中国针灸腧穴与尼泊尔传统医学生命点的对比研究

中国和尼泊尔的传统医学理论体系都有悠久的历史, 且两者的治疗手段都源自相同的哲学和理论基础。在使用自然疗法治疗疾病的过程中, 两种医疗体系均提出了人体的重要位置点的理论, 即中医的经络腧穴理论和尼泊尔传统医学中的生命点理论。初步将中国针灸腧穴以及尼泊尔传统医学中的生命点的进行对比研究, 为今后两者的结合应用提供依据。     

胰岛素诱导因子2基因rs7566605位点对中国老年人群肥胖及血脂影响

目的 探索胰岛素诱导因子2（insulin-induced gene 2，INSIG2） 基因多态性rs7566605 在中国人群中与肥胖及血脂代谢的关系。 方法 收集2009 年9 月- 2010 年6 月参加并完成北京市老年人健康调查的2 014 例样本，内容包括身体测量指标、血生化指标及环境因素并提取全部样本DNA，利用芯片技术进行基因分型。观察所有参与者基本健康情况并分析不同rs7566605 基因型与肥胖及血脂代谢异常疾病之间的关联。 结果 INSIG2 基因上游多态性rs7566605 C 位点与男性血清甘油三酯水平升高（P =0.029） 及男女合并样本的血清高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C） 降低（P =0.029） 关联存在统计学意义，并且可能增加高甘油三酯血症（P =0.019，OR=1.175） 和低高密度脂蛋白血症（P =0.020，OR=1.178） 患病风险。杂合共显性模型可能是主要遗传模式。本人群中未发现该位点与体质量指数或肥胖关联存在统计学意义。 结论 rs7566605 可能与中国老年人群与脂类代谢相关，未发现与肥胖相关联。     

Effects of Public Hospital Reform on Inpatient Expenditures in Rural China

Public hospital reform is one priority area in the healthcare system reform that China launched in 2009. The Chinese government invested over $10bn for pilot projects in public hospital reform in rural China. However, little evidence exists on their effects. Using a quasi‐natural experiment design, we evaluated the effects of a public hospital pilot project in Hubei province on inpatient spending. We obtained inpatient claims data from 1/1/2011 through 6/30/2013 for enrollees in the New Cooperative Medical Scheme in two counties: Danjiangkou, one of the pilot counties selected for reform in September 2012, and Laohekou, a similar, adjacent county serving as the control group. Using a difference‐in‐differences approach with propensity score weighting, we found that total inpatient spending increased ¥1160 (95% CI 1155–1166), out‐of‐pocket spending increased ¥385 (95% CI 382–389), length of stay increased 0.51 days (95% CI 0.50–0.52), but inpatient medication spending decreased ¥147 (95% CI 145–150), post‐policy in Danjiangkou, relative to the control group. The overall reimbursement rate increased by 5.7 percentage points. One of the goals of the recent public hospital reform is to make inpatient services affordable to patients. We found that although patients spent less on inpatient medications, total out‐of‐pocket spending increased considerably after reform. Copyright © 2016 John Wiley & Sons, Ltd.     

Depression hurts,depression costs: The medical spending attributable to depression and depressive symptoms in China

Due to its fast economic growth and lifestyle changes, China is experiencing a rapid epidemiological transition from communicable to noncommunicable diseases (NCDs). Mental disorder such as depression is an important yet often neglected NCD and is becoming a growing cause of disability, suicides, and disease burden. This paper provides the first nationally representative estimate of the medical cost attributable to depression and depressive symptoms among the adult population in China. On the basis of the 2012 China Family Panel Studies survey, our results indicate that these mental health conditions have significant impacts on the individual medical expenditure, and they jointly contribute to 14.7% of total personal expected medical spending in China, with depression and depressive symptoms accounting for 6.9% and 7.8%, respectively. Given that patients with mental illness face multiple psychological and institutional barriers in seeking appropriate treatment, the high depression‐induced medical costs may be primarily driven by the cost‐shifting effect from mental health care to general health care, as mental disorders often coexist with other NCDs such as diabetes and hypertension. As an implication, our study calls for an urgent reform of China's mental health and insurance systems to remove the policy‐induced obstacles for the access to mental health care resources.     

Liver transplantation for hepatocellular carcinoma: Recent advances in China

Orthotopic liver transplantation is currently the best treatment option for selected patients with hepatocellular carcinoma (HCC). From 1980 to 2011, 8874 patients with HCC in China underwent liver transplantation. The organ donation classification criteria of China (China criteria), which are established by the Government of China, are divided into three parts: China criteria I, donation after brain death; China criteria II, donation after cardiac death and China criteria III, donation after dual brain‐cardiac death. Data from the China Liver Transplant Registry (CLTR) System shows that patients within the Milan criteria have higher survival rates than those who are beyond these criteria. Based on CLTR data, altogether 416 patients received living‐donor liver transplantation (LDLT) in China. Their 1‐year and 3‐year survival rates were significantly higher than those of the non‐LDLT recipients. The most common early stage (<30 days after liver transplantation) complications include pleural effusion, diabetes, peritoneal effusion or abscess, postoperative infection, hypertension and intraperitoneal hemorrhage; while the most common late stage (≥30 days after liver transplantation) complications were diabetes, hypertension, biliary complications, postoperative infection, tacrolimus toxicity and chronic graft rejection. The incidence of vascular complication, which is the main reason for acute graft failure and re‐transplantation, was 2.4%. Liver transplantation is an effective treatment for patients with HCC in China.     

The presence of post‐traumatic stress disorder symptoms in earthquake survivors one month after a mudslide in southwest China

The psychological impact of a mudslide on survivors of the Wenchuan earthquake in China and the risk factors for development of disaster‐related post‐traumatic stress disorder (PTSD) were investigated. The study design was cross‐sectional and included 1321 survivors who had endured both an earthquake and a mudslide. Participants filled out a self‐report questionnaire. One month after the mudslide, the rate of PTSD symptoms was 18.7%. Females, the elderly, those with lower educational levels, those that lacked social support, those who did not take precautionary measures, those living with children below 6 years of age, and those who had higher exposure to traumatic events experienced a higher level of PTSD symptoms. Results indicated that timely rescue, abundant material help, and mental rehabilitation after a disaster play important roles in recovery, and that there are still some high‐risk groups that need attention, care, and effective intervention from healthcare professionals and society.