Aminated ß-Glucan with immunostimulating activities and collagen composite sponge for wound repair.

Immunostimulating activities of yeast ß(1 â†’ 3)-D-Glucan (ß-Glucan) mainly depended on its structures. However, due to the tight triple helix structure of ß-Glucan, its immunostimulating activity is greatly weakened. Therefore, in order to partially unwind the tight triple helix structure of ß-glucan and improve its solubility in the medium, we modified it by amination in this study (A-Glu). The results showed that A-Glu could stimulate Raw264.7 macrophages and significantly enhance its TNF-α, IL-6, and IL-10 cytokine expression levels in vitro. A-Glu could also induce a shift of M0 Raw264.7 toward M1, and M2 toward M1. To expand the application of A-Glu in wound repair, the composite sponge consisting of A-Glu and type I collagen via the formation of a stable polyion complex (PIC) was developed. Moreover, the composite sponge could accelerate wound repair significantly. These results reveal that soluble A-Glu as an immunostimulating agent has potential applications in biomedicine.

Economic crisis of rural patients insured with critical illness insurance: Do working-age patients have higher financial burden?

Working-age patients are generally found to have higher healthcare expenditure than elder. China implemented critical illness insurance (CII) in 2012 to decrease the medical expenditure of patients. The aim of this study was to determine if the economic burden of rural working-age patients with CII was more serious than other age groups. A questionnaire survey was undertaken in two counties of central and western China in 2017. Comprehensive financial measurement was used, including direct costs, indirect costs and medical debt rate. All data collected were used for descriptive statistics and multivariate variance analysis. Linear regression with random effect analysis upon area was used to evaluate the differences in ages. A total of 834 rural patients were surveyed in this study. Patients aged 18-44 years had the highest lodging and food payments (3,838 Chinese Yuan [CNY]), work loss (15,350 CNY) and medical debt rate (83.24%). Patients who were of working age, sought health services out of counties, had longer length of stay, and were diagnosed with chronic illness had higher healthcare expenditure. Rural working-age patients with CII had higher direct and indirect costs, which were attributed to medical debt. The increased service capability of hospitals in counties and improved medical financial assistance may also be issues of concern.

What contributes to medical debt? Evidence from patients in rural China.

BACKGROUND: Rural households in developing countries usually have severe medical debt due to high out-of-pocket (OOP) payments, which contributes to bankruptcy. China implemented the critical illness insurance (CII) in 2012 to decrease patients' medical expenditure. This paper aimed to explore the medical debt of rural Chinese patients and its influencing factors. METHODS: A questionnaire survey of health expenditures and medical debt was conducted in two counties of Central and Western China in 2017. Patients who received CII were used as the sample on the basis of multi-stage stratified cluster sampling. Descriptive statistics and multivariate analysis of variance were used in all data. A two-part model was used to evaluate the occurrence and extent of medical debt. RESULTS: A total of 826 rural patients with CII were surveyed. The percentages of patients incurring medical debt exceeded 50% and the median debt load was 20,000 Chinese yuan (CNY, 650 CNY = US$100). Financial assistance from kin (P < 0.001) decreased the likelihood of medical debt. High inpatient expenses (IEs, P < 0.01), CII reimbursement ratio (P < 0.001), and non-direct medical costs (P < 0.001) resulted in increased medical debt load. CONCLUSIONS: Medical debt is still one of the biggest problems in rural China. High IEs, CII reimbursement ratio, municipal or high-level hospitals were the risk determinants of medical debt load. Financial assistance from kin and household income were the protective factors. Increasing service capability of hospitals in counties could leave more patiemts in county-level and township hospitals. Improving CII with increased reimbursement rate may also be issues of concern.

The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients.

BACKGROUND: Tuberculosis (TB) is still a major public health problem in China. To scale up TB control, an innovative programme entitled the 'China-Gates Foundation Collaboration on TB Control in China was initiated in 2009. During the second phase of the project, a policy of increased reimbursement rates under the New Cooperative Medical Scheme (NCMS) was implemented. In this paper, we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data. METHODS: In two cross-sectional surveys, quantitative data were collected before (January 2010 to December 2012) and after (April 2014 to June 2015) the intervention in the existing NCMS routine data system. Information on all 313 TB inpatients, among which 117 inpatients in the project was collected. Qualitative data collection included 11 focus group discussions. Three main indicators, non-reimbursable expenses rate (NER), effective reimbursement rate (ERR), and out-of-pocket payment (OOP) as a percentage of per capita household income, were used to measure the impact of intervention by comprising post-intervention data with baseline data. The quantitative data were analysed by descriptive analysis and non-parametric tests (Mann-Whitney U test) using SPSS 22.0, and qualitative data were subjected to thematic framework analysis using Nvivo10. RESULTS: The nominal reimbursement rates for inpatient care were no less than 80% for services within the package. Total inpatient expenses greatly increased, with an average growth rate of 11.3%. For all TB inpatients, the ERR for inpatient care increased from 52 to 66%. Compared with inpatients outside the project, for inpatients covered by the new policy, the ERR was higher (78%), and OOP showed a sharper decline. In addition, their financial burden decreased significantly. CONCLUSIONS: Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy, inpatient OOP expenditure was still a major financial problem for patients. Limited diagnosis and treatment options in county general hospitals and inadequate implementation of the new policy resulted in higher inpatient expenditures and limited reimbursement. Comprehensive control models are needed to effectively decrease the financial burden on all TB patients.

The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China.

Background: Tuberculosis (TB) remains a major social and public health problem in China. The "China-Gates TB Project" started in 2012, and one of its objectives was to reduce the financial burden on TB patients and to improve access to quality TB care. The aims of this study were to determine if the project had positive impacts on improving health service utilization. Methods: The 'China-Gates TB Project' was launched in Yichang City (YC), Hubei Province in April 2014 and ended in March 2015, lasting for one year. A series of questionnaire surveys of 540 patients were conducted in three counties of YC at baseline and final evaluations. Inpatient and outpatient service utilization were assessed before and after the program, with descriptive statistics. Propensity score matching was used to evaluate the impact of the China-Gates TB Project on health service utilization by minimizing the differences in the other characteristics of baseline and final stage groups. Focus group discussions (FGDs) were held to further enrich the results. Results: A total of 530 patients were included in this study. Inpatient rates significantly increased from 33.5% to 75.9% overall (p < 0.001), with the largest increase occurring for low income patients. Outpatient visits increased from 4.6 to 5.6 (p < 0.001), and this increase was also greatest for the poorest patients. Compared with those who lived in developed counties, the overall increase in outpatient visits for illness in the remote Wufeng county was higher. Conclusions: The China-Gates TB Project has effectively improved health service utilization in YC, and poor patients benefited more from it. TB patients in remote underdeveloped counties are more likely to increase the use of outpatient services rather than inpatient services. There is a need to tilt policy towards the poor, and various measures need to be in place in order to ensure health services utilization in undeveloped areas.

Does the critical illness insurance reduce patients' financial burden and benefit the poor more: a comprehensive evaluation in rural area of China.

BACKGROUND: Critical illness insurance (CII) is one kind of health insurance that is gradually gaining attention worldwide. China implemented CII in 2012 to decrease patients' out-of-pocket (OOP) medical payments. The aims of this study were to determine if the project had positive impacts on relieving financial burden and improving health equity. METHODS: A series of questionnaire surveys were undertaken in two counties before and after the intervention in rural China. OOP expenditure, catastrophic Health Expenditure (CHE) incidence, and associated average gap (AG) were assessed across different income groups and project durations, measuring short-term direct medical cost. Medical debt rate and amount were used to measure long-term financial burden; concentration index (CI) was calculated for equity. All data were evaluated by descriptive statistics and multi-variate variance analysis. The linear regression and logit regression with random effect analysis upon area was used to evaluate the effect of CII. RESULTS: Six hundred and thirteen and 834 patients were surveyed at baseline and final evaluation. After the program, the OOP payments of hospitalizations sharply decreased from RMB 39,363.2 to RMB 28,426.1 (p < 0.001), with the largest decrease for lowest income patients (from RMB 44,507.6 to RMB 29,214.2). With longer duration of CII, more OOP medical payments decreased. The amount of medical debt was decreased by RMB 7,209.4 among all the patients, and the decrease was highest in the highest income group (RMB 8,119.9). The CI of AG changed a lot (from -0.858 to -0.670). CONCLUSION: The CII has effectively reduced the financial burden of patients with high medical cost, whether in the short-term or a longer length of time. It also improved health equity in health service utilization and expenditure. However, rich householders still receive more benefits from the policy, government health insurance financing is increased, and the policy needs to further benefit the poor.

Dual responsive zein hydrogel membrane with selective protein adsorption and sustained release property.

Drug-loaded hydrogels have been paid increasing attentions in biomedical fields. As a sort of natural plant protein, zein generally cannot form hydrogel with high water retention because of its predominant hydrophobicity, which will limit its application as biomaterial. In this paper, zein electrospun fibrous membranes (ZEFM) are fabricated through a chemical modification of zein using citric acid and acetic anhydride. The resulting ZEFM can be totally soluble in neutral phosphate buffer solution. After being crosslinked by sodium hexametaphosphate, the ZEFM can form a hydrogel membrane and displays stimuli-responsive behavior towards pH and ionic strength. The hydrogel membrane exhibits better protein adsorption, selectivity and sustained release profile for positively-charged proteins such as cytochrome C, compared with those unmodified ones, and also shows fast biodegradation behavior and qualified cytotoxicity, which all make it favourable for biomedical use.

Nanofibrous asymmetric membranes self-organized from chemically heterogeneous electrospun mats for skin tissue engineering.

Asymmetric membranes, which mimic the structure and functions of human skin, have been extensively pursued as ideal skin tissue engineering constructs. In this study, we demonstrated that nanostructured asymmetric membranes can be prepared by the self-organization of chemically heterogeneous bilayer electrospun membranes in aqueous solutions. Structurally, the skin layer consists of hydrophobic ß-glucan butyrate nanofibers and its inner layer consists of hydrophilic ß-glucan acetate nanofibers. After the electrospinning process, both of the layers are in a dense state. When placed in water, the skin layer absorbs little water and still remains dense, but the fibers in the inner layer become extensively hydrated and spontaneously reorganize into a fully stretched structure, resulting in a significant volume increase and a density decrease of the inner layer. SEM imaging showed that ß-glucan ester nanofibers exhibited a bead-free and uniform structure. Contact angle measurement and swelling tests showed that the inner layer was highly hydrophilic with extensive swelling, but the skin layer was highly hydrophobic with little swelling. Mechanical tests indicated that the nanofibrous asymmetric membranes had good mechanical properties in both the dry and wet states. In vitro cytocompatibility tests showed that nanofibrous asymmetric membranes could promote the adhesion and proliferation of fibroblasts and keratinocytes. A preliminary in vivo study performed on a full thickness mouse skin wound model demonstrated that the nanofibrous asymmetric membranes significantly accelerated the wound healing process by promoting re-epithelialization, tissue remodeling and collagen deposition. Taken together, our study provides a novel model for the design and fabrication of nanostructured asymmetric membranes, and our ß-glucan based nanofibrous asymmetric membranes could be used as an advanced platform for skin tissue engineering.