Suchergebnisse

BACKGROUND: The Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009. Among all endeavors, the most obvious and significant improvement lays in maternal and child health. This study was designed to explore the association of primary care physician supply with maternal and child health outcomes in China, and provide policy suggestions to the law makers. METHODS: Six-year panel dataset of 31 provinces in China from 2012 to 2017 was used to conduct the longitudinal ecological study. Linear fixed effects regression model was applied to explore the association of primary care physician supply with the metrics of maternal and child health outcomes while controlling for specialty care physician supply and socio-economic covariates. Stratified analysis was used to test whether this association varies across different regions in China. RESULTS: The number of primary care physicians per 10,000 population increased from 15.56 (95% CI: 13.66 to 17.47) to 16.08 (95% CI: 13.86 to 18.29) from 2012 to 2017. The increase of one primary care physician per 10,000 population was associated with 5.26 reduction in maternal mortality per 100,000 live births (95% CI: − 6.745 to − 3.774), 0.106% (95% CI: − 0.189 to − 0.023) decrease in low birth weight, and 0.419 decline (95% CI: − 0.564 to − 0.273) in perinatal mortality per 1000 live births while other variables were held constant. The association was particularly prominent in the less-developed western China compared to the developed eastern and central China. CONCLUSION: The sufficient supply of primary care physician was associated with improved maternal and child health outcomes in China, especially in the less-developed western region. Policies on effective and proportional allocation of resources should be made and conducted to strengthen primary care system and eliminate geographical disparities.

Children whose parents have mental health disorders are at increased risk for deliberate self-harm (DSH). However, the effect of timing of parental mental health disorders on adolescent DSH risk remains under-researched. The aim of this study was to investigate how parental hospital admissions for mental health disorders and/or DSH in different developmental periods impact on the child's DSH risk in adolescence. A nested case-control sample was compiled from a total population cohort sample drawn from administrative health records in Western Australia. The sample comprised 7,151 adolescents who had a DSH-related hospital admission (cases), and 143,020 matched controls who hadn't had a DSH-related hospital admission. The occurrence of parental hospital admissions related to mental health disorders and/or DSH behaviours was then analysed for the cases and controls. The timing of the parental hospital admissions was partitioned into four stages in the child's life course: (1) pre-pregnancy, (2) pregnancy and infancy, (3) childhood, and (4) adolescence. We found that adolescents of a parent with mental health and/or DSH-related hospital admissions in all developmental periods except pregnancy and infancy were significantly more likely than controls to have a DSH-related hospital admission. Compared to parental hospital admissions that occurred during childhood and adolescence, those that occurred before pregnancy conferred a higher risk for adolescent DSH: adjusted odds ratio (aOR) = 1.25 for having only one parent hospitalised and 1.66 for having both parents hospitalised for mental health disorders; aOR = 1.97 for having any parent hospitalised for DSH, all being significant at the level of p < .001. This study shows that timing is important for understanding intergenerational transmission of DSH risk. The pre-pregnancy period is as critical as period after childbirth for effective intervention targeting adult mental health disorders and DSH, highlighting the important role of adult mental health services in preventing DSH risk in future generations.

Adolescent deliberate self-harm (DSH) has been found to be associated with a range of bio-psycho-social factors. Simultaneous investigations of these factors enable more robust estimation of the independent effect of a specific risk factor by adjusting for a more complete set of covariates. However, few studies have had the ability to examine all of these factors together. This study used the linkage of population-level de-identified data collections from government agencies to investigate a range of biological, psychological, and social risk factors and their effects on adolescent risk of DSH (with or without suicidal intent). The investigation was undertaken by progressively adjusting for plausible covariates, including fetal growth status and birth order, early familial social factors, parental hospital admissions due to psychiatric disorders or DSH, and parental all-cause death. Conditional logistic regression was used for data analysis. Children's psychiatric history was analysed to examine the extent to which it may account for the link between the risk factors and adolescent DSH risk. This study identified significant biological and perinatal social risk factors for adolescent DSH risk, including overdue birth, high birth order (≥2), single or teen/young motherhood, high neighbourhood socioeconomic disadvantage, and parental psychiatric and/or DSH-related hospital admissions. Further, parental psychiatric and/or DSH-related admissions, and children's psychiatric admissions in particular, largely attenuated the effects of the perinatal social risk factors but not the biological factors on adolescent DSH risk. These results highlight the importance of taking joint actions involving both health and social services in the prevention of adolescent DSH.

Objective: The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10-19 years old) and young adults (20-29 years old). Methods: We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm-related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses. Results: The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode. Conclusion: Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term.

ABSTRACTIntroductionIt is well established that parental mental health disorders increase children's risk of deliberate self-harm (DSH). However, little is known about how early life exposure to social disadvantage influences DSH among children whose parents have a mental health disorder.
AimsTo examine how early life exposure to high neighbourhood socioeconomic disadvantage and having a teen mother influence the DSH risk among children whose parents have a mental health disorder.
MethodsThis study was based on the linkage of population-level records routinely collected by government agencies in Western Australia. A birth cohort including 474,860 non-Aboriginal individuals born between 1981 and 2001 was followed up until 2011. A nested case-control sample was compiled from the birth cohort for data analysis. A total of 7,151 people with DSH-related contacts (cases) and 143,020 matched controls were analysed. Conditional logistic regression models were utilised in this study.
ResultsExposure to high neighbourhood socioeconomic disadvantage was associated with additionally increased odds of DSH among children exposed to maternal mental health disorders during early childhood (1-4 years) (OR=1.75, 95%CI:1.30-2.36, p<0.001). However, this was not observed for children exposed to maternal mental health disorders during late childhood (5-9 years) or adolescence (10-19 years). Comparatively, exposure to high socioeconomic disadvantage was related to additionally increased odds of DSH among children exposed to paternal mental health disorders during adolescence (10-19 years) (OR=2.25, 95%CI:1.60-3.16, p<0.001), but not childhood. Having a teen mother was significantly associated with additionally increased odds of DSH, regardless of when the parental mental health disorders occurred. Children with a teen mother and early life exposure to socioeconomic disadvantage were at additionally increased odds of DSH, compared to children with only one form of disadvantage (OR=1.51,95%CI:1.07-2.12%,p=0.018) among children exposed to parental mental health disorders during childhood, but not during adolescence.
Conclusion Among children of parents with mental health disorders, early life exposure to social disadvantage is not uncommon, and confers additionally increased risk of DSH. Therefore, preventive strategies need to be based on joint actions involving both social and health services, and need to incorporate child mental health interventions into adult mental health services. The cross-cutting efforts would provide a greater positive impact in effectively addressing the multifaceted nature of reducing DSH among children of parents with mental health disorders.

PurposeThis paper aims to examine the effects of task and relationship conflicts on team creativity, and the moderating role of shared leadership in inter-organizational teams. An inter-organizational team normally comprises employees from collaborated organizations brought together to conduct an initiative, such as product development. Practitioners and researchers have witnessed the prevalence of conflict in inter-organizational teams. Despite significant scholarly investigation into the importance of conflict in creativity, a deep theoretical understanding of conflict framework remains elusive.Design/methodology/approachA questionnaire survey was conducted in China to collect data. Consequently, 54 teams, which comprised 54 team managers and 276 team members, were deemed useful for the study.FindingsBy testing our hypotheses on 54 inter-organizational teams, we found that relationship conflict has a negative relationship with team creativity, whereas task conflict has an inverted U-shaped (curvilinear) relationship with team creativity. Furthermore, when shared leadership is stronger, the negative relationship with team creativity is weaker for relationship conflict, whereas the inverted U-shaped relationship with team creativity is stronger for task conflict.Research limitations/implicationsThe main limitation is cross-sectional, which cannot establish causality in relationships. Despite this potential weakness, the present research provides insights into conflict, leadership and inter-organizational collaboration literature.Practical implicationsThe findings of this study offer some guidance on how managers can intervene in the conflict situations of inter-organizational teams.Social implicationsManagers are struggling to identify ways to effectively manage team conflict when a team of diverse individuals across organizational boundaries are brought together to solve a problem. The findings of this study offer some guidance on how managers can intervene in the conflict situations of inter-organizational teams.Originality/valueThis paper provides understandings about how relationship and task conflicts affect team creativity in inter-organizational teams.