Drug policy in China: pharmaceutical distribution in rural areas

In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.     

Evaluation of the purity of a purified, inactivated hepatitis A vaccine (VAQTA).

Manufacture of VAQTA, an inactivated hepatitis A virus vaccine, includes extensive purification of the intact virus particle to remove endogenous components from the host cell culture lysate as well as compounds introduced in the upstream purification process. Analysis of the final purified hepatitis A virus product by SDS-PAGE prior to inactivation shows that greater than 95% of the protein in the preparation is found in four protein bands, which have been confirmed to be hepatitis A virus capsid proteins VP0, VP1, VP2 and VP3 based on Western blot and mass spectrometry analyses. Validation of the manufacturing process and direct analysis of the final product were used to demonstrate that no other specific host cell-derived components are detected and that process residuals are all below the limits of detection of the assays used. Establishment of a rigorous standard of high purity for this product was pursued to minimize the impact of impurities during clinical development of this product and will facilitate the incorporation of this product into combination vaccines.     

Evaluation of the completeness of cancer case ascertainment in the Seoul male cohort study: application of the capture-recapture method.

Since the completeness of case ascertainment is directly related to the validity of a study, the evaluation of completeness is an essential feature of a cohort study. To estimate the completeness of cancer case ascertainment during a three year period (Jan. 1, 1993, to Dec. 31, 1995) in which the Seoul Male Cohort was followed up, we applied capture-recapture method. Data were obtained from the cancer registries, medical records and death certificates, with cases identified from each source numbering 103, 105, and 38, respectively. After eliminating duplicate cases, the total number was 141, and by using a log-linear model, the number of cases not detected by any of the three data sources was estimated to be 16. For all cancers, the estimated completeness of follow-up was 89.9%.     

复合法建立大鼠溃疡性结肠炎模型

为建立一种类似人类溃疡性结肠炎（UC）特点的动物模型,将60只封闭群健康成年Wistar大鼠随机分为3组造模,每组20只,A组应用2,4－二硝基氯苯（DNCB）和乙酸复合法,B组单纯应用DNCB,C组单纯应用乙酸,对3组进行对照研究。结果：病程：A组大于16周,B组2周,C组8周;免疫学反应：造模前及造模完成后1周CD4＋CD29＋细胞A组为5．01±2．01％,11．17±2．18％,P＜0．01;B组为4．96±1．87％,10．98±2．87％,P＜0．01;C组为4．93±1.96％,5．06±2．03％,P＞0．05;病理学改变：3种方法均可产生粘膜溃疡、炎性细胞浸润、隐窝脓肿等UC组织学特征;症状：3种方法均可造成大鼠腹泻、粘法血便等UC症状。结论：复合法大鼠UC模型既克服了DNCB病程短、自愈性强的缺点,也克服了乙酸法不具有免疫反应模型特征的缺点,又同时保留了二者症状、组织学改变与人类UC相似的优点,是一种较理想的新的UC模型。     

补肾活血对D—半乳糖诱导的衰老小鼠皮层一氧化氮的影响

探讨一氧化氮（ＮＯ）与衰老的关系及补肾活血衰老的机理,用分光光度法测定Ｄ－半乳糖诱导的亚急性衰老小鼠皮层ＮＯ含量,观察补肾活血中药对衰老小鼠皮层ＮＯ的影响,结果表明,衰老小鼠皮层ＮＯ含量明显增高,补肾活血中药能明显降低衰老小鼠皮层ＮＯ的含量,提示ＮＯ与衰老关系密切,补肾活血处延缓衰老的有效手段。     

nm23基因在大肠癌组织中的表达及临床意义

目的研究nm23基因在大肠癌组织中的表达及临床意义。方法用免疫组化方法对63例大肠癌患者骨髓内转移癌细胞及肿瘤组织内nm23表达进行了测定。结果骨髓内转移癌细胞阳性者原发灶nm23蛋白表达率53．1％,低于骨髓内转移癌细胞阴性者的表达率77．4％,有统计学差别（P＜0．05）。发生肝、肾及腹腔广泛转移者原发灶表达率50．0％,低于未发生转移者的表达率81．8％（P＜0．05）。nm23蛋白表达与淋巴结转移无显著相关性。结论nm23蛋白表达与远处转移及骨髓内转移癌细胞呈负相关性,可作为预测转移和判断预后的标志物。     

上海粘土的成拱能力探讨

针对用于上海污水外排的黄浦江底隧道工程,通过土工离心模拟试验,探讨了上海粘土的成拱能力.对于无支护的情况,开挖双孔隧道时,洞底以上约8 m厚的灰色砂质粉土或粘土中不能形成稳定的天然拱.进一步研究表明,该层土所需的成拱厚度至少为12 m;对于有混凝土管支护的情况,由于支护刚度较大,管顶上土压力基本上等于管顶以上土层的自重应力.     

复方丹参、黄芪注射液治疗不稳定型心绞痛临床观察

目的观察复方丹参、黄芪注射液治疗不稳定型心绞痛的临床疗效;方法61例不稳定型心绞痛患随机分为两组,对照组采用常规西药治疗;治疗组在对照组的基础上,加用复方丹参注射液20ml,黄芪注射液20ml加入5％葡萄糖250ml中静脉滴注,每日1次,两组均2周为1个疗程,对其结果做统计学赴理;结果治疗组在总的临床疗效方面和心电图缺血性S—T段恢复以及症状控制时间上,均明显优于西药对照组(总有效率分别为93.55％和73．33％,P<0.05);结论复方丹参、黄芪注射液联用治疗不稳定型心绞痛疗效显,并与抗心绞痛西药有协同治疗作用。     

国内关于缩短平均住院日的影响因素及对策研究

平均住院日是衡量医院医疗质量与管理水平的综合指标。医院合理提速运行的基础是控制平均住院日的影响因素,这些因素可分为可控因素和不可控因素。相应可通过宏观协调转化不可控因素,引入的新的管理思想,制定适宜的平均住院日标准,配以微观措施以降低医院的平均住院日。     

转轨时期医院经营管理效益量化评价方法研究

效益评价是医院经营管理中的一项重要工作。医院经营管理的效益分为社会效益和经济效益。两个效益的人为脱节和社会效益指标的虚化,形成了效益评价的难点。本文采取层次分析法,将医院的社会效益、经济效益与医院的投入、消耗和产出的１９个指标有机结合起来,使两个效益在有机统一的前提下指标量化,这样既增强了两个效益评价工作的可操作性,也增强了效益评价结果对医院经济工作指导的操作性。