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      Systematic reviews in general practice: Applicability of the review “Mass media interventions for preventing smoking in young people” in the People’s Republic of China

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          Abstract

          A major problem for Chinese primary health providers such as general practitioners has been the lack of a clear role within the entire health system, unlike in other countries where the general practitioner is rightly considered to be the cornerstone of the system and the gatekeeper to specialist services. In 2011 the national government of the People’s Republic of China issued a policy acknowledging the role of primary health and the general practitioner as a gatekeeper, with an inherent expectation of the provision of quality services. For the most part, this means that evidence-based practice will be increasingly relied on to supplement existing polices, practices, and prescribed care plans currently in use within many community health centers. This article explores the concept of hierarchy of evidence for use by general practitioners by considering the applicability of the findings of the systematic review “Mass media interventions for preventing smoking in young people” published by the Cochrane Collaboration in the context of the health systems in the People’s Republic of China, and in particular, the contribution general practice may have in addressing this issue.

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          Most cited references 32

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          A hierarchy of evidence for assessing qualitative health research.

          The objective of this study is to outline explicit criteria for assessing the contribution of qualitative empirical studies in health and medicine, leading to a hierarchy of evidence specific to qualitative methods. This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the reliability of study conclusions for decisions made in health practice and policy. We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidence-for-practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for each level. A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation.
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            Tobacco smoking in China: prevalence, disease burden, challenges and future strategies.

            About one-third of the world's tobacco is produced and consumed in China. Despite existing tobacco control policies and activities, the prevalence of smoking in China remains high with 350 million smokers and 740 million passive smokers. Furthermore, smoking rates in the young population and in females are increasing. The number of deaths attributed to tobacco use has reached 1.2 million per year, whereas the death toll is expected to rise to 2 million annually by 2025. Sociocultural factors favouring smoking initiation, lack of awareness among the public about the hazards of smoking, weak support from the government and strong resistance from the tobacco industry are major reasons for the lack of effectiveness of current tobacco control measures. Effective intervention efforts are urgently required. Commitments from the government are crucial in tobacco control. Firm action should be taken on tobacco control issues at multiple levels including a reduction in tobacco supply, increased tobacco taxation, increased education, tobacco advertising limitations, decreased second-hand smoke exposure and smoking cessation support. The health-care community should also play a leading role in anti-tobacco campaigns and take a more active role in smoking cessation programmes. © 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.
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              Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?

              Objective To determine whether the New Cooperative Medical Insurance Scheme (NCMS) is associated with decreased levels of catastrophic health expenditure and reduced impoverishment due to medical expenses in rural households of China. Methods An analysis of a national representative sample of 38,945 rural households (129,635 people) from the 2008 National Health Service Survey was performed. Logistic regression models used binary indicator of catastrophic health expenditure as dependent variable, with household consumption, demographic characteristics, health insurance schemes, and chronic illness as independent variables. Results Higher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. While the higher socio-economic status households had similar levels of catastrophic health expenditure as compared with the lowest. Households covered by the NCMS had similar levels of catastrophic health expenditure and medical impoverishment as those without health insurance. Conclusion Despite over 95% of coverage, the NCMS has failed to prevent catastrophic health expenditure and medical impoverishment. An upgrade of benefit packages is needed, and effective cost control mechanisms on the provider side needs to be considered.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                December 2015
                December 2015
                : 3
                : 4
                : 65-73
                Affiliations
                1School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
                Author notes
                CORRESPONDING AUTHOR: John Adamm Ferrier, RN MHA PGDHSM, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia, E-mail: adamm.ferrier@ 123456latrobe.edu.au
                Article
                fmch20150141
                10.15212/FMCH.2015.0141
                Copyright © 2015 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Product
                Self URI (journal page): http://fmch-journal.org/
                Categories
                China Focus

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