Objective This paper explores the role of long-term care insurance(LTCI)in China on the unmet long-term care needs of middle-aged and elderly people and its influencing factors.Methods Based on China health and retirement longitudinal study data for 3 periods from 2013 to 2018.We use difference-in-difference method to explore the impacts of LTCI on unmet long-term care needs of middle-aged and elderly people.Results The implementation of LTCI resulted in an average release of 0.051 long-term care needs(P＜0.1)and an average increase of 0.045 unmet long-term care needs(P＜0.05)among middle-aged and older adults aged 45 years and older in China.Heterogeneity analysis shows that the implementation of LTCI promotes the growth of long-term care needs and unmet needs of residents in urban areas,rural hukou residents,high-income residents and moderately and severely disabled residents.Conclusion Our findings demonstrate the role of LTCI in reducing family caregiving burden and promoting the release of caregiving demand,and provide guidance for the further promotion of LTCI in China.

Objective This study aimed to explore the impact of Urban and Rural Resident Basic Medical Insurance(URRBMI)on the healthcare utilization for middle-aged and older adults,in order to provide evidence for the optimization of China's medical security system.Methods This study used data from the China Health and Retirement Longitudinal Study(CHARLS)in 2018.Based on a modified Andersen's behavioral model,we applied Probit model,Tobit model and Biprobit model to analyze the impact of URRBMI on the use of healthcare for middle-aged and older people,as well as the impact of outpatient services on inpatient services.Results A total of 8753 cases were investigated.The proportions of outpatient and inpatient were 18.83%and 19.75%respectively,and the participation rate of URRBMI was 96.38%.Participation in URRBMI had an effect on inpatient care utilization of middle-aged and older people(P<0.05),with an average increase of 11.2%in the probability of hospitalization and an average increase of 0.232 hospitalizations.However,URRBMI had no effect on outpatient services(P>0.05),and there was a positive relationship between outpatient and inpatient.In addition,the utilization of inpatient services was higher among those aged 60 years and older and those with urban households.Conclusion URRBMI has improved the utilization of inpatient services among middle-aged and elderly people,but there are problems of over-utilization of inpatient services.There are differences in the impact of URRBMI on the utilization of inpatient services among different age groups and household type groups.The government should further improve the reimbursement mechanism of URRBMI to guide residents to seek medical treatment reasonably and improve the equity of healthcare utilization.

Objective:To explore the CT three-dimensional reconstruction in percutaneous balloon compression of the semilunar ganglion of trigeminal nerves.Methods:Thirty-one patients with trigeminal neuralgia, admitted to our hospital from May 2018 to August 2018, were treated by percutaneous balloon compression of the semilunar ganglion of trigeminal nerves. All patients underwent intraoperative mobile CT scan; the distance from the external aperture of foramen ovale to the petrous ridge, the angle from puncture needle and the petrous ridge, and the angle from puncture needle and the clivus were analyzed by three-dimensional reconstruction technology. Prognoses were recorded immediately after surgery and 10-12 months after follow-up.Results:The distance from the external aperture of foramen ovale to the petrous ridgea was (2.14±0.17) cm, ranged from 1.83 cm to 2.42 cm. The angle from puncture needle and the petrous ridge was (102.03±7.60)°, ranged from 91.00° to 116.00°. The angle from puncture needle to the clivus was (68.03±7.06)°, ranged from 52.00° to 80.00°. The puncture succeeded in all patients under the help of CT three-dimensional reconstruction. The volume of the inflated balloon ranged from 0.30 cm 3 to 0.47 cm 3 (averaged 0.42±0.05 cm 3). The compression time ranged from 3.00 min to 5.00 min (averaged 4.72±0.53 min). The incidence of diplopia was 3.23%, and the incidence of dry eyes/decreased corneal sensation was 12.90%. During the follow-up, one patient relapsed 10 months after surgery; the left patients recovered with disappeared complications. Conclusion:The CT 3D reconstruction can reduce the difficulty of ovale foramen puncture during operation, assist the judgment and adjustment of intraoperative balloon volume, and improve the surgical efficacy.

BACKGROUND: Both aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism and lifestyle behaviors are involved in coronary artery disease (CAD), while the interaction between them is currently unknown. METHODS: A nested case-control study was conducted in 161 patients with CAD and 495 controls in dyslipidemia population in Yinzhou District, Ningbo, Zhejiang Province, China, in August 2013. Anthropometric data and blood samples were collected, demographic characteristics and lifestyle behaviors information were obtained by a face-to-face interview, dietary intake was assessed by a food frequency questionnaire, and genomic DNA was genotyped. RESULTS: Carriers with increasing number of A alleles had an elevated CAD risk compared with G allele carriers (adjusted OR = 1.483, 95% CI = 1.114-1.974). Carriers of rs671 A/G and A/A genotypes had a higher CAD risk than carriers of G/G genotype (adjusted OR = 1.492, 95% CI = 1.036-2.148). Similarly, individuals with rs671 A/A genotype had a higher CAD risk than individuals with A/G and G/G genotypes (adjusted OR = 2.161, 95% CI = 1.139-4.101). We found a borderline additive interaction between regular fried food intake and A/A and A/G genotypes, and a significantly additive interaction between sedentary/light physical activity and A/A and A/G genotypes. CONCLUSIONS Individuals with A/A or A/G genotypes of rs671 have a higher CAD risk, if they lack physical activity and take fried food regularly, than individuals with G/G genotypes. These findings can help to provide a guide to targeted heart health management.
Adult ; Aged ; Aged, 80 and over ; Aldehyde Dehydrogenase, Mitochondrial ; genetics ; Alleles ; Case-Control Studies ; China ; Coronary Artery Disease ; blood ; genetics ; Dyslipidemias ; blood ; genetics ; Female ; Genetic Association Studies ; Genetic Predisposition to Disease ; Genotype ; Humans ; Life Style ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Risk Factors

Objectives To explore the relationships between the current physical exercise behaviors and psychological factors of middle school students,so as to provide scientific evidence for improving health education and carrying out targeted health intervention measures.Methods The Multi-stage stratified sampling and cluster sampling method was adopted to choose 3600 students from 12 junior and senior middle schools in Hangzhou,Wuhan and Xi'an.The date was collected using the adolescent physical exercise behavior-psychological measurement scale(Chinese version).The structural equation model was built to explore the relationships between psychological factors(including the change of strategy,decision balance positive effect,decision balance negative effect and self-efficiency)and physical exercise.Results The change of strategy has biggest effect on physical exercise behaviors,with the standardized direct effect value of 0.344.The standardized direct effect value of decision balance negative effect,decision balance positive effect and self-efficiency were 0.071,0.093 and 0.169 respectively.The negative correlation among the four dimensions was significant statistically.Conclusion Psychological factors have direct effects on the change of the behaviors,and the change of the strategy has the largest impact on physical exercise behaviors of middle school students.The four psychological factors are closely correlated with one another,which is important in formulating middle school sports programs to promote the physical quality of middle school students.

Objective: To investigate the situation of social support (SS), and explore its relationship with antenatal depression (AD) among Zhejiang primiparas in their third trimesters. Methods: From March to August 2016, a cross-sectional study was conducted and the questionnaire was used at the outpatient consulting room of one maternity hospital in Hangzhou. Inclusion criteria includes the primiparas over 18 years old, gestation from 30 to 36 weeks, been able to understand and complete the questionnaires independently, no family history and history of mental disorders and no use of psychotropic drugs, without serious illness and so on. Exclusion criteria was that the primiparas were unable to complete all the contents of the questionnaire and of poor compliance. 1 150 questionnaires were actually given out, and 1 075 questionnaires were valid, so the valid rate was 93.48%. AD was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) and SS was evaluated by the Perceived Social Support Scale (PSSS). SS between the non-AD group and the AD group was compared. The correlation between SS and AD was analyzed. Binary logistic regression model was used to assess the relationship between SS and AD. The level of SS was divided by average scores, groups lower than the average score was defined as the low-score group, groups higher than the average score was defined as the high-score group. Results: The prevalence of AD (score≥9) was 27.3% (293/1 075) among Zhejiang primiparas in their third trimesters. The scores of family support, friend support and other support, and the total score of SS among the non-AD group were 24.80±2.83, 23.40±3.00, 21.91±3.54 and 70.11±7.92, respectively, which were higher than those in the AD group (22.71±3.88, 21.45±3.59, 19.95±3.97, 64.10±10.01), (t values were 8.43, 8.29, 7.83 and 9.25, respectively, P<0.001 for all). The scores of family support, friend support and other support, and the total score of SS were negatively correlated with AD (rs values were-0.26,-0.25,-0.22 and-0.28, respectively, P<0.001 for all). Compared with low-score group, the scores of family support, friend support and other support, and the total score of SS among the high-score group had a lower risk of antenata depression among primiparas in their third trimesters, OR(95%CI) values were 0.56 (0.41-0.77), 0.66(0.47-0.92), 0.57(0.41-0.79) and 0.36(0.27-0.48), respectively. Conclusion The prevalence of AD among Zhejiang primiparas was relatively high, and AD was negatively associated with SS level. We suggest adding SS in community pregnancy health management service in the future.

OBJECTIVETo learn the dietary fat intake behavior status and influencing psychological factors in teenagers.

METHODSAccording to the multi-stage stratified cluster sampling method, students were recruited from middle and high schools in Hangzhou, Wuhan and Xi'an from March to May, 2012. Chinese version of adolescent dietary fat intake behavior of psychological measurement scales was utilized in field investigations with 3 448 effective questionnaires. Under the transtheoretical model, the status quo of teenagers fat intake behavior was analyzed and it shows the relationship between stages and psychological variables, including strategy of change, decision balance and self-efficacy.

RESULTSIn the 3 448 participants, the proportion of girls were 52.4% (1 806/3 448) and boys were 47.6% (1 642/3 448), while the mean age was (14.85 ± 1.46). There are significant differences among distributed stages of behavior change, grouped by gender, grade and region (χ(2) values were 33.59, 20.53, 27.92, P < 0.001). In different gender groups, the number of boys in precontemplation came to the first and accounted for 24.2% (438/1 806), and the number of girls were more in contemplation and preparation stage, which accounted for 49.5% (813/1 642), and it was the least both in the action stage with the ratio 12.1% (218/1 806) and 14.7% (241/1 642) respectively; in different grade groups, the numbers of student in middle school and high school were the largest in contemplation and precontemplation stage, accounted for 24.9% (494/1 986) and 23.4% (343/1 462); and among different regions, the proportion in precontemplation, contemplation and preparation stage was not a few, and this ratio in Hangzhou, Wuhan, Xi'an area was 70.6% (801/1 135), 61.7% (649/1 052) and 68.8% (867/1 261), respectively. The number in action stage was the least of all, which were 144, 147, 168, respectively. Ordinal logistic mode showed that the four variables, including the scores of process of change, decision balance (pros), decision balance (cons) and self-efficacy, were factors which significantly affected the stages of behavior change, which showed a significant difference (F values were 155.12, 19.86, 44.59, 94.27, P < 0.001) in different stages. From precontemplation stage to action stage, the score of the process of change, decision balance (pros) and self-efficacy showed an upward trend, and achieved the highest score in the action stage (from 32.6 ± 12.8, 8.4 ± 2.9, 19.7 ± 6.9 to 48.4 ± 12.6, 10.1 ± 2.5, 25.9 ± 6.9, respectively); contrarily, the decision balance (cons) decreased with the development of behavioral stage (from 14.7 ± 4.4 to 12.2 ± 3.9). Post hoc comparison also found that the score of process of change, decision balance (pros) and self-efficacy after action stages were higher than those before action, while the score of decisional balance (cons) in the precontemplation stage was higher than that in the other 4 stages.

CONCLUSIONFat intake behavior in teenagers showed different stages, whose psychological factors had significant influences, with decision balance (pros) hindered the progress of stages of behavior change, while other three factors played a positive role.

Adolescent ; Adolescent Behavior ; Decision Making ; Dietary Fats ; Female ; Humans ; Male ; Models, Theoretical ; Self Efficacy ; Students ; Surveys and Questionnaires

OBJECTIVETo develop a suitable fat intake behavior of psychological measurement scales for the Chinese adolescents and evaluate its validity and reliability.

METHODSAccording to the multi-stage stratified cluster sampling principle, a total of 3 600 junior students were recruited from the classes in 12 selected high schools in Hangzhou, Wuhan and Xi'an from March to May, 2012. Based on introducing and translating the original scale abroad, Chinese version of adolescent fat intake behavior of psychological measurement scales was utilized in field investigations. The reliability was assessed, using Cronbach's α and split-half reliability; while exploratory factor analysis used to test its validity, with entries-dimension correlation coefficient (IIC), correlation coefficient between the scores and the dimension, and the dimension of correlation coefficient test content validity.

RESULTSThe valid subject of the study was 3 448(of whom males were 52.4% (1 806/3 448) and female were 47.6% (1 642/3 448)), while the mean age was (14.85 ± 1.46) years old. The internal consistency reliability (Cronbach's α) for total scale score and four domains were 0.922,0.933, 0.660, 0.773 and 0.869 respectively, whose split-efficacy reliability were separately 0.927, 0.933, 0.790, 0.624 and 0.889. Data from the exploratory factor analysis revealed the following dimensions:the entries were all inclusive, with the cumulative contribution rate at 59.453%, 56.062% and 52.668%, respectively. The results of IIC showed that in the four dimensions, the contained entries between Spearman correlation coefficient have statistically significant, with the r value range of 0.584-0.793, 0.665-0.818, 0.654-0.765 and 0.622-0.747 severely, while other dimensions from weak to moderate relationships, the r value ranged from -0.028 to 0.614.

CONCLUSIONThe reliability and validity of the adolescent fat intake behavior of psychological measurement scales (Chinese version) were good, and could be used to measure the fat intake behavior of psychological conditions in Chinese adolescents.

Adolescent ; Dietary Fats ; Eating ; psychology ; Feeding Behavior ; Female ; Humans ; Male ; Psychological Tests ; Students ; psychology ; Surveys and Questionnaires

Objective To explore the relationship of different body mass index, waist circumference and serum lipid levels with essential hypertension among residents of Ningbo. And to explore the predictive value of BMI and WC (Waist Cir-cumference) for hypertension. Methods Adopting cluster sampling, 2 303 people (1 081 cases of hypertension and 1 222 people with normal blood pressure) were collected in the four townships of Ningbo City. We conducted questionnaires, physi-cal examination and blood lipid testing for all of subjects. WC group:WC≥85 cm in male or WC≥80 cm in female is central obesity, and the others are normal. BMI groups:BMI≥24 kg/m2 is overweight, and BMI<24 kg/m2 is normal. The relationship of BMI, WC and serum lipid levels with hypertension was analyzed by multivariate unconditional logistic regression model. The predictive value of BMI and WC for hypertension was analyzed by receiver operating characteristic (ROC) curve. Results WC, BMI, total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) in hypertension group were higher than those in control group (P<0.01). And WC, BMI, TG, LDL-C is the impact factor for hypertension. The overweight rate and central obesity rate in hypertension group were higher than control group (P<0.01). TG and LDL-C level abnormality, overweight and central obesity were the risk factors of hypertension. As a risk factor of hypertension, over-weight with central obesity group is higher than overweight with normal waistline group, simple central obesity group and nor-mal group. In the area under the ROC curve, BMI is higher than WC in both male and female population. Conclusion WC, BMI, TG and LDL-C abnormalities were risk factors for hypertension, and BMI was a better predictive factor for hyper-tension than WC.

Objective To Investigate the mechanism of augmenter of liver regeneration (ALR) in promoting proliferation of damaged hepatocyte. Methods The inhibitory effects of ALR on the expression of TGF-?_1 in hepatic stellate cell and Kupffer cell were studied by immunohistochemistry and Western blot. The effects of hepatic stellate cell (Ito cell) conditioned medium (ICCM+) and Kupffer cell conditioned medium (KCCM+) prepared by treatment of using augmenter of liver regeneration (ALR) on damaged hepatocytes proliferation were studied by MTT. The antagonistical role of ALR on TGF-?_1, which inhibited damaged hepatocyte proliferation was investigated by MTT determination. Results Immunoreactive positive signal of TGF-?_1 in hepatic stellate cell and Kupffer cell stimulated by ALR were decreased. Immunolabeling of TGF-?_1 in hepatic stellate cell stimulated by ALR was weakened. The proliferation of damaged hepatocytes was increased significantly by administration of ICCM and KCCM. ALR could reverse the inhibitory role of TGF-?_1 on the proliferation of damaged hepatocyte. Conclusion ALR can promote proliferation of injured hepatocyte indirectly by inhibiting expression of TGF-?_1 in hepatic stellate cell and Kupffer cell.