目的 对浙江省11个地级市2020年的卫生人力资源配置现状及公平性进行总结分析,2025年的卫生人力资源配置现状及公平性进行预测分析.方法 使用GM(1,1)灰色模型和三次指数平滑法预测2025年数据,采用Excel软件对2020年、2025年浙江省卫生人力资源的配置进行描述性统计,并通过洛伦兹曲线和基尼系数进行公平性分析.结果 2020年各地市因资源配置缺乏均衡性等问题均存在医疗卫生人力资源配置不公平现象;2025年各地市医疗卫生人力资源处于达公平阶段,但按面积分布的公平性仍需要重视提升.结论 浙江省卫生人力资源总量持续提升,不断向着公平发展,2025年有望使医疗卫生人力资源按人口分布达到公平.

Objective To analyze regional balance of highly educated practicing physicians allocation in Zhejiang province in 2020, and to provide references for improving policies. Methods The coefficient of variation, Lorenz curve, and Gini coefficient were used to analyze regional balance of highly educated practicing physicians allocation in 10 cities and 77 counties of Zhejiang Province（excluding Hangzhou）.Results In 2020, there was a significant difference in the number of highly educated practicing physicians per thousand people in 10 cities in Zhejiang province, with the highest being 1.749 in Ningbo and the lowest being 1.050 in Lishui, with a coefficient of variation of 0.14.The Gini coefficients for the number of practicing physicians per thousand people in 10 cities were 0.457 for M.D., 0.163 for M.M., and0.083 for MBBS. The Gini coefficients for the number of practicing physicians per thousand people in 77 counties were 0.798 for M.D.,0.602 for M.M., and 0.210 for MBBS. Conclusion The higher the qualifications of practicing physicians, the worse the regional balance.The number and regional balance of highly educated practicing physicians need to be improved in Zhejiang province.

Objective:To establish a set of scientific and reasonable indicator system of common prosperity in the field of health, so as to promote the construction and evaluation of the demonstration area of common prosperity with high quality of health.Methods:According to the requirements of promoting common prosperity demonstration area with high quality of health in Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis in July 2021, and experts were convened to carry out expert brainstorming to determine indicator system in the form of meetings. Delphi method was used to conduct two rounds of expert consultation on the indicator system.Finally, the analytic hierarchy process and percentage weight method were used to calculate the indicator weight value.Results:The final indicator system included 4 first-level indicators and 30 second-level indicators. Among the first-level indicators, the weight values of the development, equilibrium, inclusiveness, and sustainability were 0.326 4, 0.242 8, 0.245 8, and 0.185 0. There were 8 second-level indicators in developmental indicator dimension, of which the indicator with the highest weight was the per capita health expectancy. The balance indicator dimension included 6 second-level indicators, of which the indicator with the highest weight was the per capita financing difference of basic medical insurance between the urban workers with the urban-rural residents. The inclusive indicator dimension included 6 second-level indicators, and the proportion of personal health expenditure to total health expenditure had the highest weight. The sustainability indicator dimension included 10 second-level indicators, and the proportion of government health expenditure in fiscal expenditure had the highest weight.Conclusions:The indicator system constructed in this research could provide certain guidance and reference for promoting the construction of common prosperity in health, and provide some reference for follow-up research in this field.

With the opportunity of the construction of curriculum ideology and politics and first-class courses,Medical Information Retrieval and Utilization, one of the demonstration courses of Zhejiang Province curriculum ideology and politics, an online first-class course, and a hybrid online and offline first-class course, was taken as an example and the basic principles of ideological and political education were elaborated. The teaching model “one whole process, two types of resources, three stages, four modules and five dimensions” was built, integrating ideological and political education throughout the process, using effectively the resources jointly built by teachers and students to consolidate teaching in stages, and evaluating the teaching quality and condensing the characteristic innovation of ideological and political education. Through four modules of “learning, thinking,understanding and doing”, the teaching practice was carried out to achieve “erudition, elegance, accessibility,expressiveness” of the students’ studies, so that they can use the knowledge flexibly to retrieve information and use high-quality information effectively to solve practical problems, which will help them in their future studies and careers.

目的 通过描述性统计对嵊州市按人头付费与签约服务相结合试点改革的效果进行初步评估,为后续的改革推进提供指导和建议.方法 采用Excel2016对所有数据进行整理,对按人头付费改革的医院业务数据和医保基金运行情况进行表述性统计分析.结果 改革后,门急诊和住院业务数量增长显著,平均住院日延长.门急诊和住院收入均增加,但住院收入增加更为显著,但住院药品收入控制比门急诊药品收入控制效果更好.门诊和住院的年人次均费用的增长率为负增长,初步实现均次费用控费目标.居民医保支付总费用改革前为1167.77万元,改革后为1366.35万元,实际增长率为11.44％,医保支付费用仍在增长.医保基金结余改革前后均处于赤字状态,但改革后有所改善.结论 按人头付费效果初步显现,基本实现门急诊和住院次均费用控费目标,但医保基金仍处于赤字,仍需要改革的持续推进,逐步实现结余目标.

Dengue is an emerging mosquito-borne disease, and the use of prophylactic vaccines is still limited. We previously developed a tetravalent dengue vaccine (rMV-TDV) by a recombinant measles virus (MV) vector expressing envelope protein domain III (ED3). In this study, we used dengue-susceptible AG129 mice to evaluate the protective and/or pathogenic immune responses induced by rMV-TDV. Consistent with the previous study, rMV-TDV-immunized mice developed a significant neutralizing antibody response against all serotypes of DENV, as well as a significant IFN-γ response biased to DENV-3, compared to the vector controls. We further demonstrated that this DENV-3-specific IFN-γ response was dominated by one CD4+ T-cell epitope located in E349−363. After DENV-2 challenge, rMV-TDV-immunized mice showed a significantly lower viremia and no inflammatory cytokine increase compared to the vector controls, which had an ~100 times higher viremia and a significant increase in IFN-γ and TNF-α. As a correlate of protection, a robust memory IFN-γ response specific to DENV-2 was boosted in rMV-TDV-immunized mice after challenge. This result suggested that pre-existing DENV-3-dominated T-cell responses did not cross-react, but a DENV-2-specific IFN-γ response, which was undetectable during immunization, was recalled. Interestingly, this recalled T-cell response recognized the epitope in the same position as the E349−363 but in the DENV-2 serotype. This result suggested that immunodomination occurred in the CD4+ T-cell epitopes between dengue serotypes after rMV-TDV vaccination and resulted in a DENV-3-dominated CD4+ T-cell response. Although the significant increase in IgG against both DENV-2 and -3 suggested that cross-reactive antibody responses were boosted, the increased neutralizing antibodies and IgG avidity still remained DENV-2 specific, consistent with the serotype-specific T cell response post challenge. Our data reveal that immunodomination caused a biased T-cell response to one of the dengue serotypes after tetravalent dengue vaccination and highlight the roles of cross-reactive T cells in dengue protection.

Objective To analyze the medical service capacity of primary healthcare in Zhejiang province since the ongoing healthcare reform and put forward suggestions. Methods Key indicators of healthcare resources and medical service utilization from 2009 to 2015 reflecting the primary healthcare were identified,for a quantitative analysis in terms of the structure-process-outcome dimensions. Results In terms of structural service capacity,the average headcount growth rate of primary healthcare′s technical personnel was 5. 7% per year; the personnel competence structure kept improving; the hospital beds at primary institutions and their ratio among all were slightly decreased,with better devices and informatization. In terms of procedural service capacity,the proportion of primary institutions with contract-based services amounted to 89. 9%,with the standard contract signing rate up to 18. 8%. In terms of consequential service capacity,the average growth rate of the number of outpatient visits at primary institutions was 6. 3%. The amount and proportion of inpatients were slightly decreased,while the hospital bed utilization ratio was increased slightly. Conclusions It is necessary to further strengthen the training and introduction of primary healthcare professionals. The functional orientation of hospitals at various levels should be clarified, encouraging contract-signing of general practitioners, promote the medical insurance payment reform featuring the capitation payment at primary level,and improve the income distribution and incentive mechanism.

目的 对我国县级妇幼保健机构的卫生资源配置进行评价,探索优化资源配置的措施和途径,为卫生规划和深化卫生改革提供政策建议.方法 用数据包络分析方法,对全国27个省(自治区)的县级妇幼保健资源配置的横向及纵向效率进行相对有效性评价.结果 浙江、江苏、江西和广西等4个省份的县级妇幼保健资源配置效率呈相对有效;2005-2011年和2013年的规模报酬均递增,2014年卫生资源配置效率相对有效,规模效率不变.结论 建议加强区域卫生规划,适当调整县级妇幼保健资源配置结构和规模.

Dengue has a major impact on global public health, and the use of dengue vaccine is very limited. In this study, we evaluated the immunogenicity and protective efficacy of a dengue vaccine made from a recombinant measles virus (MV) that expresses envelope protein domain III (ED3) of dengue-1 to 4. Following immunization with the MV-vectored dengue vaccine, mice developed specific interferon-gamma and antibody responses against dengue virus and MV. Neutralizing antibodies against MV and dengue viruses were also induced, and protective levels of FRNT50 ≥ 10 to 4 serotypes of dengue viruses were detected in the MV-vectored dengue vaccine-immunized mice. In addition, specific interferon-gamma and antibody responses to dengue viruses were still induced by the MV-vectored dengue vaccine in mice that were pre-infected with MV. This finding suggests that the pre-existing immunity to MV did not block the initiation of immune responses. By contrast, mice that were pre-infected with dengue-3 exhibited no effect in terms of their antibody responses to MV and dengue viruses, but a dominant dengue-3-specific T-cell response was observed. After injection with dengue-2, a detectable but significantly lower viremia and a higher titer of anti-dengue-2 neutralizing antibodies were observed in MV-vectored dengue vaccine-immunized mice versus the vector control, suggesting that an anamnestic antibody response that provided partial protection against dengue-2 was elicited. Our results with regard to T-cell responses and the effect of pre-immunity to MV or dengue viruses provide clues for the future applications of an MV-vectored dengue vaccine.

目的:评价浙江省经济欠发达地区基层医疗机构的影像设备:彩超、黑白B超、直接数字化X射线摄影系统(DR)、计算机X成像(CR)、X光机和CT的配置现状和公平性,指导浙江省“十三五”期间医疗设备合理配置.方法:以浙江省35个经济欠发达县(市、区)的所有基层医疗卫生机构为研究对象,资料来源于浙江省卫生和计划生育委员会2014年医疗设备配置现状和规划调查数据,采用SPSS17.0和Excel 2007对数据进行统计描述、Lorenz曲线和Gini系数分析.结果:在6种影像设备中,以彩超、黑白B超和X光机的配置最为齐全,以彩超、黑白B超和直接数字化X射线摄影系统(DR)的购置需求最为迫切.彩超、黑白B超和X光机按照服务人口分布的公平性较好,DR、CR和CT的公平性较差,处于警戒状态.结论:浙江省欠发达地区的基层医疗机构中影像设备配置受到经济、地理和政策等因素的影响.

目的:对浙江省各地市卫生资源的数量、种类及分布进行评价,为在“十三五”期间缩小区域性差异,改善浙江省卫生资源可及性等问题提供参考依据.方法:引入集聚度的概念对浙江省卫生资源进行评价,分析不同地市间城乡卫生资源的集聚度. 结果:(1)经济发达地区的卫生资源的地理可及性和公平性要优于经济欠发达地区.(2)杭州市的卫生资源集聚度明显高人口集聚度,卫生资源相对过剩,温州、台州等地的卫生资源则相对不足,丽水和舟山市的卫生资源较均衡.(3)大部分地市的医生集聚度要高于护士的集聚度,部分地市护士配置不足更为显著.(4)除杭州和温州外,大部分地市的卫生资源配置逐年趋近于最优.结论:为了促进浙江省卫生资源配置的合理性,应进一步提高丽水、衢州等经济欠发达地市的卫生资源可及性,改善护理人员在不同地市间分布的合理性,并科学设置资源配置标准,提高卫生资源布局的公平性.

BACKGROUND:Pulmonary arterial hypertension (PAH), as a life-threatening disease with no efficient cure, may impose a tremendous economic burden on patients and healthcare systems. However, most existing studies have mainly emphasised epidemiology and medications, while large observational studies reporting on the economic burden are currently lacking. OBJECTIVES:To review and evaluate evidence on the costs of PAH and the cost effectiveness of PAH treatments, and to summarise the corresponding cost drivers. METHODS:Systematic literature searches were conducted in English-language databases (PubMed, Web of Science, ScienceDirect) and Chinese-language databases (China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP) to identify studies (published from 2000 to 2014) assessing the costs of PAH or the cost effectiveness of PAH treatments. The search results were independently reviewed and extracted by two reviewers. Costs were converted into 2014 US dollars. RESULTS:Of 1959 citations identified in the initial search, 19 papers were finally included in this analysis: eight on the economic burden of PAH and 11 on economic evaluation of PAH treatments. The economic burden on patients with PAH was rather large, with direct healthcare costs per patient per month varying from $2476 to $11,875, but none of the studies reported indirect costs. Sildenafil was universally reported to be a cost-effective treatment, with lower costs and better efficacy than other medications. Medical costs were reported to be the key cost drivers. CONCLUSION:The economic burden of patients with PAH is substantial, while the paucity of comprehensive country-specific evidence in this area and the lack of reports on indirect costs of PAH warrant researchers' concern, especially in China.

“翻转课堂”是一种广受教育界重点关注的新兴教学模式.本文对翻转课堂教学模式进行了简单阐述,并对目前高职学生的学习状态进行了具体分析,指出在教学中合理应用翻转课堂教学模式将会取得预期的教学效果.

The increasing survival of patients with pulmonary arterial hypertension (PAH) has shifted attention towards the disease burden that PAH imposes on patients and healthcare systems. Most studies emphasize epidemiology and medications, while large observational studies reporting on the health-related quality of life (HRQOL) of patients with PAH are lacking.

Objectives: To evaluate the allocation present situation and the equity of the imaging equipments in primary medical establishments in Zhejiang Province and to provide evidences for medical equipment resource allocation standard in the 13th five years planning of health. The main imaging equipments include the Color Doppler Ultrasound, Black and White Ultrasound, Direct Digital radiography system (DR), computed radiography (CR), x-ray machine, and computer tomography (CT). Methods: The study undertakes the descriptive statistics and the Theil index analysis by SPSS 17.0 and Excel 2007. Results: The order of allocation of all selected equipment except the Black and White Ultrasound was the Central Town, Small City and Less Developed area. The result of the Theil Index shows that the inequity of imaging equipment resource was caused by both inter-regional and internal region differences, but the inter-regional difference was the main reason. Conclusion: The allocation of imaging equipment resource should be combined with the economy, geography and policy factors and use the classification management to reduce the inter-regional difference.

Background Metformin is the first-line oral hypoglycemic agent for type 2 diabetes mellitus recommended by international guidelines. However, little information exists comparing it with acarbose which is also commonly used in China. This study expanded knowledge by combining direct and indirect evidence to ascertain the glucose lowering effects of both drugs. Methods PubMed (1980- December 2013) and China National Knowledge Infrastructure databases (1994-January 2014) were systematically searched for eligible randomized controlled trials from Chinese and English literatures. Meta-analysis was conducted to estimate the glucose lowering effects of metformin vs. acarbose, or either of them vs. common comparators (placebo or sulphonylureas), using random- and fixed-effect models. Bucher method with indirect treatment comparison calculator was applied to convert the summary estimates from the meta-analyses into weighted-mean-difference (WMD) and 95% confidence intervals (CIs) to represent the comparative efficacy between metformin and acarbose. Results A total of 75 studies were included in the analysis. In direct comparison (8 trials), metformin reduced glycosylated hemoglobin (HbA1c) by 0.06% more than acarbose, with no significant difference (WMD,-0.06%; 95% CI, -0.32% to 0.20%). In indirect comparisons (67 trials), by using placebo and sulphonylureas as common comparators, metformin achieved significant HbA1c reduction than acarbose, by -0.38% (WMD,-0.38%, 95% CI, -0.736% to -0.024%) and -0.34% (WMD, -0.34%, 95% CI, -0.651% to -0.029%) respectively. Conclusion The glucose lowering effects of metformin monotherapy and acarbose monotherapy are the same by direct comparison, while metformin is a little better by indirect comparison. This implies that the effect of metformin is at least as good as acarbose's.

Dengue is the leading cause of mosquito-borne viral infections and no vaccine is available now. Envelope protein domain III (ED3) is the major target for the binding of dengue virus neutralizing antibodies; however, the ED3-specifc T-cell response is less well understood. To investigate the T-cell responses to four serotypes of dengue virus (DENV-1 to 4), we immunized mice using either a tetravalent ED3-based DNA or protein vaccine, or combined both as a DNA prime-protein boost strategy (prime-boost). A significant serotype-dependent IFN-γ or IL-4 response was observed in mice immunized with either the DNA or protein vaccine. The IFN-γ response was dominant to DENV-1 to 3, whereas the IL-4 response was dominant to DENV-4. Although the similar IgG titers for the four serotypes were observed in mice immunized with the tetravalent vaccines, the neutralizing antibody titers varied and followed the order of 2 = 3>1>4. Interestingly, the lower IFN-γ response to DENV-4 is attributable to the immunodominance change between two CD4+ T-cell epitopes; one T-cell epitope located at E349-363 of DENV-1 to 3 was more immunogenic than the DENV-4 epitope E313-327. Despite DENV-4 specific IFN-γ responses were suppressed by immunodominance change, either DENV-4-specific IFN-γ or neutralizing antibody responses were still recalled after DENV-4 challenge and contributed to virus clearance. Immunization with the prime-boost elicited both IFN-γ and neutralizing antibody responses and provided better protection than either DNA or protein immunization. Our findings shed light on how ED3-based tetravalent dengue vaccines sharpen host CD4 T-cell responses and contribute to protection against dengue virus.

Background High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. Methods A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Results Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. Conclusion The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.

总结了1例扑感敏致大疱性表皮松解坏死型药疹患者，经创面护理、心理护理、饮食护理、严格的无菌技术、特殊的环境要求等护理后，症状好转、无并发症且顺利出院的护理经过。

目的:了解浙江省乡镇卫生院(社区卫生服务中心)设备配置现状,提出科学配置医疗设备的对策建议;方法:对浙江省210个中心镇(含小城市培育试点镇)和35个经济欠发达县(市、区)的所有建制乡镇卫生院和社区卫生服务中心开展问卷调查,并选取不同经济发展水平的11个县(市、区),召开专题座谈会;结果:回收有效问卷640份,有效率为91.69％.根据卫生院的规模分为A、B、C三个类别,不同类别的卫生院主要设备配置存在明显差异;结论:要严格遵循医疗设备配置原则,制定不同类别乡镇卫生院(社区卫生服务中心)配置标准,完善设备配置方案,加大财政补助力度,提升设备配置水平;探索建立医疗设备县域维修维护中心.