Acupoint thread-embedding for children with tic disorders of spleen deficiency and liver hyperactivity and its effect on serum level of NSE / 中国针灸

OBJECTIVES@#To observe the clinical efficacy of acupoint thread-embedding for children with tic disorders of spleen deficiency and liver hyperactivity and its effect on serum level of neuron-specific enolase (NSE).@*METHODS@#A total of 68 children with tic disorders of spleen deficiency and liver hyperactivity were randomized into an observation group (34 cases, 1 case dropped out) and a control group (34 cases, 3 cases dropped out, 1 case was eliminated). In the observation group, acupoint thread-embedding was applied at Baihui (GV 20) and bilateral Hegu (LI 4), Taichong (LR 3), Pishu (BL 20), Ganshu (BL 18), Quchi (LI 11), Zusanli (ST 36),etc., once every 4 weeks. In the control group, tiapride hydrochloride tablet was given orally, twice a day. Both groups were treated for 12 weeks. Before and after treatment, the Yale global tic severity scale (YGTSS) score and serum level of NSE were observed in the two groups, and the clinical efficacy was evaluated.@*RESULTS@#After treatment, except for vocal tic score of YGTSS in the control group, the each-item scores and total scores of YGTSS and serum levels of NSE in the two groups were decreased compared with those before treatment (P<0.05); the each-item scores and total score of YGTSS and serum level of NSE in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 87.9% (29/33), which was higher than 76.7% (23/30) in the control group (P<0.05).@*CONCLUSIONS@#Acupoint thread-embedding has a good effect in the treatment of children with tic disorders of spleen deficiency and liver hyperactivity, could reduce the YGTSS score and serum level of NSE.

Discussion on Pathogenesis of Major Depressive Disorder from Correlation of "Brain-Heart-Triple Energizer" / 中国实验方剂学杂志

Major depressive disorder （MDD） is an affective disorder characterized by significant and long-lasting depression， hypoactivity， and thinking and cognitive retardation. Some patients may conduct self-hram or suicide and have delusion， hallucination， and other mental symptoms. MDD is believed to be correlated with brain and heart， but there is no complete theory or mechanism fully explaining the pathogenesis of MDD. Traditional Chinese medicine （TCM） holds that the brain and heart dominate the formation of and change in mind， and MDD falls into the category of mental disease. It is mainly diagnosed as depression， visceral agitation， or Lily disease. Triple energizer is a key zang-fu organ that governs Qi transformation. There has always been some controversy about its anatomical structure. In recent years， important progress has been made in the research on the substantive structure of triple energizer. It is found that the structure and function of triple energizer are highly consistent to those of "mesenchyme"， a fluid space supported by a complex network of collagen fibers and widely distributed throughout the body. Different from known tissues and organs， it is a large organ responsible for information communication， material exchange， and energy metabolism. The triple energizer is partially contained in the structure of brain and heart and connects with the brain and heart， thus forming a "brain-heart-triple energizer" system with close physiological and pathological connections. With the association of "brain-heart-triple energizer" as the basis and Qi transformation as the core link， this paper elucidated the pathogenesis of MD and put forward that MDD resulted from "brain and heart Yang deficiency and Qi depression due to triple energizer obstruction"， so as to improve TCM understanding of the pathogenesis of MDD and perfect the TCM theories of encephalopathy and triple energizer.

Therapeutic effect of acupuncture on dysphagia in children with severe hand foot and mouth disease / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture combined with conventional symptomatic and supportive treatments on swallowing function and nutritional status in children with severe hand foot and mouth disease complicated with dysphagia.@*METHODS@#A total of 68 children with severe hand foot and mouth disease complicated with dysphagia were randomized into an observation group and a control group, 34 cases in each one. Symptomatic and supportive treatments such as lowering temperature, tranquilizing and mechanical ventilation were adopted in the control group. On the basis of the treatments in the control group, acupuncture was applied at Lianquan (CV 23), Jialianquan (Extra), cervical Jiaji (EX-B 2), Fengfu (GV 16), Fengchi (GB 20), Yamen (GV 15), scalp motor and sensory areas in the observation group, once a day, 6 times a week, one month as a course and totally 3 courses were required. Time spent on restoring swallowing function was observed in both groups. Besides, score of dysphagia disorder survey (DDS) and nutritional status were evaluated before and after treatment, and the clinical effects were compared.@*RESULTS@#The total effective rate was 91.2% (31/34) in the observation group, which was superior to 73.5% (25/34) in the control group (<0.05). The time of restoring swallowing function in the observation group was advanced than the control group (<0.05). Compared before treatment, the DDS scores after treatment were decreased in both groups, and the reduction in the observation group was larger than the control group (all <0.05). After the treatment, the normal rate of nutritional status was 61.8% (21/34) in the observation group, which was superior to 32.4% (11/34) in the control group (<0.05).@*CONCLUSION@#On the basis of conventional treatment, acupuncture can effectively treat the severe hand foot and mouth disease complicated with dysphagia, improve the swallowing function and nutritional status.

[Reform steps of reestablishing disease prevention and control system of China].

OBJECTIVE: To develop and demonstrate the reform steps of reestablishing disease prevention and control system of China. METHODS: A model named "strategies of fulfilling public functions of disease prevention and control system of China" has been employed to develop reform steps. 154 centers for disease prevention and control (CDC) have been sampled to consult the opinions about the reform steps developed by research team. RESULTS: To reestablish the disease prevention and control system of China, the following reform steps should be kept to: (1) increase government's attention to disease prevention and control, (2) insure feasible government investment to disease prevention and control, (3) increase the stability and efficiency of government financing, (4) reform management system to enhance the operation efficiency of the CDC, (5) revise labor regulation to attract and stabilize specialists, (6) be carefully to dispose the non-public-service now delivered by the CDC. The consent percent of all sampling CDC was 98.7%.

[A study on the cause of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To demonstrate the cause of public health service delivery insufficiency of disease prevention and control system of China. METHODS: 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various causes of public health service delivery insufficiency of disease prevention and control system of China. RESULTS: Literatures review demonstrated that the financing from government to disease prevention and control system of China was insufficiency and show lower efficiency, which has been agreed by 99.3% of CDC. Literatures review demonstrated that the financing administration idea of permitting charging service caused the fee-for-service played a key role in the economic reimbursement of various levels of CDC, which has been agreed by 96.0% of CDC. CONCLUSION: The causes of public health service delivery insufficiency of disease prevention and control system of China were the government financing insufficiency and the defective administration strategies.

[Fundamental strategies to address the problem of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To develop and demonstrate the strategies to solve the problem of public health service delivery insufficiency of disease prevention and control system of China. METHODS: 205 literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various reform strategies. Based on the causes and mechanism of public health service delivery insufficiency of disease prevention and control system, the logic analysis has been employed to develop fundamental strategies, which has been demonstrated by 154 CDC using intention questionnaires. RESULTS: There are fundamental strategies to which the agreeing rate for sampling CDC was over 95%: to make sure government should afford the financing function of disease prevention and control and secure the feasible investment for centers of disease prevention and control. Meanwhile, the working efficiency of CDC should be improved through strengthening management and reforming government investing manner.

[Results summarize of the project of "reestablishing disease prevention and control system of China"].

This paper introduced the following study results of the project of "reestablishing the disease control and prevention system of China" in brief: (1) the chief problem existed in disease control and prevention system of China is the lower fulfilling level of public functions. (2) the parents of this chief problem are the lower financing level and the lower managing responsibility of government. (3) to reestablish the disease control and prevention system of China, government should increase the investment and strengthen management, which may need the following preconditions: more government recognitions to the disease control and prevention, more government investment, more sustainable government investment, higher efficiency of CDC, more competitive salary system to recruit specialists, more reliable disposal about non-public-product provided by CDC. (4) the public functions of CDC could be defined as 7 categories and 255 items. (5) according to the calculating method of human resources allocation of CDC which has been developed and demonstrated by the project team, 159086 persons, which is equal to 76.9% of human resources of CDC in 2002, are needed to fulfill all the public function of CDC throughout the country. (6) based on the model of input-output analysis, to exclude the non-public-service of CDC, government should give another yen 10.29 billions on the basis of current 3.9 billions of government investment to CDC.

[The problem of public health service delivery insufficiency of disease prevention and control system of China].

OBJECTIVE: To demonstrate the chief problem existed in the disease control and prevention system of China. METHODS: Literatures in 8 national academic journals concerning health service management have been reviewed. The method of boundary analysis has been employed to conclude the various problems existed in the disease prevention and control system of China. RESULTS: 205 literatures have been carefully reviewed and 12 kinds of problems have been concluded. Furthermore, 98.0% investigated CDC agreed that the insufficiency of public health service delivery was the chief problem existed in the disease prevention and control system of China. CONCLUSION: Some powerful policies should be developed to increase the public health service delivery of the disease prevention and control system of China.

[A study on the sero-epidemiology of hepatitis B in Chinese population aged over 3-years old].

OBJECTIVE: To better understand and measure the impact from immunization activities over the last 10-years, we conducted a sero-epidemiological study using the remaining blood samples of a nationwide survey on Nutrition and Health in Chinese residents, in 2002. METHODS: HBsAg, anti-HBs and anti-HBc in blood samples were tested using enzyme-linked immunosorbent assay(ELISA) reagents and revised by solid phase radioimmunoassay and Abbott ELISA reagents. RESULTS: Among population older than 3 years, the prevalence rates of HBsAg, anti-HBs and hepatitis B virus(HBV) infection were 9.09%, 37.48% and 50.04% but for children between 3 and 12 year olds, they were 5.03%, 45.33% and 29.10% respectively. Among population older than 3 years, the rates of HBsAg and HBV infection in urban area were 4.61% and 43.51%, but the rates in rural area were 9.41% and 56.77% respectively while for children from 3-years to 12-years old, they rates were 2.10%, 20.45% in urban area and 8.25%, 39.22% in rural areas, respectively. CONCLUSION: Results revealed that since the hepatitis B vaccine was introduced into the expanded program on immunization(EPI) from 1992, the prevalence rates of HBsAg and HBV infection, especially in the children from 3 to 12 years of age, had obviously declined, suggesting that some changes had happened in the epidemic characters of hepatitis B in China.

[Study on the cost of expanded programme on immunization in areas with different economic levels].

OBJECTIVE: The expanded programme on immunization (EPI) is an important part of the social commonwealth projects providing health care service by the government, which benefits communities. Government has the responsibility for EPI's financing which should be covered by the national budget. It is essential that the cost of EPI service be scientifically estimated to provide propriety information for policy makers. METHODS: This study, using the cost accounting theory of health economics, to calculate EPI service cost at different levels. 3 provinces, 3 prefectures, 9 counties, 18 towns and 12 villages were selected from three provinces Guizhou, Heilongjiang and Zhejiang from the western, central and eastern regions of the country. RESULTS: The average costs for one EPI-targeted child in Guizhou, Heilongjiang and Zhejiang, were 15.68 Yuan, 29.00 Yuan and 31.09 Yuan, and the costs for one dose were 10.99 Yuan, 18.64 Yuan and 16.51 Yuan, respectively. The costs for complete immunization program for one child were 131.88 Yuan, 242.32 Yuan and 280.67 Yuan, respectively. The main factors affecting the cost would include the average personnel cost (salary and benefit cost) by different economic levels of areas, the number of EPI items developed, and the number of total doses for one child. CONCLUSION: (1) Obvious differences were found between different areas. (2) The proportion of the cost was not reasonably set because of the shortage of input. (3) Guideline for different areas to compensate the working item cost according to the number of the items should be formulated.