PURPOSE:
To explore the accuracy and cost-effectiveness of three vision screening models among preschool children in rural China.

METHODS:
Vision screening was carried out among children aged 4-5 years in 65 preschools in two counties in Northwest China, using Crowded Single Lea Symbols to test visual acuity. Children were assigned randomly by school to one of three screening models: screening by teachers (15 schools, 1835 children), local optometrists (30 schools, 1718 children) or volunteers (20 schools, 2183 children). Children identifying ≥2 symbols incorrectly in either eye failed screening. Accuracy of screening was compared with screenings executed by experienced optometrists among 141 children selected randomly from the three screening models. Direct and indirect costs for each model were assessed. Costs to detect a true case failed screening were estimated.

RESULTS:
The sensitivity for three models ranged from 76.9% to 87.5%, specificity from 84.9% to 86.7% and standardized positive predictive value from 83.7% to 85.7%. None differed significantly between models. The costs per case detected were $37.53, $59.14 and $52.19 for the teachers, local optometrists and volunteers. In producing the cost estimates for teacher screening and local optometrist screening models, we used a salary payment that was identical for both models (with the salary being equal to that of the optometrist). The teacher screening model was the most cost-effective.

CONCLUSION:
Accuracy of screening by teachers, local optometrists and volunteers was the same in this setting, but the use of teachers was most cost-effective, reducing the cost per case detected by almost 40%.

PURPOSE:
To assess the prevalence of visual impairment and spectacles ownership among academic and vocational upper secondary school students in rural China.

METHODS:
This cross-sectional study included 5583 students from four academic upper secondary schools (AUSSs) and two vocational upper secondary schools (VUSSs) in Mei and Qianyang counties, Baoji Prefecture, Shaanxi Province. In March and April 2016, students underwent assessment of visual acuity (VA) and completed a questionnaire regarding spectacles use and family characteristics. Students with visual impairment (presenting VA ≤6/12 in the better eye) and students needing spectacles (uncorrected VA ≤6/12 in the better eye, which could be improved to >6/12 with refraction) were identified.

RESULTS:
Among 5583 students (54% boys, mean age 16.4±1.0 years) in grades 10 and grade 11 attending AUSSs (n=4549) and VUSSs (n=1034), visual impairment was detected in 4026 students. Among the AUSS students, 3425 (75%) needed spectacles; 2551 (75%) had them. Among the VUSS students, 601 (58%) needed spectacles; this proportion was significantly smaller (P=0.004), as was the proportion who had spectacles (n=212, 35%, P<0.001), compared with the AUSS students. Multivariate analysis showed that ownership of spectacles among children who needed them was associated with worse uncorrected VA (P<0.001), male sex (P<0.001), and residence in an urban area (P<0.034). Spectacles ownership was also strongly associated with AUSS education (P<0.001).

CONCLUSION:
There is a high rate of unmet need in visual care among upper secondary school students. Lack of spectacles ownership among children who needed them was significantly associated with VUSS education.

KEYWORDS:
China; Eyeglasses; Rural population; Students; Vision disorders

Background
To assess the prevalence of visual impairment and rate of wearing spectacles in schools for children of migrant workers in Shanghai, China.

Methods
Children from grade 1 to 5 in schools for children of migrant workers were randomly chosen for ocular examinations. All children were screened for uncorrected visual acuity and presenting visual acuity. After screening, the children whose uncorrected visual acuity was 20/40 or less received ocular motility evaluation, cycloplegic refraction/non-cycloplegic refraction, and external eye, anterior segment, media, and fundus examinations.

Results
A total of 9673 children were enumerated and 9512 (98.34%) participated in this study. The prevalence of uncorrected, presenting, and best-corrected visual acuity of 20/40 or worse in the better eye were 13.33%, 11.26%, and 0.63%, respectively. The rate of wearing spectacles of the children with visual impairment in one or both eyes was 15.50%. Of these, 26.05% were wearing spectacles with inaccurate prescriptions. Refractive error was a major cause of visual impairment, accounting for 89.48% of all the visual impairment causes. Other causes of visual impairment included amblyopia accounting for 10.12%; congenital cataract, 0.1%; congenital nystagmus, 0.1%; ocular prosthesis, 0.1%; macular degeneration, 0.05%; and opaque cornea, 0.05%.

Conclusions
This is the first study of the prevalence and causes of visual impairment in schools for children of migrant workers in Shanghai, China. The visual impairment rate in schools for children of migrant workers in suburbs of Shanghai in the best eye before vision correction was lower than those of urban children in mainstream schools in Guangzhou in 2012, and higher than students in rural of Beijing in 1998 and in suburb of Chongqing in 2007. The refractive error was the principal cause of the visual impairment of the children of migrant workers. The rate of wearing spectacles was low and the percentage of inaccurate prescriptions, among those who wore spectacles, was high. Uncorrected refractive error was a significant cause of visual impairment in migrant children.

The past four decades have witnessed unprecedented economic growth and rapidly rising food demand in China. This paper provides an introduction to readers with useful information summarising the development of China’s agricultural sector and the transformation of its rural economy over the 40 years of economic reform. It is, however, impossible to cover all aspects of this recent and rich history in a single journal special issue. Nevertheless, we are of the view that these papers address the most fundamentally important and insightful topics including: land reform and rural development; technology progress and productivity growth; changing food consumption patterns; rural education and human capital accumulation; and poverty alleviation.

ABSTRACT The migration of hundreds of millions of rural Chinese workers to the city has contributed substantially to China’s economic growth since the beginning of the country’s economic reform in 1978. However, this migration has also led to societal issues, including more than 60 million left-behind children. Empirical studies that seek to measure the impact of being left-behind on academic performance have led to inconsistent results, perhaps because the effects may be different for first-parent migration (migration during the first period of time in which one parent migrates) and second-parent migration (migration when the remaining parent leaves the home). Here we have examined how school performance changes before and after the second parent out-migrates. We use a panel dataset of over 5,000 students from 72 primary schools in rural China. Using a difference-in-difference approach, supported by a placebo test, we find that second-parent migration has statistically significant negative impacts on student performance. Importantly, our data provide convincing evidence that second-parent migration has a more negative impact on academic performance than first-parent migration. Our results have broad implications for China’s future economic growth and inequality.

Background: Medical records play a fundamental role in healthcare delivery, quality assessment and improvement. However, there is little objective evidence on the quality of medical records in low and middle-income countries.

Objective: To provide an unbiased assessment of the quality of medical records for outpatient visits to rural facilities in China.

Methods: A sample of 207 township health facilities across three provinces of China were enrolled. Unannounced standardised patients (SPs) presented to providers following standardised scripts. Three weeks later, investigators returned to collect medical records from each facility. Audio recordings of clinical interactions were then used to evaluate completeness and accuracy of available medical records.

Results: Medical records were located for 210 out of 620 SP visits (33.8%). Of those located, more than 80% contained basic patient information and drug treatment when mentioned in visits, but only 57.6% recorded diagnoses. The most incompletely recorded category of information was patient symptoms (74.3% unrecorded), followed by non-drug treatments (65.2% unrecorded). Most of the recorded information was accurate, but accuracy fell below 80% for some items. The keeping of any medical records was positively correlated with the provider’s income (β 0.05, 95% CI 0.01 to 0.09). Providers at hospitals with prescription review were less likely to record completely (β −0.87, 95% CI −1.68 to 0.06). Significant variation by disease type was also found in keeping of any medical record and completeness.

Conclusion: Despite the importance of medical records for health system functioning, many rural facilities have yet to implement systems for maintaining patient records, and records are often incomplete when they exist. Prescription review tied to performance evaluation should be implemented with caution as it may create disincentives for record keeping. Interventions to improve record keeping and management are needed. 

We find that rapid worker turnover significantly disrupts the productivity of responsive manufacturers. Our study uses a uniquely rich dataset drawn from China-based FATP (final assembly, testing, and packaging) facilities that produce millions of units of consumer electronic goods weekly yet exhibit high worker turnover exceeding 300% annually. The data cover the firm's weekly production plans, 52,214 workers' compensations and assignments, and assembly station productivity. To study managerial prescriptions, we extend the classical production planning problem to include endogenous worker turnover as an Experience-Based Equilibrium and use advances in reinforcement learning and approximate dynamic programming to estimate and simulate our model. Our empirical analyses exploit instrumental variables, including the firm's demand forecasts as demand shifters". We find that turnover's impact on yield waste is conservatively $146-178M, and that a well-calibrated wage increase reduces the manufacturer's variable production costs (including wages) by up to 21%, or $594M for the product we study. The wage increase reduces the firm's reliance on a larger workforce and overtime to hedge against yield disruptions from turnover; it stabilizes a leaner workforce and improves both production reliability and exibility. In settings where performance depends on workers repeating known tasks in coordinated groups, our results suggest that firms responsively matching supply to demand can pay a steep price for a disruptively turnover-prone workforce.