医疗服务价格水平差异评价及政策启示——以四川省为例

本文构建了医院医疗服务价格水平差异指数HPDI作为量化评价工具,对四川省18家公立医院价格水平及影响因素进行评价分析。结果表明,区域内公立医院价格水平管制合理、有效,内部因素中医技和临床类项目影响显著,外部因素中等级与规模因素影响显著。建议价格主管部门更加科学化、精细化研究价格水平问题,合理把握价格调整尺度、做好价格改革方案。     

Inverted U-Shaped Associations between Glycemic Indices and Serum Uric Acid Levels in the General Chinese Population: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study

Objective The relationship between serum uric acid(SUA)levels and glycemic indices,including plasma glucose(FPG),2-hour postload glucose(2 h-PG),and glycated hemoglobin(HbA1 c),remains inconclusive.We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.Methods The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study.A total of 105,922 community-dwelling adults aged≥40 years underwent the oral glucose tolerance test and uric acid assessment.The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.Results A total of 30,941 men and 62,361 women were eligible for the current analysis.Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels,but with different inflection points in men and women.The thresholds for FPG,2 h-PG,and HbA1 c for men and women were 6.5/8.0 mmol/L,11.0/14.0 mmol/L,and 6.1/6.5,respectively(SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).Conclusion An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes,while the inflection points were reached earlier in men than in women.     

泡球蚴持续感染对小鼠肝脏纤维化的影响

目的 评价泡球蚴持续感染对小鼠肝脏纤维化的影响,为研究泡型棘球蚴病肝纤维化进展及其治疗方法提供参考.方法 以泡球蚴感染长爪沙鼠血清(25、50、100 μL)和泡球蚴及其生发层细胞、原头节分别对肝星状HSC-T6和LX-2细胞进行体外刺激48 h,采用CCK-8法检测细胞增殖,应用酶联免疫吸附试验(enzyme-lin...     

取暖固体燃料暴露及其时长对30~79岁居民呼吸系统疾病发病风险影响的前瞻性研究

目的 探讨取暖固体燃料暴露及其时长与呼吸系统疾病发病风险之间的关联。方法 利用中国慢性病前瞻性研究四川省彭州市项目点数据,采用Cox比例风险回归模型分析取暖固体燃料暴露及其时长与总呼吸系统疾病发病风险之间的关联,进一步分析其与呼吸系统疾病中慢性阻塞性肺疾病（COPD）、肺炎发病风险之间的关联。结果 共纳入46 082名30~79岁研究对象,冬季11 634名（25.25%）进行取暖,其中8 885名（19.28%）使用清洁燃料,2 749名（5.97%）使用固体燃料;34 448名（74.75%）不取暖。控制多个混杂因素后,Cox比例风险回归模型分析显示,与清洁燃料相比,不取暖降低总呼吸系统疾病（HR=0.81,95%CI：0.77~0.86）、COPD（HR=0.86,95%CI：0.78~0.95）、肺炎（HR=0.80,95%CI：0.74~0.86）的发病风险;固体燃料暴露增加总呼吸系统疾病的发病风险（HR=1.10,95%CI：1.01~1.20）,与COPD、肺炎的发病风险无统计学关联。与没有固体燃料暴露相比,随着固体燃料暴露时长增加,总呼吸系统疾病（1~19年：HR=1.23,95%CI：1.10~1.37;20~39年：HR=1.25,95%CI：1.16~1.35;≥40年：HR=1.26,95%CI：1.15~1.39）及肺炎（1~19年：HR=1.21,95%CI：1.03~1.42;20~39年：HR=1.30,95%CI：1.16~1.46;≥40年：HR=1.35,95%CI：1.18~1.54）发病风险增加（趋势检验均P<0.001）;固体燃料暴露时长1~19、20~39年使COPD的发病风险增加23%（HR=1.23,95%CI：1.02~1.49）、16%（HR=1.16,95%CI：1.00~1.35）。结论 取暖固体燃料暴露增加了总呼吸系统疾病、COPD、肺炎的发病风险。     

基于基尼系数的棘球蚴病防治卫生人力资源配置公平性分析

目的　分析四川省甘孜藏族自治州棘球蚴病防治卫生人力资源配置现状并评价其公平性,为优化棘球蚴病防治卫生人力资源配置提供实证依据。方法　2020年,采用问卷调查收集2016—2019年四川省甘孜藏族自治州2个棘球蚴病重度流行县和3个轻度流行县每1 000名常住人口、每1 000 m2面积、采用B超每筛查1 000人、每1 000例棘球蚴病患者拥有的卫生人力资源（包括卫生人员、卫生技术人员、执业/助理医师和注册护士）数量,并运用洛伦兹曲线、基尼系数对2016—2019年甘孜藏族自治州棘球蚴病防治卫生人力资源按常住人口和地理面积配置的公平性进行评价。结果 　2019年,四川省甘孜藏族自治州棘球蚴病轻度流行县每1 000名常住人口拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的0.99、1.06、1.78、1.88倍,每1 000 m2面积拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的3.38、3.67、6.00、6.00倍,采用B超每筛查1 000人拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的1.64、1.74、3.22、3.18倍,每1 000例棘球蚴病患者拥有的卫生人员、卫生技术人员、执业/助理医师和注册护士数量分别是重度流行县的64.92、70.39、139.34、117.44倍。2016—2019年,甘孜藏族自治州棘球蚴病防治卫生人力资源按常住人口计算的基尼系数为0.371 ~ 0.397、按地理面积计算的基尼系数为0.477 ~ 0.591;2019年,执业/助理医师和注册护士按常住人口和地理面积计算的基尼系数（0.469 ~ 0.730）均高于卫生人员和卫生技术人员（0.302 ~ 0.451）。结论　2016—2019年,四川省甘孜藏族自治州棘球蚴病防治卫生人力资源按常住人口配置的公平性一般、按地理面积配置的公平性较差。     

Forensic characterization and statistical considerations of the CaDNAP 13-STR panel in 1,184 domestic dogs from Germany,Austria, and Switzerland

Crime scene samples originating from domestic dogs such as hair, blood, or saliva can be probative as possible transfer evidence in human crime and in dog attack cases. In the majority of such cases canine DNA identification using short tandem repeat (STR) analysis is the method of choice, which demands, among others, a systematic survey of allele frequency data in the relevant dog populations. A set of 13 highly polymorphic canine STR markers was used to analyze samples of 1,184 dogs (including 967 purebred dogs) from the so-called DACH countries (Germany, Austria, Switzerland). This CaDNAP 13-STR panel has previously been validated for canine identification in a forensic context. Here, we present robust estimates of allele frequencies, which are essential to assess the weight of the evidence by estimating the probability of a matching DNA profile within the dog population under question, e.g. in the form of a random match probability (RMP). The geographical provenance of the tested dogs showed a negligible influence on the observed genotype variation. Therefore, we combined the STR data from all three countries into a single dog population sample (DPS). In contrast, pronounced genetic differentiation between dog breeds was found by principal component analysis and sub-structure analysis with the STRUCTURE software. These findings entailed the need to account for the effects of DPS breed composition on allele frequency estimates. A possible strategy, which was favored here, relies on collecting a DPS that is guided by the breed composition of the relevant dog population. In total, dogs from 166 different breeds were included in our DPS, 64 of them including at least 5 individuals (n = 771 dogs). Sampling reflected the abundance of breeds in the DACH countries with the following being the most common ones: German Shepherds (population frequency: 14.3%), Dachshunds (5.9%), Labrador Retrievers (3.9%), and Golden Retrievers (3.2%). The pedigree listing of the purebred dogs in our DPS ranked German Shepherds (DPS frequency 8.5%) first, followed by Labrador Retrievers (3.9%), Golden Retrievers (3%), and Dachshunds (2.5%). RMP values based on overall allele frequencies and accounting for substructure using F_ST between breeds ranged between 10-13 and 10-14 and represent a conservative approach of RMP assessment.     

Routine immunization services costs and financing in China, 2015

ObjectiveTo estimate the costs of routine immunization (RI) services in China in 2015, to provide objective data relevant to investment in the Expanded Program on Immunization, and to contribute to global data on costing and financing of RI.MethodsThe study was conducted between January and March 2016. We selected 276 villages, 138 townships, 46 counties, and 40 prefectures from 15 provinces as investigation sites at random, stratified by eastern, middle, and western regions. Direct cost items included vaccines, personnel, cold chain, surveillance, communication, training, and supervision at the national, provincial, prefecture, county, township, and village levels. We obtained financial data from governmental and external sources. Indirect costs of RI included parents’ transportation costs and productivity lost due to taking their children for vaccination.ResultsTotal direct costs were $92.42 for each child fully immunized ($4.20/dose), which equates to $1529.55 million per birth cohort. RI costs were higher in the eastern region than in the western region, and higher than that of the central region. Vaccination coverage was positively associated with direct routine immunization costs. The cost of the recommended vaccines was $19.08/child and vaccine only accounted for 20.64% of total costs. Operational cost, including surveillance, communication, training and supervision, was $217.31/child, accounting for 14.21% of total cost. The indirect cost per child was $72.86; the total indirect cost was $1205.83 million for the birth cohort. Government investment in RI accounted for about 70% of total costs. Revenue from sales of private-sector vaccine supported the remaining 30% of RI costs.ConclusionsWhile government financing has increased, some operating costs continue to be provided from revenue generated by sales of Category 2 (private-sector) vaccines to families. China could benefit from bringing new and underutilized vaccines into the EPI system based on evidence that includes routine immunization vaccine and operations costs.