Suchergebnisse

Pan Zhao,1 Yinying Lu,1 Chunya Wang,2 Limin Wang,3 Jinfeng Li,1 Meina Li4 1The Fifth Medical Center (formerly Beijing 302 Hospital), Chinese PLA General Hospital, Beijing, 100039, People's Republic of China; 2Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China; 3Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, People's Republic of China; 4Department of Health Service, Second Military Medical University, Shanghai, 200433, People's Republic of ChinaCorrespondence: Limin Wang; Pan Zhao Tel +86 10 56119097; +86 10 66933464Email cynthia0929@sina.com; doczhaopan@126.comIntroduction: Hepatocellular carcinoma (HCC) remains the major challenge in the management of patients with hepatitis B virus (HBV) infection. To date, limited studies have been done on pediatric HBV-associated HCC specifically.Methods: Pediatric patients younger than 16 years with HBV-associated HCC were included in the study. HBV integration detection was performed using a high-throughput viral integration detection (HIVID) method.Results: Among the 13 included pediatric patients, boys predominated (10, 76.9%). The median age at diagnosis of HCC was 13 years and the youngest age was 6 years. Nine patients had initially seronegative hepatitis B e antigen (HBeAg) and 4 had seropositive HBeAg. All patients had cirrhosis and elevated alpha-fetoprotein. Splenomegaly was present in all patients. Intrahepatic HBsAg was not detected in any tumor tissues from 5 patients who underwent biopsy or excision, while it was positive in all matched non-tumor tissues. In the tumor and matched non-tumor tissues from 3 individuals, HBV integration was identified except in the neoplastic specimen from 1 patient. Integration into the reported genes associated with hepatocarcinogenesis was not found in the tumor tissues from the 3 patients.Discussion: Hypervigilance for HCC development is required in HBeAg-negative cirrhotic children. The findings based on the immunohistochemical and genetic results expand the knowledge of pediatric HCC development.Keywords: hepatitis B virus, hepatocellular carcinoma, children

BACKGROUND: Infectious and endemic diseases are a serious public health concern worldwide, and their prevention and treatment are globally controversial. This study aimed to establish an system dynamics (SD) model to analyze the factors influencing public health services provided by the Chinese Centers for Disease Control and Prevention (China CDC) to implement infectious and endemic disease control in China, by establishing more effective interventions to provide public health services and thus achieving the goal of controlling infectious and endemic diseases. MATERIALS AND METHODS: An SD model was constructed using the Vensim DSS program. Intervention experiments were performed using the SD model, which reflected the influences on disease control by adjusting the governmental investment and compensation level for public health products. RESULTS: The experimental results showed that increasing the governmental investment in China CDC and compensation level for public health products will significantly increase the public health product rate provided by China CDC. DISCUSSION: Problems with infectious and endemic disease prevention and treatment are the result of the system's incomplete functioning and limited health resources. To address the current problems and improve the system, the government should increase its investment in the public health service system and improve the compensation system to ensure smooth implementation of infectious and endemic disease prevention and treatment and, ultimately, improve public health in China.

Meina Li,1,* Wenya Yu,1,* Wei Tian,2,* Yang Ge,3 Yuan Liu,1 Tao Ding,1 Lulu Zhang1 1Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, China; 2Medical Care Department, Dalian Rehabilitation Center of PLA, Dalian, China; 3School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China *These authors contributed equally to this work Background: Infectious and endemic diseases are a serious public health concern worldwide, and their prevention and treatment are globally controversial. This study aimed to establish an system dynamics (SD) model to analyze the factors influencing public health services provided by the Chinese Centers for Disease Control and Prevention (China CDC) to implement infectious and endemic disease control in China, by establishing more effective interventions to provide public health services and thus achieving the goal of controlling infectious and endemic diseases. Materials and methods: An SD model was constructed using the Vensim DSS program. Intervention experiments were performed using the SD model, which reflected the influences on disease control by adjusting the governmental investment and compensation level for public health products. Results: The experimental results showed that increasing the governmental investment in China CDC and compensation level for public health products will significantly increase the public health product rate provided by China CDC. Discussion: Problems with infectious and endemic disease prevention and treatment are the result of the system's incomplete functioning and limited health resources. To address the current problems and improve the system, the government should increase its investment in the public health service system and improve the compensation system to ensure smooth implementation of infectious and endemic disease prevention and treatment and, ultimately, improve public health in China. Keywords: epidemic model, transmission, spread, epidemiology, public health, system dynamics, disease management

Wenya Yu,1,* Meina Li,1,* Chen Xue,1,* Jingrui Wang,1 Jiazhen Liu,2 Haiping Chen,1 Lulu Zhang1 1Institute of Military Health Management, Second Military Medical University, 2Shanghai Sixth People's Hospital, Shanghai, People's Republic of China *These authors contributed equally to this work Objective: Most patients in the People's Republic of China prefer tertiary hospitals when seeking medical services. The aim of this study was to assess outpatient satisfaction with tertiary hospitals in the People's Republic of China, test overall and subscale satisfaction, and explore whether sociodemographic characteristics lead to different degrees of satisfaction and whether subscale outpatient satisfaction contributes to overall satisfaction.Methods: A closed questionnaire was given out to investigate outpatients' sociodemographic characteristics, overall satisfaction, and various subtypes of satisfaction, and a 5-point Likert scale was employed to measure the degree of outpatient satisfaction. Descriptive analysis, Kruskal–Wallis test, Spearman's rank correlation coefficient, and logistic regression analysis were employed for statistical analysis.Results: Response rate was 92.48% (971/1,050). Outpatients' sociodemographic characteristics (including sex, age, occupation, monthly income, residence, and marital status) were related to various subtypes of satisfaction to varying degrees. Outpatients who were male, older, married, with low or middle incomes, living in Shanghai or other areas of the People's Republic of China, medical staff, or students were more satisfied with various subtypes of satisfaction than those without these characteristics. In further analyses, satisfaction with their medical needs being met by doctors had the strongest relation to overall satisfaction, followed by satisfaction with doctors' service attitudes, medical costs, waiting time, prescription, and diagnosis and treatment time. Satisfaction with environment had the weakest contribution to overall satisfaction.Conclusion: This study gave some suggestions for tertiary hospitals in advanced areas of the People's Republic of China. Outpatient sociodemographic characteristics should be paid more attention by medical staff to improve the degree of satisfaction. Tertiary hospitals in the People's Republic of China should provide more support on the management of doctors, medical costs, and time. Keywords: outpatient satisfaction, tertiary hospitals, sociodemographic characteristics, influencing factor

Haiping Chen,1 Meina Li,1 Jingrui Wang,1 Chen Xue,1 Tao Ding,1 Xin Nong,2 Yuan Liu,1 Lulu Zhang11Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai, 2Department of Medical Research, Rizhao Maternity and Infant Hospital, Shandong, People's Republic of ChinaObjective: The aim of this study was to observe the current status of inpatient satisfaction and analyze the possible factors influencing patient satisfaction during hospitalization.Methods: A cross-sectional investigation was conducted to obtain basic information about inpatient satisfaction, and statistical methods were used to describe and analyze the data. A total of 878 questionnaires were included in this study. A 5-point Likert scale rating was employed to assess items related to hospitalization care. Nonparametric tests and ordinal logistic analysis were used to explore the relationship between predictors and the patients' overall satisfaction.Results: Among the respondents, 89.75% were satisfied overall with the service they received during hospitalization, while 0.57% reported dissatisfaction. Inpatient demographic characteristics such as sex of the patients, occupation, age, and residence had significant associations with satisfaction, while monthly income and marital status did not. Additionally, the statistical outcome indicated that doctors' and nurses' service attitudes, and expenditure and environment were found to have an impact on the inpatient satisfaction ratings, with odds ratio of 2.43, 3.19, and 2.72, respectively.Conclusion: This study emphasizes the influence of sex of the patients, the service attitudes of the doctors and nurses, and expenditure and environment on inpatient satisfaction. An increase in satisfaction ratings concerning the areas of doctors' and nurses' service attitudes, and expenditure and environment can improve the overall satisfaction levels. Responsible health management departments should pay attention to patient satisfaction and improve the quality of relevant health services, thus ultimately enhancing inpatients' hospitalization experiences.Keywords: inpatients' satisfaction, hospitalization service, influencing factors

The purpose of this study was to build a healthcare quality assessment system with disease category as the basic unit of assessment based on the principles of case classification, and to assess the quality of care in a large hospital in Shanghai. Using the Delphi method, four quality indicators were selected. The data of 124,125 patients discharged from a large general hospital in Shanghai, from October 1, 2004 to September 30, 2007, were used to establish quality indicators estimates for each disease. The data of 51,760 discharged patients from October 1, 2007 to September 30, 2008 were used as the testing sample, and the standard scores of each quality indicator for each clinical department were calculated. Then the total score of various clinical departments in the hospital was calculated based on the differences between the practical scores and the standard. Based on quality assessment scores, we found that the quality of healthcare in departments of thyroid and mammary gland surgery, obstetrics and gynaecology, stomatology, dermatology, and paediatrics was better than in other departments. Implementation of the case classification for healthcare quality assessment permitted the comparison of quality among different healthcare departments.