中国三明市医改下药品费用影响因素分析

目的：探讨三明市医药卫生体制改革期间药品费用变化情况,并分析药品价格、药品用量和用药结构对药品费用变化的影响,以期为今后药品费用改革决策提供视角和参考。方法：收集三明市1家医院（实验组）和福建其他地区18家医院（对照组）在2011-2016年期间的药品采购数据,采用"A.M"指数体系进行因素分析。结果：自2011年起实验组药品总费用保持平稳,年均增长率为1.4%,对照组涨速较快,年均增长率为6.4%;实验组和对照组价格因素及用量因素变化趋势一致、变化速度相近;在结构因素方面,实验组保持平稳,对照组涨速较快。结论：三明市医改明显降低了药品价格并抑制了"同类别药品高价药替代低价药"的趋势,控制结构因素是抑制药品费用上涨的有效手段。     

The economic burden of preventable adverse drug reactions: a systematic review of observational studies

Introduction: Adverse drug reactions (ADRs) are an important cause of morbidity and mortality worldwide. They are associated with healthcare costs due to hospital admissions or prolonged length of stay, as well as additional interventions. The aim of this study was to conduct a systematic review of observational studies to evaluate the economic impact of preventable ADRs.

Areas covered: Published observational research investigating the cost of preventable ADRs in Western countries (limited to the USA and European countries).

Expert opinion: Several reviews have been carried out in the field of the ADR epidemiology but fewer reviews have investigated the economic impact of ADRs, and at the time of writing, none has focused on preventable ADRs. The reason why future research should focus on the costs of preventable ADRs is that both the costs and the negative clinical outcomes are preventable, and as such, are a key point of public health policy action. Nevertheless, the present review highlights an important and sobering limitation of published research on the cost of preventable ADRs, of which the major limitation is the heterogeneity in methods and in reporting which limit what can be known through the summarizing work of a systematic review.     

The impact of NHS expenditure on health outcomes in England: Alternative approaches to identification in all‐cause and disease specific models of mortality

Several recent studies have estimated the responsiveness of mortality to English National Health Service spending. Although broadly similar, the studies differ in how they identify the outcome equation. One approach uses conventional socio‐economic variables as instruments for endogenous health care expenditure, whereas the other exploits exogenous elements in the resource allocation formula for local budgets. The former approach has usually been applied to specific disease areas (e.g., for cancer and circulatory disease), whereas the other has only been applied to all‐cause mortality. In this letter, we compare the two approaches by using them to estimate the direct all‐cause elasticity as well as disease‐specific elasticities. We also calculate the implied all‐cause elasticity associated with the disease‐specific results. We find that the “funding rule” approach to identification can be successfully replicated and applied to disease area models. This is important because disease area models reduce the danger of aggregation bias present in all‐cause analysis, and they offer the opportunity to link estimated mortality effects to more complete measures of health outcome that reflect what is currently known about the survival and morbidity disease burden in different programmes.     

肾病患者医疗花费趋势研究——基于北京市某三甲医院的分析

目的: 探究肾病患者医疗费用变化趋势及原因,为医疗改革决策提供参考依据。方法: 使用北京市某三甲医院成年肾病患者2012—2017年门诊及住院数据,利用描述性统计的方法分析患者次均花费和人均花费的时间趋势,并探究医疗花费变化的原因。结果: 肾病患者年均花费在2012—2017年间出现较快上涨。门诊和住院的花费上涨由不同原因导致,其中门诊年均花费的上升来源于患者年均就诊次数的增加,而住院年均花费的上升来源于患者次均花费的增加。住院花费上涨贡献最大的类别为药品和耗材,其中药品类费用上涨贡献最大,2017年次均12 524元,占当年平均次均总花费的32.4%;耗材类次均9 215元,占比23.9%。结论: 门诊年均花费的上升主要来源于肾病患者年均就诊次数的增加,药物类和耗材类费用的增长是导致住院医疗总费用上升的主要因素。治疗类费用以及医疗服务费在总花费中所占比例仍然较低,可能需要适当调整。     

孕期活动能量消耗与分娩进展的关系探讨

目的探讨孕期活动能量消耗与分娩进展的关系。方法自行设计问卷对140例经阴道分娩单胎产妇进行调查,记录孕期活动方式和时间、妊娠终止时间和分娩进展等。结果孕期活动能量消耗多者引产、催产及需人工破膜者少(P<0．05),第一产程宫缩强度大和时间短(P<0．01)。结论孕期进行适当活动和延长坚持工作时间有助于自然分娩进展。     

Intact brown adipose tissue thermogenesis is required for restorative sleep responses after sleep loss

Metabolic signals related to feeding and body temperature regulation have profound effects on vigilance. Brown adipose tissue (BAT) is a key effector organ in the regulation of metabolism in several species, including rats and mice. Significant amounts of active BAT are also present throughout adulthood in humans. The metabolic activity of BAT is due to the tissue‐specific presence of the uncoupling protein‐1 (UCP‐1). To test the involvement of BAT thermogenesis in sleep regulation, we investigated the effects of two sleep‐promoting stimuli in UCP‐1‐deficient mice. Sleep deprivation by gentle handling increased UCP‐1 mRNA expression in BAT and elicited rebound increases in non‐rapid‐eye‐movement sleep and rapid‐eye‐movement sleep accompanied by elevated slow‐wave activity of the electroencephalogram. The rebound sleep increases were significantly attenuated, by ~ 35–45%, in UCP‐1‐knockout (KO) mice. Wild‐type (WT) mice with capsaicin‐induced sensory denervation of the interscapular BAT pads showed similar impairments in restorative sleep responses after sleep deprivation, suggesting a role of neuronal sleep‐promoting signaling from the BAT. Exposure of WT mice to 35 °C ambient temperature for 5 days led to increased sleep and body temperature and suppressed feeding and energy expenditure. Sleep increases in the warm environment were significantly suppressed, by ~ 50%, in UCP‐1‐KO animals while their food intake and energy expenditure did not differ from those of the WTs. These results suggest that the metabolic activity of the BAT plays a role in generating a metabolic environment that is permissive for optimal sleep. Impaired BAT function may be a common underlying cause of sleep insufficiency and metabolic disorders.