Abstract To identify the factors that impair the effectiveness of public health emergency drills in China by assessing staff perspectives for improvements, we conducted a cross-sectional survey in Heilongjiang, a province in northeastern China by stratified cluster sampling. The staff perceived the inadequacy of equipment and facilities for scenario training (practice drills) to be the most important factors that impair response capacity. Conversely, integrated knowledge and skill-oriented emergency skills were enhanced during scenario training, as well as if such training were repeated periodically. We found that funding constraints, lack of departmental coordination, and insufficient leadership attention adversely affect the response capacity and effectiveness. A greater focus on emergency training and participation in simulated drills improves the preparedness of public health personnel to face crises. We consider the equipping of CDC staff with practical skills to face complex emergencies a priority, which will require a strategic decision to increase funding for equipment, leadership training support, and effective emergency coordination.
Introduction: Serum cotinine and magnesium intake are often associated with childhood asthma. This study evaluated the interaction between serum cotinine, magnesium intake with childhood asthma. Methods: This cross-sectional study included 14,159 subjects from National Health and Nutrition Examination Survey 2005-2018. Serum cotinine levels were classified according to the lower quartile: ≤0.2089 ng/mL as low-level and >0.2089 ng/mL as high-level. Magnesium intake were categorized as high (>98 mg/1000kcal) or low level (≤98 mg/1000kcal) based on the upper quartile. Adopted the weighted logistic regression analyses to analyze the association between cotinine, magnesium intake and childhood asthma. Additionally, the combined effect of cotinine and magnesium intake on childhood asthma risk was examined. The stratified analyses based on gender, body mass index and family history of asthma to further examine the relationship between cotinine, magnesium intake and childhood asthma. Results: The prevalence of asthma was approximately 17.56%. Compared to low-level cotinine, high-level cotinine was associated with asthma [odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.04-1.50]. Low-level magnesium intake was related to asthma compared with high-level magnesium intake (OR=1.21, 95%CI: 1.04-1.40). Using interaction analysis, we also found that the combined effect of cotinine and magnesium intake was associated with childhood asthma risk, and the interaction between high-level cotinine and low-level magnesium intake was associated with the highest risk of childhood asthma (OR=1.35, 95%CI: 1.04-1.74). Additionally, this interaction was also found in male, overweight/non-overweight and those with family history of asthma. Conclusion: There was an interaction between serum cotinine and magnesium intake on childhood asthma. The results suggested that implementing smoking bans in certain settings (e.g., communities, schools) and promoting the consumption of magnesium-rich foods may be effective strategies for preventing childhood asthma.
Background Numerous studies have investigated the association between adiponectin concentrations and diabetic retinopathy (DR) caused by type 2 diabetic mellitus. However, the results remain conflicting. We performed a metaanalysis to explore the relationship between adiponectin concentrations and risk of DR caused by type 2 diabetic mellitus from published articles. Methods A published literature search was performed through the PubMed, Cochrane Library, EMBASE, Science Citation Index Expanded database, Chinese CNKI, and Chinese Wan Fang databases for articles published in English and Chinese. Pooled standardized mean differences (SMDs) and 95% confidence intervals (95% CIs ) were calculated using random or fixed effects model. Heterogeneity between studies was assessed using the Cochrane Q test and I 2 statistics. Results Nineteen studies with a total of 1 545 cases and 1 502 controls were retrieved. The original meta-analysis found a significant difference in the adiponectin concentrations between the DR and non-DR (NDR) groups. After excluding the high heterogeneity studies, the second meta-analysis also demonstrated the significant association (SMD (95% CI ) =-0.62 (-0.80 to -0.44), P =0.0001). According to the available data, there was statistical significance in the adiponectin concentrations considering non-proliferative DR (NPDR) versus NDR, PDR versus NPDR in Chinese populations with high heterogeneity. Conclusion Adiponectin concentrations are correlated with DR; however, the relationship between adiponectin concentrations and DR needs more in-depth investigations with larger sample sizes.
Objective To determine whether the New Cooperative Medical Insurance Scheme (NCMS) is associated with decreased levels of catastrophic health expenditure and reduced impoverishment due to medical expenses in rural households of China. Methods An analysis of a national representative sample of 38,945 rural households (129,635 people) from the 2008 National Health Service Survey was performed. Logistic regression models used binary indicator of catastrophic health expenditure as dependent variable, with household consumption, demographic characteristics, health insurance schemes, and chronic illness as independent variables. Results Higher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. While the higher socio-economic status households had similar levels of catastrophic health expenditure as compared with the lowest. Households covered by the NCMS had similar levels of catastrophic health expenditure and medical impoverishment as those without health insurance. Conclusion Despite over 95% of coverage, the NCMS has failed to prevent catastrophic health expenditure and medical impoverishment. An upgrade of benefit packages is needed, and effective cost control mechanisms on the provider side needs to be considered.
We aimed to explore the relationship between hypoxia-inducible factors-1α (HIF-1α) and lncRNA nuclear-enriched abundant transcript 1 (NEAT1), and their functions on hepatocellular carcinoma (HCC) under hypoxia.HIF-1α and NEAT1 levels in HCC tissues and corresponding non-tumor tissues were determined by qRT-PCR, and the correlations of their levels in HCC tissues were analyzed by Pearson test. The relationship between overall survival and the two genes (HIF-1α and NEAT1) for HCC patients was detected by log-rank test. Clinicopathological features of NEAT1 in HCC patients were collected. HIF-1α and NEAT1 levels in HCC cells were measured by qRT-PCR and Western blot, and their relationship was determined by co-immunoprecipitation (Co-IP) assay. Cell viability, migration and invasion were detected by CCK-8, scratch wound healing and transwell assay, respectively. The interaction of NEAT1 with HIF-1α in tumor development was determined by xenograft tumor assays in nude mice.NEAT1 and HIF-1α were highly expressed and showed a positive relationship in HCC tissues, and specifically, higher NEAT1 expression was positively associated with advanced TNM stage and metastasis in HCC patients. Up-regulated NEAT1 or HIF-1α in HCC patients had poorer prognosis. NEAT1 was induced by HIF-1α and suppressed by siHIF-1α. NEAT1 overexpression further promoted development of HCC under hypoxia while promoting cell viability, migration and invasion and suppressing apoptosis, and such effects were reversed by down-regulating HIF-1α. NEAT1 overexpression promoted tumor growth, which was reversed by down-regulating HIF-1α.HIF-1α knockdown inhibits NEAT1 expression, which suppresses progression of HCC and improves its prognosis.
Abstract Background: To investigate current knowledge, attitudes, and practices for CPR quality control among emergency physicians in Chinese tertiary hospitals. Methods: Anonymous questionnaires were distributed to physicians in 75 tertiary hospitals in China between January and July 2018. Results: A total of 1405 respondents answered survey without obvious logical errors. Only 54.4% knew all criteria of high-quality CPR. The main problems during CPR were related to chest compression: low quality due to fatigue (67.3%), inappropriate depth (57.3%) and rate (54.1%). 91.0% respondents considered CPR quality monitoring should be used, 72.4% knew objective method for monitoring, and 63.2% always/often monitored CPR quality during actual resuscitation. The utilization rate of recommended monitoring methods was reported as follow, ETCO 2 was 42.7%, audio-visual feedback devices was10.1%, coronary perfusion pressure was 17.9%, and invasive arterial pressure was 31.1%. 96.3% respondents considered it was necessary to participate in regular CPR retraining, but 21.4% did not receive any retraining. The ideal retraining interval was considered to be 3 to 6 months, but actual interval was 6 to 12 months. CPR feedback devices were always/often used in training was reported by 49.7% of respondents. Conclusion: Chinese emergency physicians were very concerned about CPR quality, but they did not fully understand the high-quality criteria and impact on prognosis. CPR quality monitoring was not routine procedure during actual resuscitation. The methods recommended in guidelines were rarely used in practice. Many physicians have not received retraining or have received retraining at long intervals. Feedback devices were not commonly used in training.
Objective
To compare the time consumed for the procedure done, satisfaction and safety of the establishment of intraosseous (IO) access and central intravenous line placement (CVL) in critically ill patients using a randomized controlled trial.
Methods
The patients were randomly divided into the IO access group versus CVL group according to the inclusion criteria. The IO access and CVL were established, respectively for medicine or fluid administration. The success rates at the first attempt, time required for procedure completed, satisfaction and complications were recorded.
Results
During the study period, 24 patients were enrolled, and divided equally and randomly into IO group (n=12) and CVL group (n=12). There were no significant differences in age, gender, BMI between the two groups. The patients with shock and cardiac arrest accounted for 83.3 % in IO group and 58.3 % in CVL group, respectively. The success rates at the first attempt was 91.7 % in IO access group versus 66.7 % in CVL group (P=0.158). the time required for procedure done was significantly shorter in IO access group (74.9 ±43.7)s compared with CVL group (944.0 s±491.5 s) (P<0.01). The satisfaction of operators at the instruments used was 8.0±1.1 for IO access group versus 7.2±0.8 for CVL group (P=0.053). The overall satisfaction of the operators at the entire course of procedure was 3.7 + 0.7 in IO access group versus 3.9±0.3 in CVL group (P=0.377). Complications were not observed during the study period in the two groups.
Conclusions
The success rate at the first attempt was significantly higher in IO access group compared with CVL grouThe mean time consumed for procedure completed in IO group was much shorter than that in CVL group, and the operation was simple and practicable. During the emergency care of critical patients, if the peripheral intravenous line placement was difficult to establish, and IO access could be a choice of alternative used as a bridging procedure to rapidly establish the vascular access and win the rescue opportunity.
Key words:
Intraosseous vascular access; Central venous catheterization; Critical disease; Blood vessel; Success rates on first attempt; Procedure time; Satisfaction; Complications
Therapeutic hypothermia is an important treatment for cerebral resuscitation in patients after cardiac arrest. But it is rarely used for comatose survivor post-cardiac arrest in China. The patient was the first case who was in coma post cardiac arrest caused by acute myocardial infarction and given hypothermia therapy in our hospital. After coronary reperfusion and therapeutic hypothermia, the patient's sneurologic function was recovered to normal. The paper discussed the indications, contraindications, cooling methods and complications of therapeutic hypothermia.
People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity.Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups.Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient).Inequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current insurance schemes are insufficient to address this inequity. A comprehensive social policy that encompasses a more progressive taxation package and redistribution of social capital as well as pro-poor welfare is needed.
This research aimed to determine the prevalence of workplace violence (WPV) against healthcare workers, explore the frequency distribution of violence in different occupational groups, and determine which healthcare occupation suffers from WPV most frequently. Furthermore, the current study aimed to compare risk factors affecting different types of WPV in Chinese hospitals. A cross-sectional design was utilized. A total of 1899 healthcare workers from Heilongjiang, a province in Northeastern China, completed the questionnaire. Of the respondents, 83.3% reported exposure to workplace violence, and 68.9% reported non-physical violence. Gender, education, shift work, anxiety level, and occupation were significantly correlated with physical violence (p < 0.05 for all correlations). Additionally, age, professional title, and occupation were correlated with non-physical violence, which critically affected doctors. Thus, gender, age, profession, anxiety, and shift work were predictive of workplace violence toward healthcare workers. Doctors appeared to experience non-physical workplace violence with particularly higher frequency when compared to nurses and other workers in hospitals. For healthcare workers, interventions aimed at WPV reduction should be enacted according to the types of violence, profession, and other factors underlying the various types of WPV in hospitals.
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