Strategies to improve the accuracy of vision measurement by teachers in rural Chinese secondary schoolchildren: Xichang Pediatric Refractive Error Study (X-PRES) report no. 6.

OBJECTIVE: To assess and improve the accuracy of lay screeners compared with vision professionals in detecting visual impairment in secondary schoolchildren in rural China. METHODS: After brief training, 32 teachers and a team of vision professionals independently measured vision in 1892 children in Xichang. The children also underwent vision measurement by health technicians in a concurrent government screening program. RESULTS: Of 32 teachers, 28 (87.5%) believed that teacher screening was worthwhile. Sensitivity (93.5%) and specificity (91.2%) of teachers detecting uncorrected presenting visual acuity of 20/40 or less were better than for presenting visual acuity (sensitivity, 85.2%; specificity, 84.8%). Failure of teachers to identify children owning but not wearing glasses and teacher bias toward better vision in children wearing glasses explain the worse results for initial vision. Wearing glasses was the student factor most strongly predictive of inaccurate teacher screening (P < .001). The sensitivity and specificity of the government screening program detecting low presenting visual acuity were 86.7% and 28.7%, respectively. CONCLUSIONS: Teacher vision screening after brief training can achieve accurate results in this setting, and there is support among teachers for screening. Screening of uncorrected rather than presenting visual acuity is recommended in settings with a high prevalence of corrected and uncorrected refractive error. Low specificity in the government program renders it ineffective.

The impact of parental migration on health status and health behaviours among left behind adolescent school children in China.

BACKGROUND:

One out of ten of China's population are migrants, moving from rural to urban areas. Many leave their families behind resulting in millions of school children living in their rural home towns without one or both their parents. Little is known about the health status of these left behind children (LBC). This study compares the health status and health-related behaviours of left behind adolescent school children and their counterparts in a rural area in Southern China.

METHODS:

A cross-sectional study was conducted among middle school students in Fuyang Township, Guangdong, China (2007-2008). Information about health behaviours, parental migration and demographic characteristics was collected using a self-administered questionnaire. Overweight/obesity and stunting were defined based on measurements of height and weight. Univariate and multivariate analyses were used to estimate the differences in health outcomes between LBC and non-LBC.

RESULTS:

18.1% of the schoolchildren had one or both parents working away from home. Multivariate analysis showed that male LBC were at higher risk of skipping breakfast, higher levels of physical inactivity, internet addiction, having ever smoked tobacco, suicide ideation, and being overweight. LBC girls were more likely to drink excessive amounts of sweetened beverage, to watch more TV, to have ever smoked or currently smoke tobacco, to have ever drunk alcohol and to binge drinking. They were also more likely to be unhappy, to think of planning suicide and consider leaving home.

CONCLUSIONS:

Our findings suggest that parental migration is a risk factor for unhealthy behaviours amongst adolescent school children in rural China. Further research is required in addition to the consideration of the implications for policies and programmes to protect LBC.

Quality of life and near vision impairment due to functional presbyopia among rural Chinese adults.

PURPOSE: To evaluate the impact of near-vision impairment on visual functioning and quality of life in a rural adult population in Shenyang, northern China. METHODS: A population-based, cross-sectional study was conducted among persons aged 40+ years, during which functional presbyopia (correctable presenting near vision < 20/50 [N8] at 40 cm) was assessed. Near-vision-related quality of life and spectacle usage questionnaires were administered by trained interviewers to determine the degree of self-rated difficulty with near tasks. RESULTS: A total of 1008 respondents (91.5% of 1102 eligible persons) were examined, and 776 (78%) of completed the questionnaires (mean age, 57.0 ± 10.2 years; 63.3% women). Near-vision spectacle wearers obtained their spectacles primarily from markets (74.5%) and optical shops (21.7%), and only 1.14% from eye clinics. Among 538 (69.3%) persons with functional presbyopia, self-rated overall (distance and near) vision was worse (P < 0.001) and difficulty with activities of daily living greater (P < 0.001) than among nonpresbyopes. Odds of reporting any difficulty with daily tasks remained higher (OR = 2.32; P < 0.001) for presbyopes after adjustment for age, sex, education and distance vision. Compared to persons without presbyopia, presbyopic persons were more likely to report diminished accomplishment due to vision (P = 0.01, adjusted for age, sex, education, and distance vision.) CONCLUSIONS: Difficulties with activities of daily living and resulting social impediments are common due to presbyopia in this setting. Most spectacle wearers with presbyopia in rural China obtain near correction from sources that do not provide comprehensive vision care.

Is prohibiting land reallocation enough to promote development of farmland rental markets in China?

Prohibiting land reallocation improves tenure security, but it remains unclear whether this sufficiently facilitates the development of farmland rental markets in China. To fill this gap, we investigate how farmland rental activities are influenced by full-scale land reallocation (FSLR) and partial land reallocation (PLR), which differ in scale and imposition. Employing the instrumental-variables and the difference-in-differences approaches, we find that PLR substitutes relation-specific contracting in the markets, while FSLR complements arms-length contracting. The different impacts are attributable to the difference in imposition rather than scale. These findings suggest the need for further reforms.

Participation in farmer's cooperatives and its effects on agricultural incomes : evidence from vegetable-producing areas in China

Chinese agricultural cooperatives, called Farmer's Professional Cooperatives (FPCs), are expected to become a major tool to facilitate agro-industrialization for small farmers through the diffusion of new technologies, the supply of high-quality agricultural inputs and the marketing of their products. This study compares FPC participants with vegetable-producing non-participants and grain farmers in vegetable-producing areas in rural China to investigate the treatment effect of participation in FPCs as well as implementation of vegetable cultivation. I adopt parametric and nonparametric approaches to precisely estimate the treatment effects. Estimated results indicate no significant difference between participants and non-participants of FPCs on agricultural net income in both parametric and non-parametric estimations. In contrast, the comparison between vegetable and grain farmers using propensity score matching (PSM) reveals that the treatment effect of vegetable cultivation is significantly positive for total and agricultural incomes, although vegetable cultivation involves more labor-intensive efforts. These results indicate that it is the implementation of vegetable cultivation rather than the participation in an FPC that enhances the economic welfare of farmers, due to the non-excludability of FPCs' services as well as the risks involved in vegetable cultivation.

Enhancing the capacity of kin caregivers and their families to meet the needs of children left behind

Based on qualitative research of the experiences of 23 kin caregivers and five school personnel, this article explores the role of informal kinship care in addressing the needs of school-age children left behind in rural China. The findings of this study suggest that kin caregivers' child-rearing capacity is limited in the rural context, and they are often overwhelmed by children's diverse and complex needs, particularly their emotional ones. In view of the huge population and their vulnerability, it is imperative for the state to take up its responsibilities and develop specific social work services and other support for children left behind and their families. 根据对23位亲属照顾者和5位学校人员的质性研究，文章探讨在处理中国留守学龄儿童的需要时，非正式亲属照料所担当的角色。研究发现，在农村的亲属照料者的抚养儿童能力有限，而且他们时常在面对儿童众多复杂的需求时应接不暇，问题又以情绪需要尤甚。有见于留守儿童的数目众多和易受伤害，政府急切需要承担相关的责任，为留守儿童及其家庭发展专门的社会工作服务和其他支援。

Safety of Spectacles for Children's Vision: A Cluster-Randomized Controlled Trial.

Purpose: To study safety of children’s glasses in rural China, where fear that glasses harm vision is an important barrier for families and policy-makers. Design: Exploratory analysis from a cluster-randomized, investigator-masked, controlled trial.Methods: Among primary schools (n=252) in western China, children were randomized by school to one of three interventions: free glasses provided in class, vouchers for free glasses at a local facility or glasses prescriptions only (Control group). The main outcome of this analysis is uncorrected visual acuity after 8 months, adjusted for baseline acuity.Results: Among 19,934 children randomly selected for screening, 5852 myopic (spherical equivalent refractive error <= -0.5 D) eyes of 3001 children (14.7%, mean age 10.5 years) had VA <= 6/12 without glasses correctable to > 6/12 with glasses, and were eligible. Among these, 1903 (32.5%), 1798 (30.7%), and 2151 (36.8%) were randomized to Control, Voucher and Free Glasses respectively. Intention-to-treat analyses were performed on all 1831 (96.2%), 1699 (94.5%), and 2007 (93.3%) eyes of children with follow-up in Control, Voucher and Free Glasses groups. Final visual acuity for eyes of children in the treatment groups (Free Glasses and Voucher) was significantly better than for Control children, adjusting only for baseline visual acuity (difference of 0.023 logMAR units [0.23 vision chart lines, 95% CI: 0.03, 0.43]) or for other baseline factors as well (0.025 logMAR units [0.25 lines, 95% CI 0.04, 0.45]). Conclusion: We found no evidence that spectacles promote decline in uncorrected vision with aging among children.

Spectacle design preferences among Chinese primary and secondary students and their parents: A qualitative and quantitative study

Purpose: To identify the specific characteristics making glasses designs, particularly those compatible with adjustable glasses, more or less appealing to Chinese children and their parents. Patients and Methods: Primary and secondary school children from urban and rural China with < = -1.00 diopters of bilateral myopia and their parents ranked four conventional-style frames identified by local optical shops as popular versus four child-specific frames compatible with adjustable spectacles. Scores based on the proportion of maximum possible ranking were computed for each style. Selected children and their parents also participated in Focus Groups (FGs) discussing spectacle design preference. Recordings were transcribed and coded by two independents reviewers using NVivo software. Results: Among 136 urban primary school children (age range 9-11 years), 290 rural secondary school children (11-17 years) and 16 parents, all adjustable-style frames (scores on 0-100 scale 25.7-62.4) were ranked behind all conventional frames (63.0-87.5). For eight FGs including 12 primary children, 26 secondary children and 16 parents, average kappa values for NVivo coding were 0.81 (students) and 0.70 (parents). All groups agreed that the key changes to make adjustable designs more attractive were altering the round lenses to rectangular or oval shapes and adding curved earpieces for more stable wear. The thick frames of the adjustable designs were considered stylish, and children indicated they would wear them if the lens shape were modified. Conclusions: Current adjustable lens designs are unattractive to Chinese children and their parents, though this study identified specific modifications which would make them more appealing.

Mobilités de travail et (re)construction des rapports sociaux au sein d’une communauté Hmong de Chine (province du Guizhou)

La mobilité rurale-urbaine est sans contredit l’un des phénomènes les plus marquants que la Chine a connus depuis ses réformes des années 1980. D’une ampleur colossale, elle a constitué un fondement essentiel de sa transition et de son développement économiques. Or, si l’impact social de cette mobilité a été abondamment étudié dans les villes où séjournent les paysans, il demeure peu connu dans leur communauté d’origine, et encore moins en contexte de « nationalité minoritaire ». Reposant sur une enquête de terrain de plus d’une année, cette thèse en géographie sociale examine la (re)construction sociale dans une communauté rurale et minoritaire (c.àd. Hmong ou Miao) de Chine en lien avec le phénomène de la mobilité de travail. D’une intensité croissante, la pratique de la mobilité de travail par les membres de cette communauté est double. Les migrants sont soit des herboristes ambulants dans les villes de l’espace régional, soit des travailleurs salariés dans les villes orientales du pays. L’utilisation d’une approche du changement social intégrant les sphères du réel et de l’imagination et prenant en compte les dimensions territoriale et économique du phénomène migratoire est originale. De même, l’importance égale portée aux discours et aux actions des migrants et des non-migrants dans le processus de transformation sociale se veut novatrice. Dans ses résultats, cette thèse fait état, premièrement, d’une refonte des logiques territoriales et économiques de la communauté étudiée sous l’effet du phénomène migratoire. De toute évidence, les fondements géographiques de son territoire se sont récemment complexifiés et multipliés. Désormais, une variété de lieux, de frontières, de réseaux sociaux et d’échelles se dessine dans les configurations territoriales de ses membres. Les implications économiques sont tout aussi patentes. Outre la forte dominance des transferts d’argent des migrants dans les budgets familiaux, les questions du développement et des inégalités aux différentes échelles de la communauté renvoient aujourd’hui essentiellement au fait migratoire. Deuxièmement, cette thèse montre la forte empreinte laissée par la mobilité dans la sphère sociale. Nécessitant soutien aux extrémités de leur parcours, les migrants sollicitent de plus en plus l’aide de leurs réseaux lignagers, claniques, villageois et matrilinéaires. Et dans ce processus, il n’est pas rare qu’ils enfreignent consciemment les principes hiérarchiques traditionnels de leurs rapports familiaux. Aussi, au travers de la mobilité, des groupes longtemps marginalisés, tels les femmes et les jeunes adultes, ont acquis estime, autonomie et pouvoir décisionnel. Parallèlement, l’ordre social s’est bouleversé. Ce n’est plus le volume de la production agricole, mais le nombre de travailleurs migrants qui détermine aujourd’hui les différentes classes sociales de la communauté. Finalement, dans le contexte plus large des populations rurales et minoritaires de Chine et du Massif sud-est asiatique, cette thèse fait ressortir l’importance d’aborder la question de l’impact social de la mobilité au-delà des paradigmes de la modernisation et de l’intégration. Contrairement à la plupart des écrits touchant à cette question, il ne suffit pas de porter le regard sur l’influence que les urbains et leur mode de vie soi-disant moderne exercent sur les migrants. Il est également nécessaire de reconnaître les capacités d’initiative et d’innovation sociale des membres de ces populations, migrants et non-migrants. Mais aussi, cette recherche démontre que la question identitaire se doit d’être prise en compte. Les sentiments de marginalité et de subordination demeurent vivaces au travers du phénomène migratoire. Et de tels sentiments semblent se traduire, le plus souvent, par un renforcement des liens sociaux et intracommunautaires au sein même de ces populations minoritaires.

A survey study of voting behavior and political participation in Zhejiang

Two existing models are used to conceptualize the constrained and limited participation in the communist system. The mobilization model suggests that participation was so mobilized by the party/state that it was largely meaningless, while the disengagement model supports the idea that many communist citizens adopted non-participatory behaviors such as non-voting as a means of protest. This paper attempts to demonstrate the importance of a third model – the emergent democratic culture model. The survey results show that the participation index is in proportion to the number of elections in which a villager is involved; and a growing number of voters in Zhejiang are developing citizen-initiated participation, with rights consciousness.

This research finds that the level of participation is influenced by three major factors: the perceived worth of the election itself, regularity of electoral procedures, and the fairness of electoral procedures. It also finds that parochial political culture and political apathy still exist, and the emergent democratic consciousness falls short of an ideal democratic standard. While a highly democratic culture helps to develop village democracy, the apathetic attitude continues to support the authoritarian leadership and structure in many villages. The paper also gives an account of survey research in rural China and offers a thoughtful critique of the use of voting and non-voting as the sole indicator of political participation.

Delay in the search for health services for the diagnosis of tuberculosis in Ribeirao Preto, Sao Paulo

The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.

Essays on durable goods consumption and firm innovation

This dissertation comprises three individual chapters. Chapter Two examines how free riding across neighbors influenced the diffusion of color television sets in rural China. Chapter Three tests for asymmetric information between a firm’s management and other investors concerning its patent output. Chapter Four discusses how knowledge stocks influence a patenting firm’s later diversification. Chapter Two documents the existence of a type of network effects—free riding across neighbors—in the consumption of color television sets in rural China, which reduces the propensity of non-owners to purchase. I construct a model of the timing of the purchase of a durable good in the presence of free riding, and test its key implications using household survey data in rural China. Chapter Three tests for asymmetric information between a firm’s management and other investors about its patent output by examining insider trading patterns and stock price changes in R&D intensive firms. It demonstrates that management has considerable information about its patent output beyond what is known to investors. It also shows that the predictive power of insider trading patterns on patent output comes from purchases rather than sales. Chapter Four discusses two sequential channels through which knowledge stocks may influence a firm’s later diversification. One is that firms with more knowledge are more likely to enter a new industry. The other is that firms’ businesses have a better chance of surviving, conditional on being formed. By examining U.S. public patenting firms in manufacturing sectors for 1984-1996, I find that knowledge stocks predict the likelihood of new industry entry when controlling for firm size. However, this predictive power is weakened when diversification effects are included. On the other hand, a survival study of newly established segments shows that initial knowledge stocks have significant positive effects on segment survival, whereas diversification effects are insignificant.

Depresión en pacientes con epilepsia: Revisión sistemática de la literatura

Esta revisión sistemática de la literatura tuvo como objetivo investigar sobre la depresión en personas con epilepsia en la última década (2005-2015), enfocándose en identificar en el paciente con epilepsia: características sociodemográficas, prevalencia de la depresión, tipos de intervención para el manejo de la depresión, factores asociados con la aparición y el mantenimiento de la depresión y por último, identificar las tendencias en investigación en el estudio de la depresión en pacientes con epilepsia. Se revisaron 103 artículos publicados entre 2005 y 2015 en bases de datos especializadas. Los resultados revelaron que la prevalencia de depresión en pacientes con epilepsia es diversa y oscila en un rango amplio entre 3 y 70 %, por otro lado, que las principales características sociodemográficas asociadas a la depresión está el ser mujer, tener un estado civil soltero y tener una edad comprendida entre los 25 y los 45 años. A esto se añade, que los tratamientos conformados por terapia psicológica y fármacos, son la mejor opción para garantizar la eficacia en los resultados del manejo de la depresión en los pacientes con epilepsia. Con respecto a los factores asociados a la aparición de la depresión en pacientes con epilepsia, se identificaron causas tanto neurobiológicas como psicosociales, asimismo los factores principales asociados al mantenimiento fueron una percepción de baja calidad de vida y una baja auto-eficacia. Y finalmente los tipos de investigación más comunes son de tipo aplicado, de carácter descriptivo, transversales y de medición cuantitativa.