ABSTRACT
To analyze the efficiency of prenatal ultrasound screening service in Beijing and thus optimize the secondary prevention system for birth defects in Beijing. Data were collected from the prenatal screening work reports of Beijing from 2010-2016.Key variables were extracted after data quality control.Data envelopment analysis was performed to analyze the efficiency and changing trend of ultrasound-based screening service and to compare the service efficiency between urban and suburban areas in Beijing. From 2010 to 2016,the technical efficiency of ultrasound screening services showed an increasing trend,and the geometric mean of technical efficiency in suburban areas was higher than that in urban areas.From 2010 to 2016,the total factor productivity of ultrasound screening service increased by 12.3% annually,in which the technical change increased by 12.0% annually;the technical efficiency increased by 0.3%,the pure technical efficiency increased by 13.9% annually,and the scale efficiency decreased by 0.4%. The technical efficiency of ultrasound screening service in Beijing increased from 2010 to 2016,and the total factor productivity improved.Technical change and pure technical efficiency change were the main reasons for the improvement.The resource allocation should be further optimized to improve the scale efficiency and enhance the training of prenatal ultrasound screening technicians.
Subject(s)
Female , Humans , Pregnancy , Beijing , Mass Screening , Prenatal Diagnosis , Ultrasonography, PrenatalABSTRACT
Objective To approach the significance of changes of percutaneous-arterial blood carbon dioxide partial pressure difference [P(tc-a)CO2] in liquid resuscitation of patients with septic shock. Methods One hundred and sixty-eight patients with septic shock admitted and treated in the Department of Intensive Care Unit (ICU) of Quzhou People's Hospital from January 2015 to January 2018 were enrolled, and after early goal-directed therapy (EGDT) for 6 hours, according to central venous oxygen saturation (ScvO2) and lactate clearance (LC), they were divided into ScvO2 and LC achievement group (ScvO2 ≥ 0.7 and LC≥10%), ScvO2 achievement group (ScvO2 ≥ 0.7 and LC < 10%), LC achievement group (ScvO2 < 0.7 and LC≥10%), and un-achievement group (ScvO2 < 0.7 and LC < 10%). The mechanical ventilation time, ICU hospitalization time, 28-day mortality, P(tc-a)CO2 etc. were compared among the four groups; the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of P(tc-a)CO2 for 28-day prognosis in patients with septic shock. Results The trends of mechanical ventilation time, ICU hospitalization time, and 28-day mortality were all ScvO2 and LC achievement group < LC achievement group < ScvO2 achievement group < un-achievement group [the mechanical ventilation times (days) were respectively 6.12±2.59, 8.43±3.24, 11.78±4.12, 13.03±4.75, ICU hospitalization times (days) were 10.31±2.32, 13.85±3.56, 16.41±3.83, 18.52±4.05, and 28-day mortality rates were 28.85% (15/52), 40.91% (18/44), 51.28% (20/39), 69.70% (23/33)] and the differences among the four groups were statistically significant (all P < 0.05). After 6 hours of EGDT, the heart rate (HR), lactate (Lac), and P(tc-a)CO2 were lower than those before fluid resuscitation, but the mean arterial pressure (MAP), central venous pressure (CVP), and ScvO2 were higher than those before fluid resuscitation among four groups. Except CVP, the differences of other indicators compared among the ScvO2 and LC achievement group, ScvO2 achievement group, LC achievement group and un-achievement group were statistically significant (all P < 0.05). After 6 hours of EGDT, HR, Lac, P(tc-a)CO2 in ScvO2 and LC achievement group, ScvO2 achievement group and LC achievement group were significantly lower than those in the un-achievement group [HR (bpm): 89.05±29.43, 98.82±30.21, 94.33±28.64 vs. 112.85±32.74, Lac (mmol/L): 2.97±1.95, 3.87±2.32, 2.69±1.52 vs. 4.17±2.44, P(tc-a)CO2 (mmHg, 1 mmHg = 0133 kPa): 7.18±4.61, 12.61±5.34, 9.71±4.11 vs. 16.56±10.19], MAP and ScvO2 were significantly higher than those of the un-achievement group [MAP (mmHg): 88.05±21.67, 77.33±18.56, 83.11±19.71 vs. 70.32±18.79, ScvO2: 0.76±0.14, 0.75±0.16, 0.67±0.14 vs. 0.63±0.18, all P < 0.05]. The P(tc-a)CO2 of 28 days survivors were significantly lower than that of the deaths among four groups (mmHg: 5.78±2.27 vs. 14.14±3.65, 7.07±2.81 vs. 15.06±4.11, 6.35±2.09 vs. 14.94±4.06, 7.93±3.81 vs. 18.34±4.63, all P < 0.05). When P(tc-a)CO2 > 7.24 mmHg predicted 28-day mortality in ScvO2 and LC achievement group, the sensitivity was 89.29%, specificity was 91.45%, and the area under ROC curve (AUC) was 0.86; when P(tc-a)CO2 > 9.46 mmHg predicted 28-day mortality in LC achievement group, the sensitivity was 88.72%, specificity was 85.83% and AUC was 0.91; when P(tc-a)CO2 >12.05 mmHg predicted 28-day mortality in ScvO2 achievement group, the sensitivity was 82.79%, specificity was 86.90% and AUC was 0.79; when P(tc-a)CO2 > 16.22 mmHg predicted 28-day mortality in un-achievement group, the sensitivity was 73.35%, specificity was 80.68% and AUC was 0.68. Conclusion P(tc-a)CO2 can be used as an indicator to evaluate fluid resuscitation effect and prognosis in patients with septic shock.
ABSTRACT
Objective To examine the two-week morbidity rates and the associated factors among the residents of Jilin province and to learn the health services needs among residents before and after new health care reform and provide basis for the establishment of health planning. Methods We used the data from the National Health Services Survey of Jilin from 2008 to 2013,with a total sample size of 29 495. Descriptive analyses were performed to analyze two-week morbidity rates,and Logistic regression was employed to explore the associated factors. Results From 2008 to 2013,the two-week morbidity rate increased from 9.2% to 25.7% (P<0.001). In 2013 and 2008,the two-week morbidities of onset had significantly different compositions (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="Mml2-1000-503X-39-2-247"><mml:mtable frame="none" columnlines="none" rowlines="none"><mml:mtr><mml:mtd><mml:maligngroup/><mml:mrow><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup></mml:mrow></mml:mtd></mml:mtr></mml:mtable></mml:math></inline-formula>=240.86,P<0.001). Chronic conditions continuing to two weeks accounted for 80.4% in the onset time of two weeks in 2013. Hypertension,diabetes,and other chronic diseases had become the leading disorders. The influential factors of the two-week morbidity in 2008 were residency (OR=0.97,95% CI=0.64-0.93),age (OR=2.29,95% CI=1.46-3.60),marital status (OR=2.05,95% CI=1.28-3.27),and chronic diseases (OR=15.02,95% CI=12.93-17.43).The influential factors of the two-week morbidity in 2013 were age (OR=4.79,95% CI=3.01-7.63),chronic diseases (OR=60.14,95% CI=53.03-68.21),and medical insurance coverage (OR=1.33,95% CI=1.03-1.74). Conclusion The needs for health care services have dramatically increased after new health care reform among residents of Jilin province. Chronic diseases have become the major health concerns.
ABSTRACT
Objective To analyze the influencing factors of stunting in children under 5 years old in Jilin province in 2013,with an attempt to further improve the nutrition status among children. Methods Data on stunting in children under 5 years old in Jilin province were extracted from the National Health Services Survey 2013 in Jilin province. The influencing factors of stunting were analyzed by using univariate analysis and Logistic regression analysis.. Results The stunting prevalence in children under 5 years old was 23.8% in 2013. Univariate analysis showed that urban residence (OR=0.38,95% CI=0.25-0.57),high income (OR=0.40,95% CI=0.24-0.66),mother's education level (higher than primary school) (OR=0.50,95% CI=0.32-0.81),safe water coverage (OR=0.41,95% CI=0.22-0.75),and clean toilet coverage (OR=0.36,95% CI=0.24-0.53) are protective factors of stunting. After adjusting other factors,urban residence (OR=0.54,95% CI=0.31-0.94),safe water coverage (OR=0.28,95% CI=0.13-0.60),and clean toilet coverage (OR=0.40,95% CI=0.24-0.67) still showed protective effects. Conclusion The urban-rural disparity and the availability of safe water and clean toilet are the major factors of stunting among children under 5 years old in Jilin province. The major public health service program should be fully implemented to improve the nutrition status among children.
ABSTRACT
Objective To understand the health-related quality of life (HRQoL) and its influencing factors in Jilin province and compare two life quality measurement methods. Methods The data of 13 700 people aged above 15 years in Jilin province were extracted from the National Health Services Survey 2013. Self-rated health scores and EuroQol 5-dimension utility values were used to evaluate the HRQoL. Multivariable linear regression model was used to analyze the influencing factors. Results The self-rated health score was 81.26±15.73 in Jilin province,while utility values of health status were 0.959±0.124. The influencing factors of HRQoL included age,residency,education,income,type of health insurance,having non-communicable chronic disease and having disease in last two weeks. The age under 45,income,having non-communicable chronic disease,and having disease in last two weeks had stronger effect on self-rated health,whereas residency and type of health insurance had more effect on utility values of health status. Conclusion People in Jilin province have good quality of life. Both methods have their advantages and weakness. It is important to choose the right evaluation method depended on the objective of a specific study.
ABSTRACT
Objective:China was categorized as one of the 68 countdown countries to achieve the United Nations Millennium Development Goals (MDG) 5. This paper aimed to analyze the situation of maternal survival, and coverage of proven cost effective interventions in China, where specific attention was paid to disparities. Methods: National maternal and child mortality surveillance data were used to estimate maternal mortality ratio (MMR). Coverage for proven interventions was analyzed based on National Health Services Survey, where experts' consultations were made for complementation. Results: There had been a significant reduction of MMR in China, however great disparities existed, with rural Ⅱ to Ⅳ areas experiencing 2 to 5 times higher maternal mortality risks than urban areas and accounting for over 70% maternal mortality burdens. Postpartum hemorrhage, pregnancy associated hypertension, embolism and sepsis were the leading causes, and over 75% of the maternal mortality was caused by preventable or curable causes. Maternal health services utilization decreased in accordance with region' s development level. Socioeconomic factors like financial difficulties were the main obstacles hindering access of care.Even those who made deliveries in hospitals faced different probabilities in receiving qualified care according to their socioeconomic standings. Conclusion: China is on track to achieve MDG 5, however great disparities exist. It is necessary to specifically target rural types Ⅱ to Ⅳ areas. Major causes of maternal mortality which can be prevented or averted through the provision of essential obstetrical care. Yet as compared with maternity health needs, insufficient coverage of maternal and child health (MCH) care services and poor service quality are the leading predisposing factors contributing to maternal mortality in China.
ABSTRACT
Objective:To investigate the impact of social determinants of health on the inequality of child health and health care utilization.Methods:Information of 1 118 children aged 0 to 16 is extracted from the Chinese Family Panel Studies(CFPS)year 2008 cross sectional survey data for the analysis.Age standardized concentration curves and concentration indices are employed to assess the inequalities for incidence of low birth weight,self reported good health,adequate timing of breast feeding,health insurance coverage and incidence of catastrophic health expenditures for these children.Concentration indices are decomposed to four levels of social determinants of health(community,family,mother and individual level)to understand their contributions to health inequality respectively.Results:There are health inequalities existing in the investigated children,among which social factors at mother and family level have the largest contribution.Conclusion:To respond to the call by the WHO to achieve health equity through action on the social determinants of health in a generation,the inequalities of health and health care utilization amongst Chinese children should be put on the policy agenda,and social policies should intervene from multiple social dimensions,especially from family and mother levels.