ObjectiveTo improve the response capabilities to disasters and prevent major epidemics， it is of practical use to study the capability evaluation system of the national emergency medical rescue team that combines theoretical training and practical exercises， to enhance the overall quality of the teams. MethodsFirst， a capability assessment system for the national emergency medical rescue team was constructed based on the INSARAG External Classification （IEC） standards of the national emergency medical rescue team. Then， based on the outcome based education （OBE） concept， we conducted innovative research on the curriculum design and exercise programs for team building and member training. Finally， an empirical analysis was conducted on the effectiveness of the evaluation system and training exercises based on the statistical analysis of the comprehensive quality evaluation of the Shanghai national emergency medical rescue team from 2020 to 2023， as well as the empirical analysis of the rescue exercise on the Cruise of spectrum. ResultsBased on the linear regression analysis of each core competency indicators， the five core competencies in the evaluation system， including rescue skills， medical and health knowledge， disaster coping ability， team cooperation ability， and mental resilience training， were positively correlated with the cumulative number of trainings （r=0.71， r=0.76， r=0.81， r=0.84， r=0.96，all P<0.05）， indicating that the training was effective and the course design was reasonable. Empirical cases showed that the three-dimensional rescue drill model had remarkable results in the actual combat application and ability improvement of team members. ConclusionThe training courses and drills designed based on the three-level assessment system are effective in improving the comprehensive capabilities of the national emergency medical rescue team.

Objective To understand the serotype,molecular typing and drug sensitivity characteristics of Salmonella isolated from food and stool samples of diarrhea patients in Nan'an District of Chongqing.Methods A total of 71 Salmonella strains isolated from food and stool samples of diarrhea patients in Nan'an District of Chongqing from 2019 to 2022 were serotyped,and the drug resistance of the strains was determined by the micro-broth dilution method.Multilocus sequence typing(MLST)was performed on 2 Salmonella Ken-tucky strains,and whole genome sequencing was performed on 8 Salmonella typhimurium strains and 2 Sal-monella typhimurium variants.Results The 71 strains of Salmonella included 13 serotypes.A total of 48 Sal-monella strains were isolated from stool samples of diarrhea patients,with Salmonella typhimurium(56.25％,27/48)and Salmonella enteritidis(18.75％,9/48)as the main serotypes.A total of 23 Salmonella strains were isolated in food samples,with Salmonella Rissen(26.09％,6/23)as the predominant.The total drug re-sistance rate of 71 strains of Salmonella was 97.18％.The highest drug resistance rate was ampicillin(69.01％),followed by tetracycline(64.79％),compound sulfamethoxazole(43.66％)and chloramphenicol(43.66％).The multidrug resistant strains accounted for 61.97％(44/71),including 60.42％(29/48)of stool samples of diarrhea patients and 65.22％(15/23)of food samples.The two Salmonella Kentucky strains iso-lated from food and diarrhea patients were resistant to 7 and 8 types,respectively,with the largest number of drug resistant types in the corresponding samples.The MLST types of both Salmonella Kentucky strains was ST198 type.The MLST types of 8 Salmonella typhimurium strains selected for sequencing were ST19,and the MLST types of 2 Salmonella typhimurium monophasic variants were ST34.The genetic relationship of Salmo-nella typhimurium with the same ST type was different.Conclusion The serotypes of Salmonella isolated from Nan'an District of Chongqing are diverse and the drug resistance is serious.The detection of ST198 Sal-monella Kentucky is more accurate by using whole genome sequencing than MLST.The surveillance of Sal-monella serotypes,molecular typing and drug resistance should be strengthened.

In recent years, researchers have found that patients with nonalcoholic fatty liver disease (NAFLD) often have urolithiasis, and the incidence of urolithiasis increases gradually with the severity of NAFLD. Meanwhile, the detection rate of NAFLD was higher in patients with urolithiasis than in normal controls. In this paper, we reviewed the domestic and international studies on the correlation between urolithiasis and NAFLD and described the related pathogenesis, such as insulin resistance, oxidative stress, abnormal lipid metabolism and impaired glyoxalate detoxification. Meanwhile, this paper proposed preventive measures to reduce the risk of development and recurrence of NAFLD-associated urolithiasis by addressing the common risk factors of both diseases, including metabolism-related diseases, lifestyle and diet.

Objective: To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform. Methods: A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index. Results: The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability. Conclusions In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.

Objective: To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform. Methods: Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity. Results: 29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken. Conclusions The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.

Family physicians contracted service is an important choice to deepen the reform of China′s healthcare reform and achieve the strategic goal of " health for all" . In order to effectively promote the contracted service, the central government has successively issued a number of policy documents, which are echoed by the localities in their proactive explorations, achieving remarkable results. But there are also multiple roadblocks hindering the contracted service to progress. This article referred to the three-circle theory and studied policy implementation from the three dimensions of policy value, policy resources, and policy impetus. A thorough analysis of the problems in the implementation process revealed such main problems as insufficient family physicians, inadequacy of supporting policies and low level of policy acceptance among the young healthy age groups. The follow-up work will promote the long-term implementation of the family physicians contracted service policy by enriching the family physicians team, enriching supporting policies, and focusing on promotions to key age groups.

Objective To analyze the dilemmas of our hierarchical medical system, in order to seek a viable path for effective implementation.Methods Based on the Meter-horn model, six related factors were used, including policy standards and goals, policy resources, implementation methods, characteristics of the actuator, value orientation of the executive and the system environment, to analyze the dilemmas of the implementation of hierarchical medical system.Results This policy had not achieved the expected effect in the implementation process, which deviated from the original intention of policy designers to some extent. There exist the following setbacks for the roadblocks. For example, policy standard was ambiguous, the policy resources were insufficient, the execution method was not proper, the implementation mechanism was"criticized" , the implementation personnel value orientation was biased and the complex system environment.Conclusions All the factors involved in the implementation of the hierarchical medical policy affect each other.In this consideration, medical institutions at all levels and the relevant departments should coordinate and deal with the relationship between these six related factors, and timely take effective measures to amend and improve the policy, so as to ensure the orderly progress and long-term implementation of the hierarchical medical system.

Objective: To investigate the usage of medical and health care APP among female college students, and to understand possible influencing factors, so as to provide reference for medical health care behaviors and personal health among college students. Methods: A stratified random sampling method was used to select 891 female college students from 3 colleges in Weifang. A questionnaire survey on their concentration on their own health, the knowledge, cognition and behavior of medical and health care APP, and Logistic regression analysis was used to analyze the influencing factors. Results: There were 55.4% female college students who had used medical and health care APP, and most of them (290) had used fitness and weight loss APP. There was statistical significance of the different usages of students of different degrees, majors and grades(χ2=26.55, 7.72, 13.96, P<0.05). Logistic regression analysis showed that educational background, annual medical costs, awareness of medical and health care APP and attitude towards APP prospect were the factors influencing the utilization of medical and health care APP (OR=0.44，0.69，1.36，1.23，P<0.05). Conclusion The usage rate of medical and health care APP is general, and sustained utilization rate is low, the APP should enrich menstrual period consumption and figure report, add video recommendation, interactive dating, and other functions, improve female students medical and health care APP cognition, female college students to change health care APP attitude.

Objective To systematic review the influence of case-based payment on inpatient costs since China′s new medical reform. Methods Studies about inpatient costs before and after the implementation of case-based payment were collected. The literature collected underwent a meta-analysis by RevMan 5. 0. Results A total of 11 articles in compliance were included in the study. The meta-analysis of random effect model showed the overall effect size (SMD) was -1. 54 with 95% CI being -1. 79, -1. 29, showing a significant difference (P<0. 05). The subgroup analysis showed that the overall effect size (MD) in the low-cost disease group was -585. 57 yuan with 95% CI being -750. 34, -420. 80, showing a significant difference (P < 0. 05). The overall effect size (MD) in the high-cost disease group was-4 172.65 yuan with 95% CI being -5 368. 21, -2 977. 10, showing a significant difference ( P <0.05). The funnel plot was approximately symmetrical, suggesting a publication bias as less likely in the study. Conclusions The implementation of case-based payment has reduced the inpatient costs to some extent thanks to China′s new healthcare reform. And the effect in the high-cost disease group was more obvious than that in the low-cost disease group.

There is growing interest in the whole saliva as a diagnostic fluid because of the relatively simple and non-invasive collection.Research on salivary proteomic and genomic has greatly facilitated the diagnosis and therapy of oral diseases,also revealed the molecular mechanism of the diseases.Saliva-derived exosome as a new source,with various molecular constituents of their cells of origin,including proteins,mRNA and miRNA might serve as potential biomarker.This article reviews the biological properties of saliva exosome,its separation and other aspects associated with disease.