Cardiac autonomic disturbance following sprint-interval exercise in untrained young males: Does exercise volume matter?

OBJECTIVES: This study examined the influences of the volume of all-out sprint-interval exercise (SIE) on acute post-exercise heart rate variability (HRV) recovery. METHODS: HRV recovery following a session of (i) 2 × 30-s SIE (SIE2), (ii) 4 × 30-s SIE (SIE4), and (iii) non-exercising control (CON) were compared in 15 untrained young males. Time domain [standard deviation of normal-to-normal intervals, root mean square of successive R-R differences] and frequency domain [low frequency (0.04-0.14 Hz), high frequency (0.15-0.40 Hz)] measures of HRV were assessed every 20 min for 140 min after the exercise, and every hour during the first 4 h of actual sleep time at immediate night. All trials were scheduled at 19:00. RESULTS: In comparison to CON, both SIE2 and SIE4 attenuated the HRV markedly (p < 0.05), while the declined HRV restored progressively during recovery. Although the sprint repetitions of SIE4 was twice as that of SIE2, the declined HRV indices at corresponding time points during recovery were not different between the two trials (p > 0.05). Nevertheless, the post-exercise HRV restoration in SIE2 appeared to be faster than that in SIE4. Regardless, nocturnal HRV measured within 10 h following the exercise was not different among the SIE and CON trials (p > 0.05). CONCLUSION: Such findings suggest that the exercise volume of the SIE protocol may be a factor affecting the rate of removal of the cardiac autonomic disturbance following the exercise. In addition, rest for ∼10 h following either session of the SIE protocol appears to be appropriate for the cardiovascular system to recover.

Anatomy of provincial level inequality in maternal mortality in China during 2004-2016: a new decomposition analysis.

BACKGROUND: The maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016. METHODS: We collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values. RESULTS: During our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality. CONCLUSION: Access to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.

Impact of the Global Budget Payment System on Expenditure of Cardiovascular Diseases: An Interrupted Time Series Analysis in Shanghai, China.

Since few studies evaluated the impact of the global budget payment system (GBPS) over time, and by expenditure type, this paper aims to evaluate the impact of the GBPS on expenditure of inpatients, and explores how hospitals curb the expenditure in patients with cardiovascular diseases (CVDs) in Shanghai. We built a time series model with the monthly expenditure of CVDs from 2009 to 2012. We evaluated the instant impact and trends impact of the GBPS and analyzed results based on medical expenditure types (e.g., drug, examination, cure, unclassified items), discharge number, and expenditure per capita. We found GBPS instantly dropped the medical expenditure by Chinese Yuan (CNY) 55.71 million (p < 0.001), and decreased the monthly increasing trend by CNY 4.23 million (p = 0.011). The discharge number had 10.4% instant reduction and 225.55 monthly decrease (p = 0.021) while the expenditure per capita experienced fewer changes. Moreover, the expenditure of drug and cure had an instant reduction of CNY 28.31 million and 16.28 million (p < 0.001). In conclusion, we considered the GBPS is an effective solution to control the expenditure of CVDs by decreasing the discharge number, and a focus on the drug and cure expenditures lead to greater spend reduction than other types of expenditures.

Does the leading pharmaceutical reform in China really solve the issue of overly expensive healthcare services? Evidence from an empirical study.

BACKGROUND: Healthcare system reform of Sanming city has become a leading healthcare reform model in China. It has developed a rigorous pharmaceutical reform consisted of the Zero Mark-up Drug Policy and the Centralized Procurement of Medicine Policy to bring down drug expenses and total health expenditures. However, despite the credit and much attention have been given to Sanming's pharmaceutical reform, its impact still remains unclear. Therefore, the purpose of this study was to explore the impact of the pharmaceutical reform of Sanming on both drug and total health expenditures. METHODS: Interrupted time series analysis with three segments divided by two intervention points was employed to evaluate the impact of the pharmaceutical reform. Segment 1 was the pre-reform period which captured the baseline information. Segment 2 occurred after the first intervention point when the Zero Mark-up Drug Policy was implemented, whereas Segment 3 was after the implementation of the Centralized Procurement of Medicine Policy. Primary outcomes are outpatient drug expenditure, outpatient total health expenditure, inpatient drug expenditure, and inpatient total health expenditure. Data spanning from May 2012 to May 2014 are included. RESULTS: Both drug and total health expenditures exhibited rising trends before any policy was carried out. The launch of Zero Mark-up Drug Policy led to significant instant reductions in levels of outpatient drug expenditure (coefficient = -6,602.99, p<0.01), outpatient total health expenditure (coefficient = -9,958.58, p<0.05), inpatient drug expenditure (coefficient = -7,520.90, p<0.01), and inpatient total health expenditure (coefficient = -16,737, p<0.01). Moreover, the previous upward trends were changed into downward trends for inpatient drug expenditure (coefficient = -2,747.02, p = 0.00) and total health expenditure (coefficient = -3,069.29, p = 0.12). However, after the implementation of Centralized Procurement of Medicine Policy, we observed no significant instant level changes and also, the inpatient drug expenditure (coefficient = 372.95, p = 0.01) and total health expenditure (coefficient = 788.76, p = 0.06) resumed upward trends again. CONCLUSIONS: Although the pharmaceutical reform could control or reduced drug expenditure and total health expenditure in short term, expenditures gradually resumed growing again and reached or even exceeded their baseline levels of pre-reform period, indicating the effect became weakened or even faded out in long term. In all, the pharmaceutical reform as a whole failed to meet its goal of combating sharp growth of drug and total health expenditure.

Research on demands and accessibility of health services for AIDS long-surviving patients with AIDS-nonrelated diseases: a survey in central China.

INTRODUCTION: Compared with western countries, China started to provide free medicine for AIDS patients years later, which leads to the late emergence of problems on health service demands of AIDS long-surviving patients with non-AIDS-related diseases. Government hasn't laid enough stress on it. MATERIALS AND METHODS: The interviews and questionnaire surveys are conducted and analyzed to get information. The interviewees include 81 AIDS long-surviving patients in three villages and several hospitals in Shangcai, Zhumadian, and 18 AIDS-related decision makers and health service providers. RESULTS: There are 79 long-surviving patients out of 81. 58 patients have non-AIDS-related diseases. 21 patients get hypertension and 28 get HCV. 100% patients have been to the clinics with their real-name IC cards for minor illness. 43 patients have been transferred to assigned hospitals at the county level. Seven have the experience utilizing health services in the municipal or provincial assigned hospitals. The problem is on accessibility. 40 patients hope to get more convenient and cheap health services. Among them, 37 say the kinds and the amount of medicine in village clinics are not adequate. Seven give up because of the expensive treatment expense. For 21 patients with hypertension, 3 buy medicine at the county-level hospitals. The other 18 choose to buy at private pharmacy. For 28 patients with HCV, 3 are not aware they actually got HCV. Free hepatic protector medicine is provided at village clinics. Up to 11 patients have not taken any treatment for HCV. CONCLUSIONS: Patients with hypertension go to the private pharmacy for medicine instead of higher level hospital because of lack of medicine in clinics, far distance from hospitals, cumbersome procedures in hospitals, limited dosage of prescriptions and too little discount. The situation for patients with HCV is even worse. It is predicted 70% of AIDS long-surviving patients have HCV. The treatment is expensive and out of pocket. And free liver-protection medicine does not work sometimes. Some patients working outside their home town do not want to reveal their health situation to get free medicine. The elderly with multiple co-morbidities need more caring. Government should expand the scale of free medicine. Hospitals need to improve medicine plans and assist on medicine purchase. For patients, attitude decides everything.