Objective: To analyze the equity of benefit for inpatient services under the three basic medical insurance programs in China.Methods: Using the baseline survey data collected by China Family Panel Studies (CFPS) in 2010, and the two-part model was applied to explore whether the insured groups with different income levels had different aspects on inpatient rate and the compensation of hospitalization expenses in health insurance coverage.Results: There was no significant difference in the inpatient service utilization rate for different income groups, but the highest and second highest income groups reimburse more expenses than the lowest income group, that is 36.5% and 26.3%, respectively.Specifically, the income level and the compensation amount are not significantly correlated in the Urban Employer Medical Insurance (UEMI) program;the compensation amounts to be paid by urban residents are basically increasing with the increase of the income level;and there is a moderate discrepancy between the highest and the lowest income groups in the New Rural Cooperative Medical System (NCMS).Conclusion: The benefit equity is obviously fair in terms of inpatient service utilization rate, but the benefit degree increases for higher income groups, which shows that there are unfair inequalities related to the income at the level of reimbursement.In terms of program comparison, the benefit degree equity is higher for the UEMI program, followed by the URMI program and the NCMS program is the worst.Besides, the impatient rate and reimbursement amounts are significantly lower for NCMS program participants.The government should merge URMI and NCMS programs, actively promote the integration of basic medical insurance system by strengthening the construction of the medical assistance system and improving the system of catastrophic disease medical expenditure insurance in order to achieve better benefit equity.

The reform for medical insurance payment was the important method for standardizing medical service provider behavior,controlling costs and improving efficiency,which was also the important measurement for further improve and implement the reform of drug and health system.Since the new medical reform in 2009,the central and local government had paid more attention on the role of medical insurance payment reform.Local medical departments of different places implemented reform pilots.Through summarizing the foreign and domestic researches around capitation,bundle payment and global payment,the experiences and effectiveness of these pilots were evaluated so as to provide corresponding policy implications.

Objective To investigate the effects of recombinant human interleukin-10 (IL-10) on serum tumor necrosis factor α (TNF-α) and histopathological changes of pancreas in rats with severe acute pancreatitis (SAP),and provide theorical basis for SAP clinical treatment.Methods 90 Sprague-Dawley (SD) rats were randomly divided into three groups:normal control group (group N,n =30),SAP group (group S,n =30) and IL-10 interference group (group Ⅰ,n =30).5％ sodium taurocholate was retrogradely injected into the pancreatic duct in S group and Ⅰ group to induce SAP model.Rats in N group whose pancreas was just flipped and stricken gently without injection.Group Ⅰ was treated with 10 000 units of intraperitioneal recombinant human IL-10 at 1,3 and 5 h.Group N and group S received three intraperitoneal injections of 0.9％ normal saline at the same time points.Rats were killed at 6,12 and 24 h.The level of TNF-α in serum was determined by enzyme-linked immunosorbent assay (ELISA),and the level of amylase was assayed by biochemical methods.The pancreas histological changes were observed by H-E staining.Results Compared with group N [serum amylase (1 025.3 ±326.9),(999.9 ±212.3),(962.3 ± 128.9) IU/L;TNF-α (55.6 ± 2.1),(56.1 ± 2.2),(58.7 ± 1.3) ng/L;pancreatic histopathological score 0.13 ±0.11,0.15 ±0.12,0.16 ±0.15],serum amylase (6 633.9 ±846.7),(9421.4 ± 1 031.8),(8 755.6 ± 734.5) IU/L,TNF-α (87.6 ± 3.3),(113.3 ± 10.2),(100.2 ± 2.3) ng/L and pancreatic histopathological score (8.58 ± 0.63,13.41 ± 0.79,16.78 ± 0.87) in group S were increased significantly at 6,12 and 24 h (P ＜ 0.05).The pancreatic damage at 24 h was the most severe,and the peak concentration of AMY and TNF-α reached at 12 h.Compared with group S,pancreatic histopathological scores 6.52 ± 0.54,9.37 ± 0.35,12.43 ± 0.69,the level of serum amylase (6 032.8 ± 534.9),(7 475.8 ± 834.2),(6903.4 ±377.1) IU/L and TNF-α (67.5 ±2.5),(93.0 ±4.9),(86.7 ±6.6) ng/L in group Ⅰ were significantly decreased at corresponding time points (P ＜ 0.05).Conclusions Early application of recombinant human IL-10 can attenuate SAP inflammatory response and relieve the histopathological injury of pancreas by inhibiting the release of TNF-α.IL-10 can be used for the treatment of SAP.

Adolescent ; Atherosclerosis ; drug therapy ; etiology ; prevention & control ; therapy ; Child ; Humans ; Hyperlipidemias ; complications ; prevention & control ; therapy ; Hypolipidemic Agents ; therapeutic use ; Life Style ; Obesity ; complications ; prevention & control ; Primary Prevention ; Risk Factors

Objective To determine the anatomical and visual outcome of indocyanine-green (ICG)-assisted internal limiting membrane (ILM) peeling for idiopathic macular holes. Methods Thirty-one eyes of 31 patients with 3- (14 eyes, 45.2%) and 4-staged (17 eyes, 54.8%) primary idiopathic macular holes were analyzed. All the patients underwent the subtotal pars plana vitrectomy with removal of the posterior vitreous. ICG solution with the concentration of 1.25 mg/ml was injected into vitreous cavity. The ILM was stained and removed in a circular fashion of 2 to 3 disc-diameter from the edge of the hole. At the end of the surgery, 14% C 3F 8 mixed gas was used and the patients were required to maintain a prostrate posture for two weeks postoperatively. The mean follow-up duration was 9.1 months. Results The preoperative median visual acuity was 20/200. In the final follow-up, 28 eyes (90.3%) had anatomical restoration of the macular holes, 21 eyes had improvement of two lines or more of visual acuity. There was no direct complication or toxicity related to ICG-assisted ILM peeling except one patient with retinal detachment caused by peripheral retinal hole. Conclusion ICG-assisted retinal ILM removal appears beneficial and safe for primary idiopathic 3 and 4-staged macular holes.

Objective:To evaluate the efficacy of individualized cognitive behavioral therapy for unprotected sex and sexual attitude of middle school students having unprotected sex.Methods:A target sample of 68 adolescents having unprotected sex was recruited from 4 secondary schools in Changsha,Hunan [the unprotected sex (US) score of Health-Risk Behavior Inventory for Chinese Adolescents (HBICA) ≥ 1].Subjects were randomized assigned to cognitive behavioral therapy group (CBT group) and control group.Each group had 34 subjects.The CBT group was giving one-on-one counseling for 6 weeks (50 to 60 minutes weekly).The control group didn't receive intervention by counselors.The US and Attitudes Toward Sexuality Scale (ATSS) were selected as criterion measurements.Outcome assessments were made at baseline and at 1-and 3-month follow-up.Results:The reduction rate of US scores showed that the response rate of therapy was over 80％.Mixed linear model analysis showed that there were significant group effect,time effect and group × time effect in scores of US and ATSS (Ps ＜ 0.05).Simple effect analysis indicated that the scores of US and ATSS of CBT group were significant lower than those of baseline from 1-month follow-up [(2.2 ± 2.9) vs.(4.7 ± 3.1),(3.2 ± 1.6) vs.(4.7 ± 3.1);(38.2 ± 4.9) vs.(40.9 ±5.1),(37.2 ±5.4) vs.(40.9 ±5.1),Ps ＜0.01],whereas the scores of those in the control group did not show any significant difference (Ps ＞0.05).At l-month and 3 month follow-up,moderate effect sizes were found for the CBT and control groups on all the outcome measures (Cohen's d =0.50-0.70).Conclusion:The individualized cognitive behavioral therapy could effectively reduce the level of unprotected sex and sexual attitude of adolescents having unprotected sex.

Objective To study the effects of panax notoginseng saponins (PNS)on rat superficial renal medulla cells after femoral fracture and to discuss the protective role of PNS in renal injury after fracture. Methods We divided 102 Wistar rats randomly into simple fracture group (n =36),fracture and medication group (n =36)and normal control group (n =30).In the former two groups 6 rats were respectively executed at 1,6,12, 24,36,48 h after fracture modeling,while 5 rats in normal control group were executed at the corresponding time points.Regular HE staining was used to observe pathological changes and TUNEL was used for apoptotic cells.And immunohistochemistry and in situ hybridization were used to detect the expressions of Bcl-2 and Bax in superficial renal medulla tissues.Results In simple fracture group,mild granular degeneration could be seen in renal tubular epithelial cells of superficial renal medulla and the interstitial small vessels were slightly expanded and congested. Compared with simple fracture group,the lesions were slighter in fracture and medication group.In simple fracture group,Bcl-2 and Bcl-2 mRNA expressions were significantly higher than those in normal control group at 1 -36 h (P <0.01).Bax expression was higher than that in normal control group at 12-36 h (P <0.01),and Bax mRNA expression was higher than that in normal control group after 6 h after fracture (P < 0.01 ).In fracture and medication group,Bcl-2 expression was obviously higher than that in simple fracture group at 1 h (P <0.01),and Bcl-2 mRNA expression was higher than that in simple fracture group at 1 -48 h (P <0.01).Bax and Bax mRNA expressions were both lower than those in simple fracture group at 1 - 48 h (P < 0.01 ).Conclusion Fracture trauma has significant influences on protein expression and mRNA transcription of Bcl-2 and Bax in superficial renal medulla.PNS can upregulate anti-apoptosis gene Bcl-2 and downregulate pro-apoptosis gene Bax,thus playing the role of inhibiting tissue cell apoptosis.

Purpose To observe the effects of umbilical cataplasm on rat gastrointestinal motility and gastrointestinal hormones using rat model of gastric operation,and to explore its possible mechanism.Methods ①The peristalsis length of carbon ink in small intestine of 20 rats was investigated by the use of umbilical cataplasm,compared with the matrix cataplasm group and the untreated control group. ②By means of radioimmunoassay,the levels of motilin(MOT) and somatostatin(SS) in small intestine tissue of 20 rats were investigated after a ten-day course of application of umbilical cataplasm.Results ①The group of umbilical cataplasm could significantly increase the peristalsis length of carbon ink in the rat small intestine and the distance percentage to the whole intestine,compared with the matrix cataplasm group and the untreated control group has significant difference(P＜0.01),and has no significant differernce between the other two groups(P＞0.05). ②Umbilical cataplasm can increase the levels of MOT and decrease the levels of SS in small intestine tissue of rat,compared with the untreated group P＜0.05 or P<0.01.Conclusion Umbilical cataplasm can promote gastrointestinal peristalsis of the rat model of gastric operation, and can regulate the levels of gastrointestinal hormones.

Objective This paper aims to make clear the post-disaster medical needs of residents in the disaster areas and changes among the poor population, for the purpose of policy recommendations on post-disaster medical assistance. Methods Such methods as in-home questionnaire survey and literature study were used to study the income, prevalence rate and mental health of 4 380 households in 10 counties (cities and districts) in the disaster areas. Results In the hardest hit areas, 80. 4% and 52. 8% of residents in rural and urban areas are dependent on government relief respectively;the proportion of poor population resulting from the disaster rose from 5% before the disaster to over 75% afterwards in the hard-hit areas, while such a population rose to 15% in the hardest-hit areas and about 10% in general disaster areas;It is estimated that the new medical aid funds in Sichuan Province will reach 350 million yuan, two-fold that of the budget for 2009;In the hardest hit areas, the two-week prevalence rate per thousand people is twice that found in the third survey of health services in 2003, characterized of acute respiratory illness and rheumatoid;In the hardest-hit areas, nearly 70% of the residents are exposed to high mental health risks. Conclusion Recommendations: Strengthening the raising and use of medical aid fund;dynamic management for the population in need of post-disaster medical aid;Developing appropriate medical aid packages to fit post-disaster health needs and postdisaster disease characteristics;and consolidating the connection between medical aid and primary medical insurance system.

Aged ; Antitubercular Agents ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Factor VIII ; therapeutic use ; Hemophilia A ; drug therapy ; etiology ; Humans ; Lumbar Vertebrae ; Male ; Phytotherapy ; Tuberculosis, Spinal ; complications ; drug therapy