Gatekeeping and referral system are core institutional arrangements in health resource allocation which regulate the consumers’ entry points and their fluxion in the healthcare service delivery system. Hiding behind such arrangements are numerous stakeholders and their sophisticated interactions of obligation, responsibility and ben-efits. For this reason, it is of great importance to build a more systematic and integrated policy framework to promote and impoverish the gatekeeping and referral system. This paper puts forward the definition of“general practice-based gatekeeping and referral system” and revealed the political values embedded in it. We then identified the ten essen-tial components for policy implementation based on this definition. For each component, we recognized the involved actors, and elaborated their obligations, boundaries and interactions. This ten-component policy framework could be used in the international comparison research as a map, guiding the implementation of gatekeeping and referral system.

The definition and connotation of tiered health care system ( THCS ) is a fundamental field of re-search for the system and a logic orientation of institution establishment and smoothing as well. Through analyzing and distinguishing the related international and domestic THCS concepts and exploring its essence from the general prac-tice attributes perspective, we found several problems existing in the Chinese THCS. First of all, the three-tiered pa-tient transfer principle which, merely based on the disease, have seriously neglected patient’s health care system serv-ice requirements. Second, the specialty of the general practice lost the function of making a supplement of specialized disciplines. Third, it did not generate a straightforward boundary between the general practice and special care sys-tem. Forth, the organizational management was adopted to replace the professional one required by two specialties. Based on these findings, we gave a clear and smooth THCS definition and answered three fundamental TMSS ques-tions. Additionally, we proposed a concept for which TMSS management should be composed of micro-, medium-and macro-level institutions.

General practice is the core of primary care.The attributes of primary care includes five core attributes (first-contact, accessibility, continuity, comprehensiveness and coordination) and three derived attributes (community orientation, family base and patient-centerdness).Only if the general practitioners integrate these attributes in their daily provision of health care, may the genaral medical care be transformed into high quality health care.The conceptualization of the core attributes lays the groundwork for theories of core attributes, which is an essential part of primary care theories.However, there exists an overlapping between the existing definitions and concepts of primary health care and their boundaries are not clear.Therefore, this paper first reviews the current literature on definitions and connotations of primary care attributes, then discusses the potential problems and solutions that may emerge during conceptualization, and finally provides the three principles to define the concepts and connotations of general practice attributes, namely controllability, exclusiveness and exhaustion.

ObjectiveTo study the mechanism by which antidepressant works on vascular endothelial cell growth factor(VEGF) in rat hippocampus of depression model.MethodsForty SD rats were randomly and equally divided into 5 groups: stress+fluoxetine,stress+tianeptine,stress,stress+normal sodium,blank matched control.We adopted separation and chronic unpredicted mild stress to establish depression in all rats except those in blank matched control group,and the behavior of all animals was evaluated by open-field and fluid consumption test.VEGF expression was detected by immunohistochemisty after intragastric administration respectively with fluoxetine,tianeptine or normal sodium for 30 d.ResultsVEGF expression in hippocampus was decreased in all stress groups compared with control group(P

BACKGROUND: Personality obstacle is a special type of psychopathy. Since it can reflect personal psychological traits, such as emotion, cognition, behavior mode and the ways one gets along with others, it may lead to meaningful functional impairments and psychological pains if they obviously deviate the normal range, resulting in functional malajustment to society, occupation, social ethics, rules and law. Therefore it deserves further investigation with respect to its criminological significance.OBJECTIVE: To investigate the influence of personality traits, age, educational degree, and marriage state before serving the sentence on criminal behavior of female offenders.DESIGN: A retrospective and control study based on patients.SETTING: Center of psychological sanitary in a hospital of a university.PARTICIPANTS: This study was carried out in the Psychological Sanitary Center of the First Affiliated Hospital of Chongqing Medical College between April 2004 and May 2004. Totally 223 female offenders who incarcerated in Chongqing Female prison were selected. Inclusion criteria: All participants aged from 18 to 60 years old and received above elementary school education. Exclusion criteria: Those who have definite body ailments or psychopaths. Finally totally 204 valid questionnaires were collected from female offenders who were then divided into violent criminal group( n = 120) and non-violent criminal group ( n = 84).METHODS: Totally 223 female offenders who incarcerated in Chongqing Female Prison were asked to fill personality diagnostic questionnaires (PDQ-R), Esonk' personality questionnaires(EPQ), and symptom self-rating chart(SCL-90). Finally totally 204 effective questionnaires were collected for statistical analysis with SAS software.MAIN OUTCOME MEASURES: Comparison of scores for three questionnaires between the two groups; relationship between general condition(age,educational degree and marriage state before incarceration) with the scores for the three questionnaires.RESULTS: The total score for PDQ-R was above 30 in both the two groups and without significant difference between them, ( P ＞ 0.05); the different results for EPQ between the two group was of statistical significance( P ＞ 0. 05); but the total scores for SCL-90 were markedly different between the two groups,( P ＜ 0.01 ); only "educational degree" was found positively correlated with "histrionic trait"; all items except "psychopathy" were close lined with the general state in EPQ questionnaires( P ＜ 0.05); "impulsion and the number of positive items" in SCL-90 were found related with the general condition( P＜ 0.05).CONCLUSION:All criminals have personality obstacle of different type and different degree, but the difference of personality traits between violent female offenders and non-violent female offenders was of no statistical significance.

Objective To learn current needs of and satisfaction with health management among liver or kidney transplant recipients.Methods Our data,including needs of and satisfaction with physical or mental management and social supports,were from China Transplant Recipients Health Research Project.Chi-square test was used for data analysis.Results There was a gap between needs of and satisfaction with knowledge management of surgical operation and medication (x2 values were 22.2 and 34.2,respectively ; both P ＜0.05).No significant difference was found between needs of and satisfaction with knowledge management of appetite,energy status and physical comfort (x2 values were 25.5,30.7 and 26.3,respectively; all P ＜0.05).Difference between needs of and satisfaction with respection or understanding and support from family numbers,trust by colleagues and friends,stress release,personal performance and success,social support,friend making,leisure and entertainment activities,and improved quality of life was statistically significant (x2 values were 46.5,43.4,39.2,19.2,31.9,23.7,117.7,258.4,59.6 and 33.3,respectively ; all P ＜0.05).Conclusion Management of disease,medication,and physiological-psychological-social supports may affect health outcomes of transplant recipients,and current health management system could not meet the needs of this population.

BACKGROUND:Compared with rigid internal fixation, semi-restricted non-fusion system (Cosmic) can reduce the destruction of lumbar physiological structure during operation, partly retain the range of motion, maintain the stability of surgical segment, and help to prevent the adjacent segment degeneration.
OBJECTIVE:To observe the mid-term folow-up outcome of semi-restricted non-fusion system (Cosmic) in the treatment of lumbar degenerative disease.
METHODS:21 patients with lumbar degenerative disease, including 10 male patients and 11 female patients, at the age of 19-63 years old, received posterior decompression by fenestration, nucleotomy, and Cosmic system internal fixation. Visual analogue scale score and Oswestry disability index were used for clinical evaluation. Intervertebral height and range of motion of surgical segment and the proximal adjacent segment were colected before and after operation.
RESULTS AND CONCLUSION: Al the patients were folowed up for 15-48 months. No internal fixator loosening or rupture was found during the folow-up. The visual analogue scale score and Oswestry disability index at the last folow-up were lower than those before operation (P < 0.01). During the last folow-up, there were no significant differences in the intervertebral height of surgical segment and the proximal adjacent segment, and the range of motion of surgical segment was lower than that before operation (P < 0.01). No significant difference was found in range of motion of the proximal adjacent segment. These results suggest that semi-restricted dynamic non-fusion system (Cosmic) can reduce the destruction of lumbar physiological structure during operation, partly retain the range of motion, maintain the stability of surgical segment, and help to prevent the adjacent segment degeneration with wel mid-term folow-up outcomes.

Objective To investigate the clinical efficacy of trimetazidine in treatment of ischemic cardiomy-opathy heart failure and its influence on cardiac function and heart rate variability .Methods 160 cases of patients with ischemic cardiomyopathy heart failure were randomly divided into the two groups with 80 cases in each group .The
two groups were given conventional treatment of anti heart failure ,the observation group used trimetazidine on basis of that,clinical effect and the influence on the index of heart rate variability and cardiac function of two groups were ob -served.Results The total effective rate of the observation group was 91.25%,significantly higher than 73.75% of the control group (χ2 =9.57,P<0.05);LVEDD and LVESD of the observation group after treatment were (49.88 ± 4.60)mm and (37.10 ±3.15)mm,significantly reduced than before treatment (t=7.44,7.83,all P<0.05) and the control group (t=6.60,6.85,all P<0.05); while the LVEF was (48.04 ±4.20)%,increased significantly than before treatment (t=6.51,P<0.05) and the control group (t=7.11,P<0.05);SDNN,SDANN,rMSSD and PNN50 of the observation group after treatment were (124.72 ±7.02)ms,(111.20 ±5.89)ms,(46.74 ±4.22)ms and (17.72 ±2.08)%,increased significantly than before treatment (t=7.43,7.83,7.06,8.17,all P<0.05) and the control group (t=6.66,6.90,6.15,7.21,all P<0.05).Conclusion Trimetazidine has an exact effect in treat-ment of ischemic cardiomyopathy heart failure ,which can improve heart function and heart rate variability which has an important value in clinical application .

General practice is the core of primary care, and it has become the fundamental part of some high-valued health care system. The function-orientated definition of primary care comprise of five core attributes, which are first-contact, accessibility, continuity, coordination and comprehensiveness of service. This paper started from the definition of general practice and sought to clarify and summarize the definitions, contents and functions of its five core attributes;meanwhile, the high-performance functional mechanism of health care system was also explored. On this basis, four suggestions are put forward: The basic medical health care system should be renamed primary care system;Five core attributes of primary care should be emphasized when strengthening the primary care system; the primary care system should be improved, and the key points are the number of general practitioners (GPs), payment system, primary care purchasing, educational system of GPs and etc.;The management system and service process should be developed which would benefit the implementation of the core attributes of primary care at an organizational level.

Objective To study the efficacy and safety of Fasudil in treatment of elderly diastolic heart fail -ure related pulmonary hypertension ,and provide evidence for clinical treatment .Methods 70 cases of elderly dias-tolic heart failure related pulmonary hypertension were divided into the study group and control group of 35 cases in each group according to random number table methods ,the two groups were given beta blockers ,angiotensin converting enzyme inhibitors and other drugs for treatment ,the study group was given fasudil on basis of that ,6min walking dis-tance,pulmonary artery systolic pressure ,arterial partial pressure of oxygen ( PaO2) of two groups before and after treatment as well as the changes of blood pressure and heart rate of the study group before and after treatment were compared.Results Before treatment,6min walking distance,pulmonary artery systolic pressure and PaO2 of the two groups were (290.3 ±1.3)m,(83.3 ±0.9)mmHg,(66.3 ±1.4)mmHg and (289.2 ±1.1)m,(82.9 ±0.8)mm-Hg,(65.9 ±1.3)mmHg showed no statistical significance (t=2.392,4.927,5.132,P=0.073,0.069,0.063),after treatment,6min walking distance ,pulmonary artery systolic pressure and PaO 2 of the study group were (410.4 ±2.3) m,(60.1 ±1.1) mmHg,(89.3 ±0.6) mmHg significantly better than those of the control group ,with statistically significant difference(t=8.918,9.142,11.319,P =0.024,0.019,0.017);the systolic blood pressure,diastolic pressure and heart rate of the study group before and after treatment were (132.8 ±2.1)mmHg,(84.3 ±1.1)mm-Hg,(69.2 ±1.4) times/min and (133.2 ±1.9) mmHg,(83.9 ±0.9) mmHg,(68.9 ±1.3) times/min showed no statistical significance(t=4.193,4.018,3.987,P=0.061,0.078,0.068).Conclusion Fasudil has a better effect in treatment of elderly diastolic heart failure related pulmonary hypertension ,which can significantly reduce the pulmo-nary artery pressure ,and has a little effect on the heart ,with high safety .