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The Master of Public Health (MPH) is one of the internationally recognized ways of training professionals in the medical and health field. With the outbreak of COVID-19 pandemic, the need for talents who can serve the national public health emergency management system has accelerated. This article makes the comparison of public health education in China and the UK, starting from the reasons and advantages of medical education in two countries, selecting several universities with high rankings in public health in China and the UK as the research objects, collecting and summarizing their programme descriptions, from the enrollment mode, training objectives, cultivation mode and degree types, curriculum settings, etc., in the MPH programme descriptions in order to find the advantages of MPH education in the UK, which can be used for reference in the education and training of public health talents in China, and is of great significance for the improvement and optimization of MPH education in China.
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Objective:To study the difference in the extraction efficiency of the novel coronavirus (2019-nCoV) nucleic acid by using magnetic beads method, centrifugal column method and one-step method.Methods:On March 5, 2021, 10 throat swabs were collected from the staff working in the nucleic acid sampling room in Department of Clinical Laboratory, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University. The positive quality control samples were mixed into the swabs and used as mock positive samples. The RNA was extracted from simulated positive samples and their diluted samples by using magnetic beads method, centrifugation column method and one-step method. The purity ( A260/ A280 ratio) and concentration of the nucleic acid obtained were measured by micro-uv photometry, and fluorescence quantitative PCR was performed to compare the CT value and extraction efficiency. The three methods were used to extract the simulated weak positive specimens and to compare the difference of CT values after amplification. The measurement data that followed normal distribution were expressed by xˉ±s, the t test was used for comparing in the same group, and single factor analysis of variance was used for comparing among multiple groups. A P value smaller than 0.05 indicated a significant difference. Results:2019-nCoV nucleic acid extracted by magnetic bead method, centrifugal column method and one-step method could amplify positive results. There was no significant difference between the CT value of RNA amplification extracted by magnetic bead method and one-step method ( t=? 0.995 , P=0.376). The CT values of orf1ab gene amplified by centrifugal column method, magnetic bead method and one-step method were 29.28±0.06, 30.82±0.14 and 29.79±0.01 respectively ( F=11.196 , P=0.041). The CT values of E gene were 28.52±0.40, 27.33±0.78 and 27.38±0.13 respectively ( F=3.407, P=0.169). The CT values of N gene were 28.61±1.02, 27.24±0.20 and 27.25±0.47, respectively ( F=2.880 , P=0.020). The CT values of human genes extracted by centrifugal column method, magnetic bead method and one-step method were 19.68±0.36, 20.14±0.06 and 20.58±0.49 respectively, which was statistically significant ( F=4.904, P=0.048). The CT value of amplified human gene was affected by the dilution of human samples twice. The CT value of undiluted samples was smaller than that of diluted samples twice, with a difference of 2.95±0.22, which was statistically significant ( t=?3.025, P=0.039). The extraction time of one-step method, magnetic bead method and centrifugal column method were (15.00±1.50), (20.00±1.50) and (40.00±5.5) min respectively, and the difference was statistically significant ( F=688 , P=0.027). Conclusions:Magnetic bead method, centrifugal column method and one-step method can be used to extract 2019-nCoV nucleic acid, for the centrifugal column method has a higher extraction efficiency than the magnetic bead method and the one-step method. The one-step method is the fastest, followed by the magnetic bead method and the centrifugal column method. A large number of clinical samples can be processed using the magnetic bead method and one-step method. One-step rapid nucleic acid test can also be performed on samples from emergency and fever clinics. It is not recommended to dilute specimens for testing. In order to improve the detection rate, extracting RNA from highly suspected samples with negative initial nucleic acid test by centrifugal column method is suggested.
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Negative pressure wound therapy with instillation (NPWTi) is used in the treatment of various types of wounds. A series of parameters related to NPWTi have not been unified yet, including flushing fluid selection, flushing mode, and rinsing fluid soaking time, negative pressure size, treatment time, etc. This paper reviews the research progress of these parameters.
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Objective@#To establish and hevaluate a detection method for influenza virus using reverse transcriptase-recombinase polymerase amplification (RT-RPA).@*Methods@#RT-RPA was developed for detection of influenza viruses (type A and B) and subtyping of H1 and H3 using the primers targeted matrix and hemagglutinin (HA) genes of influenza A virus, and non-structural (NS) protein gene of influenza B virus. The specificity and sensitivity of RT-RPA were determined.@*Results@#The RT-RPA for the detection of influenza viruses showed specific amplification products of corresponding target gene, but no amplification products for other respiratory viruses, indicating that the method had good specificity. The detection limits of RT-RPA were 100 copies/μl. RT-RPA combined with SYBR Green I was used for the detection of influenza B virus with the detection limit of 100 copies/μl.@*Conclusions@#The feasibility of detecting influenza virus by RT-RPA was preliminarily confirmed.
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Objective@#To explore the establishment of an evaluation indicator system for disease prevention and control workload at public hospitals, based on the current situation of disease prevention and control work undertaken by public hospitals of and above secondary level in Beijing, and to provide evaluation assistance for them to do better in this regard.@*Methods@#This research was based on our pervious study of the current situation description of disease prevention and control work undertaken by public hospitals in Beijing, by which the contents of routine disease prevention and control work at hospitals have been initially established. The unit strength of each work was consulted, and the disease prevention and control work was classified according to the results. Meanwhile the consistency test of the work intensity within the category was carried out. After integration, the classification and evaluation indicator of disease prevention and control work in public hospitals of and above secondary level in Beijing was finally established.@*Results@#The workload evaluation indicator system was divided into eight parts: report work, report quality control work, monitoring work, training work, work of public health related clinical diagnosis and treatment, work of clinical examination and vaccination, work of sampling and testing and public health related consultation work. The work intensity of each category ranged from 4.78 to 7.34.@*Conclusions@#The evaluation indicator system of workload is suitable for the evaluation of basic works. The unified transformation of workload by using the value of work intensity is conducive to management evaluation, but the limitation of the indicators exists in time and region, making it necessary to adjust by the local specific situation at the promotion and application level.
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Objective@#To investigate the implementation of disease prevention and control services at tertiary public general hospitals in Beijing for providing evidences to explore and build a scientific evaluation model of disease control service in medical institutions.@*Methods@#June to September 2018, through a questionnaire survey of 50 tertiary public general hospitals in Beijing, a descriptive analysis was made on the department setting, personnel allocation and service provision status of disease prevention and control at tertiary public general hospitals in Beijing.@*Results@#Among the 44 investigated public tertiary general hospitals, 26(59.1%) medical institutions have set up departments of disease prevention and control. The average staffing of 44 hospitals was 5.8 persons for the department. Professional composition of the staff was mostly nursing and clinical disciplines, and the academic and professional titles were mostly undergraduate and intermediate degrees respectively. Overall performance of disease prevention and control services in public tertiary general hospitals was satisfactory. The work was well carried out in communicable disease control and death-surveillance management, namely in immunoprophylaxis, chronic noncommunicable diseases and injury monitoring, which varies widely in mental health services, occupational health management, environmental and health monitoring and other functions.@*Conclusions@#Professional ability and management level of personnel still need to be improved. We should further clarify the joint prevention and control mechanism of the " Three-in-one" nature of disease control institutions, medical institutions and communities, promote the combination of medical treatment and prevention, and explore the classification and grading evaluation of disease control work based on the types and quantity requirements of disease prevention and control services undertaken by hospitals, so as to effectively improve the level of disease control services in hospitals.
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An assessment is a key to public health management. This article reviewed the experiences and researches of assessment on public-health system, as well as public health service quality of medical institutions in America, the United Kingdom and Australia among other countries. On such basis, suggestions were provided on assessments of public health service in China, in order to help the government to improve its indicator evaluation system.
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Hospitals, especially public hospitals, are an important part of the public health service system. To clarify public health functions of secondary and tertiary public hospitals in China and provide evidences for related health policy decisions, this article introduced the public health services of hospitals in the United States, Britain, Australia and Canada, and then analyzed public health functions of secondary and tertiary public hospitals in China through literature review and case study. The authors summed up eight kinds of public health service functions, and put forward policy advices to promote the performance of public health functions of public hospitals in China.
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Objective To explore the establishment of an evaluation indicator system for disease prevention and control workload at public hospitals, based on the current situation of disease prevention and control work undertaken by public hospitals of and above secondary level in Beijing, and to provide evaluation assistance for them to do better in this regard.Methods This research was based on our pervious study of the current situation description of disease prevention and control work undertaken by public hospitals in Beijing, by which the contents of routine disease prevention and control work at hospitals have been initially established. The unit strength of each work was consulted, and the disease prevention and control work was classified according to the results. Meanwhile the consistency test of the work intensity within the category was carried out. After integration, the classification and evaluation indicator of disease prevention and control work in public hospitals of and above secondary level in Beijing was finally established. Results The workload evaluation indicator system was divided into eight parts:report work, report quality control work, monitoring work, training work, work of public health related clinical diagnosis and treatment, work of clinical examination and vaccination, work of sampling and testing and public health related consultation work. The work intensity of each category ranged from 4.78 to 7.34. Conclusions The evaluation indicator system of workload is suitable for the evaluation of basic works. The unified transformation of workload by using the value of work intensity is conducive to management evaluation, but the limitation of the indicators exists in time and region, making it necessary to adjust by the local specific situation at the promotion and application level.
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Objective To investigate the implementation of disease prevention and control services at tertiary public general hospitals in Beijing for providing evidences to explore and build a scientific evaluation model of disease control service in medical institutions. Methods June to September 2018, through a questionnaire survey of 50 tertiary public general hospitals in Beijing, a descriptive analysis was made on the department setting, personnel allocation and service provision status of disease prevention and control at tertiary public general hospitals in Beijing. Results Among the 44 investigated public tertiary general hospitals, 26 ( 59.1% ) medical institutions have set up departments of disease prevention and control. The average staffing of 44 hospitals was 5.8 persons for the department. Professional composition of the staff was mostly nursing and clinical disciplines, and the academic and professional titles were mostly undergraduate and intermediate degrees respectively. Overall performance of disease prevention and control services in public tertiary general hospitals was satisfactory. The work was well carried out in communicable disease control and death-surveillance management, namely in immunoprophylaxis, chronic noncommunicable diseases and injury monitoring, which varies widely in mental health services, occupational health management, environmental and health monitoring and other functions. Conclusions Professional ability and management level of personnel still need to be improved. We should further clarify the joint prevention and control mechanism of the " Three-in-one" nature of disease control institutions, medical institutions and communities, promote the combination of medical treatment and prevention, and explore the classification and grading evaluation of disease control work based on the types and quantity requirements of disease prevention and control services undertaken by hospitals, so as to effectively improve the level of disease control services in hospitals.
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An assessment is a key to public health management. This article reviewed the experiences and researches of assessment on public-health system, as well as public health service quality of medical institutions in America, the United Kingdom and Australia among other countries. On such basis, suggestions were provided on assessments of public health service in China, in order to help the government to improve its indicator evaluation system.
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Hospitals, especially public hospitals, are an important part of the public health service system. To clarify public health functions of secondary and tertiary public hospitals in China and provide evidences for related health policy decisions, this article introduced the public health services of hospitals in the United States, Britain, Australia and Canada, and then analyzed public health functions of secondary and tertiary public hospitals in China through literature review and case study. The authors summed up eight kinds of public health service functions, and put forward policy advices to promote the performance of public health functions of public hospitals in China.
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Objective To investigate clinicopathological features,diagnosis and treatment of cutaneous Merkel cell carcinoma (MCC).Methods CNKI,Wanfang,Vip databases were searched for reported domestic cases of MCC from January 1,1986 to October 1,2017,and clinical data were collected,and retrospectively analyzed and summarized.Results During 31 years between 1986 and 2017,a total of 171 domestic cases of MCC were reported.There were 78 males and 93 females,and the ratio of male to female was 1:1.19.Of the 171 patients,136 (79.5％) were aged more than 50 years,and lesions mostly occurred on the head and face or extremities in 139 (81.3％) patients.Clinically,149 (87.1％) patients were misdiagnosed as tumor of unknown origin (89 cases,52％),malignant lymphoma (34 cases,19.9％),benign tumors (15 cases,8.8％) or non-tumor diseases (11 cases,6.4％).As for clinical stage,84 (49.1％) patients had stage Ⅰ MCC,and 49 (28.6％)had stage Ⅱ MCC.One patient received immunotherapy,and 165 patients underwent surgical resection,including 91 patients receiving surgery alone,24 patients treated with postoperative radiotherapy,19 patients treated with postoperative chemotherapy,and 31 patients receiving postoperative chemoradiotherapy.Five patients did not describe the treatment.Among 74 patients who were followed up after the surgery,one-year survival rate and five-year survival rate were 52.7％ and 6.8％ respectively.The five-year survival rate was 6.1％ in the patients with stage Ⅰ MCC,5.6％ in those with stage Ⅱ MCC,and 0 in those with stage Ⅲ and Ⅳ MCC.Conclusions In China,cutaneous MCC mostly occurs on the head,face,neck and extremities of the middle-aged or elderly,with a high misdiagnosis rate.Surgical excision combined with radiotherapy or chemotherapy is a frequently used treatment protocol in China,but the prognosis is always poor.
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Objective To investigate the values of combined detection of serum pancreas autoantibodies (PAB),anti-saccharomyces cerevisiae antibodies(ASCA),goblet cell autoantibodies(GAB) and antineutrophil cytoplasmic antibodies(PANCA) and fecal calprotectin(FC) in the diagnosis and differential diagnosis of inflammatory bowel diseases(IBD).Methods The serum and feces samples from IBD patients,including 107 with definite Crohn's disease(CD) and 98 with definite ulcerative colitis(UC),and 79 non-IBD patients as the control were collected.Serum PANCA,ASCA,GAB and PAB were detected by an indirect immunofluorescence assay,and FC concentration by double-antibody sandwich ELISA.The results from different patients were compared and analyzed.Results The positive rates of serum PANCA,GAB,PAB and ASCA in 205 IBD patients were 36.1％,29.8％,38.0％ and 4.9％,respectively.The FC concentrations in IBD,CD and UC patients were significantly higher than that in the control(P ＜ 0.01),while there was no statistical difference between CD and UC patients (P ＞ 0.05).The positive rates of PANCA in CD and UC patients were 8.4％ and 66.3％,respectively,while those of PAB in CD and UC patients were 65.4％ and 8.2％,respectively.The sensitivity and specificity of PAB,PANCA,GAB,ASCA,FC and their combination in the differential diagnosis of IBD and non-IBD were 38.0％,36.1％,29.8％,4.9％,54.1％,63.4％ and 98.7％,96.2％,94.9％,100％,68.4％,93.7％,respectively.The area under the ROC of the combination of 5 markers was 0.819 in differentially diagnosing IBD and non-IBD.The area under the ROC of PANCA for the differential diagnosis of UC was 0.816,while that of PAB for the differential diagnosis of CD was 0.823.Conclusion GAB is an autoantibody associated with IBD,which may be helpful for the auxiliary diagnosis of IBD.PAB and PANCA are the important serological markers for the diagnosis of CD and UC,respectively.The combination of FC with PAB,PANCA,GAB and ASCA may be used for the differential diagnosis of IBD and non-IBD,but has little value in distinguishing CD and UC.
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Objective To explore the relationship between the obstetric factors defined by Robson Ten-Group Classification System (RTGCS) and cesarean section rate (CSR),and to evaluate the validity of predictive models established based on the RTGCS for cesarean section.Methods Clinical data of 41 295 cases delivered in Shanghai First Maternity and Infant Hospital from January 1,2012 to September 30,2014 were retrospectively collected.CSR of different groups categorized by the RTGCS was analyzed by descriptive epidemiological methods by three models.Model 1 was obstetrics factors (parity,history of cesarean section,number of fetus,mode of labor,fetal presentation and gestational age);model 2 was obstetrics factors (model 1) + demographic characteristics and severity (maternal age and with/without treatment in intensive care unit);model 3 was defined as model 2+ complications (placenta previa,placental abruption,chronic or gestational hypertension,preeclampsia,renal disease,or human immunodeficiency virus infection).The relationship between obstetrics factors classified by the RTGCS and CSR was analyzed by the logistic regression model (the potential confounders were controlled).The validity of predictive models was evaluated by analyzing the area under the receiver operative characteristic (ROC) curve.Results (1) There were statistical differences in total CSR and CSR before labor among those cases respectively grouped by age,medical insurance,parity,signal/multiple pregnancy,fetal presentation and gestational age (all P＜0.05).(2) The recruited cases were categorized into ten groups according to the RTGCS and among them,the second group (single,cephalic presentation,nulliparous,≥ 37 gestational weeks,induced labor or cesarean section before labor) accounted for most of the cesarean section cases (61.2％,11 217/18 322),followed by the fourth group (single,cephalic presentation,multiparous,no previous cesarean section,≥ 37 gestational weeks,induced labor or cesarean section before labor),which were 11.2％ (2 061/18 322).(3) Obstetrical parameters,including parity,number of fetus,mode of delivery,history of cesarean section,fetal presentation and gestational weeks at delivery were related to CSR,even after adjustment for maternal age and medical insurance,or obstetrical complications,or both above factors (all P＜0.05).(4) Areas under the ROC curves and the 95％ confidence intervals of model 1,2 and 3 were 0.867 (0.863-0.870),0.875 (0.872-0.878) and 0.881 (0.878-0.885),respectively (all P＜0.01).Conclusion Related variables of RTGCS highly correlate with CSR and could be used as promising indicators for prediction of cesarean section.The RTGCS is of great application value to those research subjects.
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Objective Autoantibodies and corresponding immune complexes involved directly in the development of rheuma -toid arthritis ( RA) .The effect of anti-mutated citrulline vimentin antibodies contained immune complex ( AMCV-IC) on the function of fibroblast-like synoviocytes ( FLSs) is still unclear .The aim of the study was to investigate the effect of AMCV-IC in serum of RA pa-tients on the proliferation of RA-FLSs. Methods Serum samples of RA , SLE ( systemic lupus erythematosus ) and healthy people were collected from outpatients and hospitalized patients in Nanjing General Hospital of Nanjing Military Region from March 2012 to March 2013 , including 20 RA patients ( 10 patients with serum AM-CV+and 10 patients with serum AMCV -) , 10 SLE patients and 10 healthy people .Serum AMCV of SLE patients and healthy people was negative .Serum IC was extracted by affinity chromatography with im-mobilized protein G and was divided into AMCV +-IC group,AMCV--IC group,SLE-IC group, and control group.The levels of AMCV were detected by ELISA .We cultivated RA patients'arthral FLSs in vitro .FLSs were stimulated with AMCV +-IC,AMCV--IC, SLE-IC and CON-IC (50,100,200,and 400μg/mL),respectively.And the effect of IC on RA-FLSs was detected by CCK-8. Results Compared with AMCV --IC group (1.37 ±0.86, 1.31 ±0.10),SLE-IC group (1.36 ±0.06, 1.38 ±0.03) and CON-IC group (1.08 ±0.02, 1.04 ±0.06),the A values of AMCV +-IC group (1.53 ±0.11, 1.58 ±0.05) were obviously higher after stimulating RA-FLSs with 50 and 100μg/mL IC for 24 h (P<0.05);Similarly, compared with AMCV --IC group (1.32 ±0.04, 1.38 ±0.07), SLE-IC group (1.31 ±0.10, 1.29 ±0.01) and CON-IC group (1.13 ±0.06, 1.03 ±0.09),the A values of AMCV +-IC group (1.53 ±0.16, 1.57 ±0.06) were obviously higher after stimulating RA-FLSs with 200 and 400μg/mL IC for 24 h (P<0.05). Meanwhile , the A values of AMCV --IC group and SLE-IC group were obviously higher than CON-IC group under different concentra-tions of IC(P<0.05). Conclusion AMCV+-IC can stimulate the proliferation of RA-FLSs more effectively compared with AM-CV--IC, SLE-IC and CON-IC under different concentrations of IC and involve in the pathogenesis of RA .
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With the rapid development of social economy and the improvement of multi-level medical insurance system, the health demand of people continually grow and the content and quality of health demand are more and more diversified. By contrast, the growth of health resources was very slow. The contradiction between supply and demand of health services becomes increasingly sharp and health expenditure growth rapidly. So by systemizing the related concepts and main international practices and enlightenment of managing health demand in developed countries, this article aimed to provide references and suggestions for reasonably managing health demand, standardizing the order of medical treatment and improving the phenomenon ofdifficulty in treatment.
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Based on a description of the evolution,main reform practices and effects of public hospital payment system reforms,this paper focused on analyzing the existing problems found in the reforms.Such problems namely include lack of scientific and reasonable design of payment standards,lack of systemic and coordinated system reforms,and failure to fully mobilize the enthusiasm of medical workers to participate in the reforms,as well as other underlying causes.Based on such suggestions were put forward to promote public hospital payment system reforms,as negotiation of the payment standard between purchasers and providers,combined approaches in innovation in payment methods,advancing systemic payment system reform,and establishing a transmission mechanism of incentive to the medical personnel.
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Based on summarizing the international experiences and reviewing the historical evolution and current situation of the physicians'compensation system of public hospitals in China,this paper clarified the existing problems of the current compensation system.Such problems namely included lack of security on the source of the physicians'compensation,low level of sunshine salary which caused thecompensatory mechanism,lack of scientific design of the salary structure and allocation,as well as other underlying causes.Drawing lessons from reform practices at home and abroad,the basic principles and reform directions were put forward,as well as 4 route selections,namely establishing an security investment system to guarantee a stable and higher level salary under the current compensation system, implementing a high level of flip-type annual compensation with locking the current salary into files, establishing an appropriate compensation system referring to an innovated evaluation system of physicians in public hospitals,and coordinating closely with public institution reforms to promote physicians' compensation system reform.
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<p><b>OBJECTIVE</b>To conduct with a cost analysis of the colorectal neoplasm screening program in Beijing, and provide data evidence for decision making.</p><p><b>METHODS</b>Based on stratified cluster sampling method, we carried out a 2-stage colorectal neoplasm screening program within 6 districts, Dongcheng, Xicheng, Chaoyang, Haidian, Fengtai and Shijingshan, of Beijing city between October, 2012 to May. 2013. The first stage of the program was to conducting a cancer risk level evaluation for community residents who were forty years older and the second stage's task was to providing clinical exam for those high risk people who were selected from the first stage. There were about 12 953 residents were involved in this program. We calculated the main cost of the colorectal neoplasm screen program in Beijing. Then estimate the cost of detecting one Colorectal Neoplasm patient of this program and compare it with the total treatment cost for a patient.</p><p><b>RESULT</b>2 487 high risk residents were selected by the first stage and 1 055 of them made appointment for the colonoscopy exam but only 375 accepted the exam, participate rate was 35.5%. 9 neoplasm cancer patients and 71 pre-cancer patient were found at the second stage, the detection rate were 69.2/100 000 and 546/100 000, respectively. The direct input for this neoplasm screening program was 227 100 CNY and the transport expense was 4 200 CNY in the calculations. The cost for detecting one cancer patient was about 19 900 CNY. Comparing with the total medical care cost of a cancer patient (1 282 800 CNY), especially for those have been diagnosed as middle to end stage cancer, the screening program (cost 842 800 CNY) might help to reduce the total health expenditure about 128 700 CNY, based on 12 953 local residents age above 40 years old.</p><p><b>CONCLUSION</b>An colonoscopy based colorectal neoplasm screening program showed its function on medical expenditure saving and might have advantage on health social labor creating.</p>