Relationship between adherence to anti-diabetic medication and depression among patients with diabetes mellitus in three selected Chinese hospitals

Purpose: To determine the relationship between adherence to anti-diabetic medication and depression among patients with diabetes mellitus in three hospitals in Chinese.Methods: This research utilized a quantitative and descriptive design, and included 200 diabetic patients who fulfilled the inclusion criteria for recruitment through a convenient sampling technique. The study applied Beck’s depression inventory II scale for assessment of depression, and a questionnaire for adherence to anti-diabetic medication.Results: A total of 64 (32 %) participants had diabetes for 6 to 10 years. There was a high level of adherence to anti-diabetic medication in 96 patients (48 %); 74 participants (37 %) had moderate adherence to anti-diabetic medication, while 30 patients (15 %) had low adherence. A majority of the patients (181, 90.5 %) had no depression. Six (6) patients (3 %) had mild mood disturbance, 2 patients (1 %) had borderline clinical depression, while 11patients (5.5 %) experienced moderate depression.Adherence to anti-diabetic medication was not associated with depression (p = 0.068). However, depression was associated with age ˃ 50 years (p = 0.041), female sex (p = 0.043), long duration of illness (> 5-years) (p = 0.048), and presence of one or more comorbidities (p = 0.049).Conclusion: There was no association between adherence to anti-diabetic medication and depression among diabetic patients. Keywords: Adherence to anti-diabetic medication, Beck’s depression inventory II, Depression, Diabetes mellitu

Combined finite element and multi-body dynamics analysis of effects of hydraulic cylinder movement on ploughshare of horizontally reversible plough

Abstract: Hydraulic Cylinder (HC), one of the key components of Horizontally Reversible Plough (HRP), takes the responsibilities for the commuting soiltillage of HRP. The dynamic behaviors of HC surely affectthe tilling performances of HRP. Based on our previously related work, this paper further addresses the effects of HC movements during tillage on ploughshare, especially at share-point, of HRP. For HC, uniform motion was considered in this study. A combined finite element and multi-body dynamics analysis (MDA) was implemented to assess both tillage kinematics and kinetics of the ploughshare. These numerical predictions were primarily involved in five different HC movement velocities and two actual HRP tilling scenarios, respectively, where loading data due to the HC movements were obtained from an MDA and applied to load a finite element modal of the ploughshare. Our results show that the importance of performing MDA as a preliminary step FEA to obtain an insight into the actual stress and strain variations at the share-point. Our findings demonstrate that the different movements of HC have no adverse effects on the service life of the ploughshare though they result in the maximum stress and strain at the sharepoint during HRP tillage

Combination of calcipotriol and methotrexate in nanostructured lipid carriers for topical delivery

The combination of calcipotriol with methotrexate can strengthen the topical therapy for psoriasis. The aim of the present study was to evaluate the potential of nanostructured lipid carriers (NLCs) loaded with lipophilic calcipotriol and hydrophilic methotrexate as topical therapy. NLCs composed of Precirol ATO 5 with various amounts of squalene as the liquid lipid were prepared. The particle size, surface charge, molecular environment, drug permeation, and skin irritation of the carriers were assessed. Hyperproliferative skin was also used as a permeation barrier in this study. It was found that variations in the Precirol®/squalene ratio had profound effects on the physicochemical characteristics of the NLCs. The range of particle size of the NLC preparations was 270 to 320 nm, with vehicles containing a higher Precirol amount exhibiting a larger diameter. NLCs with a higher Precirol/squalene ratio also showed greater polarity in their molecular environment. Calcipotriol-loaded NLC systems provided drug fluxes of 0.62 to 1.08 μg/cm2/h, which were slightly higher or comparable to the 30% ethanol vehicle (control, 0.72 μg/cm2/h). The methotrexate amount permeating the skin was 2.4 to 4.4-times greater using NLCs compared to that with the control. Dual drug-loaded NLCs exhibited reduced skin permeation of calcipotriol but not methotrexate. The in vivo topical delivery examined by confocal laser scanning microscopy (CLSM) showed a good correlation with the in vitro results. These two drugs with extremely different polarities can successfully be combined in NLCs. Results suggest that NLCs may have the potential to serve as delivery carriers for antipsoriatic drugs because of enhanced drug permeation and limited skin irritation

How medical insurance payment systems affect the physicians’ provision behavior in China—based on experimental economics

BackgroundIt introduced an artefactual field experiment to analyze the influence of incentives from fee-for-service (FFS) and diagnosis-intervention package (DIP) payments on physicians’ provision of medical services.MethodsThis study recruited 32 physicians from a national pilot city in China and utilized an artefactual field experiment to examine medical services provided to patients with different health status.ResultsIn general, the average quantities of medical services provided by physicians under the FFS payment were higher than the optimal quantities, the difference was statistically significant. While the average quantities of medical services provided by physicians under the DIP payment were very close to the optimal quantities, the difference was not statistically significant. Physicians provided 24.49, 14.31 and 5.68% more medical services to patients with good, moderate and bad health status under the FFS payment than under the DIP payment. Patients with good, moderate and bad health status experienced corresponding losses of 5.70, 8.10 and 9.42% in benefits respectively under the DIP payment, the corresponding reductions in profits for physicians were 10.85, 20.85 and 35.51%.ConclusionIt found patients are overserved under the FFS payment, but patients in bad health status can receive more adequate treatment. Physicians’ provision behavior can be regulated to a certain extent under the DIP payment and the DIP payment is suitable for the treatment of patients in relatively good health status. Doctors sometimes have violations under DIP payment, such as inadequate service and so on. Therefore, it is necessary to innovate the supervision of physicians’ provision behavior under the DIP payment. It showed both medical insurance payment systems and patients with difference health status can influence physicians’ provision behavior