BACKGROUNDPatient trust in physicians, which can be considered a collective good, is necessary for an effective health care system. However, there is a widespread concern that patient trust in physicians is declining under various threats to the physician-patient relationship worldwide. This article aimed to assess patient trust in physicians through a quantitative study in Shanghai, China, and to provide appropriate suggestions for improving the trust in China.

METHODSThe data from a survey conducted in Zhongshan Hospital and Shanghai Tenth People's Hospital, which are two tertiary public hospitals in Shanghai, were used in this study. Patient trust in physicians was the dependent variable. Furthermore, a 10-item scale was used to precisely describe the dependent variable. The demographic characteristics were independent variables of trust in physicians. Binomial logistic regression was employed to analyze the factors associated with the dependent variable, which was divided into two categories on the basis of the responses (1: Strongly agree or agree and 0: Strongly disagree, disagree, or neutral).

RESULTSThis study found that 67% of patients trusted or strongly trusted physicians. The mean score of patient trust in physicians was 35.4 from a total score of 50. Furthermore, patient trust in physicians was significantly correlated with the age, education level, annual income, and health insurance coverage of the patients.

CONCLUSIONSPatient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician-patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.

Adolescent ; Adult ; Aged ; China ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Physician-Patient Relations ; Trust

BACKGROUNDNational Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women.

METHODSData were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year.

RESULTSFrom 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006.

CONCLUSIONSHealth insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.

Adult ; Female ; Humans ; Income ; Insurance, Health ; Mammography ; utilization ; Middle Aged ; United States

BACKGROUNDAccording to the regulations of the Chinese and Shanghai governments, migrant workers employed in Shanghai should all be entitled to Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have the New Rural Cooperative Medical System (NRCMS). This study aimed to examine the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai.

METHODSQuantitative and qualitative research methods were employed in the study. A survey of 1020 migrant workers employed in Shanghai was conducted in 2010 with a structured questionnaire. Focus group discussions were held with respondents who were unable to maintain health insurance coverage through NRCMS or SMWHI. In-depth interviews were held with village heads and employers of the migrant workers, migrant workers who were hospitalized within the last year, and various individuals employed by the insurance agencies.

RESULTSThe study found that 72.9% and 36.5% of migrant workers were covered by NRCMS or SMWHI, respectively, while 16.7% of them had no health insurance. The coverage by NRCMS among migrant workers correlated significantly with education level and workplace, while the coverage by SMWHI correlated significantly with the length of employment in Shanghai and workplace. The qualitative results confirmed that migrant workers were the main group who were not covered by NRCMS, and the coverage by SMWHI was completely dependent upon the employers of the migrant worker. The results also showed that health insurance utilization among migrant workers was strongly limited by hospital location.

CONCLUSIONSWe observed that the status of health insurance among migrant workers was not accordant with theory, and that Chinese health insurance policy should be further reformed in order to realize full coverage and equal utilization of health insurance among migrant workers in China.

Adolescent ; Adult ; China ; Female ; Humans ; Insurance Coverage ; statistics & numerical data ; Insurance, Health ; statistics & numerical data ; utilization ; Male ; Transients and Migrants ; statistics & numerical data ; Young Adult

This study is designed to serve as a reference for the establishment of health security systems for children’s critical diseases. Through analysis of the operation of Shanghai Children Hospital Care Aid (SCHCA), this study explored the financing model and management of a children’s critical disease healthcare system and analyzed the possibility of expanding this system to other areas. It is found that a premium as low as RMB 7 per capita per year under SCHCA can provide high-level security for children’s critical diseases. With the good experience in Shanghai and based on the current basic medical insurance system for urban residents and the new rural cooperative medical scheme (NRCMS), it is necessary and feasible to build a health security system for children’s critical diseases at the national level.
Adolescent ; Child ; Child Welfare ; Child, Preschool ; China ; Delivery of Health Care ; Health Policy ; economics ; legislation & jurisprudence ; Humans ; Infant ; Infant, Newborn

Biomarkers, Tumor ; metabolism ; Carcinoma, Hepatocellular ; genetics ; metabolism ; CpG Islands ; Cyclin-Dependent Kinase Inhibitor p57 ; genetics ; metabolism ; DNA Methylation ; Gene Expression Regulation, Neoplastic ; Humans ; In Situ Hybridization ; Liver ; metabolism ; Liver Neoplasms ; genetics ; metabolism ; Polymerase Chain Reaction ; methods ; Promoter Regions, Genetic ; RNA, Messenger ; genetics ; metabolism

BACKGROUNDRheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation at the synovial membrane. Although great progress has been made recently in exploring the etiology and pathogenesis of RA, its molecular pathological mechanism remains to be further defined and it is still a great challenge in determining the diagnosis and in choosing the appropriate therapy in early patients. This study was performed to screen candidate RA-associated serum proteins by comparative proteomics to provide research clues to early diagnosis and treatment of RA.

METHODSSera isolated from 6 RA patients and 6 healthy volunteers were pooled respectively and high-abundance proteins were depleted by Plasma 7 Multiple Affinity Removal System. The protein expression profiles between the two groups were then compared by two-dimensional gel electrophoresis (2-DE) and the proteins over/under-expressed by more than 3-fold were identified by mass spectrometry analysis. To validate the differential expression levels of the identified proteins between the two groups, ELISA was performed in two of the identified proteins in individual sera from 32 RA patients and 32 volunteers.

RESULTSEight proteins which over/under-expressed in sera of RA patients were identified. Among them, chain A of transthyretin (TTR) was under-expressed, while serum amyloid A protein, apolipoprotein A (ApoA)-IV, ApoA-IV precursor, haptoglobin 2, ceruloplasmin (Cp), immunoglobulin superfamily 22 and HT016 were over-expressed. ELISA test confirmed that Cp expressed remarkably higher while TTR obviously lower in RA group compared with volunteer group.

CONCLUSIONThere were 8 identified proteins differentially expressed between RA group and volunteer group, which might be candidate RA-associated proteins and might be promising diagnostic indicators or therapeutic targets for RA.

Adult ; Apolipoproteins A ; blood ; Arthritis, Rheumatoid ; blood ; Blood Proteins ; analysis ; Ceruloplasmin ; analysis ; Electrophoresis, Gel, Two-Dimensional ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Middle Aged ; Prealbumin ; analysis ; Proteomics ; Serum Amyloid A Protein ; analysis

OBJECTIVETo investigate the clinical presentation, diagnosis, treatment and outcome of patients with pulmonary veno-occlusive disease (PVOD).

METHODSData from patients diagnosed as PVOD from May 2008 to May 2011 in Shanghai Pulmonary Hospital, Tongji University were retrospectively reviewed.

RESULTSDuring this period, 5 patients [4 female, aged from 12 to 42 (22 ± 12) years old] were diagnosed as PVOD. The durations from symptoms onset to PVOD diagnosis was 2 to 50 (16 ± 20) months and four of them were previously diagnosed as idiopathic pulmonary arterial hypertension. All patients at the time of PVOD diagnosis had a severely impaired WHO pulmonary hypertension functional class (3 in class III and 2 in class IV). Furthermore, all patients characterized by a typical sign of centrilobular ground-glass opacities in high-resolution computed tomography, a markedly reduction of diffusing capacity of the lung for carbon monoxide [(38 ± 12)% of predicted value] in pulmonary functional test and severely compromised cardio-pulmonary hemodynamics identified by right heart catheterization. All patients received conventional and pulmonary arterial hypertension specific therapies, and then followed-up regularly. Up to now, 4 out of 5 patients died due to refractory right heart failure. The durations from symptoms onset to death and from PVOD establish to death were 5 - 65 (27 ± 26) months and 1 - 16 (9 ± 9) months, respectively.

CONCLUSIONSPVOD is a rare and malignant cardio-pulmonary disorder that often be misdiagnosed as idiopathic pulmonary arterial hypertension. Given the poor responses to modern pulmonary arterial hypertension specific therapies, lung transplantation remains the treatment of choice.

Adolescent ; Adult ; Cardiac Catheterization ; China ; Diagnostic Errors ; Familial Primary Pulmonary Hypertension ; pathology ; therapy ; Female ; Hemodynamics ; Humans ; Lung ; Lung Transplantation ; Male ; Pulmonary Veno-Occlusive Disease ; diagnosis ; pathology ; therapy ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo investigate the cellular immune regulation of the long-term intervention of moxa smoke.

METHODSThirty-two Wistar rats were randomly divided into a blank group, a low concentration group, a medium concentration group and a high concentration group, 8 cases in each group. In addition to the blank group, rats in the other groups were exposed to the corresponding concentration moxa smoke for 20 min every day, the T lymphocyte subsets and proportion of the CD4+ CD25+ Treg in CD4+ T cells in peripheral blood were tested by flow cytometry after 6 months.

RESULTSCompared with the blank group, the proportions of CD3+ CD4+, CD3+ CD8+ T cells and CD3+ CD4/CD3+ CD8+ in the other 3 moxa smoke groups were not significantly different (P > 0.05), while the proportions of the CD4+ CD25+ Treg in CD4+ T cells were significantly lower (P < 0.05), but no statistically significant differences among those 3 moxa smoke intervention groups (P > 0.05).

CONCLUSIONLong-term moxa smoke intervention has no significant effect on the proportions of CD3+ CD4+, CD3+ CD8+ T cells and CD3+ CD4+/CD3+ CD8+, but it can decrease the proportions of the CD4+ CD25+ Treg in CD4+ T cells in peripheral blood of rats. The way produced by pretreatment with moxa smoke may play immunomodulatory effect.

Animals ; Lymphocyte Count ; Male ; Moxibustion ; Rats ; Rats, Wistar ; Smoke ; analysis ; T-Lymphocyte Subsets ; drug effects ; immunology ; T-Lymphocytes, Regulatory ; drug effects ; immunology ; Time Factors