Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city.

BACKGROUND: Although countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care. METHODS: The dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care. RESULTS: We demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual's risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts. CONCLUSION: This study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.

Association between cognitive function and dusty weather: a propensity score matching study.

BACKGROUND: With a rapidly aging global population, the health of older adults is a national priority for countries across the world. Dusty weather has been demonstrated to be a potential risk factor of cognitive function among the elderly population. However, there is a paucity of studies exploring the associations between dusty weather and cognitive function among the older in China. METHODS: Data on individual characteristics were obtained from the China Health and Retirement Longitudinal Survey (CHARLS) 2018, whereas data on air pollution were sourced from environmental monitoring stations in China. Cognitive function, including general cognitive function, episodic memory, and linguistic competence, was assessed by self- or informant-questionnaires. We used propensity score matching and linear regression to investigate the relationship between dusty weather and cognitive function. Sensitivity analyses were conducted to test the robustness of the results. RESULTS: This study included 8,604 participants older than 60 years old. After controlling air pollutant weather, dusty weather was demonstrated to be positively associated with a decline in cognitive function (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), 4.0, 95% confidence interval (CI): 3.11, 4.89; Mini-Mental State Exam (MMSE), 0.63, 95% CI: 0.34, 0.92). Results of sensitivity analysis showed that our research findings are robust. CONCLUSION: Older adults living in dusty weather regions suffered a higher level of cognitive impairment, and such adverse effects were more substantial among females compared with their male counterparts. Targeted health interventions to help older adults living in regions where dusty weather occurs frequently are suggested to be proposed.

The relationship of income on stroke incidence in Finland and China.

BACKGROUND: Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China. METHODS: Changde Social Health Insurance Database (N=571 843) and Finnish population register (N=4 046 205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence. RESULTS: The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576-0.696] and HR 0.572 (95% CI 0.540-0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276-0.739) and HR 0.633 (95% CI 0.406-0.708) for China. CONCLUSIONS: Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.

Is atypical monkeypox a sexually transmitted disease? / 中国热带医学

@# Atypical monkeypox broke out in many non-endemic countries in 2022, and the cumulative number of cases worldwide reached 21 775 on July 11. Although most cases of atypical monkeypox outbreaks were related to sexual behavior, there was no clear consensus on whether monkeypox is a sexually transmitted disease, and the current guidelines issued in China for the diagnosis and treatment of monkeypox do not yet rule out monkeypox as a sexually transmitted disease. This review analyzed the evidence supporting atypical monkeypox as a sexually transmitted disease and other possible explanations from the perspectives of monkeypox case definition/diagnostic criteria, epidemiology, clinical features, laboratory examinations, and public health prevention and control measures, aiming to provide suitable recommendations for the prevention and control of monkeypox outbreaks in China.

Analysis on clinical features of 17 death cases of imported malaria in China / 中国热带医学

@#Abstract: Objective　China was certified by World Health Organization as a malaria-free country in 2021. Malaria has become a rare infectious disease, and preventing the re-transmission of imported malaria and reducing deaths are the main challenges facing China after elimination of malaria. To analyze and clarify the characteristics of imported malaria deaths, and to provide prevention and treatment recommendations for overseas workers and health care workers. Methods　The data of 17 imported malaria deaths in the analysis of malaria deaths from 2016 to 2020 by the National Severe Malaria Treatment Expert Group were collected, and the relevant clinical epidemiological data and disease course records were analyzed. Results　The 17 malaria deaths were all imported from Africa with Plasmodium falciparum infection (malarial cerebral type), with no obvious regularity in the month of onset. Among them, 16 were male patients, 5 cases with underlying diseases such as diabetes mellitus, and 10 patients were first diagnosed in a second-level or lower hospital. Excluding patients who died of respiratory cardiac arrest in ambulances, the mean time difference between first onset and malaria diagnosis in 16 patients was 6.8 days (median 5.5 days), and the mean time between first onset and antimalarial treatment was 7.4 days (median 6 days), the mean time difference from initial onset to death was 10.3 days (median 8.5 days). Excluding cases with onset abroad and unknown time of return, all 14 patients developed the disease within 30 days after returning to China. Conclusion　All the fatal cases were infected with Plasmodium falciparum imported from Africa. The patients' awareness of actively seeking medical treatment is weak, and the delay in seeking medical treatment caused by the insufficient diagnosis and treatment capacity of health institutions at the township level and below is the main reason for the deaths. It is recommended to strengthen the self-protection awareness of staff in malaria-endemic areas overseas and raise their awareness of malaria. For returnees from areas with high malaria risk, primary medical institutions should pay attention to the patient's travel history in Africa, improve the awareness of malaria diagnosis, malaria diagnosis and treatment capabilities.

Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China.

BACKGROUND: The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). METHODS: A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. RESULTS: Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. CONCLUSIONS: Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Current situation and distribution equality of public health resource in China.

BACKGROUND: The public health system has been developed in China for several years while no research explores its distribution. This research aims to describe the variation and equality of public health allocation from 2013 to 2018 and explore the source of inequality. METHODS: Data in this research was obtained from the China Health Statistics Yearbook 2014 to 2019 and the China Statistical Yearbook 2019. Four indicators were chosen in describing the development and current situation of the public health system. Three of them were used to evaluate allocation equality. 31 provinces were categorized into western, middle, and eastern groups based on geographical and economic conditions. Total allocation equality, inter- and intra-difference were all measured by the Theil index. RESULTS: All indicators showed a stably upwards trend except for the number of public health institutions. The allocation gap of the public health institution per km2 was larger than that per 10,000 capita. Theil index of three indicators continually rose from 2013 to 2018 and the inequality of public health institutions allocation was the highest one. The western region had the highest Theil index in technical personnel and beds allocation. Among the three regions, the western region contributed most to inequality. CONCLUSIONS: The public health workforces and institutions are still under the requirement of the National Medical and Health Service System Plan. From 2013 to 2018, the equality of public health resources stably decreases, which is mainly contributed by the internal difference within the western region. Further research should be done to explore the possible cause of the results. Problems founded in this research should be solved by multisectoral cooperation.

Clinical characteristics and therapeutic analysis of invasive fungal infection in chronic severe hepatitis patients.

OBJECTIVE: To investigate clinical features and antifungal therapeutic effect of chronic severe hepatitis (CSH) patients with invasive fungal infection (IFI), and to improve the diagnosis and treatment. METHODS: Clinical manifestation, blood routine, imageology and mycetology characteristic, antifungal treatment perscription and therapeutic effect of 79 CSH patients with IFI were retrospectively analyzed. Antifungal therapeutic effect was compared between fluconazole and voriconazole. RESULTS: Thirteen (16.5%) patients received glucocorticoid or other immunodepressants for a relatively long time, 40 (50.6%) patients had invasive operation, and 61 (77.2 %) patients were administered 1-6 kinds of broad-spectrum antibiotics. Seventy-three patients had fever. Leucocytes and neutrophilic granulocyte increased in 96.2% of the patients. Lung (31.6%), intestinal tract (26.2%) and oral cavity (14%) infections were common. Fungus was found in 70.9% of the patients. Candida albicans (40.9%) and aspergillus (21.1%) were often seen. Halo signs and crescent signs on lung CT were relatively specific in 40% of the patients with fungal pneumonia. Voriconazole was more effective than fluconazole(71.4% vs. 39.0%, P<0.05). Twelve patients with lung aspergillus infection were administered voriconazole, 8 (66.7%) patients of whom was effective, and the other 4 (33.3%) patients died. CONCLUSION: There are high risk factors in major CSH patients with IFI. The most common clinical manifestations of CSH patients with IFI are fever, leukocytosis, lung and intestinal tract infection. Candida albicans and aspergillus infection are common. Voriconazole is more effective than fluconazole, and can increase the survival rate of CSH patients with IFI.

[Structure and regulative function of the 5' end flanking sequence of gene CCR5].

OBJECTIVE: To construct the pCAT reporter genes containing the 5'-end flanking of CC chemokine receptor 5(CCR5) gene in different sequence lengths and identify the sequence, which regulates the gene expression of CCR5 by the CAT analysis system. METHODS: The target sequences were amplified by pyrobest DNA polymerase, and were inserted into the upstream of CAT gene located in the pCAT enhancer vector by the directional clone technique respectively; the regulative sequence was identified by analyzing the CAT activities of reconstructed plasmid in Hela cells. RESULTS: The region, containing 486 bp upstreaming from exon 1, stimulated the reporter gene activity which was about 3 times that of the pCAT enhancer vector in transfected cells. CONCLUSION: There is an up-regulative element of gene transcription in the region of -1(-)-486 bp in CCR5 gene upstream.