我国医保支付改革下按病种分值付费的探讨与建议

医保支付方式作为引导医疗服务行为、调节资源配置的杠杆,对实现医保基金可持续发展,提升医院精细化管理水平具有重要作用。近年来,我国积极探索医保支付改革,以DRG和DIP为代表的支付方式已成为主要方向。文章从改革的现实出发,对DIP相较于DRG的实施优势、问题与挑战进行比较分析,并提出政策建议。     

Efficacy of a high potency O1 Manisa foot-and-mouth disease vaccine in cattle against heterologous challenge with a field virus from the O/ME-SA/Ind-2001 lineage collected in North Africa

Outbreaks of foot-and-mouth disease (FMD) in North Africa (2013) and the Gulf States (2013) of the Middle East have been caused by a FMD viral lineage (O/ME-SA/Ind-2001) that was before 2013 restricted to the Indian Sub-continent. This study was undertaken to assess the in vivo efficacy of a FMD virus emergency vaccine type O₁ Manisa against heterologous challenge with a representative field virus (O/ALG/3/2014) from this emerging lineage. This widely available vaccine was selected since in vitro vaccine-matching results gave inconclusive results as to whether or not it would be protective. Three groups of five cattle were vaccinated with O₁ Manisa (homologous potency ≥6PD₅₀/dose) using study guidelines outlined in the European Pharmacopeia, and challenged at 21 days post-vaccination by tongue inoculation. All animals that were vaccinated with the lowest dose (1/16) of vaccine developed generalised FMD, defined as vesicular lesions at the feet. One animal vaccinated with a 1/4 dose of the vaccine also developed generalised disease, as did two animals vaccinated with the full dose of vaccine. These results indicate that the heterologous potency of this high potency O₁ Manisa vaccine was approximately 3.5 PD₅₀/dose. These data support the use of the O₁ Manisa vaccine for FMD control in areas where FMDV is endemic e.g. North Africa, and motivate further studies to evaluate other vaccine candidates (or multivalent combinations) that might be potentially used for emergency purposes in FMD-free settings.     

Multiple Selectin Blockade With a Small-Molecule Selectin Inhibitor Does Not Affect Survival After a Second Inflammatory Challenge With Nonlethal LPS

The effects of anti-adhesion molecule antibodies on the blockade of leukocyte-endothelial interactions have the potential of decreasing survival through possibly increased infection vulnerability. The aim of this study was to determine the effect of a small-molecule selectin inhibitor (TBC-1269) on both liver response and survival to a nonlethal lipopolysaccharide (LPS) challenge after hemorrhagic shock. Ninety-six Sprague-Dawley rats were subjected to a model of uncontrolled hemorrhagic shock. Six groups of animals were included in this study ( n = 16 per group): sham/saline, sham/LPS, shock/saline, shock/LPS, shock/TBC1269, and shock/TBC-1269/LPS. Experimental design consisted of the development of hemorrhagick shock (3 mL/100 g) in a 15-min period, tail amputation and drug administration at 30 min, and subsequent resuscitation to maintain mean arterial pressure at 70mm Hg. A septic challenge was produced with 0.1 mg/kg of LPS ( Escherichia coli type 78H4086; Sigma Chemical, St. Louis, MO) given intravenously via penile vein at 20 h. Liver injury tests (alanine aminotransferase, ALT), liver myeloperoxidase, liver histology, and 21-day survival were evaluated. Statistical analysis included the Bartlett test for equality of variance, a two-way analysis of variance (ANOVA), and overall followed by pairwise log-rank test for survival. Significant improvements in liver function and histology were observed in animals treated with TBC-1269 with or without a nonlethal septic challenge. Neutrophil infiltration, as evidenced by liver myeloperoxidase (MPO) was significantly decreased in animals treated with TBC-1269 alone and those having LPS administration after TBC-1269 treatment. We conclude that TBC-1269, multisectin blocker, was effective in reducing liver damage even with the addition of a second inflammatory insult as the nonlethal LPS challenge used in this study.     

Four-segmented Rift Valley fever virus induces sterile immunity in sheep after a single vaccination

Rift Valley fever virus (RVFV), a mosquito-borne virus in the Bunyaviridae family, causes recurrent outbreaks with severe disease in ruminants and occasionally humans. The virus comprises a segmented genome consisting of a small (S), medium (M) and large (L) RNA segment of negative polarity. The M-segment encodes a glycoprotein precursor (GPC) protein that is co-translationally cleaved into Gn and Gc, which are required for virus entry and fusion. Recently we developed a four-segmented RVFV (RVFV-4s) by splitting the M-genome segment, and used this virus to study RVFV genome packaging. Here we evaluated the potential of a RVFV-4s variant lacking the NSs gene (4s-ΔNSs) to induce protective immunity in sheep. Groups of seven lambs were either mock-vaccinated or vaccinated with 10⁵ or 10⁶ tissue culture infective dose (TCID₅₀) of 4s-ΔNSs via the intramuscular (IM) or subcutaneous (SC) route. Three weeks post-vaccination all lambs were challenged with wild-type RVFV. Mock-vaccinated lambs developed high fever and high viremia within 2 days post-challenge and three animals eventually succumbed to the infection. In contrast, none of the 4s-ΔNSs vaccinated animals developed clinical signs during the course of the experiment. Vaccination with 10⁵ TCID₅₀ via the IM route provided sterile immunity, whereas a 10⁶ dose was required to induce sterile immunity via SC vaccination. Protection was strongly correlated with the presence of RVFV neutralizing antibodies. This study shows that 4s-ΔNSs is able to induce sterile immunity in the natural target species after a single vaccination, preferably administrated via the IM route.     

取不易守更难: 我国巩固消除疟疾成果面临的挑战

摘要］　2021年6月我国正式通过WHO消除疟疾认证,实现了消除疟疾目标。但目前全球疟疾流行形势依然严峻,近年来疟疾发病数和死亡数不降反升,我国传疟媒介仍将长期存在,巩固来之不易的消除疟疾成果任重道远。本文对我国当前疟疾防控工作中存在的困难与挑战进行分析,并提出下一步工作重点,旨在为防止疟疾输入再传播提供科学参考。     

监测与响应: 中国消除疟疾后的核心干预措施

2021年6月,我国顺利通过WHO消除疟疾认证。但我国每年仍有数千例境外输入疟疾病例,因输入性疟疾病例引起的死亡病例每年均有报告;由输入性疟疾导致的继发病例时有发生,由于原疟疾流行区传疟媒介依然存在,在疟疾消除地区由输入性病例再次引起本地传播的风险依然较大。本文就消除后阶段我国疟疾防控工作面临的风险、监测与响应工作中面临的挑战进行分析,并对今后工作重点提出相应建议。     

How Challenge Stress Affects Mental Health among College Students during the COVID-19 Pandemic: The Moderating Role of Self-Efficacy

While a plethora of studies has been conducted to examine stress and its impact on mental health in western countries, research is scarce investigating the relationship between student challenge stress and health illness in the context of Chinese colleges. No studies examined the moderating effect of self-efficacy on the relationship between challenge stress and health illness. This study attempted to investigate the relationships between these three variables among Chinese college students. Especially, this study focused on examining whether self-efficacy moderated the effect of perceived challenge stress on students’ mental health. Also, the differences were tested between male and female students in terms of these three variables. A sample of 578 Chinese college students was recruited over an approximately 12-week period from 7 Chinese universities. An online survey link was distributed through WeChat. The SPSS version 26 software was used to analyze the data. Results showed that there is no significant difference between genders in terms of perceived challenge stress, self-efficacy, and students’ mental health. In addition, challenge stress was positively related to the students’ mental health (β = 0.35, p < 0.01) while there was a negative association between self-efficacy and mental health (β = −0.41, p < 0.01). Furthermore, self-efficacy plays a moderating role in the relationship between challenge stress and mental health (β = −0.11, p = 0.02). Students with low self-efficacy tend to experience more mental health issues. It is suggested that Chinese colleges and universities pay more attention to students with low self-efficacy, either through faculty/staff interventions or peer counseling. Professors consider reducing students’ academic stress to improve their mental health.     

传染病智慧化症状监测的进展与挑战

智慧化症状监测是我国传染病智慧化预警多点触发和多渠道预警体系的重要组成部分,是传统症状监测在新技术发展下的必然路径。智慧化症状监测不仅包括医院就诊患者的大量医疗数据,还囊括未在医院就诊、海量的非医疗数据。然而,发展的同时也迎来了挑战,如信息爆炸、成本-效益问题以及数据共享、数据安全和隐私问题。本文通过对智慧化症状监测相关概念发展的思考和总结,为传染病智慧化预警方法与技术的发展提供参考,为我国和全球传染病防控提供新思路。