ObjectivesTo synthesise evidence on longer term unmet needs perceived by stroke survivors, and psychometric properties of the tools used to evaluate unmet care needs after stroke.DesignSystematic review.SettingCommunity or patients’ home.ParticipantsStroke survivors.MethodsWe searched PubMed, PsycINFO, CINAHL, EMBASE from inception to 31 March 2018 to identify survey studies that evaluated unmet needs perceived by stroke survivors after hospital discharge. Reported unmet needs were categorised under three domains: body functioning, activity/participation and environmental factors. Ranges of prevalence rates of unmet needs reported in studies were presented.ResultsWe included 19 eligible studies, with considerable heterogeneity in patients, survey methods and results. Psychometric properties of two stroke-specific tools were formally evaluated, indicating their moderate reliability and content/concurrent validity. The median number of reported unmet needs per stroke survivor was from two to five, and the proportion of stroke survivors with at least one unmet needs was on average 73.8% (range 19.8%– 91.7%). Unmet needs perceived by stroke survivors included 55 records of unmet body functioning needs, 47 records of unmet activities/participatory needs and 101 records of unmet environmental needs. Common unmet service needs were unmet information needs (3.1%– 65.0%), transport (5.4%–53.0%), home help/personal care (4.7%–39.3%) and therapy (2.0%–35.7%).ConclusionsThe prevalence of unmet long-term needs is high among stroke survivors, and there is considerable heterogeneity in type and frequency of specific unmet needs. More research is required to link regular assessment of long-term unmet needs of stroke survivors with the provision of cost-effective patient-centred health and social care services.

Objectives There are more than 300 million smokers in China. This study aimed to evaluate the rate of smoking cessation, smoking relapse and related factors in middle-aged and older smokers in China. Methods We performed a secondary analysis of data from China Health and Retirement Longitudinal Study (CHARLS) that recruited a nationally representative sample of adults aged 45 and older. Participants were 3708 smokers in 2011 who completed two waves of follow-up interviews in 2013 and 2015. Self-reported quit and relapse rates at follow-ups were estimated. Multiple logistic regressions were conducted to identify factors associated with smoking cessation and relapse. Results The overall quit rate was 8.5% (95% CI 7.7%-9.5%) at the 2-year follow-up in 2013, and 16.6% (95% CI 15.5%-17.9%) at the 4-year follow up. Smoking cessation in 2013 was associated with not living in the northeast region (p = 0.003), fewer cigarettes smoked daily (p <0.001), and longer time to the first cigarette in the morning (p<0.001). Smoking cessation in 2015 was associated with older age (p = 0.049), smoking initiation at age �20 years (p<0.001), longer time to the first cigarette in the morning (p<0.001), and self-perceived poor health (p<0.001). Of the 317 participants who stopped smoking in 2013, 13.3% (95% CI 9.9%-17.5%) relapsed by 2015. Smoking relapse was associated with younger age (p = 0.025), shorter time to the first cigarette in the morning (p = 0.003), and self-perception of not poor health (p = 0.018). Conclusion The overall quit rate was 8.5% at the 2-year follow up, and 16.6% at the 4-year follow up in the middle-aged and older smokers, but 13% of quitters returned to smoking in two years.

Introduction Socio-economic inequalities in smoking and related health problems are a public health concern worldwide. To support the development of effective tobacco control policies, this study examines trends in smoking rates according to socio-economic status (SES) in China. Methods We analysed data from repeated cross-sectional China Health and Retirement Longitudinal Study (CHARLS) on adults aged ≥ 45 years for the years 2011 and 2018, which involved 16,471 participants in 2011 and 19,367 in 2018. We then estimated the SES of individuals based on four types of wealth-related variables, namely, education, occupation, household characteristics and durable consumer goods. Principal-component analysis was conducted to measure SES, and the Erreygers normalised concentration index (ECI) was used to calculate socio-economic inequality in current smoking by gender, age and region. Results The overall ECI (95% confidence interval) for women was −0.042 (−0.054 to −0.031) and −0.038 (−0.047 to −0.029) for 2011 and 2018, respectively. The ECI (95% confidence interval) for men was −0.077 (−0.101 to −0.050) and −0.019 (−0.042 to 0.005) for 2011 and 2018, respectively. The inequality in smoking by SES for adults aged &lt; 60 years in the Northeast region increased during 2011–2018, from −0.069 (−0.144 to 0.006) to −0.119 (−0.199 to −0.038) for women and from 0.009 (−0.115 to 0.132) to −0.164 (−0.296 to −0.032) for men. Conclusions smoking inequality by socio-economic among adults aged ≥ 45 years declined in recent years in China. However, smoking inequality by SES increased in other population groups. Implications Our research indicated that socio-economic inequality of current smoking among residents aged 45 years and older declined in 2018 when compared with 2011 numbers, particularly for men aged ≥ 60 years. Women in the Northeast region displayed more significant smoking inequality by SES than women in other regions did. During the study period, there was an increase in inequality in smoking by SES for adults aged &lt; 60 years in the Northeast region. Thus, tobacco control policies and interventions should be targeted at high-risk subpopulations with lower SES, particularly in Northeast China.

BACKGROUND Online information on electronic cigarettes (e-cigarettes) may influence people’s perception and use of e-cigarettes. Websites with information on e-cigarettes in the Chinese language have not been systematically assessed. OBJECTIVE The aim of this study was to assess and compare the types and credibility of Web-based information on e-cigarettes identified from Google (in English) and Baidu (in Chinese) search engines. METHODS We used the keywords <i>vaping</i> or <i>e-cigarettes</i> to conduct a search on Google and the equivalent Chinese characters for Baidu. The first 50 unique and relevant websites from each of the two search engines were included in this analysis. The main characteristics of the websites, credibility of the websites, and claims made on the included websites were systematically assessed and compared. RESULTS Compared with websites on Google, more websites on Baidu were owned by manufacturers or retailers (15/50, 30% vs 33/50, 66%; <i>P</i>&lt;.001). None of the Baidu websites, compared to 24% (12/50) of Google websites, were provided by public or health professional institutions. The Baidu websites were more likely to contain e-cigarette advertising (<i>P</i>&lt;.001) and less likely to provide information on health education (<i>P</i>&lt;.001). The overall credibility of the included Baidu websites was lower than that of the Google websites (<i>P</i>&lt;.001). An age restriction warning was shown on all advertising websites from Google (15/15) but only on 10 of the 33 (30%) advertising websites from Baidu (<i>P</i>&lt;.001). Conflicting or unclear health and social claims were common on the included websites. CONCLUSIONS Although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines, there was a lack of online information from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes.