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Objective:To evaluate the cognitive level of nursing professionalism quantitatively and analyze its influencing factors, so as to provide research evidences for improving nursing professionalism. Method:A question-naire survey was conducted among 741 nurses from 7 public class A tertiary hospitals in Guangdong and Hubei Province. Descriptive statistics and multiple stepwise linear regressions were adopted using total score and scores of five dimensions of nursing professionalism scale as dependent variables. Results: Total score of professionalism cognitive level was (83. 41 ± 8. 75). The five dimensions of participation in professional organization, public health philosophy, peer review philosophy, professional sense of mission and autonomy were(16. 04 ± 2. 64), (17. 25 ± 2. 89), (16. 93 ± 2. 45), (17. 82 ± 3. 13), (15. 38 ± 2. 58), separately. There were mainly 5 factors influencing nursing professionalism cognitive level, namely gender, admission volunteer, first academic qualifications, employ-ment type, and whether receiving nursing award in past 3 years. Conclusion:Cognitive level of nursing profession-alism of sample nurses in 7 class A tertiary hospitals is similar to that of American nurse, but lower than that of Ko-rean - American nurses. And it is related to basic demographic characteristics, education background, practice status, enthusiasm of participating in the professional activities.
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Objective:To compare the changing trends and differences of bed numbers,doctor numbers and medical service utilization in the US.and China so as to provide polity implication for the health care reform in China from the supply side.Methods:The data of beds,doctors,hospitalization and outpatient service utilization from the website of OECD and CDC of the United States as well as Chinese Statistical Yearbook of Health and Family Planning were used to describe the trends.Results:The beds per 1000 people in China had exceeded that of the US,while the doctors per 1 000 people in China was less than the US.Both the two countries had yearly increasing trend of outpatient visits.However,the hospitalization was decreasing in the US,while the growth rate of hospitalization was even higher than the outpatient visits in China.Conclusion:The decrease of bed amount and the increase of outpatient amount were the main changing trend of medical resources and service utilization in the US.The imbalanced structure of medical resource supply in China resulted the overuse of hospitalization services.In the supply side reform of medical reform in China,it suggested to promote the cooperation of medical insurance,drug and health care,adjusted the reform thought from resource amount into the promotion of service quality,changed the health management system from disease centered into health centered.
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Summarized in the paper are the practices and experiences of hospitals across China,in their optimization of medical resources under the Healthcare Improvement Initiative to meet medical needs.Namely rationally allocating medical resources to strengthen emergency rescue,introducing new technologies to improve procedures and efficiency,introducing day surgery and day-care units,and innovating resource sharing among others.The author also recommended on further optimization of medical resources.
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OBJECTIVE To investigate the effect of mono-2-ethylhexyl phthalate(MEHP) on proliferation of primary neural stem cells(NSCs)of rats and NE-4C cells of mice and on the migration of NE-4C cells and the mechanism. METHODS NE-4C or NSCs were treated with MEHP 1,10,100 and 1000 μmol · L-1 for 72 h,respectively. The cytotoxicity was estimated with the cell counting kit-8 (CCK-8). Cell proliferation was analyzed by EdU assay. The mRNA expression levels of the glucocorticoid receptor(GR),signal transducer and activator of transcription 3(Stat3)and sex determining region Y (SRY)-box 2(Sox2) were detected by qRT-PCR. The protein expression levels of total GR,GRβ, Sox2,Stat3 and p-Stat3 were measured by Western blotting. RESULTS Cell viability of NE-4C cells and NSCs at MEHP 1000μmol·L-1 was significantly decreased,which was 70.3%and 40.0%of the control group, respectively. EdU assay showed that MEHP 100 μmol · L-1 decreased NE-4C cells and NSCs by 74.8%and 12.0%(P<0.05)compared with control. The effect of MEHP on the cell migration of NE-4C was evidenced by the fact that the migration was obviously reduced to (63.4±2.0)%(P<0.05)after treatment with MEHP 100μmol · L-1 for 72 h. The mRNA expression levels associated with proliferation and migration in NE-4C of GR,Stat3 and Sox2 in MEHP 100 μmol · L-1 group were down-regulated to 49.8%,26.0% and 14.0%of control(P<0.05). At MEHP 100μmol · L-1,mRNA of GR, Stat3 and Sox2 in NSCs declined to 10.0%,14.0% and 15.3% of normal control. Western blotting results revealed that protein expressions of GR,GRβ,Sox2 and p-Stat3 were remarkably inhibited by MEHP 100 μmol · L-1 in that the relative expression of NE-4C was 0.92 ± 0.17,0.87 ± 0.35,0.81 ± 0.22 and 0.62 ± 0.24(P<0.05). The corresponding protein expression in NSCs was 0.82 ± 0.20,0.56 ± 0.12,0.84 ± 0.36 and 0.53 ± 0.20(P<0.05)when the cells were treated with MEHP 100μmol · L-1 for 72 h. CONCLUSION MEHP can inhibit the proliferation and migration of NE-4C cells and NSCs possibly by decreasing Stat3 and Sox2 that are mediated by GRβ.
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OBJECTIVE To investigate the effect of curcumin on proliferation of neural stem cells (NSCs) of rats and the mechanism. METHODS NSCs derived from the forebrain of rat E15 embryos were cultured in vitro and identified by neuroepithelial stem cell protein ( nestin and SOX2) staining. NSCs were treated with curcumin 0.1, 0.5, 2.5, 12.5 and 62.5 μmol.L-1 for 24 h, respectively. The cyto-toxicity was estimated by measuring the release of lactate dehydrogenase(LDH). Cell viability and prolif-eration were analyzed respectively by MTT and BrdU assay. The mRNA expression levels of glucocorti-coid receptor (GR), Stat3, Notch1 and p21 were detected by qRT-PCR. The protein expression levels of total GR, Stat3 and phosphorylated Stat3 were measured by Western blotting. RESULTS The primary neural stem cells were identified as NSCs. Curcumin 12.5 and 62.5 μmol.L-1 had cell cytotoxicity( P<0.05). Cell viability assay indicated that curcumin 0.5 and 2.5 μmol.L-1 enhanced NSCs viability( P <0.05), but in 62.5 μmol.L-1 group the cell cytotoxicity was inhibited(P<0.05). Curcumin 0.1, 0.5 and 2.5 μmol.L-1 increased NSCs proliferation ( P < 0. 05), whereas 12. 5 and 62. 5 μmol.L-1 caused a decrease in NSCs proliferation(P<0.05). The mRNA expression level of GR in 0.5 μmol.L-1 group was significantly reduced( P<0.05). Western blotting analysis revealed that the protein expression of GR, Stat3 and p-Stat3 was inhibited by curcumin in 0.5 μmol.L-1 group(P<0.05). CONCLUSION Curcumin stimulates NSCs proliferation, possibly by inhibiting GR mRNA and related protein expression.
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Objective To evaluate the role of adenosine A1 receptors in hippocampal neurons in the cognitive dysfunction caused by isoflurane anesthesia in aged mice.Methods Sixteen male adenosine A1 receptor gene knockout homozygote mice (gene knockout mice) and 16 male wild-type mice,aged 18-22 months,weighing 27-32 g,were studied.Each type of mice was randomly divided into 2 groups (n=8 each) using a random number table:control group (group C) and isoflurane anesthesia group (group Ⅰ).Mice inhaled 1.4％ isoflurane in 100％ O2 for 2 h in group Ⅰ,and 100％ O2 for 2 h in group C.All the mice underwent Morris water maze test at 24 h after isoflurane or O2 inhalation.After the test,the mice were sacrificed and the hippocampal tissues were harvested to determine the number of β-amyloid1-42 (Aβ1-42) plaques (using immunohistochemistry) and expression of phosphorylated tau (p-tau) protein,and 2B subunit-containing N-methyl-D-aspartate receptors (NR2B) (by Western blot analysis).Results Compared with group C of wild type mice,the escape latency was significantly prolonged,the number of Aβ1-42 plaques was enlarged,the expression of p-tau protein was up-regulated,and the expression of N R2B was down-regulated in group Ⅰ of wild type mice.Compared with group Ⅰ of wild type mice,the escape latency was significantly shortened,the number of Aβ1-42 plaques was decreased,the expression of p-tau protein was down-regulated,and the expression of NR2B was up-regulated in group Ⅰ of gene knockout mice.There was no significant difference in the parameters mentioned above between group Ⅰ and group C of gene knockout mice.Conclusion Adenosine A1 receptors in hippocampal neurons mediate isoflurane anesthesia-induced cognitive dysfunction in aged mice,and the mechanism may be related to promotion of deposition of Aβ,phosphorylation of tau protein and inhibition of activities of NR2B.
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<p><b>OBJECTIVE</b>To explore the application of Monte Carlo simulation in optimizing and adjusting the reimbursement scheme with regard to the New Rural Cooperative Medical System (NCMS) to scientific steering practice. Optimization of the reimbursement scheme in rural areas of China was also studied.</p><p><b>METHODS</b>A multi-stage sampling household survey was conducted in Sihui county, with 4 433 rural residents from 1 179 households from 13 towns in Guangdong province surveyed by self-designed questionnaire. Probit Regression Model was applied in fitting data and then estimating the own-price elasticity and cross elasticity of healthcare demand for both outpatients and inpatients. Monte Carlo simulation model was constructed to estimate the reimbursement effects of various alternative reimbursement schemes, by replicated simulation for one thousand times and each sampling on five hundred households. In this way, optimization of the implemented reimbursement scheme in Sihui county was conducted.</p><p><b>RESULTS</b>Own-priced elasticity of demands for outpatient visit, inpatient visit in the township hospital center, secondary hospital and tertiary hospital were -0.174, -0.264, -0.675 and -0.429, respectively. Outpatient demand was affected by the per-visit price of township hospital center and secondary hospital. The cross-priced elasticity of demands for outpatient visit appeared to be 0.125 and 0.150. The reimbursement effects of Scheme B7 showed that the efficiency of NCMS fund was 17.85% , the reimbursement ratio for healthcare was 25.63%, and the decreased percentages of poverty caused by illness was 18.25%, more than 9.37%, from the implemented scheme A. So the implemented scheme was in need for optimization.</p><p><b>CONCLUSION</b>Monte Carlo simulation technique was applicable to simulate the effects of the optimized alternative reimbursement scheme of NCMS and it provided a new idea and method to optimize and adjust the reimbursement scheme.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , China , Insurance, Health, Reimbursement , Economics , Monte Carlo Method , Rural PopulationABSTRACT
Objective To explore the application of Monte Carlo simulation in optimizing and adjusting the reimbursement scheme with regard to the New Rural Cooperative Medical System (NCMS)to scientific steering practice. Optimization of the reimbursement scheme in rural areas of China was also studied. Methods A multi-stage sampling household survey was conducted in Sihui county,with 4 433 rural residents from 1 179 households from 13 towns in Guangdong province surveyed by self-designed questionnaire. Probit Regression Model was applied in fitting data and then estimating the own-price elasticity and cross elasticity of healthcare demand for both outpatients and inpatients. Monte Carlo simulation model was constructed to estimate the reimbursement effects of various alternative reimbursement schemes,by replicated simulation for one thousand times and each sampling on five hundred households. In this way,optimization of the implemented reimbursement scheme in Sihui county was conducted. Results Own-priced elasticity of demands for outpatient visit,inpatient visit in the township hospital center,secondary hospital and tertiary hospital were-0.174,-0.264,-0.675 and -0.429,respectively. Outpatient demand was affected by the per-visit price of township hospital center and secondary hospital. The cross-priced elasticity of demands for outpatient visit appeared to be 0.125 and 0.150. The reimbursement effects of Scheme B7 showed that the efficiency of NCMS fund was 17.85%,the reimbursement ratio for healthcare was 25.63%,and the decreased percentages of poverty caused by illness was 18.25%,more than 9.37%, from the implemented scheme A. So the implemented scheme was in need for optimization. Conclusion Monte Carlo simulation technique was applicable to simulate the effects of the optimized alternative reimbursement scheme of NCMS and it provided a new idea and method to optimize and adjust the reimbursement scheme.
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Objective To explore the application of Monte Carlo simulation in optimizing and adjusting the reimbursement scheme with regard to the New Rural Cooperative Medical System (NCMS)to scientific steering practice. Optimization of the reimbursement scheme in rural areas of China was also studied. Methods A multi-stage sampling household survey was conducted in Sihui county,with 4 433 rural residents from 1 179 households from 13 towns in Guangdong province surveyed by self-designed questionnaire. Probit Regression Model was applied in fitting data and then estimating the own-price elasticity and cross elasticity of healthcare demand for both outpatients and inpatients. Monte Carlo simulation model was constructed to estimate the reimbursement effects of various alternative reimbursement schemes,by replicated simulation for one thousand times and each sampling on five hundred households. In this way,optimization of the implemented reimbursement scheme in Sihui county was conducted. Results Own-priced elasticity of demands for outpatient visit,inpatient visit in the township hospital center,secondary hospital and tertiary hospital were-0.174,-0.264,-0.675 and -0.429,respectively. Outpatient demand was affected by the per-visit price of township hospital center and secondary hospital. The cross-priced elasticity of demands for outpatient visit appeared to be 0.125 and 0.150. The reimbursement effects of Scheme B7 showed that the efficiency of NCMS fund was 17.85%,the reimbursement ratio for healthcare was 25.63%,and the decreased percentages of poverty caused by illness was 18.25%,more than 9.37%, from the implemented scheme A. So the implemented scheme was in need for optimization. Conclusion Monte Carlo simulation technique was applicable to simulate the effects of the optimized alternative reimbursement scheme of NCMS and it provided a new idea and method to optimize and adjust the reimbursement scheme.