In appropriate prescribing is a global problem. It is especially salient in China, where drug sales constitute a major portion of health care providers' incomes, price distortions are rampant, and oversight is lax. However, few data exist on the prevalence of inappropriate prescribing in China. This study, the first of its kind in China, examined 230,800 prescriptions written between 2007 and 2009 by 784 community health institutions in 28 cities across China. The data show substantial overprescribing, including twice as many prescriptions for antibiotics as recommended by the World Health Organization and rates of injection that are three times higher than in similar countries. These findings point to the need to integrate rational prescribing into China's ongoing health care reform. M arket-oriented reforms in the past three decades have brought unprecedented economic prosperity to China. At the same time, they dismantled the structure of China's equitable, albeit rudimentary, health care system. Today, with the Chinese Ministry of Health setting very low prices for physician consultation, hospitalization, and services, drug "markups" have become the major source of revenue for health care providers.Unlike the United States and many other countries, China does not have a widespread retail pharmacy system. Patients typically fill their prescriptions at the same hospital or clinic that they visit for care. These health care providers don't receive a dispensing fee but rather earn the difference between wholesale and retail price. Because these drug-related revenues are a major source of financial support for health care providers, one of the detrimental consequences is inappropriate or irrational prescribing. 1The irrational prescribing is further exacerbated by runaway manufacturer prices and lax oversight. This environment poses a serious risk for patients' health and sources of health care. 2Recognizing the ever-worsening problems in basic health care coverage, disease-induced poverty, disparities, and the resulting social instability, the Chinese government has launched a multitude of reforms. Central to the reforms has been the reconstruction of affordable and convenient community health service networks that provide basic disease prevention, medical treatment, rehabilitation, health education, and family planning services within designated urban communities. These networks are composed of health centers, each providing about 50 beds and serving 30,000 to 50,000 residents, and satellite health stations, each serving about 3,000 residents. 4 Most of these institutions are owned or subsidized by municipal governments; the rest are owned by private practitioners, trade organizations, and other nonprofit entities.5 By the end of 2008, 98 percent of the cities in all of China's thirty-one provinces had developed community health service networks. 6 In 2010 China's minister of health, Zhu Chen, Reform In China

BackgroundPatient adherence is an important issue for health service providers and health researchers. However, the knowledge structure of diverse research on treatment adherence is unclear. This study used co-word analysis and social network analysis techniques to analyze research literature on adherence, and to show their knowledge structure and evolution over time.MethodsPublished scientific papers about treatment adherence were retrieved from Web of Science (2000 to May 2011). A total of 2308 relevant articles were included: 788 articles published in 2000–2005 and 1520 articles published in 2006–2011. The keywords of each article were extracted by using the software Biblexcel, and the synonym and isogenous words were merged manually. The frequency of keywords and their co-occurrence frequency were counted. High frequency keywords were selected to yield the co-words matrix. Finally the decomposition maps were used to comb the complex knowledge structures.ResultsResearch themes were more general in the first period (2000 to 2005), and more extensive with many more new terms in the second period (2006 to 2011). Research on adherence has covered more and more diseases, populations and methods, but other diseases/conditions are not as hot as HIV/AIDS and have not become specialty themes/sub-directions. Most studies originated from the United States.ConclusionThe dynamic of this field is mainly divergent, with increasing number of new sub-directions of research. Future research is required to investigate specific directions and converge as well to construct a general paradigm in this field.

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In view of the expansion and directional change mechanisms of Yangtze River water diluted with sea water in the shelf region (also known as Changjiang diluted water [CDW]) during summer and autumn, a three-dimensional hydrodynamic model of the Yangtze River Estuary (YRE) and its adjacent waters was established based on the Finite Volume Community Ocean Model (FVCOM). Compared with the measured data, the model accurately simulates the hydrodynamic characteristics of the YRE. On that basis, the influence of the expansion patterns of the CDW in both summer and autumn was studied. It was found that, in 2019, the CDW expanded to the northeast in the summer and to the southeast in the autumn, and that the route of the CDW is mainly controlled by the wind, not the runoff. Current seasonal winds also change the transportation route of the CDW by affecting its hydrodynamic field. Typhoons are frequent in both summer and autumn, causing abnormalities in both the transportation route and expansion of the CDW. During a typhoon, a large amount of the CDW is transported in a continuous and abnormal manner, accelerating the path turning of the CDW. This paper enhances the existing theoretical research of the CDW and provides a reference with respect to the expansion of diluted water all over the world.

Harmful algal blooms (HABs) have occurred frequently in coastal waters of China, imposing negative effects on the marine ecological environment. A dataset of HABs and terrestrial runoff was collected and analyzed in this study, and factors responsible for HABs were further explored. Frequency and expansion of HABs peaked between 2001 and 2007, and although they have declined slightly since then, they have remained quite high. Frequency and accumulative area of HABs peaked in 2004–2005, and most occurred from April to August during these years. HABs occurred frequently in the Changjiang (Yangtze River) estuary, and Prorocentrum donghaiense, Noctiluca scientillans, Karenia mikimotoi, and Skeletonema costatum were the main algal species. The increases of eutrophication, the abnormal sea surface temperature caused by climate and ocean currents, and the species invasion caused by the discharge of ballast water may be important factors for the long-term outbreak of HABs in the Chinese coastal waters. These findings provide a better understanding of HABs in China, which will be helpful to further prevention and control.