Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices

<p>Abstract</p> <p>Background</p> <p>In 2003 the Chinese government introduced voluntary cooperative medical schemes (CMS), soon to be in place throughout rural China. Families who chose to enroll do so as a single unit and nothing is known about any differential effect of these new schemes on family members. This study evaluates the impact of one pilot CMS in Anhui Province on health care use by girls aged less than 5 years and women 65 years or older, and on the pattern and cost of prescriptions.</p> <p>Methods</p> <p>Health care records were extracted covering a 10 year period, before, during and after the pilot CMS in 4 townships, one with the intervention and 3 comparison townships without. The impact of the intervention on the age and gender distribution of patients presenting for health care and on the prescription of certain drugs was assessed by logistic regression. The cost of prescriptions before, during and after the intervention period was also assessed.</p> <p>Results</p> <p>203,058 registration and 643,588 prescription records were identified. During the intervention there was a reduced likelihood overall that a patient was female (OR = 0.92: 95%CI 0.87 - 0.97) at the intervention site. Girls aged < 5 years had an increased likelihood of health care (OR = 1.41: 95%CI 1.23 - 1.59) during the CMS, but women ≥ 65 years were relatively disadvantaged (OR = 0.84: 95%CI 0.75 - 0.95). The use of antibiotics and systemic steroids increased disproportionately at the intervention site for patients ≥ 5 years. Prescription costs at the township hospital also increased at the intervention site, particularly for older men.</p> <p>Conclusions</p> <p>This evaluation suggests that all family members did not benefit equally from the pilot CMS and that women ≥ 65 years may be disadvantaged by the newly available reimbursements of health care costs through the CMS. It points to the need, in future evaluations, to use individuals rather than families as the unit of analysis, in order to determine whether such health care inequalities are wide-spread and persistent or are reduced in the longer term. The results also support earlier concerns about the influence of new funding resources on prescription practices and the need for regulation of for-profit prescribing.</p

Comparative analysis of serum total IgE levels and specific IgE levels in children aged 6 to 9 years with tic disorder and normal children

Abstract Objective The study was to investigate serum total IgE levels and the distribution of specific IgE types in children aged 6–9 years with tic disorder, in order to provide knowledge for diagnosis and treatment of children with tic disorder. Methods Total serum IgE levels were detected by enzyme-linked immunosorbent assay (ELISA). Specific IgE levels in 72 children with tic disorder and normal 31 children were detected by EUROblot, respectively. Results The total serum IgE level of children with tic disorder aged 6–9 years was significantly higher than those of children in control group. Specific IgE distribution in tic disorder group was observed increased mainly including inhaled mugwort, dust mite combination 1 (house dust mite/dust mite), mold combination (penicillium point/mycobacteria/Aspergillus fumigatus/streptomyces), cockroaches in Germany respectively, and also food freshwater fish combination 1 (salmon/sea bass/carp), marine fish combination 1 (cod/lobster/scallop), egg white, and crab, while elevated specific IgE of normal children group was mainly food-based (egg white, milk, and soybean). The significant different specific IgE between two groups was dust mite combination 1 (house dust mite/dust mite) (P < 0.05). Conclusion The total serum IgE level of children with tic disorder aged 6–9 years was significantly increased, which may be related to the disease. Specific IgE in children with tic disorder was mainly inhalation allergens, especially dust mite combination 1 (house dust mite/dust mite), which should be avoided in clinical diagnosis and daily life

Keratinocyte Growth Factor Gene Delivery via Mesenchymal Stem Cells Protects against Lipopolysaccharide-Induced Acute Lung Injury in Mice

<div><p>Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with high morbidity and mortality, and have no specific therapy. Keratinocyte growth factor (KGF) is a critical factor for pulmonary epithelial repair and acts via the stimulation of epithelial cell proliferation. Mesenchymal stem cells (MSCs) have been proved as good therapeutic vectors. Thus, we hypothesized that MSC-based KGF gene therapy would have beneficial effects on lipopolysaccharide(LPS)-induced lung injury. After two hours of intratracheal LPS administration to induce lung injury, mice received saline, MSCs alone, empty vector-engineered MSCs (MSCs-vec) or KGF-engineered MSCs (MSCs-kgf) via the tail vein. The MSCs-kgf could be detected in the recipient lungs and the level of KGF expression significantly increased in the MSCs-kgf mice. The MSC-mediated administration of KGF not only improved pulmonary microvascular permeability but also mediated a down-regulation of proinflammatory responses (reducing IL-1β and TNF-α) and an up-regulation of anti-inflammatory responses (increasing cytokine IL-10). Furthermore, the total severity scores of lung injury were significantly reduced in the MSCs-kgf group compared with the other three groups. The underlying mechanism of the protective effect of KGF on ALI may be attributed to the promotion of type II lung epithelial cell proliferation and the enhancement of surfactant synthesis. These findings suggest that MSCs-based KGF gene therapy may be a promising strategy for ALI treatment.</p></div

Analysis of KGF expressions in vivo after MSCs-KGF treatment.

<p>(A) The change in the total KGF mRNA levels was analyzed using real-time PCR, and the values were normalized to that of the NS group at 0 hours before LPS administration. Group comparisons were analyzed by a one-way ANOVA with a Tukey-Kramer <i>post hoc</i> test. n = 5 per group. *<i>p</i><0.05. (B) The total KGF protein in the lung tissues was analyzed using ELISA. Group comparisons were analyzed by a one-way ANOVA with a Tukey-Kramer <i>post hoc</i> test. The data are expressed as the mean±SD. n = 5 per group. *<i>p</i><0.05</p

Analysis of SP mRNA expressions in ALI mice lungs.

<p>(A–D) mRNA levels of SPA, SPB, SPC and SPD after NS, MSCs, MSCs-vec or MSCs-KGF administration were quantitatively analyzed by real-time PCR, and the values were normalized to that of the NS group at 0 hours before LPS administration. Group comparisons were analyzed by a one-way ANOVA with Tukey-Kramer <i>post hoc</i> test. n = 5 per group. * <i>p</i><0.05.</p

Effect of MSCs-KGF on LPS-Induced ALI Permeability.

<p>Therapeutic efficacy on LPS-induced ALI permeability was assessed by measuring the BALF protein and lung wet/dry ratio. (A) Lung wet/dry ratio group comparisons were analyzed by a one-way ANOVA with a Tukey-Kramer post hoc test. (B) Total protein concentration in the BALF was measured using the bicinchoninic acid (BCA) method. Comparisons were analyzed by a one-way ANOVA with Tukey-Kramer post hoc test. The data are expressed as the mean±SD. n = 5 per group. *<i>p</i><0.05.</p

Assessment of lung inflammation after MSCs-KGF administration.

<p>(A) BALF neutrophils count; (B) MPO activity; (C) Levels of TNFα in BALF; (D) Levels of IL-1β in BALF; (E) Levels of IL-10 in BALF; (F) Levels of TNFα in plasma; (G) Levels of IL-1β in plasma; (H) Levels of IL-10 in plasma from 20 randomly selected areas per high-power field (magnification, ×400) with Scion Image software. *<i>p</i><0.05.</p

The KGF expression in <i>vivo</i>.

<p>(A) At a MOI = 20, KGF mRNA expression at day 7 after lentiviral vector transduction in the MSCs-KGF was approximately 16 times that of the MSCs-vec and MSCs alone as detected by real-time PCR. The data are expressed as the mean±SD, *<i>p</i><0.01; (B) At a MOI = 20, KGF protein expression was detected by western blot at day 7 after lentiviral vector transduction (lane 1 MSCs, lane 2 MSCs-vec, lane 3 MSCs-KGF); (C) At a MOI = 20, the levels of KGF protein in medium in MSCs-KGF group were significantly higher than that in the MSCs-vec group and MSCs group at day 3 and day 7. Data were expressed as the mean±SD, *<i>p</i><0.01.</p

Detection of transplanted MSCs in injured lungs.

<p>(A) Non-transduced MSCs (labeled with CM-Dil, red) and KGF and GFP genes transduced MSCs (green) were observed in frozen lung sections from the MSCs group and MSCs-KGF group mice respectively. All images were obtained using a confocal laser scanning microscope with a 60× objective (Scale bar =  5 µm). (B) GFP gene transduced MSCs and KGF and GFP genes transduced MSCs were observed in frozen lung sections from the MSCs-vec group and MSCs-KGF group mice sacrificed at 72 hours respectively (green, white arrow). (×200, Scale bar =  50 µm). (C) Immunohistochemistry of GFP in lungs showed that GFP+ cells were more frequent in the MSCs-KGF group than in the MSCs-vec group (Scale bar =  50 µm; Inserts, scale bar =  20 µm).</p

Transduction of KGF into MSCs using a lentiviral vector.

<p>The expression of GFP in MSCs was detected at day 7 after vec–eGFP or KGF–eGFP transduction under both white light microscopy (left) and fluorescence microscopy (right); (×200, Scale bar =  50 µm).</p