Objective:Efficiency is a key factor in the sustainable operation of the medical insurance system.By measuring the current efficiency of the urban employee basic medical insurance system in 31 provinces in China from 2020 to 2021,it discovers possible problems,and provides reference suggestions for improving the efficiency of the system.Methods:Using the super efficiency SBM model based on unexpected output and the Malmquist index to measure the static and dynamic efficiency of employee medical in-surance in 31 provinces in China,and using Tobit regression analysis to analyze its influencing factors.Results:The overall compre-hensive efficiency of the national employee medical insurance operation is 0.826 in 2020 and 0.827 in 2021 respectively.The efficien-cy of employee medical insurance operation in the eastern region is significantly higher than that in the central and westem regions.Over 60％of provinces have inefficient operation of employee medical insurance.The overall total factor productivity of employee medical insurance operation is showing a downward trend,and the decline in technological progress is the main limiting factor.The level of economic development has a significant promotion effect on the efficiency of employee medical insurance operation,and the degree of population aging has a significant inhibitory effect on it.Conclusion:The efficiency of employee medical insurance opera-tion in China still needs to be improved,and there is a significant efficiency gap among different regions.Therefore,investment and attention should be increased in the central and western regions to bridge regional gaps and promote the equity development of medi-cal insurance.Therefore,the reform efforts should be continuously intensified to achieve technological progress.In addition,attention should also be paid to the driving role of economic development in the efficiency of employee medical insurance operation and the for-mulation of positive policies on population aging.

Objective:To explore the status quo of exercise rehabilitation attitudes and compliance in patients undergoing coronary artery bypass grafting (CABG), and analyze the influencing factors, so as to provide evidence for improving the compliance of rehabilitation exercise in CABG patients.Methods:From January to August 2022, convenience sampling was used to select 228 patients with CABG in three ClassⅢ Grade A hospitals in Urumqi City as the survey subject. One month after surgery, a questionnaire survey was conducted using the General Information and Disease Information Questionnaire, the Questionnaire of Rehabilitation Exercises (QRE), the Chinese version of the Tampa Scale of Kinesiophobia for the Heart (TSK Heart), and the Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C). This study conducted a latent category analysis of rehabilitation exercise attitudes and compliance among CABG patients, and identified the influencing factors of their latent categories through Logistic regression. A total of 220 valid questionnaires were collected, with an effective recovery rate of 96.49% (220/228) .Results:The fitting results of latent category analysis showed that the rehabilitation exercise attitudes and compliance of 220 CABG patients could be divided into 4 latent categories, which were respectively named as: excellent attitude-excellent compliance group, good attitude-single exercise group, moderate attitude-poor compliance group, poor attitude-poor compliance group. Logistic regression showed that education level, nationality, pain, exercise fear and fatigue were independent influencing factors for the latent categories of exercise rehabilitation attitudes and compliance in CABG patients ( P<0.05) . Conclusions:Postoperative exercise rehabilitation attitudes and compliance in CABG patients have 4 latent categories, and patient education level, nationality, pain, exercise fear and fatigue are all factors that affect compliance. Medical and nursing workers should formulate targeted interventions based on influencing factors to improve the compliance of exercise rehabilitation in patients with CABG.

Objective: To explore the association between adverse childhood experiences (ACEs) and adolescent alcohol use and to provide evidence for prevention and intervention. Methods: A total of 1 550 students from grades 6 to 8 in three public middle schools in a district of Shanghai were selected by stratified cluster sampling method. The baseline and follow up investigation were conducted by anonymous electronic questionnaire in mobile tablet from November to December in 2017 and 2018, respectively. The latent class analysis (LCA) was applied for the classification of ACEs, while the multivariate generalized estimating Equations (GEE) model was adopted to examine the association between ACEs and adolescent alcohol use. Results: The ACEs was divided into 3 classes by LCA: high exposure (8.97%), abuse and neglect (38.97%), low exposure (52.06%). The multivariate GEE model indicates the risk of alcohol drinking among adolescents in high exposure and abuse and neglect classes were significantly higher than their counterparts in low exposure class ( OR=2.65, 95%CI=1.72-4.07; OR=1.50, 95%CI =1.14-1.96, respectively). Conclusion The effect of ACEs on alcohol use may vary across different latent classes. Supportive childhood environment may contribute to decrease the risk of adolescent drinking behavior.

Objective: To explore the relationship between gender role attitudes (GRA) and adolescent depression to provide evidence for the promotion of mental health among adolescents. Methods: A total of 1 549 students from grades 6 to 8 in three public middle schools in Jing an District of Shanghai were selected by stratified cluster sampling. The baseline and follow up surveys were conducted by anonymous electronic questionnaire on mobile tablets from November to December in 2017 and 2018, respectively. The GRA Scale and the Depression Scale were used to collect subjects attitudes towards traditional role assignment and power inequality between men and woman and depression in family and sexual relationships. The multivariate Generalized Estimating Equations (GEE) model was adopted to examine the relationship between GRA and depression. Results: The mean score of the GRA Scale was (2.52±0.83) and (2.29±0.86), while the score of Depression Scale was (15.92±5.08) and (16.48±5.29), in the baseline and follow up survey, respectively ( P <0.05). After controlling the covariates of age, bullied experience, body image, social cohesion, etc., the multivariate GEE model indicated traditional GRA was significantly associated with a higher risk of depression among both boys and girls ( β boys =0.38, β girls =0.41, P <0.05). Conclusion Traditional GRA may increase the risk of depression in adolescents, suggesting that cultivating a positive and equal GRA among this population group may help to prevent depression.

Objective: To explore the prevalence of sexting among secondary vocational school students and to examine the correlation between sexting and mental health, so as to provide evidence for prevention and intervention on adolescents mental health. Methods: In April 2021, three secondary vocational schools from central urban area, outskirts and outer suburbs in Shanghai, among 1 580 students were selected by cluster sampling. Results: The proportions of students who received and who forwarded others private photos or videos were 11.96% and 2.78%, respectively. The proportion of students who sent others personal photos or videos was 2.54%. And the proportions of boys were higher than those of girls ( χ 2=45.89, 24.09, 6.66, P <0.01). The results of multivariable Logistic analysis showed that compared with those who had never sexted, students who had ever had any sexting were at higher risk of anxiety ( OR=2.40, 95%CI =1.59-3.61), depression( OR=1.86, 95%CI =1.25-2.75), non suicidal self injury intention ( OR=2.34, 95%CI =1.48-3.69) and suicidal intention ( OR=2.96, 95%CI =1.83-4.79)( P < 0.05 ). Conclusion There is a significant correlation between sexting and mental health among secondary vocational school students. The latent risks of sexting should be included in the curriculum of comprehensive sex education for teenagers to enhance their media literacy and decision making capability, so as to prevent sexual assault or abuse caused by sexting and promote sexual and reproductive health and as well as mental health of adolescents.

Objective To explore the feasibility of decreasing radiation dose of enhanced abdominal examination in 320-row CT using 80 kV tube voltage combined with Karl iterative reconstruction.Methods One hundred patients with body mass index(BMI)＜25.0 kg/m2 who underwent enhanced abdominal examination in 320-row CT were divided into group A and group B(50 patients for each group).120 kV tube voltage and filtered back projection(FBP)reconstruction were used for group A,while 80 kV tube voltage,FBP recon-struction and Karl iterative reconstruction were used for group B.Radiation dose and image quality between the two groups were evaluated.Results The effective dose(ED)were(11.0±1.7)mSv in group A and(5.6±0.7)mSv in group B for single scan(P＜0.01).Compared with group A,the ED in group B was decreased by 49.1％.The noise on the Karl images in group B was significantly decreased compared with the FBP images in group B(P＜0.01),and there was no significant difference in noise of liver between the FBP ima-ges in group A and the Karl images in group B(P＞0.05).Compared with the FBP images in group A,the noise of abdominal aorta and portal vein on the Karl images in group B was slightly increased(P＜0.05),while the signal-to-noise ratio(SNR)and the con-trast-to-noise ratio(CNR)of abdominal aorta and portal vein on the Karl images in group B were significantly increased(P＜0.01).Image quality scores for liver,spleen,pancreas,kidney,gastrointestinal tract,abdominal aorta and portal vein on the Karl images in group B were significantly higher than those on the FBP images in group B(P＜0.01),and there was no significant difference in the image quality scores for liver,spleen,pancreas,kidney,gastrointestinal tract,and abdominal aorta between the FBP images in group A and the Karl images in group B(P＞0.05),while the image quality score for portal vein on the Karl images in group B was higher than that on the FBP images in group A(P＜0.05).Conclusion Radiation dose can be decreased obviously in 320-row CT enhanced abdominal examination using 80 kV tube voltage combined with Karl iterative reconstruction for the patients with BMI＜25.0 kg/m2,while image quality can be maintained for diagnosis.

Objective:To guide cost control and the development of orthopedic specialty services in actual payment by thoroughly analyzing the functioning of DRG simulation in the pediatric orthopedic department of the Capital Institute of Pediatrics.Methods:A total of 736 patients from the orthopedic ward of the Capital Institute of Pediatrics were included as study subjects.The four-quadrant grouping method was employed to examine the profitability status of each diagnosis group in detail.A logistic regression model explored the key factors influencing profitability.Results:Congenital illnesses and traumas account for most pediatric orthopedic cases.Benefit groups(2 groups,4.8％),disadvantageous groups(15 groups,35.7％),key groups(8 groups,19.0％),and potential groups(17 groups,40.5％)are found using the Boston Matrix analysis.The profit group depends on the benefit groups(IF19,IH15)for 67.7％of its total revenue.No matter how profitable they are,medical consumables comprise a sizable portion(43％-45％).According to regression analysis,hospital profitability is highly impacted by age,consumable ratio,examination cost ratio,surgery cost ratio,and other cost ratios(P＜0.05).The consumable ratio is the most significant negative predictor(β=-2.238).Conclusion:Hospitals need to optimize their cost structure and increase the probability of profitability through refined management of consumables,the four-quadrant analysis method,strengthened cost accounting,and differentiated resource allocation.

Objective:To guide cost control and the development of orthopedic specialty services in actual payment by thoroughly analyzing the functioning of DRG simulation in the pediatric orthopedic department of the Capital Institute of Pediatrics.Methods:A total of 736 patients from the orthopedic ward of the Capital Institute of Pediatrics were included as study subjects.The four-quadrant grouping method was employed to examine the profitability status of each diagnosis group in detail.A logistic regression model explored the key factors influencing profitability.Results:Congenital illnesses and traumas account for most pediatric orthopedic cases.Benefit groups(2 groups,4.8％),disadvantageous groups(15 groups,35.7％),key groups(8 groups,19.0％),and potential groups(17 groups,40.5％)are found using the Boston Matrix analysis.The profit group depends on the benefit groups(IF19,IH15)for 67.7％of its total revenue.No matter how profitable they are,medical consumables comprise a sizable portion(43％-45％).According to regression analysis,hospital profitability is highly impacted by age,consumable ratio,examination cost ratio,surgery cost ratio,and other cost ratios(P＜0.05).The consumable ratio is the most significant negative predictor(β=-2.238).Conclusion:Hospitals need to optimize their cost structure and increase the probability of profitability through refined management of consumables,the four-quadrant analysis method,strengthened cost accounting,and differentiated resource allocation.

Objective:To guide cost control and the development of orthopedic specialty services in actual payment by thoroughly analyzing the functioning of DRG simulation in the pediatric orthopedic department of the Capital Institute of Pediatrics.Methods:A total of 736 patients from the orthopedic ward of the Capital Institute of Pediatrics were included as study subjects.The four-quadrant grouping method was employed to examine the profitability status of each diagnosis group in detail.A logistic regression model explored the key factors influencing profitability.Results:Congenital illnesses and traumas account for most pediatric orthopedic cases.Benefit groups(2 groups,4.8％),disadvantageous groups(15 groups,35.7％),key groups(8 groups,19.0％),and potential groups(17 groups,40.5％)are found using the Boston Matrix analysis.The profit group depends on the benefit groups(IF19,IH15)for 67.7％of its total revenue.No matter how profitable they are,medical consumables comprise a sizable portion(43％-45％).According to regression analysis,hospital profitability is highly impacted by age,consumable ratio,examination cost ratio,surgery cost ratio,and other cost ratios(P＜0.05).The consumable ratio is the most significant negative predictor(β=-2.238).Conclusion:Hospitals need to optimize their cost structure and increase the probability of profitability through refined management of consumables,the four-quadrant analysis method,strengthened cost accounting,and differentiated resource allocation.

Objective:To guide cost control and the development of orthopedic specialty services in actual payment by thoroughly analyzing the functioning of DRG simulation in the pediatric orthopedic department of the Capital Institute of Pediatrics.Methods:A total of 736 patients from the orthopedic ward of the Capital Institute of Pediatrics were included as study subjects.The four-quadrant grouping method was employed to examine the profitability status of each diagnosis group in detail.A logistic regression model explored the key factors influencing profitability.Results:Congenital illnesses and traumas account for most pediatric orthopedic cases.Benefit groups(2 groups,4.8％),disadvantageous groups(15 groups,35.7％),key groups(8 groups,19.0％),and potential groups(17 groups,40.5％)are found using the Boston Matrix analysis.The profit group depends on the benefit groups(IF19,IH15)for 67.7％of its total revenue.No matter how profitable they are,medical consumables comprise a sizable portion(43％-45％).According to regression analysis,hospital profitability is highly impacted by age,consumable ratio,examination cost ratio,surgery cost ratio,and other cost ratios(P＜0.05).The consumable ratio is the most significant negative predictor(β=-2.238).Conclusion:Hospitals need to optimize their cost structure and increase the probability of profitability through refined management of consumables,the four-quadrant analysis method,strengthened cost accounting,and differentiated resource allocation.