Background The promotion of early diagnosis is undoubtedly effective in reducing the burden of disease. Contrast-enhanced ultrasound (CEUS) is a diagnostic technology for liver cancer, but its implementation faces some challenges. Understanding the influencing factors of CEUS utilization is crucial for its successful implementation. However, such research is rare. The aims of this study were to investigate the status of CEUS utilization and its predictors in China. Methods Through multistage random sampling, a cross-sectional study design was conducted among physicians in charge of direct use of CEUS working at liver disease-related departments of sampled health institutions. To access the potential influencing factors of physicians' CEUS utilization, a structured questionnaire was developed based on the theoretical model, which was developed by integration of the Theory of Planned Behavior (TPB) and Technology Acceptance Model (TAM). Structural equation modeling was used to verify the proposed hypotheses, and analyze the relationship and mechanism between the factors. Results A total of 309 physicians were enrolled. The mean score of utilization behavior was 2.04 (SD = 1.07), and 37.22% above the mean. The favorable fitting results demonstrated that the integration of TAM and TPB was an acceptable model. SEM results also identified physicians’ intentions to use CEUS was directly associated with utilization behavior (β = 0.287, P < 0.001). Attitude (β = 0.272, P < 0.001), subjective norm (β = 0.172, P = 0.013), perceived behavioral control (β = 0.491, P < 0.001) and perceived usefulness (β = 0.108, P = 0.027) significantly influenced physicians’ intentions. Besides, subjective norm (β = 0.065, P = 0.021), perceived behavioral control (β = 0.141, P = 0.003), and perceived ease of use (β = 0.022, P = 0.033) indirectly affected physicians’ CEUS utilization. Conclusions The findings provide a reference for understanding the factors associated with physicians' utilization of CEUS. Additionally, the proposed measures such as building innovative and incentive environment, providing high quality and adequate training, etc., will help promote the utilization of CEUS, thereby increasing the detection rate of liver cancer, and improving the survival rate and the quality of life for liver cancer patients.

Background With inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention. Taking tertiary general hospitals in China for example, this study aimed to identify factors to investigate the comprehensive influencing mechanism for physicians’ intention to use CPGs on antimicrobials. Methods Based on the integration of Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), and Technology-Organization-Environment framework (TOE), a questionnaire survey was conducted covering potential determinants of affecting physicians’ intentions to use CPGs on antimicrobials at the individual level (attitude, subjective norms and perceived risk), technical level (relative advantage and ease of use), and organizational level (top management support and organizational implementation). Data were collected from 644 physicians in tertiary general hospitals in eastern, central and western China, which were obtained by multi-stage random sampling. The structural equation modeling (SEM) was used to link three-level factors with physicians’ behavioral intentions. Results The majority of the participants (94.57%) showed a positive tendency toward intention to use CPGs on antimicrobials. The reliability and validity analysis showed the questionnaire developed from the theoretical model was acceptable. SEM results revealed physicians’ intentions to use CPGs on antimicrobials was associated with attitude (β = 0.166, p < 0.05), subjective norms (β = 0.244, p < 0.05), perceived risk (β = − 0.113, p < 0.05), relative advantage (β = 0.307, p < 0.01), top management support (β = 0.200, p < 0.05) and organizational implementation (β = 0.176, p < 0.05). Besides, subjective norms, perceived risk, relative advantage, ease of use, and top management support showed their mediating effects from large to small on the intentions, which were 0.215, 0.140, 0.103, 0.088, − 0.020, respectively. Conclusions This study revealed the significance of multifaceted factors to enhance the intention to use CPGs on antimicrobials. These findings will not only contribute to the development of targeted intervention strategies on promoting the use of CPGs on antimicrobials, but also provide insights for future studies about physicians’ adoption behaviors on certain health services or products.

Vibrio parahaemolyticus is one of the most hazardous pathogens causing seafood-borne diseases in the southern Fujian coast, China. From June to October 2016, a total of 250 samples were collected from retail markets in the Xiamen, Quanzhou, and Zhangzhou regions. Seventy-seven V. parahaemolyticus isolates were identified using polymerase chain reaction (PCR). Then, molecular typing was performed using repetitive extragenic palindromic-PCR (REP-PCR). The distribution of seven virulence genes was detected by PCR. In aquatic products, the prevalence of V. parahaemolyticus was 30.8%, and the prevalence of tdh + and trh + was 2.6 and 1.3%, respectively. The prevalence of type III secretion system-2 (T3SS2) and the ureC gene was 5.2 and 3.9%, respectively. All 77 strains and the reference strain V. parahaemolyticus ATCC 17802 were classified into seven molecular types using REP-PCR. Thus, our findings demonstrated that the prevalence of V. parahaemolyticus was severe in the southern Fujian coast and that the regulations for aquatic food safety should be strengthened. 1 | INTRODUCTION Vibrio parahaemolyticus (V. parahaemolyticus) is a Gram-negative, halophilic, rod-shaped bacterium that is commonly found in aquatic products in China, Japan, Korea, and other countries with long coastlines. The germ load of V. parahaemolyticus in the environment is inclined to follow clear seasonal trends, with food-borne diseases peaking in the summer months (Chen et al., 2017; Paranjpye et al., 2015). The consumption of contaminated aquatic products in the aquaculture sector is very high, which gives rise to the high prevalence of gastroenteritis infections caused by V. parahaemolyticus during summer and autumn. This food-borne pathogen can infect people through the consumption of raw or undercooked aquatic animals, especially fish, mollusks, crustaceans, etc. (Xie, Wu, Zhang, Xu, & Cheng, 2016). Patients infected with V. parahaemolyticus are most likely to experience diarrhea, abdominal cramps, vomiting and fever, septicemia, or even death (Lopatek, Wieczorek, & Osek, 2015). The number of food poisoning cases caused by V. parahaemolyticus has exceeded that caused by Salmonella, ranking first in food-borne pathogens in China (Broberg, Calder, & Orth, 2011). In recent years, several reports concerning the prevalence of V. parahaemolyticus in seafood or environmental samples have been delivered in many coastal areas in China. In seafood samples, the prevalence of V. parahaemolyticus was reported to be 10% in Zhejiang Province (Chen et al., 2017),

Background Limited diffusion of health technology has greatly halted the improvement of resource integration and healthcare outcomes. The importance of understanding the dynamics of health technology diffusion is increasingly highlighted. However, the dynamic mechanism of health technology diffusion in the context of the integrated care system (ICS) remained largely unknown. Purpose To develop and validate the scale on Dynamics of Health Technology Diffusion in Integrated Care System (DHTDICS) for providing an instrument to investigate the health technology diffusion in the ICS in China, by taking the Des-gamma-Carboxy Prothrombin (DCP) test as an example. Methods Based on previous classical theories such as the theory of planned behavior (TPB), technology acceptance model (TAM), and technology-organization-environment framework (TOE), the scale with 34 items was initially developed. It was tested in a cross-sectional questionnaire survey including 246 participants from February to August 2019 in China. Cronbach’s alpha, corrected item-total correlation, and factor loadings were used to assess reliability. Exploratory factor analysis and confirmatory factor analysis were applied to evaluate the validity by assessing factor structures and correlations. Results Reliability analysis revealed excellent internal consistency. Acceptable validity was confirmed through tests of convergent validity and discriminant validity. Regarding the domains that DHTDICS contributes, the results highlighted 4 domains: personal beliefs (including dimensions of attitudes, subjective norms and perceived behavioral control), technical drivers (including dimensions of ease of use and price rationality), organizational readiness (including dimensions of organizational culture, technology absorptive willingness and technology sharing willingness), and external environment (dimension of industry competition pressure). Conclusion The findings confirmed the reliability and validity of the scale on DHTDICS. The scale will be not only a scientific tool in determining the dynamics of health technology diffusion in the ICS, but also a helpful reference for developing future interventions to promote health technology diffusion.

Promoting clinicians’ knowledge sharing of appropriate health technology within the integrated care system (ICS) is of great vitality in bridging the technological gap between member institutions. However, the role of social networks in knowledge sharing of health technology is still largely unknown. To address this issue, the study aims to clarify the influence of clinicians’ social networks on knowledge sharing of health technology within the ICS. A questionnaire survey was conducted among the clinicians in the Alliance of Liver Disease Specialists in Fujian Province, China. Social network analysis was conducted using NetDraw and UCINET, and the quadratic assignment procedure (QAP) multiple regression was used to analyze the influencing factors of knowledge sharing of health technology. The results showed that the ICS played an insufficient role in promoting overall knowledge sharing, especially inter-institutional knowledge sharing. Trust, emotional support, material support, and cognitive proximity positively influenced knowledge sharing of health technology, while the frequency of interaction and relationship importance had a negative impact on it. The finding extended the research scope of social network theory to the field of healthcare and will bridge the evidence gap in the influence of the clinicians’ social networks on their knowledge sharing within the ICS, providing new ideas to boost knowledge sharing and diffusion of appropriate health technology.