Perceptions of Shigella and of Shigella vaccine among rural Chinese: compatibility with Western models of behavioral change.

Shigella remain a major source of morbidity and mortality in developing countries, including China. In response, national and international researchers are actively working to develop vaccines that will be effective against dysentery and diarrhea caused by shigella dysentariae. With the growing recognition of the problems associated with sustained vaccine acceptance and usage, researchers and policy makers recognize the importance of conducting theory-based qualitative research to inform vaccine development program efforts. Accordingly we undertook this qualitative study involving 81 residents of one of China's rural communities with high rates of dysentery. The semi-structured interviews suggest that a Western model of behavioral change offered a useful research construct. Consistent with the model is the community's strong perception of 'response efficacy' of vaccines, particularly in comparison with water and sanitation and disease treatment. Residents were eager to vaccinate their children despite variable perception of disease severity, while they were less consistent in their interest in vaccinating adults; this enthusiasm for vaccinating children was attributed to China's 'one child per couple' policy. Intervention implications are discussed.

Cost-effectiveness, cost-utility and cost-benefit analysis of various projects for TB control / 中华医院管理杂志

Objective To study the cost effectiveness, cost utility and cost benefit of three programs for TB control, viz. the World Bank TB project, the Ministry of Public Health TB project and measures taken by non project areas. Method A survey was conducted in TB prevention and treatment institutions in 17 counties of 6 provinces with regard to the course of disease, expenditure for treatment and financial burden of 1 700 new and retreated TB patients. Result The World Bank project, wherein the strategies of directly observed treatment and short course chemotherapy were adopted, proved to be a low input and high output program with low capitalized cost and significant effectiveness, utility and benefit. Suggestion A new round of TB control projects ought to be started so as to achieve the sustainable development of TB prevention and treatment programs and to achieve the goals of the nation in this aspect.

A study of disease financial burden with different TB control programs / 中华医院管理杂志

Objective To study the effect of different intervenient measures for TB control on disease financial burden. Method A survey was conducted of the expenses incurred on 1 700 new and retreated TB patients from areas covered by the World Bank project, the Ministry of Public Health project, and non project areas where intervenient measures were also taken. The method of economic estimation was used to explore the disease financial burden carried by the patients families and society. Result The average family disease financial burden is as follows: 1 735 yuan for a new case and 2 755.99 yuan for a retreated case in the international TB program(ITP); 2 669.27 yuan for a new case and 3 530.17 yuan for a retreated case in the national TB program(NTP); and 6 787.02 yuan for a new case and 7 276.10 yuan for a retreated case in the non project areas using conventional TB therapy(CTT). The average social disease financial burden is as follows: 4 735.55 yuan in ITP; 6 471.91 yuan in NTP; and 10 919.96 yuan in CTT. Conclusion The disease financial burden was the lowest in ITP, highest in CTT, and intermediate in NTP.

A study of the effect of TB control programs on disease burden / 中华医院管理杂志

Objective To study the effect of three different kinds of intervenient measures for TB control on the disease burden of TB patients. Method The estimating method of disability adjusted life years(DALY) as recommended by the WHO was used to assess the disease burden of TB patients. Result The average disease burden of new and retreated TB patients covered by the international TB program(ITP) was the lightest, with the loss of 0.31 DALY and 0.62 DALY respectively; the average disease burden of new and retreated TB patients covered by the national TB program(NTP) was intermediate, with the loss of 0.42 DALY and 0.59 DALY respectively; and the average disease burden of new and retreated TB patients from areas using conventional TB therapy(CTT) was the heaviest, with the loss of 0.61 DALY and 0.91 DALY respectively. From a social perspective, the average yearly loss of DALY per thousand TB patients in the ITP, NTP and CTT areas was respectively 16.42, 33.6 and 37.36, with the loss in the NTP areas being 2.05 times as much as that in the ITP areas and the loss in the CTT areas being 2.28 times as much as that in the NTP areas. Conclusion ITP was far superior to NTP and CTT in reducing the disease burden of TB patients, achieving better results both from the perspective of TB patients and the society.

Analysis of the scores of 456 doctors from 72 township health centers in a written knowledge test / 中华医院管理杂志

doctors from 72 township health centers in 3 counties of Jiangxi Province were given a written test in basic medical knowledge, clinical knowledge of prevention and healthcare and professional knowledge. The rate of excellence of the scores was 45.4% while the rate of failure was 16.9%. A comparative analysis is made of the differences in the scores of doctors of different sexes, ages, specialties, educational backgrounds, and professional titles. It is suggested that it is imperative to conduct training for all doctors so as to enhance the overall quality, to lay stress on the key points and focus on the tackling of the weak links, and to perfect the mechanism so as to promote the renewal of knowledge.

Analysis of settlement expenses of basic medical insurance and their flow directions among different kinds of medical institutions / 中华医院管理杂志

ObjectiveTo find out about changes in expenses and the orientation of the insured to medical services and analyze the causes of expense growth and the result of containment so as to offer suggestions for policy formulation. MethodsA statistical analysis was made of the actual data on the medical insurance of retired and working personnel in Nantong City from 2000 through 2002 using SPSS and Excel. Results①The mode of payment via "plate" management and total quantity and mean value control resulted in fairly good expense containment, especially outpatient expense containment while the growth of hospitalization expenses was on the rise. ②Third-tier hospitals were most popular to people seeking hospitalized services while for outpatient services people were increasingly turning to clinics and designated drugstores where the average expenses per visit were low. Conclusion①The managing party of medical insurance should step up research on expense containment strategies, steer the patients towards rational splitflow, try to contain expenses in a scientific way, and improve the efficiency of fund utilization. ②Medical institutions confronted with opportunities and crises should enhance quality construction and deliver standard and reliable services. ③It is imperative to strengthen regional health planning and raise the efficiency of health resources utilization.

Survey on the role of medical institutions in TB control / 中华医院管理杂志

Objective To analyze the current situation of TB control in Hefeng County and probe into the role of medical institutions in TB control. Methods In-depth interviews were conducted with health workers of TB prevention, TB patients and their family members; data on registered TB patients were collected; the current situation of TB control was analyzed and countermeasures were put forward. Results The TB epidemic was pretty serious in Hefeng County, with a high morbidity rate and a low cure rate. According to an epidemiological survey in 1990, the TB morbidity rate in the county was 1000/100000. Conclusion Hefeng County failed to give full play to the role of hospitals in TB control and the treatment of TB patients was separated from their management. Hence the deplorable results of TB control. The following countermeasures were presented: ①giving full play to the role of general hospitals in TB control; and ②perfecting the three-level medical networks of prevention and healthcare.