Objective To learn the present status of medical workers in pilot public hospitals in China and their response/perception of the health reform,and to analyze problems found in order to raise their satisfaction and incentives.Methods 1529 medical workers at 15 pilot county hospitals in Hubei province were surveyed by questionnaire.Results The data showed that nearly half of the doctors and nurses faced great stress and more than half of the medical workers' satisfaction was at a low level.Their responses indicated that they perceived themselves as having a low social status and nearly 80％ were dissatisfied with their income.About 30％of medical workers lack understanding of the policies for public hospitals reform and more than 60％of them were less positive on achievement of the reform goals.Conclusion It is necessary to reduce their work stress and raise their income,create an incentive mechanism,strengthen the communications on the health reform,and ignite the morality of medical workers.

Drug price plus policy had been in place at public hospitals since 1954 and began to phase out since 2009.Hubei province studied the profile and reform progress of 20 pilot county public hospitals before June 2012,and measured the drug income loss incurred by abolishment of this policy since 2012.It is recommended that the reform to abolish drug price plus policy in the province be made based on investigation,evaluation and academic research,prioritizing medical service pricing adjustment aided by government compensation.The authors proposed a new approach of medical service pricing to make up for the revenue gap caused by the abolishment.

Medical insurance system plays a key role in China's social security system.In the social insurance system,medical insurance features the widest coverage and the most complex in mechanism,while China' s medical insurance system itself is found with many setbacks.This paper probed into such risks found in the county-level medical insurance system as excessive cost growth causing overpayment of the medical insurance fund and poor supervision of the fund.On such basis,the authors recommended such policy changes as payment reform,and enhanced supervision over the fund,the demand side,and the government,in an effort to optimize China' s medical insurance system for theoretical and decision reference of other county-level hospitals in their reforms.

The United Kingdom is the longest-serving community in the welfare states, and has been serving for more than sixty years so far. The construction of community care service supply model in the United Kingdom is deeply influenced by the neo-liberalism and neo-managerialism, which dominated the reform and development of pur-chasing community care services. Presently, China is actively promoting the government to purchase pension services of public health care combined with the long-term care, especially policy and determination of community-based de-velopment of an elders' service model. Based on the purchased services experience of the United Kingdom combined with the situation in China, this paper puts forward some suggestions such as the repositioning the role of the govern-ment, actively supporting the development of civil service organizations and perfecting the legal system of care serv-ices to be purchased, supporting the development of proposals to reduce the burden on the government and enhance the efficiency of care services through improving their quality.

Objective: To understand the energy and major nutrients intake of high school students in Shanghai, and to provide basis for formulating target nutritional interventions and health education. Methods: The probability-proportional-to-size sampling technique was used to select 19 high schools, from which 9 boys and 9 girls from same class were randomly recruited for each grade. A total of 900 high school students were surveyed on their energy and major nutrients intake. Results: The medians of intake of energy, protein, fat, carbohydrate, calcium, sodium, iron, vitamin A, vitamin B-1, vitamin B-2, vitamin C and dietary fiber were 2 353 kcal/d, 97.3 g/d, 95.4 g/d, 265.4 g/d, 602.1 mg/d, 4 373 mg/d, 24.3 mg/d, 495.6 μgRE/d, 1.08 mg/d,1.21 mg/d, 83.2 mg/d and 1.01 g/d, respectively. Among of them, the medians of intake of energy, calcium, vitamin A, vitamin B-1, vitamin B-2, vitamin C and dietary fiber for boys and girls were lower than reference standard(P<0.05). The medians of intake of energy and major nutrients in high school students who lived in countryside were less than those lived in suburban and urban(P<0.05), except carbohydrates and iron. The percentages of energy supplied byprotein, fat and carbohydrate were 16.9%, 37.2%and 46.0%, respectively. Conclusion The energy and calorigenic nutrients intake can meet the demand of daily consumption in high school students in Shanghai, but the intake of dietary fiber, some minerals and vitamins have a various degrees of deficiency. The proportion of energy supplied bycalorigenic nutrients is unbalanced.

Objective: To evaluate the efficacy and safety of compound Lactobacillus acidophilus tablets or Saccharomyces boulardii Sachets combined with standard protocols for eradication of Helicobacter pylori(Hp) in children. Methods: From March 2017 to March 2018, 120 children aged 3-10 years with Hp infection were admitted into the Department of Gastroenterology, Maternal and Child Health Hospital of Hubei Province, including 67 male and 53 female childen.They were divided into 3 groups (control group, compound Lactobacillus acidophilus group, Saccharomyces boulardii Sachets group) by the method of random number table.Control group was given Clarithromycin+ Amoxicillin+ Omeprazole, for 14 days orally; compound Lactobacillus acidophilus group and Saccharomyces boulardii Sachets group were given drugs respectively on the first day, 500 mg of compound Lactobacillus acidophilus was added, twice a day or 250 mg of Saccharomyces boulardii Sachets group, twice a day orally, for 14 days, respectively.The adverse reactions in children were observed during the treatment, andurea ¹³C breath test or the stool Hp antigen test was performed at least 4 weeks by the end of the treatment, and the children with negative results were judged to be eradicated successfully.The ulcer healing, Hp eradication rate and incidence of adverse reactions(nausesa, vomiting, loss of appetite, constipation, diarrhea) among the 3 groups were observed and the Hp eradication rate and the incidence of adverse reactions (nausea, vomiting, loss of appetite, constipation, diarrhea) were compared. Results: The eradication rates in the control group, the compound Lactobacillus group, and Saccharomyces boulardii Sachets group were 80.0% (32/40 cases), 85.0% (34/40 cases), and 87.5% (35/40 cases), respectively, and the difference was not statistically significant (P=0.646); the ulcer healing rate was 100.0% of 101 Hp eradicators in 3 groups, and the ulcer healing rate of 19 cases without Hp eradicated was 48.15%, and there was a significant difference between them (χ²=51.30, P<0.01). However, there was no significant difference in the total effective rate among 3 groups (P>0.05). The overall incidence of adverse reactions in Saccharomyces boulardii Sachets group (P=0.021) and the incidence of diarrhea (P=0.002) and loss of appetite (P=0.021) was lower than that in the control group, and the differences were statistically significant.There was no significant difference in the incidence of adverse reactions between the two probiotic groups (P>0.05). Conclusions Both compound Lactobacillus acidophilus tablets and Saccharomyces boulardii Sachets group can reduce the overall incidence of adverse reactions and the incidence of diarrhea and appetite declines in children′s standard Hp eradication regimen without affecting Hp eradication rate.

Objective:To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods:A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results:One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group( M(IQR),3.0(4.3) vs.4.0(5.8), Z=-2.038, P=0.040).Additionally, the chronic venous insufficiency patients′ quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217, P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference ( χ2=0.453, P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference ( χ2=4.800, P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions:CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

Objective:To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods:A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results:One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group( M(IQR),3.0(4.3) vs.4.0(5.8), Z=-2.038, P=0.040).Additionally, the chronic venous insufficiency patients′ quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217, P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference ( χ2=0.453, P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference ( χ2=4.800, P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions:CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

ObjectiveTo provide basic data of daily dietary intake from various food categories as well as in different regions， seasons， genders， and age groups in Shanghai residents aged 15 and over. MethodsMultistage stratified proportional probability sampling （PPS） was used to extract the samples， and food frequency questionnaire （FFQ） was used to investigate the dietary intake of the subjects in four seasons from 2012 to 2013. The weighted statistical analysis of the samples comprehensively considered the sampling design weights， the stratified adjustment weights， and the non-response adjustment weights. ResultsThe total daily dietary intake （excluding drinking water） of residents aged 15 years and above was 1 174.71 g， and the highest three daily dietary intake categories were cereals （252.31 g）， vegetables （205.36 g） and fruits （141.00 g）. The total daily dietary intake of the residents in the urban area， the suburban area and the rural area was 1 209.15 g，1 172.27 g and 948.50 g， respectively， and the total daily dietary intake in the outer suburb area was significantly lower than that in other areas （F=74.12，P<0.001）. The total daily dietary intake in different seasons was 1 232.47 g in spring， 1 166.80 g in summer， 1 241.15 g in autumn and 1 088.83 g in winter， respectively. The total daily dietary intake in winter was lower than that in other seasons （F=15.96，P<0.001）. Fruits and beverages intake showed apparent seasonality. The total daily dietary intake in male and female residents was 1 234.03 g and 1 112.32 g， respectively， and the total daily dietary intake of male was higher than that of female （F=78.59，P<0.001）. The total daily dietary intake of residents in different age groups was 1 218.64 g for 15‒44 years old， 1 141.27 g for 45‒59 years old， and 1 064.54 g for 60 years old and above （F=20.28，P<0.001）. ConclusionThe daily intake of cereals， livestock and poultry meat， aquatic products， eggs and edible oil is relatively balanced， but the daily intake of vegetables， fruits and milk is relatively insufficient for the residents aged 15 years and above in Shanghai. The daily intake of different food types shows distinguishable characteristics in urban and rural areas， seasons， age groups and genders.

ObjectiveTo conduct comprehensive assessment of internal and external cadmium exposure and health risks for Shanghai residents. MethodsCadmium levels in food samples were calculated by employing two dietary exposure assessment methods， total diet study （TDS） and food frequency questionnaire （FFQ）， to estimate the daily dietary cadmium exposure of Shanghai residents. The provisional tolerable monthly intake （PTMI） of cadmium set by joint food and agriculture organization/WHO expert committee on food additives （JECFA） was applied to evaluate the health risk. Differences in dietary and urinary cadmium were compared by rank-sum test among different regions， age， gender， smoking status， and BMI groups， and the association between internal and external cadmium exposure was investigated by correlation analysis. ResultsThe mean value of urinary cadmium for 1 300 respondents was 0.542 μg·L^-1. Urinary cadmium was higher in the population in central urban and urban-rural fringe areas than in the suburban area， higher in the older age group than in the younger age group， and higher in the smoking group than in the non-smoking group （all P<0.01）. The two assessment methods showed that the mean values of daily dietary cadmium exposure for Shanghai residents were 0.306 and 0.090 μg·kg^-1， with 3.69% and 0.85% of Shanghai residents exceeding the PTMI， respectively. Correlation analyses showed that dietary exposure to cadmium based on the FFQ method was positively correlated with the urinary cadmium level when smoking status， age， gender， and BMI were adjusted. ConclusionDietary exposure to cadmium of Shanghai residents is mainly derived from vegetables， aquatic products， cereals and potatoes， and is overall at a low-risk level. Dietary exposure assessment based on FFQ and risk monitoring data can effectively estimate long-term cadmium exposure.