Evaluation of Need and Distribution of National Essential Medicines List in Village Clinics:A Cross-sectional Study Based on the Perspective of Village Doctors in China

This study aimed to evaluate the satisfaction of village doctors to essential medicines list (EML) and accessibility of essential medicines (EMs) distribution to improve the implementation of EML in village clinics.A total of 422 village doctors from five counties in three provinces of China were surveyed by questionnaires.Logistic regression analysis was conducted to identify the main factors associated with village doctors' evaluation of EML.The results showed that village doctors had a negative evaluation in satisfaction level of EML to village-based care and accessibility of EM distribution.The government should adjust EML regularly based on the actual health status of local villagers in China and focus on adding appropriate drugs that meet the needs of villagers with chronic disease.The local government should also attach importance to the distribution of EMs and maintain their supply in village clinics.

Cognitive and Behavioral Effects of Participatory Sex Education on the Dual Prevention of STI/HIV/AIDS and Unwanted Pregnancies among Adolescents in Kinshasa High Schools, DR Congo

Context: With the view to reorient both STI/HIV/AIDS prevention and adolescents pregnancies, this research study aims at evaluating cognitive and behavioral acquisitions, as well as the process of interactive sex education participatory approach among adolescents in Kinshasa high schools. Methods: Based on a “pre and post” virtually experimental design, two crosswise surveys were conducted in Kinshasa, for six months in 2011-2012 on 484 high school students (pre-survey) and on 441 high school students (post-survey), whose age range from 14 - 19 years including both sexes. Two participatory educational talks (PET) “A” and “B”, covered weekly in two different schools, were compared to a control group school. The PET “A” consisted of interactive interpersonal communication sessions given by an external expert as a substitute for the life education course in one school. The PET “B” carried out in another school, included more educational talk sessions, led by the external expert and supplemented by a close follow-up of teenagers divided into small groups of 10 participants. The subjects’ assessment was based on their knowledge, attitudes and practices relating to STI/HIV/AIDS dual prevention as well as to unwanted pregnancies. Results: The subjects involved in the PET “B” displayed a better/higher performance based on their knowledge, attitudes and practices related to STI/HIV/AIDS dual prevention and unwanted pregnancies. Broadly speaking, knowledge has been improved 6 times with the PET “B” (OR = 6, 10, IC 95%) (3.24 - 11.9), and 3 times with the PET “A” (OR = 3, 45, IC 95%) (1.79 - 6.81), compared to control school. Similarly, findings on subjects’ attitudes show an improvement rated 12 times with the PET”B” (OR = 11, 99, IC 95%) (5.67 - 27.38) and 5 times for the PET “A” (OR = 5.51, IC 95%) (2.54 - 12.87). As far as the subjects’ practices are concerned, an improvement of 6 more times of protected sexual intercourses with the PET “B” compared with the control school group (OR = 6, 52, IC 95%) (3.60 - 12.0). The process assessment records a spontaneous involvement of schools enhanced by the positive contribution of Life Education and Biology teachers;add a massive participation of adolescents who requested permanent PET program. Conclusion: The results of this study suggest that school sexual education programs can be improved to increase the quality of apprenticeship. The use of interactive methods and the consideration of the adolescents’ specific needs that take into account the gender approach may bring about beneficial advantages on both educational outcomes and reproductive health of adolescents.

A Diagnostic Tool for Identification of Etiologies of Fever of Unknown Origin in Adult Patients

The diagnosis and treatment of fever of unknown origin (FUO) are huge challenges to clinicians.Separating the etiologies of FUO into infectious and non-infectious disease is conducive to clinical physicians not only on making decisions rapidly concerning the prescription of suitable antibiotics but also on further analysis of the final diagnosis.In order to develop and validate a diagnostic tool to efficiently distinguish the etiologies of adult FUO patients as infectious or non-infectious disease,FUO patients from the departments of infectious disease and internal medicine in three Chinese tertiary hospitals were enrolled retrospectively and prospectively.By using polynomial logistic regression analysis,the diagnostic formula and the associated scoring system were developed.The variables included in this diagnostic formula were from clinical evaluations and common laboratory examinations.The proposed tool could discriminate infectious and noninfectious causes of FUO with an area under receiver operating characteristic curve (AUC) of 0.83,sensitivity of 0.80 and specificity of 0.75.This diagnosis tool could predict the infectious and non-infectious causes of FUO in the validation cohort with an AUC of 0.79,sensitivity of 0.79 and specificity of 0.70.The results suggested that this diagnostic tool could be a reliable tool to discriminate between infectious and non-infectious causes of FUO.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Summary:Throughout the duration of the New Cooperative Medical Scheme(NCMS),it was found that an increasing number of rural patients were seeking out-of^county medical treatment,which posed a great burden on the NCMS fund.Our study was conducted to examine the prevalence of out-of^county hospitalizations and its related factors,and to provide a scientific basis for follow?up health insurance policies.A total of 215 counties in central and western China from 2008 to 2016 were selected.The total out-of-county hospitalization rate in nine years was 16.95%,which increased from 12.37%in 2008 to 19.21%in 2016 with an average annual growth rate of 5.66%.Its related expenses and compensations were shown to increase each year,with those in the central region being higher than those in the western region.Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region(XI),rural population(X2),per capita per year net income(X3),per capita gross domestic product(GDP)(X4),per capita funding amount of NCMS(X5),compensation ratio of out-of^county hospitalization cost(X6),per time average in-county(X7)and out-of-county hospitalization cost(X8).According to Bayesian network(BN),the marginal probability of high out-of^county hospitalization rate was as high as 81.7%.Out-of^county hospitalizations were directly related to X8,X3,X4 and X6.The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors,economy factors,regional characteristics and NCMS policy factors was 95.7%,91.1%,93.0% and 88.8%,respectively.And how these factors affect out-of-county hospitalization and their interrelationships were found out.Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations,and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.