Towards universal health coverage: lessons from 10 years of healthcare reform in China.

Universal health coverage (UHC) is driving the global health agenda. Many countries have embarked on national policy reforms towards this goal, including China. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. The year of 2019 marks the 10th anniversary of China's most recent healthcare reform. Sharing China's experience is especially timely for other countries pursuing reforms to achieve UHC. This study describes the social, economic and health context in China, and then reviews the overall progress of healthcare reform (1949 to present), with a focus on the most recent (2009) round of healthcare reform. The study comprehensively analyses key reform initiatives and major achievements according to four aspects: health insurance system, drug supply and security system, medical service system and public health service system. Lessons learnt from China may have important implications for other nations, including continued political support, increased health financing and a strong primary healthcare system as basis

On Kalman Smoothing for Wireless Sensor Networks Systems with Multiplicative Noises

The paper deals with Kalman (or H2) smoothing problem for wireless sensor networks (WSNs) with multiplicative noises. Packet loss occurs in the observation equations, and multiplicative noises occur both in the system state equation and the observation equations. The Kalman smoothers which include Kalman fixed-interval smoother, Kalman fixedlag smoother, and Kalman fixed-point smoother are given by solving Riccati equations and Lyapunov equations based on the projection theorem and innovation analysis. An example is also presented to ensure the efficiency of the approach. Furthermore, the proposed three Kalman smoothers are compared

Establishment and Development of Oral Microflora in 12–24 Month-Old Toddlers Monitored by High-Throughput Sequencing

A cohort study was conducted to evaluate oral microbial diversity among toddlers aged 12–24 months, and to describe the dynamic processes of colonization, development, and stabilization of the oral microflora during tooth eruption using high-throughput sequencing technology. A total of 20 healthy toddlers aged 12 months were included at baseline and followed up through 18–24 months. Clinical oral examinations of dental caries status and visible plaque index were carried out at three follow-up time points. Pooled supragingival plaque biofilm samples were also collected at ages 12, 18, and 24 months. Plaque biofilm DNA was extracted and analyzed by MiSeq sequencing. A total of 18 toddlers completed three follow-ups. At 12 months of age, all the toddlers only had eruption of the anterior teeth, without dental caries. At ages 18 and 24 months, one and two toddlers showed two and three teeth with carious white spots, respectively. Depth, Good's coverage, and sample size of sequencing were reasonable. The dominant bacterial genera in the oral cavity of 12-month-old toddlers were Capnocytophaga, Neisseria, Streptococcus, Kingella, and Leptotrichia; the oral microflora composition was relatively stable by 18 months of age and included unclassified Enterobacteriaceae, Selenomonas, Prevotella, Leptotrichia, and Veillonella as the dominant genera; unclassified Enterobacteriaceae, Streptococcus, Neisseria, Leptotrichia, and Selenomonas were the dominant genera by 24 months. There were significant differences among microbial compositions in the oral cavities of 12, 18, and 24-month-old toddlers, with relatively small differences observed between the 18 and 24 months samples. In conclusion, oral microbial community of toddlers showed a trend of dynamic development. Significant differences in oral microbial diversity among toddlers aged 12–24 months were observed, while the microbial diversity differences among toddlers aged 18–24 months tended to be more similar. The findings indicated that the oral microbial community gradually matures and tends to stabilize with the growth and development of toddlers

Comprehensive transcriptome analysis reveals novel genes involved in cardiac glycoside biosynthesis and mlncRNAs associated with secondary metabolism and stress response in Digitalis purpurea

<p>Abstract</p> <p>Background</p> <p><it>Digitalis purpurea </it>is an important ornamental and medicinal plant. There is considerable interest in exploring its transcriptome.</p> <p>Results</p> <p>Through high-throughput 454 sequencing and subsequent assembly, we obtained 23532 genes, of which 15626 encode conserved proteins. We determined 140 unigenes to be candidates involved in cardiac glycoside biosynthesis. It could be grouped into 30 families, of which 29 were identified for the first time in <it>D. purpurea</it>. We identified 2660 mRNA-like npcRNA (mlncRNA) candidates, an emerging class of regulators, using a computational mlncRNA identification pipeline and 13 microRNA-producing unigenes based on sequence conservation and hairpin structure-forming capability. Twenty five protein-coding unigenes were predicted to be targets of these microRNAs. Among the mlncRNA candidates, only 320 could be grouped into 140 families with at least two members in a family. The majority of <it>D. purpurea </it>mlncRNAs were species-specific and many of them showed tissue-specific expression and responded to cold and dehydration stresses. We identified 417 protein-coding genes with regions significantly homologous or complementary to 375 mlncRNAs. It includes five genes involved in secondary metabolism. A positive correlation was found in gene expression between protein-coding genes and the homologous mlncRNAs in response to cold and dehydration stresses, while the correlation was negative when protein-coding genes and mlncRNAs were complementary to each other.</p> <p>Conclusions</p> <p>Through comprehensive transcriptome analysis, we not only identified 29 novel gene families potentially involved in the biosynthesis of cardiac glycosides but also characterized a large number of mlncRNAs. Our results suggest the importance of mlncRNAs in secondary metabolism and stress response in <it>D. purpurea</it>.</p

Spatial and temporal distribution of falciparum malaria in China

Background: Falciparum malaria is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China. This paper aimed to analyse the geographic distribution, demographic patterns and time trends of falciparum malaria in China. Methods: The annual numbers of falciparum malaria cases during 1992–2003 and the individual case reports of each clinical falciparum malaria during 2004–2005 were extracted from communicable disease information systems in China Center for Diseases Control and Prevention. The annual number of cases and the annual incidence were mapped by matching them to corresponding province- and county-level administrative units in a geographic information system. The distribution of falciparum malaria by age, gender and origin of infection was analysed. Time-series analysis was conducted to investigate the relationship between the falciparum malaria in the endemic provinces and the imported falciparum malaria in non-endemic provinces. Results: Falciparum malaria was endemic in two provinces of China during 2004–05. Imported malaria was reported in 26 non-endemic provinces. Annual incidence of falciparum malaria was mapped at county level in the two endemic provinces of China: Yunnan and Hainan. The sex ratio (male vs. female) for the number of cases in Yunnan was 1.6 in the children of 0–15 years and it reached 5.7 in the adults over 15 years of age. The number of malaria cases in Yunnan was positively correlated with the imported malaria of concurrent months in the non-endemic provinces. Conclusion: The endemic area of falciparum malaria in China has remained restricted to two provinces, Yunnan and Hainan. Stable transmission occurs in the bordering region of Yunnan and the hilly-forested south of Hainan. The age and gender distribution in the endemic area is characterized by the predominance of adult men cases. Imported falciparum malaria in the non-endemic area of China, affected mainly by the malaria transmission in Yunnan, has increased both spatially and temporally. Specific intervention measures targeted at the mobile population groups are warranted

Quality of Life of Adults with Chronic Spinal Cord Injury in Mainland China: A Cross-Sectional Study

Objective: To evaluate the quality of life of patients with chronic spinal cord injury in mainland China. Design: Cross-sectional study. Subjects: A total of 247 adults ≥ 1 year post-SCI in mainland China. Methods: The World Health Organization (WHO) Quality of Life Scale Brief Version (WHOQOL-BREF) and the add-on modules on disability-related QoL (WHOQOL-DIS) were used to assess quality of life. Anxiety/depression was measured using the Zung Self-Rating Anxiety/Depression Scale. Quality of life was compared with that of reference populations from China, Korea, the international field trial (23 countries). Multivariate linear regression was conducted to determine the factors that might be associated with quality of life. Results: The means of the 4 domains of the WHOQOLBREF varied from 11.5 to 13.0. The mean of the 12- item WHOQOL-DIS module was 38.7. The quality of life of the participants as measured by the WHOQOLBREF was 1.1--4.7 points lower than that of the global reference population, while quality of life as measured by the WHOQOL-DIS module was 1.2 points lower than that of the Korean data. Anxiety and depression were negative factors associated with quality of life (p \u3c 0.05). Better community integration was a positive factor for physical quality of life and quality of life as measured by the WHOQOL-DIS module (p \u3c0.01). Conclusion: The quality of life of adults with chronic spinal cord injury in mainland China was lower compared with reference populations. Duration of spinal cord injury, sex, community integration, anxiety, and depression were related to quality of life

Effect of acupotomy on nitric oxide synthase and beta-endorphin in third lumbar vertebrae transverse process syndrome model rats

AbstractObjectiveTo explore the long-term effects and pain relief mechanism of acupotomy by observing changes in nitric oxide synthase (NOS) and beta-endorphin (β-EP) in the hypothalamus, spinal cord, and peripheral blood of rats with third lumbar vertebrae (L3) transverse process syndrome.MethodsTwenty-eight SD rats were randomly assigned to normal, model, electroacupuncture (EA), and acupotomy group. The last three groups were put through an operation to emulate L3 transverse process syndrome. Fourteen days after the simulation operation, EA and acupotomy treatments were applied to the respective groups. Fifty-six days after the simulation operation, biochemistry tests and enzyme-linked immunosorbent assay were used to measure NOS and β-EP in the hypothalamus, spinal cord, and peripheral blood.ResultsRats with the simulation operation showed significantly higher levels of NOS and β-EP in the hypothalamus, spinal cord, and peripheral blood than those in the normal group. The EA and acupotomy groups had significantly lower levels of NOS and β-EP than those in the model group. There was no statistical difference between the EA and acupotomy groups.ConclusionEA and acupotomy treatments significantly lowered NOS and β-EP levels in the hypothalamus, spinal cord, and peripheral blood and alleviated L3 transverse process syndrome

Evaluation of six satellite-based terrestrial latent heat flux products in the vegetation dominated Haihe river basin of north China

In this study, six satellite-based terrestrial latent heat flux (LE) products were evaluated in the vegetation dominated Haihe River basin of North China. These LE products include Global Land Surface Satellite (GLASS) LE product, FLUXCOM LE product, Penman-Monteith-Leuning V2 (PML_V2) LE product, Global Land Evaporation Amsterdam Model datasets (GLEAM) LE product, Breathing Earth System Simulator (BESS) LE product, and Moderate Resolution Imaging Spectroradiometer (MODIS) (MOD16) LE product. Eddy covariance (EC) data collected from six flux tower sites and water balance method derived evapotranspiration (WBET) were used to evaluate these LE products at site and basin scales. The results indicated that all six LE products were able to capture the seasonal cycle of LE in comparison to EC observations. At site scale, GLASS LE product showed the highest coefficients of determination (R2) (0.58, p 2), followed by FLUXCOM and PML products. At basin scale, the LE estimates from GLASS product provided comparable performance (R2 = 0.79, RMSE = 18.8 mm) against WBET, compared with other LE products. Additionally, there was similar spatiotemporal variability of estimated LE from the six LE products. This study provides a vital basis for choosing LE datasets to assess regional water budget