Epidemiological characteristics of children with severe sepsis in multi-center PICU in Shandong province from 2018 to 2021 / 中国小儿急救医学

Objective:To investigate the epidemiological characteristics, treatment and prognosis of pediatric severe sepsis in PICU in Shandong Province from 2018 to 2021, in order to provide a scientific basis for the prevention and treatment of severe sepsis in children.Methods:A multicenter retrospective observational study was conducted at PICUs from 19 hospitals in Shandong Province.Patients aged>28 days and ≤18 years, diagnosed with severe sepsis or septic shock who admitted to these PICUs during January 1, 2018 and December 31, 2021 were enrolled.Results:(1)From 2018 to 2021, the total number of hospitalized children and the number of children with severe sepsis admitted to the PICU showed an overall downward trend, with the most significant decrease in 2020.(2)During the study period, among the hospitalized children in PICU, the prevalence rate of children with severe sepsis fluctuated from 1.95% to 2.37%, and the median age fluctuated from 1.29 to 2.00 years old, more males than females.(3)Median pediatric sequential organ failure assessment score fluctuated between 5 and 6 at 24 hours after admission.(4)The most common primary infection site was the respiratory system, followed by the digestive system.(5)Since 2020, the propotion of children receiving fluid resuscitation, blood purification, mechanical ventilation, and glucocorticoid therapy has decreased significantly.(6)The median length of PICU stay was 9.22 to 11.51 days.(7)The median PICU costs decreased significantly from 41 075 yuan in 2018 to 30 972 yuan in 2021.(8)In-hospital mortality showed an overall decreased trend, reaching a maximum of 17.61% in 2019 and a minimum of 12.77% in 2020.Conclusion:From 2018 to 2021, there was no significant change in the incidence of pediatric severe sepsis in PICUs in Shandong province while the overall in-hospital mortality rate and the PICU costs showed a reduced trend.

Management status analysis of Investigator-Initiated Trials in Shandong provincial medical and health institutions / 中华医学科研管理杂志

Objective:To analyze the current situation of Investigator-Initiated Trials in medical and health institutions in Shandong Province, the problems in the process of conducting clinical research, and put forward proposals for the establishment of a clinical research management system with effective supervision, sound systems and supporting services, taking into account the progress of the projects since the pilot work was carried out.Methods:A questionnaire was created, an online survey was conducted, a database was set up, a status analysis was conducted and a post-launch analysis of the progress of the pilot was carried out using the National Medical Research Registry Information System, culminating in recommendations using the literature summary method and empirical analysis.Results:Statistical analysis of the questionnaire found that 29.39% of the institutions have a dedicated clinical research management department, and 75.97% of the institutions have a management approach. 25.52%, 40.30%, and 43.07% of institutions established biobanks, clinical research centers, and follow-up centers. There was a statistically significant difference in the establishment of clinical research centers, biobanks, and follow-up centers in secondary and tertiary medical institutions ( P<0.05). The number of general clinical research projects filed, the number of submissions and the number of ethics committees filed in the filing system have all increased significantly after the pilot work, with growth percentages of 126%, 141% and 62% respectively. Conclusions:Shandong Province clinical research pilot work has begun to bear fruit, the current clinical research project still exists in the lack of special funding support, perfect service platform and system support and training system to be improved and other issues.

Resource components and utilization values of different parts of Panax quinquefolium in Shandong province / 中国中药杂志

To explore the resource components and availability of different parts of Panax quinquefolium in Shandong province, the paper employed the non-targeted metabolomics technology based on ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS) to analyze the metabolites and their metabolic pathways in the root, fibril, stem, and leaf of P. quinquefolium. The content of seven ginsenosides and polysaccharides in different parts was determined by high performance liquid chromatography(HPLC) and ultraviolet-visible spectrophotometry(UV-Vis). The results showed that the metabolites were mainly sugars, glycosides, organic acids, amino acids and their derivatives, terpenoids, etc. The total abundance of metabolites followed the trend of leaf > root > fibril > stem. Most of the differential metabolites were concentrated in phenylpropane biosynthesis, flavonoid biosynthesis, citric acid cycle, and amino acid biosynthesis. The leaf contained high levels of sugars, glycosides, amino acids and their derivatives, and flavonoids; the root was rich in terpenoids, volatile oils, vitamins, and lignin; the fibril contained rich organic acids; and the stem had high content of nucleotides and their derivatives. The content of ginsenosides Re and Rb_1 was significantly higher in the root; the content of ginsenosides Rg_1, Rg_2, Rd, F_(11), and polysaccharide was significantly higher in the leaf; and the content of ginsenoside Rb_2 was significantly higher in the stem. We analyzed the resource components and availability of different parts of P. quinquefolium, aiming to provide basic information for the comprehensive development and utilization of P. quinquefolium resources in Shandong province.

A Study on the Impact of Smoking on Catastrophic Health Expenditure in Chinese Households:A Case Study of Shan-dong Province / 中国卫生经济

Objective:It aims to investigate the impact of tobacco use on Catastrophic Health Expenditure(CHE),providing a ba-sis for government investment in tobacco control and the formulation of effective anti-smoking policies.Methods:Based on the 2018 National Health Service Survey data from Shandong Province,the incidence rate,average overshoot gap,and relative overshoot gap of CHE under different thresholds for different household were calculated to analyze the distribution of tobacco-related diseases for smoking households.Results:In 2018,the overall incidence rate of CHE for current smoking households in Shandong Province was 13.56%(at a 40%threshold),with average overshoot gap and relative overshoot gap of 4.61%and 34.02%,respectively.As income levels decreased,the overall incidence rate of CHE increased.Rural current smoking households had higher overall incidence rates of CHE,average overshoot gap,and relative overshoot gap than urban households.Smoking households that experienced CHE were pri-marily afflicted with chronic diseases.Conclusion:The CHE risk is significantly higher in smoking households,particularly in rural and low-income households.It is recommend implementing a diverse range of promotional methods to strengthen anti-smoking health education,with a specific focus on intensifying awareness of the dangers of tobacco use in rural areas.Additionally,it is suggested to further increase tobacco taxes so as to reduce the motivation for smoking among low-income populations.

Construction and Application of Evaluation Index System for Clinical Specialty Capability of Traditional Chinese Medicine in Shandong Province / 中国医院管理

Objective Construct a scientific and reasonable evaluation index system for clinical specialties of tradi-tional Chinese medicine in Shandong Province to provide a scientific basis for improving the service capacity of clini-cal specia lties of traditional Chinese medicine.Methods Based on relevant policies and literature research,the analytic hierarchy process and Delphi expert consultation method were used to determine the index system and its weight,and 509 clinical specialties of traditional Chinese medicine capacity levels of 178 medical institutions in Shandong Province were evaluated.Results A scientific and effective evaluation index system for clinical specialty capacity of traditional Chinese medicine in Shandong Province was constructed,with 23 secondary indicators in 5 dimen-sions.It comprehensively evaluats the service capacity and management level of orthopedics and traumatology de-partments of traditional Chinese medicine class hospitals in Shandong Province,uses orthopedics and traumatology as an example.Conclusion Driven by the dynamic monitoring of the evaluation index system,improve the service ca-pacity for clinical specialties of traditional Chinese medicine,guide it to strengthen the internal construction of tradi-tional Chinese medicine,and give full play to the advantages of traditional Chinese medicine characteristics.Increase the support for clinical specialties of traditional Chinese medicine in Shandong Province,and then promote the high-quality development of traditional Chinese medicine.

Analysis of ADR reports caused by cefotaxime sodium in Shandong province and effects of skin test on serious ADR / 中国药房

OBJECTIVE To analyze the clinical manifestations and characteristics of adverse drug reactions （ADR） caused by cefotaxime sodium in Shandong province， and to explore the effects of skin test before medication of cefotaxime sodium on serious ADR， so as to provide reference for safe drug use in clinic. METHODS The relevant data of cefotaxime sodium-induced ADR reported by Shandong Province ADR Monitoring Center during December 2019 to December 2021 were collected from National ADR Monitoring System. The ADR classification， age， gender， ADR occurrence time， route of administration， history of allergy， primary diseases， ADR systems/organs involved， clinical manifestations， outcome， skin test or not before medication were statistically analyzed. RESULTS A total of 1 057 ADR reports caused by cefotaxime sodium were included. Among them， there were 867 patients （82.02%） with general ADR and 190 patients （17.98%） with serious ADR. The majority were ＜11 years old （40.30%）. The main route of administration was intravenous drip （96.69%）. A total of 1 033 patients （97.73%） developed ADR 30 min to 24 h after medication. A total of 814 patients （77.01%） had no history of allergy. The primary diseases were respiratory system infection （56.58%）. Main systems/organs involved in ADR were skin and its appendants， digestive system and respiratory system， and its clinical manifestations were rash， pruritus， nausea， vomiting， chest tightness， etc. After withdrawal or symptomatic treatment， 1 050 patients （99.34%） were cured or improved. Before the use of cefotaxime sodium， 850 patients underwent skin test （151 patients occurred serious ADR）； there was no statistical significance in the incidence of serious renzhen202102@163.com ADR， compared with the incidence of serious ADR in 207 patients without skin test （39 patients occurred serious ADR）（P＝0.718）. CONCLUSIONS ADR caused by cefotaxime sodium is mainly seen in patients ＜11 years old， mostly occurring 30 min to 24 h after intravenous drip； skin test before medication of cefotaxime sodium cannot reduce the risk of serious ADR. Before using cefotaxime sodium in clinical practice， patients should be asked about their allergy and medication history in detail. During use， it is important to focus on the patient’s condition within 24 h after medication to prevent serious ADR and ensure the safety of clinical medication.

Surveillance on drug resistance of Staphylococcus aureus from bloodstream infection in Shandong, 2017-2020 / 中国热带医学

@#Abstract: Objective　To analyze the drug resistance of Staphylococcus aureus in blood samples of children and adults from 50 hospitals in Shandong Province, and to understand the drug sensitivity characteristics of Staphylococcus aureus bloodstream infection (BSI), so as to provide reference for clinical experience. Methods　The distribution and drug resistance of Staphylococcus aureus isolated from blood samples from 50 hospitals in Shandong province from 2017 to 2020 were analyzed based on the Cooperative Research Network of Pediatric Bacterial and Fungal Resistance Monitoring in Shandong Province. Meanwhile, the drug sensitivity characteristics of Staphylococcus aureus were divided into children group (<14 years old) and adult group (≥14 years old). The data were analyzed by Whonet 5.6 and SPSS 22.0 with reference to CLSI 2021 M100 document standard judgment results. Results　A total of 3 661 Staphylococcus aureus strains were collected from 50 medical institutions in Shandong Province, including 675 in 2017, 870 in 2018, 1 080 in 2019, and 1 036 in 2020. The drug resistance rates of multiple antibiotics in blood culture methicillin-resistant Staphylococcus aureus (MRSA) group and methicillin-sensitive Staphylococcus aureus (MSSA) group were significantly different (P<0.05). There were significant differences in antibiotic resistance rates between adult group and children group (P<0.05). The overall detection rate of MRSA was 27.5%, and no staphylococcus aureus strains resistant to vancomycin, linezolid and tigecycline were found. Conclusion　The detection rate of MRSA strains decreased continuously and increased by 2020. The detection rate of MRSA in adult group was lower than that in children group, suggesting that we should pay attention to the monitoring of bacterial resistance in children group, to the management of multiple resistant bacteria and rational use of antibacterial drugs.

CHINA PH ARMACY Volume 33，Number 15，August 15，2022 Semimonthly Table of Contents Expert consensus on the comprehensive clinical evaluation of lipid-lowering drugs under the centralized drug volume-based procurement policy in Shandong Province / 中国药房

Comprehensive clinical evaluation of drugs is an important technical tool to promote the return of drugs to clinical value. Under the background of normalization and institutionalization of centralized drug volume-based procurement ，it is very crucial to actively organize and carry out comprehensive clinical evaluation of drugs. As of March 2022，there are 5 lipid-lowing drugs that have been included in the centralized drug volume-based procurement of the state and Shandong Province. In order to actively promote the medical institutions to develop the comprehensive clinical evaluation of lipid-lowing drugs standardly ，led by the Shandong Provincial Hospital Affiliated to Shandong First Medical University ，supported by Shandong Hospital Association ，and 19 third grade class A hospitals in Shandong Province jointly participated ，Using Delphi method ，through three rounds of expert opinion investigation and extensive discussion ，Expert Consensus on the Comprehensive Clinical Evaluation of Lipid-lowering Drugs under the Centralized Drug Volume-based Procurement Policy in Shandong Province was developed. The expert consensus adopted the percentage system for quantitative evaluation. The comprehensive clinical evaluation on 15 lipid-lowing drugs involved in centralized drug volume-based procurement in Shandong Province was implemented from eight dimensions including pharmaceutical characteristics ，effectiveness，safety，economy，suitability，accessibility，innovation and other attributes ，and different recommendation levels were formed according to the scores. The development of this consensus will help medical institutions to reasonably allocate and use lipid-lowering drugs in the context of centralized drug volume-based procurement ，so as to better satisfy the national policy needs and continuously improve the quality of pharmaceutical services.

Analysis of allocation of antipsychotics in regions with different economic levels in Shandong province / 中国药房

OBJECTIVE To investigate the allocation of antipsycho tics in regions with different economic levels in Shandong province，and to provide reference for strengthening the management of antipsychotics allocation and promoting the balance of regional allocation. METHODS The procurement information of the secondary and tertiary public medical institutions in Shandong province from 2016 to 2019 was collected from the Drug Centralized Bidding and Procurement Information Platform of Shandong Provincial Medical Institutions. The procurement varieties of antipsychotics ，allocation proportion and procurement cost per 10 000 people were analyzed in area with different economic levels in Shandong province. RESULTS From 2016 to 2019，there were 18 kinds of antipsychotics purchased by secondary and tertiary public medical institutions in Shandong province （9 kinds of first- and second-generation antipsychotics respectively ），and the average number of purchased varieties were 3.50-4.42. The average number of purchased varieties in undeveloped areas （3.59-4.48 kinds）were slightly higher than that in developed areas （3.41-4.36 kinds）. In these four years ，average allocation proportion of antipsychotics was 17.19％，and most of them showed a fluctuating increase （the average annual increase ranged 4.64％-38.34％）. The allocation proportion of second-generation antipsychotics was higher in developed areas than that in undeveloped areas. The purchasing cost per 10 000 people showed an upward trend of fluctuation ， ranging from 2.45 to 7 440.20 yuan. Among the 18 antipsychotics procured from 2016 to 2019，61.11％，61.11％，83.33％ and 72.22％ of them were procured by developed areas with higher procurement costs per 10 000 people than by undeveloped areas. The total procurement cost of essential medicine per 10，000 people in developed areas （11 382.99-39 650.90 yuan）was also higher than that in undeveloped areas （8 353.15-30 561.77 yuan）. CONCLUSIONS The allocation proportion of antipsychotics is low in Shandong province ，and the allocation proportion of second-generation antipsychotics in developed areas are higher than that in undeveloped areas.

First report of invasive Pomacea snails in Shandong Province / 中国血吸虫病防治杂志

Objective To characterize the species of invasive Pomacea snails that were discovered for the first time in Shandong Province. Methods Pomacea snails samples were collected in the field of Jining City, Shandong Province on October 2021 for morphological identification. Pomacea snails were randomly sampled and genomic DNA was extracted from foot muscle tissues of Pomacea snails for multiplex PCR amplification. The PCR amplification product was sequenced. Then, the sequence was aligned and a phylogenetic tree was created using the software MegAlign 7.1.0. In addition, Angiostongylus cantonensis infection was detected in Pomacea snails with the lung microscopy. Results A total of 104 living Pomacea snails were collected, and all were characterized as Pomacea spp. based on morphological features. Of 12 randomly selected adult Pomacea snails, multiplex PCR assay and sequencing identified eleven snails as P. canaliculata and one as P. maculata. No A. cantonensis infection was detected in 104 Pomacea snails. Conclusion This is the first report of invasive Pomacea snails in Shandong Province, where P. canaliculata and P. maculata are found.

Change Rule of Diatom in Zhangweixin River in Dezhou / 法医学杂志

OBJECTIVES@#To study the annual variation of diatoms in Zhangweixin River, to provide theoretical support by using diatom examination to estimate the time and place of the corpse entering water, and to establish a diatom database.@*METHODS@#Samples were taken from 4 sampling sites in Decheng section of Zhangweixin River for 12 consecutive months. Non-metric multi-dimensional scaling (NMDS) analysis was performed on the species and content of diatom samples. Based on the sampling site of Tianqu Road, Sprensen similarity coefficient analysis was conducted with the data of other 3 sites in Decheng section and Leling section of Zhangweixin River and Ningjin section in previous studies.@*RESULTS@#The number of diatom species was positively correlated with diatom content. The average diatom content in different months ranged from 1 054 to 13 041/10 mL, and the species composition ranged from 8 to 16, with differences in dominant species. The similarity coefficient of diatom species within 2 km were all higher than 0.956 52, which could not be distinguished effectively. The similarity coefficients of Leling section and Ningjin section were 0.736 84 and 0.588 24 respectively, which could be effectively distinguished.@*CONCLUSIONS@#The species and content of diatom vary in different months in Zhangweixin River, and the composition of diatom species is different in different basins, which can provide reference for estimating the time and place of the corpse entering water in the river.

Study on the construction status and countermeasures of Shandong Provincial Clinical Research Center / 中华医学科研管理杂志

Objective:By analyzing the development purpose and goals, status quo and achievements, characteristics, and problems identified of Shandong Provincial Clinical Research Center, tailored measurements and suggestions are put forward in this paper, to serve for better development of Shandong Provincial Clinical Research Center, and construct a more efficient clinical research transformation platform.Methods:Carrying out statistical analysis of the annual reports of the first two batches of 12 Shandong Provincial Clinical Research Centers to identify similarities and uniqueness; Benchmarking with the construction goals of Shandong Provincial Clinical Research Centers to figure out achievements and space for improvement; SWOT analysis was conducted to analyze opportunities and challenges, and experiences were summarized.Results:After two years’ construction, the centers have remarkable achievement by facilitating resources, establishing research platforms, and setting up collaborative research networks. However, common problems are still existed, such as: weak innovation foundation, insufficient attention from supporting institutions, lacking of compound talents in clinical research, peak discipline should be developed at provincial centers to promote the capacity building, and the ability to promote innovation at local level also needs to be improved.Conclusions:The construction of Shandong Provincial Clinical Research Center is facing a great deal of opportunities and challenges. By boosting attention of the supporting institution, enhancing continuing investment, implementing annual evaluation system, guiding the outstanding provincial centers to apply for national centers, and strengthening the achievement transfer and promotion, the construction of the provincial centers will be improved, and further enhance the clinical research capacity at provincial level.

Analysis of current situation and countermeasures for the development of hospital scientific and technological innovation in Shandong Province / 中华医学科研管理杂志

Objective:To analyze the overall situation and existing problems of the scientific and technological innovation capacity of hospitals in Shandong Province, propose strategies for the construction of first-class medical disciplines in hospitals, promote the transformation of medical science and technology achievements into clinical application, and provide a reference basis for building a highland of health scientific and technological innovation.Methods:Science and Technology Evaluation Metrics (STEM) data of hospitals in Shandong Province in 2020 were obtained by network research method, and the scientific and technological innovation capacity and sustainability of hospitals and disciplines were analyzed by statistical description method, assignment method, and NetDraw visualization tool.Results:The number of national top 100 hospitals and disciplines in Shandong Province ranks seventh and sixth in China, respectively. Only three hospitals in Shandong Province are among the national top 50, covering 80.6% of provincial top-ranked disciplines, while 41.6% of the national top 100 disciplines in Shandong Province are ranked after the top 50 in their respective discipline lists. The hospital scientific and technological innovation capacity of Shandong Province is at the middle-upper level with few and uneven distributions of first-class hospitals and disciplines, leading to a relatively weak overall science and technology impact.Conclusions:Given the current situation in Shandong Province, it is suggested that hospitals should take STEM as a guide to strengthen the construction of scientific research environments, vigorously develop clinical research, continuous strengthen discipline construction, and emphasize scientific innovative talent training and research integrity education, providing a science and technology strategic support for the acceleration of the medical scientific and technologic innovation and the promotion of high-level innovative province construction.

Study on contract renewal willingness and influencing factors of contracted residents to family doctor service in Shandong Province / 中华医院管理杂志

Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.

Analysis of 8 566 New ADR Reports in Shandong Province / 中国药房

OBJECTIVE：To investigate the occurrence and characteristics of new adverse drug reactions （ADR）in Shandong province，so as to provide reference for the safety of drug use in the clinic. METHODS ：The data of new ADR reports were collected from Spontaneous Reporting System of Shandong ADR Monitoring Center during Oct. 2019 to Mar. 2020. Those reports were analyzed statistically in respects of report types ，reporting institution ，reporters’occupation，gender and age of patients ，drug type ，organs/ systems involved ，clinical manifestations. RESULTS & CONCLUSIONS ：A total of 8 566 new ADR reports were screened out ， accounting for 10.81％ of the effective ADRs. Among them ，there were 7 961 new and general ADR （92.94％）and 605 new and serious ADRs （7.06％）. For the new ADR ，the reporting institutions were mainly medical institutions （98.42％），and the reporters ’ occupation were mainly doctors （78.44％）. Female （4 860 cases）was slightly more than male （3 698 cases）；most of them were 45 years old and above （70.00％），and intravenous drip （47.67％）was the main route of administration. The top five ADR suspected drugs were TCM preparations （34.50％），anti-microbials（13.75％），circulatory system drugs （11.41％），nervous system drugs （6.39％）and blood system drugs （4.81％），involving 517，91，64，53，50 types，respectively，among which Levofloxacin injection caused the most serious ADR （24 cases）. The new and general ADR mainly involved gastrointestinal system ，skin and its appendant ； their clinical manifestations were nausea ，vomiting，rash，etc. New and serious ADR mainly caused systemic damage ；their clinical manifestations were anaphylactic shock ，chest tightness and shivering ，etc. It is suggested to strengthen the ADR monitoring of TCM preparations，anti-microbials，circulatory system drugs and other drugs ，so as to ensure the safety of clinical drug use.

Surveillance of Enterobius vermicularis infections among children in Shandong Province from 2016 to 2020 / 中国血吸虫病防治杂志

Objective To investigate the prevalence and changing trend of Enterobius vermicularis infections among children in Shandong Province, so as to provide the scientific evidence for the adjustment and development of the enterobiasis control strategy. Methods Soil-borne nematodiasis surveillance sites were assigned in 51 counties (districts, cities) in Shandong Province from 2016 to 2020, and the E. vermicularis infections were detected using a modified Kato-Katz technique and the cellophane tape method among children at ages of 3 to 9 years living in these surveillance sites. The epidemiological profiles of E. vermicularis-infected children were descriptively analyzed. Results A total of 5 060 children at ages of 3 to 9 years were detected in 51 soil-borne nematodiasis surveillance sites in Shandong Province from 2016 to 2020, and the overall prevalence of E. vermicularis infections was 2.23%. The annual prevalence of E. vermicularis infections was 3.99% (26/651), 1.70% (14/824), 0.96% (8/837), 2.90% (45/1 552) and 1.67% (20/1 196) from 2016 to 2020, respectively, with a significant difference detected among years ( χ2 = 21.455, P < 0.01). The prevalence of E. vermicularis infections was 1.25% (15/1 198), 1.85% (14/755), 3.18% (84/2 640) and 0 (0/467) among children from central, eastern, southern and northern Shandong Province (χ2 = 27.326, P < 0.01). In addition, there was no significant difference in the prevalence of E. vermicularis infections between male (1.98%, 56/2 831) and female children (2.56%, 57/2 229) (χ2 = 1.916, P > 0.05); however, there was age-specific prevalence of E. vermicularis infections among children (χ2 = 16.448, P < 0.05), with the greatest prevalence detected among children at ages of 6 years (3.18%, 25/786), and the lowest prevalence seen among children at ages of 3 years (0.75%, 6/800). Conclusions The prevalence of E. vermicularis infections remained at a medium level among children at ages of 3 to 9 years in Shandong Province from 2016 to 2020, with region-specific prevalence found across the province. An integrated strategy is required for enterobiasis control.

Association between availability of glucose-lowering drugs in primary health institutions and diabetes patients' medication adherence:a cross-sectional study in Shandong Province,China / 《全球健康杂志（英文）》

Background:Primary health care system is a critical component of diabetes care and management.This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions (PHIs) in China,and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus (T2DM) patients.Methods:This cross-sectional study conducted in Shandong Province,eastern China (hereafter referred to as Shandong),between August and December 2017.In total,2520 community-managed T2DM patients were se-lected from 68 PHIs in Shandong,including 62 village-level and 6 township-level PHIs.The self-developed ques-tionnaire was used to survey the availability of glucose-lowering drugs in PHIs.Patients' medication adherence was assessed by four self-reported questions,and was classified as either adherent or non-adherent.Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients.Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients' medication adherence.Results:A total of 1866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis.Among them,58.5％ patients followed their antidiabetic treatment well.In village-level PHIs,the pa-tient's adherence rate was lower than in township-level PHIs (55.9％ vs.61.1％,P ＜ 0.05).Among the 68 PHIs,average (2.53±0.97) glucose-lowering products (generic names) were available,which in village-level PHIs were less than in township-level PHIs (2.47 vs.3.17,P ＜ 0.05).And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients.Conclusion:Poor availability of glucose-lowering products was found in PHIs in Shandong.The availability of glucose-lowering products in PHIs was positively associated with patients' medication adherence,and could be enhanced to improve the control of diabetes in primary care settings.

Correlation of serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, and alkaline phosphatase with blood pressure in patients with nonalcoholic fatty liver disease in coastal regions of Shandong Province in China / 临床肝胆病杂志

Objective To investigate whether there was a correlation between serum liver enzyme levels and blood pressure in the Chinese Han population with nonalcoholic fatty liver disease (NAFLD) in Shandong coastal regions in China. Methods A total of 269 NAFLD patients who lived in Shandong coastal regions and attended or underwent physical examination in Qingdao Municipal Hospital from December 2019 to June 2020 were enrolled, among whom 105 had hypertension and 164 did not have hypertension. Morning blood pressure was measured to calculate mean arterial pressure (MAP), and laboratory tests were performed to measure the serum levels of liver enzymes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP)] and fasting blood glucose (FBG). The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was used to investigate the correlation of four liver enzymes with the indices including MAP, and a binary logistic regression model was used to analyze the impact of serum liver enzymes on hypertension. Results Compared with the non-hypertension group, the hypertension group had significantly higher body mass index (BMI), MAP, and GGT (all P < 0.05). For all NAFLD patients and the NAFLD patients without hypertension, male patients had significantly higher BMI, MAP, ALT, AST, and GGT than female patients (all P < 0.05), and for the NAFLD patients with hypertension, male patients had a significantly higher level of GGT than female patients ( P < 0.05). There was a significant difference in the distribution of GGT between the hypertension group and the non-hypertension group, and compared with the non-hypertension group, the hypertension group had a significantly higher proportion of patients with GGT exceeding the normal range ( χ 2 =4.781, P =0.029). Serum GGT level was correlated with MAP within the normal range (70-105 mm Hg) ( r =0.178, P =0.011), while there was no significant correlation when MAP exceeded the normal range ( P =0.415). After adjustment for age and sex, the binary logistic regression model showed that AST level was positively associated with hypertension in the population with NAFLD (odds ratio [ OR ]=1.011, 95% confidence interval [ CI ]: 1.000-1.022, P =0.040), and after further adjustment for BMI and FBG, the results showed that AST level was still positively associated with hypertension ( OR =1.011, 95% CI : 1.000-1.022, P =0.044). Conclusion In Chinese Han population with NAFLD in Shandong coastal regions, higher levels of AST may predict an increased risk of hypertension.

Status research of village doctors′ vulnerability in Shandong province based on the set pair analysis / 中华医院管理杂志

Objective@#To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.@*Methods@#A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.@*Results@#The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.@*Conclusions@#In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.

Formation mechanism of the weakening of village clinic′ s medical service capacity in Shandong province / 中华医院管理杂志

Objective@#To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.@*Methods@#Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.@*Results@#29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.@*Conclusions@#The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.