公立医院补偿机制改革研究

随着药品加成政策的全面取消,我国公立医院的补偿渠道、主体、途径、水平和结构发生了重大变化。当前公立医院补偿机制改革存在着财政直接补偿不足、医保间接补偿激励约束有限、医疗服务价格形成与调整机制不健全、公立医院自我补偿能力较弱等问题。对此,应依据补偿主体多元化、补偿方式多样化、补偿标准清晰化、补偿效应积极化原则,加大财政补助力度,深化医保制度改革,完善医疗服务价格形成机制,提高医院自我补偿能力。

贫困人口因贫致病和因病致贫影响因素分析

目的通过实证研究的方式,了解我国城乡二元结构下健康与贫困的关联程度,分析健康贫困风险的关键影响因素,为摆脱健康贫困问题找到路径。方法以2012年CFPS成人数据库中35 719个访问对象作为样本,以国家贫困线作为判断低收入的标准,以自评健康状况作为健康标准,用logistic回归分析法了解健康贫困风险的社会因素和疾病因素。结果在调查的≥16岁成年人口中,自评不健康的人群占18%,存在健康贫困风险的人群占13%;不健康与低收入之间存在明显相关关系(P <0.01),在城乡二元结构下,农村地区不健康与低收入的关联程度更高;性别、年龄和受教育程度均是导致健康贫困风险的关键社会因素(P <0.01);导致疾病产生的贫困因素,并不在于贫困本身,而在于与贫困有关的低下的教育水平和有待改善的居住环境(P <0.01);恶性肿瘤、血液疾病和生殖系统疾病因病致贫的效应更为显著(P <0.01)。结论中国健康贫困问题是脱贫的关键,健康贫困与教育贫困和环境贫困之间存在密切的关联。由于城乡社会人口结构的差异,健康贫困问题表现出不同的程度和特点,在精准扶贫的背景下,需要根据社会特征和疾病特征采取有针对性的扶贫策略。

Induction of virus-neutralizing antibodies and T cell responses by dengue virus type 1 virus-like particles prepared from Pichia pastoris

Background Dengue is currently a significant global health problem but no vaccines are available against the four dengue serotypes virus infections. The development of safe and effective vaccines has been hampered by the requirement of conferring complete protection against all four dengue serotypes and the lack of a convenient animal model. Virus-like particles （VLPs） have emerged as a promising subunit vaccine candidate. One strategy of vaccine development is to produce a tetravalent dengue subunit vaccine by mixing recombinant VLPs, corresponding to all four dengue virus serotypes. Towards this end, this study aimed to establish a Pichia pastoris （P. pastoris） expression system for production of dengue virus type 1 （DENV-1） VLPs and evaluate the humoral and cellular immune response of this particle in mice. Methods A recombinant yeast P. pastoris clone containing prM and E genes of DENV-1 was constructed and DENV-1 VLPs expressed by this clone were analyzed by sucrose density gradient centrifugation, Western blotting, and transmission electron microscope. Groups of mice were immunized by these particles plus adjuvant formulations, then mice were tested by ELISA and neutralization assay for humoral immune response, and by lymphocyte proliferation and cytokine production assays for a cellular immune response. Results Our data demonstrated that recombinant DENV-1 VLPs consisting of prM and E protein were successfully expressed in the yeast P. pastoris. Sera of VLPs immunized mice were shown to contain a high-titer of antibodies and the neutralization assay suggested that those antibodies neutralized virus infection in vitro. Data from the T lymphocyte proliferation assay showed proliferation of T cell, and ELISA found elevated secretion levels of interferon IFN-γ and IL-4. Conclusions P. pastoris-expressed DENV-1 VLPs can induce virus neutralizing antibodies and T cell responses in immunized mice. Using P. pastoris to produce VLPs offers a promising and economic strategy for dengue virus vaccine development.

旅行者发热的临床应对

旅行者发热是感染科医生、国境卫生检疫人员经常遇到的问题。近年来,随着国际旅行者数量的增加,旅行者发热的人数增加,对国家生物安全防控造成潜在威胁。如何根据旅行者发热的地理特征、临床表现有效识别旅行者发热,判断发热原因,有针对性地防控,是传染病防控领域的主要问题之一。本文综述了旅行者发热的潜在威胁,临床应对模式和处理路径,希望于有助于更加有效地发现、鉴别、应对旅行者发热。