In the context of ongoing health reform,it is important to establish and improve the regulation system of public hospitals.By defining the concept of regulation,regulation theories for public hospitals,the regulation systems of the typical countries,the paper summarizes the international experience enlightenment to China's public hospital regulation reform.

A summary of the reform for public hospitals'internal operating mechanism in 17 pilot cities identified its four main patterns,the internal decision-making machanism,human resource management mechanism,compensation allocation system,and business mechanism.It also analyzed the initial outcomes and problems encountered in the reform.On this basis,the authors proposed the direction for the reform pattern in designing the internal operating mechanism for reference of a wholescale reform of public hospitals in China.

Objective To investigate the occurrence and influencing factors of perimenopausal syndrome (MPS) and natural menopause women age 40-60 years in Guiyang city, with the purpose of providing information for planning care for menopausal women. Methods A convenient sampling was conducted among 40-60 years old healthy women visiting the three Medical Examination Centers of affiliated hospital of Guizhou Medical University, 1594 subjects were interviewed using a self-designed questionnaire. Improved Kupperman Scale was used to evaluate the MPS. Results The percentage of MPS in the 40-60 years old women is 61.60%, of them, the proportion of mild, moderate and severe cases were 38.96%, 21.52% and 1.13% respectively. Mild and moderate account for the most cases. The top 5 symptoms of MPS were:mood agitation (60.85%), wakefulness (58.22%), muscle or joint ache (57.40%) , fatigue (57.09%) and dizziness (48.68%). The incidence of MPS was related to the following factors: age, marital status, degree of education, family monthly income, current menstrual conditions, age of first sexual life and the frequency of pregnancies and deliveries. The occurrence of MPS were associated with age, educational status,family income,current menstruation condition, age of first sexual intercourse and number of pregnancies. As age increases, the severity of MPS arise. With menstrual changes from normal to irregular and menopause, the rate and severity of MPS increased. With the frequency of pregnancies increases, the possibility of moderate and severe degree of PMS increase. The natural menopause age of healthy women in Guiyang was 49.17 ± 3.12. Conclusion The occurrence of perimenopausal syndrome was related to age,current menstruation condition and frequency of pregnancies. Care for perimenopausal period should start as early as possible.

Objective To study the awareness of perimenopausal hormone replacement therapy (HRT) among a part of the medical care personnel in Guiyang . Methods A survey was conducted among 500 medical staff members in 4 hospitals of Guiyang by cluster random sampling using questionnaire about HRT. Results The survey showed that 74.6% (373/500) medical staff thought that the hormone replacement therapy was necessary to perimenopausal women; 96.7% (87/90) of obstetrics and gynecology doctors believed that it was necessary for perimenopausal women to use HRT,which was significantly higher than the doctors of other specialties 68.6% (166/242) and the nurses group 71.4% (120/168) (χ2=28.509, 23.537, P<0.01). Only 5.8%(29/500) of the medical personnel were willing to recommend HRT. In light of the attitude for recommending HRT, the obstetricians and gynecologists group was more significantly higher than the other specialties doctors group (χ2=86.781, P<0.01). Conclusion The knowledge of hormone replacement therapy in part of Guiyang medical personnel is not sufficient;the recommending rate of HRT was low;the side effects of HRT was still a concern. There are differences between obstetrics and gynecology doctors and doctors other specialties and nurses in HRT knowledge.

Objective To investigate the assessment and influencing factors of the cerebrovascular function in 40-60 years old women in Guiyang city,and to provide information for the prevention of stroke in menopausal women.Methods Self-designed questionnaire was used among randomly selected healthy women aged 40-60 years who received health checkup from April 2016 to April 2017 in the Medical Examination Center of Affiliated Hospital of Guizhou Medical University.Levels of height,weight,blood pressure,blood lipid,blood glucose,blood uric acid and the cerebral hemodynamics were checked,comparing the influence of different factors for cerebrovascular function integral value differences,and assess the risk of stroke.Results A total of 439 cases were included in the study,the number of cases with abnormal cerebro vascular function (the score of cerebro vascular function score ＜75) accounted for 13.2％ (58/439).Increased age,being ethnic minorities,menopause,obesity,high blood pressure,high blood sugar,high blood uric acid,increased high-density lipoprotein cholesterol (HDL-C),total cholesterol and triglycerides were related to the abnormal scores of brain function,and the difference was statistically significant (P＜0.05).Logistic regression analysis indicated that minority,High HDL-C [OR(95％CI):0.38 (0.25-0.58),P=0.036],obesity [OR(95％CI):11.62 (5.17-26.14),P=0.001] and hypertension [OR(95％CI):14.87(2.46-89.75),P=0.001] are the factors influencing the cerebro vascular function.Conclusion The proportion of abnormal cerebrovascular function was 13.2％.Increased HDL-C is the protective factor for perimenopausal cerebro vascular function.Minority,obesity and high blood pressure are risk factors for cerebro vascular function,of which,the association between hypertension and cerebro vascular function worsens with elevated blood pressure.

Objective To explore the relationship between blood lipid levels and cerebrovascular hemodynamic indices (CVHI) in a young and middle?aged population, and to identify reference values for early warning of stroke. Method Between June 2015 and June 2016, a total of 6 252 young and middle?aged patients were assessed for cerebrovascular function in The Health Management Center of Affiliated Hospital of Guizhou Medical University. Patients were divided into abnormal and normal blood lipid groups. Differences in CVHI indicators and scores between the groups were determined, and factors influencing CVHI indices were compared using multivariate logistic regression analysis. Results Mean (Vmean), maximum (Vmax), and minimum blood flow velocity (Vmin) and cumulative scores for CVHI indices in the abnormal blood lipid group were significantly lower than in the normal blood lipid group (P<0.001). However, pulse wave velocity, characteristic impedance, peripheral vascular resistance, dynamic resistance, critical pressure, and differences between diastolic blood pressure and critical pressure were greater than those in the normal blood lipid group (P<0.001). Multivariate logistic regression analysis indicated that a high triglyceride level, overweight or obesity, high systolic blood pressure, high diastolic blood pressure, and age were risk factors for low CVHI scores, with odds ratios (95% confidence intervals) of 1.455 (1.195- 1.771), 2.271 (1.782-2.895), 5.967 (4.557-7.815), 4.251 (3.349-5.396), 2.560 (1.993-3.287), and 1.448 (1.189-1.763). Conclusion Abnormal blood lipid levels can lead to abnormal cerebrovascular function in young and middle?aged population; elevated triglyceride level was an independent risk factor for impaired cerebrovascular function.

Caliciviridae Infections ; prevention & control ; therapy ; Disease Outbreaks ; prevention & control ; Humans ; Norovirus ; Practice Guidelines as Topic

Objective:To describe the baseline characteristics of the subjects enrolled in the China Quantitative CT (QCT) big data program in 2018—2019.Methods:Based on baseline data from the Chinese health big data project from January 2018 to December 2019 from the eligible enrolled population, measurements of bone mineral density (BMD) and visceral adipose tissue (VAT) were performed using Mindways′ QCT Pro Model 4 system. The baseline data of age, gender, regional distribution, height, weight, abdominal circumference, blood pressure, blood routine and blood biochemical tests were analyzed. And the single factor analysis of variance (ANOVA) was used to check the age related trend of BMD and VAT in both genders.Results:After screening the inclusion exclusion criteria and outliers of the main indicators, 86 113 people were enrolled in the project. The enrollment rate was 92.47%, including 35 431 (41.1%) women and 50 682 (58.9%) men, and the ratio of men to women was 1.43. The mean age was (50.3±12.7) years in all the subjects, and it was (50.2±12.8) years and (50.4±12.5) years in men and women, respectively, and there was no statistical difference between the two genders ( P>0.05). Total of 43 833 people were enrolled in east China, it was the largest group by region (50.90%), it was followed by central China (16 434 people, 19.08%), and the number of people enrolled in Northeast China was the lowest (2 914 people, 3.38%). The rate of completing of health information indicators related to the main outcome of the study were all above 70%, and there were significant differences between men and women (all P<0.05). The mean BMD was (139.33±46.76) mg/cm 3 in women, (135.90±36.48) mg/cm 3 in men, which showed a decreasing trend with age in both gender (both P<0.001); the mean intra-abdominal fat area was (116.39±56.23) cm 2 in women, (191.67±77.07) cm 2 in men, and there was an increasing trend with age in both men and women (both P<0.001). Conclusions:There are gender differences in BMD and VAT measured by QCT with different age tendency, and there are gender differences in health information index. Regional factors should also be taken into account for regional differences in the inclusion of data.

Objective:To investigate the normal reference values of spinal bone mineral density measured by quantitative computed tomography (QCT) and the differences of bone mineral density (BMD) in different regions of in Chinese adult males.Methods:Men who underwent low-dose CT lung scan for cancer screening in regions of Northeast, North, East, South, Central and Southwest of China from January 2018 to December 2019 were selected. And the lumbar vertebrae BMD values in the male subjects were measured by the QCT system (Mindways Software, Inc.). The mean BMD values and their decline rates were calculated at an age interval of 10 years, and the prevalence of osteoporosis was calculated according to the American College of Radiology spine QCT osteoporosis diagnostic criteria.Results:A total of 50 682 males with a mean age of (50.22±12.79) years (ranged 20 to 98 years) were included in this study. The peak BMD of (173.11±28.56) mg/cm 3 in the healthy Chinese adult male population appeared in the age group of 20 to 29 years and then declined with age. Before the age of 70 years, the BMD was relatively higher in males in South China, and it was lower in Central China and Southwest China, and it was intermediate in Northeast, North and East of China, with statistically significant differences. There was no significant differences in BMD in the males in the two age groups of 70 to 79 years and 80 and older among the regions in China. The overall decline rate of spinal BMD in Chinese males under QCT was about 46.92% over the lifetime, and it declined obviouslyin the 40-49 age group. The overall prevalence of osteoporosis in Chinese male population aged 50 years and above was approximately 11.42%, with the highest prevalence in Southwest China and Central China (14.72% and 13.87%, respectively) and the lowest in North China and South China (8.53% and 7.71%, respectively). Conclusions:A reference of lumbar spine BMD values for healthy males in China based on QCT is established. BMD values were highest in South China and Lowest in Central China.

Objective:To establish the normal reference value of lumbar bone mineral density (BMD) under quantitative CT (QCT) in Chinese healthy adult females and to explore the regional differences.Methods:Total of 35 431 healthy women who met the inclusion criteria of Chinese health quantitative CT big data program were selected in this study. The BMD of the central plane of L 1 and L 2 vertebrae was measured by Mindways′s QCT system, and the mean value was taken. One-way analysis of variance was used to compare the BMD differences of lumbar vertebrae in women of different ages and regions. The subjects were grouped by an age interval of 10 years, and the level of BMD in different regions of the same age group were compaired. Results:The peak BMD of Chinese healthy adult women appeared in the age group of 20-29 years (Northeast China(183.01±24.58) mg/cm 3, North China (188.93±24.80) mg/cm 3, East China (187.54±27.71) mg/cm 3, South China (186.22±33.72) mg/cm 3, Central China (176.33±24.91) mg/cm 3, Southwest China(182.25±28.00) mg/cm 3), and then it decreased with age. The level of BMD in different regions decreased with the age. Before the age of 70 years, BMD in Central and Southwest China was always at a low level((176.23±24.91) to (90.38±28.12) mg/cm 3, 182.25±28.00 to (88.55±25.68) mg/cm 3), lower than those in Northeast China ((183.01±24.58) to (99.69±27.85) mg/cm 3), North China ((188.93±24.80) to (95.89±26.12) mg/cm 3), East China ((187.54±27.71) to (95.65±27.86) mg/cm 3). After 70 years of age, BMD tended to be the same in different regions ( P>0.05). The BMD values in Central China and Southwest China were similar in the age group of 40-60 years ( P>0.05). The BMD values in the health adult femles in the age group of 60 years in different regions of Chinawere all lower than those of bone mass abnormality (all P<0.05). The detection rate of osteoporosis in females over 50 years was the highest in Southwest China (25.65%) and it was the lowest in North China (17.30%). Conclusions:This study establishes reference values of BMD under QCT in healthy Chinese women, which can be used as a reference basis for identifying women with low BMD who are at risk of osteoporosis. The BMD value is the lowest in Southwest China and the highest in South China.