采用集合RNA检测方法估计高危人群的HIV感染发病率

目的 及时发现艾滋病自愿咨询检测(VCT)人群和男男性行为人群(MSM)HIV抗体窗口期感染者,并估计发病率.方法 收集2012年1-10月云南省疾病预防控制中心VCT门诊和MSM活动室HIV抗体筛查阴性样本,以50∶1和10∶1二级集合方式进行HIV-1 RNA检测,并随访HIV-1 RNA阳性者,最后以Ron Brookmeyer方法估计VCT和MSM人群的HIV感染年发病率.结果 1400份VCT门诊HIV抗体筛查阴性样本中,发现2名HIV-1 RNA阳性窗口期感染者,HIV感染年发病率为1.87％(95％CI:1.23％-2.65％).MSM 500份HIV抗体筛查阴性样本中,发现2名HIV-1 RNA阳性窗口期感染者,HIV感染年发病率为5.31％(95％CI:3.52％ - 7.45％).结论 集合RNA检测为及时发现VCT和MSM的HIV窗口期感染者提供有效方法,建议通过提高集合RNA检测频率等方式,加强MSM及其他高危人群HIV感染窗口期的筛查.     

以市级统筹为基础提高医疗保险统筹层次的探索:以沈阳经济区的改革为例

提高统筹层次有利于提高医疗保险的公平和效率,也是深化医药卫生体制改革的发展要求。本研究以沈阳经济区的改革为例,阐述了提高医疗保险统筹层次的必要性,分析了以市级统筹为基础提高统筹层次对于解决医疗保障差异的作用,同时论证了沈阳经济区以市级统筹为基础提高统筹层次各项任务的逻辑关系,并提出了开展提高医疗保险统筹层次的政策建议。     

河南省武陟县新型农村合作医疗门诊统筹方案效果评价

目的:探索门诊统筹运行存在的问题,为新农合门诊统筹的顺利推行提供理论依据,对如何完善新型农村合作医疗补偿方案提出政策建议。方法:通过文献研究和纵向对比研究,分析河南省武陟县门诊统筹实施前后的状况。结果:武陟县自2009年实行门诊统筹制度以来,参合率和住院率有所提高(χ2=1101.010,P=0.000),门诊资金支付率和住院资金支付率提高,门诊补偿人次和人均门诊补偿人次增多(χ2=70.401,P=0.000),次均门诊费用和实际补偿比有所降低。结论:门诊统筹的实行可以增加农民参加新农合的积极性,加大对门诊和住院资金的使用,在一定程度上释放了农民的门诊需求,加大对卫生服务的利用。     

城镇职工基本医疗保险统筹基金运行情况及统筹基金住院支出影响因素的调查分析

目的 了解城镇职工基本医疗保险统筹基金的运行情况,探讨统筹基金住院支出的影响因素,提出符合我国医疗保险现状的对策.方法 以某市为例,对该市统筹基金的运行现状进行描述,并从统筹基金住院支出的角度对医疗保险统筹基金的使用现状进行分析.结果 影响统筹基金住院支出的因素为药品费、个人现金支付、当年月交费、个人账户支付、起付标准、公务员补助、年龄.结论 统筹基金住院支出的影响因素包括系统内风险因素和系统外风险因素两种.建议财政介入建立"老龄化医疗风险基金",以抵御人口老龄化给基本医疗保险基金运行带来的各种风险;控制医疗费用的快速上涨;重视社区卫生服务的建设,建立多层次的医疗保障体系.     

Serum pooling for rapid expansion of anti-SARS-CoV-2 antibody testing capacity

ObjectivesExamine possible pooling strategies designed to expand SARS-CoV-2 serological testing capacity.MethodsNegative pools were assessed to determine optimal optical density (OD) cutoffs, followed by spiking weak or strong positive samples to assess initial assay performance. Samples were then randomly subjected to pool and individual testing approaches.ResultsSingle positive specimens consistently converted pools of 5, 10, or 20 into positive outcomes. However, weaker IgG-positive samples failed to similarly convert pools of 50 to a positive result. In contrast, a stronger individual positive sample converted all pools tested into positive outcomes. Finally, examination of 150 samples configured into pools of 5, 10, 20 or 50 accurately predicted the presence of positive or negative specimens within each pool.ConclusionsThese results suggest that pooling strategies may allow expansion of serological testing capacity. While limitations exist, such strategies may aid in large-scale epidemiological screening or identification of optimal convalescent plasma donors.     

Methods for combining randomized clinical trials: strengths and limitations

Methods for combining data from several studies exist and appear to be quite useful. None satisfactorily addresses the question of what studies should be combined. This issue is the most serious methodological limitation. Even studies with statistically significant interaction might still be combined if the effect were in the same direction. Thus, substantial scientific input is required as to what criteria must be met by each potential study. Much can be learned from combining or pooling data but it must be done cautiously. Pooling exercises do not replace well designed prospective clinical trials. Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful.     

Health sector reforms in Argentina and the performance of the health financing system

In Argentina, health sector reforms put particular emphasis on decentralization and self-management of the tax-funded health sector, and the restructuring of the social health insurance during the 1990s. Unlike other countries in the region, there was no comprehensive plan to reform and unify the sector. In order to assess the effects of the reforms on the performance of the health financing system, this study looks at impacts on the three inter-related functions of revenue collection, pooling, and purchasing/provision of health services. Data from various sources are used to illustrate the findings. It was found that the introduction of cost recovery by self-managed hospitals increased their budgets only marginally and competition among social health insurance funds did not reduce fragmentation as expected. Although reforming the Solidarity Redistribution Fund and implementing a single basic package for the insured was an important step towards equity and transparency, the extent of risk pooling is still very limited. This study also provides recommendations regarding strengthening reimbursement mechanisms for public hospitals, and regulating the private sector as approaches to improving the fairness of the health financing system and protecting people from financial hardship as a result of illness.     

Clinical features of multiple gastrointestinal stromal tumors: A pooling analysis combined with evidence and gap map

BACKGROUNDMultiple gastrointestinal stromal tumors (MGISTs) are a very rare type of gastrointestinal stromal tumor (GIST) and are usually observed in syndrome.AIMThe paper aimed to describe the clinical and oncological features of MGISTs and to offer evidence for the diagnosis and treatment.METHODSData of consecutive patients with MGISTs who were diagnosed at Peking University People’s Hospital (PKUPH) from 2008 to 2019 were retrospectively evaluated. Further, a literature search was conducted by retrieving data from PubMed, EMBASE, and the Cochrane library databases from inception up to November 30, 2019.RESULTSIn all, 12 patients were diagnosed with MGISTs at PKUPH, and 43 published records were ultimately included following the literature review. Combined analysis of the whole individual patient data showed that female (59.30%), young (14.45%), and syndromic GIST (63.95%) patients comprised a large proportion of the total patient population. Tumors were mainly located in the small intestine (58.92%), and both CD117 and CD34 were generally positive. After a mean 78.32-mo follow-up, the estimated median overall survival duration (11.5 years) was similar to single GISTs, but recurrence-free survival was relatively poorer.CONCLUSIONThe clinical and oncological features are potentially different between MGISTs and single GIST. Further studies are needed to explore appropriate surgical approach and adjuvant therapy.