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The reform of medical insurance payment system could promote the transformation of medical services from price medical care to value medical care, which is very important to promote the construction of medical alliance. The authors discussed the reform of medical insurance payment system to promote the construction of medical alliance, and the order of medical alliance covering medical services and seeking medical treatment.For medical service providers, the reform of medical insurance payment system helped to promote the construction of closer medical alliance, guided the sinking of high-quality resources, helped to form a smooth referral mechanism, and strengthened the supervision and assessment of medical behavior. For the demanders of medical services, the differentiated medical insurance reimbursement proportion policy within the medical alliancewas more conducive to attracting the first consultation at the grass-roots level. At the same time, patients had a wider choice of medical treatment and more freedom of choice. In view of the problems existing in practice, the authors suggested that a variety of medical insurance payment and performance systems with value-based medical care as the core should be implemented to deepen the development of medical alliance, the medical insurance system and municipal subsidies should jointly undertake the salary subsidies for sinking medical personnel, and integrate the grass-roots fragmented health care business with the help of medical insurance payment tools, and promote the coverage expansion of the medical insurance reform of the medical alliance based on policy guidance.
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Health promotion is to intervene all health influencing factors, health management is the specific measure to implement health promotion strategy, and primary health care is the basis and way to achieve the goal of Universal Health Coverage. Based on the analysis of the relationship among health promotion, health management and primary health care, the authors put forward a health management model based on primary health care, which is based on the primary health care system, effectively integrates all relevant health services and resources, implements a full human-centered process and comprehensive life-cycle health management, conducts effective intervention on health influencing factors, improves residents′ health conditions, and builds a long-term mechanism for poverty prevention in China. Primary health care-based health management model asks for a systematic health management service system and an effective collaborative support mechanism. Primary health care-based health management services emphasize the application of basic principles of primary health care, and focus on the integration of prevention and medical treatment, group and individualization, service provision and self-management. The key is to clarify and standardize the tasks, paths, standards, and quality control of health management services. Meanwhile, centering on the connotation of health management services, the county-level medical and health institutions, health personnel, health information, health financing, and operating mechanisms should be coordinated and integrated to ensure the effectiveness and sustainability of health management services.
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Due to the impact of COVID-19, the online problem-based learning (PBL) teaching mode was first implemented based on the curriculum integration of basic medicine and clinical medicine in our university in 2020. A total of 357 eight-year program clinical medicine students from three grades participated in the online PBL courses. The students have had related skills and knowledge of integration curriculum, and the teachers have carried out sufficient analysis of learning situation, preparation of software and hardware, as well as teaching design. Teachers and students has communicated with each other smoothly and cooperated closely through the Tencent Conference software platform, therefore this teaching mode has gained better feedback among students, with higher satisfaction of courses and significantly improved students' learning enthusiasm. The curriculum integration has laid the foundation for the case design and application of online PBL teaching, while the success of online PBL teaching has also reflected the original intention of curriculum integration reform.
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Objective@#To assess plantar arch index (AI) and prevalence of flat feet in school-age children (7-12 years old) in Shanghai and evaluate the relationship between flat feet with age, gender, weight status (BMI) and occurring sides, and to provide a reference for the prevention of flatfeet.@*Methods@#Three-dimensional foot measuring instruments were used to measure bilateral foot length, medial arch height, AI and arch height ratio (AHR) in school-age children in Shanghai. Statistical analysis of these foot parameters was performed.@*Results@#A total of 3 226 children between aged 7 and 12 in Shanghai were measured with AI of (0.27±0.05) and AHR of (3.02±1.89). Prevalence of flat feet in the group of 7 to 12 year old children was 56.1%. Prevalence of flatfeet decreased significantly with age: 72.6% at 7 years old and 37.9% at 12 years old. Boys had a significantly greater risk for flat feet than girls: the prevalence of flat feet was 62.9% for boys and 47.8% for girls (OR=1.81, 95%CI=1.57-2.10). This risk was independent of age but related to gender. The risk of flat feet in boys was always higher than that in girls at every age. For children aged 7-8, being overweight was not significantly related to the occurrence of flat feet. However, for children aged 9-12 who were overweight were more likely to have flat feet than those of normal weight. The OR increased with age: from 1.44 (95%CI=1.03-2.03) at 9 to 2.96 (95%CI=1.68-5.23) at 12. There was no difference on which side flat feet would occur (χ2=0.95，P=0.33).@*Conclusion@#This finding shows that prevalence of flat feet is influenced by age, gender and weight status. AI and prevalence of flat feet in children aged 7-12 decreases with age, and boys have significantly higher prevalence of flat feet than girls. Overweight children aged 9 or older have a higher risk of flat feet.
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Objective@#To systematically review the structure and content of physical activity questionnaires for children and adolescents and assess the overall validity and reliability of the existing international questionnaires in the last 10 years.@*Methods@#Search terms, including"Physical Activity" AND "Questionnaire" OR "Self-report" OR "Recall" AND "Child*" OR "Adolescen*" OR "Youth" AND 'Valid*’ OR "Reliab*" OR "Reproducib*" OR "Sensitiv*" OR "Responsiv*", were searched for evaluation studies on physical activity questionnaires for children and adolescents in PubMed/Medline and EMBASE database from January 2008 to December 2018. The quality of eligible literature was assessed by using the consensus-based standards for the selection of health status measurement instruments (COSMIN).@*Results@#A total of 37 articles containing 36 physical activity questionnaires in 7 989 participants were included. There were 68 studies on the assessment of the validity and reliability of assorted physical activity questionnaires, 45 studies for validity and 23 for reliability. The median Spearman correlation coefficients in validity studies were 0.28 for moderate-to-vigorous intensity physical activity, 0.15 for moderate-intensity physical activity, 0.27 for vigorous-intensity physical activity and 0.31 for physical activity energy expenditure. The median reliability correlation coefficients were 0.32 for sedentary behaviors, 0.53 for light-intensity physical activity, 0.80 for moderate-to-vigorous intensity physical activity, 0.54 for moderate-intensity physical activity and 0.69 for vigorous-intensity physical activity.@*Conclusion@#The reliability of physical activity questionnaires measured moderate-to-vigorous intensity physical activity for children and adolescents is acceptable, but the validity is low.
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Objective@#To investigate the prevalence of biting pencils among pupils living in Harbin, Guangzhou, and Beijing and to compare the differences among these cases.@*Methods@#Stratified sampling method was used to select four elementary schools in Harbin and Guangzhou from April 2015 to April 2016. Firstly, Simple random sampling method was used in every grade (grade 1-grade 5) to select 3 or 4 classes (71 classes in total).After the sample selection, questionnaire surveys were conducted among pupils and their guardians (anyone of their guardians) who belonged to these classes. Secondly, the study extracted part of these pupils to conduct a field survey. Every school was classified by grade, and every grade adopted the method of random sampling to select one classes (20 classes in total). Meanwhile, the study randomly selected pupils from 10 classes in 2 elementary schools in Beijing. All together, 1 627 pupils participated in the field survey. The questionnaire included general information about the students and their guardians, the situation of biting pencils, the awareness of the harm of biting pencils, etc.; the field survey considered if participates' pencils have tooth marks and the severity of the marks, etc. χ2 was applied to test and compare the differences among pupils of different genders and different cities. The comparison focused on the proportion of students who bited pencils, the proportion of pencils with tooth marks and the proportion of students and guardians already awared of the harm of biting pencils, etc.@*Results@#The number of the valid questionnaires in Harbin and Guangzhou were 1 842, and 1 210, respectively. The occurrence rate of pupils biting pencils in Harbin (18.0% (333/1 842)) was higher than that in Guangzhou (11.3% (137/1 210)) (χ2=29.16, P=0.001). Specifically, in Harbin, the rate of boys biting pencils was 21.9% (212/965), which was higher than girls (13.8% (121/877)) (χ2=27.04, P=0.001). Similarly, in Guangzhou, the rate of boys biting pencils was 14.5% (92/632), which was also higher than girls (7.7% (45/578)) (χ2=15.34, P=0.001). The awareness rate of the harm of biting pencils among students from these two cities were 88.5% (1 611/1 819), and 90.8% (1 098/1 208), respectively, and the difference was statistically significant as well (χ2=4.39, P= 0.020). Compared with these data, the awareness rate of the harm of biting pencils among guardians from these two cities were 74.7% (1 339/1 791), and 79.4% (832/1 047), respectively as well as the statistically significant difference appeared (χ2=9.83, P=0.007). The result of field survey showed the rate of tooth-marked pencils in Harbin, Guangzhou and Beijing was 30.5% (187/613), 14.8% (79/534), and 28.3% (136/480), respectively. The difference was also statistically significant (χ2=42.68, P=0.001). The degree of tooth marks was mainly mild, while the percentage of mild degree in Guangzhou (54.4%(43/79)) and Beijing (41.2% (56/136)) was apparently higher than that of Harbin (39.0% (73/187)). The difference was not statistically significant (χ2=7.01, P=0.136).@*Conclusion@#The behavior of biting pencils existed universally among pupils in Harbin, Guangzhou, and Beijing , which the situation of pupils biting pencils in Harbin and Beijing was more serious than that in Guangzhou. Pupils, parents and teachers should pay attention to such a behavior.
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Objective To evaluate the effect of cell-penetrating peptide (protein transduction domain 4,PTD4) mediated copper-zinc superoxide dismutase (Cu/Zn SOD) on hypoxia/reoxygenation injury (HRI) in rat myocardial cells.Methods Rat myocardial cell H9C2 HRI model was prepared by using the anaerobic incubator (85% N2,10% H2,5% CO2).The HRI group (without adding any treating factor in HRI cell culture fluid),HRI+Cu/Zn SOD group (adding 10 μmol/L Cu/Zn SOD) and HRI+PTD4-Cu/Zn SOD group (10 μmol/L PTD4-Cu/Zn SOD) were set up.In addition,normally cultured myocardial cells served as the normal control group.After incubating for 30 min,the ultra microstructure of mitochondria was observed under transmission electron microscope.The mitochondrial membrane potential was detected by JC-1 kit.The myocardial cell apoptosis was detected by TdT mediated dUTP nick end labeling TUNEL technique.Results The mitochondria injury degree after 30 min incubation in the PTD4-Cu/Zn SOD group was significantly improved compared with the HRI group.Compared with the normal control group,the mitochondrial membrane potential in the HRI group was significantly decreased,while the mitochondrial membrane potential in the PTD4-Cu/Zn SOD group was lower than that in the normal control group,but compared with the HRI group,which was obviously recovered.The cardiomyocyte apoptosis in the HRI+PTD4-Cu/Zn SOD group was (10.20±2.77)%,which was significantly decreased compared with (28.40±2.41)% in the HRI group,the difference was statistically significant (P<0.05).Conclusion PTD4 mediated Cu/Zn SOD can attenuate HRI in rat myocardial cells.
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The effects of prescriptions of fragrant traditional Chinese medicine covered in ancient books on traditional Chinese medicine published in the past dynasties on disease control and treatment were retrieved from the Full-text Database of Ancient Books on Traditional Chinese Medicine developed by Nanjing University of Traditional Chinese Medicine. A fragrant medicinal subject system with unique characteristics was established by analyzing the characteristics of prescribed fragrant traditional Chi-nese medicine and the prescribing rules of fragrant traditional Chinese medicine according to theirprinciples-methods-formulae-medicinal, clarifying the related factors influencing diseases and the related mechanisms of prescriptions, which can not only promote the theoretical and practical development of external treatment with prescriptions of fragrant traditional Chinese medicine but also provide the reliable philological basis for external diseases and pharmacology of traditional Chinese medical formulae.
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OBJECTIVE To observe the neurotoxicity of 1-bromopropane(BP) and investigate the protective effects of edaravone(Edv) against BP-induced deficits of spatial learning and memory ability in rats by its anti-inflammatory mechanism. METHODS Adult male Wistar rats were ig given BP 800 mg·kg-1 to develop the model, followed by Edv 1, 3 and 5 mg·kg-1 ip treatment respectively 4 h later for consecutive 12 d. From the 7th day (d 7), all rats were subjected to the five-day place navigation in Morris water maze (MWM) to measure the escape latency and the total swimming distance. On d 6 of MWM, spatial probe test was performed and the crossing times of rats were recorded to evaluate the spatial memory ability. At the end of the behavioral experiment, four rats in each group were randomly selected and the frozen section of the whole brain was sliced for thionin staining and immunohisto?chemistry. The other eight sacrifced rat brains from each group were harvested for the determination of the tumor necrosis factor-α (TNF-α) and nitric oxide (NO) by ELISA and nitrate reductase method, respectively. RESULTS The results of MWM test showed that compared with control rats the escape latencies of rats in BP group were increased by 60.8%, 81.9%,124.0% and 323.3%, respectively, during the d 2-d 5 of MWM, and the total swimming distance increased by 47.0%, 66.4%, 106.0% and 277.6%, respectirely. All the differences between BP group and control group were significant (P<0.05, P<0.01). In the spatial probe trial, the crossing times of rats in BP group were significantly decreased, compared with the control rats (P<0.01). Morphologically, thionin staining and immunohistochemistry revealed significant microglia activation and neuron loss in the rat forebrains, accompanied by a 147.6% and 18.7% increase in NO and TNF-α levels in rats treated with BP respectively compared with control values (P<0.05, P<0.01). After co-treatment at different dosages of Edv with BP, the escape latencies of rats in BP+Edv 5 mg·kg-1 group were decreased by 38.4%and 44.3%(P<0.01), and the total swimming distance decreased 34.5%and 43.3%(P<0.05, P<0.01), respectively, compared with the BP treated rats on the d 4 and d 5 of MWM test. The microglia activation and neuron damage in the brain of rats induced by BP treatment were significantly alleviated in BP+Edv groups. In addition, the contents of NO and TNF-α were decreased in BP+Edv 1, 3 and 5 mg · kg-1 groups, with a decrease of 53.8%, 55.4% and 59.8% in NO, and 12.2%, 15.8% and 22.2% in TNF-α(P<0.05, P<0.01), respectively. CONCLUSION Edv could effectively protect against central neurotoxicity induced by BP via anti-neuro?inflammation.
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Endothelial dysfunction was closely related with AS , NO bioavailability ( production and utilization of endothelial NO ) was decreased by oxidative stress , lipid infiltration , inflammatory factor expression , vascular tone alteration and so on , which play an important role in endothelial dysfunction .Enhanced arginine , activityand asym-metric dimethylarginine together with increased hyperhomocysteinemia all promote AS by intervening NO bioavail -ability.Diabetes mellitus, obesity, chronic kidney disease , smoking and so on also involved in AS via influencing NO bioavailability and NO level .
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Objective To explore the clinical efficacy of Naikan cognitive therapy(NCT) for alcohol dependent patients.Methods 64 cases of alcohol-dependent patients were randomly assigned to the study group (32 cases) and the control group (32 cases).The study group was treated with NCT for successive 7 days on the basis of taking original drugs; and the control group was only given the original drug therapy.The obsessive compulsive drinking scale (OCDS),self-report symptom inventory(SCL-90),nurses observation scale for inpatient evaluation(NOSIE) were administered to all subjects at pre-and post-treatment.Results ①After the treatments,the scores of OCDS in study group (49.51 ± 1.63) were lower than that in control group(53.92 ± 1.82),and the statistical difference had the significance (P ＜ 0.01).②After the treatments,the total scores and some factor scores of SCL-90 in study group were lower than in control group (t =-2.413,P =0.019 ; t =-2.033,P =0.047 ; t =-2.065,P =0.044 ; t =-2.038,0.046),and the difference was statistically significant.③After the treatments,in the study group,the scores of the total estimated factor and total positive factor(187.10 ± 18.80;78.51 ±12.22) were higher than in control group (175.51 ± 11.71 ; 68.22 ± 11.87),total negative factor score (15.55 ±9.46) were lower than in control group (20.51 ± 9.33),and the difference was statistically significant.Conclusion NCT can effectively inhibit alcohol craving,and reduce the drinking wine relevant questions.It can help to improve psychological symptoms in patients with alcohol dependence,especially depression and anxious symptoms.
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This study examined the methylation difference in AIRE and RASSF1A between maternal and placental DNA, and the implication of this difference in the identification of free fetal DNA in maternal plasma and in prenatal diagnosis of trisomy 21. Maternal plasma samples were collected from 388 singleton pregnancies, and placental or chorionic villus tissues from 112 of them. Methylation-specific PCR (MSP) and methylation-sensitive restriction enzyme digestion followed by fluorescent quantitative PCR (MSRE + PCR) were employed to detect the maternal-fetal methylation difference in AIRE and RASSF1A. Diagnosis of trisomy 21 was established according to the ratio of fetal-specific AIRE to RASSF1A in maternal plasma. Both methods confirmed that AIRE and RASSF1A were hypomethylated in maternal blood cells but hypermethylated in placental or chorionic villus tissues. Moreover, the differential methylation for each locus could be seen during the whole pregnant period. The positive rates of fetal AIRE and RASSF1A in maternal plasma were found to be 78.1% and 82.1% by MSP and 94.8% and 96.9% by MSRE + PCR. MSRE + PCR was superior to MSP in the identification of fetal-specific hypermethylated sequences (P<0.05). Based on the data from 266 euploidy pregnancies, the 95% reference interval of the fetal AIRE/RASSF1A ratio in maternal plasma was 0.33-1.77, which was taken as the reference value for determining the numbers of fetal chromosome 21 in 102 pregnancies. The accuracy rate in 98 euploidy pregnancies was 96.9% (95/98). Three of the four trisomy 21 pregnancies were confirmed with this method. It was concluded that hypermethylated AIRE and RASSF1A may serve as fetal-specific markers for the identification of fetal DNA in maternal plasma and may be used for noninvasive prenatal diagnosis of trisomy 21.
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BACKGROUND: Preplant diagnosis and rigorous implant strategy based on multislice spiral computed tomography (MSCT) imaging can improve success rate of mini-implants as anchorage. Effective application of imaging information in implant anchorage requires reliable tools and methods.OBJECTIVE: To investigate the accuracy of the radiographic and tunnel-type surgical templates assisting implant anchorage surgery and evaluate the clinical significance.METHODS: The transparent radiographic templates were made with occlusal rest to assist MSCT to scan two pigs' skulls locatively. After designed the implant anchorage angles in MSCT images accurately, we made the tunnel-type surgical template by angle data. A total of 32 miniscrews were implanted by surgical template, and the two pigs skulls were rescanned by MSCT. After dissected the pig alveolar process, the MSCT preoperative planning angles, the MSCT postoperative measurement angles and the measurement angles of anatomic bone samples were analyzed statistically. RESULT AND CONCLUSION: The 32 miniscrews were implanted successfully. They did not damage dental roots or surrounding important structures. Compared MSCT preoperative planning angles with MSCT postoperative measurement angles and anatomic bone samples measurement angles, there were no significant differences on axial sections or cross-sections and the r concordance correlations were very good. Results show that the radiographic and the tunnel-type surgical templates are accurate and reliable for operation and will help to improve the success rate of implant anchorage.