Health systems efficiency in China and ASEAN, 2015-2020: a DEA-Tobit and SFA analysis application.

OBJECTIVE: To evaluate the health systems efficiency in China and Association of Southeast Asian Nations (ASEAN) countries from 2015 to 2020. DESIGN: Health efficiency analysis using data envelopment analysis (DEA) and stochastic frontier approach analysis. SETTING: Health systems in China and ASEAN countries. METHODS: DEA-Malmquist model and SFA model were used to analyse the health system efficiency among China and ASEAN countries, and the Tobit regression model was employed to analyse the factors affecting the efficiency of health system among these countries. RESULTS: In 2020, the average technical efficiency, pure technical efficiency and scale efficiency of China and 10 ASEAN countries' health systems were 0.700, 1 and 0.701, respectively. The average total factor productivity (TFP) index of the health systems in 11 countries from 2015 to 2020 was 0.962, with a decrease of 1.4%, among which the average technical efficiency index was 1.016, and the average technical progress efficiency index was 0.947. In the past 6 years, the TFP index of the health system in Malaysia was higher than 1, while the TFP index of other countries was lower than 1. The cost efficiency among China and ASEAN countries was relatively high and stable. The per capita gross domestic product (current US$) and the urban population have significant effects on the efficiency of health systems. CONCLUSIONS: Health systems inefficiency is existing in China and the majority ASEAN countries. However, the lower/middle-income countries outperformed high-income countries. Technical efficiency is the key to improve the TFP of health systems. It is suggested that China and ASEAN countries should enhance scale efficiency, accelerate technological progress and strengthen regional health cooperation according to their respective situations.

Analyzing the efficiency of Chinese primary healthcare institutions using the Malmquist-DEA approach: Evidence from urban and rural areas.

Background: China has been increasing the investment in Primary Health Care Institutions (PHCIs) since the launch of the New Health Care System Reform in 2009. It is a crucial concern whether the PHCIs can meet residents' need both in urban and rural with the limited government finance, especially encountering the challenge of the COVID-19. This study aimed to reveal the trend of the primary health service efficiency in the past decade, compare the urban-rural differences, and explore relevant factors. Methods: DEA and Malmquist models were applied to calculate the health service efficiency of PHCIs among 28 provinces in China, with the input variables including the number of institutions, number of beds, number of health technicians, and the outputs variables including the number of outpatients and emergency visits, number of discharged patients. And the Tobit model was used to analyze the factors on the efficiency in urban and rural. A sensitivity analysis for model validations was also carried out. Results: The average technical efficiency (TE) of urban PHCIs fluctuated from 63.3% to 67.1%, which was lower than that in rural (75.8-82.2%) from 2009 to 2019. In terms of dynamic efficiency, the urban PHCIs performed better than the rural, and the trends in the total factor productivity change were associated with favorable technology advancement. The population density and dependency ratio were the key factors on TE in both of the urban and rural PHCIs, and these two factors were positively correlated to TE. In terms of TE, it was negatively correlated with the proportion of total health expenditure as a percentage of GDP in urban PHCIs, while in rural it was positively correlated with the urbanization rate and negatively correlated with GDP per capita. Besides, the tests of Mann-Whitney U, and Kruskal-Wallis H indicated the internal validity and robustness of the chosen DEA and Malmquist models. Conclusions: It needs to reduce the health resource wastes and increase service provision in urban PHCIs. Meanwhile, it is necessary to strengthen medical technology and gaining greater efficiency in rural PHCIs by technology renovation.

Corner Detection Based Automatic Segmentation of Bioresorbable Vascular Scaffold Struts in IVOCT Images.

Bioresorbable Vascular scaffold (BVS) is a promising type of stent in percutaneous coronary intervention. Struts apposition assessment is important to ensure the safety of implanted BVS. Currently, BVS struts apposition analysis in IVOCT images still depends on manual delineation of struts, which is labor intensive and time consuming. Automatic struts segmentation is highly desired to simplify and speed up quantitative analysis. However, it is difficult to segment struts accurately based on the contour, due to the influence of fractures inside strut and blood artifacts around strut. In this paper, a novel framework of automatic struts segmentation based on four corners is introduced, in which priori knowledge is utilized that struts have obvious feature of box-shape. Firstly, a cascaded AdaBoost classifier based on enriched haar-like features is trained to detect struts corners. Then, segmentation result can be obtained based on the four detected corners of each strut. Tested on five pullbacks consisting of 483 images with strut, our novel method achieved an average Dice's coefficient of 0.82 for strut segmentation areas. It concludes that our method can segment struts accurately and robustly. Furthermore, automatic struts malapposition analysis in clinical practice is feasible based on the segmentation results.

Automatic analysis of bioresorbable vascular scaffolds in intravascular optical coherence tomography images.

The bioresorbable vascular scaffold (BVS) is a new generation of bioresorbable scaffold (BRS) for the treatment of coronary artery disease. A potential challenge of BVS is malapposition, which may possibly lead to late stent thrombosis. It is therefore important to conduct malapposition analysis right after stenting. Since an intravascular optical coherence tomography (IVOCT) image sequence contains thousands of BVS struts, manual analysis is labor intensive and time consuming. Computer-based automatic analysis is an alternative, but faces some difficulties due to the interference of blood artifacts and the uncertainty of the struts number, position and size. In this paper, we propose a novel framework for a struts malapposition analysis that breaks down the problem into two steps. Firstly, struts are detected by a cascade classifier trained by AdaBoost and a region of interest (ROI) is determined for each strut to completely contain it. Then, strut boundaries are segmented within ROIs through dynamic programming. Based on the segmentation result, malapposition analysis is conducted automatically. Tested on 7 pullbacks labeled by an expert, our method correctly detected 91.5% of 5821 BVS struts with 12.1% false positives. The average segmentation Dice coefficient for correctly detected struts was 0.81. The time consumption for a pullback is 15 sec on average. We conclude that our method is accurate and efficient for BVS strut detection and segmentation, and enables automatic BVS malapposition analysis in IVOCT images.

Automatic Side Branch Ostium Detection and Main Vascular Segmentation in Intravascular Optical Coherence Tomography Images.

Intravascular optical coherence tomography is the state-of-the-art imaging modality in percutaneous coronary intervention planning and evaluation, in which side branch ostium and main vascular measurements play critical roles. However, manual measurement is time consuming and labor intensive. In this paper, we propose a fully automatic method for side branch ostium detection and main vascular segmentation to make up manual deficiency. In our method, side branch ostium points are first detected and subsequently used to divide the lumen contour into side branch and main vascular regions. Based on the division, main vascular contour is then smoothly fitted for segmentation. In side branch ostium detection, our algorithm creatively converts the definition of curvature into the calculation of the signed included angles in global view, and originally applies a differential filter to highlight the feature of side branch ostium points. A total of 4618 images from 22 pullback runs were used to evaluate the performance of the presented method. The validation results of side branch detection were TPR = 82.8 $\%$, TNR = 98.7$\%$ , PPV = 86.8$\%$, NPV = 98.7$\%$. The average ostial distance error (ODE) was 0.22 mm, and the DSC of main vascular segmentation was 0.96. In conclusion, the qualitative and quantitative evaluation indicated that the presented method is effective and accurate.

Utilization of psychiatric rehabilitation services and influencing factors among people with psychotic disorders in rural communities of Guangxi, China.

OBJECTIVES: To identify the rate and predictors of utilization of rehabilitation services among people with psychotic disorders in rural communities of Guangxi. STUDY DESIGN: A cross-sectional survey was conducted among individuals with schizophrenia or other psychoses (severe mental disorder, ICD10: F20-F29), aged over 15 years, and their care-givers in Guangxi, China. Trained village doctors located individuals known to them and suspected as having schizophrenia or other psychoses within the target areas and recruited them into the study. Data on demographic characteristics, clinical symptoms and functions, treatment history, and reasons, if any, for non-utilization of mental health service were collected. Logistic regression was used to determine associated factors for utilization of mental health services. RESULTS: A total of 424 individuals experiencing psychosis (mean age 41.4 ± 13.0 years, 60.6% male) and 319 caregivers (mean age 55.3 ± 14.2 years) were interviewed. The median duration of disease was 13.4 years. 83.0% of patients had never used rehabilitation services. Greater use of rehabilitation was associated with having a non-organic disorder (OR = 11.6, 95% CI = 1.6-86.0) and living with a caregivers (OR = 3.2, 95% CI = 1.2-8.3). The top three reasons for not using rehabilitation services were lack of awareness (57.1%), lack of money (14.2%) and lack of belief in the service (12.8%). CONCLUSIONS: These findings indicate a high unmet need for psychiatric rehabilitation services among people with psychotic disorders in rural areas of Guangxi. Strategies such as outreach programme and collaborative and partnership network with the local community are needed to encourage people with psychotic disorders in rural communities to increase their utilization of rehabilitation services.

Balanced scorecard-based performance evaluation of Chinese county hospitals in underdeveloped areas.

Objective Since the Guangxi government implemented public county hospital reform in 2009, there have been no studies of county hospitals in this underdeveloped area of China. This study aimed to establish an evaluation indicator system for Guangxi county hospitals and to generate recommendations for hospital development and policymaking. Methods A performance evaluation indicator system was developed based on balanced scorecard theory. Opinions were elicited from 25 experts from administrative units, universities and hospitals and the Delphi method was used to modify the performance indicators. The indicator system and the Topsis method were used to evaluate the performance of five county hospitals randomly selected from the same batch of 2015 Guangxi reform pilots. Results There were 4 first-level indicators, 9 second-level indicators and 36 third-level indicators in the final performance evaluation indicator system that showed good consistency, validity and reliability. The performance rank of the hospitals was B > E > A > C > D. Conclusions The performance evaluation indicator system established using the balanced scorecard is practical and scientific. Analysis of the results based on this indicator system identified several factors affecting hospital performance, such as resource utilisation efficiency, medical service price, personnel structure and doctor-patient relationships.

Equity in health financing of Guangxi after China's universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013.

BACKGROUND: Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. METHODS: Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. RESULTS: The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. CONCLUSION: Our study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Automatic Lumen Segmentation in Intravascular Optical Coherence Tomography Images Using Level Set.

Automatic lumen segmentation from intravascular optical coherence tomography (IVOCT) images is an important and fundamental work for diagnosis and treatment of coronary artery disease. However, it is a very challenging task due to irregular lumen caused by unstable plaque and bifurcation vessel, guide wire shadow, and blood artifacts. To address these problems, this paper presents a novel automatic level set based segmentation algorithm which is very competent for irregular lumen challenge. Before applying the level set model, a narrow image smooth filter is proposed to reduce the effect of artifacts and prevent the leakage of level set meanwhile. Moreover, a divide-and-conquer strategy is proposed to deal with the guide wire shadow. With our proposed method, the influence of irregular lumen, guide wire shadow, and blood artifacts can be appreciably reduced. Finally, the experimental results showed that the proposed method is robust and accurate by evaluating 880 images from 5 different patients and the average DSC value was 98.1% ± 1.1%.

Two new cassane-type diterpenes from the seeds of Caesalpinia crista.

Two new cassane-type diterpenes, phangininoxys D and E (1 and 2), together with five known compounds were isolated from the seeds of Caesalpinia crista Linn. The structures of these compounds were elucidated by means of various spectroscopic analyses. All the isolated compounds were evaluated for cytotoxicity activities against HeLa, HT-29 and KB cell lines, and compound 7 showed moderate selective activities against KB cell line with an IC50 value of 17.1 µM.

Cytochrome P1B1 (CYP1B1) polymorphisms and cancer risk: a meta-analysis of 52 studies.

CYP1B1 plays a critical role in the oxidative metabolism of a variety of exogenous compounds, including carcinogenic compounds, which may be activated during metabolism. There are only a few studies that have examined the association between the two polymorphisms and cancer, and that these studies have been inconclusive. Hence, the aim of the present meta-analysis was to evaluate the relationship between polymorphisms in CYP1B1 G119T and A453G and cancer risk. We performed a detailed search using the PubMed and EMBASE libraries to obtain all relevant published reports on the relationship between the G119T and A453G polymorphisms in CYP1B1 and cancer risk. Combined odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by Stata version 11.2. We conducted stratified analyses based on cancer types, ethnicity, source of controls, and quality assessments. We also made assessments of heterogeneity tests, sensitivity analyses, and publication bias. There were a total of 25 articles with 15,376 cases and 18,382 controls concerning CYP1B1 G119T and 40 articles with 27,983 cases and 35,839 controls concerning A453G polymorphisms. Regarding G119T, the combined results indicate that the variant genotypes were significantly associated with a slightly increased cancer risk in comparison to the homozygote (TT versus GG: p=0.006, OR=1.231, 95% CI: 1.061-1.428), especially for breast cancer and prostate cancer. Moreover, significantly increased associations with cancer risk were demonstrated in Asians in all genetic models. The combined results indicated no association of A453G with cancer risk; however, an association was observed specifically for prostate cancer. This meta-analysis suggests that the CYP1B1 G119T polymorphism may confer to genetic susceptibility to cancer in Asians, especially to breast cancer and prostate cancer. The A453G polymorphism was found to modify the risk of prostate cancer.

N-butanol fraction of Entada phaseoloides ethanol extract inhibits hepatocellular carcinoma HepG2 cell proliferation by inducing apoptosis.

PURPOSE: To screen for substances with inhibitory effects on the proliferation of hepatocellular carcinoma (HCC) HepG2 cell line from extracts of traditional Chinese medicinal plants including Heliciopsis lobata (Merr.) Sleum, Bidens pilosa, Entada phaseoloides, Plantago major, and Smilax, and unveil their mechanism of action. METHODS: 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay was used to assess the inhibition of HepG2 cell proliferation by plant extracts. Cell apoptosis was evaluated by Hoechst 33342 staining and mitochondrial transmembrane potential (ΔCgr;m) dissipation was measured using JC-1 probe by fluorescence microscopy. RESULTS: Heliciopsis lobata, Bidens, Plantago, and Smilax extracts showed reduced inhibitory effects on HepG2 cell proliferation compared with Entada phaseoloides (all p<0.05). The n-butanol fraction of Entada phaseoloides ethanol extract exhibited the highest inhibition rate. Treatment of HepG2 cells with 500, 250, and 100 µg/ml n-butanol extract resulted in 89.92±0.58%, IC50 81.66±0.42%, 68.85±0.57% decrease in cell viability, respectively, indicating an IC50 of 9.27 µg/ml. In the presence of 100 µg/ml entada phaseoloides n-butanol extract for 24h, apoptotic nuclei and hyperchromatic, dense fluorescent massive granules were observed in the cytoplasm, effects that increased with extract concentrations in HepG2 cells. Finally, we showed that Entada phaseoloides n-butanol extract induced depolarization of mitochondrial membrane potential. CONCLUSIONS: Entada phaseoloides n-butanol extract inhibits HepG2 cell proliferation by inducing cell apoptosis likely through mitochondrial apoptotic pathway. This extract is therefore a potential natural source towards the discovery for a new drug-candidate for the treatment of HCC.

Voltammetric determination of TBHQ at a glassy carbon electrode surface activated by in situ chemical oxidation.

In this article, a bare glassy carbon electrode (GCE) surface was directly activated by a simple in situ chemical method, which was characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and cyclic voltammetry (CV), differential pulse voltammetry (DPV) and electrochemical impedance spectroscopy (EIS). Based on these results, it was found that oxygen-containing functional groups at the modified GCE surface were enhanced with a low damage to the surface state. Hence, the modified GCE exhibited an excellent performance, such as the negatively charged surface, good reproducibility and high selectivity. The resulting electrode was applied as a sensitive sensor for detection of antioxidant tertiary butyl hydroquinone (TBHQ), and a good linear relationship was obtained between the oxidation peak current and the concentration in a broad range of 1.0 µM-1.1 mM, with detection limits of 67 nM (S/N = 3) by DPV. Electrochemical parameters of TBHQ on the resulting GCE were also investigated, suggesting that the modified GCE could promote electron transfer kinetics towards the electrochemical reaction of TBHQ. Besides, the present method was used for determination of TBHQ in jatropha biodiesel with recovery ranging from 95.2% to 103.2%.

Adaptive shape prior constrained level sets for bladder MR image segmentation.

Three-dimensional bladder wall segmentation for thickness measuring can be very useful for bladder magnetic resonance (MR) image analysis, since thickening of the bladder wall can indicate abnormality. However, it is a challenging task due to the artifacts inside bladder lumen, weak boundaries in the apex and base areas, and complicated outside intensity distributions. To deal with these difficulties, in this paper, an adaptive shape prior constrained directional level set model is proposed to segment the inner and outer boundaries of the bladder wall. In addition, a coupled directional level set model is presented to refine the segmentation by exploiting the prior knowledge of region information and minimum thickness. With our proposed method, the influence of the artifacts in the bladder lumen and the complicated outside tissues surrounding the bladder can be appreciably reduced. Furthermore, the leakage on the weak boundaries can be avoided. Compared with other related methods, better results were obtained on 11 patients' 3-D bladder MR images by using the proposed method.