The influence of the national drug price negotiation policy reform on the medical expenses of patients in Xuzhou City: an interrupted time series analysis.

Background: To reduce the burden of patients' medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou's 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance. Methods: The Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022. Results: Following the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month (p = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan (p < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan (p < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month (p < 0.001), whereas the monthly decrease was 22.11 yuan per month (p = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio. Conclusion: After the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance.

[Review of classical prescriptions in treatment of ulcerative colitis].

Ulcerative colitis(UC) is a continuous inflammatory bowel disease with the main clinical manifestations of abdominal pain, diarrhea, and mucous bloody stools, mainly attacking the colorectal mucosa and submucosa. It is characterized by high recurrence rate, difficult cure, and clustering and regional occurrence. Chinese medicinal prescriptions for the treatment of UC have good therapeutic effect, multi-target regulation, slight toxicity, and no obvious side effects. In particular, the classical prescriptions highlight the characteristics and advantages of traditional Chinese medicine theory and have attracted much attention in recent years. To enable researchers to timely and comprehensively understand the classical prescriptions in the treatment of UC, we reviewed the studies about the pharmacodynamic material basis, quality control, action mechanism, and clinical application of relevant classical prescriptions. We first introduced the latest research progress in the active components such as alkaloids, polysaccharides, saponins, and flavonoids in relevant classical prescriptions. Then, we reviewed the latest research achievements on the quality control of classical prescriptions for the treatment of UC by gas chromatography, liquid chromatography, mass spectrometry, liquid chromatography-mass spectrometry and the like. Further, we summarized the research advances in the mechanisms of relevant prescriptions in the treatment of UC based on network pharmacology, molecular docking, integrated pharmacology platform, and animal experiments. Finally, we generalized the clinical application of the classical prescriptions for clearing heat and removing dampness, mildly regulating cold and heat, soothing liver and regulating spleen, strengthening spleen and invigorating Qi, and tonifying spleen and stomach. By systematic summary of the research progress in relevant classical prescriptions, we hope to promote the application and development of such prescriptions in UC treatment.

Assessment of serum Vit A, D and zinc nutritional status and related dietary and exercise behaviors of children and adolescents in rural and urban area.

Vitamin A and vitamin D deficiency in children and adolescents has a negative impact on their growth and development. This study aimed to learn the nutritional status of vitamin A and D among rural children and adolescents and to explore related dietary and exercise behaviors. A total of 10 counties (cities, districts) from 90 counties (cities, districts) in Zhejiang Province were selected by the method of random cluster sampling. Children and adolescents were investigated and their food and nutrient intake were calculated. The concentration of serum vitamin A in urban area was 0.38 ng/ml, which was higher than that in rural area (p < 0.05); while the concentration of serum vitamin D in urban area was 21.25 mg/L, which was lower than that in rural area (p < 0.05). The concentration of serum zinc was 101 µg/dl in urban area and 107 µg/dl in rural area (p < 0.05). The intake of dietary fiber, calcium, vitamin A, vitamin B1, vitamin B2, and vitamin C was lower than the recommended value. In rural area, the intakes of cereals, tubers and beans, livestock, poultry and meat of children and adolescents were higher than the recommended values; while the intake of vegetables, fruits, eggs, milk, fish and shrimp, soybean and nuts was lower than the recommended value. The intake of edible oil and salt is higher than the recommended value. The time of medium and high intensity exercise time in rural area is more than that in urban area in the age group of 12-17 years, while the sitting time is less than that in urban area. Children and adolescents living in rural area should be guided to eat reasonably, and to choose foods with high nutrient density and with low oil, salt and sugar.

Biological Control of Plant Diseases: An Evolutionary and Eco-Economic Consideration.

Biological control is considered as a promising alternative to pesticide and plant resistance to manage plant diseases, but a better understanding of the interaction of its natural and societal functions is necessary for its endorsement. The introduction of biological control agents (BCAs) alters the interaction among plants, pathogens, and environments, leading to biological and physical cascades that influence pathogen fitness, plant health, and ecological function. These interrelationships generate a landscape of tradeoffs among natural and social functions of biological control, and a comprehensive evaluation of its benefits and costs across social and farmer perspectives is required to ensure the sustainable development and deployment of the approach. Consequently, there should be a shift of disease control philosophy from a single concept that only concerns crop productivity to a multifaceted concept concerning crop productivity, ecological function, social acceptability, and economical accessibility. To achieve these goals, attempts should make to develop "green" BCAs used dynamically and synthetically with other disease control approaches in an integrated disease management scheme, and evolutionary biologists should play an increasing role in formulating the strategies. Governments and the public should also play a role in the development and implementation of biological control strategies supporting positive externality.

Estrogens in municipal wastewater and receiving waters in the Beijing-Tianjin-Hebei region, China: Occurrence and risk assessment of mixtures.

The potentially high release of estrogens to surface waters due to high population density and local livestock production in the Beijing-Tianjin-Hebei region may pose adverse effects on reproductive systems of aquatic organisms. This study found that total measured concentrations of estrone (E1), 17ß-estradiol (E2), estriol (E3), 17α-ethinylestradiol (EE2) and diethylstilbestrol (DES) were 468 ± 27 ng/L in treated wastewater and 219 ± 23 ng/L in river waters in this region. E2, E3 and EE2 were the predominant estrogens in river waters. The restriction of DES for human use should have been enforced, however concentrations of DES were relatively high compared to other studies. Haihe and Yongdingxin Rivers delivered approximately 1.8 tonnes of estrogens to the Bohai Bay annually. Concentrations of individual estrogens were significantly higher in river waters in the dry season, however, mass loadings were significantly higher in the wet season. The average E2-equivalent concentrations reached 1.2 ± 0.2 and 0.64 ± 0.08 µg-E2/L following long-term and short-term exposure estimates, respectively, in river waters with an EE2 contribution of over 90 %. This could give rise to high risks to fish. Estrogens in river waters largely derived from human excretion. Field studies on estrogenic effects on fish reproductive systems are required locally considering high estrogen contamination levels.

Road traffic safety: An analysis of the cross-effects of economic, road and population factors.

PURPOSE: Through the study of economic, traffic and population data related to road traffic accidents from 2004 to 2016, this paper analyzed the impact of various factors on road traffic casualties in China, and provided theoretical basis and suggestions for the road traffic safety management in China. METHODS: Based on three aspects (economy, road, population) with five factors (gross domestic product (GDP), traffic investment, new vehicle ownership, new road mileage and newly increased population), this paper collected the relevant data of road traffic accidents in 31 provinces and cities in China, from 2004 to 2016. A panel model was established to carry out empirical analysis. RESULTS: All factors have a significant impact on the number of road traffic accident casualties. When other factors remain unchanged, the number of road traffic casualties decreased by an average of 0.19 for every 100 million CNY increased in GDP. For every 100 million CNY increased in traffic investment, the number of road traffic casualties is reduced by an average of 13.93, indicating that economic development can improve road traffic safety to a certain extent. On the contrary, the growth in road mileage, new motor vehicles and population has increased the number of road traffic casualties. For every 10, 000 km of new road mileage, the number of traffic accident casualties has increased by 284.04. For every 10,000 newborns, the number of road traffic casualties increased by 7.33; as the number of new motor vehicles increases by 10,000, the number of road traffic casualties increased by an average of 21.77. CONCLUSION: The increase of GDP and traffic investment can significantly reduce the number of road traffic casualties in China, which shows that economic development is essential to improve road traffic safety. The numbers of new road mileage, newly increased population and the new motor vehicles are positively correlated with the number of traffic accident casualties in traffic accidents, which reflects the existing problems in road design, distribution of road resources, and traffic management in China. Therefore, it is necessary to improve the economic and road related aspects to improve road traffic safety.

Spatial and seasonal variations of antibiotics in river waters in the Haihe River Catchment in China and ecotoxicological risk assessment.

Concentrations of widely used antibiotics were predicted to be the highest in the Haihe River Catchment across China previously, potentially resulting in high ecotoxicological risks in this region. As a result of growing usage and regulation of antibiotic use in animals, the pattern of use may have altered temporally for different antibiotics. It is important to monitor the occurrence of antibiotics within different categories for understanding their mass loading to the catchment and the potential ecotoxicological risks involved. This study investigated the seasonal occurrence and spatial variation of 15 antibiotics in the Haihe River Catchment during 2016-2017. The investigated compounds included veterinary antibiotics, human-use antibiotics, and those intended for both human and animal use. Measurements reported from previous studies were compared with the results of this study and indicated that the use of veterinary antibiotics is probably increasing around the catchment. The ∑antibiotics concentration (i.e. the summed concentration of the 15 target antibiotics) ranged from 414 to 1951 ng/L, with an average of 821 ng/L. Discharges from wastewater treatment plants were the main sources of these compounds. The mass loading of antibiotics to the river waters was higher during wet seasons than during dry seasons. The mass fluxes of the antibiotics continuously increased towards the lower reaches of the rivers. The total annual input of the antibiotics from the Haihe River and Yongdingxin River into the Bohai Bay was 5008 kg/yr. Ofloxacin, trimethoprim, leucomycin, anhydro erythromycin and florfenicol were the predominant antibiotics, whilst amoxicillin, anhydro erythromycin, ofloxacin, norfloxacin and enrofloxacin may pose high ecotoxicological risks to the investigated aquatic ecosystem. Several antibiotics selected in this study were reported for the first time in this catchment. This study provides important information for chemical management and indicates that further monitoring is needed on the more harmful and veterinary antibiotics in the catchment.

Analysis on the accident casualties influenced by several economic factors based on the traffic-related data in China from 2004 to 2016.

PURPOSE: By studying the economic data related to road traffic accidents in recent 10 years, this paper explores the impact of various economic factors on the number of casualties in traffic accidents in China, and puts forward related prevention and management measures. METHODS: Based on five economic factors including the number of new health institutions, health investment, transportation investment and disposable income per capita, this paper collects the data of traffic accidents in 31 provinces and municipalities of China from 2004 to 2016 and estimates the parameters using fixed effect model. RESULTS: The number of health institutions, health investment, transportation investment and disposable income per capita are negatively correlated with the number of traffic accident casualties; the number of new health institutions is positively correlated with the number of traffic accident casualties; health investment and transportation investment have a great impact on the number of road traffic accident casualties. CONCLUSION: Economic development has a positive impact on improving traffic conditions, but the increase in the number of new health institutions does not reduce the number of casualties in accidents. The irrational layout of health institutions and imperfect road traffic management mechanism should be taken into account.

Assessment of mechanical stability of rapidly separating microneedles for transdermal drug delivery.

The rapidly separating microneedles (RS-PP-MNs), composed of PVA (separable arrow head) MNs and a poly(L-lactide-co-D, L-lactide) (PLA) supporting array, are used for transdermal delivery system at high humidity. The fabricated RS-PP-MNs should have sufficient mechanical strength at different humidity. In general, the water adsorption rate was increased with increasing humidity; by contrast, storage time was decreased with increasing humidity. The higher water adsorption rate indicated the lower mechanical strength, thereby lowering drug delivery efficiency. The prepared RS-PP-MNs could be successfully inserted within the skin at high humid atmosphere due to PLA supporting array. The bright field and fluorescence microscopic images suggested the probable real-time applicability of RS-PP-MNs. The in vitro and in vivo assay suggested that RS-PP-MNs potentially were able to deliver the drugs at high humidity condition. The significant improvement in the drug delivery efficiency and skin penetration ability was observed compared with the traditional MNs. In addition, the fabrication of RS-PP-MNs is facile and scalable. Therefore, the prepared RS-PP-MNs with supporting solid PLA array might be advantageous in real-time applications. This study is of great importance for the MN field as it offers more theoretical support for clinical applications.

Quantitative and noninvasive assessment of chronic liver diseases using two-dimensional shear wave elastography.

Two-dimensional shear wave elastography (2D-SWE) is a rapid, simple and novel noninvasive method that has been proposed for assessing hepatic fibrosis in patients with chronic liver diseases (CLDs) based on measurements of liver stiffness. 2D-SWE can be performed easily at the bedside or in an outpatient clinic and yields immediate results with good reproducibility. Furthermore, 2D-SWE was an efficient method for evaluating liver fibrosis in small to moderately sized clinical trials. However, the quality criteria for the staging of liver fibrosis are not yet well defined. Liver fibrosis is the main pathological basis of liver stiffness and a key step in the progression from CLD to cirrhosis; thus, the management of CLD largely depends on the extent and progression of liver fibrosis. 2D-SWE appears to be an excellent tool for the early detection of cirrhosis and may have prognostic value in this context. Because 2D-SWE has high patient acceptance, it could be useful for monitoring fibrosis progression and regression in individual cases. However, multicenter data are needed to support its use. This study reviews the current status and future perspectives of 2D-SWE for assessments of liver fibrosis and discusses the technical advantages and limitations that impact its effective and rational clinical use.

[Use of dinoflagellates as a metal toxicity assessment tool in aquatic system].

Although dinoflagellates have been used to assess biological toxicity of contaminants, this method still lacks of corresponding toxicity assessment standard. This study appraised the toxicity of selected heavy metals to dinoflagellates based on the dinoflagellates bioluminescence with QwikLite developed by the United States Navy. The results show that single heavy metal biological toxicity is in the order: Hg2+ > Cu2+ > Cd2+ > As5+ > Pb2+ > Cr6+; Two, three and four heavy metal mixture experiments show synergism primarily, antagonism is in minority. pH has not remarkable effect on dinoflagellates, they can be applied directly in natural water, but pH influence Hg2+ and Cu2+ toxicity greatly, eliminating the influence of pH is essential when doing these two kind of ions measurements. The nutrients has little influence on dinoflagellates, change in COD has obvious effect on the response relationships between dinoflagellates and Hg2+ or CU2+. Metal toxicity assessment using dinoflagellates shows great sensitivity, narrow response scope and high stability. Dinoflagellates are good species for heavy metal biological toxicity test in aquatic system.

[Risk assessment of nitrogen and phosphorus export in upper reach of Daliao river watershed].

With the development of point pollution control, non-point source pollution has become an important environmental and water quality management problem. Land cover composition across a watershed is a dominant factor in controlling the amount of nitrogen and phosphorus exported from a watershed. Generally, urban and agricultural land covers are considered as principal sources of excess loads of nitrogen (N) and phosphorous (P) in receiving waters. A well developed literature of nutrient export coefficients by land-cover class was used to model the risk of equaling or exceeding specified levels of nutrient export in drainage basin of Dahuofang Reservoir. The model was applied to about 513 comparatively small watersheds mapped for the drainage basin of Dahuofang Reservoir for environmental analysis and planning. The results suggest that the probabilities of risk are 19.31% and 8.95% for N and P nutrient respectively. As the spatial distribution concerned, risk estimates generally differed with different slope degrees and districts. Risk estimates generally increased from the places where lies near the rivers to the places where are far from the river, but numerous areas of high variability were evident.

[The SWOT analysis and strategic considerations for the present medical devices' procurement].

In this paper, the SWOT analysis method is used to find out the internal strength, weakness, exterior opportunities and threats of the present medical devices' procurements in hospitals and some strategic considerations are suggested as "one direction, two expansions, three changes and four countermeasures".