Comparative analysis of clinical features between giant cell arteritis and polymyalgia rheumatica / 中华风湿病学杂志

Objective:To identify the differences in clinical manifestations between Chinese giant cell arteritis (GCA) patients and polymyalgia rheumatica (PMR) patients.Methods:Twelve GCA patients were included during September 2010 to September 2019 in our hospital. Clinical and laboratory data were collected. Twenty-four age and sex-matched pure PMR patients were selected as control. Statistical analysis was performed using Statistical product and service solutions (SPSS) software. The categorical variables were tested by chi square test, and the continuous variables were expressed by mean and standard deviation ( ± s). The comparison between groups was conducted by t-test. P<0.05 was considered statistically significant. Results:In these 12 GCA patients, the onset age was 55-70 (67±7) years old, and male to female ratio was 1∶11. The most common initial symptom of GCA was the same as PMR (7/12, 58%) . Compared with PMR patients, the specific clinical manifestations of GCA patients were scalp pain ( P=0.031), mandibular claudication ( P=0.031) and migraine ( P=0.000). The creatine kinase of GCA (60±27) U/L patients was higher than that in PMR (41±15) patients ( t=1.098, P=0.029). There was no significant difference in other laboratory tests including erythrocyte sedimentation rate, C reactive protein level. Seven of 12 GCA patients were first diagnosed with PMR, then were diagnosed with GCA during follow-up. No obvious differences could be found in clinical manifestations between these 7 patients and 24 pure PMR patients. Through imaging examinations, we found that 9 of the 12 GCA patients had arterial stenosis, 5 had thickened vascular walls, 5 had atherosclerosis, and 2 had rough endometrium. Conclusion:GCA patients and PMR may have similar clinical presentations. The presence of scalp pain, mandibular claudication and migraine during the course of the disease implies that GCA is more likely. Vascular ultrasound, arterial CTA, and positron emission tomograph (PET)/CT play an increasingly important role in the diagnosis of GCA.

Equity of outpatient service utilization for hypertensive patients in community / 中南大学学报(医学版)

To analyze the equity of outpatient service utilization for hypertensive patients (HPs) under 3 kinds of social medical insurance, and to explore its influential factors.
 Methods: A total of 8 670 HPs (aged at 15 years old from 28 sub-centers) in 14 provinces were selected. Indirectly standardized method and concentration index were used to analyze the equity of outpatient utilization in HPs, and decomposition analysis was used to explore the impact factors of outpatient treatment among the whole sample population, population with urban employees' basic medical insurance (UEBMI), and population with urban residents' basic medical insurance (URBMI) and new rural cooperative medical systems (NCMS).
 Results: The overall concentration index (CI) for the whole sample population was 0.2378. After the standardizing "need" variable, horizontal inequity (HI) was 0.2360, indicating that the outpatient service of HPs was inequity and that the higher economic level, the more outpatient services received. The decomposition of overall CI results showed that the positive factors for contribution were gross domestic product (GDP) level, retired, UEBMI and URBMI, and the negative factors for contribution were NCMS. The CI of UEBMI, URBMI and NCMS was 0.2017, 0.1208 and 0.0288, respectively; the HI was 0.1889, 0.1215 and 0.0219, respectively. The inequity in UEBMI is the most serious, followed by NRCMS and URBMI. The economic level was the main factor that caused inequity in the outpatient services utilization in three social medical insurance. In addition to the economic level, a common positive factor for the contribution to UEBMI and URBMI was district of residence, and the age was the positive factor to UEBMI as well.
 Conclusion: There are different levels of inequity in the HPs covered by 3 kinds of social medical insurance, and the inequity of UEBMI is the highest one among 3 kinds social medical insurance. The economic level is the main factor that affects the equity of outpatient in the HPs under 3 kinds of social medical insurance.

Clinical characteristics in juvenile gout patients / 中华全科医师杂志

To analyze the clinical characteristics of juvenile gout,101 gout patients in Affiliasted First Hospital of Wanan Medical College from 2016 January to Decemder were divided into juvenile group (≤ 20 years,n=41) and adult group (＞20 years,n=60),the clinical data and related biochemical tests were collected.The body mass index (BMI),fasting blood glucose (FBG),TC,TG,uric acid,urea nitrogen,creatinine,cystatin C,glomerular filtration rate (GFR) and C-reactive protein (CRP),the first gout position,the duration of disease,the family history,the number of involved joints and the tophi were compared between two groups.Compared with the adult group,the juvenile group had significantly higher BMI [(25.6± 1.3) vs.(22.8± 1.0),t=-12.51)],TC [(5.55±0.51) vs.(5.07±0.54),t=-4.44),TG [(2.04±0.32) vs.(1.83±0.39),t=-2.92),uric acid[606.0 (541.0,641.0) vs.502.5 (447.5,542.2),Z=-5.65land C-reactive protein[68.0(57.0,83.5) vs.46.0 (36.0,59.8),Z=-4.64],while lower FBG [(4.83±0.68) vs.(5.74± 1.23),t=4.31)] and the number of involved joints[1(1,1) vs.2(1,4),Z=5.45].The GFR was higher in the juvenile group [(140.4± 31.0) vs.(77.7±22.5),t=-ll.81,P＜0.001)],while the urea nitrogen [6.3 (5.8,6.9) vs.7.6 (6.8,8.4),Z=5.89],creatinine [65.1 (56.2,75.1) vs.87.4 (78.5,98.4),Z=7.18] and cystatin C[1.0(0.9,1.1) vs.1.9(1.5,2.0),Z=7.66]were lower than those in adult group(all P＜0.01).The incidence of the first metatarsophalangeal joint involvement and the ankle joint involvement had no statistical difference between two groups (x2=3.434,P＞0.05).The proportion of family history of gout was higher in juvenile group (x2=6.174,P＜0.05)but the proportion of tophi was lower (x2=16.564,P＜0.01) than those in adult group.The characteristics of juvenile gout are significantly different with those of adult gout patients,so the juvenile patients should be managed differently from the adult patients.

Basic Logic Framework and Key Elements of Health Sector Governance / 中国卫生经济

It systematically analyzed the basic framework and key elements of health sector governance,such as,accountability,transparency,participation,integrity and capacity of policy,based on the method of systematic literature review and related theory and practice of governance.It systematically expounded the concepts of each element,the associated policy and managed tools,as well as the authority-responsibility relationship of pluralistic subjects in the governance framework.These five key elements were mutually reinforcing,not only to build the basic framework of the health sector governance,also to determine its policy decision-making pattern,which aimed to identify actual or potential governance problems.Through forming an inclusive and mutually reinforcing governance framework,the coordination among the conflicting or different stakeholders was encouraged by the mode and mechanism which embodied their governing bodies' values.The cooperation and sustainable development way formed to improve the supply of the medical and health services,and the use efficiency of resources.

Effects of Chinese medicine portions of Weibimei on cell cycle regulation and tumor inhibition in nude mice / 中国生化药物杂志

Objective To study the effects of Weibimei and its Chinese medicine portions(cortex frangulae, fennel powder, acorus tatarinowii, glycyrrhizae and asparagus) on cell cycle regulation in gastric cancer cells and growth inhibition in gastric cancer Xenografts.Methods Gastric cancer SGC-7901 cells were normally cultured and treated with Weibimei, extractum glycyrrhizae, cortex frangulae, fennel powder, acorus tatarinowii and asparagus.Then, the proliferation of SGC-7901 cells were detected by MTT assay, their effect on SGC-7901 cell cycle were measured by flow cytometry, and the expression of cell cycle related proteins were examined by Western blot.Animal models of SGC-7901 cells xenografts in nude mice were constructed to evaluate the growth inhibition effects of Weibimei and its Chinese medicine portions, and the expression of STAT3,p-STAT3, Cyclin D1, Bcl-2 and Survivin in gastric tumors were detected by immunohistochemical assays.Results Weibimei and its three kinds of Chinese medicine portions, cortex frangulae, fennel and acorus tatarinowii could obviously inhibit the proliferation of SGC-7901 cells, compared to control group, with a statistical significant difference (P<0.05).The cell cycle of SGC-7901 was arrested at G1 phase with cortex frangulae, fennel and acorus tatarinowii treatment, the expression of Cyclin A, B, D, E were decreased significantly (P<0.05).However, no significant effects was found in glycyrrhizae or asparagus group.Xenografts tumor sizes in Weibimei, cortex frangulae, fennel or acorus tatarinowi groups were much smaller than that in saline group or Triple Therapy group (three-kinds-drugs-combination for the treatment of gastric ulcer) (P<0.05).Xenografts experiments showed that the tumor growth in nude mice in Weibimei, cortex frangulae, fennel or acorus tatarinowi groups were significantly smaller than that in control group or in Triple Therapy Group (P<0.05), and phosphorylated STAT3, and STAT3 signaling targeted genes, including Bcl-2, Cyclin D1 and Survivin were all significantly down-regulated by immunostaining.Conclusion Weibimei and its Chinese medicine portions including cortex frangulae, fennel and acorus tatarinowii can could significantly inhibit the growth of SGC-7901 cells proliferation and arrested the cell cycle of G1 phase in vitro, and inhibit gastric cancer xenografts in nude mice in vivo.

Influential factors of treatment cost of antihypertensive drugs for hypertensive patient in community / 中南大学学报(医学版)

OBJECTIVE@#To explore the influential factors of treatment cost of antihypertensive drugs for hypertensive patient in community.@*METHODS@#A total of 220 community health centers (CHCs) from 15 provinces were selected across China in view of geographical location, economic level and previous cooperative experience to implement standardized blood pressure management for hypertensive patients for 1 year, based on guidelines for prevention and control for hypertension in China (2009 Community-based revision). Baseline and follow-up information for each hypertensive patient under the care of these CHCs was collected. A total of 22 683 hypertensive patients in hypertension community standardization management were enrolled in this study. We used multivariate linear regression model to analyze the influential factors of treatment cost of antihypertensive drugs.@*RESULTS@#Cultural degree, regional distribution, medical security system, the blood pressure classification, complications, and treatment options were statistically significant independent variables.@*CONCLUSION@#In hypertension community standardization management, the blood pressure of hypertensive patients should be controlled in advance to reduce the economic burden, , the occurrence of complications should be reduced, and economic factors should also be considered when selecting a treatment option.

Efficiency characteristics and changes of county hospitals / 中国卫生政策研究

Objectives:To study efficiency characteristics and changes of county hospitals based on data envel-opment analysis model from 2008 to 2012 . Methods:A three-stage DEA model which can exclude the external envi-ronment variable on its efficiency is also added along with the C2 R and BC2-DEA traditional model. Results: From 2008 to 2012, the technical efficiency value was ranging between 0. 723 and 0. 681 in county hospitals, the pure technical efficiency was 0 . 785~0 . 771 and the scale efficiency value scaled between 0 . 908 and 0 . 897 . These values showed a low efficiency, but had annually improved. This reflects that the new health care reform policies have played an important role in improving county hospitals efficiency. Development of medical service ability is behind the development of hospital scale. How to improve the service and management capabilities has gradually become a major direction to improve the county hospital efficiency.

Efficiency characteristics and changes in tertiary general hospitals / 中国卫生政策研究

Objective: To analyze the efficiency characteristics and trend of tertiary general public hospitals from both static and dynamic perspectives. Methods: After collecting data of personnel, equipment, assets, health services and other inputs-output indicators from 50 tertiary public hospitals from 2006 to 2012 , this paper uses C2 R-DEA and BC2-DEA models, as well as Malmquist Index model to build suitable analysis model. Results:About 10%~12% of the sample hospitals are in a relatively effective operational state, and the mean values of allocation effi-ciency and scale efficiency are 0. 956 and 0. 943, respectively, which are close to the efficient frontier. The mean values of pure technical efficiency, technical efficiency, cost efficiency and overall efficiency are 0. 796, 0. 784, 0. 714 and 0. 714, respectively, which are relatively poor compared with the efficiency frontier. Moreover, the number of hospitals that are in the state of diminishing returns to scale increased from 7 . 69% to 26 . 31%, while the number of hospitals that are in the state of increasing returns to scale decreased from 80. 77% to 58. 34%. The changes in techno-logical progress, Malmquist productivity index, technical efficiency index, pure technical efficiency index and scale effi-ciency index remained a relatively stable consistency, and showed continuous improvement and steady development trend. Conclusion:Tertiary general public hospitals are facing the transformation of driving force for development and incentive mechanisms. This needs not only to change the management concept and development mode of the hospitals, but also to build evaluation standards of optimum efficiency that are relevant to the structure, process and outcome, in order to pro-mote the transformation of hospital governance and development model that includes the functions of government.

Evidence-based Policy Study of National Heath Budget Mode in Some Countries / 中国卫生经济

From the perspective of government health budget management system, health budget decision-making and health budget reform, to make a systematic introduction of government health budget reform’s characteristics, measurement and related experiences in some countries, especially Organization for Economic Cooperation and Development(OECD) countries, so as to provide references for the improvement of government health budget management in China.

Evaluation and characteristics of government health spending in China / 中华医院管理杂志

Literature review, field survey and data analysis were called into play in this paper for systematic analysis of the basic models and performance of government health spending in China. The paper covered features and problems in China's health spendings and analyzed the growth rate and performance appraisal of such spendings. Recommendations for improved government health spendings include such six aspects as forming a consensus for building a new concept on government spendings, building a stable and sustainable health input mechanism for public finance, expanding government health financing capacity for assured health spendings, building a mechanism of balanced interests in health reform, intensifying health governance and government accountability mechanism, as well as reinforcing the supervision and assessment of government health spending.

International experiences on government health spending / 中华医院管理杂志

A review of the yearbook World Health Statistics 2009 revealed the basic features of health spending of member states of the World Health Organization. A review of the policies and experiences of government health spending of the international community points the following findings:this health spending is characteristic of social values deciding government health spending, legislature determines the stable mechanism and priority of government health spending local government shoulders main duties of government health spending, policy objectives of government health spending may be dynamic with stronger function of guidance, greater health financing sources of the government can empower government health spending, a government accountability mechanism should be built for better governance of the health system and for a better social medical assurance system.

Dynamic efficiency analysis based on the DEA-Malmquist index for township health centers in Hunan / 中华医院管理杂志

Objective To analyze the dynamic efficiency of township health centers. Methods Based on the DEA-Malmquist indices model, this paper analyzed the total factor productivity change indices of 281 township health centers in Hunan province with panel data from 2000 to 2008. These include technological change indices, efficiency change indices, pure technical efficiency change indices and scale efficiency change indices. Results A growth trend is identified with all the input/output factors in all the 281 township health centers; the sample health centers are found with a growth in the total factor productivity, efficiency and pure technical efficiency; the center health centers are found with a growth in the total factor productivity, technology, efficiency and pure technical efficiency, with greater technical improvement than efficiency; health centers at large are found with improvement in total factor productivity, efficiency and pure technical efficiency. Conclusion During the study period, sample health centers were characteristic of improved efficiency in terms of all factor productivity; central health centers characteristic of improvement in technology, while health centers at large are characteristic of improved efficiency.

Development milestones for health strategy of the United States and inspirations for China / 中华医院管理杂志

The United States is one of the pioneers in the world to introduce a heath strategy, making its practice highly significant for other countries. The paper described the four health strategies developed by the US government in succession, including the goals, focused areas and key health indicators of the strategies in different stages. In addition, it analyzed the patterns of evolution and key features of the strategy, offering references for the development and implementation of the "Health China by the Year 2020".

Introduction to the healthcare assurance system in South Korea / 中华医院管理杂志

It described the status quo of the healthcare system in South Korea, and the milestones of the country to achieve universal coverage of social medical insurance. The paper presented in focus the development from multiple social medical insurance funds to a universal social medical insurance system in South Korea, and analyzed those serious setbacks including monopolizing private medical organizations, lack of first-visit and referral system, and excessive percentage of personal payment, as a result of unparallel progress of the reform of medical insurance and that of healthcare system. Authors hope to be inspirational for the ongoing reforms in the social medical insurance system and healthcare system, in an effort to avoid likewise mistakes.

The assessment of life quality of patients with chronic hepatitis B after the treatment with lamivudine / 中国实用内科杂志

Objective To assess the life quality of patients with chronic hepatitis B after the treatment of lamivudine,to find an ideal way of medical treatment for the chronic hepatitis B.Methods The quality of life of 150 patients with chronic hepatitis B and 50 healthy controls were assessed by the quality of life questionnaire.The laboratory data and marks of questionnaires were compared before and after the using of lamivudine in order to assess its comprehensive curative effect on chronic hepatitis B.Results The marks of SF-36 of chronic hepatitis were significantly different compared with those of control group (P