Social net work analysis of referral of stroke inpatients in Changsha / 中华医院管理杂志

Objective:To analyze the current status of referral of stroke inpatients and explore the characteristics of the referral network in Changsha, for the reference to improve and promote the hierarchical medical system of stroke.Methods:Data of the inpatient medical record of stroke patients and the annual reports of medical institutions in Changsha in 2018 were collected from the health statistics network direct reporting system of Health Commission of Hunan province, for analysis of the referrals of inpatients in different medical institutions. Social network analysis was adopted to analyze the density, centrality and K-core of the referral network of stroke inpatients.Results:A total of 82 medical institutions for stroke inpatients were included with 2 859 referrals of patients. Most of the referrals were made between tertiary hospitals(1 515), especially within hospitals of a stroke alliance(1 123). The density of referral network was 0.613.Tertiary hospitals were in the center of the network, the entry points of secondary hospitals were in the center of the network and primary medical institutions were located at peripheral positions. Most of the tertiary hospitals in the 15-core(14, 72.68%), 12 of them were the units of Hunan Stroke Alliance.Conclusions:Tertiary hospitals played an important role in the region, secondary hospitals were able to receive patients referred by tertiary hospitals, but few patients were transferred to primary care institutions; The primary medical institutions failed to play due roles in the referral network. The establishment of stroke alliances could promote the cooperation of hospitals in the alliance, but the division of labor and cooperation among different levels of medical institutions in the region needed to be further optimized.

Optimization of enterokinase secretion in Pichia pastoris / 生物工程学报

Enterokinase is a class of serine proteases that specifically recognize the cleavage DDDDK sequences. Therefore, enterokinase has been widely used as a tool enzyme in the field of biomedicine. Currently, the expression level of enterokinase in Pichia pastoris is low, which hinders related practical applications. In this study, the effects of six different signal peptides SP1, SP2, SP3, SP4, SP7 and SP8 on the secretory expression of enterokinase in Pichia pastoris were studied. Compared with α-factor, SP1 significantly increased the secretory expression of enterokinase (from 6.8 mg/L to 14.3 mg/L), and the enterokinase activity increased from (2 390±212) U/mL to (4 995±378) U/mL in shaking flask cultures. On this basis, the enterokinase activity was further enhanced to (7 219±489) U/mL by co-expressing the endogenous protein Kex2. Moreover, the activity that the mutant strain with N-terminal fusion of three amino acids of WLR was increased to (15 145±920) U/mL with a high specific activity of (1 174 600±53 100) U/mg. The efficient secretory expression of enterokinase laid a foundation for its applications in near future.

Application study of the evaluation index system of Hunan Medical Science and Technology Award / 中华医学科研管理杂志

Objective:To test the practicality and effectiveness of Evaluation system of Hunan Medical Science and Technology Awards by empirical data.Methods:The empirical data of this paper is based on the 48 award-winning projects of the 2018 Hunan Medical Science and Technology Award. The actual evaluation process was simulated and peer experts were invited to grade the researching samples by index system to collect measured data. Use AMOS and SPSS as tools to test the reliability, validity and the correlation of the Evaluation system.Results:The internal consistency reliability of Cronbach α is 0.820, which shows this evaluation system with good reliability; sample data of confirmatory factor analysis matches the theoretical model, which shows this evaluation system with good validity; The results of analysis of variance showed that the differences among the three winning groups were statistically significant( P<0.05); The correlation coefficient of spearman rank correlation analysis is 0.335( P<0.05), which shows the positive correlation between the theoretical results and the actual evaluation results. Conclusions:The evaluation system of Hunan Medical Science and Technology Awards performs well and possesses strong applicability and practicality. The higher the score of the project measured by this indicator, the higher the quality of the project, and the higher the order of rewards that can actually be obtained. It could be used as an objective reference for the evaluation of Hunan Medical Science and Technology Award.

Construction of evaluation index system of Hunan Medical Science and Technology Award / 中华医学科研管理杂志

Objective:To establish an evaluation index system for Hunan Medical Science and Technology Award.Methods:Based on the literature review and expert demonstration, combined with the previous review experiences of Hunan Medical Science and Technology Award, a review system framework was initially developed. Delphi method was used for expert consultation, outcome analysis were also adopted for the modification and reconstruction of this index system.Results:The standard evaluating system was set up with four first-level indicators, fifteen second-level indicators and their scoring standards.Conclusions:The evaluation index system established has the characteristics of scientific, systematic, pertinent, practical, simple and operable, also provides a reference and basis for scientific, objective and accurate evaluation of Medical Science and Technology Awards.

Application of satisfaction index of basic medical insurance for rural and urban residents to pupils familial decision making in Kunming and Changsha City / 中南大学学报(医学版)

OBJECTIVES@#To verify the applicability and extensibility of the satisfaction index of basic medical insurance for rural and urban residents, and to explore the mechanism responsible for the satisfaction index in Kunming and Changsha City, and provide references for effective management and policy making.@*METHODS@#A stratified cluster sampling method was conducted. A total of 560 familial decision makers were randomly selected in 24 classes of 14 schools of Kunming and Changsha City. Model reliability was tested by SPSS18.0. In addition, Smart PLS 3.0 was applied to conduct model validity test, calculate the satisfaction index, and to compare the model path coefficients of Kunming and Changsha by multi-group analysis.@*RESULTS@#In the application of the satisfaction index of basic medical insurance for rural and urban residents in Kunming, Cronbach's α of the model was 0.93, split-half reliability coefficient was 0.90, and the latent variable composite reliability coefficient values were more than 0.86; the latent variable average variance extraction (AVE) values were greater than 0.66, and the square root of the AVE of each latent variable (all greater than 0.66) was larger than the correlation coefficient with other latent variables. The factor loading values were greater than 0.70, with statistical significance. The basic health insurance satisfaction index of Kunming and Changsha was 60.40 and 52.05, respectively. The difference between the path coefficient of Kunming and Changsha was not statistically significant except the path from public satisfaction to public loyalty. Perceived value had the largest direct and total effect on public satisfaction latent variable in Kunming City. While the perceived value had the largest direct effect on public satisfaction, and the perceived quality had the largest total effect on public satisfaction in Changsha City.@*CONCLUSIONS@#The satisfaction index model reflects the satisfaction of pupils' basic medical insurance for urban and rural residents, and it also shows good reliability and validity in Changsha and Kunming. What's more the model can be extended to the national level to evaluate the satisfaction of basic medical insurance for urban and rural residents for primary school students. The basic health insurance satisfaction index of familial decision makers in Kunming is higher than that of Changsha. There are differences between Kunming and Changsha in the influential mechanism of the satisfaction index of for Chinese pupils with basic medical insurance for rural and urban residents, and the measures taken by the government and relevant departments to improve the satisfaction of basic medical insurance should be based on local conditions.

Association rule regarding chronic disease-relevant risk factors for the adults in Haidian District / 中南大学学报(医学版)

Objective:To investigate the association patterns of chronic disease-relevant risk factors for the adults in Haidian District.Methods:Data for chronic disease-relevant risk factors for 3 219 adults in Haidian District in 2014 were collected and analyzed.SPSS 18.0 was used for statistical description and logistic regression.SPSS Modeler 14.1 was used to explore the association among the chronic disease-relevant risk factors.Results:Among men,5 patterns of chronic disease-relevant risk factors were identified,which suggested that heavy drinking,inadequate intake of fruit and vegetables,and physical inactivity were associated with smoking while inadequate intake of fruit and vegetables and smoking were associated with physical inactivity.Among women,one pattern of chronic disease-relevant risk factor was identified,which suggested that inadequate intake of fruit and vegetables was associated with physical inactivity.Conclusion:Chronic disease-relevant risk factors are intercorrelated among the adults in Haidian District.Information on patterns of chronic disease-relevant risk factors could assist interventions targeting multiple behaviors simultaneously.

Comprehensive evaluation on the prescription behavior for outpatients in primary health care institutions of Yiyang / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the prescription behavior for outpatients in primary health care institutions of Yiyang and to provide scientific basis for promoting the rational use of drugs.
@*METHODS@#A multi-stage random sampling method was conducted in 21 primary health care institutions from Yiyang. Fifteen prescriptions were randomly selected in every month from each institution and a total of 3780 prescriptions were eventually collected in a year.
@*RESULTS@#Both the number of drugs and percentage of injection in a prescription were greater than the international standards. Children were more likely to be prescribed by multiple prescriptions, antibiotics prescriptions, hormones and injections prescriptions. The utilization of essential drug was more frequent in female. Antibiotics and hormones were more frequently used in summer and autumn season. Polypharmacy, antibiotics, injections and essential drugs were more frequently used in hospitals of small town. The skin and subcutaneous tissue diseases were often treated with multiple prescriptions, while the respiratory diseases were often treated with antibiotics, hormones and injections. Most primary health care institutions were at the upper limit of rational drug use.
@*CONCLUSION@#The usage of prescription drug in most primary health care is rational, but some still surpass international standards. Thus, primary health care physicians should strictly control their prescriptions behavior.

Study on out-of-pocket expenditure and related factors among cancer inpatients with Hunan Provincial Urban Employee Basic Medical Insurance / 中南大学学报(医学版)

OBJECTIVE@#To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
@*METHODS@#Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
@*RESULTS@#The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
@*CONCLUSION@#OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.

Effect of implementation of essential medicine system in the primary health care institution in China / 中南大学学报(医学版)

Our primary health care institution began to implement national essential medicine system in 2009. In past fi ve years, the goal of national essential medicine system has been initially achieved. For examples, medicine price is steadily reducing, the quality of medical services is improving and residents' satisfaction is substantial increasing every year. However, at the same time, we also found some urgent problems needed to be solved. For examples, the range of national essential medicine is limited, which is difficult to guarantee the quality of essential medication. In addition, how to compensate the primary health care institution is still a question.

Comparison of the diagnosis and medication strategy for patient of benign prostatic hyperplasia between urologist and geriatrician in China / 中华泌尿外科杂志

Objective To promote the standardization of medical practice in China by comparing the discrepancies of diagnosis and medication strategies for benign prostatic hyperplasia (BPH) between urologists and geriatricians.Methods Departments of urology and geriatrics in general hospitals in China were selected through stratified sampling and 145 315 patients who went for the outpatient service in certain days during December 2011 to December 2012 were recruited by cluster.Questionnaires were completed by corresponding doctors and data of patient clinical characteristics as well as diagnostic and therapeutic pattern were collected.Results A total of 142 511 valid questionnaires were collected with 119 426 from urology and 23 085 from geriatrics.The average age of BPH patients was (68.34±8.61) years and the average IPSS was 17.93±4.73.The rates of diagnostic method were IPSS (99.2％),ultrasonic inspection (86.0％),digital rectal examination (DRE) (66.0％) and urine flow rate test (55.2％).The rate of ultrasonic application was lower while the rates of other methods were higher among urologists (P＜0.01) ; the rate of DRE among urologists was 2.2 times to that among geriatricians.For patients with moderate or severe symptoms,most urologists (72.1％ in moderate patients and 79.9％ in severe patients) applied drug-combination strategy and the rate was 2 times to that among geriatricians (P＜0.01).In contrast,most geriatricians (59.7％ in moderate patients and 56.1％ in severe patients) applied single drug to BPH patients.Urologists utilized α-receptor blockers,plant preparations and traditional Chinese medicine more frequently than geriatricians (P＜0.01).Conclusions Urologists performed more integrated diagnosis strategy compared with geriatricians.The urologists tended to use 5α-reductase inhibitor combined with α-receptor blocker to treat BPH patients with moderate or severe symptoms,while geriatricians preferred 5α-reductase inhibitor alone.

Comparison of the diagnostic and therapeutic strategies for patients with benign prostatic hyperplasia between doctors in general hospitals and community hospitals in urban China / 中华老年医学杂志

Objective To comparing the diagnostic and therapeutic strategies for patients with benign prostatic hyperplasia(BPH) between doctors in general hospitals and community hospitals,and to provide scientific clues for the standardization in medical practice.Methods General and community hospitals in urban China were selected via the stratified sampling.127,325 outpatients in these hospitals from December 2011 to December 2012 were randomly recruited.Results The average age of patients was(67.82±8.62) years.There were significant differences in I-PSS,prostate volume,urinary flow rate(UFR) and result of digital rectal examination(DRE) between patients in general and community hospitals.The rates of diagnostic applications were different between doctors in the two kinds of hospitals except I-PSS.Compared with community hospitals,DRE was more frequently applied while ultrasonic inspection and UFR test were less used in general hospitals in North China.A totally opposite situation was observed in East China as compared with the north.The application rates of DRE and UFR test were lower and ultrasonic inspection rate was higher in community hospitals than in general hospitals in South China.Pharmacotherapy was the most common treatment for BPH patients in both types of hospitals(97.53 ％).The rates of drug combinations were statistically different but both were close to 75％ in the two types of hospitals.In community hospitals,the percentage of patients receiving watchful waiting with severe symptoms and signs were lower than that of patients receiving watchful waiting with moderate symptoms and signs,but the percentage of patients receiving operation was not significantly increased.On the contrary,the percentage of patients receiving operation with severe symptoms and signs was higher than that of patients receiving operation with moderate symptoms and signs in general hospitals,but the percentage of patients receiving watchful waiting was not decreased.Conclusions Applications of diagnostic methods are significantly different between doctors in general hospitals and community hospitals and vary among regions.Therapeutic strategies are correlated with the severity of obstructive symptoms or signs.The medication strategy is similar between the two types of doctors.

The efficacy of α1-adrenergic receptor blocker, 5α-reductase inhibitor or combination therapy in benign prostatic hyperplasia / 中华老年医学杂志

Objective To compare the efficacy of α1 adrenergic receptor blocker,5α-reductase inhibitor or combination therapy in benign prostatic hyperplasia (BPH),and to explore the application of multi-level statistical model in assessment of BPH treatments.Methods Pragmatic clinical trials (PCT) design was used.BPH patients received drug therapy including α-adrenergic receptor blocker,5α reductase inhibitor,and combination therapy were followed up for 4 years.Multilevel statistical model was used to compare the scores of international prostate symtom score(IPSS) and BPH qality of life scale(QLS) among the 3 therapeutic regimens.Results The intra class correlation coefficients of I-PSS and BPH-QLS were 0.6136 and 0.6946 respectively,which indicated that both data were hierarchical structured.During the follow-up period,scores of IPSS and BPH-QLS were improved along with the drug therapy in 3 regimens.There was curve relationship between treatment time and IPSS and BPH-QLS scores in 3 regimens (all P＜0.05),and there was no significant differences in the trend of curves between the 3 regimens (P＞0.05).Conclusions For BPH patients with moderate symptoms bothering the quality of life,α-adrenergic receptor blocker,5α-reductase inhibitor,or combination therapy are significantly effective in reducing symptoms and improving quality of life.There are no efficacy differences among the 3 drug therapy during the 4-years follow-up.Compared with traditional analysis,multilevel statistical model is a more suitable and precise method for assessment of BPH treatments.

Label identities and basic situation of health food in Changsha / 中南大学学报(医学版)

OBJECTIVE@#To study the relevant information on the label of health food in Changsha, and provide scientific evidence for health food hygienic supervision.@*METHODS@#Investigation was conducted in department stores, supermarkets, pharmacies, and wholesale markets in the 5 districts in Changsha with multistage stratified sampling method. Self designed basic information of health food questionnaire was used to investigate the quality of labels the health food products.@*RESULTS@#Among the 408 random samples, the unidentified rates of label items were ranked in descending order: functional components (49.8%), unsuited community (27.9%), manufacturing date (23.0%), approval number and others (9.6%). The qualified rates of labels were different in different management types (χ(2)=59.793, P<0.05): the highest rate was in supermarkets (71.15%), followed by pharmacies (70.07%), shopping malls (57.47%), and wholesale markets (26.23%).@*CONCLUSION@#The supervision of label identities of health food should be strengthened, especially for the health food in the wholesale markets.

Prohibited substances in cosmetics: prospect of the toxicity of acrylamide / 中南大学学报(医学版)

Prohibited substances in cosmetics refer to substances which must not be among the raw material ingredients of cosmetic products. These substances are absorbed mostly through skin, as well as via lung and gastrointestinal tract. Polyacrylamide is ubiquitously used in industry and its decomposition residue acrylamide (ACR) easily finds its way into cosmetic products. ACR can either be oxidized to epoxide glycidamide or conjugated with glutathione, hemoglobin or DNA; ultimately it is excreted in urine. ACR causes neurotoxicity, reproductive toxicity and tumors in rodents. Occupational exposure to ACR causes neurotoxicity in humans; however, epidemiological evidence have not unambiguously answered the question of whether ACR exposure can increase cancer risk for humans.

Analyses of cosmetic sanitary quality in Hunan Province in 2010 / 中南大学学报(医学版)

OBJECTIVE@#To establish a scientific foundation for cosmetic supervision and administration based on the analysis of the sanitary quality of cosmetics in Hunan Province during 2010.@*METHODS@#According to Cosmetic Sanitary Standards (set by the Ministry of Health, People's Republic of China), 150 random samples of cosmetics in Hunan were assayed both for microbial items (including total plate count, fungus and yeast, fecal coliform, staphylococcus aureus, pseudomonas aeruginosa) and chemical items (including 17 kinds of prohibited substances and 14 kinds of restricted substances).@*RESULTS@#The total rate of cosmetics failing to meet the standards was 22.0% of the 150 samples; specific rates for failing perfumes, skin care products (eye cream) and deodorant products were, relatively, 70.6%, 60.00%, and 44.4%. Four kinds of prohibited substances, including diethyl phthalate, acrylamide, asbestos and neodymium, as well as 2 kinds of restricted substances, including triclosan and formaldehyde, were found to exceed standards. None of microbial items exceeded standard levels.@*CONCLUSION@#The sanitary quality control of cosmetics is lax. Administrative departments should not only reinforce their post-production supervision with respect to cosmetics, but also consolidate their control over the process of cosmetic production in order to solve the problem of toxic residues or illegal and intentional adulterations.

Content validity index in scale development / 中南大学学报(医学版)

Content validity is the degree to which an instrument has an appropriate sample of items for the construct being measured and is an important procedure in scale development. Content validity index (CVI) is the most widely used index in quantitative evaluation. There are 2 kinds of CVI: I-CVI and S-CVI. A method to compute a modified kappa statistic (K*) can be used to adjust I-CVI for chance agreement. S-CVI/UA and S-CVI/Ave are both scale level CVI with different formulas. Researchers recommend that a scale with excellent content validity should be composed of I-CVIs of 0.78 or higher and S-CVI/UA and S-CVI/Ave of 0.8 and 0.9 or higher, respectively. The characteristics and qualifications of the experts, process and main results of content validity evaluation should be reported in scale-related manuscript.