Development and Assessment of Acyclovir Gel Plaster Containing Sponge Spicules.

Acyclovir is an acyclic purine nucleoside analog that is highly effective in inhibiting the herpes simplex virus. However, topical acyclovir has poor efficacy because of its low skin permeability. This study aimed to develop an acyclovir gel plaster containing sponge spicules (AGP-SS) to achieve synergistic improvements in skin absorption and deposition of acyclovir. The process of preparing the gel plaster was optimized by orthogonal experiments, while the composition of the formulation was optimized using the Plackett-Burman and Box-Behnken experimental designs. The selected formula was tested for physical properties, in vitro release, stability, ex vivo permeation, skin irritation, and pharmacokinetics. The optimized formulation exhibited good physical characteristics. In vitro release and ex vivo permeation studies showed that acyclovir release from AGP-SS was dominated by diffusion with significantly higher skin permeation (20.00 ± 1.07 µg/cm2) than that of the controls (p < 0.05). Dermatopharmacokinetic analyses revealed that the maximum concentration (78.74 ± 11.12 µg/g), area under the curve (1091.81 ± 29.05 µg/g/h) and relative bioavailability (197.12) of AGP-SS were higher than those of the controls. Therefore, gel plaster containing sponge spicules show potential for development as transdermal delivery systems to achieve higher skin absorption and deposition of acyclovir, especially in deep skin layers.

Association between resident status and patients' experiences of primary care: a cross-sectional study in the Greater Bay Area, China.

OBJECTIVES: Patients' experiences are important part of health services quality research, but it's still unclear whether patients' experiences are influenced by resident status. This study aimed to evaluate the association between resident status and patients' primary care experiences with the focus on migrants vs local residents. DESIGN: A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models. SETTING: Six community health centres in Guangzhou, China. PARTICIPANTS: 1568 patients aged 20 years or older. MAIN OUTCOME MEASURES: Patients' primary care experiences were assessed using the Primary Care Assessment Tool. The 10 domains included in Primary Care Assessment Tool (PCAT) refers to first contact-utilisation, first contact-access, ongoing care, coordination (referral), coordination (information), comprehensiveness (services available), comprehensiveness (services provided), family-centredness, community orientation and cultural competence from patient's perspective. RESULTS: 1568 questionnaires were analysed. After adjusting for age, sex, education, annual family income, self-perceived health status, chronic condition, annual medical expenditure and medical insurance, the PCAT total scores of the migrants were significantly lower than those of local residents (ß=-0.128; 95% CI -0.218 to -0.037). Migrants had significantly lower scores than local residents in first contact utilisation (ß=-0.245; 95% CI -0.341 to -0.148), ongoing care (ß=-0.175; 95% CI -0.292 to -0.059), family-centredness (ß=-0.112; 95% CI -0.225 to 0.001), community orientation (ß=-0.176; 95% CI -0.286 to -0.066) and cultural competence (ß=-0.270; 95% CI -0.383 to -0.156), respectively. CONCLUSION: Primary care experiences of migrants were significantly worse off than those of local residents, especially in terms of primary care utilisation, continuity and cultural competence. Given the wide disparity in primary care experiences between migrants and local residents, Chinese healthcare system reform should focus on improving quality of primary care services for migrants, overcoming language barriers and creating patient-centred primary care services.

Heavy Metal Pollution and Potential Ecological Risk Assessment in a Typical Mariculture Area in Western Guangdong.

The distribution characteristics, environmental contamination states, and potential ecological risks of chromium (Cr), copper (Cu), arsenic (As), lead (Pb), and cadmium (Cd) in seawater, sediment and breeding feed were studied in a typical mariculture area in western Guangdong of China. Pearson correlation analysis was used to determine metal homology, and the single-factor index, potential ecological risk index, hazard quotient (HQ), and joint probability curve (JPC) were used to evaluate pollution states and ecological risk of metals. Four main statements can be concluded from the results: (1) Pb and Cu showed a similar distribution pattern in the seawater and sediment and their contents in the breeding wastewater exceeded the standard limits in several stations. (2) Cr, Cu, and As have similar sources in the feeds, which may be an important source of metals in water. (3) The risk assessment revealed that the sediment from the studied areas was at a low ecological risk of heavy metal, whereas, water in the pond and outfall was slightly polluted by Pb, and water in the cages and outfall were slightly polluted by Cu. (4) Both the hazard quotient (HQ) and joint probability curve showed the overall risk probabilities (ORPs) in the waters ranked as Cu > Cr > Pb > Cd > As. Although Pb and Cd had HQ values greater than 1, their ORPs were acceptable. This study highlights that multiple evaluation models are more reliable than the single ecological risk assessment for evaluating heavy metal pollution risks in the mariculture area.

The institutional primary healthcare service quality and patients' experiences in Chinese community health centres: results from the Greater Bay Area study, China.

BACKGROUND: The goal of this paper was to assess the quality of primary healthcare services at community health centres (CHCs) from the demand (patient) and supplier (healthcare service institution) angles. METHODS: This study was conducted at six CHCs in the Greater Bay Area of China. Between August and October 2019, 1,568 patients were recruited (55.8% women and 44.2% men). We evaluated the service quality of CHCs using the National Committee for Quality Assurance Patient-Centred Medical Home (NCQA-PCMH) recognition questionnaire. We assessed patients' experiences with medical and health services using the Primary Care Assessment Tools (PCAT). RESULTS: PCAT total and sub-domains scores were significantly difference at the six CHCs (P < 0.001). Among the six CHCs, Shayuan CHC had the highest PCAT total and sub-domain scores and the highest NCQA-PCMH total and sub-domain scores, as well. Older (> 60 years), female, lower education, and employee medical-insured individuals had better patient experiences. CONCLUSIONS: Our results indicate that CHCs could improve their service quality by improving both institutional health service quality based on NCQA-PCMH assessment and patient experiences based on PCAT scales. These findings can help inform patient-centred primary healthcare policy and management.

Sources and ecological risk assessment of the seawater potentially toxic elements in Yangtze River Estuary during 2009-2018.

The purpose of this paper is to understand the sources of potentially toxic elements (PTE) and provide some suggestions to control PTE pollution. For this purpose, data from 30 monitoring stations for 2009-2018 were used to assess the PTE concentrations of Hg, Cu, Pb, Cd, Zn, and As in the Yangtze River Estuary. The PTE concentrations varied significantly (P < 0.05) by one-way ANOVA in the ranges of 0.002-0.224 (Hg, 0.043 ± 0.032), 0-9.700 (Cu, 1.600 ± 1.000), 0-3.900 (Pb, 1.000 ± 0.700), 0.002-0.370 (Cd, 0.050 ± 1.000), 0.100-85.000 (Zn, 14.000 ± 13.000), and 0.998-3.290 µg/L (As, 1.857 ± 0.455). Generally, the PTE concentrations decreased from year to year and were consistently satisfied the "grade-one seawater" quality standard after 2014. The concentrations of Cu, Cd, Zn, and As decreased as far from inshore, while increased closer to land in the estuary. Concentrations of Pb and Hg showed differences because of local industrial and aquacultural activities. This study identified three clusters and two PTE sources and provided some constructive suggestions for pollution control in PTE.

Research on the Influence of Environmental Regulation on Social Employment-An Empirical Analysis Based on the STR Model.

Environmental regulation will affect social employment through corporate costs, technological innovation, industrial upgrading, and industrial transfer. To verify the effect of environmental regulation on social employment in different periods and under the intensity of environmental regulation, in this paper, environmental regulation is introduced as an influencing factor of social employment levels, based on China's urban registration unemployment data from 1987 to 2017. A nonlinear smoothing autoregressive model is used to analyze the nonlinear long-term effect relationship between environmental regulation and social employment. The research results show that the relationship between environmental regulation and social employment does exhibit the characteristics of nonlinear transformation under different mechanisms, and the transformation speed is fast. The specific manifestation is that the environmental regulation has a restraining effect on social employment in the short term, and the environmental regulation has a promoting effect on social employment in the long term. Continued high-level environmental regulations will exacerbate the adverse impact of environmental regulations on social employment.

Patient-doctor concordance of perceived mental health service needs in Chinese hospitalized patients: a cross-sectional study.

BACKGROUND: To assess the subjective concordance on mental health service needs in hospitalized patients between patients and doctors in China. METHODS: A cross-sectional study was performed in one day. All hospitalized inpatients from selected departments of West China Hospital were recruited as potential participants. A questionnaire set including demographic variables and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) questionnaires were completed by the included patients. They and their doctors in-charge were asked if they perceived that the patients needed mental health services. RESULTS: The overall response rate in patients was 84.25% and the final sample consisted of 1,273 patients. Among those, 605 patients (47.53%) themselves believed that they needed mental health services, whereas only 345 patients (27.10%) were deemed to be in need of mental health services only by their doctors. Kappa statistics showed that the concordance rate between patients and doctors was low in the total patient group (kappa =0.055) and in the group of patients with significant depression or anxiety (kappa =0.080). A logistic regression analysis showed that the ward where the patients were treated was related to a consistent recognition of mental health needs (OR =1.667). CONCLUSIONS: The concordance between Chinese inpatient perception and doctor evaluation of mental health service needs for these patients was low. Therefore, it seems necessary to develop effective strategies to improve the detection rate, such as the use of screening-instruments and the training of health professionals in the detection of psycho-social distress.

Why is the recognition rate of psychological distress under-estimated in general hospitals? A cross-sectional observational study in China.

This study aimed to investigate the recognition rate of psychological distress in general hospitals in China and to examine the main associated factors.Using a cross-sectional study design, the questionnaires were administered to a total of 1329 inpatients from a tertiary hospital. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire (PHQ-15) and the Whiteley-7 (WI-7) were used to assess patients' mental health status. Two subjective questions were used to identify the awareness of psychological distress in patients and doctors.The frequency of psychological distress measured by the questionnaires was high in our sample (53.4%). However, the recognition rates of both patients (34.9%) and by doctors (39.1%) was low. The concordance rate between patients and doctors of whether the patient had psychological distress or not was extremely poor (Kappa = 0.089, P = .001). Factors associated with the poor concordance rate included patients' annual household income and clinically significant self-reported symptoms of anxiety and hypochondriasis.The recognition rate of psychological distress was underestimated and this may be related to a lack of awareness of mental disturbances and patients' low annual household income.

[Stability of penicillin potassium with linear degradation programmed humidifying experiments].

A linear degradation humidifying model for drug stability experiment is introduced. This new humidifying model is presented as: H(r) = -M1-ln {exp(- MH(r,0)) - [exp(-MH(r,0)) -exp(-MH(r-m)) t(m)-t}. Where H(r) is the relative humidity; t is the time; H(r,m) and t(m) are the final relative humidity and time of the experiment, respectively. M is humidifying constant used in the humidifying program. In the new programmed humidifying model, a linear relationship between the content function of drugs and the relative humidity is obtained, the degradation of drugs can be more uniform within different humidity ranges and the experimental results are more accurate than those in the reported linear humidifying model. The stability of penicillin potassium, as a solid state model, was investigated by the linear degradation programmed humidifying and the exponential heating experiments. The results indicated that the kinetic parameters obtained by the linear degradation programmed humidifying and the exponential heating models were significantly more precise than those obtained by the linear programmed humidifying and the reciprocal heating models.