Intra-operative open-lung ventilatory strategy reduces postoperative complications after laparoscopic colorectal cancer resection: A randomised controlled trial.

BACKGROUND: The role of the positive end-expiratory pressure (PEEP) and lung recruitment manoeuvre (LRM) combination (termed open-lung strategy, OLS) during intra-operative mechanical ventilation is not clear. OBJECTIVE: To determine whether an open-lung strategy constituting medium PEEP (6-8 cmH2O) and repeated LRMs protects against postoperative complications in at-risk patients undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation. DESIGN: A prospective, assessor-blinded, randomised controlled trial. SETTING: Single university-affiliated hospital, conducted from January 2017 to October 2018. PATIENTS: A total of 280 patients at risk of pulmonary complications, scheduled for laparoscopic colorectal cancer resection under general anaesthesia and low-tidal-volume (6-8 ml kg-1 predicted body weight) ventilation. INTERVENTION: The patients were randomly assigned (1 : 1) to a PEEP of 6-8 cmH2O with LRMs repeated every 30 min (OLS group) or a zero PEEP without LRMs (non-OLS group). MAIN OUTCOME MEASURES: The primary outcome was a composite of major pulmonary and extrapulmonary complications occurring within 7 days after surgery. The secondary outcomes included intra-operative potentially harmful hypotension and the need for vasopressors. RESULTS: A total of 130 patients from each group were included in the primary outcome analysis. Primary outcome events occurred in 24 patients (18.5%) in the OLS group and 43 patients (33.1%) in the non-OLS group [relative risk, 0.46; 95% confidence interval (CI), 0.26 to 0.82; P = 0.009). More patients in the OLS group developed potentially harmful hypotension (OLS vs. non-OLS, 15% vs. 4.3%; P = 0.004) and needed vasopressors (25% vs. 8.6%; P < 0.001). CONCLUSION: Among at-risk patients undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation, an open-lung strategy with a PEEP of 6-8 cmH2O and repeated LRMs reduced postoperative complications compared with a strategy using zero PEEP without LRMs. Of note, LRMs should be used with caution in patients with haemodynamic instability. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03160144.

Job satisfaction among primary care physicians in western China.

BACKGROUND: There has been great shortage of primary care physicians (PCPs) in China, especially in western areas. Job satisfaction plays a great role in retaining people. The aim of this study is to investigate the job satisfaction of PCPs and associated factors in 11 provinces of western China, thus providing necessary reference values for stabilizing the primary care workforce and improving the quality of primary care services. METHOD: A sample of 2103 PCPs working in western China were surveyed using a stratified, multistage and random sampling method in 2011. The characteristics of participants were recorded by a structured questionnaire. A multilevel model (MLM) and quantile regression (QR) were applied to assess the association between job satisfaction and possible risk factors. RESULTS: Of the 2103 doctors surveyed, the overall satisfaction score was 3.26 ± 0.68 (from 1 to 5). MLM indicated that age group, income satisfaction, unit policy approval, personal planning, career attitude, work value and patient recognition were positively correlated with job satisfaction, while turnover intention was negatively correlated with job satisfaction. QR were not completely consistent with MLM and further explored the differences in different job satisfaction score percentiles on each domains. CONCLUSION: This study showed that the job satisfaction of PCPs in western China was not high. The MLM and QR discussed were not entirely consistent, the latter one provided more information and robust results. Measures should be taken in streamlining administration and institute decentralization, creating more opportunities for additional training, raising PCPs' income, improving the social status of doctors and improving the relationship between doctors and patients.

Final-year pharmacy undergraduate students' career intention and its influencing factors: a questionnaire study in northwest China.

BACKGROUND: Career intention is closely related to the distribution of university graduates across sectors in pharmacy-related field. The aim of the study was to describe career intention and identify its influencing factors among final-year pharmacy undergraduate students in China. METHODS: A questionnaire study on demographic characteristics, educational situation, family background, occupational value and career intention was conducted among final-year pharmacy undergraduate students at three universities in northwest China. Exploratory factor analysis was used to identify the constructs of occupational value. Multinominal logistic regression was adopted to analyse the factors influencing career intention. RESULTS: Among the 275 student participants, 62.6% intended to work in public medical institutions (rural: 44.4%; urban: 18.2%), 26.5% aimed to work in the pharmaceutical industry, 6.5% wanted to work in other sectors in the pharmacy-related field, and 4.4% planned to work in other fields. Their gender, father's education level, monthly household income per capita, whose opinions were considered most during job selection, the self-gratification factor of occupational value, and employment guidance had significant impacts on students' career intentions. CONCLUSION: In the Chinese background, the career intention of more than half of the undergraduate pharmacy students was to work in public medical institutions. The career intentions of the overall participants were mainly determined by their gender, family background as well as psychological self-gratification, and they could also be influenced by employment guidance.

Awareness of HIV/AIDS and its routes of transmission as well as access to health knowledge among rural residents in Western China: a cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the coverage of HIV health education among rural residents in western China by ascertaining their awareness of HIV/AIDS and its transmission routes, and to investigate how these residents receive health information. METHODS: A survey was conducted through stratified clustered sampling at 99 county hospitals in 11 provinces in western China. Information was collected on awareness of HIV/AIDS and its transmission routes, as well as residents' access to health knowledge. Chi-square analysis was used to analyse the differences in HIV/AIDS awareness (knowing of the existence of HIV/AIDS, hereinafter referred to as "HIV awareness rate") between different subgroups categorized by demographic status, regional factors, and different methods of access to health knowledge. To further analyse the effects of access to health knowledge on HIV awareness, a logistic regression model was established. The relationship between access to health knowledge and transmission routes was also examined using chi-square analysis. RESULTS: The HIV awareness rate of the total 9274 participants was 80.9%. There were statistically significant differences between subgroups classified by age (χ2 = 482.118, p<0.001), education (χ2 = 853.465, p<0.001), occupation (χ2 = 340.553, p<0.001), income (χ2 = 186.448, p<0.001), cumulative HIV cases according to province (χ2 = 59.513, p<0.001), per capita annual net income of rural households according to province (χ2 = 64.676, p<0.001), proportion of minority population according to province (χ2 = 94.898, p<0.001), direct access to health knowledge (medical staff: χ2 = 419.775, p<0.001; mass media: χ2 = 740.238, p<0.001; family members: χ2 = 12.189, p<0.001; socializing: χ2 = 48.780, p<0.001; health education activities: χ2 = 154.400, p<0.001), and indirect access to health knowledge (having a non-communicable disease with medical instructions χ2 = 78.709, p<0.001; physical examinations: χ2 = 135.679, p<0.001). The logistic regression model showed that education and mass media had the strongest impacts on HIV awareness among all methods of access. Participants had the least awareness of HIV's mother-to-child transmission route. CONCLUSION: The HIV awareness rate indicated that previous HIV health education covered 80% of the rural population in western China. Mass media should take greater responsibility in HIV health education for the general population, and special attention should be paid to the elderly, the most impoverished population, minority community as well as the mother-to-child transmission route.

Health-Related Internet Use in Hard-to-Reach Populations: Empirical Findings From a Survey in a Remote and Mountainous Province in China.

BACKGROUND: The expanding use of the internet contributes to more effective searches for health-related information and opens up opportunities for direct Web-based communication with health care professionals. However, little is known about how users' characteristics on the demand side influence health-related internet use, especially in remote and rural areas within developing countries. The absence of accurate estimates of users' characteristics and their impact on adaptations of health care services in developing countries constrains focused policy-centered discussions and the design of appropriate policies. OBJECTIVE: The aim of this study was to assess the prevalence of health-related internet use and to identify its determinants in a remote province in China. METHODS: We conducted a cross-sectional survey in June and July of 2018 in Ningxia, located in northwestern China. Rural households were selected by multistage random sampling, and households' key members were interviewed face-to-face at the respondents' home. Dependent variables were whether the households use Web health services or not. Independent variables were chosen based on the Andersen behavioral model. Sociodemographic characteristics were compared between households that used health-related Web services with nonusers. We applied logistic regression models to evaluate multivariate associations between respondents' characteristics and their usage of Web-based health services and obtained odds ratios with 95% CI. RESULTS: A total of 1354 respondents from rural households were interviewed, of whom 707 (52.22%) were men. The mean age of the respondents was 44.54 years (SD 10.22). Almost half of the surveyed households (640/1354, 47.27%) reported using 1 or more Web-based health care services, whereas 37.8% (502/1354) reported using the internet to obtain health-related information, 15.51% (210/1354) used the internet to communicate with professionals about health issues, and 7.24% (98/1354) had engaged in Web-based consultations in the last year. After controlling for potential confounders, households engaged in health-related internet use were found to be wealthier, have higher health demands, and have less geographic access to high-quality health care compared with other households. CONCLUSIONS: The internet has become a major health information resource in rural Ningxia. Social structures, family enabling factors, health needs, and characteristics relating to health care access were significant predictors of households' health-related internet use in rural and remote areas in China. Those who belong to older age groups, have low income, and whose education levels do not extend beyond primary school education are significantly less likely to use Web-based health care services and to benefit from Web-based health care programs. A need for continued collaborative efforts involving multiple stakeholders, including communities, Web-based and other health care providers, family members, and the government is needed.

Gender differences in job quality and job satisfaction among doctors in rural western China.

BACKGROUND: Few studies about gender differences in job quality and job satisfaction among medical professionals have been carried out in China. So the objectives of this study were to examine whether and to what extent gender differences existed in job quality and job satisfaction of doctors in rural western China. METHODS: From 2009 to 2011, a total of 1472 doctors from 103 selected county-level health care facilities in rural western China were recruited into the study. Information about the doctors' demographic characteristics, job quality, and job satisfaction was collected through a designed questionnaire. Besides examining gender differences in single dimensions of job quality and job satisfaction, principal component analysis was used to construct a composite job quality index to measure the differences in the comprehensive job quality, and exploratory factor analysis was applied to evaluate the differences in the overall job satisfaction. Chi-square test was used to calculate differences between proportions, and t-test was used to compare differences between means. RESULTS: Among the doctors, there were 705 males and 767 females (ratio 1:1.09). Male doctors had significantly higher monthly salaries, longer working hours, more times of night shifts per month, longer continuous working hours, and longer years of service at current facilities, and marginally significantly higher hourly wage and longer years of service in current professions. However, female doctors showed greater overall job qualities. Significant and marginally significant gender differences were only found in satisfaction with remuneration compared to workload, the chance of promotion and working environment. But female showed greater satisfaction in the overall job satisfaction and the factor including sub-aspects of working environment, remuneration compared to workload, the chance of promotion, utilization of subjective initiative, and sense of achievement. CONCLUSIONS: Gender differences in job quality and job satisfaction did exist among doctors in rural western China. The participating female doctors were shown to have better job quality and greater job satisfaction.

Current perspectives on China's national essential medicine system: primary care provider and patient views.

BACKGROUND: The National Essential Medicine System (NEMS) is a new policy launched by the Chinese government in 2009. The effects of its introduction have been widely investigated. However, little research has focused on individual patients' perspectives. The purpose of this study was to examine current understanding and opinions of China's NEMS of primary care providers (PCPs) and patients. METHODS: Providers (n = 134) and patients (n = 175) were examined based on self-completed questionnaire surveys conducted in 16 primary healthcare centers in Ningxia, northwestern China. Questions addressed the topics of: participants' socio-demographic characteristics; awareness of NEMS policies; perceptions of NEMS-related changes; satisfactions with NEMS. RESULTS: The patients had a low awareness of NEMS while a majority of providers were familiar with NEMS. All participants were satisfied with the price and quality of essential medicines, but not satisfied with the quantity. Patients felt there had been a decrease in their total medical expenses per visit and improved pharmaceutical services. Most providers perceived no change in their personal or departmental income. The overall satisfaction rate related to NEMS among providers and patients was 92.54 and 93.31%, respectively. Overall there was a link between knowledge about NEMS and satisfaction with the program: patients who had greater knowledge of reimbursement policy, and the providers with greater knowledge of NEMS, reported higher satisfaction. CONCLUSIONS: The findings revealed a high level of satisfaction towards NEMS among primary care providers and patients, which is a reflection of the improvements in the health care system. However, some patients' low awareness of NEMS should be paid attention to, as it could reduce their knowledge of essential medicines and hinder the full potential of NEMS.

The impact of China's national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces.

BACKGROUND: The National Essential Medicine System (NEMS) is a new policy in China launched in 2009 to improve the appropriate use of medications. This study aims to examine the outcomes of the NEMS objectives in terms of the rational use of medicines in primary health care facilities in China. METHODS: A total of 28,651 prescriptions were collected from 146 township health centers in four provinces of China by means of a field survey conducted in 2010-2011. Indicators of rational drug use were extracted and compared using a pre/post design and then evaluated with regard to the World Health Organization (WHO) Standard Guidelines and data from previous research. RESULTS: The average number of drugs per prescription decreased from 3.64 to 3.46 (p < 0.01) between 2009 and 2010. Little effect was found for the NEMS on the average number of antibiotics per prescription, but the percentage of prescriptions including antibiotics decreased from 60.26 to 58.48% (p < 0.01). Prescriptions for injections or adrenal corticosteroids also decreased, to 40.31 and 11.16% of all prescriptions, respectively. All these positive issues were also recorded in 2011. However, each of the above values remained higher than WHO standards. The percentage of drugs prescribed from the Essential Drug List increased after the implementation of the NEMS (p < 0.01). Where the available data allowed changes in costs to be assessed, the average expense per prescription increased significantly, from 25.77 to 27.09 yuan (p < 0.01). CONCLUSIONS: The NEMS effectively improved rational medicine use in China. However, polypharmacy and the over-prescription of antibiotics and injections remain common. There is still a large unfinished agenda requiring policy improvements. Treatment guidelines, intensive support supervision, and continuing training for both professionals and consumers are the essential actions that need to be taken.

Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area.

BACKGROUND: We examined the relationship between health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area. METHODS: We conducted in-person interviews with 913 rural women aged 23 - 57 (57.5% Hui minorities/42.5% Han ethnicity) enrolled in the Ningxia Women Health Project, gathering data on EQ-5D, self-designed HL, socio-demographic characteristics, and chronic diseases. The extent of impairments in the five dimensions of the EQ-5D was used to measure HRQoL. Factor analysis yielded a single HL factor, which was used as a dichotomous variable in multivariate log-binomial regression models that examined the adjusted association of HL with HRQoL. RESULTS: Nearly half of the women had no formal education. The most prevalent impairments were pain/discomfort and anxiety/depression (42.42% and 32.09%, respectively). The Hui minorities had 1.65 times higher rates of low HL (defined as less than mean of the factor score for HL) and 1.22 and 1.25 times for pain/discomfort and anxiety/depression impairments, respectively. Low HL was associated with poor HRQoL, with a 23% increase in the prevalence of pain/discomfort impairments after adjusting for socio-demographics. This association was significant in the Hui group (PR=1.30, 95% CI=1.06-1.58) but not for the Han group (PR=0.99, 95% CI=0.76-1.30). HL-stratified analysis revealed modification for ethnic disparities in HRQoL; for pain/discomfort impairments, high HL-PR=0.88 (95% CI=0.71-1.08), low HL-PR=1.24 (95% CI = 1.01-1.52); for anxiety/depression impairments, high HL-PR=0.98 (95% CI=0.73-1.32), low HL-PR=1.44 (95% CI = 1.05-1.98). CONCLUSIONS: Low HL is associated with poor HRQoL across the entire sample and the association may be modified by ethnicity. Similarly, ethnic disparities in HRQoL may be modified by HL, larger in low HL group. Health services should address HL in vulnerable minority women to improve their HRQoL.

Internalizing Behavior Problems Among the Left-Behind Children of the Hui Nationality in Rural China: A Cross-Sectional Study.

Background: The internalizing behavior problems (IBPs) of left-behind children (LBC) due to parental migration are a widespread public health concern in China. A previous study showed that the detection rate of behavioral problems in the Hui was far higher than in the LBC of the Han nationality. However, to date, limited research has focused on IBPs in Chinese LBC of the Hui nationality. The aims of this present study are to explore the prevalence of IBPs and the influencing factors among the Hui LBC in the rural areas of China. Methods: A cross-sectional study was conducted among school students from the southern rural areas in Ningxia, China (2012-2013). The caregivers or parents assessed IBPs using Achenbach's Child Behavior Checklist for parents. The children completed the Egma Minnen av Bardndosnauppforstran, Junior Eysenck Personality Questionnaire and Piers-Harris Children's Self-concept Scale. Data on 383 Hui LBC aged 6-16 y were included in this study. Multivariate logistic regression analysis was used to examine the relationships between the independent variables and children's internalizing behaviors. Results: Among the Hui population, the prevalence of IBPs in LBC and non-left-behind children (non-LBC) was 21.67% (83 of 383) and 18.18% (104 of 572), respectively, with no significant difference between these two groups (χ 2 = 1.77 and P = 0.18). However, among males of the Hui population, the prevalence of IBPs in LBC was 22.16%, which is significantly higher than in non-LBC (14.07%; χ 2 = 5.07; and P = 0.02). By controlling for gender and age, the multivariate logistic regression analysis showed that a mother highly favoring the subject (odds ratio [OR] = 2.70), average levels of neuroticism (OR = 9.01), and high levels of neuroticism (OR = 8.44) were risk factors for IBPs in Hui LBC. Conclusion: Our findings suggest that IBPs among male LBC of the Hui nationality in rural China were positively related to parental migration. Positive measures should be taken to prevent IBPs of male LBC of the Hui nationality in rural China in terms of personality development and parental childrearing patterns.

Interaction between COX-2 and ER stress is involved in the apoptosis-induced myocardial ischemia/reperfusion injury.

PURPOSE: Apoptosis induced by excessive endoplasmic reticulum (ER) stress is accompanied by the occurrence and progression of myocardial ischemia/reperfusion (I/R) injury. COX-2 is also known to affect the development of I/R damage in myocardium. However, the interaction between COX-2 and ER stress in aggravating myocardial I/R lesion is not well characterized. Therefore, the purpose of our research was to explore the interaction between COX-2 and ER stress on myocardial apoptosis. METHODS: The left anterior descending (LAD) coronary artery was ligatured with a 6-0# suture for 0.5 hours and subsequently subjected to reperfusion for 3 hours to simulate myocardial I/R in mice. Oxygen glucose deprivation/reoxygenation (OGD/R) was performed on H9c2 cells to construct an in vitro model of this experiment. NS398 (COX-2 specific inhibitor) and Salubrinal (Sal, ER stress inhibitor) were administered to assess the function of COX-2 and ER stress in myocardial I/R impairment. CCK-8 assay was used to evaluate the viability of H9c2 cells under different treatment conditions. TUNEL and Hoechst staining were used to detect the occurrence of apoptosis. Infarct area/area at risk and Hematoxylin-eosin stained sections were assessed after I/R. Protein expressions of glucose-regulated protein 78 (GRP78), COX-2, phosphorylation of eukaryotic translation initiation factor 2 alpha (p-eIF2α), CCAAT/enhancer-binding protein homologous protein (CHOP), and Cleaved caspase 3 in the myocardium were examined using Western blotting. Changes in Cleaved caspase 3 expression in myocardial slices were measured by immunohistochemistry. RESULTS: Sal or NS398 partly reduced I/R-induced damage as testified by the apparent decrease in infarct size after I/R and reduced cell viability following OGD/R. Sal distinctly increased p-eIF2α, but caused decreased expression of COX-2, Cleaved caspase 3, and ER stress-associated proteins after I/R, suggesting that Sal effectively inhibited ER stress, apoptosis, and COX-2. Pretreatment with NS398 blocked I/R or OGD/R-induced upregulation of COX-2, Cleaved caspase 3, and ER stress-related marker proteins. CONCLUSIONS: Interaction of COX-2 and ER stress regulates apoptosis and contributes to Myocardial lesion induced by I/R.

Dexmedetomidine Attenuates Ferroptosis-Mediated Renal Ischemia/Reperfusion Injury and Inflammation by Inhibiting ACSL4 via α2-AR.

Ischemia-reperfusion (I/R) injury is a serious clinical pathology associated with acute kidney injury (AKI). Ferroptosis is non-apoptotic cell death that is known to contribute to renal I/R injury. Dexmedetomidine (Dex) has been shown to exert anti-inflammatory and organ protective effects. This study aimed to investigate the detailed molecular mechanism of Dex protects kidneys against I/R injury through inhibiting ferroptosis. We established the I/R-induced renal injury model in mice, and OGD/R induced HEK293T cells damage in vitro. RNA-seq analysis was performed for identifying the potential therapeutic targets. RNA-seq analysis for differentially expressed genes (DEGs) reported Acyl-CoA synthetase long-chain family member 4 (ACSL4) related to ferroptosis and inflammation in I/R mice renal, which was validated in rodent renal. Liproxstatin-1, the specific small-molecule inhibitor of ferroptosis, significantly attenuated ferroptosis-mediated renal I/R injury with decreased LPO, MDA, and LDH levels, and increased GSH level. Inhibiting the activity of ACSL4 by the Rosiglitazone (ROSI) resulted in the decreased ferroptosis and inflammation, as well as reduced renal tissue damage, with decreasing LPO, MDA and LDH level, increasing GSH level, reducing COX2 and increasing GPx4 protein expression, and suppressing the TNF-α mRNA and IL-6 mRNA levels. Dex as a α2-adrenergic receptor (α2-AR) agonist performed renal protective effects against I/R-induced injury. Our results also revealed that Dex administration mitigated tissue damage, inhibited ferroptosis, and downregulated inflammation response following renal I/R injury, which were associated with the suppression of ACSL4. In addition, ACSL4 overexpression abolishes Dex-mediated protective effects on OGD/R induced ferroptosis and inflammation in HEK293T cells, and promotion of ACSL4 expression by α2-AR inhibitor significantly reversed the effects on the protective role of Dex. This present study indicated that the Dex attenuates ferroptosis-mediated renal I/R injury and inflammation by inhibiting ACSL4 via α2-AR.

Iguratimod Alleviates Myocardial Ischemia/Reperfusion Injury Through Inhibiting Inflammatory Response Induced by Cardiac Fibroblast Pyroptosis via COX2/NLRP3 Signaling Pathway.

Background: NLRP3 inflammasome contributes a lot to sterile inflammatory response and pyroptosis in ischemia/reperfusion (I/R) injury. Cardiac fibroblasts (CFs) are regarded as semi-professional inflammatory cells and they exert an immunomodulatory role in heart. Iguratimod provides a protective role in several human diseases through exerting a powerful anti-inflammatory effect. However, it is still unclear whether iguratimod could alleviate myocardial I/R injury and whether inflammation triggered by NLRP3-related pyroptosis of CFs is involved in this process. Methods: Transcriptomics analysis for GSE160516 dataset was conducted to explore the biological function of differentially expressed genes during myocardial I/R. In vivo, mice underwent ligation of left anterior descending coronary artery for 30 min followed by 24 h reperfusion. In vitro, primary CFs were subjected to hypoxia for 1 h followed by reoxygenation for 3 h (H/R). Iguratimod was used prior to I/R or H/R. Myocardial infarct area, serum level of cardiac troponin I (cTnI), pathology of myocardial tissue, cell viability, lactate dehydrogenase (LDH) release, and the expression levels of mRNA and protein for pyroptosis-related molecules were measured. Immunofluorescence was applied to determine the cellular localization of NLRP3 protein in cardiac tissue. Results: During myocardial I/R, inflammatory response was found to be the most significantly enriched biological process, and nucleotide-binding oligomerization domain (NOD)-like receptor signaling was a crucial pathway in mediating cardiac inflammation. In our experiments, pretreatment with iguratimod significantly ameliorated I/R-induced myocardial injury and H/R-induced pyroptosis of CFs, as evidenced by reduced myocardial infarct area, serum cTnI level, and LDH release in supernatants, as well as improved pathology of cardiac tissue and cell viability. Immunofluorescence analysis showed that NLRP3 was mainly localized in CFs. Moreover, iguratimod inhibited the expression of pro-inflammatory cytokines and pyroptosis-related molecules, including NLRP3, cleaved caspase-1, and GSDMD-N. Conclusion: Our results suggested that inflammatory response mediated by NOD-like receptor signaling is of vital importance in myocardial I/R injury. Iguratimod protected cardiomyocytes through reducing the cascade of inflammation in heart by inhibiting cardiac fibroblast pyroptosis via the COX2/NLRP3 signaling pathway.

Satisfaction survey among primary health care outpatients in the backward region: an empirical study from rural Western China.

BACKGROUND: With a growing health demand, patient satisfaction analysis is essential for evaluating the accessibility and performance of medical services. Previous studies had explored the Chinese outpatient satisfaction and influencing factors in developed areas and tertiary hospitals. Considering the lower education level, less income, and heavier economic burden, it was necessary to conduct a region-specific questionnaire survey for the outpatient's satisfaction in rural Western China. OBJECTIVE: To analyze the satisfaction of primary outpatient service in rural Western China, and explore the factors affecting outpatients' satisfaction. METHODS: Questionnaire composed of nine 5-Likert items was applied to survey outpatient satisfaction among randomly selected samples in 11 provinces of Western China. Exploratory factor analysis (EFA) was conducted to study the factor structure of questionnaire. Stepwise multiple linear regression analysis was performed to study the influencing factors. RESULTS: A total of 2,754 outpatients completed the questionnaire, the response rate was 88.7%. Respondents were most satisfied with medical staff service attitude (3.71±0.83) and least satisfied with medical cost (2.97±0.83). A 3-factor solution was adopted in EFA to explain the overall satisfaction. Factors identified were "Service attitude", "Facility and professional skills", and "Patients' cost". And, the questionnaire was proved to have good reliability and acceptable internal consistency. The stepwise multiple linear regression analysis results presented that factors, including sample hospital type (P<0.05), age (P<0.001), education level (P<0.05), occupation (P<0.01), monthly income (P<0.05), and chronic disease conditions (P<0.01) were significantly associated with the dimensional or overall satisfaction. CONCLUSION: The primary health care outpatient satisfaction in rural Western China is lower than developed areas and tertiary hospitals. Care providers in backward regions should pay more attention to patients' demographic characteristics and health status, to meet outpatients' actual demand. Efficient hospital management methods, modern technology, and staff training are needed to improve the service quality and care efficiency.

Effects of the National Essential Medicine System in reducing drug prices: an empirical study in four Chinese provinces.

OBJECTIVES: The rapid increase in drug expenditure has become a major source of public criticism in China. In 2009, the National Essential Medicine System (NEMS) was launched in China to control drug prices and improve access to medicines. This study investigated whether and to what extent the prices of essential medicines were reduced after the introduction of NEMS. METHODS: Data were obtained from 149 public primary healthcare centers (PHCs) in four Chinese provinces (Shandong, Zhejiang, Anhui and Ningxia) using a facility-based survey. In total, 10,988 essential medicines were investigated. Individual price differences and a price index were used to measure price changes for three different lists: 2009-2010, 2010-2011, and 2009-2011. RESULTS: In the comparison between 2009 and 2010, a median decrease of 34.4% [95% confidence interval: 30.4%-39.1%] was observed in drug prices and the number of drug sales increased by 1.5%. The higher the retail price in 2010, the more the drug sales increased compared with 2009 (χ (2) = 75.9, p < 0.01). The drug revenues in 100 of the 149 surveyed PHCs decreased by an average of 39%. Where the available data allowed price changes for 2009-2011 to be assessed, drug prices were reduced significantly in 2010, but a modest decrease was seen in 2011. The Laspeyres index was less than 100 and the Paasche index was larger than the Laspeyres index in 2010 and 2011, which indicated that the frequently prescribed drugs usually had higher prices and any price reduction was milder. CONCLUSIONS: The introduction of NEMS in PHCs in China led to price reductions in essential medicines. However, more-expensive drugs were preferred in the postreform period. Most PHCs had less drug revenue and could encounter financing dilemmas after the implementation of NEMS. Policy options such as improving the compensation mechanism and rational use of drugs should be further promoted in PHCs.

Maternal education and micro-geographic disparities in nutritional status among school-aged children in rural northwestern China.

OBJECTIVES: Prior evidence suggests geographic disparities in the effect of maternal education on child nutritional status between countries, between regions and between urban and rural areas. We postulated its effect would also vary by micro-geographic locations (indicated by mountain areas, plain areas and the edge areas) in a Chinese minority area. METHODS: A cross-sectional study was conducted with a multistage random sample of 1474 school children aged 5-12 years in Guyuan, China. Child nutritional status was measured by height-for-age z scores (HAZ). Linear mixed models were used to examine its association with place of residence and maternal education. RESULTS: Micro-geographic disparities in child nutritional status and the level of socioeconomic composition were found. Children living in mountain areas had poorer nutritional status, even after adjusting for demographic (plain versus mountain, ß = 0.16, P = 0.033; edge versus mountain, ß = 0.29, P = 0.002) and socioeconomic factors (plain versus mountain, ß = 0.12, P = 0.137; edge versus mountain, ß = 0.25, P = 0.009). The disparities significantly widened with increasing years of mothers' schooling (maternal education*plain versus mountain: ß = 0.06, P = 0.007; maternal education*edge versus mountain: ß = 0.07, P = 0.005). Moreover, the association between maternal education and child nutrition was negative (ß = -0.03, P = 0.056) in mountain areas but positive in plain areas (ß = 0.02, P = 0.094) or in the edge areas (ß = 0.04, P = 0.055). CONCLUSIONS: Micro-geographic disparities in child nutritional status increase with increasing level of maternal education and the effect of maternal education varies by micro-geographic locations, which exacerbates child health inequity. Educating rural girls alone is not sufficient; improving unfavorable conditions in mountain areas might make such investments more effective in promoting child health. Nutrition programs targeting to the least educated groups in plain and in edge areas would be critical to their cost-effectiveness.

A novel myeloid differentiation factor 88 homolog, SpMyD88, exhibiting SpToll-binding activity in the mud crab Scylla paramamosain.

Myeloid differentiation factor 88 (MyD88) is an essential regulator in the Toll or Toll-like receptor (TLR) signaling pathway. In the current study, we characterized a novel crustacean MyD88 homolog, SpMyD88, and analyzed its binding activity with SpToll. The full-length cDNA sequence of SpMyD88 is 2933 bp, with a 1419 bp open reading frame encoding a 472-amino acid protein. No signal peptide was predicted. A death domain (residues 19-103), a Toll/interleukin-1 receptor (TIR) domain (residues 156-297), and a C-terminal extension (CTE) domain (residues 298-472) were also found. In a phylogenetic tree constructed with MyD88 homologs from both invertebrates and vertebrates, arthropod MyD88s including SpMyD88 formed a cluster containing a unique CTE domain. SpToll shared the highest identity with human TLR4. These two receptors were grouped into a cluster of a tree constructed based on the conserved TIR domains. SpToll also had a close relationship with other shrimp TLRs that possess potential antibacterial activity. SpMyD88 was highly expressed in the hemocytes, gills, hepatopancreas, and eye stalks. Upon challenge with Vibrio harveyi, both SpMyD88 and SpToll were significantly increased in the hemocytes, whereas only SpMyD88 was elevated by Staphylococcus aureus. In addition, a pull-down assay demonstrated that SpMyD88 showed a binding activity with SpToll. These results suggest that SpMyD88 and SpToll are involved in the defense system of mud crabs against Gram-negative bacteria.

Identification, characterization, and functional analysis of Tube and Pelle homologs in the mud crab Scylla paramamosain.

Tube and Pelle are essential components in Drosophila Toll signaling pathway. In this study, we characterized a pair of crustacean homologs of Tube and Pelle in Scylla paramamosain, namely, SpTube and SpPelle, and analyzed their immune functions. The full-length cDNA of SpTube had 2052 bp with a 1578 bp open reading frame (ORF) encoding a protein with 525 aa. A death domain (DD) and a kinase domain were predicted in the deduced protein. The full-length cDNA of SpPelle had 3825 bp with a 3420 bp ORF encoding a protein with 1140 aa. The protein contained a DD and a kinase domain. Two conserved repeat motifs previously called Tube repeat motifs present only in insect Tube or Tube-like sequences were found between these two domains. Alignments and structure predictions demonstrated that SpTubeDD and SpPelleDD significantly differed in sequence and 3D structure. Similar to TubeDD, SpTubeDD contained three common conserved residues (R, K, and R) on one surface that may mediate SpMyD88 binding and two common residues (A and A) on the other surface that may contribute to Pelle binding. By contrast, SpPelleDD lacked similar conservative residues. SpTube, insect Tube-like kinases, and human IRAK4 were found to be RD kinases with an RD dipeptide in the kinase domain. SpPelle, Pelle, insect Pelle-like kinases, and human IRAK1 were found to be non-RD kinases lacking an RD dipeptide. Both SpTube and SpPelle were highly expressed in hemocytes, gills, and hepatopancreas. Upon challenge, SpTube and SpPele were significantly increased in hemocytes by Gram-negative or Gram-positive bacteria, whereas only SpPelle was elevated by White Spot Syndrome Virus. The pull-down assay showed that SpTube can bind to both SpMyD88 and SpPelle. These results suggest that SpTube, SpPelle, and SpMyD88 may form a trimeric complex involved in the immunity of mud crabs against both Gram-negative and Gram-positive bacteria.