Objective:To evaluate the strengths and weaknesses of the total payment policy in China′s county medical community (CMC), and to provide decision-making basis for the high-quality development of CMC and its medical security system.Methods:Official websites of China′s provincial and prefectural governments, the Health Commission and the Medical Security Bureau were searched for policies related to total payment in CMC (issued from May 2019 to December 2023), and 10 representative sample policies were selected based on the balance of the temporal and spatial distribution and the completeness of the content. The policy modeling consistency (PMC) index model was used to quantitatively evaluate the sample policies by identifying primary and secondary variables.Results:The PMC index model variables for the total payment policies in CMC included 10 primary variables such as policy nature, policy timeliness, and policy receptors, and 54 secondary variables such as prediction, recommendation, and regulation. The average PMC index score for the 10 sample policies is 6.86, which was generally at a good level, with five policies each of excellent and good grades. In terms of the primary indicators, the policy nature (0.77), policy receptor (0.82) and policy content (0.73) scored highly, while the policy timeliness (0.35), policy synergy (0.54) and guarantee mechanism (0.53) scored lowly. A comparison of the two policies with the highest and lowest scores revealed that the main reasons for the low scores were the single setting of policy objectives, the lack of dynamic monitoring of key indicators and the inadequacy of guarantee mechanisms such as multisectoral collaboration.Conclusions:China′s total payment policy in CMC was generally better, but it still needed to be strengthened in terms of policy timeliness, policy synergy and guarantee mechanism. It was recommended that local governments can optimize policies by comprehensively considering the timeliness of long-medium-and short-term policies, giving full play to the synergistic effects of medical security policies, and improving the multi-dimensional co-management and guarantee mechanism.

Objective To explore the impact of urban and rural resident basic medical insurance(URRBMI)integration policy on the health and health inequality of middle-aged and elderly people,and to provide an evidence-based basis for further improving the URRBMI system.Methods Based on data from the China health and retirement longitudinal study(CHARLS)from 2013 to 2018,the impact of the URRBMI integration policy on the self-rated health,disability,and depression of middle-aged and elderly people was investigated using the staggered differences-in-differences method.The health inequality status of middle-aged and elderly people and its change trend were analyzed by the concentration index,and the index was decomposed according to different years and different integration modes to explore the impact of URRBMI on health inequality of middle-aged and elderly people.Results A study was conducted on 7589 middle-aged and elderly individuals,which found that the URRBMI integration policy had a significant positive impact on the self-rated health of this population(OR=1.309,P<0.001).Additionally,the policy had a significant negative impact on the occurrence of depression(OR=0.696,P<0.001).However,it was found to increase the disability score of middle-aged and elderly individuals(β=0.354,P<0.001)and did not improve their disability status.In addition,health disparity exists among middle-aged and elderly people in China,and middle-aged and elderly people with health problems are mainly concentrated in groups with lower socioeconomic status,and health disparity has been increasing over time.Health insurance for urban and rural residents has a certain effect on alleviating health inequality,the contribution rate of disability inequality and depression inequality decreased from 1.21%and 1.20%in 2013 to-0.58%and 0.31%in 2018,respectively,and compared with the one-tier model,the split-tier system has a greater negative impact on the health status of low-income groups.Conclusion The URRBMI integration policy improved the self-rated health and depression status of middle-aged and elderly people,but had a limited effect on improving the disability status.The policy can reduce the health inequality of middle-aged and elderly people to some extent,but the health inequality varies widely within the population.It is recommended to strengthen the top-level design of URRBMI,to shift from a strategy that emphasizes medicine over prevention to one that emphasizes prevention and combines prevention and treatment,and to shift from formal equity based on the elimination of household boundaries to substantive equity based on the elimination of reimbursement policies and other barriers.

Objective To explore the impact of urban and rural resident basic medical insurance(URRBMI)integration policy on the health and health inequality of middle-aged and elderly people,and to provide an evidence-based basis for further improving the URRBMI system.Methods Based on data from the China health and retirement longitudinal study(CHARLS)from 2013 to 2018,the impact of the URRBMI integration policy on the self-rated health,disability,and depression of middle-aged and elderly people was investigated using the staggered differences-in-differences method.The health inequality status of middle-aged and elderly people and its change trend were analyzed by the concentration index,and the index was decomposed according to different years and different integration modes to explore the impact of URRBMI on health inequality of middle-aged and elderly people.Results A study was conducted on 7589 middle-aged and elderly individuals,which found that the URRBMI integration policy had a significant positive impact on the self-rated health of this population(OR=1.309,P<0.001).Additionally,the policy had a significant negative impact on the occurrence of depression(OR=0.696,P<0.001).However,it was found to increase the disability score of middle-aged and elderly individuals(β=0.354,P<0.001)and did not improve their disability status.In addition,health disparity exists among middle-aged and elderly people in China,and middle-aged and elderly people with health problems are mainly concentrated in groups with lower socioeconomic status,and health disparity has been increasing over time.Health insurance for urban and rural residents has a certain effect on alleviating health inequality,the contribution rate of disability inequality and depression inequality decreased from 1.21%and 1.20%in 2013 to-0.58%and 0.31%in 2018,respectively,and compared with the one-tier model,the split-tier system has a greater negative impact on the health status of low-income groups.Conclusion The URRBMI integration policy improved the self-rated health and depression status of middle-aged and elderly people,but had a limited effect on improving the disability status.The policy can reduce the health inequality of middle-aged and elderly people to some extent,but the health inequality varies widely within the population.It is recommended to strengthen the top-level design of URRBMI,to shift from a strategy that emphasizes medicine over prevention to one that emphasizes prevention and combines prevention and treatment,and to shift from formal equity based on the elimination of household boundaries to substantive equity based on the elimination of reimbursement policies and other barriers.

Objective:To evaluate the strengths and weaknesses of the total payment policy in China′s county medical community (CMC), and to provide decision-making basis for the high-quality development of CMC and its medical security system.Methods:Official websites of China′s provincial and prefectural governments, the Health Commission and the Medical Security Bureau were searched for policies related to total payment in CMC (issued from May 2019 to December 2023), and 10 representative sample policies were selected based on the balance of the temporal and spatial distribution and the completeness of the content. The policy modeling consistency (PMC) index model was used to quantitatively evaluate the sample policies by identifying primary and secondary variables.Results:The PMC index model variables for the total payment policies in CMC included 10 primary variables such as policy nature, policy timeliness, and policy receptors, and 54 secondary variables such as prediction, recommendation, and regulation. The average PMC index score for the 10 sample policies is 6.86, which was generally at a good level, with five policies each of excellent and good grades. In terms of the primary indicators, the policy nature (0.77), policy receptor (0.82) and policy content (0.73) scored highly, while the policy timeliness (0.35), policy synergy (0.54) and guarantee mechanism (0.53) scored lowly. A comparison of the two policies with the highest and lowest scores revealed that the main reasons for the low scores were the single setting of policy objectives, the lack of dynamic monitoring of key indicators and the inadequacy of guarantee mechanisms such as multisectoral collaboration.Conclusions:China′s total payment policy in CMC was generally better, but it still needed to be strengthened in terms of policy timeliness, policy synergy and guarantee mechanism. It was recommended that local governments can optimize policies by comprehensively considering the timeliness of long-medium-and short-term policies, giving full play to the synergistic effects of medical security policies, and improving the multi-dimensional co-management and guarantee mechanism.

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

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.

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.