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Objective To investigate the basic information of human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS)patients who infected with Epstein-Barr virus(EBV)or human Cytomegalovirus(HCMV),collect the relevant clinical immunological data and analyze the influencing factors.Method A total of 1 093 HIV/AIDS patients treated in the First Hospital of Changsha from January to December 2022 and underwent EBV and HCMV screening were collected.Flow cytometry was used to detect the CD4+T lymphocytes.Fluorescence quantitative PCR was applied for HIV-RNA,EBV-DNA,and HCMV-DNA testing.Statistical analysis was carried out by using SPSS 27.0,and logistic regression was used to analyze the risk factors of HIV/AIDS patients complicated with viral infection.Results Among 1 093 HIV/AIDS patients,the positive rates of EBV-DNA and HCMV-DNA were 48.22%(527/1 093)and 19.03%(208/1 093),respectively.As the number of CD4+T lymphocytes increased,the positive rates of EBV-DNA and HCMV-DNA decreased,and the differences was statistically significant(χ2=39.50,143.0,all P<0.001).As the level of HIV-RNA increased,the positive rates of EBV-DNA and HCMV-DNA increased,and the differences were statistically significant(χ2=46.18,124.3,all P<0.001).The patients receiving antiretroviral therapy(ART)significantly decreased the positive rates of EBV-DNA and HCMV-DNA(χ2=30.60,96.59,all P<0.001).There was a significant negative correlation between the number of CD4+T lymphocytes and the level of HIV-RNA(r=-0.49,P<0.001).Logistic regression analysis showed that the CD4+T lymphocyte count<200/μl(OR=1.46,95%CI:1.02～2.08,P=0.037),HIV-RNA load>200 copies/ml(OR=1.70,95%CI:1.18～2.44,P=0.004)and the age>30 years old(OR=2.15,95%CI:1.44～3.19,P<0.001)were risk factors for HIV/AIDS patients infected with EBV.Without regularly receiving ART(OR=1.83,95%CI:1.10～3.02,P=0.019),HIV-RNA load>200 copies/ml(OR=2.56,95%CI:1.50～4.35,P<0.001)and the CD4+T lymphocyte count<200/μl(OR=4.61,95%CI:2.57～8.28,P<0.001)were risk factors for HCMV infection in HIV/AIDS patients.Conclusion To reduce the possibility of opportunistic infection in HIV/AIDS patients,the surveillance of EBV and HCMV and regular ART should be strengthened,especially when the number of CD4+T lymphocytes decreases(<200/μl),the level of HIV RNA increases(>200 copies/ml)or the age>30 years old.
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Objective:To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) in AIDS patients complicated with Pneumocystis jirovecii ( P. jirovecii) infection. Methods:This is a retrospective study. From January 2019 to June 2021, the respiratory tract and other body fluid samples of 236 cases of AIDS co-infected patients diagnosed in the AIDS Department of Changsha First Hospital were collected, along with corresponding medical histories. Traditional etiological hexamine silver staining and serum 1,3-β-D glucan (BDG) were performed simultaneously with mNGS detection, and Fisher′s exact test was used to analyze the results and compare the diagnostic performances of mNGS with those of hexamine silver staining and serum G test.Results:A total of 236 cases of AIDS patients with pulmonary infection were collected and tested. Seventy-seven cases were clinically diagnosed with Pneumocystis jiroveci pneumonia and 159 cases with non- Pneumocystis jiroveci pneumonia. Among the 236 AIDS patients with pulmonary infection, mNGS detected 77 [32.63%(77/236)] positive cases of Pneumocystis jiroveci, while hexamine silver staining detected 10[4.24%(10/236)] and serum BDG detected 146 [61.86% (146/236). Based on these clinical diagnostic results, the sensitivity of mNGS detection was 100% (77/77) for the 77 patients with Pneumocystis pneumoniae, significantly higher than that of silver hexamine staining [12.99% (10/77), P=0.046] and serum BDG [58.44% (45/77), P=0.038]. The mNGS showed good specificity, which was the same as that of hexamine silver staining [100% (159/159)] and significantly higher than that of serum BDG [36.48% (58/159), P=0.026]. With therapeutic clinical diagnosis as the reference method, the accuracy of mNGS detection was 100% (236/236). Conclusions:This study evaluated the diagnostic value of mNGS detection in AIDS patients with Pneumocystis jirovecii infection. The results showed that the sensitivity and specificity of mNGS detection were high, and it had exceptional clinical application value in the pathogenic detection of infectious diseases.
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Cyclosporine A is widely used in organ transplantation and autoimmune diseases . Due to the obvious differences in metabolism between individuals ，the dosage should be adjusted according to the patient ’s blood concentration during clinical use . But the blood concentration does not reflect accurately its clinical prognosis . This article focuses on the four laboratory examination indexes following aspects ：the cyclosporine A concentration of peripheral blood mononuclear cells ，calcineurin activity ，T cell function and metabolite concentration of cyclosporine A . The relationship between them and the pharmacokinetics of cyclosporine and clinical prognosis were reviewed . It’s found that the above indicators have a certain predictive effect on the clinical prognosis of patients receiving cyclosporine A ，which can make up for the insufficiency of blood drug concentration monitoring ，and the clinical practicability needs to be further improved .
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Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.
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Objective:By investigating the demand of " Internet-based health education" for urban and rural residents, to identify the main functions of " Internet-based health education" platform and the priority order that platform design should follow, in an effort to help promote the accurate dissemination of health education.Methods:Since April 2019, a stratified random sampling method was used to collect urban and rural residents in 3 counties and cities of a city. The survey mainly investigated the importance of the preliminary function and the specific demand of residents for " Internet-based health education" . With data collected and based on Kano model, the Better-Worse coefficient was used for quantitative analysis.Results:There are 14 main functions of the function item identification and discovery platform; among them, privacy, and without product placement are regarded requisites of the platform, while simple and stable operation among others rank the expected functions. in addition, artistic interface, fun experience, etc. were seen as the undifferentiated functions.Conclusions:The platform design for " Internet-based health education" should follow the priority order of privacy, without product placement, simple and stable operation, information authority, low attrition, comprehensive functions, perfect supervision, free service and high popularity.
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The policy model of G. C. Edwards was used to study the policies on building a countywide medical community ( CMC), and identify problems in such aspects as policy communication, resources, disposition and bureaucratic structure. The analysis found that enriching health resources at primary level and powerful government support are creating ideal environment for the construction of CMC. But due to its preliminary development, rooms of improvement of its policy design, and unclear enforcement standards, there appear behavioral polarizations at local health authorities. For example, some are proactive to explore and accumulate rich experiences, while the most take a wait and see stand, or even take administrative means to cope with their authorities by forming medical communities in form only. A small part of county hospitals, thanks to support from the government and inherent conditions, take active measures in this direction as policy frontrunners. On the other hand, most county hospitals prefer to be policy followers in order to avoid cost and risks of the reform. In the worst cases, a few county hospitals have become free riders of the policy, and attempt to take advantages of their primary health institutions. Primary health institutions warmly embrace CMC, but their limited service capability constitutes roadblocks in CMC construction. What is more, poor communication and collaboration mechanisms among systems and authorities hinder the effective policy synergy and health service integration of CMS.
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Objective To analyze the motives and tactics of township health centers ( THC) to participate in the countywide medical communities of Shandong province. Methods Such tools as the new institutionalism, rational choice and social network theories, as well as the constituent ratios and Pearson correlation coefficient of data were used in a survey in August 2018 with managers of 264 THCs in Shandong. It aimed to learn from the respondents their motives, tactics, and behaviors to participate in such communities. Results Theoretical analysis of the results found that their participation was bound by both institutional environment and technical environment. For example, compliance tactics, accompanied by efficiency, was adopted to cope with stress from institutional environment. Exploratory tactics, accompanied by legitimacy, was adopted to cope with stress from technical environment. The figures showed 87. 5％ of 264 THCs investigated participated in such communities, and their main motives were in turn to follow government requests (86. 1％ ) and to seek development opportunities (69. 7％ ). The critical criteria of partner selection were in turn technological level (83. 5％ ) and matching of resources (77. 9％ ). Of 231 THCs which participated in the communities, 95. 2％ joined in countywide medical communities, and 28. 6％ participated in other forms of medical alliances. Conclusions THCs showed high organizational convergence in their participation, and adopted diversified strategies of participation in medical alliance.
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The protection of personal medical information and the rights confirmation of medical big data are issues pending solution in the era of" Internet + heahhcare".As customers,patients at large enjoy a wide variety of data rights in the era of "Internet + healthcare",including the right to informed consent,the right to delete,the right to be forgotten,and the right to automate decision-making.Based on the analysis of the privacy protocols of 20 Internet healthcare platforms in China,the authors found such loopholes as lack of privacy protocol or missing/poor privacy clauses,mandatory use of private data and the sharing of private data,as well as lack of restrictions on the transfer.It is evident that the protection of patients' personal data is poor.The state is recommended to improve the personal information protection system in " Internet + healthcare" era by formulating mandatory industry standards,establishing a unified healthcare information data platform,and using information security management capabilities as an important indicator of market access.
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The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.
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Objective To analyze the resources allocation and service provision of hospital rehabilitation departments in China from 2009 to 2016, for finding problems and providing references for improvement of hospital rehabilitation system in China. Methods Using the statistical yearbook of health and family planning in China from 2010 to 2017,descriptive analysis was made to describe the rehabilitation service and resources allocation of hospital rehabilitation departments in China in recent years. Results From the perspective of service volume, the quantity of rehabilitative services was increasing year by year, and the number of patients discharged from the hospital has increased rapidly among the total number of hospital discharged inpatients countrywide. By the end of 2016, this proportion was 1.26%. From the perspective of resources allocation, by the end of 2016, the proportion of the rehabilitation beds was just 2.62% of all hospital beds. Personnel staffing was poor by the end of 2016, as there were only 0.02 practicing rehabilitation doctors (assistants) per every 1 000 population. Conclusions It is imperative to strengthen the resources of hospital rehabilitation departments, increase the number of hospital beds and personnel,and improve the pay for these staff, to ensure their service capability. It is also an important guarantee to provide the people with healthcare that is all-dimensional and full lifecycle.
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Objective To analyze problems in the development of medical service at private hospitals, and provide references for promoting the development of these hospitals and implementing policies for encouraging this sector′s growth. Methods The data were collected from the statistical yearbook published by the National Health Commission of the People′s Republic of China, and descriptive analysis method was used to analyze the medical service workload and medical service efficiency of private hospitals in China since the new healthcare reform. Results Private hospitals accounted for 56. 39％ of the total number of hospitals in China, accounting for 21. 69％ of beds by the end of 2016. From the perspective of medical service workload, the service volume of these hospitals had increased yet at a small pace. The number of patients and inpatients received accounted for 12. 90％ and 15. 84％ respectively of all the hospitals in China. From the point of service efficiency, by the end of 2016, the bed utilization ratio was 62. 8％, the daily medical visits to their doctors were 5. 5 persons-times, and the daily number of hospitalized beds per doctor was 2. 2 beds. These numbers lag far behind public hospitals. The development of private hospitals varied with regions in imbalance. Conclusions Improving the social image, attracting talents and improving service quality are key to improving the medical service capacity of private hospitals.
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Objective:To investigate the changes of sTim-3,HMGB1 and TGF-β in the brucellosis patients and to analyse the relationship between the changes of these molecules and brucella infection. Methods:28 cases of brucellosis patient untreated and 28 healthy control cases in the age and gender matched with brucellosis cases were collected. The serum levels of sTim-3 and HMGB1 were detected by ELISA,and the levels of Spot forming cells secreting TGF-β were measured by ELISPOT in patients and healthy control group. Results: Compared with healthy controls, sTim-3/HMGB1 expression levels and Spot forming cells secreting TGF-β were significantly increased in the brucellosis patients ( P<0. 01 ) . The changes of Spot forming cells secreting TGF-β were positively correlated with the levels of HMGB1 (P<0. 05). Conclusion:The serum levels of sTim-3/HMGB1 and Spot forming cells of secreting TGF-β from peripheral blood mononuclear cell are significantly increased in the brucellosis patients. Those molecules may be involved in the process of brucella infection and may play a significant role in the immune escape of patients infected with brucella.
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Objective To identify the influencing factors for rural doctors′ training effect,and suggest on the improvement of such training.Methods On the basis of rural doctors′ survey,the theory of pre-intervention was used to probe into the influencing factors for such training in five dimensions of attention notice,mega-cognitive strategies,advance organizer,goal orientation,and preparatory information.Results 73.2% of the groups were found with satisfying effect.In the single factor analysis,comparison of training effect involving such factors as age,gender,length of work life and pre-intervention revealed statistical significance(P<0.05).As shown in the logistic regression analysis,High motivation in meta-cognitive strategies,Clear goals in goal orientation,Tiered and categorized training in advance organizers,and Practical learning in preparatory information,as well as variants like age would influence rural doctors′ training effect significantly.Conclusions The key to better training effect lies in better motivation of the trainee,setting correct training goals,emphasis on the practicability of training contents and,the pertinence of the training objects.
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Objective To analyze the outcomes of the subsidy mechanism reform for China's public hospitals through a financial perspective.Methods An evaluation index system was built using data from China's health (family planning) statistics yearbooks 2009-2016, for comparison of the constituent ratio and chain relative ratio growths of public hospitals in various years.Results Year 2015 found a lower growth rate of medical revenues of these hospitals;year-by-year drop of drug income ratio, yet a gradual rise of income from examinations and materials, and a drop of technical service income growth and its ratio of the total income;a year-by-year drop of drug income surplus growth, and an expanding deficit in medical services;a slower growth of medicine expense growth, with the asset-liability ratio rising to 45.3%, and salary ratio rising to 30.6%.Conclusions The reform on compensating mechanism at public hospitals is demonstrating its impacts on public hospitals, namely slower growth of medical revenue, weakened compensating role of drug income, lower surplus, and higher asset-liability ratio among other financial risk exposure.These hospitals are encouraged to take proactive measures to control costs, including tighter medical service cost control,to secure sufficient and timely government fiscal subsidy, and other funding measures to cope with debts of the hospitals.
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Objective To analyze the residents′ willingness to hierarchical medical system and their intention of first visit hospitals.Methods Customized questionnaire was used for in-home survey of 1 500 households in three cities of Shandong province,with 773 of the residents aware of hierarchical medical system used as the study samples.Descriptive analysis and multi factor Logistic regression were employed for statistical analysis of their intention.Results 85.0% the residents expressed willingness to embrace hierarchical medical system.55.0% of the residents prefer primary medical institutions as their first visit in case of mild illness,a choice chosen by more rural residents(58.9%)than urban residents(48.0%),a difference of statistical significance(P<0.01).In the case of severe illness,87.3% of them prefer major hospitals as their first visit,and more urban residents(94.3%)take this option than the rural residents(83.3%),a difference of statistical significance(P<0.01).Service ability of medical institutions and residents′ concept for medical service played a key role in their choice of first visit hospitals.Conclusions The key to ensuring the implementation effect of hierarchical medical system lies in better service ability of primary medical institutions and correction of residents′ irrational medication concepts.
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Objective To analyze the correlation factors that promote or impede the residents to preferentially use essential medicines.Methods Adopting stratified random sampling method,1 700 households selected from 5 cities of Shandong province were investigated with a questionnaire.The framework of Andersen behavior model of health service utilization was used as the framework,with such methods as descriptive analysis and univariate logistic regression models for the analysis and evaluation of relevant information.Results The residents′ tendency factor,ability factor and environmental factor influence their preference to use essential medicines,while the requirement factor plays a minimal role.There was a significant difference for the preference of combined medication,first visit preference and self-medication experience,the efficacy and policy response of essential medicine from logistic regression analysis.Conclusion At present,the government should focus on the construction of the formation mechanism of the residents′drug use behavior and the policy response mechanism of essential medicine system.
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Introduced are the concept and connotation of the prospect theory in behavioral economics,and the theory is used to explore the psychological characteristics and irrational decision behaviors of both supply and demand sides of talents in human resource development of township hospitals.The study found that the limited rational decision of people influenced the policy effectiveness of human resource policy for such hospitals,and the certainty effect strengthened the demand for restoration of government accountability and the breaking of staffing quota limits.The change and difference of reference point resulted in the lack of incentives and turnover of posts in such hospitals.The presence and change of the mental account caused unscientific human resource development.Based on such findings,the prospect theory can provide good explanatory power and theoretical enlightenment for such development.
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This paper discussed the concept and connotation of doctor -patient contradiction , and the ethics of doctor-patient conflicts reason carried on the thorough analysis .On this basis , from the macro and micro probes into the ethical path of resolving doctor -patient contradiction , specific include:the macro level , to accelerate the process of basic medical and health law ,public welfarereturn path , to protect the justice of medical treatment;Attaches great importance to the medical and health investment , increase the medical popular science knowledge propaganda , to improve medical limitations of cognitive science .Micro level, accelerate the reform of public hospi-tal modernization management , improve the medical staff occupational ethics quality , safeguard human dignity;at-taches great importance to the doctor -patient contradiction early warning mechanism and the patients interests ex-pression path construction , guarantee justified and lawful rights and interests of patients .
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To study performance problems found in China's essential medicine system.The SmithModel of system implementation was called into play in a systematic collation and analysis for the ideal policies,system implementation agencies,target groups and policy environment in its performance,along with relationships among the four factors.The system is found with a number of loopholes as the system itself is highly idealized,its system objectives set inappropriately,problems found with the four factors,and tension and conflicts among these factors.Given these problems found in its performance,it is inappropriate to make drastic changes to avoid instability of the system at its early stage.Government departments in question are advised to comprehensively analyze the four factors and their relationships then taking effective measures to deal with them and the tension,conflict among them.This can ensure effectively implementation of the essential medicine system.
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Objective To study and identify factors and evaluation criteria for optional health policy instruments for policy making reference.Methods A field survey was made to the10,000 primary care doctors to rural households campaign in Jining city,covering 453 doctors sent to villages,294 village doctors,and 572 rural residents,with the data obtained subject to descriptive analysis.Results In terms of equity of the campaign,97.8％ of the rural residents have entered into agreements,and 1.715 million of free visits have been provided by family doctors; in terms of economics,most of the superior doctors,rural doctors and rural residents believed that the policy could encourage high quality resources to sink to rural areas,and enhance the competence of public health services by rural doctors.In terms of the adaptability,60.4 ％ of the superior doctors and 92.7％ of the rural doctors hold that they are competent for health care role,but 51.8％ of the superior doctors were found not used to the current working mode.In terms of the enforceability,main complaints of superior doctors and rural doctors were excessive workload,overlong working hours,insufficient medical equipments,and reduced institutional revenue In terms of acceptability,90.4％ of the rural residents are supportive Conclusion The promotion of such a policy calls for a combination of compulsory,voluntary and mixed policy instruments in sinking the resources,with appropriate selection and optimization of such instruments,to ensure outcomes of the policy.