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BACKGROUND: In this study, we determined the prevalence of unmet need for hospitalization service and the characteristics of the elderly with this unmet need in Zhejiang province, China. METHODS: Data were collected from a random sample of 4046 Chinese aged 60 years and older in Zhejiang province. Based on the Andersen-Newman service utilization framework, multivariable logistic regression analysis was used to determine independent effects of these variables on the likelihood of having an unmet need for hospitalization service. RESULTS: Overall, the prevalence of unmet need was 16.2% for hospitalization service. Among predisposing factors, only educational level was statistically significant. Individuals with higher education were less likely to report unmet needs. Among enabling factors, residential area, social support, personal yearly income and personal healthcare expenditure were strongly associated with the presence of unmet need. Those with less enabling resources (e.g. residing in rural areas) were more likely to report unmet need [Odds ratio (OR) = 1.5-6.5]. All the need factors, except for physical function, were strongly associated with the presence of unmet need. Seniors in poorer health (e.g. in fair or poor health) were more likely to report unmet need than their counterparts in better health (OR = 1.5-2.8). CONCLUSIONS: In spite of relatively high insurance coverage rates, unmet need for hospitalization service remains high among the elderly people of Zhejiang province in China. Application of comprehensive intervention strategies such as conducting health education, creating social support, promoting community participation and promoting inter-sectional cooperation may be more effective in reducing unmet need for hospitalization service.
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Hospitalización , Evaluación de Necesidades , Satisfacción del Paciente , Anciano , Anciano de 80 o más Años , Envejecimiento , China , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
Objective@#To investigate the association between body mass index ( BMI ) and mortality risk among older Chinese based on the China Health and Retirement Longitudinal Study ( CHARLS ). @*Methods@#The demographic features, BMI, prevalence of chronic diseases and mortality among the elderly at ages of 60 years and greater were captured from the CHARLS database from 2011 to 2018. A multivariable Cox proportional hazards regression model was used to examine the association between BMI and the risk of death.@*Results@#Totally 6 023 subjects were enrolled, including 3 006 men ( 50.09% ) and 3 017 women ( 49.91% ), and 68.69% of the participants ( 4 137 subjects ) were at ages of 60 to 69 years. There were 637 subjects ( 10.58% ) with underweight, 1 544 ( 25.63% ) with overweight, and 557 ( 9.25% ) with obesity. During the follow-up period ( 35 091 person-years ), 1 035 subjects died. Multivariable Cox proportional hazards regression analysis revealed an increased risk of mortality among the underweight elderly ( HR=1.496, 95%CI: 1.261-1.775 ) and a reduced risk of mortality among the obese elderly ( HR=0.671, 95%CI: 0.511-0.881 ) relative to the elderly with normal weight, after adjustment for age, gender, smoking, household registration, administration of anti-diabetic drugs, administration of anti-dyslipidemia drugs, and administration of anti-hypertensive drugs.@*Conclusion@#It is found that the risk of mortality among the Chinese elderly correlatives with BMI through the analysis of CHARLS data.
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Objective:To observe the effect of Lingshao-Zaoren Decoction on urodynamics and the expression of Piezo1 if overactive bladder (OAB) rats. Methods:Thirty SPF grade female SD rats were randomly divided into blank group, model group, Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups, with 6 rats in each group. The OAB rats were modeled by intraperitoneal injection of Cyclophosphamide. After the successful modeling, Tolterodine control group was given 0.36 mg/kg Tolterodine tartrate, the low-dose and high-dose Lingshao-Zaoren Decoction groups were given 1.59 and 3.18 g/kg Lingshao-Zaoren Mianjian granules by gavage, the blank group and model group were given the same amount of distilled water, once a day for 14 days. After 14 days, the urodynamics of rats in each group were detected. The bladder volume and maximum bladder pressure were observed respectively. The pathological changes of bladder tissue were observed by HE staining. The expression of Piezo1 protein in bladder tissue was detected by immunohistochemistry and Western blot. The expression of Piezo1 mRNA in bladder tissue was detected by qPCR. Results:Compared with the blank group, the body weight, bladder volume and maximum bladder pressure of the model group were significantly reduced ( P<0.01). HE staining result showed that the model group had hyperplasia of urinary tract epithelium, degeneration, necrosis and abscission of epithelial cells, infiltration of a large number of inflammatory cells in stroma, vascular proliferation, thickening of vascular wall, hyperplasia of mucosal smooth muscle, disorder of arrangement, and significant up regulation of Piezo1 protein expression ( P<0.01). Compared with the model group, the weight [(244.83 ± 6.05) g, (233.33 ± 11.76) g vs. (219.00 ± 9.70) g] of rats in the Tolterodine control group and high-dose group of Lingshao-Zaoren Decoction significantly increased ( P<0.01), and the bladder volume [(0.93 ± 0.31) ml, (1.17 ± 0.17) ml, (1.21 ± 0.23) ml vs. (0.50 ± 0.16) ml] and maximum bladder pressure [(42.00 ± 3.03) cmH 2O, (45.83 ± 7.19) cmH 2O, (46.83 ± 8.23) cmH 2O vs. (30.50 ± 5.47) cmH 2O] of rats in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups were significantly increased ( P<0.01); the bladder epithelial hyperplasia and degeneration degree, interstitial inflammatory cell infiltration degree and vascular hyperplasia degree of rats in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups significantly increased. The expression of Piezo1 mRNA (1.50 ± 0.04, 2.05 ± 0.08, 1.44 ± 0.10 vs. 2.56 ± 0.11) and protein in the Tolterodine control group, low-dose and high-dose Lingshao-Zaoren Decoction groups were significantly decreased ( P<0.01). Conclusion:Lingshao-Zaoren Decoction can increase the bladder volume and maximum bladder pressure of urinary incontinence caused by detrusor overactivity in rats with overactive bladder, which may be related to reduction of Piezo1 expression.
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OBJECTIVE:To establish UPLC method for the content determination of related substances in Terlipressin for injection. METHODS :UPLC method was used to determine the contents of related substances in 5 batches of Terlipressin for injection. The separation was performed on Xtimate UPLC C 18 column with mobile phase A consisted of ammonium sulfate buffer (pH 2.3)-methanol(90 ∶ 10,V/V)and mobile phase B consisted of ammonium sulfate buffer (pH 2.3)-methanol(60 ∶ 40,V/V) (gradient elution )at the flow rate of 0.2 mL/min. The detection wavelength was set at 210 nm,and sample size was 5 μL. RESULTS:The linear range of impurity A ,B,C,D,F,H,I,K,L and N were 0.43-3.86,0.44-3.95,0.44-3.97,0.45-4.08, 0.45-4.05,0.50-4.50,0.47-4.26,0.47-4.23,0.46-4.13,0.44-3.96 μg/mL(r≥0.999 7),respectively. The detection limits were 0.04, 0.04,0.05,0.04,0.05,0.05,0.05,0.05,0.04 μg/mL. The quantitation limits were 0.13,0.13,0.14,0.13,0.15,0.14,0.14, 0.14,0.13 μg/mL,respectively. RSDs of precision ,reproducibility and stability tests were all lower than 8%. The average recoveries were 94.95%,97.81%,101.88%,95.26%,93.40%,102.48%,104.26%,102.31%,96.42%,90.42%,with RSD s of 1.89%,1.86%,0.68%,1.30%,1.98%,3.36%,1.26%,1.30%,1.19%,1.40%(n=9),respectively. Total contents of impurities in 5 batches of Terlipressin for injection were all lower than 4%. CONCLUSIONS :Established method is rapid ,simple, accurate and specific ,which can be used for the quantitative analysis for related substances in Terlipressin for injection.
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Objective@#To evaluate the efficacy of Fufang-Xuanju capsule combined with levofloxacin mesylate tablets in the treatment of chronic epididymitis.@*Methods@#A total of 76 patients in the Urology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences who met the inclusion criteria from December 2016 to February 2019, were divided into treatment group (43 cases) and control group (33 cases). The control group was given levofloxacin mesylate tablets orally. The treatment group was given Fufang-Xuanju capsule based on the control group. Both groups were treated for 4 weeks. Chronic epididymitis symptom index (CESI) was used to evaluate the clinical efficacy by pain score and quality of life score.@*Results@#The total effective rate was 83.7% (36/43) in the treatment group and 63.6% (26/33) in the control group. There was statistically significant difference between the two groups (χ2=4.020, P=0.045). Compared with baseline, the pain scores, quality of life scores and total scores of both groups at 2, 4 weeks after treatment were significantly lower (P<0.01). Two weeks after the treatment, the pain scores, quality of life scores and total scores in the treatment group were significantly lower than those of the control group (F value were 16.132, 9.134 and 23.681, respectively, all Ps<0.01). And 4 weeks after the treatment, the pain scores, quality of life scores and total scores of the treatment group were significantly lower than that of the control group (F value were 28.741, 74.049, 72.483, respectively, all Ps<0.01).@*Conclusions@#Fufang-Xuanju capsule combined with levofloxacin mesylate tablets can alleviate the pain of patients with chronic epididymitis, improve the quality of life and improve the clinical efficacy.
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Objective:To evaluate the efficacy of Fufang-Xuanju capsule combined with levofloxacin mesylate tablets in the treatment of chronic epididymitis. Methods:A total of 76 patients in the Urology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences who met the inclusion criteria from December 2016 to February 2019, were divided into treatment group (43 cases) and control group (33 cases). The control group was given levofloxacin mesylate tablets orally. The treatment group was given Fufang-Xuanju capsule based on the control group. Both groups were treated for 4 weeks. Chronic epididymitis symptom index (CESI) was used to evaluate the clinical efficacy by pain score and quality of life score. Results:The total effective rate was 83.7% (36/43) in the treatment group and 63.6% (26/33) in the control group. There was statistically significant difference between the two groups ( χ2=4.020, P=0.045). Compared with baseline, the pain scores, quality of life scores and total scores of both groups at 2, 4 weeks after treatment were significantly lower ( P<0.01). Two weeks after the treatment, the pain scores, quality of life scores and total scores in the treatment group were significantly lower than those of the control group ( F value were 16.132, 9.134 and 23.681, respectively, all Ps<0.01). And 4 weeks after the treatment, the pain scores, quality of life scores and total scores of the treatment group were significantly lower than that of the control group ( F value were 28.741, 74.049, 72.483, respectively, all Ps<0.01). Conclusions:Fufang-Xuanju capsule combined with levofloxacin mesylate tablets can alleviate the pain of patients with chronic epididymitis, improve the quality of life and improve the clinical efficacy.
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Objective To improve the training system of the combined education mode between professional master degree students of clinical medicine and resident standardization training (RST) in Zhe-jiang province, and improve the professional quality of medical graduate students. Methods A question-naire was designed through literature review and expert interview, and the data of 77 clinical training post-graduates were collected, and the effect of the training was evaluated by taking the reaction level, learning level, behavior level and achievement level of Ke's evaluation as the breakthrough point. Statistical analysis was performed by SPSS 20.0, and the mean score was used as the standard deviation. The scores were compared with t test, and the scores of multiple groups were made variance analysis. Results The RST attitude value in reaction layer was 9.26±1.08, RST content value was 29.29±4.36, RST teacher enthusiasm value was 11.13±2.17, RST experience value was 17.38±3.10, which indicated that residents' overall satisfaction to RST was high, but the satisfaction on teachers, evaluation and compensation was relatively low;The grade difference before and after RST in learning layer was statistically significant (P<0.05), indicating that before and after RST the grades were obviously improved, and the sense of belonging is high. The behave layer showed the residents' behavior changed obviously before and after RST (P<0.05), and their abilities in various aspects such as ward round and dealing with common diseases were largely improved;The result layer showed 77 graduate students had no medical accident and complaint , and all of them passed the annual assessment and participated in the research projects. Conclusion In general, RST graduate students are relatively satisfied with the plan, content and methods of the training, on the other hand, there are problems such as the absence of timely information feedback, teachers' poor enthusiasm, lack of effective competition mechanism, etc. Kirkpatrick Model made a comprehensive and objective eval-uation on graduate students RST from a overall perspective, and it can be introduced into the effectiveness evaluation for graduate students RST.
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Zhejiang province takes an innovative approach in its rural health service strategy featuring routine health examination,which proved an initial success.Intending to assess the effect and dilemma of such a system,and seek sustainable development in future,we made investigations in Pinhu and Xianju in Zhejiang province.Overall,rural health service strategy based on rural health routine examination,to some extent, improved patient-physician relationship,changed and strengthened their rural health concepts,and upgraded non-communicable disease control. Furthermore,the practice has economically and socially influenced rural health service institutions and rural physicians in terms of their concepts and methodology.There are also setbacks and problems in need of govemment support,programme improvement and resource optimization for further sustainability.