Healthcare reform in Norway and its enlightenments to China / 中华医院管理杂志

This study applied both qualitative and quantitative research methods to describe Norwegian health care reform, covering such performance indicators as key reform process, healthcare reform trends in number of beds per thousand, health care resource utilization, hospital management system, general practitioners, and public health management system. Moreover, the paper put forward suggestions for the reform in China, namely health governance mechanism, the transformation from scale expansion to quality and performance-based development, reforming family physician system.

Policy framework of the compensation mechanism reform for primary medical and health institutions in Zhejiang province / 中华医院管理杂志

Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.

Health care delivery system in remote areas of Japan and its enlightenment to China / 中华医院管理杂志

This paper summarized health care delivery system in remote areas of Japan including criteria for underserved areas, regular adjustment to the list, comprehensive national plans, integrated provision system, governmental responsibilities, establishment of Jichi Medical University, participation of social organizations.We raise such suggestions as leading role of the government, precision listing underserved areas,implementing special plan, financing and payment policy, human resources for health, and regional co-ordination of medical resource.

Framework of family doctors′contract-based service system and its practice in Zhejiang province / 中华医院管理杂志

The control handles( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Identification of Salmonella H antigens by xTAG technology / 中华微生物学和免疫学杂志

Objective To develop a microsphere-based suspension array for simultaneous detec-tion and identification of Salmonella H antigens by using Luminex xTAG technology and to evaluate its capa-bility in serotyping Salmonella strains. Methods The fliC and fljB genes, encoding the H antigen of Salmo-nella, were selected as the target genes. Universal upstream primers were designed based on the highly con-served regions of fliC and fljB genes, and the corresponding specific reverse primers were designed based on the variable regions. While synthesizing, the 5′end of each upstream primer was labeled with biotin and the 5′end of each specific reverse primer was modified with its certain TAG sequence. After amplified and la-beled with biotin and TAG sequence, the PCR products of specimens were hybridized with the mixture of va-rious MagPlex-xTAGTM microspheres. Each set of microspheres contained its unique anti-TAG sequences. The results of hybridization were analyzed by using Luminex MagPix reader system and the median fluores-cence intensity ( MFI) was reported. The H antigens of 145 Salmonella strains were identified with this de-veloped xTAG suspension array, and the results were compared with those obtained by using traditional ser-um agglutination test. Results The PCR products of different H antigens ranged from 94 bp to 245 bp and could be identified by hybridizing with MagPlex-xTAGTM microspheres. There was no cross-reaction between different H antigens or with DNAs derived from Escherichia coli, Vibrio cholerae, Vibrio parahaemolyticus and Shigella flexneri. Compared with the traditional serum agglutination test, the sensitivity and specificity of the xTAG suspension array in the identification of H antigens of 145 Salmonella strains were 95. 1% and 100%, respectively. Conclusion The developed xTAG suspension array was a specific, accurate and effective method for simultaneous detection and identification of 31 H antigens of common Salmonella serovars strains. It could be used for determining the H antigens of more than 90 Salmonella strains within 5 hours.

Genetic Diversity and Evolution of the M Gene of Human Influenza A Viruses from 2009 to 2013 in Hangzhou, China / 病毒学报

We investigated the genetic diversity and evolution of the M gene of human influenza A viruses in Hangzhou (Zhejiang province, China) from 2009 to 2013, including subtypes of A(H1N1) pdm09 strains and seasonal A(H3N2) strains. Subtypes of analyzed viruses were identified by cell culture and real-time reverse transcription-polymerase chain reaction, followed by cloning, sequencing and phylogenetic analyses of the M gene. Assessment of 5675 throat swabs revealed a positive rate for the influenza virus of 20.46%, and 827 cases were diagnosed as. infections due to influenza A viruses. Seventy-six influenza-A strains were selected randomly from nine stages during six phases of a virus epidemic. Sequences of the M gene showed high homology among six epidemics with identities of amino-acid sequences of 98.98-100%. All strains contained the adamantine-resistant mutation S31N in its M2 protein. Two of the A(H1N1)pdm09 strains had double mutants of V27A/S31N or V271/S31N. One of the seasonal A(H3N2) viruses had another form of double-mutant R45H/S31N. Evolutionary rate of the M gene was much lower than that of the HA gene and NA gene. Compared with A(H3N2) strains, higher positive pressure on the M1 and M2 proteins of A(H1N1) pdm09 viruses was observed. Separate analyses of M1 and M2 proteins revealed very different selection pressures. Knowledge of the genetic diversity and evolution of the M gene of human influenza-A viruses will be valuable for the control and prevention of diseases.

Analysis of epidemiologic and etiology of hepatitis E in Hangzhou, 2004-2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To comprehend the epidemiologic of hepatitis E and genetic characteristics of hepatitis E virus (HEV) in Hangzhou from 2004 to 2011.</p><p><b>METHODS</b>Using China information system for disease control and prevention, the incidence of hepatitis E from 2004 to 2011 in Hangzhou city, and the basic information of patients were collected. In 2011, 65 hepatitis E laboratory confirmed cases were selected by random number table sampling method from the hospitals designated infectious diseases in Hangzhou city, and acquisition of the 60 blood specimens and stool specimens of 18 copies. One city and two surrounding counties were selected by cluster random sampling method in the context of Hangzhou city, and the pig slaughters and farmers were selected as the sampling point, and acquisition of pig gallbladder specimens of 52 copies, and 30 stool samples of scatter-feed pigs, 15 stool specimens of scatter-feed rabbits. HEV was tested in samples, gene extraction and analysis of gene sequence were conducted which were compared with gene bank HEV gene sequence, and a phylogenetic tree was formed. The epidemic characteristics of hepatitis E of Hangzhou city from 2004 to 2011 were described. The difference of incidence of hepatitis E was analyzed between years and sexes in Hangzhou city.</p><p><b>RESULTS</b>There were reported a total of 3 490 cases of hepatitis E in Hangzhou from 2004 to 2011, and 3 cases of death; The average annual incidence rate was 5.79/100 000 (3 490/60 276 338). There was the overall upward trend in incidence between different years (χ² = 52.38, P < 0.01) , which the highest was 8.10/100 000 (705/8 700 373) in 2011, and the lowest incidence rate was 4.19/100 000 in 2005. The incidence of males (8.12/100 000 (2 474/30 450 990) ) was significantly higher than that of the females (3.46/100 000 (1 016/29 384 491) ) (χ² = 558.45, P < 0.05). 78 specimens of blood and stool were collected, including 16 positive samples, with positive rate 21%. There were a total of 97 specimens of pig gallbladder, pig manure and rabbit stool, including 2 positive rabbit stool samples, with positive rate of 2%. HEV genes isolated from Hangzhou were mainly type IV, with homology of 91.8% to 100%; compared with human type IV strains, the homology of nucleotide was 84.6%-96.7%; compared with type IV strain of pig genome sequence alignment, homology was 82.6%-95.2%.</p><p><b>CONCLUSION</b>Hepatitis E's incidence showed an increasing trend year by year in Hangzhou. HEV of type IV was dominant, and HEV strains in the human and swine were highly homologous.</p>

Molecular epidemiology of human metapneumovirus in children with respiratory tract infection in Hangzhou / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the molecular epidemiologic features of human metapnenmovirus (hMPV) in children with respiratory tract infection in Hangzhou.</p><p><b>METHODS</b>2 593 throat swabs were collected from patients with respiratory tract infections who visited the hospitals with sentinel surveillance programs from January 2011 to December 2013, including 1 676 outpatients and 917 inpatients. Total nucleic acid was extracted from the specimens and the fusion (F) protein gene of hMPV was amplified by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR), with positive samples picked to compare with the sequence of hMPV in GenBank, after the sequence of amplification products were determined. Other two types of common respiratory virus were tested using RT-PCR.</p><p><b>RESULTS</b>The overall positive rate in this study was 6.51% (169/2 593), with 6.62% (111/1 676) in outpatients and 6.32% (58/917) in inpatients, but no statistically significant difference was found (χ(2) = 0.086, P = 0.769). The rates was 7.01% in males and 5.72% in females, with no statistically significant difference in different sex (χ(2) = 1.676, P = 0.195). The positive rate was 14.14% (28/198)in the 2-year-olds, 14.01% (22/158)in 3-year olds. The rate in 2-year olds was higher than in other groups, with statistically significant differences between the groups (χ(2) = 38.654, P = 0.000). Of the 169 positive cases, 153 (90.53%) in the younger than 5 years olds. The rates of infection with hMPV in winter and spring were statistically higher than in summer and autumn (χ(2) = 67.032, P = 0.000). The rate of co-infection was 19.52% (33/169). 88 amplified productions were selected for gene sequence analysis, and the F gene homology were 81.6%-100.0% with reference strains in GenBank. Data showed that all the 4 viral subtypes: A2 (52.27% , 46/88), B1 (37.51%, 33/88), B2 (9.09%, 8/88) and A1 (1.13%, 1/88) co-circulated during the study. However, different subtypes appeared predominant in different years:hMPV subtype B1 was in 2011 and 2012, subtype A2 in the end of 2012 and in 2013. Of the 88 specimens, gene sequences were determinate, with A genotype accounted for 67.56% (25/37), B genotype for 32.43% (12/37)in children younger than 1-year olds, and A genotype accounted for 43.13% (22/51), B genotype for 56.86% (29/51)in children above 1-year olds. Significant differences between the two groups (χ(2) = 5.143, P = 0.023) were noticed.</p><p><b>CONCLUSION</b>It was confirmed that hMPV was one of the substantial pathogens causing the respiratory tract infections. Data from our study suggested that the peak time of hMPV infection predominated during winter and spring in Hangzhou. Both hMPV subtype B1 and subtype A2 were found popular in this study, with hMPV genotype A dominating in children younger than 1-year olds.</p>