ObjectivesTo conduct a bibliometric analysis to research the status of disease burden domestically and overseas so as to understand the status of diseases burden, and to provide scientific and reasonable reference for health disease prevention, control strategies formulation and future research.MethodsPubMed, Web of Science, EMbase, The Cochrane Library, WanFang Data, CBM and CNKI databases were electronically searched to collect literature on disease burden from inception to October, 2018. Two reviewers independently screened literature and extracted data. EndNote X7 software was used for literature management, Excel 2016 software and VOS viewer software were also used to analyze data. Literature was classified by the aspects of literature publication characteristics, diseases, background areas, influencing factors, evaluation indicators and poverty caused by illness.ResultsA total of 325 studies were included in the bibliometric analysis. 41 articles (12.6%) were published in journals indexed by SCIE; original research evidence accounted for 97.0% (315 articles); 272 articles were from China (83.7%). The main diseases involved were malignant tumors (58 articles, 17.8%), diabetes (29 articles, 8.9%) and hypertension (24 articles, 7.4%). Factors affecting the disease burden primarily included hospitalization days (9 articles, 2.8%), complications (5 articles, 1.5%), delays in treatment (5 articles, 1.5%), and economic income (4 articles, 1.2%). Sixity-one articles (18.8%) reported poverty due to illness, and related diseases were chronic obstructive pulmonary disease (12 articles, 3.7%), hypertension (10 articles, 3.1%), diabetes (10 articles, 3.1%), malignant tumors (9 articles, 2.8%) and hepatitis B (6 articles, 1.8%).ConclusionsAt present, the disease burden research are focusing more on the burden of chronic non-communicable diseases such as malignant tumors, hypertension, diabetes, cardiovascular and cerebrovascular diseases in developing countries and regions. Medical costs vary from different diseases and treatment, different demographic characteristics of patients, and the coverage medical security of different population are the primary reasons for the " expensive in medical treatment” of current residents and the heavy burden of disease. DALY and total direct medical expenses are the main evaluation indexes of epidemiological burden and economic burden of disease, respectively. Future researches should focus on strengthening the scientific nature of study design to improve the quality of research, as well as paying more attention to diseases and aspects that are rarely involved, such as major diseases caused by poverty due to illness, comprehensive analysis of multiple diseases and aspects of health investment measurement, and comprehensively use the evaluation indicators of disease burden to strengthen the research on the comparability index of disease economic burden.
Objective To investigate the disease constitution of Yaqian Township Health Center (YQT) in Xiaoshan District of Zhejiang Province from 2008 to 2010, so as to provide baseline data for further study. Methods Questionnaire and focus interview were carried out to collect inpatients’ case records from 2008 to 2010. The first diagnoses were classified according to ICD-10, and the data of discharge diagnoses were rearranged and analyzed by using Excel 2003 and SPSS 13.0 software. Results a) The total numbers of inpatients were 182, 195 and 248 from 2008 to 2010, respectively; b) The disease spectrum included 9-14 categories, which accounted for 47.6%-66.7% of ICD-10; c) The top 6 systematic diseases accounted for 37.37%-75.39%, which included the circulatory, injury, digestive, respiratory, neoplasms and urinary and reproductive systematic diseases; d) A total of 8 of the top 15 single diseases were the same, including hypertension, great saphenous vein varices, redundant prepuce, lung cancer, fracture, superficial injuries, acute appendicitis, and inguinal hernia; and e) The constitution ratio of the chronic diseases, compared with the acute ones, was higher in 2008, but lower in 2009 and 2010. Conclusion a) In recent three years, the main systematic diseases seen in YQT have been circulatory, injury, digestive, respiratory, neoplasms, and urinary and reproductive systematic diseases. The newly increased diseases in 2010 were pregnancy, childbirth and puerperium. The acute diseases mainly are fracture and injure, while the chronic diseases mostly are hypertension; b) A total of 8 of the top 15 single diseases are the same, indicating the stability of the common inpatients’ diseases; and c) Attention should be paid in future to the chronic diseases management, women’s health and specialized subject construction.
ObjectiveTo access the current study status and the existing problems of studies on National Essential Medicines System (NEMS) in China based on systematic review methods, and provide the evidence-based evidence and references to the studies of this field.
MethodsThe following databases such as PubMed, EMbase, The Cochrane Library (Issue 3, March 2014), CNKI, WanFang Data, VIP and CBM were electronically searched to collect studies related to the policy analysis, implementation background, implementation strategies, implementation situation, implementation problem and implementation effects about NEMS in China. The retrieval time was from inception to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and finally conducted analysis on study types, study time, source journals, authors' units, study themes, etc. of the included studies.
ResultsA total of 1 607 articles were finally included, encompassing 56.38% qualitative studies and 43.62% quantitative studies. The number of published studies per year, the number of quantitative studies as well as the number of financiallysupported studies out of the total studies published per year had increased by year since 2009. The study topics focused on every parts during the implementation of NEMS in different proportions. The proportion of the national studies in the quantitative studies was lower than that of others. The regional distribution involved in the quantitative studies was unbalanced, and the ratio of which located on the East, the Central and the West of China was 2 to 1 to 1.
ConclusionThe implementation of NEMS and related studies are mutually promoted. More studies are needed to be carried out on remote areas as well as West China. Although the studies related to these areas tend to be standardized and evidence-based, but more in-depth studies should be well advanced. Most of the topics of the studies are widely covered, and the topics of further studies should be enforced in the detail of implementation links. Most of the studies focus on primary medical institutions, and more studies are also needed for supporting and expanding the implementation of NEMS in second and three degree medical institutions.
Objective To learn the current situation of traditional Chinese medicine (TCM) systematic reviews/meta-analyses published in Chinese journals. Methods All TCM systematic reviews/meta-analyses published from 1978 to July 31, 2009 were searched in the Chinese Biomedical Database (CBM). According to the inclusion and exclusion criteria, relevant information was extracted on the basis of research purpose. Meanwhile, publication year, journal name, author’s district, number of authors and their articles, types of diseases and interventions were took as the indexes, and then descriptive analysis was performed using SPSS 15.0 software. Results A total of 245 articles including 238 in Chinese and 7 in English were included. All of them were published in 117 different journals from 1998 to 2008, showing an accelerating growth trend of article number. In addition to only one article with first author from Germany, the first author of other 244 were from 24 domestic provinces (autonomous regions and municipalities); the number of authors ranged from 1 to 11; a total of 186 people had published articles as first author, and the number of their published articles ranged from 1 to 29. There were 16 types of diseases according to the International Classification of Diseases 10th Edition (ICD-10). Totally, 218 articles took drugs as interventions (including 106 listed drugs, 25 self-made prescriptions, 70 related to both listed drugs and self-made prescriptions, and 17 without reporting detailed interventions), accounting for 89%; and 27 articles were about non-drug interventions (including 26 about acupuncture and 1 about massage), accounting for 11%. Most (95.8%) of the articles about self-made prescriptions and listed drugs/self-made prescriptions adopted inappropriate pooled analyses. Conclusion Evidence-based medicine has been spread into the field of TCM, the number of TCM systematic reviews/meta-analyses shows an accelerated growth trend. The types of diseases discussed in the literature were almost the same as the diseases those could be effectively treated by TCM, but there existed imbalance in districts. In the future, systematic review/meta-analysis on drug intervention should aim at Chinese patent medicines and single medicines rather than self-made prescriptions, and should pay more attention to advantageous drugs and advantageous treatments of diseases. Moreover, importance should be also attached to clinical heterogeneity controlling when using acupuncture as a non-drug intervention.
Objective To understand the situation of commonly-used drugs, medical device and their storages in rural households among model well-off township hospitals in eastern, central and western China, and to provide the basis for the guidance of reasonably using and scientifically storing drugs. Methods The methods of combining simple random sampling and cluster sampling were used to investigate and analyze the situation of commonly-used drugs, medical device and their storages in 162 households from three well-off township hospitals in Shanghai, Zhejiang, and Sichuan provinces, respectively. Results The storage rates of commonly-used drugs of rural households in well-off towns were cold medicine (72.2%), wound paste (51.9%), cooling oil (39.5%), essential balm (36.4%), antihypertensive (27.8%), iodine tincture (14.2%), anti-diabetic drugs (13.0%) and other drugs (17.3%). The storage rates of medical devices were thermometer (50.0%), cotton swab (47.5%), sphygmomanometer (9.3%), injector (1.2%) and other devices (22.2%). A total of 66% of respondent families stored drugs and medical devices in a fixed drawer. Only 3.1% families stored drugs and medical devices in the special portable medical kit. Conclusion Rural families have a higher rate of household drugs among model well-off township hospitals in eastern, central and western China, and most drugs are OTC drugs. The storage rates of medical devices are not high. Many rural family-owned medical devices are linked with special chronic diseases in the family. A lot of rural families place drugs and medical devices randomly. There are many security risks, and it may affect the rational utilization of drugs.
ObjectiveTo investigate the guidance centers for promoting equalization of basic public health services in Sichuan province, in order to provide evidence for construction and development.
MethodsBy questionnaire survey, we collected relevant information and data about the guidance centers at all levels in Sichuan province. The EpiData 3.0 was used to establish a database and the SPSS 16.0 was used to analyze data.
ResultsA total of 202 guidance centers had been set up in Sichuan province. All disciplines of the basic public health services were covered by these centers. There were 2 020 technicians, whose average age was 41.37, more had college degree, and intermediate professional title. 54.5% of the guidance centers didn't work together, and there were 92.7% part-time technicians. Only 40% city and 20% county guidance centers got working funds. The average working funds of province, city and county were 890 000 yuan per year, 101 000 yuan per year and 89 000 yuan per year, respectively.
ConclusionThe guidance centers of Sichuan province at all levels have effectively promoted the basic public health services project, but we should improve and perfect the management mechanism and guarantee mechanism.
Objective To investigate current situation of medical service and management in Gaozha Central Township Health Center (GzC), so as to provide baseline data for township health centers in both key techniques research and product development of drugs allocation and delivery. Methods A questionnaire combined with a special interview was carried out, which included the general information, human resources, medical service and management, and the practice of essential medicine list. Results a) The hardware condition of GzC was not good enough, and the economic status of the service recipients was lower than the average level of both Wuzhong City and China mainland; b) The constituent ratio of general practitioner (GP) and nurse, and GP and laboratorian were all lower than those of national level, while, the constituent ratio of GP and technician was a little bit higher. GzC was in short of medical technical personnel and, especially, the professional pharmacists. The logistics technical workers were as the same proportion as the nurses. The medical technical personnel without professional education background accounted for 3.4%, and about 38% of the staff members had no college degree, about 86.2% had at most primary profession titles. There was no personnel turnover of GzC in recently years; c) The bed utilization ratio was lower than national level (46.4% vs. 60.7%), while the average duration of stay and the in-patient and out-patient service workload of GP were longer or heavier than national level (8 vs. 4.8, 9 vs. 8.3, 4 vs. 1.3); d) The out-patient service in 2010 decreased 26.9% compared to 2009; and the in-patient service in 2010 decreased 42.4%; e) The average medical expense per outpatient and per inpatient increased 127.3% and 56.2%, respectively in 2010 compared to 2009; and f) Essential medicine list was put into practice in April 1st of 2010 and there was only 195 species available in GzC, which has not met the requirements of the national essential medicine list. Conclusion In order to meet the standards of general rural township health center in western China, GzC needs to cope with challenges of insufficient hardware conditions, short of staff, unreasonable personnel structure, low educational background and professional title of the staff, none human resources flow and low technical level of medical service. GzC dose well in drug expenses control, and the hospitalization costs are lower than those of the national level. However, it increases rapidly in 2010. The management of GzC may be influenced by zero-profit sale of the essential drugs, and appropriate subsidy and policy support are necessary to maintain its service quality. And it is required to complement the medicine based on the evidences, to carry out staff training and usage guidance of essential medicine, and to finally guarantee the safe and reasonable use of medicines.
ObjectiveTo study the status-quo of doctors' workload in China, analyze its influential factors, and to provide references for relevant policy-making.
MethodsA multi-centre cross-sectional study was conducted. Clinical doctors who had worked for more than 6 months from 46 hospitals in 10 provinces were enrolled. The included doctors' workload was measured with working time per week and number of daily service patients. SPSS 20.0 software was used to analyze the data.
ResultsA total of 1 537 doctors were included. The number of daily service outpatients and that of daily service inpatients per doctor were 22.17±20.95 person and 13.24±11.13 h, respectively. Working time per week were 54.06±10.76 h. The significant influential factors of the number of daily service outpatients were gender, employment relationship, hospital grade, age, professional title, and location; while those of the number of daily service inpatients were hospital grade, professional title, and location. Besides, type of department, hospital grade, doctor's age, education background and location were closely related to working time per week.
ConclusionChinese doctors' workload is very heavy especially for long-time work. Hospitals and health departments should develop some target measures to reduce doctor's workload, so as to ensure medical safety.
Objective To survey the current status of residents’ health examination in township medical units in Shuangliu county, so as to provide references for exploring the residents’ health examination mode suitable for the well-off rural hospitals, and for improving the effects of physical examination. Methods The self-designed questionnaires were made to survey the current situation of health examination for the residents in 24 township medical units in Shuangliu County, including 3 central township hospitals, 3 community health centers and 18 general township hospitals; and the outline was designed to interview the people responsible for managing and implementing the resident’s examination work. The Epidate 3.1 was used for data input, the SPSS 17.0 was used for descriptive statistics and stratified analysis, and the classification method was adopted for qualitative research of personal interview data. Results The number of primary health care units for carrying out residents’ health examination got gradually increased year by year from 2008 to 2010; and all 24 township-level medical units had already carried out that examination by 2010. But some issues still existed such as lower participation rate and ineffective utilization of the archives. Conclusion a) It is necessary to prepare well, enhance organizing, expand publicity, and increase participation rate when primary health care units carry out the health examination for residents; b) It is necessary requires to fasten the informatization construction of health archives, and to quicken the process and analysis of examination information; and c) It is advisable to constantly optimize the examination items according to exam information, to improve the qualification of medical staffs, and to fasten the construction of exam team.
ObjectiveTo explore the dynamic expression changes of neuronal growth and differentiation-associated miR-124a and miR-9 in the process of epileptogenesis.
MethodsEstablish the lithium-pilocarpine induced status epilepticus (SE) rat model. Animal behavior change induced by SE as well as in the period of chronic epilepsy was observed by naked-eye or video-recording. Major time points for the study were chosen at 1d, 7d, 14d and 28d post-SE, on which the post-SE rats were decapitated and their hippocampal specimens were obtained. Total RNA from each specimen was extracted and qPCR was exploited to detect miR-124a and miR-9 expression in the specimens. Statistical analysis was used to show the dynamic expressional changes of miR-124a and miR-9 in rat hippocampus at 1d, 7d, 14d and 28d post-SE during the process of epileptogenesis.
ResultsCompared with normal rats, the expression level of miR-124a in rat hippocampus did not show a significant difference at 1d post-SE, but it had shown markedly differences at 7d, 14d and 28d post-SE(P < 0.05), with a declining trend. Compared with normal rats, the expression level of miR-9 had demonstrated significant differences at 1d, 7d, 14d and 28d post-SE(P < 0.05)with a generally increasing trend, although there was slight fluctuation of expressional up-regulation at 7d post-SE.
ConclusionNeuronal growth and differentiation-associated miR-124a and miR-9 had shown dynamic changes of down-regulation or up-regulation in the process of epileptogenesis. It can be suspected that miR-124a and miR-9 take part in hippocampal neurogenesis post-SE and be involved in epileptogenesis process.
