[Association rule regarding chronic disease-relevant risk factors for the adults in Haidian District].

OBJECTIVE: To investigate the association patterns of chronic disease-relevant risk factors for the adults in Haidian District.
 Methods: Data for chronic disease-relevant risk factors for 3 219 adults in Haidian District in 2014 were collected and analyzed. SPSS 18.0 was used for statistical description and logistic regression. SPSS Modeler 14.1 was used to explore the association among the chronic disease-relevant risk factors.
 Results: Among men, 5 patterns of chronic disease-relevant risk factors were identified, which suggested that heavy drinking, inadequate intake of fruit and vegetables, and physical inactivity were associated with smoking while inadequate intake of fruit and vegetables and smoking were associated with physical inactivity. Among women, one pattern of chronic disease-relevant risk factor was identified, which suggested that inadequate intake of fruit and vegetables was associated with physical inactivity.
 Conclusion: Chronic disease-relevant risk factors are intercorrelated among the adults in Haidian District. Information on patterns of chronic disease-relevant risk factors could assist interventions targeting multiple behaviors simultaneously.

[Study on out-of-pocket expenditure and related factors among cancer inpatients with Hunan Provincial Urban Employee Basic Medical Insurance].

OBJECTIVE: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
 METHODS: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
 RESULTS: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
 CONCLUSION: OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.

Assessment of the Chinese Resident Health Literacy Scale in a population-based sample in South China.

BACKGROUND: A national health literacy scale was developed in China in 2012, though no studies have validated it. In this investigation, we assessed the reliability, construct validity, and measurement invariance of that scale. METHODS: A population-based sample of 3731 participants in Hunan Province was used to validate the Chinese Resident Health Literacy Scale based on item response theory and classical test theory (including split-half coefficient, Cronbach's alpha, and confirmatory factor analysis). Measurement invariance was examined by differential item functioning. RESULTS: The overall Cronbach's alpha of the scale was 0.95 and Spearman-Brown coefficient 0.94. Confirmatory factor analysis showed that the test measured a unidimensional construct with three highly correlated factors. Highest discrimination was found among participants with limited to moderate health literacy. In all, 64 items were selected from the original scale based on factor loading, Pearson's correlation coefficient, and discrimination and difficulty parameters in item response theory. Measurement invariance was significant but slight. According to the two-level linear model, health literacy was associated with education level, occupation, and income. CONCLUSIONS: The 2012 national health literacy scale was validated, and 64 items were selected based on classical test theory and item response theory. The revised version of the scale has strong psychometric properties with minor measurement invariance.

[Satisfaction degree in outpatients and the influential factors at national essential medicine system in primary health care institutions of Yiyang].

OBJECTIVE: To analyze the satisfaction degree in outpatients and influential factors at national essential medicine system in primary health care institution of Yiyang and to provide useful information for the sustainable development of the national essential medicine system in China.
 METHODS: A multi-stage random sampling method was conducted. A total of 525 outpatients were randomly selected in 21 primary health care institution. Their satisfaction degree on national essential medicine system were investigated through anonymous survey.
 RESULTS: Categories of medical institutions, age, education, medicare categories and occupation were influential factors, with statistical significance (P<0.05). 
 CONCLUSION: There's no difference among different class of outpatients' attitude on national essential medicine system. Categories of medical institutions, age, education, medicare categories and occupation are influential factors for outpatients' attitude.

[Effect of implementation of essential medicine system in the primary health care institution in China].

Our primary health care institution began to implement national essential medicine system in 2009. In past fi ve years, the goal of national essential medicine system has been initially achieved. For examples, medicine price is steadily reducing, the quality of medical services is improving and residents' satisfaction is substantial increasing every year. However, at the same time, we also found some urgent problems needed to be solved. For examples, the range of national essential medicine is limited, which is difficult to guarantee the quality of essential medication. In addition, how to compensate the primary health care institution is still a question.

Efficacy and safety of letosteine in the treatment of sputum thickening and expectoration difficulty in patients with respiratory diseases: a multicenter, randomized, double-masked, double dummy, positive drug parallel controlled trial.

This study aimed to compare the efficacy and safety of letosteine and ambroxol hydrochloride for the treatment of sputum thickening and expectoration difficulty due to either acute or chronic respiratory diseases. Patients (n = 240) were randomized to receive either letosteine + placebo (50 mg thrice daily, Group A) or ambroxol hydrochloride + placebo (30 mg thrice daily, Group B) orally for 5-14 days. The primary outcomes comprised the total effectiveness rate and the total improvement rate. Secondary outcomes included: post-treatment IgA level changes and post-treatment therapeutic evaluation scoring of clinical symptoms. The full analysis set (FAS) comprised 113 patients in Group A and 116 in Group B. The total effectiveness rates were 95.58% for Group A and 95.69% for Group B. The total improvement rates were 99.12% and 99.14% for Group A and Group B, respectively. There were no significant differences between the two groups for any of the primary or secondary outcomes in either the FAS or the per protocol populations (PPS; all P-values > 0.05). Letosteine and ambroxol hydrochloride provided equivalent efficacy and safety in the treatment of sputum thickening and expectoration difficulty due to either acute or chronic respiratory diseases.

[Comprehensive evaluation of sample data in medical research].

Comprehensive evaluation methods are generally used to assess the population data. When we need to estimate the sample data in special situations, the impacts brought by the sampling error should be considered. Due to lack of the accurate measurement for the sensitivity and stability in the comprehensive evaluation methods, sampling errors usually cannot be estimated in the sampling research. Monte Carlo simulation was used in this article to solve the probability of the ordering results, and the matlab programs were presented. Based on the simulated results, we change the conventional "absolute conclusion" of comprehensive evaluation methods to "probability results" for the sample data, and put forward a new sorting and ranking method for the results of comprehensive evaluation.

[Effect of nutrition and food safety education among middle school students in a poverty-stricken county in west China].

OBJECTIVE: To evaluate the effect of nutrition and food safety education among middle school students in a poverty-stricken county in west China, and to explore the better education model for further education. METHODS: Students of grade 7 to 9 were selected from 4 middle schools in the country through multi-stage cluster sampling for the questionnaire, and the schools were assigned into an intervention group or a control group. After students in the intervention schools completed one year nutrition and food safety education with the textbooks, students were chosen from the same 4 schools to finish the same questionnaire again. RESULTS: A total of 410 students from grade 7 to 9 were selected at the baseline study, and 474 students in the final study. The essential characteristics of the 2 groups were not statistically significant (P>0.05). In the baseline investigation, the differences in the scores on nutrition and food safety knowledge, attitude and practice between the 2 groups were not significant (P>0.05). In the final study, the scores on the knowledge, attitude of nutrition knowledge learning, and dietary habits among students in the intervention group were significantly higher than those in the control group (P<0.05). School-students mixed model demonstrated that the intervention was protective factor on scores of knowledge, in particular with nutrition related diseases and reasonable diet (P<0.05). But the intervention didn't affect the scores on attitude in both ways (P>0.05). CONCLUSION: Nutrition and food safety education can improve the nutrition and food safety knowledge effectively. The curriculum should be further standardized and different emphases should be set up to different grades to cultivate healthy diet behaviors.

[Expert investigation on food safety standard system framework construction in China].

OBJECTIVE: Through investigating food safety standard framework among food safety experts, to summarize the basic elements and principles of food safety standard system, and provide policy advices for food safety standards framework. METHODS: A survey was carried out among 415 experts from government, professional institutions and the food industry/enterprises using the National Food Safety Standard System Construction Consultation Questionnaire designed in the name of the Secretariat of National Food Safety Standard Committee. RESULTS: Experts have different advices in each group about the principles of food product standards, food additive product standards, food related product standards, hygienic practice, test methods. According to the results, the best solution not only may reflect experts awareness of the work of food safety standards situation, but also provide advices for setting and revision of food safety standards for the next. CONCLUSION: Through experts investigation, the framework and guiding principles of food safety standard had been built.

[Development of green hospitals home and abroad].

Green hospital construction is a new challenge for medical industry after global sustainable development strategy was put forward. The core connotation of green hospital includes green building, green healthcare, patient safety, and doctor-patient harmony. Many countries have established green building evaluation system to deal with energy crisis. Leadership in Energy and Environmental Design (LEED), Green Guide for Health Care (GGHC) in the U.S., and Evaluation System for Green Hospital Building (CSUS/GBC 2-2011) in China have guiding significance for the development of green hospitals in China. The evaluation system of green hospitals home and abroad still focuses on green building, and establishment of suitable synthesis evaluation system of green hospitals in China needs further research.

[A novel improved TOPSIS method and its application in medical science].

The TOPSIS method is a static comprehensive evaluation method for wide range applications. However, it encounters the reverse order problem in practical applications. Moreover, its evaluation value Ci only reflects the relative proximity of each evaluation object inside but not to the degree of closeness to the ideal optimal solution. The evaluation value is also limited to distinguish between the ranges of merit ranking. Since TOPSIS method has the wide range of applications, it is necessary to overcome the drawbacks of TOPSIS method. This article proposes a new improved TOPSIS method, which shows strict isotonicity and is more sensitive than the traditional TOPSIS method. The medical application based on this improved TOPSIS method is introduced.

[Novel dynamic TOPSIS method in evaluation for quality of medical care].

The quality of medical care shows characteristics of dynamic state with changes in time. However, many of appraisal and evaluation projects usually keep on the status of "past" or "present". Most of these models are static evaluation approach. In this study, besides the "past" and "present" status, we took one step further to unveil the future development trends of the medical therapeutical effects. Based on the index value and index increment, a dynamic TOPSIS method is presented. This method pays attention to both transverse and lengthwise information and can not only perform the evaluation on each time section but also can make the final dynamic evaluation. We applied this new method to the evaluation of quality of medical care, which was proved to be effective.

[Content validity index in scale development].

Content validity is the degree to which an instrument has an appropriate sample of items for the construct being measured and is an important procedure in scale development. Content validity index (CVI) is the most widely used index in quantitative evaluation. There are 2 kinds of CVI: I-CVI and S-CVI. A method to compute a modified kappa statistic (K*) can be used to adjust I-CVI for chance agreement. S-CVI/UA and S-CVI/Ave are both scale level CVI with different formulas. Researchers recommend that a scale with excellent content validity should be composed of I-CVIs of 0.78 or higher and S-CVI/UA and S-CVI/Ave of 0.8 and 0.9 or higher, respectively. The characteristics and qualifications of the experts, process and main results of content validity evaluation should be reported in scale-related manuscript.

[Dynamic analysis of the new rural cooperative medical system in Hunan Province from 2003 to 2009].

OBJECTIVE: To analyze the new rural cooperative medical system in Hunan from 2003 to 2009 and to provide reference for scientific decision making. METHODS: We dynamically analyzed the participation rate, fund raising and fund operation efficiency of the new rural cooperative medical system in the past 7 years. RESULTS: From 2003 to 2009, the participation rate increased from 60.7% to 91.22%, funding increased from 30 to 100 yuan/person, degree of hospitalization income from 26.75% to 41.63%, hospitalization rate from 4.57% to 8.26%, and cost of hospitalization times from 2389.46 to 2518.00 yuan. CONCLUSION: Implementation of the new rural cooperative medical system is indeed a boon to farmers, and the enthusiasm of farmers' participation is significantly improved. We must strengthen the supervision of the designated medical institutions, to effectively reduce health care cost and the burden of medical expense of farmers.

[Knowledge, attitude and practice of respiratory infection in middle school students in Changsha].

OBJECTIVE: To understand the knowledge, attitude and practice (KAP) to cope with common respiratory infection in middle school students in Changsha and to strengthen health education on respiratory infection. METHODS: The 5 districts in Changsha were included. One junior school and one high school were randomly selected from each district, from which a cluster sample class in each was randomly selected. An anonymous questionnaire was used to survey 560 students in the first and second year students in each school. RESULTS: In terms of basic knowledge of common respiratory diseases 56.6% of students had adequate "total awareness" scores, whereby the rate among urban students was higher than that of rural ones. In situations of respiratory infection outbreaks, 55.9% of students were actively knowledgeable of common respiratory disease, 43.4% of the students read related news, and 80.0% of the students followed the advisories of schools, teachers and parents. Students' knowledge of correct measures to prevent common respiratory infection was 79.5%, with girls ranking higher than boys, and urban students higher than rural ones. Students' knowledge of correct measures to treat these diseases properly was 65.7%. The Internet, television and radio were the students' main sources of knowledge. CONCLUSION: KAP levels of common respiratory infection among middle school students in Changsha is low. Schools, especially rural schools, should strengthen the health education and explore more effective methods of health education. The responsible public health authorities should exploit the Internet and mass media to disseminate accurate and pertinent health information.

[Protective effect of SjC23-Hsp70 DNA vaccine and interleukin-12 on Schistosoma japonicum infection in water buffalos].

OBJECTIVE: To determine the immune-protective effect of Japan Schistosoma (Chinese mainland strain) 23 kD membrane protein-heat shock protein (SjC23-Hsp70) DNA vaccine plus adjuvantinduced interleukin-12 (IL-12) plasmid DNA on Schistosoma japonicum infection in water buffalos. METHODS: Forty-five health water buffalos (8-10 months old) in non-endemic area of schistosomiasis were randomly assigned into group A (SjC23-Hsp70+IL-12, 300 µg), group B (SjC23+IL-12, 300 µg) and group C (pVAX+IL-12, 300 µg), 15 in each group. Each buffalo was immuned by shoulder intramuscular injection for 3 times, at an interval of 28 days. Twenty-eight days after the last immunization, each buffalo was infected with 1000 Japan cercariae of Schistosoma. Fecal examinations were conducted 2 days and 1 day before the perfusion, and on the day of perfusion. The number of hatching miracidia and eggs per gram feces was recorded. Fifty-six days after the infection, the buffalos were sacrificed and perfused via the descending aorta. The recovered adult worms and eggs in the liver tissue were counted. RESULTS: We compared group A and B with group C: the estrogen reduction rate was 45.7% and 26.61%; bug reduction rate was 44.51% and 25.84%; the fecal egg reduction rate was 41.1% and 31.63%; the miracidium reduction rate was 48.11% and 38.07%; and the liver egg reduction rate was 43.39% and 31.95%. The above rates in group A were higher than those in group B (P<0.05). CONCLUSION: SjC23-Hsp70 DNA vaccine combined with IL-12 may have a significant immunoprotective effect on buffalos.

[Analyses of cosmetic sanitary quality in Hunan Province in 2010].

OBJECTIVE: To establish a scientific foundation for cosmetic supervision and administration based on the analysis of the sanitary quality of cosmetics in Hunan Province during 2010. METHODS: According to Cosmetic Sanitary Standards (set by the Ministry of Health, People's Republic of China), 150 random samples of cosmetics in Hunan were assayed both for microbial items (including total plate count, fungus and yeast, fecal coliform, staphylococcus aureus, pseudomonas aeruginosa) and chemical items (including 17 kinds of prohibited substances and 14 kinds of restricted substances). RESULTS: The total rate of cosmetics failing to meet the standards was 22.0% of the 150 samples; specific rates for failing perfumes, skin care products (eye cream) and deodorant products were, relatively, 70.6%, 60.00%, and 44.4%. Four kinds of prohibited substances, including diethyl phthalate, acrylamide, asbestos and neodymium, as well as 2 kinds of restricted substances, including triclosan and formaldehyde, were found to exceed standards. None of microbial items exceeded standard levels. CONCLUSION: The sanitary quality control of cosmetics is lax. Administrative departments should not only reinforce their post-production supervision with respect to cosmetics, but also consolidate their control over the process of cosmetic production in order to solve the problem of toxic residues or illegal and intentional adulterations.

[Prohibited substances in cosmetics: prospect of the toxicity of acrylamide].

Prohibited substances in cosmetics refer to substances which must not be among the raw material ingredients of cosmetic products. These substances are absorbed mostly through skin, as well as via lung and gastrointestinal tract. Polyacrylamide is ubiquitously used in industry and its decomposition residue acrylamide (ACR) easily finds its way into cosmetic products. ACR can either be oxidized to epoxide glycidamide or conjugated with glutathione, hemoglobin or DNA; ultimately it is excreted in urine. ACR causes neurotoxicity, reproductive toxicity and tumors in rodents. Occupational exposure to ACR causes neurotoxicity in humans; however, epidemiological evidence have not unambiguously answered the question of whether ACR exposure can increase cancer risk for humans.

[Meta-analysis of proximal femoral nail anti-rotation versus dynamic hip screw in the treatment of trochanteric fractures].

OBJECTIVE: To compare the efficacy of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) in the treatment of trochanteric fractures in adults. METHODS: Reports of studies using randomized controlled trials (RCT) to compare PFNA with DHS in the management of intertrochanteric fractures were retrieved (up to December 5, 2011) from the Cochrane Library, MEDLINE, Elsevier, the Chinese Biomedical Database, Wanfang Data,and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman? 5.0 was used for data-analysis. RESULTS: Thirteen RCTs involving 958 cases were included in the Meta-analysis. The results showed that, compared with DHS, PFNA significantly decreased the duration of surgery [WMD = -21.38, 95%CI (-33.05,-9.26), P<0.05], intra-operative blood loss [WMD = -176.36, 95%CI (-232.20, -120.52), P<0.05], the rate of post-operative complication [RR=0.46, 95%CI (0.31, 0.70), P<0.05], the rate of post-operative fixation failure[RR=0.27, 95%CI(0.11,0.62), P<0.05]. CONCLUSION: PFNA for intertrochanteric fractures is superior to DHS in regards to the mean duration of surgery, mean intra-operative blood loss, the rate of post-operative complication, and the rate of post-operative fixation failure. But there is not enough evidence to show any difference between PFNA and DHS in regards to the mean duration of hospital, the mean duration of fracture healing, the rate of post-operative fracture, the rate of post-operative coxa vara, the rate of postoperative superficial wound infection, the rate of other post-operative complications or the Harris score after surgery.

[Label identities and basic situation of health food in Changsha].

OBJECTIVE: To study the relevant information on the label of health food in Changsha, and provide scientific evidence for health food hygienic supervision. METHODS: Investigation was conducted in department stores, supermarkets, pharmacies, and wholesale markets in the 5 districts in Changsha with multistage stratified sampling method. Self designed basic information of health food questionnaire was used to investigate the quality of labels the health food products. RESULTS: Among the 408 random samples, the unidentified rates of label items were ranked in descending order: functional components (49.8%), unsuited community (27.9%), manufacturing date (23.0%), approval number and others (9.6%). The qualified rates of labels were different in different management types (χ(2)=59.793, P<0.05): the highest rate was in supermarkets (71.15%), followed by pharmacies (70.07%), shopping malls (57.47%), and wholesale markets (26.23%). CONCLUSION: The supervision of label identities of health food should be strengthened, especially for the health food in the wholesale markets.