Research on the Operation Efficiency of Basic Medical Insurance for Urban Workers and Its Influencing Factors in China from 2020 to 2021 / 中国卫生经济

Objective:Efficiency is a key factor in the sustainable operation of the medical insurance system.By measuring the current efficiency of the urban employee basic medical insurance system in 31 provinces in China from 2020 to 2021,it discovers possible problems,and provides reference suggestions for improving the efficiency of the system.Methods:Using the super efficiency SBM model based on unexpected output and the Malmquist index to measure the static and dynamic efficiency of employee medical in-surance in 31 provinces in China,and using Tobit regression analysis to analyze its influencing factors.Results:The overall compre-hensive efficiency of the national employee medical insurance operation is 0.826 in 2020 and 0.827 in 2021 respectively.The efficien-cy of employee medical insurance operation in the eastern region is significantly higher than that in the central and westem regions.Over 60％of provinces have inefficient operation of employee medical insurance.The overall total factor productivity of employee medical insurance operation is showing a downward trend,and the decline in technological progress is the main limiting factor.The level of economic development has a significant promotion effect on the efficiency of employee medical insurance operation,and the degree of population aging has a significant inhibitory effect on it.Conclusion:The efficiency of employee medical insurance opera-tion in China still needs to be improved,and there is a significant efficiency gap among different regions.Therefore,investment and attention should be increased in the central and western regions to bridge regional gaps and promote the equity development of medi-cal insurance.Therefore,the reform efforts should be continuously intensified to achieve technological progress.In addition,attention should also be paid to the driving role of economic development in the efficiency of employee medical insurance operation and the for-mulation of positive policies on population aging.

Beverages consumption among grade four and grade five primary school students in six cities of China / 中国学校卫生

Objective@#To understand the status on beverages consumption among grade 4 and grade 5 primary school students in six cities of China, and to provide evidence for nutrition education and intervention strategies.@*Methods@#A multi-stage stratified cluster random sampling method was used to select 12 197 grade 4 and grade 5 primary school students from 72 primary schools in Beijing, Guangzhou, Nanjing, Chongqing, Jinan and Harbin. All the participants were investigated with a self-administered questionnaire survey of dietary behaviors.@*Results@#The proportion of students who consumed beverages at home, school and elsewhere was 92.5%, 51.4% and 70.6% respectively. The most popular beverages at home were milk, fruit & vegetable drinks, tea drinks (69.4%, 46.6%, 39.6%); the most popular beverages at school were milk, fruit & vegetable drinks, tea drinks (30.5%, 13.0%, 12.7%) while the most popular beverages in other places were milk, tea drinks, fruit & vegetable drinks(37.4%, 29.6%, 28.1%). The top five reasons for choosing beverages were taste delicious, healthy & nutritious, clean, choice of peers and family members(72.3%, 50.8%, 38.4%, 21.9%, 21.6%, respectively).@*Conclusion@#Consumption of drinking beverages is popular among students, most of which are unhealthy. Therefore, nutrition education for students and parents should be encouraged aiming to help students choose healthy drinks and eating behaviors.

Explore the judgmental of the indications of total knee arthroplasty using deep convolutional neural network / 中华骨科杂志

Objective To explore the feasibility of the deep convolutional neural network (DCNN) judging the indications and prognosis of the total knee arthroplasty based on the trained DCNN computer learning system.Methods C1FAR-10 DCNN model based on TensorFlow (an open source system,Google,USA) optimized by Alex Krizhevsky were constructed.There were 400 cases with knee osteoarthritis from different databases used for analysis.Three hundred patients underwent total knee arthroplasty,while 100 did not.X-ray of 200 preoperative cases from the 400 cases and their enlarged image (50 times) were applied for training DCNN,while the enlarged images from other 200 cases were used to test the DCNN.The correlation and the regression between judgment of the DCNN and clinical truth were analyzed.The clinical truths were rechecked three times and were confirmed by treatment results.Pearson correlation and linear regression analysis were used.The relation test of the software was only used as a reference.Results There was no significant difference between the baseline of cases for learning and test.After learning 200 cases,the DCNN judged the 10 000 cases enlarged from remaining 200 cases.The correlation between the DCNN judgment and the clinical truth was not significant (r=0.000,F=0.001,P=0.970).False positive was observed in 1 681 cases,false negative in 3 296.After enlarged to 10 000 images,the correlation between the two judgments was significant (F=11 228.735,P=0.000,r=0.727 and R2=0.529).The software detection precision was 0.860.Conclusion DCNN can be applied in judging the indications of the total knee arthroplasty.Large sample size can improve the accuracy of the judgment significantly.

Multicenter monitoring report on intensive care unit-acquired lower respiratory tract infection / 中国感染控制杂志

Objective To understand the status of intensive care unit-acquired lower respiratory tract infection (ICU-LRTI),and the distribution characteristics of pathogens,so as to provide the basis for taking preventive and control meas-ures,and scientific diagnosis and treatment for patients.Methods Targeted monitoring data on healthcare-associated infec-tion (HAI)in ICUs of 32 hospitals in a province in 2013 were investigated retrospectively.Results The incidence of ICU-LRTI was 5.79%,ventilator usage rate was 31.25%,incidence of ventilator-associated pneumonia(VAP)was 26.93‰;There was no linear correlation between ventilator usage rate and incidence of VAP(r=0.160,P=0.380).A total of 1 593 pathogens causing LRTI were detected,the major were gram-negative bacteria (75.77 %,n=1 207),followed by gram-positive bacteria(18.21%,n=290),fungi(5.90%,n=94),Mycoplasma pneumonia and other pathogens(0.12 %,n= 1 for each).The top five detected pathogens causing LRTI were Acinetobacter baumannii ,Pseudomonas aeruginosa ,Staph-ylococcus aureus ,Klebsiella pneumoniae and Escherichia coli ,accounting for 25.49%,15.26%,14.63%,13.37% and 5.09% respectively.Conclusion Targeted monitoring on ICU is helpful for realizing healthcare-associated LRTI, each hospital should conduct targeted monitor to find out the causes of HAI,as well as improve the awareness of VAP among ICU health care workers.

Management methods of patella in total knee arthroplasty / 中华创伤杂志

Objective To compare the clinical effects of patellar resurfacing with patella reservation and patellaplasty in the total knee arthroplasty(TKA)for osteoarthritis so as to discuss appropriate management of patellas in TKA.Methods A retrospective study was conducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008.There were 62 patients managed by patellaplasty(patellaplasty group)and 136 patients by patellar resurfacing with patella reservation(patellar resurfacing group).The osteophytes of the patella were removed to make the articular surface of patellas similar to the primary one.Knee Society Score(KSS),Bristol patellar score,satisfaction survey and evaluation of joint range of motion(ROM)were performed during the regular follow-up.Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants.Results A total of 125 patients were followed up,including 43 patients from the patellaplasty group and 82 from the patellar resurfacing group.The mean follow-up period was 51 months(range,36-80 months).Both groups showed significant improvement of each score postoperatively.No significant differences were found between the two groups regarding KSS score,patellar score and patient satisfaction in the follow-up one year later;but KSS function score in the patellar resurfacing group was superior to that in the patellaplasty group,with statistical difference.The incidence of anterior knee pain of the two groups had no statistical significance.Postoperative radiographs revealed no significant differences between the two groups concerning patellofemoral congruence,incidence of postoperative anterior knee pain or incidence of patellar related complications.Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain,with comparable mid-term results with patellaplasty.

Effect of hip joint replacement on the femoral intertrochanteric fracture with failed internal fixation / 中华创伤杂志

Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement.