Objective To analyze the policy support of rural doctors for the essential medicine system,and explore the main influence factors and mechanism affecting the support degree.Methods 621 rural doctors from five cities in Shandong province were subject to a stratified random sampling for a quantitative questionnaire,to build a hypothesis model of policy support of rural doctors,which is verified using factor analysis and path analysis.Results 59.1% of rural doctors support the essential drugs policy.It was found that the essential medicine factor,the factor to influence the practitioner,and the supporting policy factor had a direct impact on policy support of rural doctors,with the effect of 0.305, 0.1 59 and 0.135 respectively;Essential medicine factor and the supporting policy factor indirectly influence the policy support of rural doctors through the factor to influence practitioners,with the effect of 0.065 and 0.032 respectively.Conclusion The essential medicine system needs to emphasize such rationality as the quality,list and pricing of essential medicines;it is imperative for the government to better oversee the purchase and supply of essential drugs,to cater to the interests of rural doctors,to encourage the enforcement of the system,and promote the development of village clinics.

Background and purpose:MMMT is known as a rare malignancy in gynecological tumor. Because of its difficulty in diagnosis and treatment, the prognosis is extremely poor. This study was to discuss the clinicopathologic feature and PRA,PRB expressions of uterine MMMT. Methods:We analysed clinicopathologic data and the expressions of PRA,PRB by immunohistochemical staining on 17 cases of uterine MMMT, and 11 patients were followed up. Results:①The patients usually presented with abnormal vaginal bleeding with no specifi city clinically. ②The morphological changes were various and complicated, including epithelial and mesenchymal components and a variety of inter-permeated and transitional tissue elements.③The positive rate of PRA in stageⅠ and stageⅡ were 66.7% and 40%, and PRB in stage Ⅰ and stageⅡwere 55.6% and 20%, respectively. ④The mean survival time in stageⅠ,Ⅱ and Ⅲ were 43.8 months (32-59), 34.25 months (19~41) and 5 months, respectively. Conclusion:The diagnosis of uterine MMMT was mainly based on tissue morphology; the development of uterine MMMT might be related with the loss of PRA and PRB ; the clinical stage and the expression of PRA and PRB might be the prognostic factors for uterine MMMT.

Objective A systematic review of implementation outcomes of the essential medicine system in China to identify scientific evidences for a better system.Methods A systematic review is made to extract data from the research papers on outcomes of the essential medicine system,followed by an analysis and description of such data.Results Of the 87 papers included,most of them focused on primary care institutions,while four of them on residents or patients,and one of them on pharmaceutical enterprises.The study found the medical institutions with rising availability of essential drugs,lowered medicine costs,rising or dropping business volume,and apparent drop of out-of-pocket expenses for patients.These have encouraged rational drug use.Evidences in hand indicate expected outcomes from the essential medicine system.Conclusion Current researches on the system focus on primary care institutions in developed areas in China,lacking rigorous design.Studies of broader scale,further depth and more rigorous designs of the implementations of the system are recommended for evaluation of the impacts and outcomes of the system on various stakeholders of the policy.

Objective: To explore the effects of effort-reward imbalance (ERI) at work on the occupational burnout, job satisfaction and turnover intention of doctors in public hospitals. Methods: By using self-designed questionnaires to in-vestigate job attitude, this paper adopts a stratified random sampling method to select 1910 doctors from public hospitals in Jinan, Weifang and Dezhou cities based on the level of economic development in Shandong province. The data are ana-lyzed using descriptive analysis, correlation analysis, hierarchical regression analysis, etc. Results: The effort-reward imbal-ance at work exists in the surveyed public hospitals. The job effort of doctors is 1. 39 ± 0. 37 times higher than job reward. The effort-reward imbalance at work has positive predictive effects on occupational burnout, negative predictive effects on job satis-faction, and positive predictive effects on turnover intention. Conclusions:Public hospital administrators should improve the ef-fort-reward ratio of doctors in order to stabilize doctors' professional attitude at work and enhance their morale.

Objective To analyze the correlation factors that promote or impede the residents to preferentially use essential medicines.Methods Adopting stratified random sampling method,1 700 households selected from 5 cities of Shandong province were investigated with a questionnaire.The framework of Andersen behavior model of health service utilization was used as the framework,with such methods as descriptive analysis and univariate logistic regression models for the analysis and evaluation of relevant information.Results The residents′ tendency factor,ability factor and environmental factor influence their preference to use essential medicines,while the requirement factor plays a minimal role.There was a significant difference for the preference of combined medication,first visit preference and self-medication experience,the efficacy and policy response of essential medicine from logistic regression analysis.Conclusion At present,the government should focus on the construction of the formation mechanism of the residents′drug use behavior and the policy response mechanism of essential medicine system.

Objective To learn the organizational management competency of state-owned hospitals and their weakness, providing references for decision makers. Methods In the principle of stratified random sampling, 5 677 doctors in hospitals of different grades from 12 cities in Shandong Province, Hubei Province, Hebei Province and Inner Mongolia were investigated with questionnaires. Factor analysis is applied to extract factors. With results of this factor analysis, an evaluation model was built, followed by a fuzzy comprehensive evaluation on the management competency. Results The total satisfaction score on the organizational management by the doctors investigated is 3. 25, and those for system building and leadership behavior are respectively 2.88 and 3.20. Conclusions Organizational management of the public hospitals needs improving, especially development of hospital management systems and implementation.

Objective To explore the relationship between the membranous tissue(MT)and organized thrombus(OT)in membranous obstruction of the inferior vena cava(MOVC),we investigated the related cytokines expression in the membranous tissues in MOVC as well as venous organized thrombi. Methods Using immunohistochemical method the expression of TGFβR,PDGFR,ET-1,FⅧ-rAg, ferritin and α1-antitrypsin were observed in the membranous tissues in 11 cases with MOVC and organized thrombi in 8 cases with deep venous thrombosis(DVT). Results Expression rates of TGFβR,PDGFR,ET-1,FⅧ-rAg, and ferritin in membranous tissues in 11 cases with MOVC and organized thrombi in 8 cases with DVT were as follows: TGFβR:MT 72.3%,OT 50%(P＞0.05);PDGFR:MT 45.5%,OT 100%(P＜0.05＝;ET-1:MT 100%,OT 0(P＜0.05＝;FⅧ-rAg: MT 90.9%,OT 12.5%(P＜0.05＝;ferritin: MT 72.3%,OT 100%(P＞0.05).α1-antitrypasin was not detected in either membranous tissues of MOVC or organized thrombi of DVT. Conclusions ThrovIgh the investigation of the related cytokines expression, it is possible that membranous tissue formation in MOVC is related to the organized thrombus.

Objective To compare the work well-being among physicians between two surveys (2007 and 201 1 )performed in public hospital of Shandong province.Methods The constituent ratios and Pearson correlation coefficient of two surveys with 1 520 and 1 910 respondents were compared.Results The proportion of satisfied physicians decreased from 6.8% between the two surveys.Those approvingwork autonomy dropped 21.1%;those satisfied with their social standing dropped 9.1%,and those recognizing media coverage increased 12.3%.In year 2007,the top five issues most concerned with work satisfaction wereincome equity,embodiment of professional value,balance between income and workload,equity of academic title appraisal,andhealth reform policy (r were 0.53,0.5 1,0.52, 0.5 1,and 0.45,with P average< 0.01 ).While in year 201 1,the top five issues most concerned with work satisfaction were patient turst,medical lawsuit,income equity,health reform policy,dissension dealing(r were 0.50,0.50,0.50,0.49,0.48 ).Attention to medical reports rising the most (r from 0.04 to 0.45).Conclusion There was little positive change on physicians'work well-being before and after new health reform while physicians are bearing tiredness and high risk under high expectation and low trust.Rebuilding the patients'trust,dispersing risks of the medical profession and improving the practicing environment are the keys to motivating physicians.

Objective To analyze the residents′ willingness to hierarchical medical system and their intention of first visit hospitals.Methods Customized questionnaire was used for in-home survey of 1 500 households in three cities of Shandong province,with 773 of the residents aware of hierarchical medical system used as the study samples.Descriptive analysis and multi factor Logistic regression were employed for statistical analysis of their intention.Results 85.0% the residents expressed willingness to embrace hierarchical medical system.55.0% of the residents prefer primary medical institutions as their first visit in case of mild illness,a choice chosen by more rural residents(58.9%)than urban residents(48.0%),a difference of statistical significance(P<0.01).In the case of severe illness,87.3% of them prefer major hospitals as their first visit,and more urban residents(94.3%)take this option than the rural residents(83.3%),a difference of statistical significance(P<0.01).Service ability of medical institutions and residents′ concept for medical service played a key role in their choice of first visit hospitals.Conclusions The key to ensuring the implementation effect of hierarchical medical system lies in better service ability of primary medical institutions and correction of residents′ irrational medication concepts.

Objective To determine the time point when porcine pancreatic elastase(PPE)induced abdominal aortic aneurysm(AAA)reaches the regression phase in mice and observe the histological characteristics of AAA in regression phase.Methods AAAs were induced by transient intraluminal infusion of PPE in C57BL/6J mice.The diameters of the mouse abdominal aortas were measured before PPE infusion and sacrifice time,day 14 for AAA progression phase or day 56 for regression phase after PPE infusion,respectively.The histological characteristics of the aneurysm lesion site on day 14 and day 56 after surgery were compared and analyzed.Results The diameters of the abdominal aortas were significantly increased in both day 14 and day 56 after PPE infusion groups(diameter growth rate 147％and 155％,respectively)as compared to the baseline diameters.In the day 14 group,the infused aortas showed typical AAA characteristics,such as elastin break/degradation,medial smooth muscle cells depletion,and inflammatory cell diffused infiltration.In the day 56 group after PPE infusion,although the artery diameter did not change significantly as compared to the day 14 group,histology showed that elastin was partially repaired,new smooth muscle cells were added to the damaged aorta media,the infiltrated inflammatory cells were significantly subsided,and the adventitia neovascularization was reduced,showing a significant feature of the disease regression phase.Conclusion In the PPE-induced mouse AAA model,day 56 after surgery is an appropriate time point for observing aneurysm regression,and the histological characteristics of the regression are obvious.