which serves as local hospital markets to provide in-patient healthcare via connecting demanders with suppliers inside particular HSAs. Policy-makers should adopt HSAs to identify variations of total in-patient expenditures among different areas and the potential associated factors. Findings from the HSA-based analysis could inform the formulation of relevant health policies and the optimisation of healthcare resource allocations.

Background Plenty of evidence has found that successful aging and its components were significantly associated with older adults’ health, their achievement has a positive effect on reducing mortality rates. However, it is unclear whether education could modify the effect of successful aging on morality risk. Numerous literatures from worldwide were cross-sectional and previous studies on the association between successful aging and mortality in China were quite few. Methods Using four waves (2011-2012, 2013-2014, 2014-2015, 2015-2016) of a large nationally representative survey in China derived from CHARLS (China Health and Retirement Longitudinal Study) with 4,824 older adults aged 60 and older, this study aimed to evaluate the effect of successful aging and each of its components on mortality risk of different gender of older adults in China, we further discussed whether education was a moderator in this effect and investigated differences in results among males and females. Successful aging was measured by absence of major diseases, freedom from disability, high cognitive function, no depressive symptoms, and active social engagement in life. Cox proportional hazards models were applied to estimate the education's moderate effect on the relationship between successful aging and mortality after controlling a rich set of covariates that included demographics, socioeconomic status, and health behaviors.Results We found that 15.18% (n=367) for males and 15.74% (n=379) for females were defined as successful aging and the mortality were 2.61% (n=63) for males and 3.45% (n=83) for females during the survey. The overall prevalence of successful aging in both genders were12.5% (n=603) and the overall mortality rate was 3.03% (n=146).It is the first longitudinal study using national cohort data to research the educational effects on the association between mortality and successful aging, our study showed that the effect only existed in females aged 65-74 years old group with lower education.Conclusions Education has the significant effect on the relationship between successful aging and mortality. Physical health is significantly associated with the achieving of successful aging among young older. More measures should be paid on improving mental health among the young female older with lower education to achieve successful aging and to against mortality and live longevity.

Background: The Health Commission of Wuhou reformed its primary care system by implementing a Transformative Learning Collaborative (TLC): a structure that supports shared learning and rapid change among a group of providers or organisations. This paper examines the adaptation of a district TLC to implement, disseminate, and scale up the principles of a District Model for family doctor teams and managers of Community Health Centres (CHCs) in China. We describe TLC as a means of informing training content and evaluated the implementation through participant feedback. Methods: A district TLC was implemented to disseminate a District Model, which included six quality improvement principles and was developed to reform the primary care delivery process. Family doctor teams (n=26, 52 family doctor individuals) and managers (n=13) from thirteen CHCs in a Chinese district participated in the TLC organisation. The TLC process was described, and survey data served to assess the activities and resource usefulness. The perceived implementation enablers and inhibitors were also descriptively analysed. Results: The purpose, content, and process of TLC were described. The implementation included four steps: structure establishment, participants identification, activities implementation, and setting up a feedback system. The survey findings captured family doctors’ and managers’ feedback with regard to preference, needs, concerns, and problems in implementing TLC training. In general, most family doctors and managers indicated that TLC was necessary. All the successfully implemented Plan-Do-Study-Action cycles (77.6%) were applied to the model. Family doctors and managers agreed that coaches, a programme director, and data analysts were useful resources. The top three enablers for successful TLC implementation were managers’ support (93.9%); improvements in self-ability and team-based ability and impacts on participants’ career goals (89.8%), and support from family doctor teams (87.8%). Conclusions: This study offered a guided process for running TLC in the primary care system of China and provided valuable feedback from family doctors and managers regarding TLC training. Challenges were also found for future research and consideration. Our findings suggest that manager support is necessary for collaboration in family doctor teams and that participants play an important role by evaluating learning sessions and providing recommendations for future learning.