[Objective] To observe the effects of Oysters, Abalone shel , Concha arcae, Mother-of-pearl, Concha cypraeae, Clamshel , these six testacean TCM on the goiter rats. [Method] 72 healthy SD rats were randomly divided into nine groups:normal group, model group, positive group and six testacean TCM groups. Rats were given daily propylthiouracil (0.15 g·kg-1), continuous modeling for 10d, weighing thyroid wet weight,assaying T3, T4 and TSH contents in serum by ELISA, observing the morphological changes of thyroid under light microscope. [Result] Rats in the model group compared with normal group in-creased the relative weight of thyroid, reduced the content of T3,T4, and there was a significant difference( P<0.01), thyroid fol icular epithelial cellhyperplasia was obvious;compared with the model group, Oysters and Clamshel group made the content of T3,T4 in rat rebound, and there was a significant difference (P<0.05);Oyster and Clamshel group’s thyroid fol icular cellhyperplasia were not obvious, while the hyperplasia had different levels for the other 4 kinds of testacean TCM. [Conclusion] Oysters and Clamshel were better to improve the thyroid function of the goiter model rats.

Objective To measure and analyze the staffing standards of family doctor interdisciplinary team by means of the WHO workload indicator of staffing need (WISN)method,for reference of the government in building family doctor interdisciplinary teams.Methods 150 community health centers in 16 provinces were selected.The related data from 150 centers were collected to analyze the population served by each family doctor,and the staffing standards of family doctor interdisciplinary team by means of the WHO workload indicator of staffing need(WISN)method.Results There were 10 721 community health professionals in the sample centers which provide 132.14 million standard equivalents of service to the public.1 9 6 1 6 community health professionals were needed to ensure the quality of service and no extra workload after work for professionals.Averagely,each family doctor can serve 1 558 residents,who needs 1.3~1.5 nurses or public health workers.Conclusions A huge gap was found for community health professionals.The population served by each family doctor should be lowered compared to the governmental requirement and more nurses should be introduced to the family doctor interdisciplinary team.

OBJECTIVE:To learn the application and tendency of hepatoprotective drugs in a third grade class A hospital dur-ing 2011-2014,and to provide reference for rational drug use. METHODS:DDDs analysis and consumption ordering method were adopted to analyze the change of DDDs,DDC and other index of hepatoprotective drugs in this hospital from 2011 to 2014. RE-SULTS:2011-2014,the amount and DDDs of Hepatoprotective injection in this hospital increased year by year,while oral dosage form decreased year by year. DDC order of each drug kept stable during 2011-2014;DDC and DDDs of drugs for promoting ener-gy metabolism were all in high level,and ornithine aspartate and ademetionine always took up the first 2 places in 4 years. Polyene phosphatidylcholine and Reduced glutathione injection were cheap,but had higher DDDs. Except Glutathione tablet,DUI of other hepatoprotective drugs had no great difference in 3 years,and fluctuated in 2014;hepatoprotective drugs with DUI>1 and DUI<1 occupied a large proportion. From 2010 to 2014,compared with previous year,the drugs with consumption sum/DDDs ratio num-ber close to 1 reduced significantly in the next year,decreasing year by year. CONCLUSIONS:In this hospital,injections are used too frequently,and overuse of drugs for promoting energy metabolism exist. Polyene phosphatidylcholine and Reduced glutathione injection can be used as a valuable drug in the clinic,and their cost are more acceptable,but not in excess.

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.

Objective To analyze influencing factors of physicians' turnover intention at public county hospitals from career stage perspective.Methods Physicians career life was divided into three stages according to professional ranks and titles.The sample was drawn using stratified multistage random methods from public county hospitals in Shandong province and 677 questionnaires were completed,giving a 90.3％ valid response rate.Data were analyzed using multi-group stepwise linear regression.Results The percentage of responders with middle and high-level turnover intention was 23.0％and 6.5％ respectively,and there was no statistically significant difference in turnover intention across three stage subgroups.In physicians at stage 1,the most important factors to predict turnover intention were superiors ' appreciation (r =-0.22,P ＜ 0.05) and payment rationality (r =-0.21,P＜0.05),while in physicians at stage 2,the most important predicting factors were autonomy (r=-0.39,P＜0.05)and learning demand(r=-0.22,P＜0.05),and in physicians at stage 3 were career development(r=-0.31,P＜0.05)and autonomy(r=-0.21,P＜0.05).Conclusion Autonomy and workload are common factors of turnover intention with different predicting power across three career stages.Physicians adjust their career needs to self-actualization with development of career stage,so welltargeted incentives should be taken to stabilize the medical staff of public county hospitals.

Objective To study the association between neonatal asphyxia and blood glucose disorder. Methods A total of 134 cases of neonatal asphyxia born in the Maternal and Child Hospital of Hubei Province between January 2013 and January 2015 were included in this study. Blood glucose levels were determined within 30 min after birth and before glucose infusion. The infants were divided into the mild asphyxia group (Apgar score 4 to 7) and severe asphyxia group (Apgar score 0 to 3) according to the Apgar score at 5 min after birth. Statistical analyses were performed using the two-sample t-test and Chi-square test. Results The incidence of asphyxia was 3.2‰(134/41 875). Hypoglycemia was the main blood glucose disorder in the mild asphyxia group [12% (13/112)], and hyperglycemia was the main blood glucose disorder in the severe asphyxia group [32%(7/22)]. The average blood glucose level was higher in the severe asphyxia group than in the mild asphyxia group [(5.8±3.4) vs (5.0±2.3) mmol/L, t=21.979, P=0.001]. In the severe asphyxia group, the incidence of hypoglycemia was higher [18% (4/22) vs 12% (13/112), χ2=7.464, P=0.006] and the average blood glucose level was lower [(1.8±0.7) vs (2.1±0.4) mmol/L, t=5.247, P=0.042],and the incidence of hyperglycemia was also higher [32% (7/22) vs 9% (10/112), χ2=11.679, P=0.001] and the blood glucose level was higher [(11.6±3.8) vs (9.3±2.0) mmol/L, t=1.106, P=0.048]. Conclusion Neonatal asphyxia can lead to blood glucose disorders. The incidence and the severity of these disorders were higher in neonates with severe asphyxia.

Objective To analyze implementation outcomes and obstacles of “treatment before payment” reform seen by medical institutions' managers,along with an optimal strategy proposed.Methods Quantitative survey and qualitative interviews were called into play,and the data so acquired are subject to evaluation of the radar chart and fishbone diagram analysis to learn the implementation outcomes and obstacles.Results The reform proves workable at hospitals of county and lower levels,achieving win-win for the people,hospitals and government.Obstacles found include poor allocation of designated funds for risk coverage,insufficient circulating funds in advance,poor risk aversion mechanism,and poor preparation for tertiary hospitals.Conclusion It is recommended to promote awareness of the reform,enhance inter-department cooperation,improve hospital information systems,clarify the screening standards of “purposely evasion offenders”,standardize the issuance and use of the NRCMS certificates,and better build the credit system of the society.

The paper analyzed legally the following predicaments of legitimization of rural doctors in China:no legitimacy protection for their practice,vague criteria for practicing medicine,conflicts between legal regulations for medical practice and rural realities,and lack of a liability insurance system.The authors,based on an exploration of the legislative framework for rural doctors,made four corresponding legislative proposals as follows:to clearly define the legal scope and identity of rural doctors,to establish a qualification and employment system for rural doctors,to develop practicing norms applicable for rural doctors,and to set standards for their income.

ObjectiveTo explore the effects of perceived trust and occupational risk on job burnout of physicians.MethodsA multi-step random sample of 1910 physicians from medical organizations in Jinan,Weifang and Dezhou was selected and assessed with Perceived Trust Scale,Occupational Risk Scale and Maslach Burnout Inventory.ResultsPublic trust could significantly positively predict cynicism,negatively predict reduced professional efficacy ( β =0.10,-0.10; P ＜0.01 ),Patient's trust could significantly negatively predict exhaustion,cynicism and reduced professional efficacy ( β =-0.14,-0.20,-0.22; P ＜ 0.01 ).Regulator's trust could significantly negatively predict exhaustion,cynicism,and reduced professional efficacy(β=-0.12,-0.08,-0.12;P＜0.05 ).Occupational risk could significantly positively predict exhaustion and cynicism(β=0.30,0.13; P ＜0.01 ).Perceived social trust and occupational risk could together explain 22％ of exhaustion,7％ of cynicism and 13％ of reduced professional efficacy.ConclusionPerceived trust and occupational risk have significant predictive effects on dimensions of job burnout.

Objective To investigate the relationship between serum uric acid (UA) level and abdominal obesity or metabolic syndrome (MS).Methods A total of 875 subjects,with 350 males and 525 females,aged 40-65 years old,were enrolled in this study.The clinical and biochemical data were collected and MRI was used to assess the visceral and subcutaneous adipose tissues.The relationships between UA level and abdominal obesity or MS were analyzed,and the cut-off values of UA for abdominal obesity and MS were determined.Results Raised risks of abdominal obesity (OR =4.35,95％ CI 1.91-9.90 in males; OR =5.44,95％ CI 2.41-12.31 in females) and MS (OR =4.47,95 ％ CI 2.08-9.62 in males; OR =11.62,95％ CI 3.43-39.37 in females) were observed with the increase of UA level.The multiple logistic regression analysis showed that UA was an independent risk factor for hypertriglyceridemia (OR =2.23,95％ CI 1.02-4.87 in males ; OR =3.04,95％ CI 1.49-6.23 in females) in all subjects and for abdominal obesity(OR =3.23,95％ CI 1.32-7.91) and hypertension (OR =2.35,95％ CI 1.37-4.05)in the females.Among the females,the regression line analyzed by simple correlation indicated that the UA level of 244.0 μmol/L was corresponded to the visceral adipose tissue area of 80 cm2.The optimal cut-off point of UA for the diagnosis of MS was 258.8 μmol/L determined by the receiver operating characteristic curve.Conclusions The level of UA is closely correlated with abdominal obesity and MS in the middleaged Chinese.The elevated UA level is an independent risk factor for abdominal obesity and MS in the female.