Objective:To compare and analyze the changes and the influencing factors of out of pocket(OOP) expenditure before and after the new medical reform.Methods:2000-2015 time series data was used to compare the changes of OOP in different years.The cross-section data was applied to compare the OOP of China and other countries.The principle component analysis method was used to research the contribution rates of different factors for the OOP ratio changes.Result:According to the vertical comparison,it found that the OPP ratio showed steady decreasing trend.The horizontal comparison found that there were great gap for OOP ratios of China and other countries.The per capita GDP,under five mortality and proportion over 65 years were significant factors for OOP.Conclusion:The OOP ratio still needed to be devreased,which needed to promote the economic growth,implement medical insurance system,improve the public health input and decrease the health economic burden for residents.

Abstract: Objective　To study the distribution and influencing factors of hospitalization costs of elderly patients with diabetes in Hainan Province, providing evidence for the relevant governmental departments in the formulation of prevention and treatment strategies for elderly diabetes. Methods Based on the homepage data of medical records of tertiary hospitals in Hainan Province in 2022, the hospitalization costs of elderly diabetes patients in Hainan Province were divided into five grades: lower, low, general, high, and higher. The hospitalization costs of 8 183 elderly diabetes patients in Hainan Province and their influencing factors were analyzed by using an ordered multicategory logistic regression model. Results The hospitalization costs of the elderly patients with diabetes in Hainan Province as a whole showed a right-skewed distribution but followed a nearly normal distribution within the range of 0-50 000 yuan, with a mean value of (10 446.32±10 228.36) yuan. The number of hospitalizations, medical institution visited, type of medical insurance, reimbursement ratio, household registration, gender, age, place of birth, marital status, and work unit were related factors affecting the level of hospitalization costs of elderly diabetes patients in Hainan Province (P<0.05). Compared to the group with ≥4 hospitalizations, the estimated coefficients for the group with 1 hospitalization was (β=-0.728, 95%CI: -0.852 to -0.603, P<0.001), for the group with 2 hospitalizations: (β=-0.359, 95%CI: -0.511 to -0.206, P<0.001), and for the group with 3 hospitalizations: (β=-0.314, 95%CI: -0.495 to -0.133, P<0.001), indicating that fewer hospitalizations significantly reduced hospitalization costs. Compared to those treated in medical institutions in other cities and counties, patients treated in Haikou City had (β=1.137, 95%CI: 1.028 to 1.247, P<0.001), and patients treated in Sanya City had (β=1.046, 95%CI: 0.916 to 1.175, P<0.001), showing that hospitalization costs for patients in Haikou and Sanya cities were significantly higher than those in other regions. Compared to those using commercial health insurance, patients using urban employee basic medical insurance had (β=-0.352, 95%CI: -0.531 to -0.173, P<0.001), those using urban resident basic medical insurance had (β=-0.384, 95%CI: -0.587 to -0.182, P<0.001), and those using the new rural cooperative medical insurance had (β=-0.545, 95%CI: -0.754 to -0.335, P<0.001), indicating that using social medical insurance significantly reduced hospitalization costs. Conclusions Diabetes patients consume a lot of medical and health resources, imposing a heavy economic burden on individuals, families, and society. Early prevention and treatment of diabetes should be implemented, with a focus on the health management of the elderly population to reduce the medical burden of diabetes in the future.

Objective To investigate the variation of chemical characteristics with environmental factors and establish a relationship betweem morphological characters and chemical composition of Prunella vulgaris collected in different areas of China.Methods Twelve phenotypic traits and three chemical compositions were assessed in 28 populations of P.vulgaris collected from different locations in China.Results The variability ranges observed at phenotypic and chemical levels were polymorphic.According to the morphological traits,28 populations of P.vulgaris could be grouped into six clusters,and two morpho-types could be clearly distinguished.Perceptible differences could be discerned in the plant height,leaf length,corolla length,calyx length,fruiting spikes length,and maturity period.Based on three kinds of components including ursolic acid,total flavonoids,and total polysaccharides,all populations could be identified as four types.Cluster Ⅳ showing high content of ursolic acid,total flavonoids,and total polysaccharides could be utilized to develop superior derivatives.Conclusion The variation of chemical characteristics is influenced by the genetic and environmental factors,such as soil,climate,longitude,and altitude.It provides a solid basis for efficiently evaluating qualities and establishing good agricultural practices for P.vulgaris.

Objective To investigate the correlation of Bax and apoptosis in enterocytes of neonatal rats with necrotizing enterocolitis (NEC).Methods Forty-eight neonatal rats (1 day) were randomly divided into control group (n =24) and NEC model group (n =24) by use of odd and even.The rats in control group were maternal breast-fed.The rats in NEC model group were separated from their mothers.To be given formula feeding,cold exposure after hypoxic-reoxygenation treatment.The intestinal tissue located at the boundary of ileum and caecum of two groups were gained on the 24 h,48 h and 72 h with which that all rats were sacrificed by cutting neck.Section of intestinal tissue were stained with immunohistochemistry to detect the expression of Bax and were stained with TdT mediated dUTP nick end labeling(TUNEL) to evaluate the apoptosis in each group.Results The integrate optical density (IOD) value of expression of Bax in the NEC model group began to increase on the 24 h [(1 005.06-± 11.96) IOD] and reached the summit on the 72 h [(3 340.66 ±68.72)] compared with the control group[(666.55 ± 15.77)IOD].A few of TUNEL positive cells began to increase with time dependence.A lot of TUNEL positive cells could be found in NEC model group on the 24 h [(15.04 ± 0.24) ％],and the apoptotic index reached the peak on the 72 h [(35.65 ±0.61) ％] compared with the control group[(4.73 ±0.04) ％,P ＜0.01]-There was a significantly positive correlation between the cell apoptosis and the ratio change of Bax in NEC model group (r =0.94,P ＜ 0.01).Conclusion There is a significantly positive correlation between the cell apoptosis and the ratio change of Bax in enterocytes of neonatal rats with NEC.The cell apoptosis in enterocytes of neonatal rats with NEC maybe be induced by Bax.

Objective In order to test and improve the monitoring technical level and ability of radiation environmental monitoring network in Zhejiang Province, ensure the accuracy and reliability of monitoring data and information, and obtain the cosmic ray response values of instruments and equipment in this year. Methods In September 2018，an intercomparison meeting of environmental gamma radiation air absorbed dose rate within the radiation environmental monitoring network of Zhejiang province was held in Ningbo，which was organized by Zhejiang Province Radiation Environmental Monitoring Center.A total of 33 sets of instruments from 15 member units participated in the intercomparison measurements at 5 environmental measuring points, and the comparison results were evaluated by the Z score values. Results It was found that the |Z| of all measurement results were less than or equal to 2, and the evaluation results were satisfactory and acceptable. Conclusion The measured data of scintillation counters have relatively wider dispersion，and the high pressure ionization chambers have bigger response valuetocosmic ray. The measurement results of the two kinds of instruments keep a good linearity except for the measurement points of cosmic ray response.